Oktay Nazli

Women with low libido: correlation of decreased androgen levels with female sexual function index

The aim of the present study was to investigate a possible correlation between decreased androgen levels and female sexual function index (FSFI) in women with low libido and compare these findings with normal age-matched subjects. In total, 20 premenopausal women with low libido (mean age 36.7; range 24–51 y) and 20 postmenopausal women with low libido (mean age 54; 45–70 y), and 20 premenopausal healthy women (mean age 32.2; range 21–51 y) and 20 postmenopausal healthy women (mean age 53.5; range 48–60 y) as controls were enrolled in the current study. Women with low libido had symptoms for at least 6 months and were in stable relationships. All premenopausal patients had regular menstrual cycles and all postmenopausal patients and controls were on estrogen replacement therapy. None of the patients were taking birth control pills, corticosteroids or had a history of chronic medical illnesses. All completed the FSFI and Becks Depression Inventory (BDI) questionnaires. Hormones measured included: cortisol; T3, T4 and TSH; estradiol; total and free testosterone; dehydroepiandrosterone sulfate (DHEA-S); sex hormone binding globulin (SHBG). We performed statistical analysis by parametric and nonparametric comparisons and correlations, as appropriate. We found significant differences between the women with low libido and the controls in total testosterone, free testosterone and DHEA-S levels and full-scale FSFI score for both pre- and postmenopausal women (P<0.05). In addition, decreased total testosterone, free testosterone and DHEA-S levels positively correlated with full-scale FSFI score and FSFI-desire, FSFI-arousal, FSFI-lubrication and FSFI-orgasm scores (P<0.05). Our data suggest that women with low libido have lower androgen levels compared to age-matched normal control groups and their decreased androgen levels correlate positively with female sexual function index domains.

Factors Affecting Complication Rates of Ureteroscopic Lithotripsy in Children: Results of Multi-Institutional Retrospective Analysis by Pediatric Stone Disease Study Group of Turkish Pediatric Urology Society

PURPOSE We evaluated factors affecting complication rates of ureteroscopy for pediatric ureteral calculi. MATERIALS AND METHODS We retrospectively evaluated 642 children who underwent ureteroscopy at 16 Turkish centers between 2000 and 2010. Semirigid ureteroscopy was used with various calibers to treat 670 ureteral units in 660 sessions. Complications were evaluated according to the Satava and Clavien classification systems. Univariate and multivariate analyses were done to determine predictive factors affecting complication rates. RESULTS A total of 367 females and 265 males were studied. Mean±SD patient age was 90.2±51.4 months (range 4 to 204). Mean±SD stone size, operative time and postoperative hospital stay were 8.9±4.7 mm, 45.8±23.8 minutes and 1.8±2.8 days, respectively. At a mean±SD followup of 13.3±17.6 months 92.8% of patients were stone-free and efficacy quotient was 90.3%. Complications, which occurred in 8.4% of patients (54 of 642), were intraoperative in 25 (Satava grade I to II in 22), early postoperative in 25 (Clavien grade I to II in 23) and late postoperative in 4 (all grade III). While operative time, age, institutional experience, orifice dilation, stenting and stone burden were statistically significant on univariate analysis, multivariate analysis revealed that operative time was the only statistically significant parameter affecting the complication rate. CONCLUSIONS Semirigid ureteroscopy is effective, with a 90% stone-free rate and efficacy quotient. Most complications are low grade and self-limiting. Our results confirm that prolonged operative time is an independent predictor of complications, and should be considered when choosing and performing the treatment modality.

Physiology and pharmacology of the human ureter: basis for current and future treatments.

Introduction: This article sets out to be a review regarding agents that affect contraction and relaxation of the ureter in order to establish a basis for current and future treatments for upper urinary tract obstruction. Material and Methods: A complete review of the English literature using MEDLINE was performed between 1960 and 2007 on ureter physiology and pharmacology with special emphasis on signal transduction mechanisms involved in the contractile regulation of the human ureter. Results: Activation of muscarinic and adrenergic receptors increases the amplitude of ureteral contractions. The sympathetic nerves modulate the contractions by α-adrenoceptors and relaxation by β-adrenoceptors. The purinergic system is important in sensory/motor functions and ATP is an important non-adrenergic non-cholinergic (NANC) agent causing contraction. Nitric oxide (NO) is a major inhibitory NANC neurotransmitter causing relaxation. Serotonin causes contraction. Prostaglandin-F2α contracts whereas prostaglandin-E1/E2 relaxes the ureter. Phosphodiesterases (PDE) and the Rho-kinase pathway have recently been identified in the human ureter. PDE-IV inhibitors, K+ channel openers, calcium antagonists, α1-adrenoceptor antagonists and NO donors seem to be promising drugs in relieving obstruction and facilitating stone passage. Conclusions: Further understanding of the ureteral function and pharmacology may lead to the discovery of promising new drugs that could be useful in relieving ureteral colic, facilitating spontaneous stone passage, preparing the ureter for ureteroscopy as well as acting adjunctive to extracorporeal shock-wave lithotripsy.

Results of Extracorporeal Shock Wave Lithotripsy in the Pediatric Age Group

Objective: In this study we aimed to show the efficacy of extracorporeal shock wave lithotripsy (ESWL) for urinary stone disease in the pediatric age group and to evaluate the complications encountered after the treatment. Methods: 67 children with 109 stones underwent ESWL, using a Dornier MPL 9000 lithotriptor. Styrofoam boards were used to protect the lungs. KUB and chest radiographs were taken on the day after treatment. If stone-free status was achieved, the patient was followed with ultrasonography and urine analysis every 6 months for 2 years. If fragments <4 mm were present, follow-up was repeated every 3 months. Results: Stone size ranged from 0.5 to 3.5 cm. 71 renoureteral units underwent a total of 129 ESWL sessions. Retreatment was required in 28 patients. The mean number of sessions per unit was 1.8. A stone-free status was achieved in 60 renoureteral units. The overall success rate was 88.6%. The composition of the stone was mixed calcium oxalate and phosphate in the majority of the patients. Auxiliary procedures used were push-back, ureteroscopic stone removal, and open surgery. Hematuria, colics and fever over 38°C were the complications encountered after the treatment. Conclusions: ESWL is the first-line treatment for renal and upper ureteral calculi. However, larger stones which will require several ESWL sessions and consecutively increased number of shock waves are best treated with percutaneous nephrolithotomy plus ESWL. Patients with congenital anomalies necessitating surgical reconstruction are the best candidates for operation.

Factors Affecting Complication Rates of Percutaneous Nephrolithotomy in Children: Results of a Multi-Institutional Retrospective Analysis by the Turkish Pediatric Urology Society

PURPOSE We assessed factors affecting complication rates of percutaneous nephrolithotomy in children. MATERIALS AND METHODS We retrospectively evaluated data on 1,205 renal units in 1,157 children treated with percutaneous nephrolithotomy at 16 Turkish centers between 1991 and 2012. Of the patients 28.3% had a history of urolithiasis. Complications were evaluated according to the Satava classification system and modified Clavien grading system. Univariate and multivariate analyses were done to determine predictive factors affecting complication rates. RESULTS A total of 515 females and 642 males were studied. Mean ± SD patient age was 8.8 ± 4.7 years (range 4 months to 17 years). Mean ± SD stone size, operative time and postoperative hospital stay were 4.09 ± 4.06 cm(2), 93.5 ± 48.6 minutes and 5.1 ± 3.3 days, respectively. Postoperative stone-free rate was 81.6%. A total of 359 complications occurred in 334 renal units (27.7%). Complications were intraoperative in 118 cases and postoperative in 241. While univariate analysis revealed that stone history, positive urine culture, operative time, length of hospitalization, treatment success, punctured calyx and location of the stone significantly affected the complication rates (p <0.05), operative time, sheath size, mid calyceal puncture and partial staghorn formation were the statistically significant parameters affecting complication rates on multivariate logistic regression analysis. CONCLUSIONS Percutaneous nephrolithotomy is the treatment of choice for most renal calculi in children. The technique is effective and safe in children, with a high success rate and a low rate of major complications. The significant factors identified should be considered by clinicians to decrease associated complication rates.

The role of ESWL in the treatment of calculi with anomalous kidneys.

OBJECTIVE To evaluate the efficacy of Extracorporeal shock wave lithotripsy (ESWL) in renal anomalies. MATERIAL AND METHODS From 1991 to May 1995. 53 patients with calculi in anomalous kidneys presented to our clinic for treatment with ESWL. Average patient age was 39 years, a range of 6-66 years. These patients (32 male and 21 female) underwent ESWL treatments. ESWL was performed in 27 patients with urolithiasis in duplex system, 18 with horse-shoe kidneys, 4 with unilateral renal agenesis, 2 with pelvic ectopic kidneys, 1 with sigmoid kidney and 1 with L-shaped kidney. RESULTS Among patients who completed ESWL the rate free of stones was 60.4% and the rate of clinically insignificant residual fragments was 30.2%. No sign of stone disintegration was observed in 2 patients. They underwent open surgery. The shock waves per therapy varied between 811 and 18,101. Double-J stents were placed in 13 patients. CONCLUSION Most patients with calculi in anomalous kidneys can be managed primarily with ESWL.

Comparison of Gleason scores from sextant prostate biopsies and radical prostatectomy specimens

Objectives: We compared the Gleason scores obtained from sextant prostate biopsy and radical prostatectomy (RP) specimens in patients with localized prostate cancer. Patients and Methods: Sixty-one patients having a clinical diagnosis of localized prostate cancer underwent needle biopsy under transrectal ultrasonography (TRUS) and RP. Grading and staging were assigned based on Gleason scores and the TNM system, respectively. Results: Mean patient age was 65.5 ± 13.43 years and mean PSA level was 14.69 ± 3.95. Mean Gleason score for prostate biopsy and RP specimen were 5.85 ± 0.7 and 6.34 ± 1.44, respectively. With respect to clinical stage, there were 20 patients in stage 1 and 41 patients in stage 2 prostate cancer. Comparing the Gleason scores, the biopsy score was lower in 26 (42.26%) and higher than RP specimens in 7 (11.84%) cases, and there was agreement between the biopsy and RP specimens in 28 (45.9%) patients. The difference between the two Gleason scores was ± 1 for 18 patients (29.5%) and ± 2 or more for 17 patients (27.86%). Conclusion: In our study, high Gleason score biopsies with elevated PSA level (>10 ng/ml) were risk factors for extraprostatic extension, and we demonstrated that Gleason scores were significantly correlated with seminal vesicle and lymph node invasion (p < 0.05). The Gleason scores of biopsy and RP specimens agreed with 45.9% of TRUS-guided sextant prostate biopsies, and this ratio was 91.1% in moderately differentiated tumors

Intracavernosal adrenalin injection in priapism

Prolonged erection is a rare problem in urology but it must be treated effectively. The most common etiological factor is intracavernosal vasoactive agent injection for diagnosis or treatment of erectile dysfunction. The aim of this study was to evaluate the efficacy of intracavernosal adrenalin injection alone in the treatment of priapism. Nineteen patients with prolonged erection were evaluated. Seventeen out of the 19 prolonged erections were due to intracavernosal vasoactive agent injection and the remaining two were idiopathic. In all cases 2 ml adrenalin (1/100 000) was injected in each cavernosal body. In the patients who did not respond to the first injection, repeated adrenalin injections were performed at 20 min intervals. Blood pressure and heart rate were monitored during the injections. Detumescence was achieved in ten (53%) patients after the first injection. Repeated adrenalin injections (2–5 injections) were required in nine patients and eight (42%) of them achieved detumescence. Only one (5%) patient who had 26-h prolonged erection could not achieve detumescence. There was no significant difference in blood pressure and heart rate during the monitoring of the patients when compared to the initial values. No standard treatment method has yet been described for prolonged erection. Repeated aspirations and irrigations for treatment of prolonged erection are problematical applications both for patients and urologist. Intracavernosal adrenalin injection alone can be used with high efficacy and safety for the treatment of prolonged erection especially in patients with a short duration of erection.

Role of Rho-kinase in contractions of ureters from rabbits with unilateral ureteric obstruction

To investigate the expression of two isoforms of Rho‐kinase (ROCK) and its functional role in the pathophysiological control of smooth muscle contraction in rabbits with unilateral ureteric obstruction (UUO).

Transrectal ultrasonography-guided echo-enhanced seminal vesiculography in combination with transurethral resection of the ejaculatory ducts.

routinely aspirated for motile spermatozoa. All intraoperative aspirates are cryopreserved for intracytoplasmic sperm injection (ICSI) if microscopic examination shows motile spermatozoa and the volume is sufficient for harvesting. The mixture of Levovist and methylene blue dye is then administrated under real-time TRUS guidance. The patency of the ipsilateral ejaculatory duct is confirmed by directly visualizing the contrast solution as it flows through the seminal vesicle, the ampulla of the vas deferens and the ejaculatory duct, and then passes into the prostatic urethra and the bladder. The procedure is then repeated for the contralateral seminal vesicle. At the same time seminal vesicles, ejaculatory ducts and the prostatic urethra can be clearly visualized for the level of obstruction, obstructed length, distance to the cyst and distance to the rectum (Fig. 2) After evaluating these variables a strategy for the operation is selected.