Omer Demir

Association between severity of lower urinary tract symptoms, erectile dysfunction and metabolic syndrome

Introduction. The purpose of this study was to investigate the association between severity of lower urinary tract symptoms (LUTS), erectile dysfunction (ED) and metabolic syndrome. Methods. Our study population included a consecutive series of 190 patients with LUTS (International Prostate Symptom Score-IPSS >7) with or without manifestations of the metabolic syndrome. The diagnoses of diabetes mellitus and hypertension were obtained from the patients medical history. Data on blood pressure, waist measure, body height and weight were collected and body mass index were calculated. Patients were assessed based on the International Index of Erectile Function (IIEF) for ED and IPSS and IPSS-Quality of Life for LUTS. Blood samples were drawn from fasting patients to determine, fasting blood glucose (FBG), triglycerides, HDL-cholesterol and serum total testosterone levels. Results. In severe LUTS patient group, IIEF erectile function domain scores were significantly lower than moderate LUTS patient group (p < 0.05). Multiple logistic regression analysis confirmed that presence of ED was the most predictor of severe LUTS. The prevalence of metabolic syndrome was higher in patients with severe LUTS (26%vs. 46%, p = 0.009). The severe form of the LUTS was significantly correlated with waist circumference >102 cm (p < 0.05), blood pressure ≥130/85 mmHg (p < 0.05) and FBG >110 mg/dl (p < 0.01). Conclusion. Obesity, high plasma level of FBG and hypertension constitute risk factors for the development of severe LUTS. Metabolic syndrome may play a key role in the pathogenesis in both ED and LUTS. Presence of ED is the most predictor of severe LUTS.

The Relationship Between Premature Ejaculation and Hyperthyroidism

PURPOSE We determine the prevalence of premature ejaculation in patients with hyperthyroidism and observed intravaginal ejaculation latency time alterations before and after hyperthyroidism treatment. MATERIALS AND METHODS Between January 2004 and June 2007, 49 patients with hyperthyroidism and no history of hyperthyroidism treatment were enrolled in the study. After obtaining a detailed sexual anamnesis an erectile function questionnaire was completed and a patient self-reported outcome measure of difficult control over ejaculation was examined. We assessed stopwatch measurements of intravaginal ejaculation latency time performed by the patient or partner. Patient anxiety status was also evaluated. Changes in the mentioned measurements induced by hyperthyroidism treatment were examined 8 weeks after the achievement of euthyroidism. RESULTS In the 43 eligible patients mean +/- SD age was 48.0 +/- 8.8 years. Premature ejaculation was observed in 31 of the 43 patients (72.1%). Mean intravaginal ejaculation latency time in patients with hyperthyroidism was 72.8 +/- 83.3 seconds. Of the 43 patients 30 (69.8%) were considered to have definite premature ejaculation according to stopwatch measurements. In patients with hyperthyroidism who had definite premature ejaculation anxiety scores were determined to be higher. A positive correlation was noted between serum thyroid stimulating hormone and intravaginal ejaculation latency time in the patients. In 24 patients who completed the followup visits we noted statistically significant improvement in intravaginal ejaculation latency time after the achievement of euthyroidism. CONCLUSIONS Excess thyroid hormone and premature ejaculation are clinically interrelated conditions. Hyperthyroidism should be considered a novel and reversible etiological risk factor for premature ejaculation.

Penile Vascular Impairment in Erectile Dysfunction Patients with Metabolic Syndrome: Penile Doppler Ultrasound Findings

Background: The constellation of truncal obesity, glucose intolerance, dyslipidemia (high triglycerides, low HDL cholesterol), and hypertension has been recognized as metabolic syndrome. However, the pathophysiological association between metabolic syndrome and erectile dysfunction (ED) has not yet been clearly determined. This study aimed to evaluate the penile Doppler ultrasound (PDU) findings of ED patients with metabolic syndrome. Patients and Methods: Sixty-one age-matched ED patients with or without metabolic syndrome were included in the study. Patients were investigated by grouping according to risk factors of metabolic syndrome with PDU parameters (5th, 10th and 20th minute peak systolic velocity and end-diastolic velocity). PDU parameters of patients with and without metabolic syndrome were compared. Results: The mean age of the patients were 54.9 ± 8.3 and 54.9 ± 7.6 years for the groups of with (n = 27) and without (n = 34) metabolic syndrome, respectively. When the mean peak flow velocities were compared with presence of metabolic syndrome, we observed differences between at the 5th, 10th and 20th minute peak systolic velocities (p = 0.083, p = 0.022 and p = 0.080, respectively). Conclusion: Metabolic syndrome seems to be the potential risk factor for ED, which may exert its effect by decreased arterial inflow due to endothelial dysfunction.

Effect of doxazosin with and without rho-kinase inhibitor on human corpus cavernosum smooth muscle in the presence of bladder outlet obstruction.

PURPOSE We investigated the relationship of adrenergic responses in corpus cavernosum tissues in the presence of BOO using the alpha1-adrenergic receptor antagonist doxazosin (Pfizer, New York, New York) and the rho-kinase inhibitor Y-27632 (Calbiochem, San Diego, California). MATERIALS AND METHODS CCSM tissue was obtained from patients who underwent penile prosthesis implantation. Patients were divided into 2 groups according to the presence of BOO. The submaximal (EC80) concentration of phenylephrine (Sigma Chemical Co., St. Louis, Missouri) was calculated by evaluating adrenergic activity responses with cumulatively applied phenylephrine. After achieving a stable contraction plateau test compounds were put in an organ bath. The relaxant potencies of doxazosin and Y-27632 were expressed as the percent of inhibition of the contraction plateau induced EC80 concentration of phenylephrine. Relaxation responses in the 2 groups were compared. RESULTS At the highest dose of increasing concentrations phenylephrine generated 70% more contraction response in the BOO positive group than in the BOO negative group. Doxazosin and Y-27632 caused concentration dependent relaxation in CCSM precontracted by phenylephrine. With doxazosin significantly higher relaxation responses were attained in the BOO positive group in terms of log IC50 and the maximal relaxation response (p = 0.0353 and 0.0003, respectively). Maximum relaxation responses following Y-27632 administration were significantly higher in the BOO positive group. CONCLUSIONS The contractility of human corpus cavernosum is increased in the presence of BOO. Doxazosin and Y-27632 generate effective CCSM relaxation in the presence of BOO. Doxazosin and Y-27632 may be the alternatives for the treatment of erectile dysfunction associated with BPH.

Evaluation of vascular smooth muscle and corpus cavernosum on hypercholesterolemia. Is resveratrol promising on erectile dysfunction

The aim of this study is to evaluate the effects of hypercholesterolemia in thoracic aorta (TA), mesenteric artery (MA), renal artery (RA), and corpus cavernosum (CC) isolated from cholesterol-fed rabbits. For determination of the maximum detrimental effect, vasorelaxation and vasoconstriction results of arteries and CC have been compared. Animals were fed with a diet that contained 2% w/w cholesterol and 2% w/w high cholesterol plus resveratrol (4 mg kg–1 per day) for 6-week duration. Total cholesterol levels in the plasma were measured. Vascular and endothelial functions in RA, TA, MA, and CC were assessed by isolated tissue bath with cumulative doses of acetylcholine and sodium nitroprusside. The statistical significance of differences of groups was analyzed by means of one-way ANOVA or Students t-test. P-values <0.05 were considered significant. There have been no significant changes on plasma total cholesterol levels between cholesterol and cholesterol + resveratrol-treated groups. Vasorelaxation responses to acetylcholine in resveratrol-treated group showed significant changes when compared with hypercholesterolemic group. No statistically significant differences were seen between non-receptor-mediated vasorelaxation responses between the three groups. Resveratrol might be an effective treatment in the prevention of atherosclerotic changes in arteries and CC. The initial effects of hypercholesterolemia on erectile dysfunction and endothelial dysfunction may be precluded with resveratrol. This protective effect may also ensure the prevention of coronary arterial diseases and renovascular diseases in hypercholesterolemic patients.

The combined use of brachial artery flow-mediated dilatation and carotid artery intima-media thickness measurements may be a method to determine vasculogenic erectile dysfunction.

The aim of this study was to investigate the relationship between penile color Doppler sonography (CDS) findings and sonographic endothelial parameters in patients with erectile dysfunction (ED), including intima-media thickness (IMT) of common carotid arteries (CCA) and flow-mediated dilatation (FMD) of brachial artery. Fifty-six ED patients were included in the study. Penile CDS, IMT of CCA and FMD of brachial artery were performed in all patients. According to penile CDS findings, 27 (48%) patients had non-vasculogenic and 29 (52%) patients had vasculogenic ED. Among 29 patients, 17 (30%) patients had cavernous veno-occlusive disease (CVOD) and 12 (22%) patients had arterial/combined insufficiency (AI). Median (interquartile range) FMD values of non-vasculogenic ED, CVOD and AI were 12.50 (6.54)%, 12.82 (7.41)% and 6.25 (7.17)%, respectively. FMD was found to be impaired significantly in AI group when compared to the other groups. FMD values of CVOD group were lower when compared to non-vasculogenic group, but the difference was not statistically significant. IMT values of vasculogenic ED patients were higher than non-vasculogenic ED patients (P<0.05). Although IMT values were higher in AI group when compared to CVOD, the difference was not statistically significant. The combined use of IMT and FMD established the diagnosis of vasculogenic ED with 100% sensitivity and 59.2% specificity. The positive predictive value was 72%, negative predictive value 100% and accuracy 80%. The combined use of brachial artery FMD and carotid arteries IMT measurements may be suggested as an alternative method to evaluate vasculogenic ED.

Investigation of the Neural Target Level of Hyperthyroidism in Premature Ejaculation in a Rat Model of Pharmacologically Induced Ejaculation

INTRODUCTION Association between hyperthyroidism and premature ejaculation was demonstrated in clinical studies. AIM The aim of this study is to determine the target level of changes on ejaculatory physiology under hyperthyroid states. METHODS p-Chloroamphetamine (PCA)-induced pharmacologic ejaculation model with 24 male Wistar rats was used in the study. Subcutaneous injection of L-thyroxine for 14 days was performed to induce hyperthyroidism. At the end of the injection period, thyroid hormone status was evaluated by serum thyroid-stimulating hormone measurements in all rats. At the beginning of the operations, complete spinal transections (tx) at the T8-T9 level were performed to half of the L-thyroxine-injected and control group rats. Thus, experimental groups were constructed as follows: Group 1--control-spinal intact (n=6), group 2-control-spinal tx (n=6), group 3-hyperthyroid-spinal intact (n=6), and group 4-hyperthyroid-spinal tx (n=6). Ejaculatory responses were recorded before and 30 minutes after intraperitoneal administration of 5 mg/kg PCA. MAIN OUTCOME MEASURES During the operations, seminal vesicle (SV) catheterization and bulbospongiosus (BS) muscle dissections were performed in all rats to demonstrate SV pressure (SVP) BS electromyographic (EMG) activity changes. RESULTS Following PCA administration SVP tonic amplitude, SV phasic contraction (SVPC) frequency, SVPC maximal amplitude, and BS EMG area under curve values were higher in hyperthyroid intact rats than in control intact rats. The time interval between PCA administration and first ejaculation of hyperthyroid intact rats were significantly shorter than control intact rats (261 ± 7.30 seconds vs. 426 ± 49.6 seconds, P=0.008). All of the changes in the ejaculatory parameters that were induced by hyperthyroidism were completely resolved after spinal transections at the T8-T9 level in group 4. CONCLUSION In this study, we confirmed the recent data that hyperthyroidism affects both the emission and expulsion phases of ejaculation. The changes that were induced by hyperthyroidism on ejaculatory physiology probably take place in the supraspinal centers above T8 level.

An Experimental Approach to the Interrelationship Between Hyperthyroidism and Ejaculation Latency Time in Male Rats

PURPOSE We investigated the effects of experimentally induced hyperthyroidism on seminal vesicle pressure measurements and bulbospongiosus muscle contractile activity in a para-chloroamphetamine (Sigma-Aldrich) induced ejaculation model in rats. MATERIALS AND METHODS Male Wistar rats were used in the study. Daily injection of 25 microg/100 gm body weight L-thyroxine (T4, Sigma-Aldrich) for 14 days was performed in 14 rats to induce hyperthyroidism. Seven L-thyroxine injected rats were in the hyperthyroid group. The remaining 7 rats (recovery group) underwent operation after a 28-day washout period to determine spontaneous recovery from hyperthyroidism. At each operation seminal vesicle catheterization was done to measure intraluminal pressure and bulbospongiosus muscle dissection was performed for electromyography. After intraperitoneal administration of 5 mg/kg para-chloroamphetamine physiological parameters related to the ejaculatory process were measured. RESULTS The interval between para-chloroamphetamine administration and first ejaculation was significantly decreased in the hyperthyroid rat group compared with that in the control group (mean +/- SD 202.8 +/- 22.3 vs 465.4 +/- 104.6 seconds, p = 0.001). Seminal vesicle phasic contraction frequency was significantly higher than control group values in hyperthyroid rats (for 30 minutes 32.3 +/- 13.9, p = 0.047). The mean AUC of bulbospongiosus muscle electromyography activity was also significantly increased in this group (11.1 +/- 4.1 V per second x 10(-4), p = 0.0001). All parameters in recovery and control group rats were not significantly differed from each other. CONCLUSIONS Hyperthyroidism leads to enhanced seminal vesicle contraction frequency and bulbospongiosus muscle contractile activity in rats. Hyperthyroidism affects the emission and expulsion phases of ejaculation in reversible fashion.

A possible new risk factor in diabetic patients with erectile dysfunction: homocysteinemia

INTRODUCTION AND OBJECTIVE Increasing levels of homocysteine (Hcys) are related to decreased nitric oxide synthesis in the vascular endothelium and also to erectile dysfunction (ED). We investigated the traditional risk factors of ED and plasma levels of Hcys in diabetic patients. METHODS Sixty-two men with type 2 diabetes and ages of between 40 and 70 years were included in the study. Detailed medical and sexual history and physical examination were performed. Erectile function was assessed with the International Index of Erectile Function. All participants were evaluated for fasting and postprandial plasma glucose, HbA1c, total cholesterol, triglyceride, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, apolipoprotein A, apolipoprotein B-100, vitamin B(12), folic acid, and plasma Hcys levels. Patients were evaluated for diabetic neuropathy. Colored penile Doppler ultrasonography was used to detect vascular abnormalities in diabetic patients with ED. RESULTS Fasting plasma glucose, postprandial plasma glucose, and HbA1c levels were significantly higher in diabetic patients with ED (P<.05). In addition, Hcys levels were slightly high in diabetic patients with ED (P=.079). Logistic regression analysis revealed that high levels of HbA1c (P<.01) and Hcys (P<.05), and smoking status (P<.01) were the main determinants of the presence of ED in our diabetic population. CONCLUSION We conclude that traditional risk factors, poor metabolic control, and smoking are important in ED generation in diabetic patients. In addition, Hcys, which is an important risk factor in atherogenesis, seems to be important in ED generation in diabetic patients.

Silodosin Causes Impaired Ejaculation and Enlargement of Seminal Vesicles in Sexually Active Men Treated for Lower Urinary Tract Symptoms Suggestive of Benign Prostatic Hyperplasia

OBJECTIVE To evaluate the sexual side effects including ejaculation after silodosin treatment in potent men with regular sexual activity, as well as possible alterations in seminal vesicle volume. METHODS Sexually active patients aged ≥ 40 years with moderate to severe lower urinary tract symptoms were enrolled prospectively. International Prostate Symptom Score (IPSS) and Quality of Life (QoL), International Index of Erectile Function (IIEF) questionnaire, ejaculation frequency, and seminal vesicle volumes measured by transrectal ultrasonography were determined at study entry, and silodosin 8 mg/d was prescribed for 4 weeks. Alterations in IPSS-QoL, all domains of IIEF, ejaculation frequency, seminal vesicle volumes, and patient-reported side effects were evaluated after silodosin treatment. RESULTS Thirty patients were included, and mean age was 56.7 ± 6.9 years (44-70 years). IPSS-total, IPSS-storage, and IPSS-voiding subscores and QoL were significantly improved after treatment. Despite a slight decrease in erectile function domain of IIEF (26.7 ± 1.9 vs 22.9 ± 7.5; P <.05), no significant change was determined for orgasmic functions, sexual desire, intercourse satisfaction, and overall satisfaction. Ninety percent of patients (27 of 30) had impaired ejaculation, and seminal vesicles were significantly enlarged at the end of treatment (8.1 ± 6.4 vs 16.4 ± 8.2 cc; P <.001). CONCLUSION Impaired ejaculation is a common problem for sexually active men treated with silodosin, and this may result in the slight decrease in erectile functions. Enlargement of seminal vesicles may represent for the loss of seminal emission and accumulation of seminal vesicle secretion. Further studies are required for better clarifying the effects of silodosin on sexual functions including ejaculatory functions.