Omer Kurt

Combination therapies for the management of nocturia and its comorbidities

Nocturia is the most bothersome lower urinary tract symptom. It has a multifactorial etiology. It had been thought nocturia was a nonspecific symptom of lower urinary system dysfunction, but it has been determined that many diseases, related to different organ systems, might be reasons for this nonspecific symptom. Along with the importance of systemic diseases that cause nocturia, the symptom itself has adverse effects on patients’ health and quality of life. There are several studies reporting a direct relationship between nocturia and depression, cognitive dysfunction, mood disturbances, falls, and fractures. For this reason, it is important to treat nocturia both to increase quality of life and to decrease related complications. Treatment opportunities have been under investigation for 20 years. Most of the studies in the literature have reported the results of single-drug medication on nocturia, which may be insufficient for a situation that has such a multifactorial etiology. In this review, we evaluated the success of different treatment combinations on nocturia.

The Effect of Testicular Torsion Duration on Testicular Steroidogenesis in the Rat Model

Background: Testicular torsion is an emergency condition in which spermatogenesis may be irreversibly damaged. There have been controversial results about the effect of testicular torsion on steroidogenesis. We aimed at investigating the effect of testicular torsion on steroidogenesis. Material and Methods: A total of 40 adult male rats were divided into 4 groups. Left testicles were removed in all groups. Right testicles were torsioned and remained in the torsion position for 1, 3 and 5 h in study groups, whereas no torsion was performed in control. Serum luteinizing hormone (LH) and total testosterone (TT) levels were measured on the 3rd and 30th days of surgery and orchiectomy was performed on the 30th day of testicular torsion for histopathological evaluation. Results: TT levels of study groups were significantly lower than that of the control group on the 3rd day of torsion. LH of study groups was higher than that of the control group, but the difference was significant only in the 5 h-torsion group. The total number of Leydig cells increased in 1- and 3-h groups, whereas it decreased in the 5-hour group. Conclusion: Testosterone production and Leydig cell functions significantly decreased after 5 h torsion in the rat model. The duration of torsion less than 5 h yielded partial dysfunction on steroidogenesis.

Does laparoscopic transperitoneal simple nephrectomy for inflammatory and non-inflammatory kidneys differ?

BackgroundLaparoscopic simple nephrectomy is the standard procedure for the removal of non-functioning benign kidney. It can be performed transperitoneally or retroperitoneally. There are several studies comparing the results of transperitoneally or retroperitoneally laparoscopic nephrectomy but there are limited numbers of study comparing results of laparoscopic transperitoneal simple nephrectomy in non-inflammatory and inflammatory non-functioning kidneys. The aim of this study was to compare the results of laparoscopic transperitoneal simple nephrectomy in non-inflammatory and inflammatory non-functioning kidneys.ResultsWe retrospectively reviewed the records of patients who underwent laparoscopic nephrectomy for various inflammatory and non-inflammatory renal conditions at our institution from May 2012 to October 2015. We divided the patients in two groups. Group 2 involved the kidneys with stone disease and/or hydronephrosis, patients with previous renal surgery and patients with the history of recurrent infections. Group 1 involved the patients who had non-functioning kidney without these properties. All the surgeries were performed by transperitoneal approach and peroperative blood loss, operation time, hospitalization time, postoperative creatinine changes and haemoglobin drop were compared between groups. There were 22 patients with inflammatory and 27 patients with non-inflammatory non-functioning kidney. Operation time, peroperative blood loss, hospitalization time, postoperative haemoglobin drop and creatinine difference were not statistically different between groups. Surgical side and the presence of previous surgery did not affect the surgical results of inflammatory and non-inflammatory kidney nephrectomy. The only difference was postoperative fever which was more frequent after the nephrectomy of inflammatory kidney.ConclusionsOn the basis of our experience, surgical results of transperitoneal laparoscopic simple nephrectomy did not differ between inflammatory and non-inflammatory kidneys. Surgical times were higher in inflammatory group even if the difference was not significant.

Is it only a sleeping disorder or more? Restless legs syndrome and erectile function.

Abstract Objective: Sexual dysfunction and restless legs syndrome (RLS) have similar pathophysiological properties. This study evaluated the presence of erectile dysfunction (ED) and premature ejaculation (PE) in patients with RLS. Materials and methods: Fifty patients in the RLS group and 50 in the control group were included in the study. The International Restless Legs Syndrome Study Group rating scale, the five-item International Index of Erectile Function and the Premature Ejaculation Diagnostic Tool were used to define the RLS and erectile function of both the study and control groups. A stopwatch technique was used to evaluate the intravaginal ejaculatory latency time of patients in the study. Results: The mean age of patients in the RLS and control groups was 53.5 ± 9.9 and 53.2 ± 8.8 years, respectively (p = 0.527). None of the patients in either group had diabetes mellitus. There was no difference between the groups in terms of history of hypertension, body mass index and total testosterone level. There were 27 patients (54%) in the RLS group and 17 patients (34%) in the control group with PE (p = 0.008). There were 26 patients (52%) with ED in the RLS group and 17 (34%) in the control group (p = 0.069). The prevalence of moderate and severe ED was significantly higher in the RLS group (p = 0.045). Conclusions: PE was more prevalent in RLS than in control patients. On the other hand, the rate of ED did not differ between the groups. In addition to receiving a neurological evaluation, RLS patients must be evaluated for sexual function.

Female sexual dysfunction in androgenetic alopecia: Case-control study.

INTRODUCTION We sought to evaluate the association of female sexual dysfunction (FSD) with androgenetic alopecia (AGA) and metabolic syndrome (MetS) in premenopausal women. METHODS From December 2013 to June 2015, we performed a case-control, prospective study of 115 patients with AGA and 97 age-matched control patients without AGA from among premenopausal women who visited dermatology clinics of the two reference hospitals. Comprehensive history, anthropometric measurements, and questionnaire administration were performed for each of the total of 212 women. The Female Sexual Function Index (FSFI) was used to assess the key dimensions of female sexual function. AGA was assessed and graded by an experienced dermatologist according to Ludwigs classification. The MetS assessment was made according to the NCEP-ATP III criteria. RESULTS In univariate analysis, age, weight, waist circumference, hip circumference, waist-to-hip ratio, body mass index (BMI), AGA, MetS, cardiovascular event, marital status, hypertension, high fasting plasma glucose, high triglyceride, large waist, total testosterone, and free testosterone were associated with presence of FSD. In logistic regression analysis, age (odds ratio [OR] 1.21, 95% confidence interval [CI] 1.13-1.30; p<0.001), AGA (OR 3.42, 95% CI 1.31-8.94; p=0.017), MetS (OR 5.39, 95% CI 1.34-21.62; p=0.012), and free testosterone (OR 0.18, 95% CI 0.09-0.37; p<0.001) were independently associated with FSD. CONCLUSIONS Our study suggests that age, AGA, MetS, and free testosterone may have strong impact on sexual function in premenopausal women. Further studies with population-based and longitudinal design should be conducted to confirm this finding.

Effect of Tadalafil on Prevention of Urethral Stricture After Urethral Injury: An Experimental Study.

OBJECTIVE To evaluate the preventive effect of phosphodiesterase type 5 inhibitor (tadalafil) on the formation of urethral stricture after urethral injury. MATERIALS AND METHODS A total of 28, 4-month-old male New Zealand rabbits were included and divided into 3 groups. Group 1 was a sham group with 8 rabbits that underwent only urethroscopy. Group 2 was a nontreatment group with 10 rabbits that underwent urethral electrocoagulation without any treatment. Group 3 was the treatment group with 10 rabbits that underwent urethral electrocoagulation with systemic tadalafil treatment. After 30 days of follow-up, urethroscopy and retrograde urethrography were performed to evaluate the morphological changes in the urethra. The urethra tissues were examined with standard light microscopy by a histologist, and apoptosis was evaluated by the terminal dUTP nick end-labeling assay. RESULTS Urethral diameters in group 1, group 2, and group 3 were 9.14 ± 0.73 mm, 3.52 ± 1.2 mm, and 7.68 ± 1.14 mm, respectively. The differences in urethral diameters were statistically significant between groups (P < .01). Collagen deposition in submucosal connective tissue was significantly less in the tadalafil group vs the nontreatment group. The numbers of apoptotic cells in submucosal connective tissue were also quantitatively higher in urethral stricture groups compared to the sham group. CONCLUSION Tadalafil treatment had a protective effect against the formation of urethral stricture in rabbit model. This treatment can be a promising opportunity for urethral stricture and must be supported by clinical studies.

How to manage sepsis associated with ureteral calculi

abdominal BT and renal USG. It is not clear how they understand sepsis due to urological causes. They noticed all the patients have ureteral stone, but no bacterial growth has been isolated from the urine culture in 19 patients (17 %). We did not understand how they diagnosed the patients as “urosepsis”. The authors mentioned that they performed URS despite the patients have UTIs (urinary tract infections). According to the EAU (European Association of Urology) Guidelines, urine culture or urinary microscopy is mandatory before any treatment is planned [grade of recommendation (Gr): A]. UTIs must be excluded or treated prior to endourologic stone removal (level of evidence: 1a, Gr: A). They noticed that they have evaluated the patients with urine culture and given the antibiotic. But, as we know it results in 3 days. How did they decide which antibiotic is suitable for the patients. Did they wait the urine cultures’ results or begin an empiric antibiotic. It is not stated if they have given antibiotic to the patients before the eURS? Two options for urgent decompression of obstructed collecting systems are advised. These are an indwelling ureteral stent or PN tube placement [5]. They have designed the study into two groups. But, the eURS management is not an alternative treatment to PN. While drainage and stone removal can be made with URS, but only drainage can be made with PN. They found the complication rate about 10 %. By adding a third group, the study would be more meaningful as control. An indwelling ureteral stent should have been placed before antibiotic treatment in this group. In the literature, sepsis is defined as the systemic response to infection, manifested by two or more of the following conditions as a result of infection: (1) temperature >38 or <36 °C; (2) heart rate >90 beats per minute; (3) respiratory rate >20 breaths per minute or PaCO2 <32 mmHg; In this interesting study the authors compared the efficacy and complication rates of emergent ureterorenoscopy (eURS) and percutaneous nephrostomy (PN) tube placement for obstructed ureteral stones [1]. The authors have done a prospective randomized trial in a much debated topic. In the study retrograde internal ureteral stent placement or percutaneous nephrostomy (PCN) is suggested in the guidelines because none of them have superiority to the other. I congratulate the authors for successful treatment the sepsis disease likely to go to multi-organ deficiency, septic shock and even to death. Interestingly they can treat the disease without occurring pyelo interstitial reflux-related complications. Currently, infected obstructive collecting system treatment is controversial. URS after decompression for ureteral stone-related sepsis has similar success, but higher complication rates, longer hospital length of stay, and longer course of postoperative antibiotics [2]. Pearle et al. mentioned that PN and retrograde ureteral catheterization effectively relieve obstruction and infection, but they need one more procedure to get rid of stone [3]. Goldsmith et al. found both JJ stent placement and PN drainage appear effective in sepsis patients [4]. Furthermore, they adviced PN for the patients with larger stones and who are more acutely ill. Beside this we want to draw attention to some points about this article. In this study, the preoperative diagnosis was performed with urine analysis, urine culture,