Ramazan Asci

Prevalence of the Complaint of Ejaculating Prematurely and the Four Premature Ejaculation Syndromes: Results from the Turkish Society of Andrology Sexual Health Survey

INTRODUCTION In addition to the previously known lifelong and acquired premature ejaculation (PE) syndromes, the existence of two more PE syndromes has been suggested: natural variable PE and premature-like ejaculatory dysfunction. However, epidemiological studies investigating the prevalence of these four PE syndromes have yet to be conducted. AIM To determine the prevalence of the complaint of ejaculating prematurely across the four PE syndromes. METHODS This study, conducted between June 2009 and December 2009, was designed as a non-interventional, observational cross-sectional field survey. Participating couples were randomly selected from 17 provinces of Turkey. All participants were asked to complete a questionnaire including data regarding demographics, socioeconomic status, social and cultural factors, medical and sexual history, current medications, and ejaculation time. Subjects with a complaint of ejaculating prematurely were classified as lifelong, acquired, and natural variable PE, or premature-like ejaculatory dysfunction. MAIN OUTCOME MEASURES The main outcome measures were prevalence of complaint of ejaculating prematurely in the general population and across the four PE syndromes. RESULTS A total of 2,593 couples (mean age, 41.9±12.7 years for males and 38.2±12.1 years for females) were enrolled. Five-hundred twelve subjects (20.0%) complained of ejaculating prematurely. Fifty-eight (2.3%), 100 (3.9%), 215 (8.5%), and 131 (5.1%) subjects were classified as lifelong, acquired, and natural variable PE, and premature-like ejaculatory dysfunction, respectively. CONCLUSIONS The prevalence of the complaint of ejaculating prematurely among Turkish men was 20.0%, with the highest PE syndrome being natural variable PE (8.5%) and premature-like ejaculatory dysfunction (5.1%).

Fournier's gangrene : risk assessment and enzymatic debridement with lyophilized collagenase application

Objectives: Fournier’s gangrene (FG) is an abrupt, rapidly progressive, gangrenous infection of the external genitalia, perineum or abdominal wall and is a real urologic emergency. In this study, the risk factors of FG and the effects of enzymatic debridements on wound healing were investigated. Patients and Methods: We reviewed the records of 34 patients with FG to investigate the possible correlation between clinical outcome and infection focus, patient age, number of types of bacteria cultured, delay until presentation, predisposing diseases or accompanying conditions such as diabetes, neurologic deficit, chronic alcoholism and renal failure. Broad-spectrum triple antimicrobial therapy, aggressive and frequent surgical debridement, and if necessary urinary and colonic diversions were performed to control the infection. The effects of enzymatic debridements with topical lyophilized collagenase applications on the wound healing after the control of active infection were evaluated. Results: The average age of the patients was 55 years. The sources of infections were urogenital in 12 (35.3%), anorectal in 10 (29.4%), dermal in 10 (29.4%) and undetermined in 2 (5.8%) of the patients. The average presentation time was 4.4 days and the number of isolated bacteria was 3.05 per case. The number of isolated bacteria and surgical debridements, the duration of hospital stay and the rate of mortality in patients with anorectal foci were higher than those of the patients with urogenital or dermal foci (p < 0.05). Diabetes, uremia and advanced age did not significantly affect the number of surgical debridements, the duration of hospital stay and control of active infection. Mortality was increased in chronic alcoholism, a finding of undetermined significance. Enzymatic debridements decreased the duration of hospital stay (p < 0.05). Five patients (14.7%) died despite prompt medical and surgical preventive measures. Conclusion: Chronic alcoholism, anorectal infection foci, neurological deficit and delayed presentation were found as risk factors in FG. Diabetes and advanced age did not affect the progression of disease in our cases. Enzymatic debridements decrease the number of surgical debridements and the duration of hospital stay.

Vitamin D receptor gene polymorphisms in patients with urolithiasis

Urolithiasis is a multifactorial disease, the onset and severity of which is influenced by both genetic and environmental factors. This study represents an investigation of the role of vitamin D receptor (VDR) gene polymorphisms (ApaI, BsmI, and TaqI) and combined genotypes in urolithiasis in a Turkish population. We studied 110 patients with urinary stones and 150 control subjects. The polymorphic regions were amplified using polymerase chain reaction, followed by digestion with restriction enzymes BsmI, ApaI, and TaqI, and analyzed electrophoretically. Genotype and allele frequencies were calculated, and the association with urolithiasis, family history, and recurrence of stone was investigated. Our data provide no evidence for an association between urolithiasis and VDR ApaI, BsmI, and TaqI genotypes. We also analyzed the effects of VDR ApaI, BsmI, and TaqI genotypes in combination; the “GTT” VDR haplotype, constructed from three adjacent restriction fragment length polymorphisms was overrepresented among the urolithiasis patients. However, no significant differences between heterozygous carriers (OR 1.302; 95% CI 0.527–3.215) and homozygous carriers (OR 3.39; 95% CI 0.719–15.985) were observed in our study population. A significant association was found only between the ApaI polymorphism and family history (P=0.017; χ2=5.657). Our data indicate that the VDR ApaI, BsmI, and TaqI polymorphisms do not confer a significant risk for urolithiasis.

Effects of aging on the male reproductive system.

The study aims to discuss the effects of aging on the male reproductive system. A systematic review was performed using PubMed from 1980 to 2014. Aging is a natural process comprising of irreversible changes due to a myriad of endogenous and environmental factors at the level of all organs and systems. In modern life, as more couples choose to postpone having a child due to various socioeconomic reasons, research for understanding the effects of aging on the reproductive system has gained an increased importance. Paternal aging also causes genetic and epigenetic changes in spermatozoa, which impair male reproductive functions through their adverse effects on sperm quality and count as, well as, on sexual organs and the hypothalamic-pituitary-gonadal axis. Hormone production, spermatogenesis, and testes undergo changes as a man ages. These small changes lead to decrease in both the quality and quantity of spermatozoa. The offspring of older fathers show high prevalence of genetic abnormalities, childhood cancers, and several neuropsychiatric disorders. In addition, the latest advances in assisted reproductive techniques give older men a chance to have a child even with poor semen parameters. Further studies should investigate the onset of gonadal senesce and its effects on aging men.

The role of epigenetics in idiopathic male infertility.

Infertility is a complex disorder with multiple genetic and environmental causes. Although some specific mutations have been identified, other factors responsible for sperm defects remain largely unknown. Despite considerable efforts to identify the pathophysiology of the disease, we cannot explain the underlying mechanisms of approximately half of infertility cases. This study reviews current data on epigenetic regulation and idiopathic male infertility. Recent data have shown an association between epigenetic modifications and idiopathic infertility. In this regard, epigenetics has emerged as one of the promising research areas in understanding male infertility. Many studies have indicated that epigenetic modifications, including DNA methylation in imprinted and developmental genes, histone tail modifications and short non-coding RNAs in spermatozoa may have a role in idiopathic male infertility.

p53 and bcl-2 overexpression as associated risk factors in patients 40 years old or less with transitional cell carcinoma of the bladder.

Objectives: Transitional cell carcinoma (TCC) of the bladder in younger patients has historically a favourable prognosis. bcl-2 and p53 genes are implicated in cell cycle regulation with roles on programmed cell death. Presence of nuclear accumulation of p53 and cytoplasmic accumulation of bcl-2 were proposed to confer a growth advantage to tumour cells. In this study, we investigated the roles of p53 and bcl-2 as prognostic factors in TCC of bladder in patients younger than 40 years. Patients and Methods: From 1986 to 1998, 25 patients younger than 40 years were treated for TCC of bladder in our hospital. Of the tumour specimens, 24 were adequate for evaluating p53 and bcl-2 oncoproteins (group I). As a control (group II), we randomly selected 30 patients older than 50 years treated for bladder cancer in this period. Two oncoproteins were detected by immunohistochemical analysis in paired tumour tissue specimens in both groups. Retrospectively obtained clinical follow-up data were available, with a mean follow-up of 44 and 25.5 months in groups I and II, respectively. Relations between tumour recurrences and progression with positivity of bcl-2 and p53 were investigated. Results: Expression of bcl-2 was observed in 13 (54.1%) and 11 (36.7%) and nuclear p53 accumulation in 9 (37.5%) and 17 (56.7%) of groups I and II, respectively. In the presence of p53 expression, tumours showed significantly more progression in group I (55 vs. 6.7%) and group II (41.1 vs. 0%). Recurrence rates were not significantly different in tumours with and without nuclear p53 overexpression in both groups. Also, recurrence and progression rates were not significantly different in tumours with and without cytoplasmic bcl-2 overexpression in both groups. Grade (G) and stage appeared as important prognostic factors in both groups since 60% of GIII tumours showed progression in group I, but none of GI and GII tumours. Similarly, 75% of T3 tumours progressed, while these rates were 25 and 25% for T1–T2 tumours in group I. In group II, 31.2, 25 and 0% of GIII, GII and GI tumours progressed, while 50, 41.6 and 0% of T3, T2 and T1 tumours progressed, respectively. Conclusions: Nuclear p53 expression in TCC appears to be associated with a poorer prognosis in both younger and older patients. Although cytoplasmic bcl-2 overexpression is found in the majority of tumours in the younger group, it is not associated with tumour progression and recurrence.

Relationship between penile fracture and Peyronie's disease: a prospective study.

Peyronies disease is postulated to be initiated by repetitive minor traumas to the fully or partially erect penis. We investigated Peyronies disease prospectively in cases treated for penile fracture (PF) within the last 20 years. Medical records of 63 cases treated for PFs were reviewed. Subjects were required to self-assess their current penile morphologies and sexual functions. Penile nodules and Peyronies plaques were also evaluated with physical examination, ultrasonography and magnetic resonance imaging (MRI), and penile curvatures with auto-photography, and sexual function with international erectile function index (IIEF). Of the 63 cases (mean age 37 years), 46 who had mean follow-up of 63 months were re-evaluated. The mean IIEF-5 score was 23.2±3.1. Painful erections (n=5), penile nodules (n=5) and also penile curvatures <20° (n=2) were investigated. No Peyronies plaque was palpated in any of the cases. Ultrasound and MRI showed fibrotic nodules of 5 mm in diameter, which extended into the subtunical area in the rupture site in 54% of the cases, although any thickening and Peyronies plaque were not found in the tunica albuginea and intracavernosal septum of the cases examined. In PF patients treated surgically, the erectile function and penile morphology were preserved. In our cases PFs did not induce the development of Peyronies disease.

Prevalence of sexual dysfunction and urinary incontinence and associated risk factors in Turkish women

OBJECTIVES Female sexual dysfunction (FSD) and urinary incontinence (UI) are associated risk factors that might cause each other. No study has investigated prevalence of FSD and UI in the same population. The aims of the study were to investigate the prevalence of FSD and UI and associated risk factors in the same population. STUDY DESIGN The study included 1217 women in 20 provinces, representing the geographical regions of Turkey. Women aged ≥18 years with active sexual life in the last 6 months were enrolled. FSD, overactive bladder, UI, depression, and sexual distress were investigated using validated scales. Risk factors that might predict FSD and UI were determined in the same population. RESULTS The prevalence of FSD and UI was 52.5% and 14.6%, respectively. Comparing the women with and without FSD, those with FSD were older, had higher body mass index (BMI), less physical exercise, older spouses, lower educational level, and lower rates of smoking and alcohol consumption. The rates of women in menopause and those with a spouse/partner having erection problem and the rates of UI, depression, and sexual distress were higher in the FSD group. Age of spouse, low educational level, not smoking, not consuming alcohol, menopause, not giving consent to spouse/partner to use sexual performance-enhancing drugs when necessary, depression, and sexual distress were the significant risk factors for FSD. Of the women with UI, 56% had overactive bladder symptoms, 32% had stress UI, and 12% had mixed type UI. Comparing the women with and without UI, those with UI were older, had higher BMI, lower educational level, and older spouses. The rate of menopausal women and the rates of FSD, depression, and sexual distress were higher in the UI group. Menopause and FSD were the significant risk factors for UI. CONCLUSIONS This is the first study to investigate prevalence of FSD and UI in the same population. UI deteriorates sexual functions of women. Therefore, both conditions should be assessed when women complain of either sexual or urinary problems.

The Effects of Experimental Left Varicocele on the Epididymis

Most of the studies investigating the relationship between varicocele and male infertility are mainly focused on the testicles. It is obvious that varicocele would affect the morphology and function of the epididymis which is an intrascrotal organ. In this study, the effects of experimental left varicocele (ELV) on the epididymal morphology were investigated in adult rats. ELV was induced via partial obstruction of the left renal vein in 20 Sprague-Dawley adult rats. An additional twelve rats served as controls, and another twelve served as shams. Half of the rats in the groups were sacrified by the end of the first month of the experiment, and the rest were sacrified by the end of the second month. Epididymides were weighed; tubular diameters of the caput, corpus, and cauda of the epididymis were measured. The TUNEL assay was used to assess apoptosis within the epididymal tubules. The mean weight of each right and left epididymis in the varicocele group was lower than that in the control and sham groups (p < 0.01). In the varicocele group, the left epididymis weighted less than the right by the end of the second month (p < 0.01). The mean tubular diameter in the varicocele group was narrower than that in the control and sham groups (p < 0.001). Tubular diameter was significantly narrower in the caput segments in rats with varicocele by the end of the second month (p < 0.001). Apoptosis was significantly increased in principal cells of the epididymal epithelium in the varicocele groups. The apoptotic cells in the caput epididymis epithelium were more numerous than those in the other segments. In conclusion, ELV significantly decreases epididymal weight and tubular diameters presenting increased apoptosis within the principal cells. There is a positive correlation between the epididymal damage and the duration of varicocele.

Laparoscopic excision of renal hydatid cyst in a preadolescent.

The traditional method of treating hydatid disease by open surgery has, in recent years, been challenged and minimally invasive approaches, including percutaneous and laparoscopic management, have been gaining wide acceptance. We present a 13-year-old boy with the diagnosis of isolated right renal hydatid disease, and a total pericystectomy was performed laparoscopically. Total operative time was 4.5 h and estimated blood loss was 150 ml. The only complication was an early urinary leak which was successfully treated with internal stenting. We believe further experience will reduce the operative time and complications.