Sabahattin Aydin

The Efficacy of Fluoxetine in the Treatment of Premature Ejaculation: A Double-Blind Placebo Controlled Study

PURPOSE The efficacy of the selective serotonin re-uptake inhibitor fluoxetine in the treatment of premature ejaculation was examined. MATERIALS AND METHODS The study comprised 17 patients with premature ejaculation who presented to the urology clinic of our medical school. In this double-blind study the patients were randomized into treatment groups receiving 20 mg. fluoxetine daily for 1 week and 40 mg. daily afterward (group 1) or 1 capsule placebo daily for 1 week and 2 capsules daily afterward (group 2). The groups were evaluated according to the latent period of intravaginal ejaculation. RESULTS The latent period of intravaginal ejaculation in group 1 was significantly longer than that in group 2. Nausea, headache and insomnia were reported side effects. CONCLUSIONS Fluoxetine may be regarded as a safe and effective alternative in the treatment of premature ejaculation.

Undescended Testes in Adults: Clinical Significance of Resistive Index Values of the Testicular Artery Measured by Doppler Ultrasound as a Predictor of Testicular Histology

PURPOSE We evaluated the clinical significance of arterial impedance as a predictor of testicular histology in adults with undescended (inguinal) testes. MATERIALS AND METHODS We performed arterial impedance and testicular diameter measurements with the use of color Doppler ultrasonography on 22 adults with undescended testes. Arterial impedance of the contralateral descended testes served as controls. All patients later underwent inguinal orchiectomy and the testes were examined histologically. RESULTS Of the 22 undescended testes, 7 had arterial impedance values below 0.50, and the other 15 had values equal to or above 0.50. All testes with arterial impedance values below 0.50 had histologic scores between 2 and 3, whereas the others had scores of 3 and 8. Arterial impedance values and testicular volumes in the contralateral testes were significantly higher than the undescended testes. Although some of the testes with arterial impedance values above 0.50 had histologic score 3, testes with arterial impedance values below 0.50 never exceeded score 3. Volume differences of the undescended testes were not statistically significant. CONCLUSIONS Arterial impedance of an undescended testis may have a predictive value and provide more accurate information about its histology than the volume measurement itself.

Effects of sildenafil citrate, acetylcholine, and sodium nitroprusside on the relaxation of rabbit cavernosal tissue in vitro

OBJECTIVES To investigate the effect of sildenafil together with the influence of sodium nitroprusside and acetylcholine and further discuss its mechanism of action in vitro. METHODS Isolated strips of rabbit corpus cavernosum were stimulated isometrically with phenylephrine. Graded relaxations were induced using increasing concentrations of acetylcholine, sodium nitroprusside, and sildenafil alone and in combination. RESULTS The agents all relaxed the rabbit corpus cavernosal strips in a dose-dependent manner. The inhibitory potentials of the test agents were ranked (from least inhibitory to most inhibitory) as follows: sildenafil, acetylcholine plus sildenafil, sodium nitroprusside, sodium nitroprusside plus sildenafil, acetylcholine. The presence of sodium nitroprusside in the medium reduced the median effective dose for the sildenafil-induced relaxation of the cavernosal tissue from 3.65 x 10(-5) M to 2.73 x 10(-7) M, and the presence of acetylcholine reduced it to 9.79 x 10(-6) M. CONCLUSIONS Sildenafil enhances the relaxing effect of both sodium nitroprusside and acetylcholine on the phenylephrine-induced contraction of rabbit cavernosal tissue.

Multicentral clinical evaluation of the aetiology of erectile dysfunction: A survey report

Patients with erectile dysfunction, who admitted to 4 different urological centres in Turkey were evaluated in terms of aetiological factors to establish the aetiology of erectile dysfunction in our population and compare it with the data derived from Western communities. After the history, physical examination, psychological evaluation and laboratory testing, a clinical diagnosis was established as primarily psychogenic, organic, or mixed aetiology. Mean patient age was 43.5 years (range 17 to 69), and 9 of the patients were unmarried. Of the patients 53 had vascular risk factors, and 10 reported a history of alcohol abuse. Eleven patients were using drugs that might interfere with the disorder. In this multicentral study of 115 impotent men, an organic cause was found in 43%, psychogenic in 47%, and mixed in 19%. Mean age of the overall patients was 43.48. When the ages of the patients with organic erectile dysfunction and those with psychogenic erectile dysfunction were compared, it was clearly seen that those with organic erectile dysfunction were much older (52.73 versus 33.02).

Diagnostic value of cytokeratin-18 as a tumor marker in bladder cancer

OBJECTIVES The aim of the study was to compare serum levels of cytokeratin-18 of patients with bladder cancer with those of the healthy controls, and to investigate the relation between cytokeratin level and the tumor stage. DESIGN AND METHODS Serum cytokeratin-18 levels of 38 patients with bladder cancer and of 25 healthy people were determined. Tumor stage was T(1) in 12 patients, T(2) in 9 patients, T(3) in 10 patients and T(4) in 7 patients. The serum cytokeratin-18 levels in these cases were analyzed with respect to the stage of the tumor. RESULTS Cytokeratin-18 level in the patient group was found to be significantly higher than that of the control group (p < 0.010) when the groups were totally compared. However, when the levels in patients with different tumor stages were compared with that of the controls, the difference was not significant in patients with stage 1 and 2 tumors (p > 0.05). Regarding the cut off value as 4.0 ng/mL, sensitivity and specificity for serum cytokeratin-18 were found to be 53% and 72% respectively. When sensitivity was calculated with respect to tumor stages, it was 8% for T(1,) 33% for T(2,) 90% for T(3) and 100% for T(4.) On the other hand, considering higher stage (T(3) and T(4)) tumors only, the sensitivity was calculated as 94%, but the sensitivity for lower stage (T(1) and T(2)) tumors was 19%. CONCLUSIONS It is clear that serum cytokeratin-18 level increases in patients with bladder cancer. However, it can only be useful as a tumor marker in the diagnosis of T(3) and higher staged tumors. This study indicated that cytokeratin-18 does not have any diagnostic value in lower stage bladder cancers.

Bazex syndrome: acrokeratosis paraneoplastica in association with simultaneous multiple genitourinary tumors.

We report a patient with Bazex (Bazex-Dupre-Christol) syndrome in association with multifocal basal cell carcinoma, epidermoid carcinoma of the lung, adenocarcinoma of the prostate, and possibly undifferentiated carcinoma of the bladder. To our knowledge, this is the first report of a patient with Bazex syndrome that consisted of four tumors, including two genitourinary tumors.

Fibroepithelial polyp of the ureter associated with an adjacent ureteral calculus

Ureteral fibroepithelial polyps are rare benign tumours. Sometimes an ureteric calculus may be seen, proximal to the polyp. We describe a case of fibroepithelial polyp (FEP) associated with a calculus in the distal part of the right ureter.To our knowledge this is the first ureteral FEP reported in the literature associated with a ureteral calculus distal to it. Aetiology, clinical features, diagnosis and therapy of fibroepithelial polyps are discussed in the light of the literature.

Experimental testicular torsion and its effects on the contralateral testicle.

ObjectiveFollowing experimental unilateral torsion of the testis the histologic effects of unilateral testicular torsion on the contralateral testis were investigated.Materials and methodsUtilizing detorsion or orchiectomy at 4 hours and 8 hours after torsion, the effects of early and late treatment modalities on the contralateral testicle were observed.ResultsMorphometry of the contralateral testis revealed some alterations including focal sclerosis, decrease in mean seminiferous tubular diameter and a marked increase of the Leydig cells in some subgroups.ConclusionIn spite of some changes, definite evidence for contralateral damage due to ipsilateral torsion contributing to male infertility was hardly observed.

Evaluation of 42 patients with chronic abacterial prostatitis: Are there any underlying correctable pathologies?

Forty-two young men with abacterial prostatitis underwent physical examination, semen analyses, rectal US (TRUS) and magnetic resonance imaging (MRI) of the pelvis.Findings on TRUS showed no distinct differences like capsular irregularity, dilatation of the seminal vesicles and calcified foci in the prostate. In MRI pathologic conditions were noted as transitional zone cysts, prostatic utricle cysts and abscesses of the seminal vesicles.MRI had been found superior to TRUS in imaging the prostate and to predict associated pathologic conditions. It is also concluded that some additional factors as a cause of prostatitis must be determined in patients with chronic abacterial prostatitis.

Primary non-mucinous, non-papillary adenocarcinoma of the ureter

We report a case of primary, non-mucinous, non-papillary ureteral poorly differentiated adenocarcinoma. The primary focus could only be detected during surgical exploration, because computed tomography (CT), ultrasonography (US), intravenous urography (IVU) and other radiologic and endoscopic procedures revealed no primary neoplastic focus, only lymph node and various bone metastases.Total nephroureterectomy with a bladder cuff was performed to decrease pain of the patient and to remove the primary tumoral focus.