Revista Internacional De Andrologia最新文献

Introduction

Although many patients are being treated by radical prostatectomy (RP), there is still insufficient information about the changes in long-term erectile function after RP. Our aim is to examine long term, up to 5 year erectile function status of patients after Radical Perineal Prostatectomy (RPP).

Materials and methods

One hundred and thirty-two patients, who underwent bilateral nerve-sparing Radical Perineal Prostatectomy (RPP) in between January 2012 and January 2017, with preoperative age ≤ 70, prostate volume < 80 g, transrectal ultrasound (TRUS) guided biopsy Gleason score (GS) < 7, prostate specific antigen (PSA) value < 10 ng/mL, and cT stage ≤ 2 (N0, M0) were included into this study. Exclusion criteria were previous cardiovascular diseases, serious chronic renal and/or hepatic insufficiency, neurological diseases, uncontrolled diabetes mellitus, and severe lung diseases. Patients who received additional treatment (hormonal and/or radiotherapy) after RPP were also excluded from the study group. Erectile function was evaluated before surgery and at postoperative 3rd, 12th, and 60th months. Patients with an “International Index of Erectile Function (IIEF) – 5” score of ≥21 and patients whose IIEF-5 scores were between 16 and 20 but responded as “yes” to the “Sexual Encounter Profile (SEP) – 2” and “SEP-3” questions were accepted as having normal erectile function.

Results

Out of the 132 patients, 96 (72.7%) of the patients were found to be potent in the first postoperative year. A total of 118 patients were evaluated at the end of 5 years. Eighty seven (73.7%) patients had normal erectile function according to our criteria.

Discussion

According to the results of our study, short term and long term erectile function outcomes of patients undergoing RPP were favorable and there was no statistically significant difference between short and long term results.

Introduction and objectives

To investigate the role of suprapubic bladder aspiration (SBA) in the diagnosis of retrograde ejaculation (RE) which is diagnosed with the observation of sperm in post-ejaculatory urine (PEU). However, sperm is also observed in PEU after the wash out of the retained ejaculate in the urethra with the expulsion of urine in several subjects. Therefore, detection of sperm in PEU in the diagnosis of RE is problematic and a better method is needed to overcome the ambiguity of positive PEU and to identify which patient experience true RE.

Material and methods

A cohort of patients underwent an examination for RE over a two-year period at a single specialist centre. All patients underwent SBA and semen analysis. Sperm was investigated in urine aspirated from the bladder and in PEU.

Results

Thirty-two patients (age range 18–62 years) underwent SBA and PEU for investigation of RE. Sperm was detected both in SBA and PEU in 19 patients, while 5 patients revealed sperm only in PEU. The mean number of sperm found in SBA was less than the mean number of sperm observed in PEU in all 19 patients.

Conclusion

SBA is a reliable and feasible method in the diagnosis of RE and can distinguish the true RE in which sperm flows backward into the bladder from the retained ejaculate in the urethra. The whole ejaculate does not likely flow retrogradely and RE could be a partial leakage of the ejaculate into the bladder.

In 2002, Steve Wilson pioneered new procedures for alternative placement of reservoirs for inflatable prostheses in patients who have suffered damage to the space of Retzius following pelvic surgery or obliteration of the transversalis fascia by mesh hernia repair. Since then, surgical techniques and tools for ectopic reservoir placement have gradually gained acceptance to minimize palpability, and the risk of visceral and vascular lesions for high risk patients has been all but eliminated. Lockout valves and high submuscular placement techniques are now recommended, and reports of vascular, bowel or bladder injuries are uncommonly rare. While surgeons continue their search for safer and more effective placement methods, new skills and instruments are constantly being introduced to make recommendations to minimize complications and provide safety and functionality. Additional studies and comparisons of techniques are needed to achieve a consensus of best practice for reservoir placement solutions.

Introduction

Menopause refers to the permanent cessation of menstruation resulting from the loss of ovarian activity. Studies have shown that menopause has an impact on the life quality of women as well as their sexual function. In this study, we sought to characterise the differences in the sexual function of women with iatrogenic menopause and those with natural menopause.

Methods

Data were collected from 300 women in this study. The Symptom Check List and the Female Sexual Function Index were the main data collection instruments. Forty-eight patients with a Symptom Check List score ≥0.5 were not included in the study. Therefore, we enrolled a cohort of 252 menopausal women at a tertiary care setting in Turkey. The independent sample t-test, one-way analysis of variance, Pearson correlation and logistic regression analysis were used in this study and p value of <0.05 was considered statistically significant.

Results

In our study, menopause women were divided into two equal groups based on the type of menopause (natural vs. iatrogenic). The iatrogenic group was further divided into 3 sub-groups; drug-induced 30 (12%), radiotherapy-induced 18 (7%) and surgical 78 (31%). No significant difference in sexual function between groups were observed with respect to mean scores for desire, arousal, lubrication, orgasm, satisfaction, pain and sexual function (p > 0.05).

Conclusions

Our results suggest that sexuality-specific problems during menopause are multifactorial and not solely attributable to biological or psychological factors. Our findings call for comprehensive interventions to address the psychological and biological effects of menopause in order to improve the life quality of women.

Purpose

The purpose of our study is to analyze the imaging findings described in MRI and the histopathologic type of testicular lesions to determine which findings are the best predictors of malignancy.

Materials and methods

Forty six (46) patients with testicular lesions were initially studied with ultrasound (US) and with testicular MRI (tMRI) on a 1.5-T magnet. MRIs were reviewed by a radiologist with 8 years of experience and imaging findings such as the size of the lesion, the signal intensity in T1, T2 weighted sequences, and the enhancement after endovenous contrast administration, were correlated with the histopathologic diagnosis. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were analyzed.

Results

The enhancement after administration of contrast was the finding of better performance with a sensitivity, specificity, PPV and NPV of 90 (71-97), 47 (24-71), 74 (56-87) and 73 (40-92), respectively. Meanwhile, the results for hypointense/heterogeneous lesions in T2 weighted sequences and with enhancement with intravenous contrast were 87 (49-84), 47 (44-89), 74 (55-86) y 67 (35-89), respectively.

Conclusion

The finding of a testicular lesion of low signal intensity and heterogeneous in T2 weighted sequences, with IV contrast enhancement represents a valuable predictor of malignancy. The latter being the most sensitive as a predictor of malignancy.

Objective

To determine the factors that cause erectile dysfunction and penile curvature after repair of penile fracture (PF).

Methods

Data from 25 patients who underwent PF repair was retrospectively analyzed. PF was diagnosed by examining patients’ medical histories and performing physical examinations. All patients underwent immediate PF repair. All patients filled out the International Index of Erectile Function (IIEF-5) form and penile curvature was examined.

Results

The median age of patients at the time of surgery and the median follow-up duration were 46 years (22–60 years) and 95 months (12–156 months), respectively. Two of the patients had concomitant urethral injury. At the final follow up, erectile dysfunction (ED) was present in 13 patients (52%). Among these patients, 9 patients (36%) had mild ED and 4 patients (16%) had moderate ED. With a univariate analysis, age and penile curvature were significantly associated with ED (p = 0.008 and p = 0.039, respectively). With a multivariate analysis, age was independently associated with ED (p = 0.048, odds ratio = 1.104, 95% confidence interval 1.000–1.218). The IIEF-5 scores correlated with age (p = 0.009, r = 0.510). Seven patients (28%) had penile curvature and one patient underwent penile plication surgery.

Conclusion

After PF repair, age is the only risk factor for ED and penile curvature rarely requires surgical treatment.

Purpose

To investigate the effects of combined tadalafil and testosterone usage on oxidative stress, DNA damage and MMPs in testosterone deficiency.

Methods

Fifty rats were randomly divided into 5 groups (group-1: sham group-placebo, group-2: bilateral orchiectomy (ORX), group-3: bilateral ORX + tadalafil, group-4: bilateral ORX + testosterone, group-5: bilateral ORX + tadalafil + testosterone). Group-3 received tadalafil (5 mg/kg/day, oral). Group-4 was administered testosterone undecanoate (100 mg/kg i.m., single dose). Group-5 was administered a combination of tadalafil and testosterone undecanoate. All groups were compared with regard to serum nicotinamide adenine dinucleotide phosphate oxidase-4 (NOX-4), total thiol, matrix metalloproteinase-2 (MMP-2), MMP-3 and MMP-9, tissue inhibitor of metalloproteinases-1 (TIMP-1) and TIMP-2 and 8-hydroxy-2-deoxy guanosine (8-OHdG) levels.

Results

Total thiol levels of group-2 were significantly lower than the other groups and thiol levels were higher in group-1 and group-5 than in the other groups. NOX4, MMP2 and 9 levels in group-2 were higher than in the other groups. MMP-9 levels in group-5 were lower than in groups 3 and 4 (p = .001). The level of 8-OHdG in groups 2 and 3 was higher than in the other groups (p = .001). In correlation analysis, 8-OHdG, MMP2, and 9 levels were negatively correlated with total thiol, whereas NOX4 and 8-OHdG levels were positively correlated with MMPs values.

Conclusions

The combination of testosterone with PDE-5 inhibitor suppresses MMP-9 levels and increases total thiol levels better than testosterone alone and tadalafil alone. Therefore, testosterone can be considered for use with PDE-5 inhibitor from the initial stage in case of testosterone deficiency.