Objective To identify autonomic nervous dysfunction in patients with lifelong premature ejaculation. Methods The study participants were 25 men with lifelong premature ejaculation and 25 healthy ...controls. The parameters of 24-hour heart rate variability that are influenced by the autonomic nervous system were compared between the men with lifelong premature ejaculation and the healthy controls. Results The laboratory results of all patients were within normal limits, and no significant differences were found between the patients and the controls in age, body weight, and body mass index. A low-frequency signal that is influenced by the sympathetic system was increased in the patients ( P = .026). Furthermore, a high-frequency signal that is influenced by the parasympathetic system was decreased in the patients ( P = .011). Finally, the low frequency-to-high frequency ratio, an indicator of the balance between the two components of the autonomic nervous system, was increased in the patients ( P = .002). Conclusion To our knowledge, no study has investigated the influence of the autonomic nervous system on 24-hour heart rate variability in premature ejaculation. In the present study, sympathetic activity was increased in men with lifelong premature ejaculation; this overactivity might lead to lifelong premature ejaculation. Additional studies are required to reveal the possible alteration of the autonomic nervous system in premature ejaculation.
Objective To investigate benign prostatic enlargement (BPE) and lower urinary tract symptoms (LUTS) in patients with coronary artery ectasia (CAE). The relation between CAE, BPE, and LUTS has not ...been studied so far. Methods We investigated BPE and LUTS symptoms in 47 men with CAE, 45 men with coronary artery disease (CAD), and 47 male controls with normal coronary arteries. LUTS was evaluated by the International Prostate Symptom Score (IPSS). BPE was evaluated with transabdominal ultrasonography. CAD was defined as myocardial infarction and angiographically diagnosed coronary disease. CAE was defined as being without any stenotic lesions with a visual assessment of the coronary arteries showing a luminal dilatation ≥1.5 fold of the adjacent normal coronary segments. Results Prostate volume was higher in CAE and CAD patients compared with that of the control subjects, respectively (41.0 ± 10.4 vs 33.5 ± 9.4 cm3 ; 39.1 ± 10.3 vs 33.5 ± 9.4 cm3 ; P = .0001); total IPSS was higher in CAD and CAE patients compared with that of the control subjects ( P = .0001). Postmictional residual urine volume was higher in CAE and CAD patients compared with that of the control subjects ( P = .002). Conclusion We showed that patients with CAE have higher prostate volume, IPSS, and postmictional residual urine volume compared with those of controls with normal coronary angiograms. This study proposes that BPE, LUTS, and CAE maybe different disorders to a common vascular pathology and endothelial dysfunction. This study showed that BPE and LUTS were frequently seen in CAE at least as much as in CAD. Therefore, LUTS and BPE should be kept in mind for CAE patients in follow-ups.
Abstract
Objective. There are limited data on whether there is an association between nocturia, benign prostatic hyperplasia (BPH) and endothelial dysfunction. The aim of the present study was to ...evaluate whether there is an association between nocturia and endothelial dysfunction in patients with BPH. Material and methods. Forty-two men with a diagnosis of BPH and 42 age-matched controls were enrolled. All patients were assessed for frequency and duration of nocturia, and prostate volume, completed the International Prostate Symptom Score (IPSS) questionnaire, and underwent brachial flow-mediated dilatation (FMD) evaluation. Results. There was a negative correlation between FMD and frequency of nocturia (r = -0.879, p < 0.0001). Moreover, there was a negative correlation between duration of nocturia and FMD (r = -0.890, p < 0.0001). In addition, FMD was significantly decreased in the BPH group compared with the control group (6.0 ± 0.09 to 7.8 ± 0.10%) (p = 0.0001). Conclusion. In patients with BPH, nocturia is associated with endothelial dysfunction and may be an insidious risk factor for cardiovascular disease.
Objective To investigate the total prostate-specific antigen (tPSA), free PSA (fPSA), and free/total PSA (fPSA/tPSA) ratio in patients with liver cirrhosis (LC) according to the severity of hepatic ...insufficiency. Methods Eighty-two male patients with LC were studied. The severity of liver disease was categorized by Child-Pugh score (Child-Pugh A, B, and C). Forty-two age-matched healthy subjects were used as a control group. The tPSA, fPSA, fPSA/tPSA ratio, total prostate volume (TPV), total testosterone (TT), and total protein (TP) were measured. The LC group was compared with the control group in terms of these parameters. In addition, intra-comparison and inter-comparison was made between all the Child-Pugh groups and normal subjects, in terms of these parameters. Results The tPSA and fPSA levels in LC cases, Child-Pugh A, Child-Pugh B, and Child-Pugh C groups were significantly decreased compared with the control group. The ratio of fPSA/tPSA in the LC subjects and Child-Pugh A groups significantly increased compared with the control group. TT, TP levels, and TPV in patients with LC were significantly lower compared with the control group and the results were significantly correlated with the Child-Pugh score. Conclusion The present study reveals that tPSA and fPSA were decreased in patients with LC in comparison to healthy subjects in terms of 3 mechanisms. First, it might be due to shrunken prostatic volume. Second, it also resulted in decreased levels of testosterone because of the abnormality of hypothalamic-pituitary-testicular axis. Third, it might be the diminished serum protein level in the composition of the PSA.
Purpose
To investigate renal function in idiopathic hypogonadotropic hypogonadic (IHH) patients by measuring glomerular filtration rate (GFR) using modification of diet in renal disease formula, and ...determine whether there is any relationship between GFR and testosterone levels.
Methods
Thirty-three patients with IHH and 37 healthy control subjects participated in this study.
Results
The IHH group showed statistically significant higher GFR and proteinuria with respect to the control group (163.1 ± 46.9 to 117.9 ± 30.5 mL/min,
p
< 0.001; 0.2 ± 0.1 to 0.08 ± 0.02 mg/dL,
p
= 0.041, respectively). Uric acid and creatinine levels were statistically lower than in the control group (4.6 ± 0.5–3.6 ± 0.9 mg/dL,
p
= 0.02; 0.7 ± 0.2 to 0.9 ± 0.2 mg/dL,
p
< 0.001, respectively). Hyperfiltration positively correlated with IHH in multivariate linear regression analyses (
β
= 0.591,
p
< 0.001). In addition, in the IHH group, we found that the GFR increased independently of body mass index and age.
Conclusion
Our study confirms that low testosterone in IHH patients is associated with glomerular hyperfiltration. Patients with IHH should be carefully monitored with respect to their GFR.
Mean platelet volume (MPV) has been reported to be related to inflammation. Prostate-specific antigen (PSA) is a protein produced by the prostate, and this protein may be elevated for several ...reasons, including prostatitis, benign prostatic hyperplasia, and/or cancer. The aim of the current study was to investigate the predictive effect of MPV values on nonsymptomatic prostatitis diagnosis and the relation between MPV and PSA. A total of 275 patients, 89 affected by benign prostate hyperplasia, 94 by prostate adenocancer, and 92 by prostatitis were included in the current study. PSA, total blood count parameters, and urine analysis were investigated. Findings were compared with the groups. The correlation between MPV and the other parameters were analyzed. Univariate and multivariate logistic regression analysis was performed to determine independent predictors of nonsymptomatic prostatitis diagnosis. MPV was significantly higher in patients with nonsymptomatic prostatitis than the other groups. There were negative correlations between MPV and age, total PSA or free PSA (r = −.123; p = .042, r = −.235; p < .001, r = −.184; p = .006, respectively). According to multivariate regression model, only MPV was identified as the predictive factor for nonsymptomatic prostatitis (odds ratio: 1.451, 95% confidence interval 1.116, 1.887, p = .005). MPV, in the absence of other reasons that increased the MPV level, was significantly increased in cases with nonsymptomatic prostatitis; this increase is significantly higher than elevated PSA level in nonsymptomatic prostatitis patients. MPV could have a predictive value for the diagnosis of nonsymptomatic prostatitis.
Abstract
Percutaneous nephrolithotomy (PNL) is an effective procedure for the treatment of patients with large or complex stones. PNL is challenging in anomalous kidneys, certain patients, such as ...those with renal ectopia. It is unable to undergo PNL in conventional technique safely in these cases. We presented a case report of laparoscopic-assisted PNL via direct pelvic puncture in a pelvic kidney stone and discussed previous published literature. A 49-year-old man presented with right lower quadrant pain and hematuria. Intravenous pyelography and three-dimensional computerized tomography revealed an opaque 2.7 × 1.7 cm pelvis renalis stone in a right side ectopic pelvic kidney with grade III hydronephrosis. Laparoscopic-assisted tubeless PNL was performed to remove the calculus. Laparoscopic-assisted PNL as a minimally invasive therapy in ectopic kidney has many advantages. Our case showed that, in pelvic ectopic kidney with pelvic stones greater than 1.5 cm in size, laparoscopic-assisted PNL via direct pelvis puncture is a safe and effective technique.
We compared the effectiveness and complications of 980-nm diode laser vaporization and transurethral resection of the prostate (TURP) in patients with benign prostatic hyperplasia (BPH).
In total, 72 ...consecutive patients with BPH entered the study. All patients underwent general and urological evaluations. The primary outcome was improvement in the International Prostate Symptom Score (IPSS). The secondary outcomes were IPSS quality of life (QoL), maximum urinary flow rate (Qmax), residual volume, and complications. Patients were allocated randomly to the TURP and laser groups. The Ceralas HPD120, a diode laser system emitting at a wavelength of 980 nm, was used for photoselective vaporization of the prostate (PVP). TURP was performed with a monopolar 26 French resectoscope. Preoperative and operative parameters and surgical outcomes were compared.
In total, 36 patients in each group underwent PVP and TURP. The mean age ± standard deviation was 63.1 ± 9.1 years and 64.7 ± 10.2 years in the PVP and TURP groups, respectively. There were no statistically significant differences in age, prostate size, prostate-specific antigen concentration, Qmax, preoperative IPSS, or preoperative Qmax between the two groups. The operation duration was also similar between the groups (P = .36). The catheterization time was 1.45 ± 0.75 and 2.63 ± 0.49 days in the PVP and TURP groups, respectively (P < .01). The PVP group had a shorter hospital stay than the TURP group. The 3-month postoperative Qmax increased to 9.90 ± 3.61 and 6.59 ± 6.06 mL/s from baseline in the TURP and PVP groups, respectively; there was no difference in the increases between the groups (P = .08). The IPSS and IPSS-QoL were significantly improved with the operation (P < .01), and this improvement was similar in both groups P = .3 and P = .8, respectively . The complication rate was also similar between the two groups.
PVP with a diode laser is as safe and effective as TURP in the treatment of BPH, and the techniques have similar complication rates and functional results. PVP has the advantage of shorter hospitalization and catheter indwelling times and no need for discontinuation of anticoagulant therapy.
The etiology of overactive bladder (OAB) remains unclear. Observed neurogenic factors in the literature are limited to suprapontine or spinal pathologies. The blink reflex is a useful tool in the ...evaluation of brainstem functions. Blink reflex latency times were evaluated in order to reveal pathology in the brainstem.
A total of 60 women, 30 patients with idiopathic OAB and 30 healthy controls, were enrolled in the study. Blink reflex latency times were analyzed by electrical stimulation of the supraorbital nerve. Two responses in the orbicularis oculi muscle, early ipsilateral response (R1) and late bilateral response (R2) latency times, were recorded.
Mean ages of the patients and controls were 51.9 ± 5.3 and 49.2 ± 6.2 years, respectively. R2 latency times were significantly higher in patients than in controls. However, R1 latency times were similar between the two groups.
The results of the study suggest a significant relation between late blink latency times and OAB. An oligosynaptic path via the trigeminal nuclei is responsible for R1; however, R2 response is relayed through the reticular formation. Stimulation of pontine reticular formation inhibits micturition contraction. In some patients, idiopathic OAB may result from reticular formation-originated pathology. Additional studies on other reticular formation-mediated reflexes are needed to reveal possible dysfunction of reticular formation.
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