Protective effect of trapidil on long-term histologic damage in a rat model of testicular ischemia-reperfusion injury

Objectives  Trapidil is an antianginal compound with a broad spectrum of pharmacological activities. In recent years, it has been used successfully to decrease ischemia-reperfusion injury in several organ systems. We evaluated the effect of trapidil on the long-term histologic damage in testicular ischemia-reperfusion injury. Methods  Adult male Wistar rats were divided into three groups of six rats each. One group underwent 2 h of testicular torsion; one received pretreatment with trapidil before detorsion; and one group underwent sham operation. All rats underwent bilateral orchiectomy 60 days after the experiment. The mean seminiferous tubular diameter, germinal epithelial cell thickness, and mean testicular biopsy score were determined by histological examination of each testis. Results  Testicular torsion–detorsion caused a significant decrease in the mean seminiferous tubular diameter, germinal epithelial cell thickness, and mean testicular biopsy score in the ipsilateral testes, but not in the contralateral testes. The animals treated with trapidil had a significant increase in these histological parameters as compared to the torsion–detorsion group. Conclusion  Trapidil administration before reperfusion may have the potential to decrease the long-term histologic damage that occurs after experimental testicular torsion. Trapidil is used as an antianginal drug and additional clinical studies are required to elucidate the protective role of trapidil in patients with testicular torsion.     

Does response to treatment of ejaculatory duct obstruction in infertile men vary with pathology?

OBJECTIVE: To describe the pathology-specific response to transurethral resection of ejaculatory ducts (TURED) in patients with complete or partial ejaculatory duct obstruction and to evaluate the role of TURED in light of powerful assisted reproductive technologies. DESIGN: Retrospective clinical study. SETTING: University hospital. PATIENT(S): Thirty-eight infertile men with obstruction of the ejaculatory ducts. INTERVENTION(S): Diagnosis by transrectal ultrasonography or magnetic resonance imaging, and treatment with TURED. MAIN OUTCOME MEASURE(S): Changes in semen variables, pregnancy outcomes, and complication rates were analyzed before and after surgery. RESULT(S): Improvement in semen variables was significantly better in patients with partial obstruction (94%) of ducts than in those with complete obstruction (59%) (P=.04). Cystic obstruction, especially midline and eccentric cysts, responded best to TURED. Before surgery, all patients were candidates for IVF/ICSI; after surgery, 32% of azoospermic men and 81% of oligospermic men conceived spontaneously or were referred for IUI instead of IVF/ICSI. CONCLUSION(S): Ejaculatory duct obstruction due to cysts appears to respond best to TURED. In addition, TURED may decrease the need for IVF/ICSI as primary treatment in many cases. Finally, TURED may allow IVF/ICSI to be performed with ejaculated rather than surgically retrieved sperm.     

Effect of diabetes mellitus on female sexual function and risk factors

The study was conducted to investigate the effect of diabetes mellitus upon female sexual function, and to detect possible risk factors that might predict sexual dysfunction. The study consisted of 127 married women: 21 women with type 1 diabetes, 50 women with type 2 diabetes and 56 healthy women as a control. Female sexual functions were evaluated with a questionnaire to assess sexual desire, arousal, lubrication, orgasm, satisfaction and pain. The prevalence of sexual dysfunction was 71% in the type 1 diabetic group, 42% in the type 2 diabetic group and 37% in the control subjects. The scores for sexual desire, arousal and lubrication were significantly lower in the type 1 diabetes group than in the control subjects (p < 0.05). The scores of orgasm, satisfaction, dyspareunia and total sexual function were slightly lower in the type 1 diabetic group than in the other groups. No factor predicted sexual dysfunction in the diabetic women while further age, poor education, absence of occupation and menopause predicted sexual dysfunction in the control subjects. The prevalence of sexual dysfunction was significantly higher in the type 1 diabetic women than in the type 2 diabetics and control subjects. However, no risk factors that might cause sexual dysfunction could be predicted in diabetic women.     

The prevalence of female sexual dysfunction and potential risk factors that may impair sexual function in Turkish women

OBJECTIVES: To detect the prevalence of sexual dysfunction, and also to investigate possible risk factors that may cause sexual dysfunction in the Turkish women. MATERIALS AND METHODS: The study consisted of 179 women between the ages of 18 and 66 years living in households from different sociocultural areas. The women were divided into 5 groups according to their ages: 18-27 years (n = 23), 28-37 years (n = 55), 38-47 years (n = 43), 48-57 years (n = 44) and 58-67 years (n = 14). Female sexual function was evaluated with a detailed 19-item questionnaire to assess desire, arousal, lubrication, orgasm, satisfaction and pain. The prevalence of sexual dysfunction was calculated for each domain and compared among the groups. In addition, demographic characteristics and medical risk factors were assessed in all women, and the findings were compared between the women with and without sexual dysfunction. RESULTS: Based on total sexual function score, 84 (46.9%) out of 179 women had sexual dysfunction. The prevalence of female sexual dysfunction was 21.7% in the ages of 18-27 years, 25.5% in the ages of 28-37 years, 53.5% in the ages of 38-47 years, 65.9% in the ages of 48-57 years and 92.9% in the ages of 58-67 years. The prevalence of sexual dysfunction for each domain also increased with age. To investigate various factors that may cause female sexual dysfunction, no significant differences were detected in smoking history (p = 0.14), marriage age (p = 0.7), the presence of previous pelvic surgery (p = 0.09), and contraception methods used (p = 0.31). However, sexual dysfunction was observed as significantly higher in the presence of older age (p = 0.001), lower educational level (p = 0.012), unemployment status (p = 0.017), chronic disease (p = 0.032), multiparity (p = 0.0027) and menopause status (p = 0.0001). CONCLUSIONS: The prevalence of female sexual dysfunction including desire, arousal, lubrication, orgasm, satisfaction and pain problems increases with age. In addition, the presence of a lower educational level, unemployment status, chronic diseases, multiparity and menopause status are important risk factors that may cause sexual dysfunction.     

Periprostatic lidocaine infiltration and/or synthetic opioid (meperidine or tramadol) administration have no analgesic benefit during prostate biopsy. A prospective randomized double-blind placebo-controlled study comparing different methods

OBJECTIVES: To examine in a prospective, randomized, double-blind, placebo-controlled study the analgesic effect of periprostatic nerve block and/or intravenous synthetic opioid administration during a 12-core prostate biopsy. PATIENTS AND METHODS: Patients were prospectively randomized to receive unilateral periprostatic lidocaine administration and/or intravenous synthetic opioid (meperidine or tramadol) administration. Placebo groups received sterile normal saline. Unilateral infiltration was performed and biopsy was begun on this side. The degree of pain was recorded using the visual analog scale/numeric analog scale (VAS/NAS) score before the procedure, during probe introduction into the rectum, during unilateral periprostatic nerve blockade, during the first 6-core biopsy and during the second 6-core biopsy, and 30 min after biopsy completion. RESULTS: Most of the patients had mild or moderate pain (VAS/NAS <6) during the actual biopsy procedure. However, no significant differences existed between the groups with regard to the pain scores at any time (p > 0.05). Compared with pain scores, no significant differences existed between the first 6-core (blocked side) and second 6-core biopsies (p > 0.05). CONCLUSION: Periprostatic lidocaine infiltration and/or intravenous synthetic opioid analgesics are not beneficial in significantly reducing pain during biopsy. We think that most of the patients do have pain during biopsy, however the intensity of pain is tolerable and does not require analgesics.     

The assessment of sexual functions in women with male partners complaining of erectile dysfunction: does treatment of male sexual dysfunction improve female partner's sexual functions?

The aims of this prospective study were to compare sexual functioning between women with male partners who have erectile dysfunction (ED) and women without partners with ED and also to investigate the effect of the treatment of male ED on female partner's sexual function. The study included 87 women and their male partners. We divided the women into two groups: 38 women with male partners complaining of ED (ED group) and 49 women with male partners who have no ED (control group). Of the men with ED, 30 were treated with penile prosthesis implantation (n = 17) or oral sildenafil citrate (n = 13). We evaluated all the men with the International Index of Erectile Function (IIEF; Rosen, Cappelleri, Smith, Lipsky, & Pena, 1999), physical examination, and color penile Doppler ultrasound. We evaluated female sexual function with the Female Sexual Function Index (FSFI; Rosen et al., 2000) to assess sexual desire, arousal, lubrication, orgasm, satisfaction, and pain. We compared female sexual function scores between the women of the male partners with and without ED and also compared before both groups and after the treatment of male partners in the ED group. Additionally, we compare the scores according to the type of treatment given to the male partners. Sexual arousal (p = 0.009), lubrication (p = 0.001), orgasm (p = 0.006), satisfaction (p = 0.000), pain (p = 0.039), and total score (p = 0.003) were highly significantly lower in the ED group than in the control group, although sexual desire did not differ between the two groups (p = 0.515). We investigated the effect of male ED on female sexual functions and found no statistically significant differences in the presence of organic type impotence, older age, and lower erection scores on the IIEF (p = 0.53, p = 0.15, and p = 0.1, respectively). After the treatment of male ED, we observed significant improvement in sexual arousal (p = 0.001), lubrication (p = 0.002), orgasm (p = 0.000), satisfaction (p = 0.000), and pain (p = 0.002) in the women. These findings suggest that female sexual function is affected by male erection status and may improve after the treatment of male sexual dysfunction.     

Botulinum toxin type A may improve bladder function in a rat chemical cystitis model

The purpose of this study was to investigate the effect of botulinum toxin type A on bladder function and histology in a rat chemical cystitis model. The study included 41 female Sprague-Dawley rats with chemical cystitis induced by intravesical instillation of hydrochloric acid. The acid instillation was repeated monthly to maintain chronic inflammation. The treatment group (n=21) received 2-3 units of botulinum toxin type A injected into the bladder detrusor at the 3, 6, 9 and 12 o'clock positions, and the control group (n=20) underwent saline injection into the bladder detrusor at the same positions. Urodynamic studies were performed in all rats before the treatment and at death. The rats were killed at 1 week, 2 weeks, 1 month and 2 months after treatment. The bladders were removed and examined histologically for mast cells and inflammatory changes. The cystometric findings showed that, at the beginning and end of the experiment, the increases in the maximum bladder capacity and compliance were significantly higher in the treatment group than in the control group (P=0.000 and P=0.025, respectively). The histological studies revealed similar mast cell counts and leukocyte infiltration for the treatment and control groups. In conclusion, in this rat chemical cystitis model, botulinum toxin type A injected into the bladder detrusor led to a functional improvement. Thus, botulinum toxin type A injection may be an alternative, minimally invasive choice to other surgical treatment options in the treatment of a chronic inflammatory condition to improve deteriorated bladder function.     

Seasonality and temporal clustering of Kawasaki syndrome

BACKGROUND: The distribution of a syndrome in space and time may suggest clues to its etiology. The cause of Kawasaki syndrome, a systemic vasculitis of infants and children, is unknown, but an infectious etiology is suspected. METHODS: Seasonality and clustering of Kawasaki syndrome cases were studied in Japanese children with Kawasaki syndrome reported in nationwide surveys in Japan. Excluding the years that contained the 3 major nationwide epidemics, 84,829 cases during a 14-year period (1987-2000) were analyzed. To assess seasonality, we calculated mean monthly incidence during the study period for eastern and western Japan and for each of the 47 prefectures. To assess clustering, we compared the number of cases per day (daily incidence) with a simulated distribution (Monte Carlo analysis). RESULTS: Marked spatial and temporal patterns were noted in both the seasonality and deviations from the average number of Kawasaki syndrome cases in Japan. Seasonality was bimodal with peaks in January and June/July and a nadir in October. This pattern was consistent throughout Japan and during the entire 14-year period. Some years produced very high or low numbers of cases, but the overall variability was consistent throughout the entire country. Temporal clustering of Kawasaki syndrome cases was detected with nationwide outbreaks. CONCLUSIONS: Kawasaki syndrome has a pronounced seasonality in Japan that is consistent throughout the length of the Japanese archipelago. Temporal clustering of cases combined with marked seasonality suggests an environmental trigger for this clinical syndrome.