Premature Ejaculation: Bother and Intravaginal Ejaculatory Latency Time in Iran

IntroductionComplaints of premature ejaculation (PE) and its repercussions are culture‐dependent.AimTo report the measured intravaginal ejaculatory latency time (IELT) and the impact of PE in Kermanshah, Iran.MethodsFrom November 1996 through October 2008, 3,458 patients presented to us with self‐diagnosed PE. In the first visit, after obtaining a psychosocial and sexual history, PE‐specific bother was self‐rated by the patients and the patients were advised to measure their IELTs over the next 2–3 weeks. In the second visit, the measured IELTs were reported by the patients.Main Outcome MeasuresPatients' measured IELT and bother score.ResultsAge range was 17–80 years (mean 34.1, standard deviation [SD] 9.1, median 32). Sixty‐five percent were married. Primary and secondary PE was reported by 2,105 (60.8%) and 1,353 (39.1%) patients, respectively. Occasional PE was reported by 36 (0.01%). Of those with multiple partners, 6% had partner‐specific PE. IELT distribution was positively skewed. Anteportal ejaculation was reported by 97 (2.8%). In 3,458 self‐reported PE patients, IELT was 1–15 seconds in 542 (15.7%), 16–30 seconds in 442 (12.8%), 31–60 seconds in 978 (28.3%), > 1 ≤ 2 minutes in 551 (15.9%), > 2 ≤ 5 minutes in 712 (20.6%), and >5 minutes in 136 (3.9%). IELTs of ≤1 minutes and ≤2 minutes were reported by 59.5% and 75.5%, respectively. Median bother score was 3 of 4. Pearson's correlation between IELT and bother (r = ?0.607) was highly negative, with shorter IELTs being correlated with more bother. Six hundred forty‐three patients (18.6%) always consumed opium to lengthen their IELTs. All 21 patients who started to use Tramadol as a PE treatment became addicted to it. Of 168 divorced couples due to PE, 23 divorced because the sexually dissatisfied wives became involved in extramarital affairs. Applying the Diagnostic and Statistical Manual of Mental Disorders criteria for PE and a cutoff IELT point of ≤2 minutes, and thus excluding the patients with IELTs of longer than 2 minutes, the patients with occasional PE, and the patients who reported no personal bother, of 3,458 self‐reported PE patients, 2,571 (74.3%) had PE. Including the 97 patients with anteportal ejaculation, arithmetic mean IELT in 2,571 patients was 45.87 seconds, SD 36.1, median 40, and range 0–120. Excluding the anteportal ejaculation, arithmetic mean IELT in the remaining 2,474 patients was 47.67 seconds, SD 35.71, median 42, range 1–120, and geometric mean 31.06.ConclusionPE has a devastating impact. In clinical practice, primary lifelong PE is by far the most common variety of PE. Occasional PE is a very rare cause of presentation. A significant proportion of the patients who consider themselves as premature ejaculators have IELTs of more than 2 minutes; the sexual medicine community should reach a consensus on the clinical diagnostic and therapeutic approach to these patients who consider themselves as premature ejaculators. The most important cause of bother in PE is the briefness of the ejaculatory latency, rather than the lack of control. Second‐round ED (pseudoED) was reported for the first time. The worst type of PE, i.e., anteportal ejaculation, is not very rare; thus, geometric mean that excludes anteportal ejaculation is not suitable statistics to report the ejaculatory latency time; instead, median is the best measure of IELT reporting. Cutoffs of 0.5–2.5 percentiles are not suitable means to diagnose PE. Zargooshi J. Premature ejaculation: Bother and intravaginal ejaculatory latency time in Iran.     

Open stone surgery in children: is it justified in the era of minimally invasive therapies?

OBJECTIVE: To review experience with open surgery for paediatric urolithiasis during a 10-year period. PATIENTS AND METHODS: The hospital records of patients up to 13 years old and treated between 1990 and 2000 for stones were reviewed; there were 310 patients (98 girls and 212 boys, aged 9 months to 13 years, mean 6.8 years). RESULTS: The commonest symptoms were renal-ureteric colic (26.7%), gross haematuria (19%), urinary retention (16.7%), and abdominal and/or flank pain (13.2%). Because of poverty and the resultant inability to pay medical fees, 19 children presented very late with pyonephrosis (resembling peritonitis in nine) and obstructive renal atrophy in 23. In 18 other patients the delay was caused by the disappearance of pain. Delayed presentation was the most important factor in developing complications from the stone. The stones were in the calyces in 15 patients, the pelvis in 113, the ureter in 56, the bladder in 71, the urethra in 17 and in a combination of sites in 38. The mean (range, median) stone size was 27 (9-75, 22) mm; 80 (25.8%) were complete staghorn stones. Indications for open surgery were a complex stone burden (62%), ESWL failure (14.5%), need for nephrectomy (1.9%), anatomical abnormalities (2.2%), and unavailability of minimally invasive alternatives (19%). All of the nephrectomized patients underwent unilateral stone removal and contralateral nephrectomy. For parents, the cost and reliability of the result were more important than other considerations, e.g. having a large or small incision. The overall stone-free rate at discharge was 95.4% (100% for single stones). In five cases (1.6%) a repeat open procedure was needed. The mean (range, median) hospital stay was 4 (1-13, 3) days. CONCLUSIONS: Arguments against open surgery for urolithiasis in adults should not be extrapolated to children, in whom open surgery is safe and effective. In Iran and many 'developing' countries, open surgery is less expensive, more effective, more dependable, and more easily available than minimally invasive alternatives. At least in such countries it deserves to be among the first-line therapies for paediatric urolithiasis, and urologists in less-developed countries should not decline to offer open surgery because it is almost obsolete in developed countries. Delayed presentation (through poverty and/or unawareness) contributes significantly to the morbidity of urolithiasis.     

Trauma as the cause of Peyronie's disease: penile fracture as a model of trauma

PURPOSE: This study was performed to determine whether patients with penile fracture or a long history of forcefully bending the erect penis (taqaandan), as models of acute and chronic penile trauma, had an increased rate of Peyronie's disease (PD). MATERIALS AND METHODS: The study included 193 surgical cases of penile fracture (average followup 85 months), 150 cases of long history of taqaandan, and 50 cases of PD. All 3 groups of patients were interviewed and physically examined. RESULTS: Signs of PD were found in only 1 case of long-term taqaandan and in no case of penile fracture. None of the 50 cases of PD had a history of penile fracture. CONCLUSIONS: Severe, acute trauma of penile fracture and moderate, chronic buckling injury of taqaandan are not associated with later development of PD. These findings question whether the hypothesis that trauma, trauma-induced smoldering inflammatory cascade and aberrant wound healing are the main causes of PD. Alternative, plausible, evidence based explanations should be sought for the etiology of PD. Any theory on the etiology of PD should provide an explanation for total lack of occurrence of PD following the trauma of penile fracture.     

Penile fracture in Kermanshah, Iran: report of 172 cases

PURPOSE: Experience with 172 cases of penile fracture, in Kermanshah, Iran is reviewed. MATERIALS AND METHODS: Records of penile fracture cases were reviewed from April 1990 to October 1999. RESULTS: Diagnosis was made clinically and there was no need to perform cavernosography in any case. The most common mechanism of fracture was referred to by patients as "taghaandan" (to click or snap when forcibly pushing the erect penis down to achieve detumescence). All but 2 cases were treated surgically and 2 cases had concomitant urethral injury diagnosed by selective urethrography. Repair consisted of a circumferential degloving incision to evaluate the corpora. Because of unavailability of synthetic absorbables, inverted knot nylon sutures were used successfully for repair. Delay in operation did not increase difficulty in dissection or early postoperative morbidity. Preoperative and postoperative use of antibiotics was effective in eliminating risk of infection. There were no significant intraoperative or immediate postoperative complications and most patients were discharged home on postoperative day 1. CONCLUSIONS: Patient misinformation about penile tissue properties is the main explanation for the high incidence of penile fracture. Cavernosography, and urethrography and intraoperative urethral catheterization are not routinely needed, as diagnosis can be made clinically. Preoperative and postoperative use of antibiotics, and a uniform surgical plan regardless of delay in presentation are recommended.     

Iranian kidney donors: motivations and relations with recipients

PURPOSE: The motivations of Iranian kidney donors and donor-recipient relationships are clarified. MATERIALS AND METHODS: A 13-page 69-item questionnaire was completed by 100 donors and interviews were videotaped. RESULTS: Of the donors 90% did not knew the recipients preoperatively and only 13% had any information on recipient fate postoperatively. In 87% of cases there was no postoperative relationship. Because of recipient failure to appreciate the donors and refusal to realize preoperative promises 51% of donors hated the recipients and 82% were unsatisfied with their behavior. Motivations for donating were purely financial in 43% of cases and mainly financial with a minor altruistic component in another 40%. Of the donors 76% agreed that kidney sale should be banned and if there was another chance they would prefer to beg (39%) or obtain a loan from usurers (60%) instead of vending a kidney. All 6 related donors were paid. The goals of vending were achieved not at all by 75% of donors. CONCLUSIONS: None of the donors studied fulfilled the criteria of compensated donation or donation with an incentive and 97% were vendors. All evidence shows that the donor-recipient relationship in Iran is pathological with no similarity to the emotionally related category of transplantation. Reports by the reformist Iranian press, which have all been banned, show that our sample is a good representative of other Iranian donors. Almost none of the criteria of an acceptable living unrelated renal donor transplant program is met in Iran. The opinion of kidney donors should be regarded as the final arbiter when labeling the act as a sale or donation and it should be considered in discussions of living unrelated donor transplantation.     

Quality of life of Iranian kidney "donors"

PURPOSE: The quality of life of Iranian kidney vendors was clarified. MATERIALS AND METHODS: A questionnaire was completed by 300 kidney vendors 6 to 132 months postoperatively (median 61). Interviews and living conditions were videotaped. In addition, the 300 vendors and 100 controls that underwent nephrectomy for benign disease completed the RAND 36-Item Health Survey (SF-36). RESULTS: Poverty prevented 79% of vendors from attending followup visits, and vending caused negative effects on employment in 65%. Of the families 68% strongly disagreed with vending, which caused rejection of 43% and increased marital conflicts in 73% of vendors, including 21% who divorced. There were 70% of vendors isolated from society, and 71% had severe de novo postoperative depression and 60% anxiety. Vending caused somewhat (20%) to very (66%) negative financial effects. It also had negative effects on the physical abilities in 60% of vendors who were mainly unskilled laborers, and 80% were dissatisfied with postoperative physical stamina, which was decreased mostly by depression. Of the vendors 37% concealed the truth of kidney sale from anyone, 14% disclosed it only to spouses, 43% to first generation relatives and 94% were unwilling to be known as donors. The mental preoccupation with kidney loss was usually (30%) to always (57%) present and interfered negatively with vendor life, and 62% reported negative effects on sense of being useful. Effects on general health were somewhat (22%) to very (58%) negative. When thinking about vending, the majority cited negative feelings. They responded that if they had another chance 85% would definitely not vend again, and 76% strongly discouraged potential vendors from "repeating their error." Half the vendors were ready to lose greater than 10 years of life and 76% to 100% of properties to regain kidneys. Compared to controls, vendors had significantly lower scores on all SF-36 scales (p <0.001). CONCLUSIONS: Our sample is a good representative of Iranian kidney vendors, with the majority having psychosocial complications. Globally, the medical community should focus more attention on motivations, quality of life, health and opinions of kidney vendors.     

Postcoital penile drug eruption in a co-trimoxazole-sensitive patient following vaginal use of triple sulfa vaginal cream by his partner

IntroductionThis is a report of a very rare case of proven postcoital penile drug eruption in a patient following vaginal use of triple sulfa vaginal cream by his partner.AimTo report the rare case of cross‐reaction following vaginal use of triple sulfa vaginal cream in partner.MethodsA case of postcoital penile drug eruption in a patient following vaginal use of triple sulfa vaginal cream in his partner is presented including subjective reporting, physical examination, and laboratory evaluations.ResultsWe report a 42‐year‐old man with known sensitivity to trimethoprim/sulfamethoxazole (co‐trimoxazole) who developed a penile drug eruption at the glans after having intercourse with his wife, who was taking sulfathiazole/sulfacetamide/sulfabenzamide (triple sulfa) vaginal cream. The nature of the lesion was confirmed by a rechallenge test.ConclusionTo our knowledge, this is the fourth case of proven postcoital penile drug eruption in a patient following vaginal use of triple sulfa vaginal cream in his partner. Our case illustrates the importance of history taking. In clinical practice of urology, it is not rare to see patients who present with strange penile lesions following coitus. To reach a correct diagnosis, one should obtain a drug history of the sexual partner and allergic history of the patient in such cases. Zargooshi J, Kavoussi H, Rahmanian E, Motaee H, Kohzadi M, and Nourizad S. Postcoital penile drug eruption in a co‐trimoxazole‐sensitive patient following vaginal use of triple sulfa vaginal cream by his partner. J Sex Med 2012;9:758–760.     

Nonischemic priapism following penile tattooing

IntroductionTo our knowledge, here we report the first case of nonischemic priapism following penile tattooing.AimTo report the first case of nonischemic priapism following penile tattooing.MethodsA case with tattooing‐induced priapism is presented including subjective reporting, physical examination, and laboratory/radiologic evaluations.ResultsA 21‐year‐old man, presented with partially rigid penis of 3‐month duration. On examination, the penis was half rigid, with a tattoo on its dorsal surface, and a smaller tattoo on the glans (Figure 1). The patient initially stated that the tattoo had been created years ago, but later admitted that he had it created just before the occurrence of priapism. A traditional tattooist created the tattoo manually, using a handheld needle. Bleeding from deep penile tissue for several days complicated the tattooing.Known etiologies of priapism were investigated and ruled out. Specifically, perineal injury, leukemia, sickle cell trait, thalassemia, urinary tract infection, neurogenic, neoplastic, infectious, toxic, and pharmacological causes were actively investigated and ruled out. There was no history of alcohol consumption or smoking. Aspirated penile blood was bright red. Cavernous blood gas measurements confirmed high oxygen and low carbon dioxide content, diagnostic of arterial priapism.There was no embolization facility in Kermanshah. In fact, there are few experts in superselective embolization in Iran. We referred the patient for superselective embolization. However, he underwent a nonindicated Sacher procedure. Predictably, the procedure was unsuccessful. At present, the patient continues to have priapism. Because of the painless nature of erections, moderately good preservation of erectile function during intercourses, and disappointment with former surgery, the patient declined further therapies, and he lives with his condition.ConclusionsTattooing should be added to the etiologies of nonischemic priapism. Considering this case, we discourage penile tattooing. Zargooshi J, Rahmanian E, Motaee H, and Kohzadi M. Nonischemic priapism following penile tattooing. J Sex Med 2012;9:844–848.     

Sperm count and sperm motility in incidental high-grade varicocele

One hundred twenty-four otherwise healthy men with suspected high-grade varicocele, comprised of 28 patients with grade 2 and 96 with grade 3 varicocele, were referred to us by their primary care providers to determine their exact grade so that they could be exempted from the compulsory armed force service if they had grade 3 varicocele. In the grade 2 and grade 3 groups, mean sperm concentration and mean sperm motility were 80.89 million per milliliter (SD, 38.98 million/mL; median, 74.5 million/mL; range, 22-210 million/mL) and 78.77 million per milliliter (SD, 41.34 million/mL; median, 77 million/mL; range, 0-223 million/mL) and 58.39% (SD, 13.7%; median, 60%; range, 22-75%) and 60.31% (SD, 16.93%; median 65%; range, 0-80%), respectively, with no statistically significant differences between the two groups, no patient with infertility as a complaint during a 20-month period, and no patient with sperm concentrations of <20 million/mL, but with six patients with sperm motilities <50%. In summary, by far the great majority of patients with high grade varicocele have more than normal sperm output. Higher grades of varicocele are not associated with more pronounced deleterious effects on sperm concentration and percentage motility. Incidentally diagnosed high-grade varicocele is not a progressive condition, and almost all patients retain normal semen quality, at least over a period of 20 months.