Background To our knowledge, there is no study in the literature that has investigated a cutoff value of the visceral adiposity index (VAI) for erectile dysfunction (ED) in men. Aim To show a possible relationship between ED and VAI levels representing adipose tissue dysfunction and to identify a cutoff value of the VAI for ED. Methods This prospective cross-sectional study included 276 participants in 5 groups: non-ED, mild ED, mild-moderate ED, moderate ED, and severe ED. The VAI was calculated. Fasting glucose, triglyceride, high-density lipoprotein, testosterone (T), prolactin, and estradiol were measured. Erectile function, sexual satisfaction, orgasm, desire, and general satisfaction scores were recorded using the International Index of Erectile Dysfunction 1–15 questionnaire. The participants were divided into BMI1 (<25.0), BMI2 (25–29.9), and BMI3 (>30.0) categories based on body mass index (BMI) and WC1 (<94 cm), WC2 (94–102 cm), and WC3 (>102 cm) categories based on waist circumference (WC). Outcomes The VAI was investigated as an independent risk factor for ED, compared with BMI and WC. Results The median VAI progressively increased, but a marked increase was recorded in groups 4 and 5 (P = .001). A significant increase in ED was observed for a VAI score higher than 4.33 (P = .001). Each integer increase of the VAI was associated with a 1.3-fold increased risk of ED. The odds ratio of ED for the VAI = 4.33 was 4.4 (P < .001). The WC and BMI significantly increased as the degree of ED increased (P = .001), but statistical analysis showed a significant decrease only in moderate and severe ED groups (P < .05). Starting from non-ED patients, serum triglyceride increased and high-density lipoprotein decreased progressively in all ED groups (P = .001). T/E2 slightly reduced as the severity of ED increased (P > .05). T decreased in ED groups (P = .022). Regardless of the ED level, other sexual subdomains decreased in ED patients (P = .001). The ED rates in 3 increasing BMI and WC categories were similar (P > .05). For VAI = 4.33, BMI ≥ 30.0 kg/m2, and WC > 102 cm, sensitivity and specificity were 61.2% and 73.8%, 31.6% and 90.5%, and 54.3% and 69.0%, respectively. Clinical Implications The VAI should be considered as a reliable independent risk factor for ED as a predictor of visceral adipose dysfunction. Strengths & Limitations The main strength is that this is the first study to investigate the association between the VAI and sexual dysfunction in men. The low number of participants is the limiting factor. Conclusion The findings suggest that the VAI can be used as a reliable independent risk factor marker for ED as a predictor of visceral adipose dysfunction.

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Aims Erectile dysfunction (ED) is a common condition affected by many factors. We aimed to show the impact of the metabolic syndrome (MeTS) on male sexual function based on visceral adiposity index (VAI). Methods Participants who met MeTS criteria (Group 1, n = 96) and did not meet MeTS criteria (Group 2, n = 189) were included in this cross‐sectional study. The MeTS diagnosis was made in the presence of at least 3 of the following criteria: fasting serum glucose level higher than 100 mg/dL, HDL cholesterol level below 40 mg/dL, triglyceride level higher than 150 mg/dL, waist circumference higher than 102 cm and blood pressure higher than 130/85 mmHg. Demographic data were recorded; biochemical and hormonal tests were measured. Erectile and other sexual function scores were recorded. The VAI was calculated using the [(Waist Circumference/39.68) + (1.88 × body mass index)] × triglyceride/1.03 × 1.31/HDL formula. Results Mean age, smoking volume, testosterone (T) and testosterone/estradiol (T/E2) ratios of the groups were similar (P > .05). The mean VAI was two‐fold higher in patients in Group 1 (P < .001) and erectile function score was lower in Group 1 than Group 2 (P = .001). Other sexual function scores were similar (P > .05). The METS was associated with an increased risk of ED (P = .001). Logistic regression analysis showed that each integer increase in the VAI was associated with a 1.4‐fold increased risk of ED (P < .001). Higher T values were associated with a better erectile function (P = .03). For the VAI = 4.33, receiver‐operating characteristic analysis showed a sensitivity of 89.6% and specificity of 57.7%. Conclusion Compared with non‐MeTS, the presence of MeTS has emerged as a risk factor for patients with ED with high VAI levels while the other sexual functions are preserved. Management of ED patients with MeTS should cover a comprehensive metabolic and endocrinological evaluation in addition to andrological work up.

Klinefelter syndrome (KS) is the most common sex chromosomal disorder in men phenotypically. It is characterised by tall height, long legs relative to the body, atrophic-small testicles, feminine body structure and gynecomastia. Its prevalence is 1/650. 1 Newborns with KS are similar to healthy babies. 2 Classical testicular atrophy occurs with puberty. 3 Laboratory and clinical findings in adulthood are consistent with hypergonadotropic hypogonadism. High serum FSH level is the leading laboratory finding. The definitive diagnosis is made by karyotype analysis. Of the KS patients, 90% have nonmosaic 47, XXY, 10% 46, XY/47, XXY

Epigenetic changes, especially DNA methylation, are essential for the differentiation and development of the male germ cell line (Gunes & Esteves, 2020). Disturbances in the DNA methylation process may cause imprinting errors, global and/or gene-specific methylation changes, leading to infertility in men (Gunes et al., 2016). Methylenetetrahydrofolate reductase (MTHFR) is an enzyme that provides a methyl group for purine synthesis and DNA methylation and therefore participates in the one-carbon cycle which is an essential pathway for replication and cell division (Del Gobbo, Price, Hanna, & Robinson, 2018). MTHFR converts 5,10 methylenetetrahydrofolate into 5-methyl tetrahydrofolate, the active form of folate, which is subsequently necessary for the conversion of homocysteine to methionine (Liu et al., 2015). Methionine is necessary for the synthesis of S-Adenosyl methionine (SAM), a universal cofactor for methylation reactions (Del Gobbo et al., 2018). Studies have shown that various polymorphisms in MTHFR gene may cause inactivation of the enzyme and these variants may play a role in the pathology of many diseases including infertility

Aims: We aimed to investigate fertilization rates, quality of embryo, pregnancy and live birth rates, endocrine, sexual function, psychological status and quality of life of cases diagnosed with Klinefelter syndrome (KS). Methods: Clinical findings, hormone values and semen analyses in patients with nonmosaic KS (Group 1, n=121) and those with non-genetic nonobstructive azoospermia (NOA) (Group 2, n=178) were retrospectively analyzed. Sperm retrieval outcomes with microdissection testicular sperm extraction (micro-TESE), fertilization rates and embryo quality, pregnancy, abortion, and live birth rates were compared. Sexual functions were assessed using IIEF-15, quality of life was evaluated, and psychological status was assessed. Results: There was no difference in terms of age between groups. Sperm retrieval rates was 38% and 55.6% in Group 1 and 2, respectively (p=0.012). Sperm retrieval rates were higher in Group 1 before 31.5 years than in Group 2 (AUC=0.620, 0.578). Compared to Group 2, the fertilization rate was low in Group 1, whereas embryo quality was similar. Live birth rates were 12.5% and 23% in Group 1 and 2, respectively (p=0.392). The education level, libido, erectile functions, and general health satisfaction were lower in Group 1 than in Group 2 (buraya p değeri yaz). Depression and anxiety levels were higher in Group 2 than Group 1 (p değeri yaz). Conclusion: Higher sperm retrieval rate has been achieved in group 1 younger than 31.5 years. Similar embryo quality is provided between groups. Sexual dysfunction and psychiatric problems were higher in Group 1, with lower satisfaction and general health than Group 2. Patients with KS should be monitored not only with their reproductive functions but also with their general health status.

The aim of the study was to compare the patient 0 s satisfaction and long-term results of two plication techniques in patients with penile curvature.METHODS: The study included 387 patients who underwent surgical correction of penile curvature with penile plication in three tertiary university hospitals. Of the patients, 260 had congenital penile curvature, and 127 had Peyronie 0 s disease. Related to the surgical procedure, 202 patients underwent plication of tunica albuginea with Lue 0 s sixteen-dot technique, while 185 patients underwent tunica albuginea excision with traditional Nesbit technique. Surgical outcomes and patient 0 s satisfaction were compared between the two techniques in all patients.RESULTS: The mean age and follow-up period of the patients were 34 years (range 16 to 81) and 41 months (range 6 to 144), respectively. The mean angle of deformity was 42 degrees (range 30 to 80). The rates of early complications, including superficial wound infection, hematoma and urethral injury were similar and very low in the both techniques. Mean duration of surgery was significantly shorter in the 16-dot plication technique (48 minutes), compared with the Nesbit technique (63 minutes) (p¼0.001). Outcomes of the two surgical procedures are shown in the table, regardless of their etiology of penile curvature. The rates of penile sensory loss and de-novo erectile dysfunction were significantly higher in the Nesbit technique than in the 16-dot plication technique, but rate of palpable bumps or knots under the penile skin was significantly higher in the 16-dot plication technique than in the Nesbit technique. Regardless of the surgical techniques, the patients with congenital penile curvature had significantly less postoperative de-novo erectile dysfunction than Peyronie 0 s disease patients.CONCLUSIONS: Overall, both surgical techniques have very high success and satisfaction rates with very low complication rates. However, the types of complications are significantly different between the two surgical procedures. Therefore, patients with penile curvature should be informed about surgical outcomes, and surgical method for penile curvature should be preferred based on surgeon 0 s experience and patient 0 s preference.