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.

Non-alcoholic fatty liver disease (NAFLD) is considered a risk factor for atherosclerosis. The aim of the present study was to investigate the association of the pulsatility index (PI) of basilar artery (BA) and carotid intima media thickness (IMT) in diabetic and non-diabetic NAFLD patients. We compared a group of 80 stroke-free, diabetic and non-diabetic NAFLD patients and a control group of 26 healthy subjects without NAFLD. We then evaluated the PI of the BA by transcranial Doppler ultrasonography, and carotid IMT. The PI was significantly higher in diabetic NAFLD patients than in controls (p<0.003). Carotid IMT and asymmetrical dimethylarginine (ADMA) levels were higher in NAFLD patients than controls respectively (p<0.003, p<0.04). The PI of the BA was significantly correlated with age (R=0.369, p<0.001), male gender (R=0.207, p=0.035), diabetes (R=0.332, p=0.001), carotid IMT (R=0.296, p=0.002) and ADMA (R=0.349, p=0.015). A multiple regression analysis was performed with PI as the dependent variable with known clinical risk factors. Age (beta=3.54, p<0.001), diabetes (beta=2.32, p=0.022), gender (beta=2.20, p<0.03), ADMA (beta=2.25, p<0.031), and carotid IMT (beta=2.41, p<0.017), were independent predictive factors of BA PI. Adjustment for age and gender did not alter these relative risks, exhibiting a significant independent contribution to PI. The increased PI observed in this study represents enhanced cerebrovascular resistance, and we observed that the age, male gender, diabetes, ADMA levels, and carotid IMT were independent predictive factors of BA PI.

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.

Unilateral synchronous multifocal renal tumors are rare. Due to the limited data in the literature and challenges in the technique, there is still doubt on the application of laparoscopic partial nephrectomy (LPN) for the management of such tumors. Herein, we report a 36-year male patient presenting with right-sided flank pain and microscopic hematuria. Abdominal computed tomography (CT) revealed five solid masses, the largest of which was 27 x 18 mm. The patient underwent LPN and the largest mass was resected with the control of segmental artery of the lower pole of the right kidney. The remaining four masses were resected by zero-ischemia technique. Final pathology revealed renal cell carcinoma in all masses. Postoperative period was uneventful. No recurrence was detected during a 5-year follow-up.

Polycystic ovary syndrome (PCOS) is a common endocrine disorder affecting at least 5-10% of women of reproductive age. PCOS is characterized by hyperandrogenism, menstrual disturbance, anovulation, infertility and obesity and, also associated with increased number of cardiovascular risk factors and early atherosclerosis. Hyperinsulinemia is a frequent finding in PCOS patients and has cause-and-effect relationship with low-grade chronic inflammation and increased risk of cardiovascular disease. Turk Jem 2013; 17: 33-

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