Seventy-two male patients, who were included in this study, underwent ureteroscopic stone surgery (study group). Forty-two healthy males were enrolled as control group. Changes in sexual function were evaluated using International Index of Erectile Function questionnaire in pre-operative, first and third postoperative terms. Overall satisfaction in relation to the age, operation time, presence of stents, body mass index, educational status, previous operations, International Index of Erectile Function score, International Prostate Symptom Score, Quality of Life, income status, Male Sexual Health Questionnaire, stone-free rates and Beck's depression scale were evaluated. Erectile and ejaculatory functions, quality of life and lower urinary tract symptoms were negatively affected due to ureteroscopic stone surgery, while educational status, psychogenic aspect and income status remained stable. In conclusion, ureteroscopic stone surgery with JJ catheterisation seems to have a progressively decreasing negative effect on male sexual function and whenever possible, stenting should be avoided. If JJ stenting is necessary, patients should be informed that they may experience sexual dysfunction at least for 3 months and if stenting proves necessary the indwelling should be kept as short as possible.

printing of pelvic fracture urethral injuries-fusion of technology and urethroplasty.

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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The aim was to compare the differences between daily 5 mg and on-demand 20 mg tadalafil use in diabetic patients with erectile dysfunction (ED), and the effects of two different tadalafil protocols on ejaculatory and lower urinary tract symptoms (LUTS). Of the 63 diabetic patients with ED, 31 were given 5 mg tadalafil once a day, and 32 were given 20 mg tadalafil on-demand four times a month over three months. Erectile function, erectile hardness, ejaculatory function, and LUTS were assessed at pretreatment, first- and third-month controls. Both tadalafil protocols increased International Index of Erectile Function (IIEF) scores in all patients under 65 years, whereas patients older than 65 years did not benefit. Ejaculatory function, the quality of the hardness of an erection, and LUTS improved in both groups in the study. Tadalafil improved sexual function with acceptable side effects in diabetic men with ED. Both protocols equally improved LUTS and the quality of the erection. Daily use of 5 mg of tadalafil significantly improved the quality of ejaculation and LUTS more than the on-demand use of 20 mg of tadalafil. It may be beneficial to give 5 mg tadalafil daily to patients over 65 years old who do not benefit from treatment with 20 mg of tadalafil or in patients who have LUTS over 65 years old.

Objective: We aimed to compare the effectiveness of holmium YAG laser and pneumatic lithotripsy in the treatment of ureteral stones. Material and methods:A total of 216 patients who had established indications of ureteroscopy between November 2011 and June 2012 were included in this study. Patients' files were retrospectively reviewed by dividing cases as groups that underwent pneumatic (PL) or laser lithotripsy (LL) procedures. Age, sex, stone burden and localization, duration of follow-up, operative times were evaluated. Stone-free rates were evaluated by ureteroscopical examination, postoperative scout films and ultrasonography.Results: Group PL consisted of 109 and group LL of 107 patients. Median age was 43.93±15.94 years in Group PL and 46.15±14.54 years in Group LL. Male to female ratio, stone burden and localization were similar for both groups. Overall success rate was 89.9% in Group PL and 87.9% in Group LL, respectively (p<0.791). With the aid of additional procedures, success rate was 100% for both groups at the end of the first month. Groups were not different as for operative time, rate of insertion of an ureteral catheter and its removal time. Hospitalization period was apparently somewhat shorter in Group LL (p= 0.00). Conclusion:Pneumatic lithotripsy can be as efficacious as laser lithotripsy and be used safely in the endoscopic management of ureteral stone. In comparison of both methods, we detected no differences as to operative time, success of operation and the time to removal of the catheter, however, hospitalization period was shorter in Group LL.

Introduction No study has compared surgical outcomes and couples’ satisfaction among the 3 types of implants, with all brands available on the markets. Aims To compare long-term complications, mechanical reliability, and couples’ satisfaction with penile implant types and brands in patients who underwent penile prosthesis implantation. We also investigated whether there are risk factors that might predict couples’ dissatisfaction. Methods This retrospective study included 883 patients with erectile dysfunction who underwent penile prosthesis implantation. Of the patients, 349 had malleable penile implant, 26 had 2-piece implants, and 508 had 3-piece implants. Main Outcome Measure Couples’ satisfaction after surgery was evaluated with the modified Erectile Dysfunction Inventory of Treatment Satisfaction questionnaire. Surgical outcomes, mechanical reliability, and couples’ satisfaction were compared according to type and brand of the penile implants in all patients. Results The mean age and follow-up period of the patients were 57.74 ± 9.59 years and 67.81 ± 49.11 months, respectively. The couples’ satisfaction rates were significantly higher in the 3-piece implant group than in the malleable group (P &lt; .001), but there was no significant difference between the 2-piece and 3-piece implant groups. There was no difference in terms of couples’ satisfaction according to the brand of the implants. Of the patients who had malleable implants, 27 (7.7%) underwent 3-piece penile prosthesis implantation due to dissatisfaction; however, only 1 (0.2%) of the patients with a 3-piece implant was switched to a malleable implant (P &lt; .001). The highest rate of revision surgery due to penile corporal perforation was in the malleable group (2.6%), whereas the highest rate of revision surgery due to penile implant malfunction occurred in the 3-piece implant group (5.5%) (P = .021 and .001, respectively). To analyze risk factors, using multivariate analysis, presence of complication was the only predictor that might cause couples’ dissatisfaction (P = .003). Conclusions 3-piece and 2-piece implants have higher couples’ satisfaction rates than the malleable implant. Brands of implants did not have any effect on the couples’ satisfaction. Regarding detail of the complications, the 3-piece implant has a lower rate of penile corporal perforation and a higher rate of penile implant malfunction than the malleable implant. Patients with erectile dysfunction who need a penile implant should be informed about surgical outcomes, brands, and types of penile implants. Prosthesis choice should be customized to individual patient’s expectations/conditions and tailored accordingly.

The current therapy for penile fracture is immediate surgical repair, but sexual and psychosocial effects of the repair have been poorly investigated. We aimed to assess the impact of surgical correction of penile fracture on psychosocial status, sexual function, and erectile quality. Sixty-four patients classified into two subgroups according to follow-up: 2-24 months (Group 1), and longer than 24 months (Group 2), and 28 healthy men (Control group). The mean overall follow-up period was 39.1±32.7 months. The number of sexual intercourse origin was 44 (68.8%), the mean time interval from incident-to-surgery was 13.6±9.3 h. The mean sexual relationship score decreased during first year (P=0.001), and significant recovery was observed over 12-24 months. The mean overall relationship scores and the mean self-esteem scores of the study groups decreased until the end of the 24 months (P<0.05). The mean erectile function domains remained stable in all groups (P>0.05). The mean EHS scores were lower but the difference was not significant in the study groups (P>0.05). Penile fracture repair have no detrimental effect on sexual function, but psychogenic aspect may be adversely affected. This article concludes lower complication rates can be reached with immediate surgical correction of the penile fracture whereas psychogenic recovery might prolonged.