Shock wave lithotripsy (SWL), retrograde intrarenal surgery (RIRS) and minimally invasive percutaneous nephrolithotomy (MIP) are highly effective treatment options for lower pole stones up to 2 cm. Selecting the best treatment modality represents a controversial area in urology, because each treatment methods have their own advantages and disadvantages. Donaldson and co-workers have recently published a very comprehensive review and meta-analysis to compare the benefits and harms of SWL, RIRS and PNL techniques. Common and widely used treatment options for lower pole renal stones (LPS) include shock wave lithotripsy (SWL), retrograde intrarenal surgery (RIRS), and percutaneous nephrolithotomy (PNL). Selecting the best treatment modality for stones smaller than 2 cm represents a controversial area in urology, because each treatment methods have their own advantages and disadvantages (1). SWL is a minimally invasive technique and it is usually the first choice method because of good patient tolerance and low complication rate. However, it is associated with lower success rate and higher retreatment rate (2). At the same time, with the advances in endourological instrumentation and technology, RIRS and minimally invasive percutaneous nephrolithotomy (MIP) have become more increasingly considered options for the treatment of medium sized LPS (3,4).Donaldson and co-workers have recently published a very comprehensive review and meta-analysis to compare the benefits and harms of SWL, RIRS and PNL techniques in the treatment of medium-sized (≤2 cm) LPS in adults (5). Twelve articles reporting on 7 randomised controlled trials (RCTs) recruiting a total of 691 patients were included in this meta-analysis. Stone-free rate favoured PNL (96.3%) over RIRS (91.7%), and over SWL (54.5%). Stone size subgroup analyses revealed PNL and RIRS were considerably more effective than SWL for >10 mm stones, but the magnitude of benefit was markedly less for ≤10 mm stones. The major limitation of this review was the paucity of evidence for the comparison of PNL vs. RIRS and the lack of reliable evidence concerning outcomes other than stone-free rate (including complications, length of stay, analgesic requirement, and quality of life).The European Association of Urology 2015 guidelines, state clearly that renal stones for 1-2 cm in diameter can be managed with SWL or endourological interventions (6). There is a decrease in the application of SWL with a parallel increase use of RIRS and MIP techniques due to better stone-free rate. In a recent meta-analysis, De et al. demonstrated that RIRS technique provides higher stonefree rates, shorter hospital stay, and reduced bleeding when compared with MIP for intermediate-sized (1-2 cm) renal stones (7). In another study, El-Nahas and colleagues showed significantly higher stone-free rate in RIRS (86%) compared with SWL (67%), whereas the complication rates were 4% in SWL and 13% in RIRS for lower pole stones 1 to 2 cm (8).In the RIRS technique, laser energy can fragment all stones rega...
Background and objective: Premature ejaculation is one of the most common and complex sexual diseases among men. Although there are four defined subtypes of premature ejaculation, the most common subtype is acquired premature ejaculation. This study investigated the association between serum vitamin D levels and acquired premature ejaculation. Material and methods: This retrospective cross-sectional study included 94 patients with a complaint of acquired premature ejaculation (the study group) and 92 patients without a complaint of premature ejaculation (the control group) between June 2018 and March 2020. Patients' demographic characteristics, laboratory results, intravaginal ejaculatory latency time, Turkish validated premature ejaculation diagnostic tool (PEDT), International Index of Erectile Function-5 (IIEF-5) and Beck Depression scores were statistically compared between groups.Results: The patients' mean age was 49.10 ± 14.85 years. There were differences between the two groups regarding serum vitamin D levels, dehydroepiandrosterone sulfate, total testosterone, and follicle-stimulating hormone levels. Upon comparing the questionnaire scores, the PEDT, intravaginal ejaculatory latency time, and Beck depression scores were clinically significant between groups. The cut-off value for serum vitamin D levels was 8.37 ng/mL, with a sensitivity of 93% and specificity of 92%. Conclusion:We revealed that serum vitamin D and follicle-stimulating hormone levels were independent risk factors according to the multivariate analysis. Measurement of serum vitamin D levels in patients with acquired premature ejaculation may be useful for treatment.
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