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Aromatase inhibitors in infertile patients: effects on seminal parameters, serum and seminal plasma testosterone levels, and estradiol levels during short-term follow-up
(Tubitak Scientific & Technical Research Council Turkey, 2009) Basar, M. Murad; Tuglu, Devrim
Aim: To evaluate the effects of an aromatase inhibitor (anastrozole) on seminal parameters, and on serum and seminal plasma testosterone/estradiol ratios in infertile patients, as well as to clarify its place among empirical infertility treatment modalities. Patients and Methods: The study included 32 patients with spermatozoa numbering > 5 million/mL in ejaculate and a serum testosterone/estradiol ratio < 0.14. Anastrozole, an aromatase-inhibiting agent, was given (1 mg b.i.d.) and patients were re-evaluated 2 months later based on semen analysis, and measurements of serum and seminal plasma testosterone and estradiol levels. Results: Semen analysis parameters before and after treatment, respectively, were as follows: number of spermatozoa: 12.4 +/- 4.1 million/mL and 22.3 +/- 5.7 million/mL; motility: 33.4 +/- 4.2% and 47.6 +/- 7.4%; normal morphology: 5.4 +/- 1.3% and 8.9 +/- 2.7%. Differences between the values before and after treatment were statistically significant (P < 0.05). Serum testosterone level was 4.1 +/- 1.2 ng/mL, estradiol level was 52.1 +/- 9.4 pg/mL, and testosterone/estradiol ratio was 0.13 +/- 0.03 at the beginning of treatment. These values were 3.2 +/- 0.6 ng/mL, 68.4 +/- 7.3 pg/mL, and 0.05 +/- 0.001, respectively, in seminal plasma. Following 2 months of anastrozole treatment, testosterone and estradiol levels, and the testosterone/estradiol ratio showed statistically significant changes in serum and seminal plasma. While testosterone levels significantly increased, estradiol levels decreased (serum P-T = 0.001, P-E2 = 0.001; seminal plasma P-T = 0.001, P-E2 = 0.001). Conclusion: Aromatase inhibitors are a potential treatment method for infertile male patients with increased plasma estradiol levels and decreased plasma testosterone/estradiol ratios.
BAG-1 expression in hyperplastic and neoplastic prostate tissue: Is there any relationship with BCL-related proteins and androgen receptor status?
(Sage Publications Ltd, 2005) Bozdoğan, Önder; Atasoy, Pınar; Bozdoğan, Nazan; Erekul, Selim; Batislam, Ertan; Yılmaz, Erdal; Basar, M. Murad
Aims and background: To evaluate the function and distribution of BAG-1 protein in hyperplastic and neoplastic prostate tissue and establish the relationship between this protein and BCL-related proteins (BCL-2 and BAX), androgen receptor (AR) expression and chromogranin A. Methods: Twenty-eight prostatic adenocarcinomas and 16 prostate hyperplasias were included in this retrospective study. BAG-1, BCL-2, BAX, androgen receptor and chromogranin A immunostaining was performed by means of standard avidin-biotin peroxidase methods. The M30 antibody was used to identify preapoptotic and apoptotic cells. The immunohistochemical histological score (HSCORE) semi-quantative system was used to evaluate immunohistochemical staining. Results: Statistical analysis showed a significant difference in HSCOREs of BAX, M30 and AR between the carcinoma and hyperplasia groups. Carcinomas expressed higher HSCOREs of these markers than hyperplasias. There were significant differences in nuclear and cytoplasmic BAG-1 positivity between high and low-grade carcinomas. BAG-1 expression was higher in low-grade carcinomas. In the carcinoma group there was a positive correlation (Pearson) between BCL-2 and cytoplasmic/nuclear BAG-1. In the hyperplasia group there was a negative correlation between BAX and BCL-2, and between AR and M30. We also detected a positive correlation between AR and nuclear/cytoplasmic BAG-1 and between nuclear and cytoplasmic BAG-1 in hyperplasias. BAG-1 showed the same specific basal cell localization as BCL-2 in hyperplastic and normal glands. Conclusions: The BAG-1 protein showed a distinct distribution pattern in hyperplastic and neoplastic prostate. BAG-1 in association with BCL-2 inhibits apoptosis and may prolong the life of neoplastic cells and give them a chance to gain new oncogenic features in early carcinogenesis.
CAUSES OF SILDENAFIL CITRATE TREATMENT DISCONTINUATION IN PATIENTS WITH ERECTILE DYSFUNCTION
(Aves, 2005) Tuglu, Devrim; Basar, M. Murad; Akbulut, Ziya; Gungor, Sefa; Tekdogan, Umit Y.; Atan, Ali
Introduction: Although there are many methods in the treatment of erectile dysfunction, no one is successful and sufficient in all the patients. Sildenafil treatment has been found the most successful method among ED treatments. In spite of high efficacy of sildenafil, some patients still stop sildenafil treatment due to various reasons. The aim of the present study is to evaluate the causes of sildenafil citrate treatment discontinuation in the patients with erectile dysfunction. Materials and Methods: A total of 217 patients who admitted to our outpatient clinic due to erectile dysfunction were included in the study. They were evaluated with a detailed medical and sexual history and physical examination. Erectile function was assessed with IIEF scores before and after the treatment. The patients' ages ranged from 22 to 74 years (52.3 +/- 11.7). They suffered from erectile dysfunction for 34.3 +/- 31.3 months (2-240 months). Sildenafil citrate 50 mg was given for a month. At the end of this period, patients were re-evaluated and questioned about the efficacy of sildenafil citrate, its' side effects and whether they wanted to continue the treatment or not. Later, sildenafil 100 mg was recommended to patients desiring to use higher dose of it, and they were questioned 4 week later. Finally, the efficacy and side effects of sildenafil was evaluated, and the causes of dropout were obtained from the patients who discontinued sildenafil treatment. Results: At the 4th week control, sufficient erection was observed in 163 patients (75.1%), no erection was encountered in 54 patients (24.9%). Out of 163 patients, 131 (80.4%) who had sufficient erection with sildenafil left the treatment. The causes of discontinuation in these patients were the high price of the drug in 86 patients (% 65.6), improvement of erection problem in 26 (% 19.8), fear of asparagus news appearing in the media in 12 patients (% 9.2), and side effects of sildenafil in 7 patients (% 5.3). Of sildenafil failed patients (n: 54), 12 (22.2%) accepted to try sildenafil 100 mg, 42 (77.8%) did not accept to try sildenafil 100 mg. The reasons not to try sildenafil 100 mg for these patients were high prize in 20 patients (47.6%), consideration of penile prosthesis in 2 patients (3.2%), side effects of sildenafil 50 mg in 13 patients (30.9%), nothing for 7 patients (16.7%). At the end of the treatment period, only 35 (16.1%) patients continued to use sildenafil 50 or 100 mg, 182 patients (83.9%) left the treatment due to different causes. These causes were high prize in 108 patients (59.3%), improvement of erection quality in 26 patients (14.3%), side effects in 20 patients (10.9%), asparagus news in 12 patients (6.6%), inefficacy in 7 patients (3.8%), choosing other treatment alternatives in 2 patients (1.1%). The other 7 (3.8%) did not describe any cause. Side effects were headache in 15 patients (6.9%), sweating in 12 patients (5.5%), visual problems in 6 patients (2.8%) and chest pain in 4 patients (1.8%). Conclusion: Although Sildenafil treatment is found very effective with acceptable side effects in the treatment of ED regardless to the etiology, discontinuation of the drug is very high. In this study, 80.4% of the patients in whom sildenafil treatment was successful left the treatment. The most important factor of this low ratio is the difficulty of buying the drug due to economic problems.
Common symptoms in men with prostatic inflammation
(Springer, 2006) Tuncel, Altuğ; Akbulut, Ziya; Atan, Ali; Basar, M. Murad
Purpose We evaluated 96 patients with prostatic inflammation in terms of their symptoms and aimed to find common types and frequencies of symptoms in these patients. Patients and methods The mean age of the patients was 38.0 +/- 8.7 (range 21-58) years. Physical examination, digital rectal examination, microscopic prostatic secretion assessment and urine cultures after taking a detailed medical history were performed. Urine samples before and after prostatic massage were collected for urine culture. Frequency and types of patients' symptoms were evaluated. All patients were asked about lower urinary tract symptoms, sexual dysfunction and other complaints. Results Lower urinary tract symptoms and lumbal pain were more prevalent in elder patients. Ejaculation disorder was the most common sexual problem (n = 65, 67.7%). Erectile dysfunction and decreased libido were observed in 29 (30.2%) and 22 (22.9%) of the patients. Other complaints were lumbal pain (n = 34, 35.4%), perineal fullness (n = 50, 52.1%), haemospermia (n = 20, 20.8%) and scrotal pain (n = 43, 44.8%). Conclusion Prostatic inflammation was usually seen in men of the third and fourth decade. Sexual dysfunction was the most common symptom in this particular group of patients.
Comparison of the differences in circadian autonomic function in hyperlipidemic men with and without erectile dysfunction
(Springer, 2010) Doğru, M. Tolga; Basar, M. Murad
Background We aimed to investigate differences in circadian autonomic changes in patients suffering from hyperlipidemia with and without erectile dysfunction and compared results to control cases. Materials and methods A total of 77 patients (age range: 24-74, mean age: 45.3 +/- 9.3) with uncontrolled hyperlipidemia (total cholesterol > 200 mg/dL and/or LDL > 160 mg/dL despite a regular diet) were enrolled into the study. These patients were divided into two groups according to their International Index of Erectile Function (IIEF-EF) scores as having erectile dysfunction (IIEF-EF < 26) (Group 1) or as having normal erectile function (IIEF-EF >= 26) (Group 2). In addition, the control group comprised 44 healthy men (age range: 20-57, mean age: 44.0 +/- 10.8) (Group 3). Heart rate variability parameters obtained by 24-h Holter monitoring were utilized for the indirect evaluation of autonomic function. Results There were statistically significant differences between the groups with respect to daytime and nocturnal autonomic activity (p < 0.005). Moreover, Group 1 had lower nocturnal parasympathetic and higher nocturnal sympathetic activity compared to the other groups (for nocturnal HFn p(1-2) < 0.001; p(1-3) < 0.001; p(2-3) > 0.05; for nocturnal LFn p(1-2) < 0.001; p(1-3) < 0.001; p(2-3) > 0.05). Conclusion We concluded that hyperlipidemia results in deterioration of autonomic circadian rhythm. Hyperlipidemic patients with erectile dysfunction had diminished nocturnal parasympathetic activities.
Diagnosis and management of vaginal mullerian cyst in a virgin patient
(Springer London Ltd, 2008) Cil, Aylin Pelin; Basar, M. Murad; Kara, Simay Altan; Atasoy, Pinar
Benign cystic lesions of the vagina are uncommon and may become symptomatic. We describe two symptomatic anterior vaginal wall cysts in a virgin patient and the usefulness of imaging modalities. A 36-year-old virgin woman presented with a complaint of vaginal bulging and pelvic pressure. Pelvic examination revealed a cystic mass protruding from the vagina surrounded by the intact hymen. The initial abdominopelvic ultrasound showed a hypoechoic cystic mass measuring 42 x 20 mm in the vagina. She then had a pelvic magnetic resonance imaging (MRI) that revealed two anterior vaginal wall cysts with no communication with the urethra or bladder. The cysts were excised and histologic examination with mucicarmine revealed mucin-secreting tall columnar cells consistent with a diagnosis of mullerian cyst. While both ultrasonographic examination and MRI are helpful in localizing vaginal cysts, MRI is superior in showing multiple cystic lesions of the vagina and their communication with the surrounding structures.
The Effect of Behcet's Disease on Sexual Function and Psychiatric Status of Premenopausal Women
(Elsevier Sci Ltd, 2009) Koçak, Mukadder; Basar, M. Murad; Vahapoğlu, Güler; Mert, H. Çağatay; Güngör, Şule
Little is known about the relationship between Behcet's disease (BD) and female sexual dysfunction (FSD). The aims were to evaluate the prevalence of FSD in premenopausal BD patients and to compare hormonal and psychiatric conditions to healthy subjects. A total of 71 married women with BD and 63 healthy married women between 18 and 44 years old were enrolled into the study. After evaluating detailed history and physical examination, serum steroid hormone levels were measured. Presence of genital ulcerations in physical examination and any medical treatment were recorded in patients. All subjects were asked to complete the Female Sexual Function Index (FSFI) for sexual status and Beck Depression Inventory (BDI) for psychiatric assessment. FSFI and BDI scores and serum sex steroid hormone levels were measured in women with BD and healthy controls. The mean BDI score of patients was significantly greater than that for controls (P = 0.001), and there was a statistically significant difference between BDI scores (Pearson chi(2) = 19.109, P = 0.001). FSD was found in 34 patients with BD (47.9%) and in 11 controls (17.5%). A statistically significant difference was found between the two groups (Pearson chi(2) = 13.855, P = 0.001). While the most common sexual problem in the patients with BD was diminished arousal (n = 49, 69.0%), diminished desire was found in 32 patients (45.1%) and lubrication problems in 36 patients (50.7%). There was a statistically significant negative correlation between BDI and FSFI score in BD patients. On the contrary, there was no relationship between FSFI and presence of genital ulcerations. FSD is more common in BD patients than in healthy subjects. We conclude that depressive mood according to the BDI scale correlates with the sexual status of BD patients, and this may be because of the depressive effect of BD as a chronic disease. Kocak M, Basar MM, Vahapoglu G, Mert HC, and GungorS. The effect of Behcet's disease on sexual function and psychiatric status of premenopausal women. J Sex Med 2009;6:1341-1348.
Effect of sildenafil citrate treatment on serum dehydroepiandrosterone sulfate levels in patients with erectile dysfunction
(Elsevier Science Inc, 2006) Tekdoğan, Ümit; Tuncel, Altuğ; Tuglu, Devrim; Basar, M. Murad; Atan, Ali
Objectives. To investigate the effect of sildenafil citrate treatment on serum dehydroepiandrosterone sulfate (DHEAS) levels in patients with erectile dysfunction (ED). Methods. A total of 124 men with a mean age of 45.9 years were included in the study. Group 1 consisted of 78 patients with ED, as determined by the Sexual Health Inventory of Male (SHIM) scale (score less than 2 1). Group 2 consisted of 46 healthy men with a SHIM score of 21 or greater. The 78 patients with ED took 100 mg sildenafil citrate at least eight times in 1 month. The SHIM scale was administered and serum DHEAS levels measured before and after treatment in the ED group. The serum DHEAS levels were also measured in the control group. The treatment response was defined as positive if the SHIM score was 21 or greater after sildenafil administration. Results. At the end of sildenafil citrate treatment, the serum DHEAS levels and SHIM scores had increased significantly in the ED group (P = 0.013 and P = 0.001, respectively). In groups 1 and 2, the mean pretreatment serum DHEAS level of the men younger than 50 years old was 200.1 +/- 77.9 and 279.4 +/- 125.4 mu g/dL, respectively (P = 0.013). The elevation of the serum DHEAS levels and SHIM scores was more significant in the sildenafil responders (P = 0.002 and P = 0.001), respectively. Conclusions. Serum DHEAS levels were significantly greater in the patients younger than 50 years old than in the older patients in the ED group. The serum DHEAS levels increased significantly after sildenafil citrate treatment in the ED group (especially in the younger men). Also, patient age was an important factor affecting the sildenafil citrate response.
The effect of varicocele on seminal plasma and serum inhibin-B levels in adolescent and adult men
(Springer, 2010) Basar, M. Murad; Kisa, Ucler; Tuglu, Devrim; Kacmaz, Murat; Basar, Halil
In the present study, the relationship between serum/seminal plasma and serum FSH and seminal parameters was evaluated in adults and adolescent varicocele patients and compared with normal fertile cases. A total of 50 adult patients with varicocele (Group-1) and 50 adolescents with varicocele (Group-2) were enrolled into the study. Fifty fertile cases without any scrotal pathology were accepted as control group (Group-3). Serum gonadotropin, sex steroids and serum and seminal plasma inhibin-B levels were measured, and semen analysis was performed after 2 and 5 days of sexual abstinence. All parameters were compared among three groups by using one-way ANOVA test. There were statistically significant differences among three groups on seminal parameters due to disturbed spermatogenesis in patients with varicocele (P < 0.05). However, there were not statistical differences between serum and seminal plasma Inhibin-B levels among groups. In varicocele patients, serum inhibin-B levels showed negative and significant correlation only with FSH levels (r = -0.253, P = 0.011). On the contrary, neither serum nor seminal plasma inhibin-B levels showed significant correlation with seminal parameters. While varicocele affects different mechanisms in the regulation of spermatogenesis in testes, serum and seminal plasma inhibin-B have not any role in decreased spermatogenesis in varicocele.
Effectiveness of eutectic mixture of local anesthetic cream and occlusive dressing with low dosage of fentanyl for pain control during shockwave lithotripsy
(Mary Ann Liebert, Inc, 2005) Yilmaz, Erdal; Batislam, Ertan; Basar, M. Murad; Tuglu, Devrim; Özcan, Şaziye; Basar, Halil
Background and Purpose: To investigate the effect and usefulness of Eutectic Mixture of Local Anesthetic (EMLA) applied with an occlusive dressing and used simultaneously with a low dose of fentanyl during shockwave lithotripsy (SWL). Patients and Methods: One hundred sixty patients with kidney stones, aged between 19 and 68 years, were randomly, divided into seven groups that were treated as follows: group 1: fentanyl 1 mu g/kg by intravenous infusion (IV); group 2: IV fentanyl 0.25 mu g/kg; group 3: occlusive dressing and IV fentanyl 0.25 mu g/kg; group 4: placebo cream and IV fentanyl 0.25 mu g/kg; group 5: EMLA cream and IV fentanyl 0.25 mu g/kg; group 6: placebo cream and IV fentanyl 0.25 mu g/kg with an occlusive dressing; and group 7: EMLA cream and IV fentanyl 0.25 mu g/kg with an occlusive dressing. The mean arterial pressure (MAP), heart rate, ventilatory rate, and oxygen saturation (SpO(2)) were recorded on all patients. A visual analog scale 0-100 mm (VAS) was used for the evaluation of pain. The skin integrity was inspected to detect any lesions after SWL. Results: The SPO2 in group I was lower statistically than in the other groups. The VAS score in group 7 was clearly lower than in the others in the first, tenth, and twentieth minutes and at the end of SWL. In groups 6 and 7, additional fentanyl doses were lower than in the other groups, but only in group 7 was the total fentanyl dosage low. Skin lesions were not seen only in groups 3, 6, and 7. Conclusion: Use of EMLA and an occlusive dressing with low doses of fentanyl during SWL provides appropriate analgesia with minimal morbidity.
Effects of statin treatment on serum sex steroids levels and autonomic and erectile function
(Elsevier Science Inc, 2008) Dogru, M. Tolga; Basar, M. Murad; Simsek, Ali; Yuvanc, Ercan; Guneri, Mahmut; Ebinc, Haksun; Batislam, Ertan
OBJECTIVES To investigate the effect of statin treatment on serum sex steroid levels, heart rate variability, erectile function, and libido in patients with hyperlipidemia. METHODS A total of 74 patients (mean age 44.7 +/- 7.1 years) with hyperlipidemia were enrolled into this study. After a cardiac examination, the serum lipid levels were measured, and the 24-hour Holter monitoring, heart rate variability, and autonomic test results were also evaluated. Erectile function was assessed using the International Index of Erectile Function (IIEF) questionnaire. Later, atorvastatin 40 mg/day was initiated in all patients and used for the subsequent 12 months. All diagnostic tests (cardiac, biochemical, and autonomic and the IIEF questionnaire) were performed again at 6 and 12 months of follow-Lip. RESULTS A statistically significant decrease was found in the serum lipid levels at 6 months (P<0.05). In contrast, the average IIEF scores (24.7 +/- 6.4 at baseline) had increased to 25.0 +/- 4.9 and 26.1 +/- 5.9 at 6 and 12 months of follow-up, respectively. Although the parasympathetic activities increased and sympathetic activities decreased with atorvastatin treatment, these changes were not statistically significant (P>0.05). In paired comparison, significant differences were found among the IIEF scores of the three periods (P = 0.013). The difference was more evident after 6 months of treatment (IIEF1vs2 = 0.475; IIEF1vs3 = 0.027; IIEF2vs3 = 0.012). CONCLUSIONS Although improvement in the lipid profile occurred early during the statin treatment, restoration of erectile function appeared later, which Could be attributed to the restoration of endothelial functions by lowered serum lipid levels.
Efficacy of clomipramine, sertraline and terazosin treatments in premature ejaculation
(Tubitak Scientific & Technical Research Council Turkey, 2008) Tuncel, Altug; Aslan, Yilmaz; Basar, M. Murad; Atan, Ali
Aim: To compare the efficacy of oral domipramine, sertraline and terazosin to placebo in premature ejaculation. Materials and Methods: A total of 90 patients aged from 20 to 58 years were enrolled in this study. Patients were randomized into 4 groups. Group 1 (n: 22) took placebo and served as controls. Group 2 (n: 23) patients took 25 mg clomipramine HCl nightly; Group 3 (n: 20). 50 mg sertraline nightly; and Group 4 (n: 25) 5 mg terazosin nightly. The medications were used for two months. After 8 sexual attempts, the patients' clinical responses were assessed using the patient self-description method. Clinical responses were classified as "no change", "improvement" and "under control". Success was described as improvement + under control. Results: Success rates were 36.3% in Group 1, 91.3% in Group 2, 90% in Group 3 and 76% in Group 4. Although the efficacy of each medical treatment was superior to placebo (P = 0.001), no significant difference in efficacy was found between the medical treatment groups (P = 0.537). Conclusions: Clomipramine, sertraline and terazosin are more efficient than placebo. No significant difference was observed in terms of efficacy among these three medical treatments.
Endogenous sex steroids and bone mineral density in healthy men
(Elsevier France-Editions Scientifiques Medicales Elsevier, 2006) Keles, ışık; Aydin, Gülümser; Basar, M. Murad; Hayran, Mutlu; Atalar, Ebru; Orkun, Sevim; Batislam, Ertan
Objective. - To evaluate the role of endogenous sex steroids on bone mineral density (BMD) in healthy Turkish men. Methods. - Serum total testosterone (TT), free testosterone (FT), dehydroepiandrosterone sulfate and estradiol levels were assayed in 174 healthy men of 240 volunteers, aged 22-76 years. Dual-energy X-ray absorptiometry was used to measure the BMD (g/cm(2)) of lumbar spine, femoral neck and non-dominant proximal and distal radius-ulna sites. Linear regressions were conducted using each BMD site as the dependent variable and each sex. steroid as the independent variable. Four models were run for each bone site and sex steroid; crude, age-adjusted, adjusted for age and body mass index (BMI), and adjusted for age, BMI and cigarette-smoking. Results. - The mean age and BMI of men enrolled in the study were 47.7 +/- 13.7 years and 26.9 +/- 3.6 kg/m(2). Log of FT was significantly associated with the BMD of distal forearm in all models analyzing the crude and adjusted effects. Dehydroepiandrosterone sulfate effect on BMD of proximal forearm came closer to the level of statistical significance when adjusted with age, BMI and cigarette-smoking. Estradiol and TT levels were not found to be associated with BMD of any sites measured. Conclusion. - Among the endogenous sex steroids in men, predominantly FT seems to be one of the determinants of BMD. Therefore a decrease in serum levels of testosterone in aging male or secondary causes may negatively affect BMD. (c) 2005 Published by Elsevier SAS.
Hereditary haemochromatosis gene (HFE) H63D mutation shows an association with abnormal sperm motility
(Springer, 2009) Gunel-Ozcan, Aysen; Basar, M. Murad; Kisa, Ucler; Ankarali, Handan C.
The aim of this study was to screen infertile men for HFE H63D mutation in correlation with clinical characteristics of infertile men (sperm concentration, sperm motility, morphology, testicular volume, Follicle Stimulating Hormone (FSH), Luteinizing Hormone (LH) and total Testosterone levels) and find out if the HFE H63D mutation has an effect on male infertility. After excluding hormonal treatment, any scrotal pathology, having any systemic diseases such as diabetes mellitus, sickle cell anemia and microdeletions of the Y chromosome, a total of 148 infertile men with age range between 17 and 52-years-old (average age 29.6 +/- A 7.2) were enrolled into the study. Our analysis indicates that the mean FSH levels are significantly higher (6.3 +/- A 4.6 mIU/ml, P = 0.03), whereas sperm motility is significantly lower (36.6 +/- A 28.1%, P = 0.01) in the infertile men with the HFE H63D mutation compared with subjects lacking this mutation. Comparison of allele frequencies of the infertile men with Ts < 50% versus the infertile men with Ts > 50% revealed a significant difference as expected (P = 0.001, OR = 0.14, %95 CI = 0.04-0.44). Comparison of allele frequencies of infertile men with abnormal sperm motility versus infertile men with normal sperm motility revealed a highly significant difference (P = 0.005, OR = 3.11, %95 CI = 1.41-6.86). Thus, the HFE H63D mutation seems to be an important risk factor for impaired sperm motility and is clinically associated with male infertility.
Local anesthesia in transrectal ultrasound-guided prostate biopsy: EMLA cream as a new alternative technique
(Informa Healthcare, 2005) Basar, Hülya; Basar, M. Murad; Özcan, Şaziye; Akpinar, Serpil; Basar, Halil; Batislam, Ertan
Objectives. The aims of the present study were to evaluate the efficacy of eutectic mixture of local anesthetics ( EMLA) cream in transrectal-guided prostate biopsy and to compare its effect with that of other injectable anesthetic procedures. Material and methods. Eighty male patients with prostate-specific antigen (PSA) levels >4 ng/ml or who had prostate nodules on digital rectal examination were randomly divided into four groups. In Group 1 ( controls), prostate biopsy was performed after application of a placebo cream. In Group 2, local surface anesthesia with EMLA cream was performed 15 min before biopsy. Periprosthetic nerve blockade was performed with 1% prilocaine and 1% lidocaine in Groups 3 and 4, respectively. Pain was evaluated using a visual analog scale (VAS) after each core biopsy. In addition, blood pressure, heart rate and oxygen saturations were recorded after each biopsy and then at 5-min intervals for 15 min. Results. Average VAS scores in Groups 1-4 were 5.5, 2.9, 2.4 and 2.2, respectively. There was a statistically significant difference in VAS scores between the treatment groups and the placebo group (p=0.000). There were no statistically significant differences in VAS scores between the three treatment groups (p(2-3) = 0.126, p(2-4) = 0.303, p(3-4) = 0.537). We detected no statistically significant differences between the groups based on the hemodynamic data (p(MAP) = 0.899). Moreover, these measurements did not show statistically significant changes with time in any of the groups (p > 0. 05). Conclusion. Intrarectal application of EMLA cream provides equal anesthesia to periprostatic nerve blockade with prilocaine and lidocaine.
Magnetic Resonance Imaging (MRI) in penile metastases of extragenitourinary cancers
(Springer, 2006) Kendi, Tuba; Batislam, Ertan; Basar, M. Murad; Yılmaz, Erdal; Altınok, Deniz; Basar, Halil
Background: The aim of present study is to evaluate the efficacy of magnetic resonance imaging (MRI) in different types of penile metastases. Materials and methods: In this report, we present three cases of penile metastases that have been developed secondary to extragenitourinary malignancies. Two of them did not have any primary malignancy history. Results: Penile biopsies were performed in all patients and metastatic penile tumours were found due to extragenitourinary malignancies. Penile MRI was performed before biopsies. The findings of MRI were correlated with histopathologic diagnosis. Moreover, penile MRI was found to be more sensitive in the evaluation of the lesions than ultrasonography. Conclusion: MRI can be accepted as a reliable non-invasive method for the evaluation of the extent of penile metastases and involvement of tunica albuginea or urethral.
Preparation and Characterization of Infection-Resistant Antibiotics-Releasing Hydrogels Rods of Poly[hydroxyethyl methacrylate-co-(poly(ethylene glycol)-methacrylate]: Biomedical Application in a Novel Rabbit Penile Prosthesis Model
(Wiley, 2008) Arica, M. Yakup; Tuglu, Devrim; Basar, M. Murad; Kilic, Dilek; Bayramoglu, Guelay; Batislam, Ertan
In this work, preparation and characterization of novel three different antibiotic loaded penile prosthesis in the rod form were investigated by copolymerization of 2-hydroxyethylmethacrylate (HEMA) with poly(ethylene glycol)-methacrylate, (PEG-MA). To achieve this goal, a series of novel copolymer hydrogels were prepared in rod form using HEMA and PEG-MA monomers via UV initiated photopolymerization. The thermal stability of the copolymer was found to be lowered by increase in the ratio of PEG-MA in the rod structure. Contact angle measurements on the surface of copolymer hydrogel demonstrated that the copolymer gave rise to a significant hydrophilic surface compared with pure poly(HEMA). The blood protein adsorption and platelet adhesion were significantly reduced on the surface of the copolymer hydrogels compared with control pure poly(HEMA). Poly(HEMA:PEG-MA;1:1)-1 formulation containing different antibiotics (20 mg antibiotic/g polymer) released about 90, 91, and 55% of the total loaded cephtriaxon, vancomycin, and gentamicin in 48 h at pH 7.4, respectively. Finally, antibiotics loaded biocompatible poly(HEMA:PEG-MA;1:1)-1 hydrogel compositions was used as a penile prosthesis in preventing cavernous tissue infections in a rabbit prosthesis model. The efficacy of the three different antibiotics loaded hydrogel system was evaluated in four different groups of rabbits, in which various infectious agents were inoculated. The animals were sacrificed after predetermined time periods, and clinical, histological and microbiological assessment on the implant side were carried out to detect infections. Eventually, we concluded that three different antibiotic loaded penile prostheses (i.e. poly(HEMA:PEG-MA;1:1)-1 hydrogel systems) were as effective as parenteral antibiotics applications. (C) 2007 Wiley Periodicals, Inc.
Relationship between nocturnal penile tumescence parameters, International Index of Erectile Function symptom scores and sildenafil responses
(Informa Healthcare, 2006) Basar, M. Murad; Tuğlu, Devrim; Yılmaz, Erdal; Başar, Halil; Batislam, Ertan
Objective. To evaluate the correlation between International Index of Erectile Function (IIEF) questionnaire scores, nocturnal penile tumescence parameters and sildenafil response in patients with erectile dysfunction using a minimal investigations approach. Material and methods. A total of 97 patients without any risk factors for erectile dysfunction were included. After completing the IIEF questionnaire, nocturnal penile tumescence monitoring was performed in all patients for 1 or 2 nights. Subsequently, sildenafil was given at a dosage of 50 or 100 mg according to the response. The relationship between nocturnal penile tumescence results, the severity of erectile dysfunction according to the IIEF questionnaire and sildenafil response was evaluated using Pearson's chi(2) test. Results. Based on the questionnaire scores, 25 patients (25.8%) had mild, 44 (45.4%) had moderate and 28 (28.8%) had severe erectile dysfunction. Forty-four patients (45.4%) had normal and 53 (54.6%) had abnormal parameters after nocturnal penile tumescence recording. The sildenafil response was positive in 63 patients (64.9%) who were given 50 mg and in 26 (26.8%) who were given 100 mg. However, eight patients (8.2%) did not respond to sildenafil. While the severity of erectile dysfunction according to IIEF scores and the sildenafil response did not show any correlations with nocturnal penile tumescence results, there was a statistically significant relationship between sildenafil response and the severity of erectile dysfunction. Conclusion. Changing concepts in the evaluation of ED have resulted in the use of effective therapeutic applications consistent with the degree of symptoms of patients without the waste of time caused by performing expensive, invasive, ineffective and time-consuming diagnostic tests.
Relationship between sexual dysfunction and psychiatric status in premenopausal women with fibromyalgia
(Elsevier Science Inc, 2006) Aydın, Gülümser; Basar, M. Murad; Keleş, Işık; Ergun, Gülbahar; Orkun, Sevim; Batislam, Ertan
Objectives. To evaluate the possible relationship between the sexual and psychiatric status of premenopausal female patients with fibromyalgia compared with healthy controls. Methods. A total of 48 female patients with fibromyalgia and 38 age-matched healthy controls were enrolled in the study. All the subjects were asked to complete the Female Sexual Function Index (FSFI) for sexual status and the State-Trait Anxiety Inventory (STAI) and Beck Depression Inventory (BDI) for psychiatric assessment. Serum biochemical analysis was done, and the serum hormonal levels were analyzed. Results. The mean BDI score for patients was significantly greater than the score for the controls (P 0.017) and the mean FSFI score was significantly lower than the score for the controls (P = 0.001). According to the FSFI data, female sexual dysfunction was found in 26 patients (54.2%) with fibromyalgia and only 6 controls (15.8%), a significant difference (Pearson chi-square = 14.46, P = 0.000). When the subscores of each domain of FSFI were evaluated, the most common sexual problem was diminished desire in patients (n = 30, 62.5%) and controls (n = 11, 28.9%). In the correlation analysis, the FSFI score showed a significant negative correlation with the BDI (r = -0.337, P = 0.002) and STAI (r = -0.413, P = 0.004) scores. No significant correlation was revealed between the FSFI and BDI or FSFI and STAI scores in the controls. Conclusions. Depression is one of the emotional disorders commonly encountered in women with fibromyalgia, most possibly leading to sexual dysfunction. Thus, sexual dysfunction related to impaired psychiatric status should be considered a common problem in premenopausal women with fibromyalgia.
Serum homocysteine levels and sildenafil 50 mg response in young-adult male patients without vascular risk factors
(Natl Inst Science Communication-Niscair, 2013) Basar, M. Murad; Ozkan, Yesim; Kisa, Ucler; Simsek, Bolkan
The aim of the present study was to investigate serum homocysteine levels in patients with erectile dysfunction and to evaluate the relationship between serum homocysteine levels and response to the standard 50 mg phosphodiesterase 5 inhibitor treatment. Twenty-eight erectile dysfunction patients having normal vascular parameter according to Penile Doppler Ultrasonography and twenty healthy subjects were enrolled in the study. All subjects filled The International Index of Erectile Function (IIEF) questionnaire. A total of 4-6 doses of phosphodiesterase 5 inhibitor (sildenafil 50 mg) were given to patients. Later, they were divided into two groups as sildenafil responder and non-responder. Serum homocysteine levels were compared in groups based on sildenafil response: Compared with healthy subject, higher homocysteine levels were observed in patients with erectile dysfunction (p = 0.005), especially in sildenafil non-responder group (p = 0.005). There was significant negative correlation between homocysteine and TIFF scores in group responder to sildenafil treatment (r = -0.698, p = 0.008). Mean IIEF scores of patients with non-responder to sildenafil 50 mg were lower than those of controls (p = 0.0001), but mean IIEF scores of patients with responders approached values observed in control subjects (p = 0.002). The results indicated that measurement of serum homocysteine levels could be used as a marker for the evaluation of efficacy of phosphodiesterase 5 inhibitor and the selection of efficacious alternative therapies.

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