Publications by authors named "Sinan Levent Kirecci"

19 Publications

  • Page 1 of 1

The fate of paratesticular masses: 13 years' experience in a tertiary referral centre.

Aktuelle Urol 2021 Apr 14. Epub 2021 Apr 14.

Şişli Hamidiye Etfal Training and Research Hospital, Urology, Şişli, Turkey.

Objective: Paratesticular neoplasms exhibit different behaviours, depending on the embryological tissue of origin. Treatment modalities can depend on the differential diagnosis. The aim of this study is to present the clinical, morphological and histopathological features of patients with paratesticular masses and their follow-ups and is intended to increase awareness of the issues.

Methodology: We included 31 excisions of paratesticular masses, after radiological diagnosis as paratesticular mass in our hospital between 2007-2020. Information on treatment modalities, tumour recurrence, metastasis, and survival rates were obtained from hospital archives. All patients were evaluated by taking patients' history, physical examination, scrotal ultrasound, chest radiography, and serum tumour markers. Treatment modality was selected according to intraoperative findings. Haematoxylin-eosin sections were examined, and immunohistochemical analyses were performed for smooth muscle actin, desmin, Ki67, CD34, S100, and myogenin. Ten high-power fields were counted to document Ki67 and p53 nuclear positivity rates.

Results: A total of 31 operations were performed with recurrence in three patients. Histomorphological and immunohistochemical examination revealed eleven malignant masses; eight rhabdomyosarcomas, a leiomyosarcoma, a liposarcoma and a large B cell lymphoma. Other excised masses were benign and infective lesions.

Conclusion: Paratesticular masses are heterogeneous tumours that follow different clinical courses. Clinicians must be aware of this histological diversity in order to plan a treatment pathway. This study is one of the largest published series, with a long follow-up period. It shows that the most critical features in determining prognosis are histopathological subtype and tumour grade.
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http://dx.doi.org/10.1055/a-1345-6808DOI Listing
April 2021

Sexual intercourse before exercise has a detrimental effect on lower extremity muscle strength in men.

Postgrad Med J 2021 Apr 1. Epub 2021 Apr 1.

Urology, University of Health Sciences Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey.

Introduction: The question of whether sexual intercourse can harm athletic performance is a long-debated topic since first sport competitions were invented. Therefore, due to the lack of solid evidence, we aimed to evaluate the effects of sexual intercourse on muscle training performance.

Materials And Methods: Physically and sexually active, 50 men (age=29.3±1.14 years) were enrolled in the study. Participants completed three weight training sessions and all sessions were at the same time of the day. The maximum weight was adjusted in the first session. In the second and third sessions, they performed five repetitions of the squat with their maximum weight for each set with a total of five sets after participating in and abstaining from sexual intercourse the night before, respectively. The duration of sexual intercourse was measured with a stopwatch.

Results: The mean duration of sex was measured to be 13.8±3.61 min. Furthermore, the mean lifted weight before sex was calculated to be 109.4±11.41 kg and the mean lifted weight after sex was calculated to be 107±11.05 kg. According to obtained data, sexual intercourse has a significant detrimental effect on maximum weight in squat training (p=0001).

Conclusion: Results demonstrate that sexual intercourse within 24 hours before exercise have detrimental effect on lower extremity muscle force, which suggests that restricting sexual activity before a short-term activity may be necessary.
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http://dx.doi.org/10.1136/postgradmedj-2020-139033DOI Listing
April 2021

Regression of the Sweet's syndrome after Bacillus Calmette-Guérin therapy: A bladder cancer case report.

Urol Case Rep 2020 Jul 9;31:101202. Epub 2020 Apr 9.

University of Health Sciences Sisli Hamidiye Etfal Training and Research Hospital Urology Department Istanbul Turkey, Turkey.

The Sweet's syndrome is a rare dermatosis which can be related to underlying malignancies. In this case we presented a case, who applied to our clinic with severe dermatosis and hematuria. We diagnosed high grade non-muscle invasive bladder tumor, which was treated with transurethral resection of bladder-tumor and six cycle of Bacillus Calmette-Guérin therapy. After the treatment the dermatosis was regressed almost completely. However, recurrent bladder tumor was detected at the first control cystoscopy.
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http://dx.doi.org/10.1016/j.eucr.2020.101202DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7163327PMC
July 2020

The rupture of an abdominal aortic aneurysm at the level of horseshoe kidney: A case report.

Urol Case Rep 2020 May 23;30:101110. Epub 2019 Dec 23.

University of Health and Sciences Sisli Etfal Traning and Research Hospital Urology Department Istanbul, Turkey.

Kidney anomalies are always a challenge even for the most experienced vascular and urologic surgeons in the reconstruction of the abdominal aortic segment. In the literature, the most common anomalies of the kidney are the horseshoe kidney.

The Case: A 77-year-old male headed to the emergency department with complaints of acute abdominal pain and sudden onset of fatigue. The enhanced CT-scan performed and the horseshoe kidney with the ruptured aortic aneurysm seen. The cardiovascular and transplantation surgery team decided to perform explorative surgery.
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http://dx.doi.org/10.1016/j.eucr.2019.101110DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7066202PMC
May 2020

First live donor nephrectomy with abdominal tortuous aorta and two renal arteries: A renal transplantation case report.

Urol Case Rep 2020 Mar 11;29:101097. Epub 2019 Dec 11.

Health Sciences University, Sisli Hamidiye Etfal Training and Research Hospital, Department of Pediatric Surgery, Istanbul, Turkey.

46-year-old wife (donor) and 52-year-old husband (recipient) admitted to our clinic for kidney transplantation. CT angiography of the donor showed us there were bilateral renal double artery and a tortuous aorta that is deviated to the left side. The main artery cannot be reached by laparoscopy because of the upper level of renal artery and deviation of the aorta and an open conversion was performed. Presence of tortuous aorta with multiple renal arteries makes laparoscopic donor nephrectomy a challenging procedure even preformed by an experienced surgeon. The possibility of open conversion should always be kept in mind in these cases.
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http://dx.doi.org/10.1016/j.eucr.2019.101097DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6931104PMC
March 2020

Sarcoidosis is a rare cause of infertility: A case report.

Urol Case Rep 2020 Jan 1;28:101065. Epub 2019 Nov 1.

University of Health Sciences Sultan Abdulhamid Han Training and Research Hospital Istanbul, Turkiye.

In this paper, we presented a patient, who applied to our clinic because of infertility. After an intensive investigation, we diagnosed systemic sarcoidosis with testicular involvement. Urogenital sarcoidosis is a rare and insidious condition, however, it can lead to infertility. Therefore, following the diagnosis, we applied systemic steroid therapy to the patient. Within one year, the patient had a child without assisted reproductive techniques. According to our experience, in this case, we concluded that infertility without an etiology should be investigated elaborately. Furthermore, urogenital sarcoidosis should keep in mind as a rare etiology.
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http://dx.doi.org/10.1016/j.eucr.2019.101065DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6864313PMC
January 2020

A purely penoscrotal approach: Reservoir placement of an inflatable penile prosthesis (IPP) in an orthotopic neobladder patient. Case report.

Arch Ital Urol Androl 2019 Oct 2;91(3). Epub 2019 Oct 2.

Department of Urology, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Science, Istanbul.

Introduction: The inflatable penile prosthesis (IPP) is the last step in drug-resistant erectile dysfunction treatment. IPP implantation can be challenging, especially following a cystoprostatectomy with an orthotopic neobladder. There is no consensus about surgical techniques for placement of an IPP reservoir in such patients. In this paper, we present a case of an IPP and reservoir placement with a single penoscrotal incision.

Case: A 55-year-old patient, who underwent radical cysto-prostatectomy with an orthotopic neobladder seven years ago, presented with severe erectile dysfunction. His oncologic status was stable, and he was in remission. He also had high blood pressure and took medication for it. He previously used different medical treatments, such as oral phosphodiesterase-5 inhibitors (PDE5i), intraurethral prostaglandin E2 (PGE2) installations, and Trimix injections. As far as we know, he had no benefit from these treatments. A three-piece IPP was recom- mended. After a discussion of surgical techniques, we chose the penoscrotal approach, and the ectopic reservoir was placed through the inguinal canal, guided by a forefinger.

Results: The total operative time was 60 minutes, and the estimated blood loss was minimal. There were no perioperative complications. The patient was discharged on postoperative day one. He could start to use the IPP in the first month. His sexual and urinary functions were normal, and there was no abdominal bulging from the ectopic reservoir at the three-month follow-up.

Conclusions: In conclusion, ectopic placement of the reservoir through a single penoscrotal incision appears to be a safe and acceptable surgical technique for postoperative ED following a radical cystoprostatectomy with an orthotopic neobladder.
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http://dx.doi.org/10.4081/aiua.2019.3.191DOI Listing
October 2019

Kidney Transplantation Outcomes in Temporarily Protected Syrian Patients With End-Stage Renal Failure in Turkey.

Transplant Proc 2019 Sep 26;51(7):2279-2282. Epub 2019 Jul 26.

Nephrology Department, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey.

Background: Approximately 6.3 million Syrian people migrated to other countries due to war since 2011. There are more than 3.5 million Syrian people living in Turkey under temporary protection. Syrian people receive free health care in Turkey, including kidney transplantation. Our institution started a kidney transplantation program about 3 years ago. It is the first institution performing living, related kidney transplantation for Syrian patients with end-stage renal failure.

Methods: All living, related kidney transplantations to Turkish and Syrian patients from the beginning of our transplantation program until September 2018 were enrolled in this study. Donor and recipient characteristics, induction and maintenance immunosuppression, length of hospital stay, creatinine values at first week and first month, treatment incompatibility, and graft survival were evaluated.

Results: Of the 25 living, related kidney transplantations 20% were Syrian. Three of 5 Syrian recipients were in the pediatric age group. None of the Syrian transplantations were preemptive, while half of the Turkish transplantations were preemptive (P = .005). Immunosuppression protocols, creatinine values, length of hospital stay, and graft survival rates were similar between groups. None of the Syrian recipients had treatment incompatibility (0%), unlike the Turkish recipients (15%).

Conclusion: Outcomes of kidney transplantation for Syrian recipients are similar to those of Turkish recipients. Having this no-cost facility is great for Syrian kidney failure patients. The number of transplantations for Syrian patients under temporary protection in Turkey is expected to increase in the future, with these favorable results and easy to access, free health care facilities.
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http://dx.doi.org/10.1016/j.transproceed.2019.01.194DOI Listing
September 2019

Plication without degloving - Safe and effective approach for correcting lateral and dorsal penile curvature: Case series.

Urol Ann 2019 Apr-Jun;11(2):217-218

Department of Urology, Şişli Hamidiye Etfal Training and Research Hospital, University of Health Science, Istanbul, Turkey.

Penile curvature deformities are often manageable with surgical reconstruction methods. We aimed to show the safety and efficacy of ventral and dorsal plication techniques without degloving in our two patients who have penile curvature. Two young adults, aged 20 and 23 years, presented to our clinic with lateral and dorsal penile curvatures. This problem has been sustaining since their teenage. Following the required preparations, two surgical techniques were used, namely Nesbit and Lue's "16-dot" technique. Patients completed a satisfaction survey at a mean of 6 months later the surgery. Although both patients reported a subjective decrease in penile length, their satisfaction rate was high. Penile plication without degloving is a safe and effective technique for correcting dorsal and lateral penile curvatures.
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http://dx.doi.org/10.4103/UA.UA_181_17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6476212PMC
May 2019

The rarest phenomenon of flexible ureterolithotripsy: Kidney stone in supernumerary type combination with a horseshoe kidney.

Urol Ann 2017 Oct-Dec;9(4):384-386

Department of Urology, Urology Clinic, Sisli Hamidiye Etfal Research and Training Hospital, University of Health Sciences, Istanbul, Turkey.

The horseshoe kidney (HSK) is common and supernumerary kidney is the rarest developmental anomaly of the urogenital system. The supernumerary kidney in a HSK conjunction is extremely rare, and prevalence of it is unknown. A review of literature, there have been a few case reports about the supernumerary and HSK combination, however, none of which also had a concomitant kidney stone and obstructive pathology. Our case indicated that patient referred to flank pain and visible hematuria to our clinic, and further investigations demonstrate supernumerary kidney in a horseshoe configuration and kidney stone. Kidney stone could not be found at the first attempt because of the anatomical malformation. Retrograde pyelography showed ureteral branching and helps to define the placement of stone. This stone was fragmented with flexible ureteroscopy in the lower pole of the middle kidney in the second session. There was no stone fragments absence at the 1-month control. This exceedingly rare type case should be evaluated meticulously on preoperative duration otherwise can be a challenge for surgeons. Visualize pelvicalyceal system under the fluoroscope is a vital step in this regard to being guidance during the procedure.
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http://dx.doi.org/10.4103/UA.UA_56_17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5656967PMC
November 2017

Evaluation of per-operative cough stress test during transobturator mid-urethral sling surgery.

Arch Ital Urol Androl 2017 Oct 3;89(3):222-225. Epub 2017 Oct 3.

Bakirkoy Sadi Konuk Research and Training Hospital, Department of Urology.

Purpose: Currently, it is unclear how the mesh tension should be adjusted on the transobturator tape surgery (TOT) for improving continence. The aim of this study was to evaluate the effects of per-operative cough stress test on TOT.

Materials And Methods: Between March 2007 and December 2011, 206 women with SUI were enrolled in this study. Patients were randomly categorized to treatment with TOT (96) or TOT with cough stress test (110). The IIQ-7 and the UDI-6 were used to identify satisfaction level. At the end of 1st year, two groups were compared patient characteristics, operation time, duration of hospital stay, cure and complication rates.

Results: The cure rate was 84.37% 81/96) versus 83.63% (92/110) in TOT and TOT with cough test groups, respectively. Postoperatively ten patient (10/110, 9.09%) suffered voiding difficulties (> 250 ml residual urine) in TOT with cough stress test group. Five patients were discharged with transurethral catheter, whereas, in traditional TOT group, two patients (2/96, 2.1%) had transient postoperative voiding difficulty and two patients were treated with repeated catheterization for 1 week (p < 0.05). Postoperative groin pain was present in 7/96 (8%) versus 24/110 (22%) in TOT and TOT with cough test groups, respectively (p < 0.05). TOT with cough stress test group had an higher rate of complications like, retention of urine, necessitating to cut the tape, mesh erosion and pain in groin or leg. No patient had resistant voiding difficulty or prolonged urinary retention (> 1 week) in traditional TOT group.

Conclusions: We believe that per-operative cough stress test leads to overtreatment of stress urinary incontinence when the complication rates were considered.
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http://dx.doi.org/10.4081/aiua.2017.3.222DOI Listing
October 2017

A rare malformation of urinary system: Right ectopic thoracic kidney.

Urol Ann 2017 Jul-Sep;9(3):299-300

Thoracic Surgery Clinic, Sisli Hamidiye Etfal Research and Training Hospital, University of Health Sciences, Sisli, Istanbul, Turkey.

An ectopic kidney is a common developmental anomaly of the urinary system. However, the thoracic kidney (TK) is the rarest state form of an aberrant kidney. The aim of this case report is defining the symptoms in TK diagnosis and constructing a treatment model will promote the best outcomes. These patients come to the physician with the various symptoms, and they could be diagnosed incidentally. In our case, we describe 40 years female patient with severe respiratory problems and upper back pain. In the pulmonary clinic, suspected mass was diagnosed with chest X-ray, and computerized tomography detected nontraumatic nonhernia associated, a truly ectopic TK. Moreover, the thoracic surgeon and urologist team decided to exploration and reconstructed the right ectopic kidney. The 1 month of the control of patient symptoms was disappeared. Overall, TK should be kept in mind in the differential diagnosis of thoracic tumors. Surgical exploration and reconstruction should be thought in patients who have severe respiratory symptoms.
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http://dx.doi.org/10.4103/UA.UA_169_16DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5532905PMC
August 2017

A rare malformation of urinary system: Right ectopic thoracic kidney.

Urol Ann 2017 Jul-Sep;9(3):299-300

Thoracic Surgery Clinic, Sisli Hamidiye Etfal Research and Training Hospital, University of Health Sciences, Sisli, Istanbul, Turkey.

An ectopic kidney is a common developmental anomaly of the urinary system. However, the thoracic kidney (TK) is the rarest state form of an aberrant kidney. The aim of this case report is defining the symptoms in TK diagnosis and constructing a treatment model will promote the best outcomes. These patients come to the physician with the various symptoms, and they could be diagnosed incidentally. In our case, we describe 40 years female patient with severe respiratory problems and upper back pain. In the pulmonary clinic, suspected mass was diagnosed with chest X-ray, and computerized tomography detected nontraumatic nonhernia associated, a truly ectopic TK. Moreover, the thoracic surgeon and urologist team decided to exploration and reconstructed the right ectopic kidney. The 1 month of the control of patient symptoms was disappeared. Overall, TK should be kept in mind in the differential diagnosis of thoracic tumors. Surgical exploration and reconstruction should be thought in patients who have severe respiratory symptoms.
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http://dx.doi.org/10.4103/UA.UA_169_16DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5532905PMC
August 2017

Selective Nuclear Factor Kappa b (NFkB) Inhibitor, Pyrrolidium Dithiocarbamate Prevents, Long-Term Histologic Damage in Ischemia-Reperfusion Injuries after Delayed Testicular Torsion.

Urol J 2016 Jun 28;13(3):2702-6. Epub 2016 Jun 28.

Department of Pathology, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey.

Purpose: Nuclear factor kapa b (NFKB) is a transcription factor that is required for cytokine-mediated induction of the human inducible nitric oxide synthase (iNOS) gene. Recent studies have shown that in the pathophysiology of ischemia-reperfusion (IR) injuries NFKB is involved. In our study we aimed to determine the efficacy of the selective NFKB inhibitor, pyrrolidium dithiocarbamate (PDTC), on long-term histological damage in testicular IR injuries.

Materials And Methods: Twenty-one adult male Wistar albino rats were divided into 3 equal groups. In groups 1-2, the left testes in rats underwent 4 hours of 720° experimental torsion. In group 2, PDTC (100 mg/kg) was administered intraperitoneally in the last 1 hour before detorsion; and group 3 underwent a sham operation. All rats underwent bilateral orchiectomy 45 days after the experiment. The testes weights were measured and compared to the other groups and their contralateral values. Testes samples were fixed with Bouin solution for histological (Johnsen score) and immunohistochemical examination. Immunohistochemically iNOS and an active subunit of NFKB, p65 were evaluated using mouse primary monoclonal antibodies and were evaluated semi quantitatively.

Results: Testicular weights and Johnsen scores in ipsilateral testes were 0.67 ± 0.85, 1.54 ± 0.11, 1.84 ± 0.64 and 1.63 (1-4), 6.94 (4-10), 5.29 (1-9) in the torsion, sham and PDTC groups, respectively. In contralateral testes the same values were 1.74 ± 0.84, 1.59 ± 0.13, 1.50 ± 0.54 and 5.38 (2-8), 7.17 (5-10), 6.30 (4-9). Testicular weights and Johnsen scores were significantly different in the ipsilateral torsion group (P < .05). In the PDTC group testicular weights and Johnsen scores were similar with the control group (P > .05). Immunohistochemically there was marked staining in the iNOS and p65 expressions in the torsion group compared with group 2 and 3. In rats administered PDTC, iNOS and p65 expressions were significantly reduced compared with the torsion group. There were no significant differences between the histological and immunohistochemical results of groups 2 and 3.

Conclusion: This data suggests that IR induces iNOS expressions through the activation of NFKB, p65. The NFKB pathway plays major role in testicular reperfusion injuries. It is possible to prevent reperfusion injuries using selective the NFKB inhibitor. .
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June 2016

Female sexual function after transobturator tape in women with urodynamic stress urinary incontinence.

Springerplus 2014 30;3:570. Epub 2014 Sep 30.

Department of Urology, Haseki Research and Training Hospital, Millet Cad. No: 11, Fatih, Istanbul 34098 Turkey.

We evaluate quality of life and sexual function before and after transobturator tape procedure (TOT) using the International Consultation on Incontinence Questionnaire (ICIQ -SF) and Female Sexual Function Index (FSFI). Between 2008 and 2013, 92 patients with stress urinary incontinence (SUI) underwent TOT procedure. A total of 81 patients were sexual active and enrolled in the study. All patients completed the Turkish translation ICIQ -SF and FSFI forms before and 1, 3, 6, 12 months after surgery. To evaluate the impact of incontinence and TOT success on sexual function, we compared patients that were dry after surgery and patients still incontinent and/or facing complication. All 81 patients completed the study protocol. The total FSFI score was 21.3 ± 7.9 and statistically significant when compare with preoperative total FSFI score (16.2 ± 7.9). The mean postoperative ICIQ -SF score (2 ± 2.9) was also significantly lower than the mean preoperative ICIQ -SF score (17.3 ± 1.8). Complications were encountered in 13 patients, including vaginal erosion (4 patients), de novo urge incontinence (4 patients), vesico-vaginal fistula (1 case), cysto-rectocele (1 case) and high postoperative residue requiring mesh excision (3 patients). Continent (n = 68) patients had a significantly better postoperative total FSFI and ICIQ -SF score against patients who had urine loss. Our study found a significant improvement of FSFI score and ICIQ -SF score after TOT operation in women with SUI. Additionally, urine loss due to complications was related with worsened FSFI score and ICIQ score compare with healthy patient's scores.
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http://dx.doi.org/10.1186/2193-1801-3-570DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4193969PMC
October 2014

Results of tension-free vaginal tape for recurrent stress urinary incontinence after unsuccessful transobturator tape surgery.

J Obstet Gynaecol Res 2014 Jun;40(6):1764-9

Department of Urology, Haseki Research and Training Hospital.

Aim: The aim of this study was to evaluate cure rate and mid-term results of tension-free vaginal tape for recurrent stress urinary incontinence after failed transobturator tape surgery.

Material And Methods: Between January 2006 and December 2011, 42 women were enrolled in this study. Patient characteristics and operating parameters were recorded, and any complications were noted. All patients were followed up for at least 24 months after the second surgery. The Incontinence Impact Questionnaire and the Urinary Distress Inventory were used to identify satisfaction level.

Results: The mean age of the patients was 49.07 ± 8.6 years, and median period between transobturator surgery and the tension-free vaginal tape procedure was 12.8 (range 9.2-17.8) months. The cure rate was 83.3% and 76.2% at the first- and second-year follow-up visits, respectively. Intraoperative complications were transient and slight. Bladder injury in five patients and subcutaneous hematoma above the pubis in two patients were the most serious complications, but they were managed conservatively. We found the scores of the Incontinence Impact Questionnaire and Urinary Distress Inventory to be significantly lower at follow-up, compared to the preoperative assessment. De novo urgency was the most common complaint at follow-up and occurred in 11.9% of the women.

Conclusions: We suggest that tension-free vaginal tape is a feasible surgical option for recurrent stress urinary incontinence. Further studies with larger patient numbers and longer follow-up periods are needed to support this finding.
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http://dx.doi.org/10.1111/jog.12410DOI Listing
June 2014

Comparison of paroxetine and dapoxetine, a novel selective serotonin reuptake inhibitor in the treatment of premature ejaculation.

Asian J Androl 2014 Sep-Oct;16(5):725-7

Department of Urology, Haseki Research and Training Hospital, Fatih, Istanbul, Turkey.

Dapoxetine hydrochloride is a selective serotonin reuptake inhibitor and the first drug approved for the on-demand treatment of premature ejaculation (PE). Our objective in this study was to characterize the efficacy of on-demand dapoxetine (30 and 60 mg) and daily paroxetine (20 mg) usage in treating PE. We conducted a 1 month study involving a total of 150 patients. Patients were divided into three groups of 50. Group 1 were treated with on-demand dapoxetine (30 mg), Group 2 with on-demand dapoxetine (60 mg) and Group 3 with daily paroxetine (20 mg). Our outcome measurement was increased from baseline intravaginal ejaculatory latency time (IELT) after treatment. The IELT increased from baseline to posttreatment by 117%, 117% and 170% in the paroxetine group (P < 0.01), 30 mg dapoxetine group (P < 0.01) and 60 mg dapoxetine group (P < 0.01), respectively. The increase from baseline IELT were similar for the 30 mg dapoxetine and paroxetine groups (P > 0.05), while the 60 mg dapoxetine group had a larger posttreatment IELT increase compared with the 30 mg dapoxetine (P < 0.05) and paroxetine (P < 0.01) groups. Dapoxetine (60 mg) 1-3 h before planned intercourse is a very effective treatment modality for PE. However, an on-demand dose of 30 mg dapoxetine is no more effective than the currently prescribed paroxetine treatment.
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http://dx.doi.org/10.4103/1008-682X.128467DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4215669PMC
June 2015

Relationship between plasma melatonin levels and the efficacy of selective serotonin reuptake inhibitors treatment on premature ejaculation.

Int J Urol 2014 Sep 8;21(9):917-20. Epub 2014 Apr 8.

Department of Urology, Sisli Etfal Research and Training Hospital, Istanbul, Turkey.

Objectives: To examine the relationship between premature ejaculation and plasma melatonin levels, and assess the efficacy of selective serotonin reuptake inhibitors in treating premature ejaculation.

Methods: A total of 60 men with lifelong premature ejaculation and 40 healthy male controls were included in the present study. For each participant, a medical history was obtained, a physical examination was carried out, and intravaginal ejaculation latency time and melatonin levels were measured. Premature ejaculation patients were randomly categorized into three treatment groups: group 1 received fluoxetine (20 mg/day), group 2 received paroxetine (20 mg/day) and group 3 received sertraline (50 mg/day).

Results: The mean baseline plasma melatonin levels in men with premature ejaculation were significantly lower than in the healthy controls (5.34 vs 14.84 pg/mL). After 4 weeks of treatment, the mean intravaginal ejaculation latency time scores for all of the premature ejaculation treatment groups showed a significant improvement from the baseline values. The plasma melatonin levels were also significantly increased (P < 0.05) from baseline (5.34 pg/mL) to 9.50 pg/mL, 10.24 pg/mL or 13.30 pg/mL for groups 1, 2 and 3, respectively.

Conclusions: Our findings show that premature ejaculation is associated with decreased plasma melatonin levels. After treatment with selective serotonin reuptake inhibitors, an increased plasma melatonin level can retard ejaculation, presumably by both central and peripheral mechanisms. This is the first study to evaluate the possible role of serotoninergic interactions on the melatoninergic system in premature ejaculation.
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http://dx.doi.org/10.1111/iju.12461DOI Listing
September 2014