A possible mechanism of erectile dysfunction in coronavirus disease-19: Cavernosal smooth muscle damage: A pilot study

INTRODUCTION

Studies have reported that coronavirus disease 2019 (COVID-19) may cause erectile dysfunction (ED), however, its role in the pathophysiology of ED has not yet been fully elucidated. We aimed to elucidate COVID-19's effects on cavernosal smooth muscle, which has a pretty important role in erection physiology, by corpus cavernosum electromyography (cc-EMG).

MATERIALS AND METHODS

Twenty-nine male patients aged 20-50 years who applied to the urology outpatient clinic due to ED were included in the study. Nine patients that had COVID-19 and were treated as outpatients were classified as group 1, 10 patients who were hospitalized due to COVID-19 were classified as group 2, and 10 patients who did not have COVID-19 were classified as the control group (group 3). Patients underwent diagnostic evaluation including International Index of Erectile Function (IIEF)-5 form, penile color Doppler ultrasonography (CDUS), cc-EMG, and fasting serum levels of reproductive hormones (07-11am).

RESULTS

According to penile CDUS and hormonal values results, there was no significant difference between the groups. According to cc-EMG results, amplitudes and relaxation capacities of the cavernosal smooth muscle of patients in group 3 were significantly higher than those in the other groups.

CONCLUSIONS

COVID-19 can cause ED not only by psychogenic and hormonal factors but also with cavernosal smooth muscle damage.

CLINICAL TRIAL REGISTRATION NUMBER

NCT04980508.

Effect of endoscopic urethral procedures applied after robotic radical prostatectomy on urinary incontinence: A prospective cohort pilot study

OBJECTIVES

The most common complications after radical prostatectomy (RP) are erectile dysfunction (ED) and urinary incontinence (UI). After RP, patients may require endoscopic urethral procedures (EUP) for other urological diseases such as hematuria, urinary system stone disease, and suspicion of bladder tumor. In clinical practice we observed that EUP performed after robot assisted RP (RARP) can cause an increase in the UI level. In this study, we investigated whether there is a change in the UI level in patients that underwent EUP after RARP and whether this change was affected by the duration of the procedure and type of endoscopic device used.

MATERIAL AND METHODS

Twenty-six patients were included who underwent EUP after RARP in this study. The patients were divided into three groups based on the endoscopic device used: group 1 rigid cystoscopy (n = 9), group 2 flexible cystoscopy (n = 7), and group 3 semi-rigid ureterorenoscopy (URS) (n = 10). The Turkish version of the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-SF) and the number of pads used daily was questioned before the EUP and 1 month after the procedure.

RESULTS

While a significant increase in ICIQ-SF score was observed in group 1 (p = 0.027), no significant increase was observed in group 2 and group 3 (p > 0.05). No significant difference was observed between the number of pads used preoperatively and the postoperative first month in all groups (p > 0.05). There was no significant correlation between increased operation time and both the pad usage and ICIQ-SF score (p > 0.05).

CONCLUSION

The use of small diameter endoscopic instruments and flexible instruments is important for patient comfort and to avoid damage to urethrovesical anastomosis in patients who need to undergo EUP after RP.

Predictive features of pre-operative computed tomography and magnetic resonance imaging for advanced disease in renal cell carcinoma

OBJECTIVE

We evaluated predictive features of pre-operative computed tomography and magnetic resonance imaging for advanced disease in renal cell carcinoma.

MATERIALS AND METHODS

92 patients with pathologically confirmed diagnosis of renal cell carcinoma were included in our study. Patients were divided into two groups according to preoperative imaging as computed tomography (CT) (55 patients) and magnetic resonance imaging (MRI) (37 patients). Within the imaging groups, the patients were divided into two groups according to pathological tumor stage: 1-2 (pT1-2) versus ≥ pT3a. It was evaluated whether there was a difference between the two groups in terms of the presence of pre-operative imaging (CT and MRI) features. Predictive value of these features for ≥ pT3a disease was evaluated both for CT and MRI.

RESULTS

The cut-off value for the Gerota's fascia thickness in predicting ≥ pT3a disease was calculated as 0.205 cm. Positive predictive value (PPV) for Gerota's fascia thickness was 52.4% (31.0-73.7) and 66.7% (40.0-93.3) for CT and MRI respectively. The PPV value for renal capsule invasion was 75.0% (53.8-96.2) and 90.0% (71.4-108.6) for CT and MRI respectively. PPV of perirenal fat invasion for CT and MRI was 69.2% (44.1-94.3) and 81.8% (59.0-104.6) respectively.

CONCLUSION

Renal capsular invasion and perirenal fat invasion are reliable signs for locally advanced (≥ pT3a) renal cell carcinoma both in CT and MRI. Gerota's fascia thickness has relatively low PPV value for prediction of locally advanced disease. Presence of enlarged collateral vessels, tumor necrosis, perinephric stranding are not reliable signs. For all predictors MRI seems more reliable than CT.

Predictive Value of Preoperative High-Sensitive C-reactive Protein (hs-CRP)/Albumin Ratio in Systemic Inflammatory Response Syndrome (SIRS) After Semi-rigid Ureteroscopy

Objective: To determine the predictive value of high-sensitive C-reactive protein (hs-CRP)/albumin ratio in systemic inflammatory response syndrome (SIRS) after semi-rigid ureteroscopy (URS).

Material and Methods: Between April 2021 and October 2021, 148 patients who had ureteral stone treatment with a ureteroscope in our hospital were included. Preoperative hs-CRP/albumin ratio was obtained by dividing the hs-CRP level by the albumin level. High-sensitivity modified Glasgow prognostic score (hs-mGPS) was obtained according to hs-CRP and albumin values. Two groups were identified as post-URS SIRS positive and negative. Inflammation biomarkers were evaluated in groups.

Results: There was a statistically significant difference between groups in terms of preoperative hs-CRP, albumin, and hs-CRP/albumin ratio (p < 0.001, p = 0.003, and p < 0.001, respectively). The optimal cutoff value for the hs-CRP/albumin ratio was 0.04651. While the risk of developing SIRS after surgery was 72.73% in patients with a hs-CRP/albumin ratio higher than 0.04651, the chance of not developing SIRS was 87.5% in patients below this value. The probability of developing SIRS was found to be significantly different in hs-mGPS (p < 0.001).

Conclusion: Our study indicated that hs-CRP/albumin ratio can predict post-URS SIRS. Larger-scale, multicentric prospective studies should certainly be done to validate the predictive value of hs-CRP/albumin ratio in post-URS SIRS.

Relationship between oxidative stress and detrussor overactivity: a case control study

PURPOSE

We analyzed the role of oxidative stress in detrusor overactivity (DO) by measuring serum total antioxidant capacity (TAC), total oxidant status (TOS), binding capacity of exogenous cobalt to human albumin (IMA), serum advanced oxidation protein products (AOPP), paraoxonase (PON), and arylesterase.

MATERIALS AND METHODS

The study included 38 female patients diagnosed with DO and 29 healthy female subjects forming the control group. Serum total antioxidant capacity (TAC), total oxidant status (TOS), binding capacity of exogenous cobalt to human albumin (IMA), serum advanced oxidation protein products (AOPP), paraoxonase (PON), and arylesterase were analyzed. The results of serum TAC, TOS, IMA, AOPP, PON, and arylesterase of the subjects in both groups were compared.

RESULTS

There was no difference between the groups in terms of age. When compared to the control group, serum TAC and IMA levels were statisticaly lower (P  < 0,001)  and higher (P = 0,003), respectively. However, TOS, AOPP, PON, arylesterase levels were similar in both groups ( p > 0.05 ).

CONCLUSION

There seems to be an association between DO and oxidative damage according to our results, this can be measured by analyzing TAC and IMA in this patient group.

Does mean platelet volume (MPV) have a role in evaluation of erectile dysfunction and its severity?

PURPOSE

The mean platelet volume (MPV) has important role in the pathophysiology of vascular diseases as a marker of the platelet activity. To investigate the association between mean platelet volume and erectile dysfunction (ED) and to search whether this marker can be used for diagnosis of ED.

MATERIALS AND METHODS

Of the 312 patients with ED of various degrees, 122 patients without ED (IIEF-5>21) were included in this prospective study. Severity of ED was determined according to IIEF-5 questionnaire. MPV, fasting serum glucose, cholesterol, low density lipoprotein (LDL) and serum testosterone levels are also recorded. The mean platelet volume was calculated by the Coulter counter technique and sexual function was determined by International Index of Erectile Function erectile function domain (IIEF-5).

RESULTS

The mean age of patients was 58.4 years. The mean MPV value of patients with ED was significantly higher compared to the non-ED patients (8.91 vs. 8.22, p=0.0001). The severity of ED was shown to have a positive strong correlation with MPV values (r=0.719, p=0.001). Mean serum triglyceride, glucose, total cholesterol and LDL cholesterol levels were noted higher in patients with ED. MPV values were found to be significantly higher in patients with ED.

CONCLUSION

MPV level shows significant correlation with severity of ED. This cheap laboratory test can have potential to be a marker of ED. Further prospective larger studies with vascular wall thickness measurements should be conducted.

Evaluation of oxidative stress status and antioxidant capacity in patients with renal cell carcinoma

Introduction

We evaluated and compared the serum oxidative stress and antioxidant enzymes in patients with renal cell carcinoma (RCC) and the control group.

Material and methods

The prospective study consisted of 97 patients with RCC (Group 1) and 80 age and sex matched healthy volunteers (Group 2). Group 1 and 2 were compared concerning serum mean total oxidant status (TOS), total antioxidant capacity (TAC), paraoxonase-1 (PON-1), arylesterase, total thiol, catalase (CAT), myeloperoxidase (MPO) and ceruloplasmin.

Results

Patients’ mean age was 58.5 ±12.3 and 56.9 ±15.8 years, respectively, in Group 1 and 2. No statistically significant differences were detected between the groups in terms of oxidative stress parameters and antioxidant capacity measured in the serum of patients including, TOS, TAC, PON1, arylesterase, total thiol, CAT, MPO, and ceruloplasmin levels (p >0.05 for all parameters). The PON-1 value was significantly higher in patients with pT1 stage than pT3 stage (p = 0.007). The arylesterase value was significantly higher in patients with Fuhrman's nuclear grade 3 than grade 2 (p = 0.035). There was no correlation between these parameters level and Fuhrman's nuclear grade, stage, or histopathological tumor type.

Conclusions

Our results demonstrated that evaluation of these parameters in the serum of patients with localized RCC may not be used as a marker to discriminate between patients with RCC and healthy people.

An Assessment of Patient Comfort and Morbidity After Robot-Assisted Radical Prostatectomy with Suprapubic Tube Versus Urethral Catheter Drainage

OBJECTIVE

Robot-assisted laparoscopic prostatectomy (RALP) with suprapubic tube (SPT), compared to urethral catheter (UC) drainage, has been proposed to improve patient comfort and recovery. We sought to compare short-term outcomes for pain and morbidity after RALP with SPT vs UC drainage.

METHODS

Between August 2012 and 2014, 159 men underwent a RALP and prospectively completed a questionnaire addressing postoperative pain and satisfaction. Group 1 (n = 94) underwent a RALP by one surgeon who placed a UC and removed it between postoperative day (POD) 7 and 10. Group 2 (n = 65) underwent a RALP by a different surgeon who placed an SPT and UC. On POD 1, the UC was removed. On POD 9, the SPT was capped and removed on POD 11 if the patient was voiding adequately. Preoperative and intraoperative data, complications, questionnaires, and patient-reported morbidity, including unplanned telephone calls and emergency department (ED) visits, were compared between groups.

RESULTS

Patient characteristics were similar between groups. One week after surgery, the penile pain score was statistically significantly lower in Group 2 compared to Group 1 (56.9% and 79.8%, respectively, reported minimal-to-moderate pain, p = 0.003). Bladder spasms and overall pain were not significantly higher for Group 1 compared to Group 2 (p > 0.05). When asked "How big a problem has your urine storage device been?," 20.2% of patients in Group 1 reported it as a "moderate-to-big" problem compared to 10.8% in Group 2 (p > 0.05). The number of catheter-related unplanned telephone encounters did not differ between the two groups (p = 0.7), however, although not statistically significant, 4.6% of patients in Group 2 presented to the ED with catheter-related issues (p = 0.07).

CONCLUSION

SPT after RALP was associated with less penile pain compared to UC drainage, and modestly better patient satisfaction. There were no significant differences in bladder spasms, overall pain, and patient-reported morbidity between groups.

Comparison of Retrograde Intrarenal Surgery and Percutaneous Nephrolithotomy: From the View of an Anesthesiologist

PURPOSE

To determine the differences among the hemodynamics, neuroendocrine stress response (NESR), and postoperative visual analogue scale (VAS) scores of pain between the procedures of retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PNL) for lower pole kidney stones.

PATIENTS AND METHODS

Fifty-six patients undergoing RIRS and PNL with lower puncture approach, under general anesthesia, were prospectively enrolled in our study. Perioperative blood pressure (systolic, diastolic, and mean), heart rate, and peripheral oxygen saturation (SpO2) values were recorded at intervals. Arterial blood gas (ABG) and blood glucose, serum insulin, and cortisol levels as stress response markers were analyzed in the perioperative period. Postoperative VAS scores were recorded at 30 minutes and 2, 4, 6, and 12 hours after extubation. Duration of surgery, stone sizes, and stone-free rates (SFRs) were noted.

RESULTS

SFRs were 93.3% in the PNL group (28/30 patients) and 88.5% in the RIRS group (23/26 patients) (p = 0.52). There was no statistical difference between the hemodynamics of both groups. Perioperative ABGs and NESRs were similar between groups (p > 0.05). Postoperative VAS scores and analgesic consumptions were also similar between groups (p > 0.05). Duration of surgery was significantly shorter in the RIRS group (p = 0.001). Stone size was significantly higher in the PNL group (p = 0.013).

CONCLUSION

Although the PNL is assumed to be more invasive than the RIRS procedure among urologists and anesthesiologists, both techniques may have similar perioperative outcomes in terms of hemodynamics, ABG, NESR, and pain scores in the management of lower pole stones with lower pole approach.

Single- versus dual-console robot-assisted radical prostatectomy: impact on intraoperative and postoperative outcomes in a teaching institution

OBJECTIVE

To compare the outcomes of robotic-assisted laparoscopic prostatectomy (RALP) using a dual versus single-console system in a resident training program using intraoperative, perioperative and postoperative measures.

METHODS

Patients with PCa who underwent RALP prior to and after implementing a dual-console system at an academic institution were reviewed from 2006-2012. All surgeries were performed by a single-faculty surgeon well after the learning curve was established. In all cases, chief residents participated in the surgery and performed progressively more portions. Demographic, intraoperative and pathologic parameters were obtained. Continence and erectile function were assessed at 6 and 12 months. Postoperative complications were graded using the Clavien-Dindo classification. Predictors of outcomes on univariate analysis were included in multivariate logistic or linear models.

RESULTS

Of 381 patients, 185 and 196 underwent single- or dual-console RALP, respectively. There was a significant decrease in mean operative time using the dual-console system (222 vs. 171 min, p < 0.0001) as well as in the incidence of intraoperative complications (8.65 vs. 1.53%, p < 0.0001) and postoperative complications (14.1 vs. 6.63%, p = 0.03.) Complications of Clavien grade ≥3a occurred more frequently with a single-console system (7 vs. 1%, p = 0.003.) Differences persisted when controlling for potential confounders by multivariate regression. Postoperative measures of continence, erectile function and the rate of biochemical recurrence were similar between cohorts.

CONCLUSIONS

When training resident surgeons to perform RALP, a dual-console system may improve intraoperative and perioperative outcomes. The dual-console may represent a safer, more efficient modality for robotic surgical education as compared to a single-console system.