Digitalization and Urological Diseases: Severity of Cyberchondria and Level of Health Anxiety in Patients Visiting Outpatient Urology Clinics

This study aimed to evaluate the cyberchondria levels of patients who applied to the urology outpatient clinic. The second goal of this study was to evaluate the relationship between cyberchondria severity and health anxiety in these patients. The present prospective observational study was conducted at the urology outpatient clinic of two tertiary centers in our city between September and December 2021. Eligible patients were the adult patients (>18 and ≤60 years) who used the Internet for health purposes and had no self-reported psychological or mental disease. The patients were divided into following groups according to their complaints: general urology, uro-oncology, andrology, functional urology, and endourology (stone disease). The level of cyberchondria and health anxiety was evaluated for these patients by using the Short Health Anxiety Inventory (SHAI) and a short-form version of the Cyberchondria Severity Scale (CSS-12). This study enrolled 578 patients (190 female, 388 male). The mean age of patients was 43.4 ± 13.3 years (18-60 years). The mean CSS-12 was 28.1 ± 12.1, and the mean value of SHAI was 18.9 ± 13.6. The patients had andrological symptoms, is uniquely related to higher CSS and health anxiety, and followed by uro-oncological diseases. However, the least relationship was observed in patients with functional urological diseases (analysis of variance [ANOVA], p < 0.001 for CSS-12; p < 0.001 for SHAI). In addition, a positive correlation was observed between the CSS and SHAI (Pearson's correlation = 0.782). The increased level of cyberchondria causes increased health anxiety and an increased disease burden in these patients. Therefore, physicians should consider this increased treatment burden during the treatment of patients.

Through the zipper or pants down: Does it change uroflowmetry parameters in healthy males?

OBJECTIVE

To evaluate if voiding through the zipper or voiding pants down would make any difference with regard to uroflowmetry parameters and postvoiding residual urine (PVR) volumes in healthy males with no lower urinary tract symptoms (LUTS).

METHODS

Healthy males over 18 years of age with no LUTS were prospectively evaluated using a uroflowmetry test. Each individual was asked to void through the zipper (group 1) and pants down (group 2) at different times. The uroflowmetry test was repeated if the voided volume did not exceed 150 mL. Uroflowmetry results such as voided volume, maximum flow rate (Qmax), average flow rate (Qave), and duration of voiding were noted. PVR volume was assessed using ultrasonography. Electromyography was not used. Data are shown as mean ± standard deviation. For statistical analysis, a paired t test was used to analyze parametric parameters.

RESULTS

A total of 44 males were enrolled. The median age of the individuals was 24 (range 18-44 years). There were no statistically significant differences between the two measurements in terms of voided volume (307 ± 121 mL vs 325 ± 145 mL, P = .365) and duration of voiding (25 ± 11 s vs 23.8 ± 11.6 s, P = .526). However, there were statistically significant differences in Qmax (26.6 ± 6.7 mL/s vs 30.0 ± 8.2 mL/s, P = .001), Qave (14.4 ± 3.6 mL/s vs 16.2 ± 5.1 mL/s, P = .009), and PVR volumes (23.9 ± 19.4 mL vs 3.9 ± 9.6 mL, P = .0001).

CONCLUSION

Voiding pants down shows higher flow rates and lower PVR than voiding through the zipper in individuals with no LUTS. Future studies with a larger number of individuals (including those with LUTS) and a broader age range cohort are required for solid conclusions.

The effect of hyperbaric oxygen therapy on bladder symptoms of female patients with overactive bladder

Overactive bladder (OAB) is a disease with symptoms such as feelings of urgency, nocturia, and frequent urination which is usually accompanied by urinary incontinence. We aimed to assess the effect of hyperbaric oxygen (HBO2) therapy on the symptoms of female patients with overactive bladder (OAB). This study is a prospective observational cohort study. The patients were analyzed into two groups. The patients who received HBO2 therapy were in Group 1, and the patients who received mirabegron treatment were in Group 2. The symptom scores and quality of life scores of the patients before and after treatment were recorded and compared. Significant improvement in symptom scores were seen in both groups after treatment compared to baseline. The study included 31 patients in Group 1 and 44 patients in Group 2. The mean changes in the ICIQ-SF, OAB-V8, and IIQ-7 scores in the third month of treatment in Group 1 were 4.12 ± 3.51, -10.70 ± 6.92, and -4.51 ± 2.68, respectively. The corresponding mean score changes in Group 2 were -4.31 ± 3.16, -11.22 ± 5.93, and -3.68 ± 2.67, respectively. The mean changes in all three scores were not significantly different between Groups 1 and 2 (p = 0.81, 0.73, and 0.19, respectively). We observed that HBO2 treatment improved quality of life by reducing the symptom score in patients with OAB. Moreover, this effect continued in the third month after the treatment. Considering the efficacy and side effect profiles of the available treatments, HBO2 therapy may be a new treatment alternative in OAB.

Effect of SARS-CoV-2 infection on semen parameters

INTRODUCTION

There are not enough studies showing the degree to which the SARS-CoV-2 virus affects the semen parameters after coronavirus infection in comparison to before they were infected. In this study, we aimed to assess the effect of SARS-CoV-2 infection on semen parameters.

METHODS

Patients were screened if they had had semen analysis performed from October 1, 2019, to December 1, 2020, in the assisted reproduction unit and later had positive polymerase chain reaction (PCR) test for SARS-CoV-2 infection. The patients' semen parameters were recorded before and after SARS-CoV-2 infection, along with degrees of SARS-CoV-2 infection, dates of SARS-CoV-2 infection, durations between the treatment for SARS-CoV-2 infection and the second semen analysis, time of symptom onset, duration of their symptoms, ages, comorbidities, and any medications patients were taking.

RESULTS

Forty-one patients were included in the study. The mean age of the patients was 31.29±5.95 years. The mean duration from first semen analysis to the PCR test was 7.74±3.03 months. The mean duration between the PCR test and later semen analysis was 2.35±1.35 months. The median sperm concentration for the patients before and after SARS-CoV-2 infection were 24 mil/ml and 13 mil/ml, respectively (p<0.001). The normal morphology percentage before infection was 3.16±0.92, while it was 2.44±1.04 after infection (p=0.011). In 26 patients, the period from the time of infection to the second semen analysis was over 70 days, while this period was less than 70 days in the other 15 patients; however, in both patient groups, a significant decrease was detected in the sperm concentrations and total sperm count.

CONCLUSIONS

In the semen samples we assessed, we observed a significant decrease in the mean sperm concentration, total sperm count, and mean percentage of samples with normal morphology after SARS-CoV-2 infection.

At What Age Threshold does the Decline in Semen Parameters Begin?

OBJECTIVE

 To analyse changes in semen parameters according to different age groups in men presenting to an infertility clinic, and determine the age threshold for decline in semen quality.

STUDY DESIGN

Observational study.

PLACE AND DURATION OF STUDY

Andrology Laboratory, Department of Urology, Kahramanmaraş Sütçü İmam University, Turkey, from January 2018 to December 2019.

METHODOLOGY

Semen analysis records of infertile men, who were referred to Andrology Laboratory, were retrospectively evaluated. The age groups were categorised as 20-29, 30-34, 35-39, 40-44, and 45-55 years. Each group was completed to 100 semen samples retrospectively and sequentially without any preferences. The differences of semen parameters between age groups were analysed with the one-way ANOVA test. Linear relationship was checked by ANOVA.

RESULTS

The mean age of 500 patients was 37.18 ± 8.11 years. While no linear relationship was observed in semen volume, concentration, and total sperm count with age (p=0.133, p=0.290 and p=0.261, respectively). A linear decline was observed in progressive motility, vitality, and morphology parameters with advancing age (all, p<0.001). In linear contrast analysis according to the 20-29 age group; significant decline in progressive sperm motility, morphology, and vitality started and continued in the 35-39 age group (all, p<0.001).

CONCLUSION

With advancing age, a significant linear decrease in sperm motility, morphology and vitality was observed in infertile men. This significant decline in sperm motility, morphology and vitality continues at age 35 and over. Therefore, infertile men who plan to postpone paternity should consider the age factor. Key Words: Aging, infertility, Paternal age, Semen analysis, Sperm.

Is erectile dysfunction related to self-esteem and depression? A prospective case-control study

Sexual activity is important role in life of men. Decreased sexual function has a negative impact on the quality of life of the patients and their partners. In this study, we aimed to evaluate the relationship of erectile dysfunction (ED) with self-esteem, symptom severity and depression. The 80 patients were evaluated prospectively. Group 1 (cases group) included 40 patients who with ED an age range of up to 18-70 years. Group 2 (healthy control group) included 40 patients who apply to the urology clinic for various reasons without ED. All patients were filled international index of erectile function-5 (IIEF-5), Beck Depression questionnaire (BDI-2) and Rosenberg self-esteem questionnaires (RESQ). Demographic characteristics and inventory results of the patients were compared between the two groups. Significant differences were found between the two groups in IIEF-5, RESQ and BDI-2 scores. In Group 1, IIEF-5 score was low, RESQ, BDI-2 scores were significantly higher (All scores p < 0.001). As a result people significantly reflect their sexual satisfaction in their social life. The patients with mild ED are not entirely satisfied in spite of normal sexual frequency. This situation causes significantly low the self-esteem of men. Prevention of ED will contribute to increased self-esteem and happy lives.

Placement of double-J stent in patients with malignant ureteral obstruction: antegrade or retrograde approach?

AIM

To determine whether antegrade or retrograde methods should be preferred for double-J stent placement in patients with malignant ureteral obstruction (MUO).

MATERIAL AND METHODS

The medical records of patients treated for MUO in the Urology and Interventional Radiology Clinic, Konya Training and Research Hospital, were reviewed retrospectively. Patients with benign aetiology were excluded from the study. Reports of the procedures, ultrasonography findings, computed tomography (CT), angiography, and pyelography images and the follow-up records of patients with MUO were assessed. A total of 111 patients and 114 ureteral stenting treatments were included in the study; 63 (55.3%) were operated on using the antegrade ureteral stenting (AUS) method, whereas 51 (44.7%) were operated on using the retrograde ureteral stenting (RUS), method, and the characteristics of these groups were evaluated. The presence of hydroureteronephrosis and ureteral tortuosity were determined.

RESULTS

Overall success rates were found to be 95.2% using the AUS method and 47.1% using the RUS method. The technical success of the antegrade method was significantly higher in patients with or without tortuosity (respectively: p=0.005, Z shape p=0.001, pigtail shape p=0.035″). The technical success of the antegrade method was significantly higher in patients with hydroureteronephrosis (p=0.001).

CONCLUSION

The AUS technique should be the first choice for double-J stent placement in patients with MUO.

Infective complications in patients after transrectal ultrasound-guided prostate biopsy and the role of ciprofloxacin resistant Escherichia coli colonization in rectal flora

OBJECTIVE

In the present study, we aimed to invastigate the ciprofloxacin resistance in rectal flora of the patients undergoing prostate biopsy in our department. Additionally, the possible effects of the presence of ciprofloxacin resistant bacteria in faecal flora on the risk of infective complications after the procedure as well as the effect of antibiotic prophylaxis on such infectious complications have been evaluated.

MATERIAL AND METHODS

A total of 142 patients undergoing transrectal ultrasound-guided prostate biopsy were included into the study program. Rectal swab samples were taken from all patients prior to biopsy. The presence of complications have been evaluated after a week following the biopsy procedure. Patients with fever were also evaluated. The possible correlation between the presence of ciprofloxacin-resistant bacteria in faecal flora and the risk of urinary tract infection development and the other complications were evaluated.

RESULTS

E. coli bacteria were present in all cultures of rectal swab samples obtained from 142 patients prior to prostate biopsy. Of all these patients, while ciprofloxacin-resistant E. coli (CR E. coli) grew in 76 (53.5%) patients; ciprofloxacin susceptible E. coli (CS E. coli) was obtained in 66 (46.5%) patients. In 16 patients (11.3%), infectious complications were observed. While the infective complications were present in the 14.5% of patients with CR E. coli; they were present in the 7.6% of patients with CS E. coli (p=0.295). High fever was observed in nine patients (6.3%). Of these nine patients, although six had CR E. coli growth as detected during culture sensitivity tests; three had CS E. coli growth in their rectal swab culture tests. Sepsis was observed in three (2.1%) of these patients with high fever. Ciprofloxacin-resistant E. coli grew in all of the rectal swab cultures obtained from these patients with sepsis.

CONCLUSION

In the light of our findings we may say that, it will be appropriate to reconsider the ciprofloxacin prophylaxis and prefer to use other prophylactic agents for a certain period of time in populations with higher rates of resistance to this medical agent. Furthermore, it will be appropriate again to obtain rectal swab specimens for culture tests before biopsy procedure in order to perform targeted prophylaxis according to the culture antibiogram test results. This approach will enable us to evaluate the cost-effectiveness of the procedure in detail.