Penile necrosis is a very rare complication because of its rich collateral supply. Conservative management is apt to be ineffective; thus penectomy is usually performed. We present a case of penile necrosis and claudication of both legs with multiple atherosclerosis in a type II diabetes mellitus patient who was successfully treated with angioplasty, penoplasty, and additional intracavernous injections of prostaglandin E1. The treatment resulted in relief of the leg pain and healing of the penile ischemic lesions.
Alprostadil ; Angioplasty ; Atherosclerosis* ; Diabetes Mellitus ; Humans ; Leg ; Male ; Necrosis* ; Penis*

Primary seminal vesicle (SV) adenocarcinoma is a rare tumor. A small amount of data about the role of imaging to detect tumor recurrence is available. We report the case of a 58-year-old patient with primary SV clear-cell well-differentiated adenocarcinoma. Clinical and instrumental examinations were negative for the 32 months after treatments when computed tomography scan, [18F]fluoro-D-glucose positron emission tomography/computed tomography and pelvic magnetic resonance imaging showed the appearance of a lesion in the left perineal muscle suspected for recurrence. Patient was symptomless. Cytology of the suspected lesion confirmed SV adenocarcinoma recurrence. The combined approach, using radiological and nuclear medicine techniques, seems to be effective in the follow-up of SV adenocarcinoma. Technological advances, together with awareness of this rare tumor, have the potential of improving patients outcomes not only by providing earlier detection and accurate staging, but also by detecting recurrence and thereby avoiding delays and therapeutic dilemmas.
Adenocarcinoma* ; Diagnosis* ; Electrons ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging ; Middle Aged ; Multidetector Computed Tomography ; Nuclear Medicine ; Positron-Emission Tomography ; Recurrence* ; Seminal Vesicles* ; Urogenital Neoplasms

PURPOSE: In the present study, we aimed to identify the incidence of fever in patients after subinguinal microsurgical varicocelectomy and to evaluate the clinical factors associated with the occurrence of the fever. MATERIALS AND METHODS: We retrospectively reviewed the cases of patients who underwent subinguinal microsurgical varicocelectomy (group A) under spinal anesthesia. In addition, we reviewed the cases of patients who underwent microsurgical vasovasostomy under spinal anesthesia as a control group (group B). The incidence of fever in each group was compared. We investigated the clinical factors influencing the occurrence of fever in the patients of group A. RESULTS: The incidence of fever in group A was significantly higher than that in group B (32.5% [53/163] vs. 0.4% [1/284]; p<0.001). Clinical factors such as age, varicocele grade, weight, height, operation time, number of ligated veins, usage of immediate postoperative analgesics, presence of postoperative hematoma, and duration of hospital stay were not significantly associated with the occurrence of fever. CONCLUSIONS: We found that one-third of the patients developed transient fever after subinguinal microsurgical varicocelectomy, and therefore, this information should be provided during preoperative counseling.
Analgesics ; Anesthesia, Spinal ; Counseling ; Fever* ; Hematoma ; Humans ; Incidence* ; Length of Stay ; Retrospective Studies ; Varicocele ; Vasovasostomy ; Veins

PURPOSE: To determine whether it is necessary to analyze the semen of varicocele patients in their early 20s who are not complaining of infertility. MATERIALS AND METHODS: Data was collected retrospectively from 128 men with varicocele with no complaint of infertility, but with complaints of pain/discomfort or a mass/swelling during a 4-year period beginning in January 2009. The varicocele cases were matched 4 : 1 by age to 32 hemospermia controls. RESULTS: The median patient age was 22.0 years in the case group and 24.0 years in the control group. The median values of the percentage of normal motility, normal morphology, and density in the case group were 42.5%, 40.0%, and 51.0x10(6)/mL, respectively. The median serum testosterone level was 4.2 ng/mL and 7.0% of the total patients had low serum testosterone levels in the case group. The number of patients with asthenospermia (17.2%), oligospermia (10.9%), and teratospermia (5.5%), and those with at least one abnormal semen parameter (19.5%) was significantly higher in the case group than the control group. The median values of the motility, morphology, and density of the case group were significantly lower than those of the control group. The multivariate analysis showed that patient characteristics (age, presence of pain, duration of symptoms, and grade of varicocele) cannot help to predict abnormal semen parameters (asthenospermia, oligospermia, teratospermia, or cases of at least 1 abnormal semen parameter) or serum testosterone levels <3.0 ng/mL. CONCLUSIONS: Semen analysis is required as a screening test for semen abnormalities regardless of the chief complaint in varicocele patients in their early 20s.
Hemospermia ; Humans ; Infertility ; Infertility, Male ; Male ; Mass Screening ; Multivariate Analysis ; Oligospermia ; Retrospective Studies ; Semen ; Semen Analysis* ; Testosterone ; Varicocele*

PURPOSE: We aimed to evaluate the efficacy of using testicular biopsy histopathology as an indicator of the success of loupe-assisted subinguinal varicocelectomy in non-obstructive azoospermia (NOA) patients. MATERIALS AND METHODS: In a 2-year period, a prospective study was carried at Minoufiya University Hospital on 20 NOA patients with clinical bilateral varicoceles. These patients underwent loupe-assisted subinguinal varicocelectomy with simultaneous testicular biopsy. All patients were evaluated by determining their hormonal profile and performing semen analyses and scrotal Doppler and transrectal ultrasonography. Two semen analyses showing azoospermia were performed before the surgery and two semen analyses were received at 3 and 6 months post-operatively for follow-up. RESULTS: The mean age was 29.9+/-6.7 years, and the mean follow-up duration was 17.3+/-8.3 months. We noted the restoration of spermatogenesis in six men (30% of all patients). Testicular biopsy results were as follows: hypospermatogenesis in 7 patients, maturation arrest in 3, and Sertoli cell-only syndrome in 10. The improvement in the sperm counts of these patients ranged from 3 million to 15 million/mL. Sperms were recovered in the hypospermatogenesis (6 patients, 85.5%) patients only, but other patients with testicular biopsy results of Sertoli cell-only or maturation arrest did not show any improvement in their semen parameters. CONCLUSIONS: Testicular biopsy results showed that hypospermatogenesis patients have a better chance of improvement in their semen analysis after varicocelectomy in contrast to NOA patients with Sertoli cell-only syndrome or maturation arrest.
Azoospermia* ; Biopsy* ; Follow-Up Studies ; Humans ; Male ; Oligospermia ; Prospective Studies ; Semen ; Semen Analysis ; Sertoli Cell-Only Syndrome ; Sperm Count ; Spermatogenesis* ; Spermatozoa ; Testis ; Ultrasonography ; Varicocele

PURPOSE: We aimed to investigate the utility of sympathetic skin response (SSR) test for evaluating vasculogenic erectile dysfunction (ED) which is the most common type of impotence. MATERIALS AND METHODS: Men in the age group of 28 to 60 years and suffering from vasculogenic ED, as confirmed by a papaverin test and color Doppler sonography, at least for 6 months referred from our university urology department were included. We used the International Index of Erectile Function (IIEF-5) for grading severity of dysfunction and recorded the SSR of every patient from the median, tibial, and dorsal nerves of the penis. One-way analysis of variance (ANOVA), independent t-test and Pearson's correlation coefficient were used for comparing quantitative variables, and Fisher's Exact test was used for comparing qualitative variables. The Mann-Whitney U Test and the Kruskal-Wallis test were performed for analysis of data that were not normally distributed. A p value of less than 0.05 was considered significant. RESULTS: Forty-two patients were recruited for the study. We found a strong statistical relationship between the IIEF score and the pathologic SSR registered from every mentioned nerve. Patients with abnormal SSR had more severe ED according to IIEF score (p<0.001). In addition, the IIEF score had a significantcorrelation with diabetes mellitus and cardiovascular disease (t-test; p<0.05). CONCLUSIONS: Our results confirmed the presence of autonomic dysfunction in patients with vasculogenic impotence via an SSR test. We suggest evaluating the efficacy of the SSR test in patients with vascular impotence for treatment response monitoring in future studies.
Autonomic Nervous System ; Cardiovascular Diseases ; Diabetes Mellitus ; Electrodiagnosis ; Erectile Dysfunction* ; Female ; Humans ; Impotence, Vasculogenic ; Male ; Penis ; Skin* ; Urology

PURPOSE: This post hoc integrated analysis assessed the efficacy and safety of tadalafil 5 mg once daily in a large Korean population with lower urinary tract symptoms suggestive of benign prostatic hyperplasia (BPH-LUTS). MATERIALS AND METHODS: Individual Korean participant data were integrated from three 12-week, randomized, double-blind, placebo-controlled studies in Asian men with BPH-LUTS, wherein 177 Korean men received placebo and 177 received tadalafil 5 mg once daily. The primary objective was to compare the change from baseline to week 12 in total International Prostate Symptom Score (IPSS) after treatment with tadalafil versus placebo. RESULTS: A significantly greater improvement (p<0.001) in total IPSS from baseline to week 12 was observed for tadalafil compared to placebo (least squares mean: tadalafil=-5.97; placebo=-3.94 ). Total IPSS at weeks 4 and 12, IPSS voiding and storage subscores at weeks 4, 8, and 12, and IPSS quality of life index at weeks 8 and 12 were also significantly improved (p<0.05) for tadalafil compared to placebo. There was significant improvement (p<0.001) in the patient global Impression of improvement responses and numerical improvement in the clinician global impression of improvement responses with tadalafil compared to placebo. There were no significant treatment differences for peak urine flow rate or postvoid residual volume . Few participants had treatment-emergent adverse events and there were no unexpected safety findings. CONCLUSIONS: This integrated analysis of three randomized, placebo-controlled Asian studies confirmed tadalafil 5 mg once daily as an efficacious and well-tolerated treatment for Korean men with BPH-LUTS.
Asian Continental Ancestry Group ; Humans ; Lower Urinary Tract Symptoms* ; Male ; Phosphodiesterase 5 Inhibitors ; Prostate ; Prostatic Hyperplasia* ; Quality of Life ; Residual Volume ; Tadalafil

Phosphodiesterase type 5 (PDE5) inhibitors are the most commonly used treatment for erectile dysfunction (ED). Since the launch of sildenafil, several drugs-including mirodenafil, sildenafil citrate (sildenafil), tadalafil, vardenafil HCL (vardenafil), udenafil, and avanafil-have become available. Mirodenafil is a newly developed pyrrolopyrimidinone compound, which is a potent, reversible, and selective oral PDE5 inhibitor. Mirodenafil was launched in Korea in 2007, and an orally disintegrating film of mirodenafil was developed in 2011 for benefitting patients having difficulty in swallowing tablets. This study aimed to review the pharmacokinetic characteristic profile of mirodenafil and report evidence on its efficacy in the case of ED. In addition, we reviewed randomized controlled studies of mirodenafil's daily administration and efficacy for lower urinary tract symptoms.
Citric Acid ; Deglutition ; Erectile Dysfunction* ; Humans ; Korea ; Lower Urinary Tract Symptoms ; Male ; Phosphodiesterase 5 Inhibitors ; Tablets ; Treatment Outcome ; Sildenafil Citrate ; Tadalafil ; Vardenafil Dihydrochloride

Infertility affects approximately 15% of couples trying to conceive, and a male factor contributes to roughly half of these cases. Oxidative stress (OS) has been identified as one of the many mediators of male infertility by causing sperm dysfunction. OS is a state related to increased cellular damage triggered by oxygen and oxygen-derived free radicals known as reactive oxygen species (ROS). During this process, augmented production of ROS overwhelms the body's antioxidant defenses. While small amounts of ROS are required for normal sperm functioning, disproportionate levels can negatively impact the quality of spermatozoa and impair their overall fertilizing capacity. OS has been identified as an area of great attention because ROS and their metabolites can attack DNA, lipids, and proteins; alter enzymatic systems; produce irreparable alterations; cause cell death; and ultimately, lead to a decline in the semen parameters associated with male infertility. This review highlights the mechanisms of ROS production, the physiological and pathophysiological roles of ROS in relation to the male reproductive system, and recent advances in diagnostic methods; it also explores the benefits of using antioxidants in a clinical setting.
Antioxidants ; Cell Death ; DNA ; Family Characteristics ; Free Radicals ; Humans ; Infertility ; Infertility, Male ; Male ; Oxidative Stress* ; Oxygen ; Reactive Oxygen Species ; Reproduction* ; Semen ; Spermatozoa

Torsion of a hernia sac is an extremely rare condition that presents as acute scrotum in children. We report a case of a 6-year-old boy who presented with an acute scrotum and was found during surgical exploration to have torsion of an indirect hernia sac associated with hydrocele. Upon scrotal exploration, deterioration of the scrotum due to inflammatory changes was found. A necrotic cyst was recognized within a communicating hydrocele of the scrotum and was twisted at an angle of about 360degrees. All urologists should be aware of this special condition in the differential diagnosis of acute scrotum.
Child ; Diagnosis, Differential ; Hernia ; Hernia, Inguinal ; Humans ; Scrotum ; Torsion Abnormality