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Objectives: To investigate the relation of testosterone-induced relaxation with smooth muscle K+ channels in human internal spermatic veins. Testosterone induces relaxation in human isolated internal spermatic veins, and this effect decreases in high-grade varicocele (recently reported)., Methods: The responses of isolated internal spermatic veins from patients with varicocele were recorded isometrically using a force displacement transducer. After contracting the venous rings with 45 mM KCl, relaxation with testosterone (0.1-300 μM) was recorded in the absence or presence of large conductance calcium-activated K+ channel and the voltage-sensitive K+ channel inhibitor tetraethylammonium, adenosine triphosphate-sensitive K+ channel inhibitor glibenclamide, voltage-dependent inward rectifier K+ channel inhibitor barium chloride, and voltage-sensitive K+ channel inhibitor 4-aminopyridine., Results: Testosterone induced relaxation in human isolated internal spermatic veins in the absence of inhibitors (maximal effect 52.88±6.72, n=24). Although tetraethylammonium, barium chloride, and 4-aminopyridine did not alter the testosterone-induced relaxant responses, GLI inhibited these responses., Conclusions: These results have demonstrated that testosterone induces relaxation in human isolated internal spermatic veins of patients with varicocele by way of adenosine triphosphate-sensitive K+ channels., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Objectives: To evaluate the effect of biofeedback therapy on the residual urine volume in children with dysfunctional voiding., Methods: This prospective study was conducted in children with dysfunctional voiding associated with abnormal postvoid residual urine (PVR) from June 2002 to 2007. The children were divided randomly into 2 groups. Group 1 was treated with standard urotherapy combined with biofeedback therapy and group 2 was treated with only standard urotherapy. The outcomes of uroflow-electromyography pattern, urinary tract infection (UTI), and PVR were recorded before and at the end of sixth month of treatment., Results: A total of 94 patients were enrolled in this study. Groups 1 and 2 consisted of 62 and 32 patients, respectively. The voiding pattern became normal in 80.6% (50/62) and 56.2% (18/32) of patients in groups 1 and 2, respectively. The PVR resolved in 40 of 62 (64.5%) patients in group 1 and in 11 of 32 (34.4%) children in group 2. Before the treatment, UTI was noted in 22.5% of patients (14/62) in group 1 and 21.8% of patients (7/32) in group 2. After the treatment, UTI was observed in 3.2% of patients (2/62) and in 9.3% (3/32) of patients in groups 1 and 2, respectively. Although both treatment modalities changed the voiding pattern, rate of febrile UTI, and PVR positively, these outcomes were better in a combination group., Conclusions: The combination of standard urotherapy with the biofeedback therapy improved the results significantly., (Copyright (c) 2010 Elsevier Inc. All rights reserved.)

Objectives: To investigate the effect of testosterone on contractile tone of endothelium-denuded human corpus cavernosum strips. Human studies designed to examine a possible relaxant effect of testosterone on corpus cavernosal circulation are lacking., Methods: Testosterone (0.1-300 microM) was added cumulatively to organ baths after precontraction of isolated human corpus cavernosum strips (n = 5) with KCl (45 mM). Testosterone-induced responses were tested in the presence of nonselective, large, conductance Ca(2+)-activated and voltage-sensitive K(+) channel inhibitor tetraethylammonium (1 mM), adenosine triphosphate-sensitive K(+) channel inhibitor glibenclamide (10 microM), voltage-dependent inward rectifier K(+) channel inhibitor barium chloride (30 microM) and voltage-sensitive K(+) channel inhibitor 4-aminopyridine (1 mM)., Results: Testosterone (0.1-300 microM) produced relaxation in human corpus cavernosum (maximum relaxation 65.4% +/- 3.3% of KCl-induced contraction) that reached a maximum at a concentration of 300 microM. Testosterone-induced relaxation was significantly attenuated by glibenclamide, but it was not affected by the other K(+) channel inhibitors (tetraethylammonium, barium chloride, or 4-aminopyridine)., Conclusions: Testosterone might induce relaxation in human isolated corpora cavernosa strips by activation of smooth muscle adenosine triphosphate-sensitive K(+) channels. This finding suggests that testosterone, in addition to its known endothelial action, might regulate erectile function locally by its action on the smooth muscle of the human corpus cavernosum.

Objectives: Inhibin B reveals Sertoli cell activity. After our previous findings of an increase in inhibin B succeeding classic inguinal orchiopexy, we sought to determine the changes in endocrine parameters after scrotal orchiopexy in patients with cryptorchidism and to compare these findings with the results of classic orchiopexy., Methods: A total of 50 boys with an undescended testis, 32 unilateral and 18 bilateral, were included in the present study. Scrotal orchiopexy was performed in all of them. Before and 6 months after orchiopexy, the serum basal inhibin B and other serum hormonal levels were measured in all patients., Results: The mean serum basal inhibin B levels had significantly increased and the other reproductive hormonal levels had not changed at 6 months after successful scrotal orchiopexy in our 50 patients (P = 0.016). Within the subgroups, the increase in inhibin B levels was significant in only those 2-9 years old with a unilateral undescended testis. The increase in inhibin B in those 10-12 years old with unilateral or bilateral undescended testis resulted from the start of puberty. No significant difference was found in terms of an increase in inhibin B after classic and scrotal orchiopexy., Conclusions: The measurement of inhibin B levels could be used as a follow-up parameter after orchiopexy. The serum inhibin B level increases after scrotal incision orchiopexy just as after classic inguinal orchiopexy. The increased level of inhibin B might indicate that the orchiopexy has been beneficial.

Objectives: Spinning top urethra (STU) deformity arises secondary to detrusor instability, leading to an increase in the intravesical pressure against a closed sphincter. We retrospectively analyzed the effect of biofeedback treatment on STU in children with dysfunctional voiding., Methods: A total of 121 patients with STU and voiding dysfunction were enrolled in this study. The patients divided into two groups. Group 1 (n = 49) were treated with simple bladder retraining with timed voiding, and group 2 (n = 72) were treated with biofeedback therapy. Voiding cystourethrography was performed 6 and 12 month later to determine the status of the STU after both therapies., Results: The patient age range was 5 to 13 years (mean 8.1 +/- 1.9) in group 1 and 5 to 13 years (mean 8.2 +/- 1.7) in group 2. Group 1 consisted of 41 girls and 8 boys; group 2 consisted of 63 girls and 9 boys. Voiding cystourethrography revealed vesicoureteral reflux in 39 and 59 children in groups 1 and 2, respectively. The improvement rates of the biofeedback therapy in children with STU and vesicoureteral reflux were significantly greater than the children treated with timed voiding at 6 months and 1-year of follow-up., Conclusions: For children admitted to urology clinics with urinary infection or complaints thought to be an unstable urinary bladder, proximal urethral dilation called STU is detected at a high frequency. It should be remembered that this situation can be related to vesicoureteral reflux and urinary bladder instability. Biofeedback training is a simple, effective, and well-tolerated treatment modality for these children.

Objectives: To perform a prospective study to evaluate the success of scrotal incision orchiopexy in children with a palpable undescended testis within the inguinal canal or beyond the external inguinal ring with or without inguinal hernia., Methods: A total 204 scrotal orchiopexies were performed in 166 patients with a primary undescended testis. These children were followed up for an average of 29.4 months to document the testicular position and size., Results: The scrotal orchiopexy technique was successful in 192 testes; the remaining 12 testes required conversion to traditional inguinal orchiopexy because of inadequate mobilization. Of 108 children (128 testes) in whom the testis was distal to the external inguinal ring, this technique was successful in 104 (124 testes). The success rate was 96.9% (124 testes of 128), and only 4 patients (four testes) required conversion to a traditional inguinal incision. The average operative time was 15 minutes in this group. In the other group with 58 children (76 testes) with a testicular location within the inguinal canal, conversion to the traditional inguinal orchiopexy was performed in 8 patients (eight testes). The success rate in this group was 89.5% (68 of 76 testes). The average operative time was 21 minutes in these patients, and follow-up ranged from 16 to 68 months (average 29.4). All testes were satisfactorily positioned in the scrotum, and no testicular atrophy developed., Conclusions: The results of our study have shown that scrotal orchiopexy is simple, safe, and effective in selected cases compared with the standard two-incision approach in the treatment of the palpable undescended testis.

Objectives: It is well known that a relationship exists between vesicoureteral reflux (VUR) and dysfunctional voiding, and the spontaneous resolution rate in older children is lower than the rate in younger children. In this study, we analyzed our experience with biofeedback treatment in older children with confirmed voiding dysfunction and VUR and investigated the effect of this treatment on the reflux resolution rates in these children., Methods: A total of 78 children, 5 to 14 years old (mean age 9), with voiding dysfunction and VUR detected by voiding cystourethrography were treated with biofeedback therapy. Voiding cystourethrography was performed 6 months after completion of the biofeedback program to determine the reflux status. The treatment results were also documented as subjective and objective improvements., Results: The reflux in 98 units (20 bilateral) was grade 1 in 26, grade 2 in 32, grade 3 in 28, and grade 4 in 12. At 6 months of follow-up, VUR had resolved on voiding cystourethrography in 62 units (63%), the grade had improved in 28 units (29%), and the reflux had remained unchanged in 8 units (8%). Among the older children treated with biofeedback, we also observed improvements in nocturnal enuresis (82%), daytime wetting (70%), constipation (78%), frequency (76%), infrequency (64%), urgency (71%), staccato voiding (81%), flattened voiding (81%), bladder overactivity (82%), detrusor sphincter dyssynergia (77%), spinning top urethra (67%), and urinary tract infection (80%)., Conclusions: Biofeedback therapy is applicable in older children with dysfunctional voiding and VUR and yields greater resolution rates than the historical resolution rates.