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Purpose: To evaluate the expression of core molecular clock genes/proteins in penile cavernous tissue from healthy male subjects and to determine whether their expression has circadian variation., Materials and Methods: Corpus cavernosum biopsy samples were obtained from 10 healthy males with penile deviation or fracture who underwent surgical intervention during the day and night. The daytime group (n=5) underwent corpus cavernosum tissue sampling during zeitgeber time (ZT) 8-12, while the nighttime group (n=5) underwent sampling during ZT 20-24. The expression and localization of BMAL1, CLOCK, PER1, PER2, PER3, CRY1, and CRY2 proteins were analyzed using immunohistochemistry and quantified using H-score analysis. RT-qPCR analysis was performed to assess the expression of core molecular clock genes in the corpus cavernosum tissue of 5 additional daytime patients., Results: The expression of core molecular clock proteins was detected in vascular endothelial cells (VECs) and smooth muscle cells (SMCs) in corpus cavernosum during daytime and nighttime. BMAL1 exhibited the most significant nuclear expression during daytime in both cell types, whereas its expression decreased significantly at night. In VECs, a significant decrease in the nuclear expression of CRY1 was observed at night. In SMCs, a significant decrease in the cytoplasmic expression of PER3 was observed at night. The expression patterns of the core molecular clock genes were ascertained through a RT-qPCR analysis., Conclusions: Our research provides compelling evidence that core molecular clock genes are distinctly expressed in penile tissue in humans. Furthermore, we observed the expression of molecular clock proteins within the VECs and SMCs of the corpus cavernosum, with BMAL1 being the most prominently expressed. The discovery of core molecular clock genes in penile tissue, as well as proteins within the SMCs and VECs of the corpus cavernosum, introduces the potential significance of the molecular clock mechanism in the physiology of penile erection., Competing Interests: The authors have nothing to disclose., (Copyright © 2024 Korean Society for Sexual Medicine and Andrology.)

Objective: We aimed to investigate the possible effect of topiramate (TOP, 0.02 mg/kg/day) on the livers in a high-fat diet (HFD)-induced obesity rat model. The other objective was to evaluate the relationship between TOP administration and NPY level using anti-NPY1R antibody., Methods: Twenty-four adult female Wistar albino rats were randomly assigned into four equal groups as follow: control (CONT), obese (OBS), TOP, and OBS+TOP. All liver samples were investigated using the stereological analysis, as well as immunohistochemical and histopathological examination., Results: The total number of hepatocytes was significantly decreased in the OBS+TOP group compared to the CONT group or the OBS group (p < 0.05). We found a significant increase in the mean volume of liver in the OBS group compared to the CONT group (p < 0.05). Also, the mean volume of liver was significantly decreased in the OBS+TOP group compared to the OBS group (p < 0.05)., Conclusion: Taken together, our findings suggest that decreased liver volume is possibly attributed to TOP administration via setting the NPY level in the obese rats. Further, the side effects of TOP in combination with health risk of obesity may have led to an increase in hepatotoxicity and the subsequent hepatocyte loss (Fig. 7, Ref. 56). Text in PDF www.elis.sk Keywords: immunohistochemistry, liver, neuropeptide Y, obesity, rat, topiramate.

Purpose: To investigate the relationship between 25-hydroxyvitamin D (25 (OH) D) levels and acquired premature ejaculation (PE)., Materials and Methods: A total of 97 patients with acquired PE and 64 healthy men as a control group selected from volunteers without PE attending our Andrology Outpatient Clinic between November 2016 and April 2017 were included the study. All patients were considered to have acquired PE if they fulfilled the criteria of the second Ad Hoc International Society for Sexual Medicine Committee. Premature ejaculation diagnostic tool questionnaires were used to assessment of PE and all participants were instructed to record intravaginal ejaculatory latency time. Vitamin D levels were evaluated in all participants using high performance liquid chromatography method included in the study., Results: Compared to men without PE, the patients with acquired PE had significantly lower 25 (OH) D levels (12.0 ± 4.5 ng/mL vs. 18.2 ± 7.4 ng/mL, p < 0.001). In the logistic regression analysis, 25 (OH) D was found to be an independent risk factor for acquired PE, with estimated odds ratios (95% CI) of 0.639 (0.460-0.887, p = 0.007) and the area under curve of the ROC curve of 25 (OH) D diagnosing acquired PE was 0.770 (95% CI: 0.695 to 0.844, p < 0.001). The best cut-off value was 16 ng/mL with a sensitivity of 60.9%, specificity of 83.5%, PPV of 70.9%, and NPV of 76.4% to indicate acquired PE., Conclusions: This study demonstrates that lower vitamin D levels are associated with the acquired PE. The result of our study showed that the role of serum vitamin D levels should be investigate in the etiology of acquired PE. Perhaps supplementation of vitamin D in men with acquired PE will ameliorate the sexual health of these patients., Competing Interests: None declared., (Copyright® by the International Brazilian Journal of Urology.)

Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS) is often associated with erectile dysfunction (ED). However, the underlying pathophysiological mechanisms of ED occurrence are still unclear in patients with CP/CPPS. The aim of the study was to investigate superoxide anion (O 2 •- ) and total reactive oxygen species (ROS) production in semen of men with category IIIA CP/CPPS and their association with ED. This prospective study included 33 men with category IIIA CP/CPPS. Control group consisted of 13 healthy men. Total ROS and O 2 •- production were assayed by luminol and lucigenin-dependent chemiluminescence (CL) methods, respectively. ED was evaluated using the IIEF-5 questionnaire. Patients with CP/CPPS had significantly higher seminal total ROS and O 2 •- levels than healthy control subjects (2.9 ± 0.5 relative light unit (RLU) vs. 2.4 ± 0.2 RLU, p < 0.001; luminol-dependent CL and 2.5 ± 0.4 RLU vs. 2.3 ± 0.2 RLU, p = 0.02; lucigenin-dependent CL, respectively). Seminal O 2 •- and ROS levels were negatively correlated with IIEF-5 scores (r = -0.556, r = -0.536; p < 0.001, respectively). These results may suggest O 2 •- /ROS overproduction could be one of the important mechanisms in the etiology of ED development in CP/CPPS patients.

Purpose: To investigate the pathophysiological role of superoxide anion and total reactive oxygen species (ROS) production by the spermatozoa of men with varicocele and its relationship with varicocele grade and semen parameters., Materials and Methods: This prospective study included 34 men with grade II-III varicocele, regardless of their fertility status. The control group consisted of 13 healthy men. Semen characteristics were examined according to the 2010 World Health Organization criteria. The swim-up method was used for sperm preparation. Total ROS and superoxide anion production was assayed by luminol- and lucigenin-dependent chemiluminescence (CL), respectively., Results: The men with varicocele had significantly higher total ROS and superoxide anion levels than the healthy control subjects (2.9±0.4 relative light unit (RLU) vs. 2.4±0.1 RLU, p=0.001 for luminol-dependent CL and 2.8±0.4 RLU vs. 2.3±0.2 RLU, p=0.002 for lucigenin-dependent CL). Cases of grade III varicocele had significantly higher superoxide anion and total ROS levels than grade II cases and control subjects (p<0.001). Superoxide anion and total ROS levels were negatively correlated with all semen parameters., Conclusions: The superoxide anion levels produced by spermatozoa were significantly higher in varicocele patients than in control subjects. ROS production was related to increased varicocele grade, impaired semen concentration, and abnormal morphology in men with varicocele. Our findings suggest that superoxide anion overproduction may be an important step in the cascade of ROS-related damage to spermatozoa, resulting in impaired semen parameters in patients with varicocele., Competing Interests: The authors have no potential conflicts of interest to disclose., (Copyright © 2018 Korean Society for Sexual Medicine and Andrology.)

Purpose: To assess the relationship between De Ritis (aspartate aminotransaminase [AST]/Alanine aminotransaminase [ALT]) ratio and pathological variables and whether it is an independent prognostic factor., Materials and Methods: We analyzed 298 consecutive patients who underwent radical or partial nephrectomy for non-metastatic renal cell carcinoma (RCC) between 2006 and 2015. The association between De Ritis ratio and pathological variables including tumor size, presence of renal vein invasion, vena cava invasion, renal capsule infiltration, Gerota fascia invasion, renal sinus involvement, renal pelvic invasion, angiolymphatic invasion, adrenal gland involvement, lymph node involvement, tumor necrosis, and Fuhrman's grade was tested. Multivariable Cox analysis was performed to evaluate the impact of this ratio on overall survival and cancer-specific survival., Results: An increased preoperative De Ritis ratio was significantly associated with renal vein invasion, renal capsule infiltration and renal pelvis involvement (p<0.05) in non-metastatic RCC. On multivariate analysis we found that tumor size, Fuhrman grade and lymph node involvement were independent prognostic factors for cancerspecific survival. AST/ALT ratio had no influence on the risk of overall and cancerspecific survival., Conclusion: An increased preoperative AST/ALT ratio had a significant association with renal vein invasion, renal capsule infiltration and renal pelvis involvement in patients with non-metastatic RCC. However, it does not appear to be an independent prognostic marker in non-metastatic RCC., Competing Interests: Conflict of interest: None declared., (Copyright® by the International Brazilian Journal of Urology.)

Technological devices have become essential components of daily life. However, their deleterious effects on the body, particularly on the nervous system, are well known. Electromagnetic fields (EMF) have various chemical effects, including causing deterioration in large molecules in cells and imbalance in ionic equilibrium. Despite being essential for life, oxygen molecules can lead to the generation of hazardous by-products, known as reactive oxygen species (ROS), during biological reactions. These reactive oxygen species can damage cellular components such as proteins, lipids and DNA. Antioxidant defense systems exist in order to keep free radical formation under control and to prevent their harmful effects on the biological system. Free radical formation can take place in various ways, including ultraviolet light, drugs, lipid oxidation, immunological reactions, radiation, stress, smoking, alcohol and biochemical redox reactions. Oxidative stress occurs if the antioxidant defense system is unable to prevent the harmful effects of free radicals. Several studies have reported that exposure to EMF results in oxidative stress in many tissues of the body. Exposure to EMF is known to increase free radical concentrations and traceability and can affect the radical couple recombination. The purpose of this review was to highlight the impact of oxidative stress on antioxidant systems. Abbreviations : EMF, electromagnetic fields; RF, radiofrequency; ROS, reactive oxygen species; GSH, glutathione; GPx, glutathione peroxidase; GR, glutathione reductase; GST, glutathione S-transferase; CAT, catalase; SOD, superoxide dismutase; HSP, heat shock protein; EMF/RFR, electromagnetic frequency and radiofrequency exposures; ELF-EMFs, exposure to extremely low frequency; MEL, melatonin; FA, folic acid; MDA, malondialdehyde.

The radiation emitted from mobile phones has various deleterious effects on human health. This study was conducted to evaluate the effects of exposure to the 900-MHz radiation electromagnetic fields (EMF) emitted by mobile phones on Ammon's horn and the dentate gyrus (DG) in the hippocampus and cerebellum of male Wistar albino rats. We also investigated the neuroprotective effects of the antioxidants Boswellia sacra (BS) and folic acid (FA) against exposure to EMF. Twenty-four adult male rats were randomly divided into four groups of six animals each, an EMF group, an EMF + FA exposure group (EFA), an EMF + BS exposure group (EBS) and a control group (Cont). The EMF, EFA and EBS groups were exposed to 900-MHz EMF radiation inside a tube once daily over 21 days (60 min/day). The Cont group was not exposed to 900-MHz EMF. The results showed that EMF caused a significant decrease in total pyramidal and granular cell numbers in the hippocampus, and DG and in Purkinje cell numbers in the cerebellum in the EMF group compared to the other groups (p < 0.05). BS and FA attenuated the neurodegenerative effects of EMF in the hippocampus and cerebellum. Significant differences were also determined between the numbers of neurons in the EFA and EMF groups, and between the EBS and EMF groups (p < 0.05). However, there were no significant differences among Cont, EFA and EBS (p > 0.05). Our results may contribute to ongoing research into the effects of 900-MHz EMF exposure. Abbreviations : BS, Boswellia sacra ; CA, cornu ammonis; CAT, catalase; CE, coefficient of error; CV, coefficient of variation; DG, dentate gyrus; DNA, deoxyribonucleic acid; EMF, electromagnetic field; EBS, the group that is exposed to EMF and received a single daily gavage of BS (500 mg/kg/day) during 21 days; EEG, electroencephalogram; EFA, the group that is exposed to EMF and received a single daily gavage of folic acid (50 mg/kg/day) during 21 days; FA, folic acid; gr, granular layer; H 2 O 2 , hydrogen peroxide; MHz, Megahertz; ml, molecular layer; RF, radiofrequency; ROS, reactive oxygen specimens; SEM, standard error of the mean.

Background: To evaluate the impact of poor glycemic control of type 2 diabetes mellitus (T2DM) on serum prostate-specific antigen (PSA) concentrations in men., Methods: We performed a prospective analysis of 215 consecutive patients affected by erectile dysfunction (ED). ED was evaluated using the IIEF-5 questionnaire and the poor glycemic control (PGC) of T2DM was assessed according to the HbA1c criteria (International Diabetes Federation). Patients were divided into PGC group (HbA1c ≥ 7%) and control group (CG) (HbA1c < 6%). Correlations between serum HbA1c levels and various variables were evaluated and multivariate logistic regression analyses were carried out to identify variables for PGC., Results: We compared 110 cases to 105 controls men ranging from 44 to 81 years of age, lower PSA concentrations were observed in men with PGC (PGC mean PSA: 0.9 ng/dl, CG mean PSA: 2.1 ng/dl, p < 0.001). Also mean prostate volume was 60% was smaller among men with PGC compared with men with CG (PGC mean prostate volume: 26 ml, CG prostate volume: 43 ml, p < 0.001). A strong negative correlation was found between serum HbA1c levels and serum PSA (p < 0.001 and r = -0.665) concentrations in men with PGC. We also found at the multivariate logistic regression model that PSA, prostate volume and peak systolic velocity were independent predictors of PGC., Conclusion: Our results suggest that there is significant impact of PGC on serum PSA levels in T2DM. Poor glycemic control of type 2 diabetes was associated with lower serum PSA levels and smaller prostate volumes.

Background: To evaluate men, with lower urinary tract symptoms and newly elevated serum prostate specific antigen (PSA) to determine whether a three-week course of ciprofloxacin antibiotics lowers serum PSA levels and affects recommendations for prostate biopsy., Methods: A prospective, controlled, single-center prospective trial of 177 men with a newly elevated PSA and lower urinary tract symptoms was conducted. Patients were randomized to three weeks of ciprofloxacin or observation. After three weeks, patients PSA levels and derivatives were repeated. At the end of 3 weeks, all patients underwent TRUS guided systematic 12-core prostate biopsies regardless of the final PSA value., Results: Of 177 men who completed the study, 88 were in the treatment and 89 in the observation group. 46.5% of treatment and %18 of control groups patients PSA levels had decreased after 3 weeks and a significant PSA reduction was observed in the treatment group compare to control group (p: 0.035) but no significant prostate cancer detection rates were observed between the groups (p: 0.418). Also, in the treatment group prostate cancer detection rate was significantly higher in patients whom PSA levels were decreased (p: 0.011)., Conclusion: This study has shown that, use empirical antibiotic treatment decreased the PSA levels but did not have any effect on prostate cancer detection. In addition, prostate cancer detection rates were found to be higher in patients with reduced PSA levels after treatment. Therefore, it may not be safe to rule out biopsies in patients who achieve a satisfactory PSA response to antibiotics.

Objective: To investigate the impact of personalized three dimensional (3D) printed pelvicalyceal system models on patient information before percutaneous nephrolithotripsy surgery., Material and Methods: Patients with unilateral complex renal stones with indicatation of percutaneous nephrolithotripsy surgery were selected. Usable data of patients were obtained from CT scans as Digital Imaging and Communications in Medicine (DICOM) format. Mimics software version 16.0 (Materialise, Belgium) was used for segmentation and extraction of pelvicalyceal systems. DICOM format were converted to Stereolithography file format. Finally, fused deposition modeling was used to create plasticine 3D models of pelvicalyceal systems. A questionnaire was designed for patients to assess personalized 3D models effect on patient's understanding their conditions before percutaneous nephrolithotripsy surgery (PCNL). The day before surgery, each patient was seen by a urologist to deliver information about surgery. Questionnaire forms were asked to patients complete before and after presentation of 3D models and the results of the questions were compared., Results: Five patient's anatomically accurate models of the human renal collecting system were successfully generated. After the 3D printed model presentation, patients demonstrated an improvement in their understanding of basic kidney anatomy by 60% (p=0.017), kidney stone position by 50% (p=0.02), the planned surgical procedure by 60% (p=0.017), and understanding the complications related to the surgery by 64% (p=0.015). In addition, overall satisfaction of conservation improvement was 50% (p=0.02)., Conclusion: Generating kidney models of PCSs using 3D printing technology is feasible, and understandings of the disease and the surgical procedure from patients were well appreciated with this novel technology., Competing Interests: Conflict of interest: None declared., (Copyright® by the International Brazilian Journal of Urology.)

Objectives: To evaluate the long-term surgical, functional, and quality-of-life (QoL) outcomes after Holmium laser enucleation of the prostate (HoLEP) in patients with symptomatic benign prostatic hyperplasia (BPH)., Materials and Methods: We retrospectively reviewed recorded data on patients who underwent HoLEP between June 2002 and February 2005. Ninety-six patients were enrolled. Demographic, perioperative, and postoperative data were recorded. On follow-up, International Prostate Symptom Scores (IPSSs), prostate-specific antigen (PSA) levels, QoL scores, peak uroflowmetric data (Qmax values), and post-voiding residual urine volumes (PVR volumes), were recorded. Complications were scored using the Clavien system. Statistical significance was set at p<0.05., Results: The mean follow-up time was 41.8±34.6 months and the mean patient age 73.2±8.7 years. The mean prostate volume was 74.6±34.3mL. Significant improvements in Qmax values, QoL, and IPSSs and decreases in PSA levels and PVR volumes were noted during follow-up (all p values=0.001). The most common complication was a requirement for re-catheterisation because of urinary retention. Two patients had concomitant bladder tumours that did not invade the muscles. Eight patients (8.3%) required re-operations; three had residual adenoma, three urethral strictures, and two residual prostate tissue in the bladder. Stress incontinence occurred in one patient (1%). All complications were of Clavien Grade 3a. We noted no Clavien 3b, 4, or 5 complications during follow-up., Conclusions: HoLEP improved IPSSs, Qmax values, PVR volumes, and QoL and was associated with a low complication rate, during extended follow-up. Thus, HoLEP can be a viable option to transurethral resection of the prostate.

Background: One of the most important reasons for the high mortality rates of cancer is the low level of awareness, which can lead to a late diagnosis and treatments starting too late. Therefore, it is necessary for individuals, especially at younger age, to gain awareness and integrate taking the necessary precautions into their lifestyle in order to prevent cancer and ensure early diagnosis. The aim of this study was to assess the levels of awareness of factors for major cancers among students studying in two different campuses of a university in the Western Black Sea Region., Materials and Methods: This descriptive/cross-sectional study was performed between January-March 2014. Students studying in the 2013-2014 academic year in a university in the Western Black Sea Region in two separate campuses were the subjects., Results: The mean age was 21.01 ± 3.63. While female students (51.2%) were the majority in the health sciences campus (74.8%), male students (48.8% ) were the majority in the social sciences campus (76.5%). Some 9.6% of the students from the health sciences campus and 12.4% of the students from the social sciences campus thought that cancer was communicable, while most of the students from both campuses knew that smoking caused cancer. It can also be seen that the rate of answering questions regarding cancer correctly was higher among students studying in the health sciences campus., Conclusions: It was determined that students who do not study at the health sciences campus have insufficient information on cancer, cancer symptoms, and the possibility of breast cancer in males and approximately half of them regarded obesity as a risk factor for cancer.

Objectives: The transdermal fentanyl (TDF) patch has become widely used in the treatment of cancer pain. We aimed to compare the analgesic efficiency, side effects and patient satisfaction of TDF in adult and geriatric patients., Methods: The data of 181 patients who were observed in our pain clinic were included in this retrospective study. There were 95 patients in the adult group (Group A) and 86 patients in the geriatric group (Group G). Demographic data, cancer type, duration of pain, side effects, visual analog scale (VAS) score, treatment assessment scale (TAS) score, TDF dosage, and the number of patients in whom therapy has been terminated were recorded., Results: After the usage of TDF, reduction in pain score was observed in both groups (p<0.001). The TAS score was similar between the groups at the end of the first month, but it was lower in Group G in the following months. Constipation, dry mouth, somnolence, and dyspnea were seen more frequently in Group G. Because of these side effects, the number of patients in whom therapy was terminated was higher in Group G., Conclusion: The TDF patch is a good choice for cancer pain treatment for both adult and geriatric patients. Since it was observed that the incidence of side effects was higher in the geriatric patients, they should be treated more carefully.