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Abstract Background Vinclozolin is a fungicide that has been reported to have anti-androgenic effects in rats. We have found that in utero exposure to natural or synthetic progesterones can induce hypospadias in mice, and that the synthetic progesterone medroxyprogesterone acetate (MPA) feminizes male and virilizes female genital tubercles. In the current work, we selected a relatively low dose of vinclozolin to examine its in utero effects on the development of the genital tubercle, both at the morphological and molecular levels. Methods We gave pregnant dams vinclozolin by oral gavage from gestational days 13 through 17. We assessed the fetal genital tubercles from exposed fetuses at E19 to determine location of the urethral opening. After determination of gonadal sex, either genital tubercles were harvested for mRNA quantitation, or urethras were injected with a plastic resin for casting. We analyzed quantified mRNA levels between treated and untreated animals for mRNA levels of estrogen receptors α and β, progesterone receptor, and androgen receptor using nonparametric tests or ANOVA. To determine effects on urethral length (males have long urethras compared to females), we measured the lengths of the casts and performed ANOVA analysis on these data. Results Our morphological results indicated that vinclozolin has morphological effects similar to those of MPA, feminizing males (hypospadias) and masculinizing females (longer urethras). Because these results reflected our MPA results, we investigated the effects of in utero vinclozolin exposure on the mRNA expression levels of androgen, estrogen α and β, and progesterone receptors. At the molecular level, vinclozolin down-regulated estrogen receptor α mRNA in females and up-regulated progesterone receptor mRNA. Vinclozolin-exposed males exhibited up-regulated estrogen receptor α and progesterone receptor mRNA, effects we have also seen with exposure to the synthetic estrogen, ethinyl estradiol. Conclusion The results suggest that vinclozolin virilizes females and directly or indirectly affects progesterone receptor expression. It also affects estrogen receptor expression in a sex-based manner. We found no in vivo effect of vinclozolin on androgen receptor expression. We propose that vinclozolin, which has been designated an anti-androgen, may also exert its effects by involving additional steroid-signaling pathways.

Objectives: To evaluate the impact of the presence and severity of urinary incontinence (UI) on pregnancy-related anxiety., Study Design: This prospective case-control study included 160 pregnant women. Pregnant women with UI (n = 80) were compared with continent pregnant women (n = 80; control group) in terms of scores on the Incontinence Consultation Questionnaire-Short Form (ICIQ-SF) and the Pregnancy-related Anxiety Questionnaire-Revised 2 (PRAQ-R2) scale. Gynaecological examination was performed, and pelvic organ prolapse was diagnosed using the Pelvic Organ Prolapse Quantification system. UI was classified as stress UI (SUI), urge UI (UUI) or mixed UI (MUI)., Results: The total PRAQ-R2 score was significantly higher in all pregnant women with UI, as well as the UI subgroups, compared with the control group [mean ± standard deviation; 21.77 ± 8.1 (UI), 19.39 ± 6 (SUI), 20.13 ± 7.2 (UUI) and 28.1 ± 9.5 (MUI) vs 15.76 ± 5.9 (control group); p < 0.0001, p = 0.002, p = 0.012 and p < 0.0001, respectively). Significant positive correlation was found between the total ICIQ-SF and total PRAQ-R2 scores (r = 0.533; p < 0.0001). The score for the fear of giving birth domain in PRAQ-R2 was higher in women with SUI and MUI compared with the control group (9.5 ± 4 and 11.1 ± 2.6 vs 5.43 ± 2.4; p < 0.0001). Concern about own appearance was greater in the UUI and MUI groups compared with the control group (9.68 ± 4.5 and 7.8 ± 3.1 vs 4.85 ± 2.3; p < 0.0001)., Conclusion: To the authors' knowledge, this is the first study to report the impact of the presence and severity of UI on pregnancy-related anxiety. The current findings show that anxiety may be an important psychosocial consequence of UI in pregnancy. This may lead to a clinical approach focusing on both the physical and psychological well-being of pregnant women with UI., (Copyright © 2022. Published by Elsevier B.V.)

Objectives: In the present study, we aimed to investigate the effect of dexpanthenol on wound healing at the histopathological level on cavernous tissue., Materials and Methods: Forty-four Wistar albino rats weighing 220-250 g were used. The rats were randomly divided into four groups as Group B, Group S, Group LD, and Group SD. In Group B, the incision was not repaired and left to secondary healing. In Group S, the incision line was repaired with 5/0 polyglactin suture. In Group LD, 0.25 mg/kg dexpanthenol was applied subcutaneously below the repaired wound region once a day during 14 days. In Group SD, 500 mg dexpanthenol was applied intraperitoneally once a day during 14 days., Results: No fibrosis was observed in 8 (80%) rats in group SD. Fibrosis rates were significantly lower in Group SD compared to Group B, Group S, and Group LD (p = 0.013, p = 0.005, and p = 0.003, respectively)., Conclusion: Systemic dexpanthenol administration significantly decreased fibrosis in penile fracture model on rats., (Copyright: © 2022 Permanyer.)

Purpose: We designed a multicenter, retrospective study to investigate the current trends in initial management of reflux with respect to European Association of Urology (EAU) Guidelines in Urology clinics of our country., Materials and Methods: The study group consisted of 1988 renal units (RU) of 1345 patients treated surgically due to vesicoureteral reflux (VUR) (between years 2003 and 2017) in nine different institutions. Patients were divided into two groups according to time of initial treatment and also grouped according to risk factors by "EAU guidelines on VUR.", Results: In this series, 1426 RUs were treated initially conservatively and 562 RUs were initially treated with surgery. In initially surgically treated group, success rates of surgery decreased significantly in low and moderate risk groups after 2013 (P = .046, P = .0001, respectively), while success rates were not significantly different in high risk group (P = .46). While 26.6% of patients in low risk group were initially surgically treated before 2013, this rate has increased to 34.6% after 2013, but the difference was not statistically significant (P = .096). However, performing surgery as the initial treatment approach increased significantly in both moderate and high risk groups (P = .000 and P = .0001, respectively) after 2013. Overall success rates of endoscopic treatments and ureteroneocystostomy (UNC) operations were 65% and 92.9% before 2013 and 60% and 78.5% after 2013, respectively. Thus, the overall success rate for surgery was 72.6%. There was significant difference between success rates of UNC operations before and after 2013 (P = .000), while the difference was not significant in the injection group (P = .076)., Conclusion: Current trends in management of reflux in our country do not yet follow the EAU guidelines on VUR in low and moderate risk groups despite these reliable and accepted guidelines were expected to influence our daily approach., (© 2021 John Wiley & Sons Ltd.)

Ranolazine is a drug used in refractory chronic stable angina. In this study, it was aimed to evaluate the protective effect of ranolazine in a testis torsion model in light of objective biochemical and pathological data. A total of 24 pre-pubertal male Wistar albino rats were separated into three groups of 8 as the sham group, control group and ranolazine group. Testis torsion was applied for 3 hr to all the rats in Group Control and Group Ranolazine. In Group Control, 0.9% NaCl was applied 1 hr after the torsion. In Group Ranolazine, ranolazine 30 mg/kg was dissolved in a 0.9% NaCl solution and was administered intraperitoneally 1 hr after torsion. Histopathological evaluation was made using the Cosentino score. As a result of the objective biochemical and pathological criteria used in this study, this protective effect of ranolazine was observed in testis torsion. The results obtained in this study may suggest that ranolazine is a drug that could be applied after detorsion to patients diagnosed with torsion., (© 2020 Blackwell Verlag GmbH.)

Introduction: Human papillomavirus infection (HPV) is one of the most common sexually transmitted infections and can cause penile and anal cancer in men, and invasive cervical cancer in women., Objective: To evaulate the colonization of 32 HPV subtypes in the foreskin of boys., Study Design: A prospective analysis was made of the data of 62 healthy boys who had undergone standard circumcision. Deoxyribonucleic acid (DNA) was isolated from the foreskin tissues, and the integrity of DNA was tested. The DNA of each patient was further assessed with real-time polymerase chain reaction (PCR) and the presence of 32 subtypes of HPV was explored. To confirm the results, melting curve analysis and agarose gel electrophoresis (AGE) were performed for all samples. Further analysis was made using LCD-array on six randomly selected samples to confirm the results together with negative and positive controls., Results: The mean age of the boys was 6.8 ± 2 years at the time of surgery. All positive controls and samples were positive, all negative controls were negative in the first HPV amplification assay. All positive controls had typical melting curve peaks, whereas all sample amplifications had non-specific, atypical melting curves not fitting with those of the positive controls. Two bands of expected sizes (124 and 405 bp) were only observed in positive controls, but not in negative controls or samples on AGE. The same results were observed on the 6 randomly selected samples using LCD-array. Consequently, all the foreskin samples were evaluated as negative for the 32 HPV types investigated in the study., Discussion: Literature shows a high prevalence of genital HPV in newborns, in early infancy, late adolescence and adulthood. However there is a lack of data in literature on the prevalence in early and late childhood. The negative results of HPV colonization on the foreskin in the current study may be attributed to the conservative and mostly monogamous nature of most family structures in Turkey., Conclusion: The results of the present study have shown that foreskin tissue is not a natural reservoir for HPV and subclinical HPV infection is not likely in the absence of suspected sexual contact., (Copyright © 2020 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.)

Purpose: We aimed to compare the effectiveness of intranasal desmopressin and doxazosin treatments in patients with nocturia and benign prostatic hyperplasia (BPH)., Material and Methods: Thirty one men with BPH and three or more episodes of nocturia were randomized to receive 2 mg doxazosin at night for two weeks increasing to 4 mg for a further two weeks versus 20 μg intranasal desmopressin at night. For all patients, number of nocturia, urinary flow rate, residual urine volume and quality of life score were checked. Outcomes were measured at two months. The comparison of before and after treatment changes between the groups were done by student's t-test., Results: In doxazosin group, mean number of nocturia were 3.2 &plus mn; 0.4 (3-4 times) times per night and 1.2 +/- 0.8 (0-3 times) times per night before and after treatment, respectively. In desmopressin group, mean number of nocturia were 3.4 +/- 0.5 (3-4 times) and 1.5 +/- 0.6 (1-3 times) times per night before and after treatment, respectively. In doxazosin group, mean residual urine volumes were 44.3 +/- 35.9 ml (range 0-120 ml) and 23.1 +/- 18.8 ml (range 0-50 ml) before and after treatment, respectively. In desmopressin group, mean residual urine volumes were 36.6 +/- 32.4 ml (range 0-120 ml) and 14.0 +/- 26.9 ml (range 0-90 ml) before and after treatment, respectively. Improvements in number of nocturia, residual urine volume, quality of life scores and peak urinary flow rates weren't statistically significant between two groups, whereas change in international prostate symptom score (IPSS) score was more significant in doxazosin group., Conclusion: Intranasal desmopressin, is an effective symptomatic treatment of men with BPH complaining of nocturia, as well as doxazosin treatment.

Introduction: This study aimed to investigate the surgical results of incision and vein grafting combined with two types of plication sutures, including Essed-Schroeder and longitudinal imbrication, to correct the cavernous sacculation in complex curvature resulting from Peyronie's disease., Material and Methods: Between 2004 and 2008, 15 patients with complex curvature resulting from Peyronie's disease were surgically treated. Essed-Schroeder plication and venous grafting were performed in 10 patients. Five of the 15 patients had cavernous sacculation, which was defined as albugineal elongation, except for the normally morphological cavernosal structure, which caused some degree of penile torsion beside the angulation. Surgery was used to establish sufficient cosmetic results by performing longitudinal imbrication on the cavernous sacculation on the same side as that of the Essed-Schroeder plication combined with venous grafting in these five patients., Results: Complete penile straightening was achieved in all the patients. Two patients (13.3%) reported penile shortening without showing dissatisfaction about it. One patient complained of anesthesia on part of the skin of the penile shaft. All the patients were satisfied with the final surgical results., Conclusions: A combination of the surgical methods might be necessary to correct the complex deformities due to Peyronie's disease. Further studies with larger patient populations are needed to standardize these procedures., (Copyright 2010 S. Karger AG, Basel.)

Purpose: Endoscopic treatment of large bladder stones via cystoscope is still bothersome, and open cystolithotomy is the preferred method in many centers. To gain more insight into the endoscopic bladder stone management, we aimed to compare the transurethral use of nephroscope and cystoscope randomly., Patients and Methods: Forty-three male patients with bladder stones were randomized into two groups, to perform nephroscopic (group 1, n = 22) and cystoscopic (group 2, n = 21) stone fragmentation procedures transurethrally. Combined pneumatic/ultrasonic lithotripsy device was used in both groups to fragment the bladder stones., Results: The mean stone size in group 1 and group 2 was 3.6 +/- 1.3 cm and 3.5 +/- 1.6 cm, respectively (p > 0.05). Stone fragments were removed completely in all of the patients, and the mean operation time was calculated as 48.2 +/- 13.2 minutes in group 1 and 68.1 +/- 22.7 minutes in group 2, with no intraoperative complications (p < 0.01). None of the patients developed urethral stricture disease in the early (postoperative third month) follow-up. Three patients with previously known urethral stricture disease have shown to have the same disease in the late (postoperative 14.4 +/- 5.1 months) follow-up., Conclusion: Treatment of large bladder stones by transurethrally placed nephroscope is a fast and effective treatment modality compared to endoscopic treatment via cystoscope. Nephroscope allows for use of larger forceps and facilitates collection of large stone fragments through its 24F sheath. It also prevents multiple entries to the urethra and hence avoids possible urethral injury. Combined pneumatic/ultrasonic lithotripsy device, with its aspiration quality, enables the surgeon to gain a better endoscopic view during both procedures.

Objective: Arterialization operations of the penis are recommended for young patients with erectile dysfunction (ED). In this study, we investigated the efficiency of deep dorsal vein arterialization (DDVA) in carefully selected healthy elderly patients, Patients and Methods: An initial extensive evaluation with corpus cavernosum electromyography, cavernosometry, and penile doppler ultrasonography was performed for 43 elderly patients with ED for whom the presence of risk factors (hypertension, diabetes, hyperlipidemia, smoking habit, psychiatric or neurologic disorders, liver or kidney failure, and history of major trauma) had been ruled out. All patients underwent to DDVA using the Furlow-Fisher technique. Surgical outcome was tested postoperatively by use of the fifteen-item International Index of Erectile Function questionnaire (IIEF-15). Surgical success was assumed if the score in the five-item version of the IIEF (IIEF-5) had increased by at least five points., Results: Of the patients, 21 were detected to have caverno-occlusive disease, 13 had arteriogenic disease, and 9 had both caverno-occlusive and arteriogenic disease. The mean age of the patients was 59.7+/-4.6 years and the mean follow-up time was 22.1+/-7.1 months. The operation was successful in 26 cases (60.5%) according to IIEF-5. Total IIEF-15 score was increased from 19.2+/-5.0 to 28.5+/-9.4 (P<0.05). Significant increases were observed in the erectile function, intercourse satisfaction, and overall satisfaction domains of IIEF-15. The preoperative degree of ED or the etiology of ED had no impact on the surgical results. Percent changes in the total IIEF-15 score and in its domains were no different between patients aged <60 and those aged >or=60., Conclusion: DDVA could successfully be performed for carefully selected elderly patients as long as the presence of risk factors for ED are ruled out.

During bladder development, primitive mesenchyme differentiates into smooth muscle (SM) under the influence of urothelium. The gene(s) responsible for this process have not been elucidated. We propose that the Sonic hedgehog (Shh) signaling pathway is critical in bladder SM formation. Herein, we examine the role of the Shh-signaling pathway during SM differentiation in the embryonic mouse bladder. Genes in the Shh pathway and SM expression in mouse embryonic (E) bladders (E12.5, 13.5, and 14.5) were examined by immunohistochemistry (IHC), in situ hybridization, and reverse transcription polymerase chain reaction (RT-PCR). To examine the effects of disrupting Shh signaling, bladder tissues were isolated at E12.5 and E14.5, that is, before and after bladder SM induction. The embryonic bladders were cultured on membranes floating on medium with and without 10 muM of cyclopamine, an Shh inhibitor. After 3 days, SM expression was examined by assessing the following: SM alpha-actin (SMAA), SM gamma-actin (SMGA), SM-myosin heavy chain (SM-MHC), Patched, GLI1, bone morphogenic protein 4 (BMP4), and proliferating cell nuclear antigen (PCNA) by IHC and RT-PCR. SM-related genes and proteins were not expressed in E12.5 mouse embryonic bladder before SM differentiation, but were expressed by E13.5 when SM differentiation was initiated. Shh was expressed in the urothelium in E12.5 bladders. Shh-related gene expression at E12.5 was significantly higher than at E14.5. In cyclopamine-exposed cultures of E12.5 tissue, SMAA, SMGA, GLI1, and BMP4 gene expression was significantly decreased compared with controls, but PCNA gene expression did not change. In cyclopamine-exposed E14.5 cultures, SMGA and SM-MHC gene expression did not change compared with controls. Using an in vitro embryonic bladder culture model, we were able to define the kinetics of SM- and Shh-related gene expression. Cyclopamine inhibited detrusor SM actin induction, but did not inhibit SM-MHC induction. SMAA and SMGA genes appear to be induced by Shh-signaling pathways, but the SM-MHC gene is not. Based on Shh expression by urothelium and the effects of Shh inhibition on bladder SM induction, we hypothesize that urothelial-derived Shh orchestrates induction of SM in the fetal mouse bladder.

Objectives: The phytoestrogen (plant estrogen) genistein, present in soy products, is of interest because in utero exposure to genistein can cause hypospadias in our mouse model and maternal consumption of soy is prevalent in human populations. Another compound of interest is the fungicide vinclozolin, which also causes hypospadias in the mouse and rat and can occur concurrently with genistein in the diet as a residue on exposed foods. A study in the United Kingdom found no relationship between a maternal organic vegetarian diet and hypospadias frequency, but women who consumed nonorganic vegetarian diets had a greater percentage of sons with hypospadias. Because nonorganic diets can include residues of pesticides such as vinclozolin, we sought to assess the interaction of realistic daily exposures to genistein and vinclozolin and their effects on the incidence of hypospadias., Methods: Pregnant mice were fed a soy-free diet and orally gavaged from gestational days 13 to 17 with 0.17 mg/kg/day of genistein, 10 mg/kg/day of vinclozolin, or genistein and vinclozolin together at the same doses, all in 100 microL of corn oil. The controls received the corn oil vehicle. The male fetuses were examined at gestational day 19 for hypospadias, both macroscopically and histologically., Results: We identified no hypospadias in the corn oil group. The incidence of hypospadias was 25% with genistein alone, 42% with vinclozolin alone, and 41% with genistein and vinclozolin together., Conclusions: These findings support the idea that exposure to these compounds during gestation could contribute to the development of hypospadias.

Purpose: In fetal mice genital tubercles the ontogenetic expression of progesterone receptors and the effect of in utero estrogen and testosterone exposure were investigated., Materials and Methods: To evaluate ontogenetic progesterone receptor expression genital tubercles from untreated fetuses at gestational days 12, 14, 16 and 18, and newborn pups were prepared for real-time reverse transcriptase-polymerase chain reaction or immunohistochemistry. To evaluate estrogen and testosterone effects pregnant dams were gavaged once daily with corn oil (vehicle), ethinyl estradiol or testosterone propionate from gestational days 12 through 17. At gestational day 19 the genital tubercles of delivered fetuses were harvested for morphological examination and then pooled for real-time reverse transcriptase-polymerase chain reaction., Results: Progesterone receptor protein was first detected at gestational day 12 in the urethral plate and mesenchyma. At later stages staining intensity increased with a greater progesterone receptor signal, especially in the urethra. Progesterone receptor mRNA expression showed different increasing patterns in each sex until birth. However, no difference was noted between male and female genital tubercles in terms of the distribution and quantity of progesterone receptor expression. In utero ethinyl estradiol led to 8.2, 9.7 and 5.2-fold increases in progesterone receptor mRNA in females and in males with and without hypospadias, respectively. Testosterone propionate significantly decreased progesterone receptor mRNA levels in females and males., Conclusions: Progesterone receptors are expressed in developing genital tubercles, suggesting a direct role of progesterone in normal genital tubercle patterning. Their increasing expression until birth also implies increasing sensitivity of the genital tubercles to the effects of estrogenic and progestogenic endocrine disruptors during fetal life. Ethinyl estradiol and testosterone propionate lead to opposing effects on progesterone receptor expression, in addition to their opposing morphological effects on the genital tubercles. These findings expand our knowledge of genital tubercle morphogenesis and provide important information for understanding the effects of endocrine disruptors.

Purpose: We examined the ontogenic and sex specific expression of estrogen receptor-alpha and beta in mouse genital tubercles and assessed the effects of in utero estrogen exposure on these parameters., Materials and Methods: Expression of the 2 genes was detected in mouse genital tubercles from fetuses collected on gestational days 12, 14, 16 and 18, and from newborns using immunohistochemistry and quantitative polymerase chain reaction. Pregnant dams were exposed to ethinyl estradiol or corn oil as the control., Results: Estrogen receptor-alpha and beta proteins first appeared on gestational days 12 and 14, respectively. The 2 proteins were expressed in the urethral plate and mesenchyma. Staining intensity was more prominent in the mesenchyma for estrogen receptor-alpha and in the urethral plate for estrogen receptor-beta. Female genital tubercles expressed more estrogen receptor-alpha than male genital tubercles (p <0.01), while estrogen receptor-alpha expression increased gradually in the 2 sexes until birth. Estrogen receptor-beta expression did not differ between males and females, and it showed no notable variation during fetal life. Ethinyl estradiol led to a 2.1 and 3.8-fold increase in estrogen receptor-alpha expression in females and in males with hypospadias (p = 0.002 and 0.04, respectively). Estrogen receptor-beta expression did not change in response to ethinyl estradiol., Conclusions: This study provides in vivo evidence that estrogen receptor-alpha expression in the genital tubercles of each sex increases until parturition but estrogen receptor-beta expression does not, implying genital tubercle sensitivity to estrogen increases during fetal life. Exogenous administration of estrogens results in a response of increased expression of estrogen receptor-alpha but not of estrogen receptor-beta. These differential findings for estrogen receptor-alpha and beta imply that the 2 receptors may have different roles in normal or anomalous genital tubercle development.

Background: The ideal time for distinguishing a renal scar from acute inflammatory lesions by renal DMSA scintigraphy remains controversial., Objective: To determine the time needed for resolution of lesions after acute pyelonephritis., Materials and Methods: A total of 105 children with acute pyelonephritis underwent renal sonography, voiding cystourethrography and baseline DMSA scintigraphy. Two subsequent scans were performed during the 6th and 12th months in patients with abnormal findings on the previous scan., Results: The baseline DMSA scintigraphy revealed cortical lesions in 37 patients. At 6 months, 13 patients (38.2%) were found to have cortical lesions. At 12 months, 6 patients (17.6%) were found to have persistent renal cortical lesions. The resolution rates for lesions detected on the first scan were 61.8% and 82.4% on the 6- and 12-month scans, respectively. Vesicoureteric reflux, and bilaterality or multifocality were not relevant for resolution of lesions. Female gender seemed to be associated with a higher persistence rate., Conclusions: The renal cortical defects present at 6 months have a high rate of resolution later during follow-up. DMSA scintigraphy performed 12 months after the infection provides more reliable data regarding persistence of renal cortical lesions.

Objective: To determine the ability of transanal pelvic plexus stimulation (TPPS) in inducing penile tumescence in patients with non-neurogenic erectile dysfunction (ED) and to compare the erection degree with papaverine-induced erection., Patients and Methods: The cavernous electrical activity (CEA) in 21 men with non-neurogenic erectile dysfunction was measured during TPPS by electromyography of corpus cavernosum and the erection degree of penis (flaccid, semi-rigid, rigid) was noted. The stimulation amplitude was increased from 20 to 100 mA. All patients also underwent intracavernous papaverine injection and further CEA recordings were obtained., Results: Twelve and nine patients were diagnosed with vasculogenic (VED) and non-vasculogenic ED (NVED), respectively. TPSS led to a penile erectile response in 12 patients (57%), whereas papaverine injection caused erection in 16 (76.2%) patients. The mean baseline CEA (16.9 +/- 9.1 mV) did not change with TPPS, but papaverine significantly decreased the mean CEA to 12.3 +/- 4.9 mV (P < 0.001). CEA recordings of 16 (76.2%) patients revealed a significant decrease after papaverine injection, however seven (33.3%) patients showed significant CEA decrease in response to TPPS. Both TPPS and papaverine were observed to have a higher effect in patients with NVED in terms of inducing penile erection and decreasing CEA compared to their effects in patients with VED., Conclusion: TPPS induces penile erection and decreases CEA for some extent, but to a lesser degree compared to papaverine. As further improvements are achieved in the methodology of TPPS, it may be a valuable method in the evaluation patients with erectile dysfunction.

We describe a case with perirenal retained sponge presenting as renal tumor who had undergone surgery for urolithiasis 38 years ago. After remaining silent so many years, it was incidentally diagnosed during operation. We suggest further investigation in patients with renal masses and history of retroperitoneal surgery to avoid unnecessary nephrectomy.

Objective: To investigate the role of a new preoperative parameter, relaxation degree (RD), in the prediction of postoperative success after deep dorsal vein arterialization operations., Patients and Methods: Chart reviews and electromyographic recordings were evaluated in 52 patients on whom deep dorsal vein arterialization was carried out for pure caverno-occlusive dysfunction. The efficiacy of the operation was assessed as improvement or failure according to the five-item version of international index of erectile function (IIEF). RD was defined as the percentage decrease in cavernous electrical activity (CEA) after intracavernous papaverine injection. Preoperative RD measurements were statistically compared between the improvement and the failure groups., Results: The mean age of patients was 34.2 +/- 8.1 years (range 25-49) with a mean follow-up of 32 +/- 8 months. Improvement was observed in 39 (75%) and failure in 13 (25%) patients. The mean RD values were 60% and 32% for surgical improvement and failure groups respectively (P < 0.01). In patients with mild ED, the mean RD value was 70.3% whereas it was 28.7% in patients with severe ED. The RD value of greater than 40% predicts surgical success with a specifity of 75% and a sensitivity of 90%., Conclusion: The RD value of cavernous muscle seems to decrease as the severity of ED increases. In addition, RD may predict the outcome of penile revascularization operations and it may be a useful preoperative indicator for surgical success.

Purpose: The ontogeny of androgen receptor expression in male and female mouse genital tubercles, and the effects of in utero ethinyl estradiol exposure on androgen receptor mRNA expression in the hypospadias model were studied., Materials and Methods: Androgen receptor mRNA expression was measured in mouse genital tubercles from fetuses and pups collected on gestational days 12, 14, 16 and 18, and from newborns using immunohistochemistry and real-time quantitative polymerase chain reaction. Pregnant dams were exposed to ethinyl estradiol or corn oil as controls from gestational days 12 to 17. Genital tubercles of gestational day 19 fetuses were then examined by further quantitative polymerase chain reaction analysis after identification of the seam area using a dissecting microscope to diagnose hypospadias in males., Results: Androgen receptor protein was detected in genital tubercles by gestational day 14. Androgen receptor mRNA expression increased gradually in each sex during normal development. However, female genital tubercles expressed a higher level of androgen receptor mRNA throughout development compared to male genital tubercles (p <0.0001). In utero ethinyl estradiol exposure led to a 5.4 and 4.5-fold increase in androgen receptor mRNA in the genital tubercles of female and male embryos (p = 0.004 and 0.001, respectively). Hypospadiac male genital tubercles showed increased androgen receptor mRNA expression compared to control males (p = 0.006). Levels in hypospadiac males did not differ from those in control females but they were less than those in ethinyl estradiol treated females (p >0.05 and 0.01, respectively)., Conclusions: Androgen receptor protein is expressed abundantly in male and female genital tubercles. Androgen receptor mRNA levels are higher in female than in male genital tubercles through development and they increase in response to in utero ethinyl estradiol exposure with ethinyl estradiol treated females having the highest levels of expression, followed by ethinyl estradiol treated hypospadiac males. We infer that higher estrogen in genital tubercles results in a physiological response of increased androgen receptor mRNA expression. We found no direct association between changes in androgen receptor mRNA expression and the presence or absence of hypospadias in males, suggesting that alterations in the expression of proteins other than or in addition to androgen receptor result in anomalous urethral development. This finding supports the idea that the etiology of hypospadias is multifactorial in origin.

Purpose: We investigated the role of steroid receptors in normal and abnormal genital tubercle development in males and females. We hypothesized that progesterone receptor expression might be involved in abnormal development in both sexes., Materials and Methods: We examined the effects of medroxyprogesterone acetate on steroid receptor mRNA expression and assessed the involvement of androgen receptor in the action of medroxyprogesterone acetate on genital tubercle development using androgen receptor deficient (Tfm) mice., Results: Quantitative reverse transcriptase polymerase chain reaction and morphological results demonstrated a pattern of virilized females and feminized males in medroxyprogesterone acetate exposed embryos. Progesterone receptor was the only steroid receptor examined that did not differ between medroxyprogesterone acetate treated males and vehicle treated females. At the morphological level in utero exposure to medroxyprogesterone acetate from gestational days 12 to 17 feminized male genital tubercles, producing a more proximal urethral opening. Female fetuses exposed for the same period exhibited virilized genitalia, with a more distal urethral opening. We also exposed Tfm mice to medroxyprogesterone acetate to assess the role of androgen receptor in the activity of medroxyprogesterone acetate. These medroxyprogesterone acetate exposed mice did not differ morphologically from vehicle treated Tfm mice, indicating that medroxyprogesterone acetate requires androgen receptor to elicit genital tubercle abnormalities., Conclusions: The increase of progesterone receptor mRNA expression in males and the decrease in females as a result of exposure to medroxyprogesterone acetate, which also causes urethral abnormalities in both sexes, suggests a previously unidentified role for progesterone receptor, possibly interacting with androgen receptor, in anomalous genital tubercle development.

Objectives: To compare the efficacy of sildenafil (Viagra) only, sildenafil plus topical anesthetic cream (EMLA), and topical EMLA-cream-only to that of placebo in treating premature ejaculation., Methods: A total of 84 patients were enrolled in this study. The duration of premature ejaculation in the patients ranged from 9 to 60 months (mean 32.5 +/- 14.6). Patients were randomized into four groups. Group 1 consisted of 20 patients who took placebo for 2 months. Groups 2 and 3 consisted of 20 and 22 patients, respectively, and they received 50 mg sildenafil 45 minutes before coitus for 2 months. In addition, patients in group 3 applied topical EMLA cream to the glans penis 15 minutes before coitus. The 22 patients in group 4 used topical EMLA-cream-only. After at least eight sexual attempts, the patients' clinical responses were assessed using the patient self-description method. Effectiveness was described as improvement plus cure., Results: The effectiveness was 40% in group 1, 55% in group 2, 86.4% in group 3, and 77.3% in group 4. Of the groups, a significant difference was found in the effectiveness of the treatments (Pearson chi-square= 0.00). No significant difference was found between groups 1 and 2 (P = 0.26). Efficacy was more successful in groups 3 and 4 than in the others (P = 0.00). The difference between groups 3 and 4 was not significant (Pearson chi-square = 0.42)., Conclusions: Sildenafil-only was not superior to placebo or combination treatment. Topical EMLA-cream-only had equal effectiveness to that of sildenafil plus topical EMLA treatment. The use of topical EMLA-cream-only seems to be an effective treatment of premature ejaculation.

Purpose: Hypospadias is a developmental anomaly of the penis and urethra that can be steroid mediated. It is characterized by a urethral opening occurring below the normal location at the tip of the penis. The link between loratadine, the active ingredient in a common over-the-counter antihistamine, and hypospadias, the most common congenital abnormality, has been the subject of controversy. We examined the effect of in utero exposure to an over-the-counter loratadine syrup on urethral development, and expression of androgen and estrogen receptors., Materials and Methods: We orally gavaged pregnant dams with the equivalent of a daily dose of loratadine syrup, with 3 times that dose or with a corn oil gavage control from GD 12 through GD 17. Using gross and histological assessment and 3D reconstruction, we looked for urethral abnormalities in fetal GTs at E 19. We also used real-time quantitative PCR to characterize the expression levels of steroid receptor mRNA in the GT at E 19, a critical stage for completion of urethral and penile development in this species., Results: Loratadine syrup disrupted normal urethral development in the mouse, based on gross morphology and histological assessment, and also disrupted steroid receptor expression, producing an expression profile similar to that resulting from in utero exposure to ethinyl estradiol., Conclusions: In utero exposure to over-the-counter loratadine syrup can result in hypospadias in this model, and creates changes in the steroid receptor mRNA expression profile similar to those elicited by a synthetic estrogen.

Background/aims: Synthetic estrogens induce hypospadias, an anomaly of genital tubercle/urethral development. Activating transcription factor 3 (ATF3), which is estrogen-responsive in vitro, is upregulated in hypospadiac human tissue. We used a mouse model of steroid-dependent genital tubercle development to elucidate the ontogeny of ATF3 expression and the developmental response of ATF3 in vivo to estrogen exposure., Methods: We used quantitative RT-PCR to assess ontogenic expression of ATF3 and its response to estrogen treatment in utero. Immunohistochemistry was used to localize the protein., Results: Quantitative RT-PCR showed that ATF3 mRNA is upregulated in all estrogen-exposed fetal genital tubercles compared to controls (p = 0.024), including specifically in males exposed in utero (p = 0.049). Additionally, its expression increases significantly during the period of sexual differentiation in both sexes and significantly correlates with female development (p = 0.004), a phenomenon that appears to be attributable to higher levels at birth in females. The protein localizes in the nucleus, as expected., Conclusions: ATF3 is estrogen-responsive in vivo. The response of ATF3 to estrogenic stimulation in utero at an earlier stage may contribute to urethral abnormalities observed in estrogen-exposed male fetuses, although it is likely not the only gene involved, which supports the general understanding that hypospadias is subject to multifactorial influences. ATF3 may therefore be an appropriate gene for further investigations in an endocrine context.

Hypospadias is a congenital anomaly of the genitalia characterized by abnormalities of the urethra and foreskin, with the urethral meatus located in an abnormal position anywhere from the distal ventral penile shaft to the perineum. Because the incidence of hypospadias is approximately 1/200-1/300 live male births, it is one of the most common congenital malformations, but its etiology is largely uncharacterized. Genomic analysis of hypospadic tissue indicated a potential role for activating transcription factor 3 (ATF3) in the development of this anomaly. ATF3 may be involved in homeostasis, wound healing, cell adhesion, or apoptosis, and normally it is expressed at a steady-state in quiescent cells. Additionally, it has been shown to be an estrogen-responsive gene, and the etiology of hypospadias may be related to in utero exposure to estrogenic or anti-androgenic compounds. We examined the expression of ATF3 in tissues from 28 children with hypospadias compared with 20 normal penile skin tissue samples from elective circumcision. Eighty-six percent of the hypospadias samples were immunohistochemically positive, compared with 13% of normal tissue samples. Seventy-five percent of hypospadias samples were positive from in situ hybridization, compared with 1% of circumcision samples. Our results indicate that ATF3 is up-regulated in the penile skin tissues of boys with hypospadias, suggesting a role for this transcription factor in the development of this abnormality. Because the etiology of hypospadias may include exposure to estrogenic compounds, the responsiveness of ATF3 to estrogen is also discussed.

A 14-year-old boy presented with painless gross hematuria after a blunt trauma to his right lumbar region. Abdominal ultrasonography and abdominal computerized tomography revealed that the right kidney was hydronephrotic; contrast material delineated a hematoma inside the kidney. The patient underwent a right simple nephrectomy and after histopathological examination was found to have a renomedullary interstitial cell tumor of the right kidney. This tumor is common in patients older than 50 years, whereas our patient was very young. The diagnosis of this small tumor is not possible by conventional radiological techniques and histopathological examination is mandatory for its diagnosis.

Objectives: To determine whether the level of serum prostate-specific antigen (PSA) varies with fasting and nonfasting., Methods: The study involved 80 male patients with normal digital rectal examination who were hospitalized for benign urologic problems. The patients with active urinary tract infection, urologic cancer, urethral catheterization, diabetes mellitus, or acute or chronic renal failure and those who had undergone urologic manipulations within the past 45 days were excluded from the study. All the patients were asked to fast between 12:00 am and 8:00 am. The next morning, 10-mL venous blood samples were obtained at 8:00 am. Then each patient was provided with breakfast, which was followed by additional serial venous serum sampling during the first and second hour. The patients ate lunch at 12:00 pm. The final venous serum sampling was conducted at 2:00 pm. The serum PSA levels were determined for all the serum samples., Results: The mean patient age was 62.42 +/- 8.75 years (range 46 to 82). The mean serum total PSA value at fasting and the first, second, and sixth hour was 2.78 +/- 2.19, 2.7 +/- 2.0, 2.7 +/- 2.1, and 2.78 +/- 2.10 ng/mL, respectively. In the comparisons of the fasting values and first, second, and sixth hour values and the values at each hour with those at the other hours, no significant differences were observed (P > 0.05)., Conclusions: According to our results, blood samples can be obtained for serum PSA measurement at any time of the day, regardless of whether the patient has fasted or not.