Obesity is an important health problem with an increasing frequency in the world. In recent years, obesity has been shown to be closely related to infertility in addition to causing many important additional and systemic health problems. The relationship between obesity and infertility is evaluated based on many complex mechanisms, such as inflammatory cellular response, endocrine factors released from adipose tissue, and epigenetic changes, as well as other known factors including increased scrotal temperature and hormonal imbalance. While increasing BMI negatively affects the known reproductive hormonal mechanism, on the other hand, adipose tissue acts as an endocrine organ and secretes several hormones called adipokines. These hormones affect spermatogenesis both central and testicular ways. Moreover, increased adipose tissue and BMI cause to rising scrotal temperature, and result in sperm DNA damage. Therefore, sperm DNA damage caused by both the negative effect of adipokines, increased scrotal temperature, and increased inflammatory response impairs sperm functional structure. In addition to all these factors, sexual dysfunction which develops due to hormonal imbalance as a result of excess weight and psychologic factors caused by a distorted body image, constitute an important obstacle to a healthy sexual life. As a result, obesity should be considered as a health problem that plays a role in male infertility with its multi-faceted interaction.

Abstract Objective The aim of the present study was to investigate serum ghrelin and orexin levels in patients with varicocele and compare these levels with idiopathic infertile male and healthy control cases. Methods This study enrolled 24 men with varicocele, 24 males having idiopathic infertility, and 21 fertile men as the control group. Hormonal analyses, ghrelin and orexin levels were measured samples. Semen was analyzed after 3 and 5 days of sexual abstinence. Results Serum ghrelin levels were statistically different among the three groups (p=0.015), and it was due to a statistically lower level in group-1 than the level in the control cases (p=0.012). On the other hand, serum orexin levels were lower than healthy subjects in infertile groups with/without varicocele, but there was no difference (p=0.685) among three groups. Serum ghrelin level showed a negative and significant correlation only with sperm motility (r=−0.646, p=0.022), there was no correlation with other parameters. On the other hand, serum orexin levels did not show a significant correlation with seminal parameters. Conclusion Both new investigated peptides ghrelin and orexin have regulatory effects on testicular function. However, ghrelin has a more obvious and complex effect on spermatogenesis. Impaired seminal parameters, especially motility was associated with increased serum ghrelin levels in infertile patients, especially with varicocele.

You have accessJournal of UrologyInfertility: Therapy I1 Apr 2017MP89-07 ARTIFICIAL REOPRODUCTIVE TECHNIQUE OUTCOMES IN MALE HYPOGONODOTROPIC HYPOGONODISM REGARDING SPERM SOURCE M. Murad BASAR, Caroline Pirkevi-Cetinkaya, Yesim Kumtepe-Colakoglu, Serkan Selimoglu, and Semra Kahraman M. Murad BASARM. Murad BASAR More articles by this author , Caroline Pirkevi-CetinkayaCaroline Pirkevi-Cetinkaya More articles by this author , Yesim Kumtepe-ColakogluYesim Kumtepe-Colakoglu More articles by this author , Serkan SelimogluSerkan Selimoglu More articles by this author , and Semra KahramanSemra Kahraman More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2805AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Hypogonadotropic hypogonadism is a rare disease for infertile patients. Generally, sperm can be obtained in ejaculate after medical treatment, but some patients can undergo testicular sperm extraction. The aim of the present study was to evaluate ART outcomes in men with hypogonadotropic hypogonadism. METHODS A total of 119 ART cycles in 61 patients were evaluated in this study between January 2004 to August 2016. Hormone replacement therapy including human chorionic gonadotropin 5.000-10.000 IU weekly and human menopausal gonadotropin 150-225 IU weekly were given before ART cycles. ART cycles were planned when hormone levels were in eugonadotropic and/or sperm was observed in the ejaculate. ART cycles were divided into two groups according to sperm source as ejaculated (n=94) and testicular spermatozoa used (n=25). Total number of retrieved and metaphase II oocytes, fertilization, clinical pregnancy and life birth rates were compared between two groups. Additionaly, ART cycles were also evaluated in fresh (n=91) and frozen embryo (n=28) cycles. RESULTS Male mean age and duration of infertility were 35.8±5.64 and 6.1±4.16 years, respectively. While ejaculated sperm was used in 94 (79%) cycles, testicular sperm was used in 25 (21%) cycles with persistent azoospermia despite hormonal treatment. Micro TeSe was performed on 16 patients (13.4%), and sperm was found in 13 of them. Therefore, the sperm retrieval rate with micro TeSe was 81.3% in hypogonadotropic hypogonadism. Compared parameters were given in Table 1. While there was observed statistically significant difference in clinical pregnancy rate between two groups according to sperm source (p=0.017); there were not observed any statistical differences among other compared parameters. Additionally, the ART outcomes were evaluated in fresh and frozen embryo transfered ART cycles. In fresh and frozen embryo cycles, pregnancy rate was 48.4% and 42.9% and life birth rate was 34.1% and 25%, respectively. There were not observed statistical differences between these parameters (p>0.05). CONCLUSIONS Patients with hypogonadotropic hypogonadism have high fertilization and pregnancy rates in both of fresh and frozen ART cycles. Although sperm retrieval rate is higher with micro TeSe, ejaculated spermatozoa can be used effectively for ART. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e1204 Advertisement Copyright & Permissions© 2017MetricsAuthor Information M. Murad BASAR More articles by this author Caroline Pirkevi-Cetinkaya More articles by this author Yesim Kumtepe-Colakoglu More articles by this author Serkan Selimoglu More articles by this author Semra Kahraman More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

OBJECTIVES:Female sexual dysfunction (FSD) and urinary incontinence (UI) are associated risk factors that might cause each other. No study has investigated prevalence of FSD and UI in the same population. The aims of the study were to investigate the prevalence of FSD and UI and associated risk factors in the same population.STUDY DESIGN:The study included 1217 women in 20 provinces, representing the geographical regions of Turkey. Women aged ≥18 years with active sexual life in the last 6 months were enrolled. FSD, overactive bladder, UI, depression, and sexual distress were investigated using validated scales. Risk factors that might predict FSD and UI were determined in the same population.RESULTS:The prevalence of FSD and UI was 52.5% and 14.6%, respectively. Comparing the women with and without FSD, those with FSD were older, had higher body mass index (BMI), less physical exercise, older spouses, lower educational level, and lower rates of smoking and alcohol consumption. The rates of women in menopause and those with a spouse/partner having erection problem and the rates of UI, depression, and sexual distress were higher in the FSD group. Age of spouse, low educational level, not smoking, not consuming alcohol, menopause, not giving consent to spouse/partner to use sexual performance-enhancing drugs when necessary, depression, and sexual distress were the significant risk factors for FSD. Of the women with UI, 56% had overactive bladder symptoms, 32% had stress UI, and 12% had mixed type UI. Comparing the women with and without UI, those with UI were older, had higher BMI, lower educational level, and older spouses. The rate of menopausal women and the rates of FSD, depression, and sexual distress were higher in the UI group. Menopause and FSD were the significant risk factors for UI.CONCLUSIONS:This is the first study to investigate prevalence of FSD and UI in the same population. UI deteriorates sexual functions of women. Therefore, both conditions should be assessed when women complain of either sexual or urinary problems.

The aim of the study is to evaluate extracorporeal shock wave lithotripsy (ESWL) related alterations in renal pelvis and proximal ureter by using histopathological methods and analayting hydroxy-proline levels. Twelve New-Zealand rabbits were allocated into two groups (n=6). Right sites of control group (CG, n=6) were harvested without any intervention. In ESWL group (EG), right kidneys of subjects were exposed to 3000 shock waves (14 kV) by using electro-hydraulic type ESWL device three times. Rabbits in EG were sacrificed on day 7. Tissues were examined histopathologically for presence of edema, inflammation, congestion, hemorrhage, fibrosis, vascularization and biochemically for hydroxyproline concentrations. Histopathologically, tissue edema was increased in renal pelvises and inflammation was increased in ureters in the EG compared to that in the CG (p 0.05). Tissue collagen density did not show any significant difference (p>0.05). There was no difference in the tissue hydroxyl-proline levels of ureter samples (p>0.05). Tissue hydroxyproline levels were significantly higher in EG than CG in renal pelvis (p<0.05). In conclusion, although no major histopathological alteration due to ESWL was detected in renal pelvis and proximal ureter, increased hydroxyproline levels in the renal pelvis can be suggested as a finding of tissue injury in collecting system.

BACKGROUND AND OBJECTIVES:In this retrospective study, nature, clinical presentations, diagnostic modalities, and endoscopic treatment of urinary system foreign bodies were evaluated.METHODS:A total of 8 cases were treated with endoscopic surgery between February 15, 2007 and June 12, 2012. Clinical findings, radiologic diagnosis, and management were reviewed.RESULTS:We observed that urinary tract foreign bodies were generally secondary to iatrogenic causes; however, bladder/urethral foreign bodies could also be due to self-insertion. Clinical findings were different secondary to their location in the urinary system. All foreign bodies were treated endoscopically.CONCLUSIONS:Foreign bodies of the urinary system can successfully be treated with endoscopic modalities without any complications.

Purpose. To evaluate the safety and efficacy of RIRS for the treatment of multiple unilateral intrarenal stones smaller than 20 mm.Methods. Between March 2007 and April 2013, patients with multiple intrarenal stones smaller than 20 mm were treated with RIRS and evaluated retrospectively. Each patient was evaluated for stone number, stone burden (cumulative stone length), operative time, SFRs, and complications.Results. 173 intrarenal stones in 48 patients were included. Mean age, mean number of stones per patient, mean stone burden, and mean operative time were40.2±10.9years (23–63),3.6±3.0(2–18),22.2±8.4 mm (12–45), and60.3±22.0minutes (30–130), respectively. The overall SFR was 91.7%. SFRs for patients with a stone burden less and greater than 20 mm were 100% (23/23) and 84% (21/25), respectively (χ2=26.022,P<0.001). Complications occurred in six (12.5%–6/48) patients, including urinary tract infection or high-grade fever >38.5°C in three cases, prolonged hematuria in two cases, and ureteral perforation in one case, all of whom were treated conservatively. No major complications occurred.Conclusions. RIRS is an effective treatment option in patients with multiple unilateral intrarenal stones especially when the total stone burden is less than 20 mm.

OBJECTIVE:We aimed to investigate the changes in endothelial nitric oxide synthase (eNOS) and inducible nitric oxide synthase (iNOS) expression and apoptotic index in rat testicular tissue, as well as serum and seminal plasma sex hormone levels after vasectomy, and the effect of ozone therapy (OT). MATERIAL AND METHODS:Adult male Wistar rats were used (n=6 per group). Control (G1), sham for 4 weeks (G2) or 6 weeks (G3), orchiectomy at the 4(th) (G4) or 6(th) (G5) week after left vasectomy, orchiectomy at the 4(th) (G6) or 6(th) (G7) week after bilateral vasectomy, orchiectomy after 6 weeks OT following left (G8) or bilateral (G9) vasectomy, orchiectomy after 6 weeks OT (G10). RESULTS:In the left testes, while there were increases in eNOS and iNOS immunoreactivity and apoptotic indexes in G4 and G5, no changes were observed in contralateral testis. These values increased in G6 and G7, while OT inhibited these parameters in the left testis of G8 and both testes of G9. Sex hormone levels did not show any changes after vasectomy and ozone therapy. CONCLUSION:While OT was found to be protective against some parameters mentioned above under stress conditions, it seemed to cause some harmful effects when used in healthy conditions.

The aim of the present study was to investigate serum homocysteine levels in patients with erectile dysfunction and to evaluate the relationship between serum homocysteine levels and response to the standard 50 mg phosphodiesterase 5 inhibitor treatment. Twenty-eight erectile dysfunction patients having normal vascular parameter according to Penile Doppler Ultrasonography and twenty healthy subjects were enrolled in the study. All subjects filled The International Index of Erectile Function (IIEF) questionnaire. A total of 4-6 doses of phosphodiesterase 5 inhibitor (sildenafil 50 mg) were given to patients. Later, they were divided into two groups as sildenafil responder and non-responder. Serum homocysteine levels were compared in groups based on sildenafil response. Compared with healthy subject, higher homocysteine levels were observed in patients with erectile dysfunction (p = 0.005), especially in sildenafil non-responder group (p = 0.005). There was significant negative correlation between homocysteine and IIEF scores in group responder to sildenafil treatment (r = -0.698, p = 0.008). Mean IIEF scores of patients with non-responder to sildenafil 50 mg were lower than those of controls (p = 0.0001), but mean IIEF scores of patients with responders approached values observed in control subjects (p = 0.002). The results indicated that measurement of serum homocysteine levels could be used as a marker for the evaluation of efficacy of phosphodiesterase 5 inhibitor and the selection of efficacious alternative therapies.

Aim: In this study, we aimed to investigate the relationship between heart rate recovery (HRR) time and Chronotropic Index (CHIND) parameters, which also reflect autonomic function, after exercise stress test (EST) in males with or without erectile dysfunction (ED), and we investigated the relationship between HRR and CHIND and serum steroid hormone levels. Material and Methods: A total of 135 participants (mean age: 45.0 ± 11.8 years) were enrolled into the study. Detailed biochemical and hormonal analyses, 12‐lead electrocardiography and EST (Treadmill) were performed in all participants. Erectile function was assessed using the International Index of Erectile Function (IIEF) questionnaire form. Patients were categorized into two groups according to their IIEF scores as ED (+) (IIEF < 26) and ED (−) (IIEF ≥ 26). Afterward, statistical analyses were performed to evaluate the correlations between ED and HRR and CHIND. Results: A total of 65 patients were ED (+) (mean age 44.9 ± 6.4 years), while 70 patients (mean age 43.7 ± 7.7 years) had normal erectile status. There were statistically significant differences in CHIND (P = 0.015) and HRR time (P = 0.037) between ED (+) and ED (−) patients. In correlation analysis, IIEF score was found positively correlated with HRR and metabolic equivalent (MET) values (rHRR= 0.293, P = 0.037; rMETs= 0.388, P = 0.011, respectively). Linear regression analysis revealed that METs value and total exercise time had a more linear relationship with IIEF score compared to the other EST parameters (pMETs= 0.002 and pTET= 0.015, respectively). Conclusion: Chronotropic incompetence and dynamic postexercise autonomic dysfunction are present in ED patients. This condition may reflect decreased functional capacity and exercise intolerance in these patients. Ann Noninvasive Electrocardiol 2010;15(3):223–229

BackgroundWe aimed to investigate differences in circadian autonomic changes in patients suffering from hyperlipidemia with and without erectile dysfunction and compared results to control cases.Materials and methodsA total of 77 patients (age range: 24–74, mean age: 45.3 ± 9.3) with uncontrolled hyperlipidemia (total cholesterol >200 mg/dL and/or LDL >160 mg/dL despite a regular diet) were enrolled into the study. These patients were divided into two groups according to their International Index of Erectile Function (IIEF-EF) scores as having erectile dysfunction (IIEF-EF < 26) (Group 1) or as having normal erectile function (IIEF-EF ≥ 26) (Group 2). In addition, the control group comprised 44 healthy men (age range: 20–57, mean age: 44.0 ± 10.8) (Group 3). Heart rate variability parameters obtained by 24-h Holter monitoring were utilized for the indirect evaluation of autonomic function.ResultsThere were statistically significant differences between the groups with respect to daytime and nocturnal autonomic activity (p < 0.005). Moreover, Group 1 had lower nocturnal parasympathetic and higher nocturnal sympathetic activity compared to the other groups (for nocturnal HFn p1-2 < 0.001; p1-3 < 0.001; p2-3 > 0.05; for nocturnal LFn p1-2 < 0.001; p1-3 < 0.001; p2-3 > 0.05).ConclusionWe concluded that hyperlipidemia results in deterioration of autonomic circadian rhythm. Hyperlipidemic patients with erectile dysfunction had diminished nocturnal parasympathetic activities.