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    Auditory event-related potentials in patients with premature ejaculation
    (Elsevier Science Inc, 2001) Ozcan, C; Ozbek, E; Soylu, A; Yilmaz, U; Guzelipek, M; Balbay, MD
    Objectives. To investigate in a descriptive manner the P300 component of the event-related potential (ERP), which is related to aspects of cognitive processing, in patients with premature ejaculation (PE) to determine whether there is a cognitive alteration in this condition. Recent studies with short latency evoked potentials such as cortical somatosensory evoked potentials have indicated that afferent sensory inputs from the genital area to the nervous system are increased in PE, However, the cortical neural process of ejaculation has remained poorly understood. Methods. We performed ERPs in 20 patients with PE and in 20 age-matched healthy subjects. ERPs were evoked by an auditory oddball paradigm consisting of 150 tone bursts (80% 1 kHz; 20% 2 kHz). The latencies of the N200 and the P300 waves and the amplitude of the P300 wave were measured. Results. The mean latencies of the N200 and P300 waves were significantly longer in the patients with PE than in the controls (P<0.04 and <0.03, respectively). No significant difference was found in the P300 amplitude between the controls and patients (P>0.05). Conclusions. These data indicate that the greater cortical representation of sensory stimuli from the genital areas that has been shown with somatosensory evoked potential studies might be related to a cognitive/neurobehavioral dysfunction. The dysfunction involves an increased time to evaluate and categorize the stimuli in the central nervous system, with no change in the quality of cognition and neural disinhibition by the prefrontal cortex to early sensory processing in subcortical or primary cortical regions, which are cognitive neural processes underlying ERP generation. UROLOGY 58: 1025-1029, 2001 (C) 2001, Elsevier Science Inc.
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    Effects of micronised purified flavonoid fraction on pain, spermiogram and scrotal color Doppler parameters in patients with painful varicocele -: Results of a pilot study
    (Karger, 2005) Kiliç, S; Günes, A; Ipek, D; Dusak, A; Günes, G; Balbay, MD; Baydinç, YC
    Purpose: Micronised purified flavonoid fraction (MPFF) is a phlebotropic drug improving venous tone, elasticity and lymphatic drainage, decreasing venous distensibility, venous emptying times, reflux time of venous blood and capillary hyperpermeability, and having antioxidant activities. Since varicocele is a venous pathology, we evaluated the effects of MPFF on pain, spermiogram and color Doppler parameters in patients with painful varicocele. Material and Methods: Semen analyses and Doppler sonography were performed in 16 patients ( aged 20 - 62 years, mean 31.2 +/- 10.9) before and after 1,000 mg/day MPFF treatment. Pain change was assessed with visual analogue scale scored between 0 and 10. Patient satisfaction with outcome and side effects were recorded. Results: Mean pain scores at 1, 3, and 6 months were 1.25 +/- 1.34, 0.25 +/- 0.68, and 0.12 +/- 0.34, respectively, all being significantly lower ( p < 0.001 for each) than baseline ( 4.93 +/- 1.77). Mean score at 12 months (0.93 +/- 1.06) was still lower than baseline ( p < 0.001) but higher than at 6 months ( p = 0.019). Respectively, 14 (87.5%) and 2 (12.5%) patients reported complete and very significant resolution of pain at the 6th month. All patients were very satisfied with the outcome. While semen volume, total sperm count, sperm concentration and morphology did not change significantly, motility increased significantly ( p = 0.009) due to decrease of grade 0 sperms ( p = 0.006) and increase of grade 3 + 4 sperms ( p < 0.001). Reflux time of left spermatic vein during the Valsalva maneuver decreased significantly ( p = 0.003). No significant change occurred in reflux time of the right spermatic vein. No side effect was recorded. Conclusions: Results of this preliminary study suggest the safety and efficacy of MPFF in the treatment of varicocele-associated pain. However, no recommendation for the use of MPFF in the treatment of pain associated with varicocele can be made before these preliminary results are confirmed by a randomized placebo-controlled trial. Copyright (C) 2005 S. Karger AG, Basel.
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    The role of adrenomedullin in varicocele and impotence
    (Blackwell Science Ltd, 2000) Ozbek, E; Yurekli, M; Soylu, A; Davarci, M; Balbay, MD
    Objective To assess the levels of adrenomedullin (a vasodilatory peptide) in penile blood before and after injection with papaverine in impotent men, and in the internal spermatic vein in infertile patients with varicocele, comparing the results with levels in the brachial vein in the same patients. Patients and methods Intracavernosal levels of adrenomedullin were determined in 14 impotent men (with no vascular pathology, as assessed by colour Doppler ultrasonography) before and after papaverine-induced penile erection. The effect of needle puncture alone was assessed in eight control patients. The level of adrenomedullin was also measured in the internal spermatic vein and brachial vein in 14 infertile men with varicocele. Results The mean (SD) intracavernosal adrenomedullin levels in the 14 impotent men were significantly different between the flaccid and papaverine-induced erectile state, at 93.5 (33.0) and 135.8 (34.9) pmol/mL, respectively, (P < 0.05). Needle puncture alone had no effect on adrenomedullin levels. In men with varicocele, the adrenomedullin level of 139.0 (34.3) pmol/mL within the internal spermatic vein was significantly higher than that in the brachial vein, at 103.9 (37.6) pmol/mL (P < 0.05). Conclusion Injection with papaverine increases adrenomedullin release into penile blood; this release may be responsible for the increase in penile blood flow and penile erection. Higher levels of adrenomedullin within the internal spermatic vein of patients with varicocele may result from the retrograde flow of venous blood from the left adrenal gland and kidney. Further studies are needed to determine the role of adrenomedullin in male infertility and impotence.