Çağatay Özsoy

Background: Arteriogenic insufficiency (AI) is the most common vascular cause of erectile dysfunction (ED) and is traditionally diagnosed using semi-invasive papaverine-induced penile Doppler ultrasonography (P-PDUS). Aim: To evaluate the feasibility and diagnostic accuracy of the cavernosal artery ondulation index (CA-OI) measured during the flaccid penile phase for identifying AI in men with ED. Methods: This prospective study included 90 men with clinically confirmed ED (International Index of Erectile Function-5 ≤ 25) and suspected vascular etiology. Gray-scale and color Doppler ultrasonography were performed in the flaccid state to measure CA-OI. AI was diagnosed according to established P-PDUS criteria, and patients were classified into AI (n = 28) and non-AI (n = 62) groups. CA-OI values were compared between groups, and receiver operating characteristic curve analysis was used to evaluate diagnostic performance. Outcomes: The primary outcome was the diagnostic accuracy of flaccid-phase CA-OI for detecting AI. Results: Patients with AI were significantly older than those without AI (59.8 ± 8.8 vs. 46.4 ± 13.5 years, P < .001) and had a higher prevalence of diabetes mellitus (P < .001). Mean CA-OI values were significantly higher in the AI group (2.76 ± 0.28 vs. 2.33 ± 0.17, P < .001). Receiver operating characteristic analysis demonstrated excellent diagnostic performance, with an area under the curve of 0.906. A CA-OI cut-off value of 2.46 yielded 89.3% sensitivity and 79% specificity for identifying AI. Clinical Implications: Measurement of CA-OI in the flaccid phase offers a non-invasive and clinically practical approach for the initial screening of arteriogenic ED, potentially reducing the need for intracavernosal injection. Strengths and Limitations: The principal strength of this study is the first evaluation of CA-OI as a non-invasive diagnostic marker obtained during the flaccid penile phase; limitations include the single-center design and the use of P-PDUS rather than angiography as the reference standard. Conclusion: CA-OI measured during the flaccid penile phase is a highly accurate, non-invasive marker for AI in men with ED.

Objective: To investigate the association between serum testosterone levels and the severity of penile curvature and plaque size in men with Peyronie’s disease (PD). Materials and Methods: This retrospective cross-sectional study included 108 men diagnosed with Peyronie’s disease who presented to our urology outpatient clinic between January 2022 and July 2025. Patients with prior testosterone replacement therapy, pelvic surgery, intralesional treatment, or systemic conditions affecting testosterone metabolism were excluded. Demographic and clinical data—including disease duration, penile pain, erectile dysfunction (assessed by IIEF-5), and disease phase—were recorded. Penile curvature was assessed via self-photographs during natural or pharmacologically induced erections, and plaque size was measured ultrasonographically. Fasting morning serum samples were analyzed for total testosterone (TT), free testosterone (FT), sex hormone-binding globulin (SHBG), luteinizing hormone (LH), follicle-stimulating hormone (FSH), estradiol, and metabolic parameters. Results: Mean age was 59.6 ± 7.5 years, and mean disease duration was 22.7 ± 29.4 months. Mean horizontal and vertical curvatures were 12.1 ± 19° and 28.5 ± 19.8°, respectively. Mean plaque size was 8.9 ± 7 mm. No significant differences were observed between hypogonadal and eugonadal groups in curvature severity (p>0.05), plaque size (p=0.54), or disease phase. Hypogonadal men had significantly lower SHBG and estradiol levels and higher HbA1c and triglyceride values (all p<0.05). No correlations were found between testosterone levels and curvature degree or plaque dimensions. Conclusion: Serum testosterone levels are not associated with PD severity. Hypogonadism appears to be a comorbidity rather than a determinant of disease severity, suggesting routine testosterone evaluation may not be necessary in PD management. Keywords: Peyronie’s disease, penile curvature, penile plaque, testosterone levels

Amaç: Penil fraktür cerrahisi sonrası intravajinal ejakülatuvar latens süresindeki (IELT) değişiklikleri değerlendirmek ve uzun dönem postoperatif IELT ile ilişkili klinik ve intraoperatif faktörleri belirlemek. Gereç ve Yöntem: Bu retrospektif kohort çalışmasına, tek bir üçüncü basamak merkezde penil fraktür nedeniyle cerrahi onarım uygulanan 38 hasta dâhil edildi. Hastaların kendi bildirimlerine dayanan IELT değerleri preoperatif dönemde ve postoperatif 6., 12. ve 24. aylarda kaydedildi. Zaman içindeki IELT değişiklikleri Friedman testi ile, ikili karşılaştırmalar ise Bonferroni düzeltmeli Wilcoxon testi ile analiz edildi. Yirmi dördüncü aydaki IELT’nin bağımsız belirleyicilerini saptamak amacıyla; demografik değişkenler, fraktür özellikleri, perioperatif faktörler ve preoperatif IELT’yi içeren çok değişkenli gama regresyon analizi yapıldı. Bulgular: Medyan IELT’nin, preoperatif dönemde 255 saniye iken postoperatif 6., 12. ve 24. aylarda sırasıyla 265, 280 ve 280 saniyeye progresif olarak arttığı gözlendi (p <0,001). Postoperatif 6. ayda IELT, başlangıç değerleriyle anlamlı farklılık göstermezken, 12. ve 24. aylarda preoperatif değerlere kıyasla anlamlı uzama saptandı. Çok değişkenli analizde, daha uzun yırtık uzunluğu (Exp[B]=1,016; %95 GA 1,001–1,031; p=0,043) ve daha yüksek preoperatif IELT (Exp[B]=1,006; %95 GA 1,005–1,007; p <0,001) 24. aydaki IELT uzaması ile bağımsız olarak ilişkili bulundu. Proksimal fraktür lokalizasyonu IELT uzaması ile sınırda ilişki gösterirken; yaş, diabetes mellitus, fraktür yönelimi ve cerrahiye kadar geçen süre anlamlı belirleyiciler değildi. Sonuç: Penil fraktürün cerrahi onarımı, ejakülatuvar latens süresinde gecikmiş ancak kalıcı bir uzama ile ilişkilidir. Tunikal hasarın boyutu ve başlangıç ejakülatuvar fonksiyon, uzun dönem postoperatif IELT’nin temel belirleyicileridir. Bu bulgular, penil fraktür onarımı sonrası hasta değerlendirme ve danışmanlığında erektil fonksiyonun yanı sıra ejakülatuvar sonuçların da dikkate alınması gerektiğini düşündürmektedir. Anahtar Kelimeler: penil fraktür, tunika albuginea, intravajinal ejakülatuvar latens süresi, cerrahi onarım

Gelmis M, et al. Investig Clin Urol. 2026 Jan;67(1):43-51. https://doi.org/10.4111/icu.20250218

Objective: This study aims to evaluate the clinical outcomes of patients receiving antithrombotic (antiaggregant and anticoagulant) therapy who underwent emergency percutaneous nephrostomy (PN) for the treatment of receiving complicated upper urinary tract infection. Material and Methods: Data of consecutive patients who underwent emergency PN from January 2014 to October 2024 were retrospectively reviewed. A total of 34 patients on antithrombotic treatment (Group 1) and 35 control group patients (Group 2) without bleeding disorders or any antithrombotic treatment were included. Demographics, indications for PN, pre- and postprocedural hematological, biochemical, and microbiological parameters and complications were analyzed. Results: The mean age was 68.65±1.49 in group 1 and 62.09±1.77 in group 2 (p = 0.006). Sex distribution and indications for PN were comparable between groups. There was no significant difference in emergency PN indications, grade of hydronephrosis, and PN placement sides. The most common antithrombotic agent in group 1 was warfarin (44.1 %). Escherichia coli was the most common bacteria isolated in both groups (55.9% vs. 48.6 % for groups 1 and 2, respectively). No major complications were observed in either group. Blood replacement was performed in 4 and 3 patients in groups 1 and 2, respectively. Mean post-procedure Hg levels were similar in both groups (9.53 ±1.39 vs. 9.98 ±1.18 for groups 1 and 2, respectively). No difference in median hospital stay was observed between the groups. Conclusion: Antithrombotic drugs pose a potential bleeding risk during PN placement. This is the first study in the literature on PN placement in patients on antithrombotic therapy, and it shows that the procedure can be performed with low complication rates in patients on antithrombotic therapy.

OBJECTIVE: The aim of this study was to investigate the relationship between metabolic syndrome (MetS) and acquired premature ejaculation (PE). MATERIAL and METHODS: A total of 50 patients with acquired PE and 50 control cases were enrolled in the study. After obtaining a detailed medical history, anthropometric (weight, height and waist circumference) and blood pressure measurements were performed. Ejaculation and erection functions were evaluated by Premature Ejaculation Diagnostic Tool (PEDT) and International Index of Erectile Function-5 (IIEF-5), respectively. Self-estimated intravaginal ejaculatory latency time (IELT) of the participants was recorded. Fasting blood samples were taken for biochemical and hormonal work-up. RESULTS: The median PEDT scores were 15 (9–20) and 4 (0–8) in acquired PE and control groups, respectively (p<0.001). The mean estimated IELT values in PE patients and controls were 50,76 ± 11,19 versus 506,08 ± 49,47 s (p<0.001). MetS was diagnosed in 20 patients (40%) in the PE group and 6 (12%) participants in the control group (p=0.001). A significant negative correlation was observed between the components of MetS and estimated IELT, except for systolic blood pressure. Moreover, there was a significant positive correlation between the all components of MetS and total PEDT score. Logistic regression analysis revealed that MetS components were significant risk factors for PE. CONCLUSION: MetS is associated with acquired PE. Keywords: acquired premature ejaculation, metabolic syndrome, risk factor