Tehran University Medical Journal

Erectile dysfunction is an important problem for men and their families which has an organic cause in about 50 percent of cases. When there is a vasculogenic etiology for this defect, radiologic assessment is unavoidable. Cavernosometry and Cavernosography are ultimate procedures for diagnosis of venous leakage. There is no reliable data about this defects in Iran. The objective of this study was to determine the rate of venous leakage in patients with erectile dysfunction by Pharmarco-Cavernosometry and Cavernosography. In this case series study, 100 patient with erectile dysfunction who referred to radiologic ward in Sina hospital was selected and Pharmarco-Cavernosometry and Cavernosography were conducted for them. In Cavernosometry, after injection of Prostaglandin E1 and salin normal infusion into corpus covernosum, the pressure was determined. In cavernosography, diluted omnipaque was injected and venous leakage and other defects were recognized. Myoclinic's criteria was use for analysis of the results. Mean age of patients was 35.6±11.6. Most of the cases were in 20 to 40 age group. The frequency of venous leakage based on 50 mmHg reduction in pressure (from 150 mmHg), after 30 seconds discountinuance of normal salin infusion was 90 percent. This figure based on the ratio of Maintenance Flow Rate to Induced Flow Rate, was more than 92 percent. The frequency of venous leakage according to Cavernosography was 89 percent. There was no significant side effects in any of cases induced by procedures. The results of study, shows the high prevalence of venous leakage in patients referring for erectile dysfunction.

Erectile dysfunction is an important problem for men and their families which has an organic cause in about 50 percent of cases. When there is a vasculogenic etiology for this defect, radiologic assessment is unavoidable. Cavernosometry and Cavernosography are ultimate procedures for diagnosis of venous leakage. There is no reliable data about this defects in Iran. The objective of this study was to determine the rate of venous leakage in patients with erectile dysfunction by Pharmarco-Cavernosometry and Cavernosography. In this case series study, 100 patient with erectile dysfunction who referred to radiologic ward in Sina hospital was selected and Pharmarco-Cavernosometry and Cavernosography were conducted for them. In Cavernosometry, after injection of Prostaglandin E1 and salin normal infusion into corpus covernosum, the pressure was determined. In cavernosography, diluted omnipaque was injected and venous leakage and other defects were recognized. Myoclinic's criteria was use for analysis of the results. Mean age of patients was 35.6±11.6. Most of the cases were in 20 to 40 age group. The frequency of venous leakage based on 50 mmHg reduction in pressure (from 150 mmHg), after 30 seconds discountinuance of normal salin infusion was 90 percent. This figure based on the ratio of Maintenance Flow Rate to Induced Flow Rate, was more than 92 percent. The frequency of venous leakage according to Cavernosography was 89 percent. There was no significant side effects in any of cases induced by procedures. The results of study, shows the high prevalence of venous leakage in patients referring for erectile dysfunction.

Background: Impairment in the function of the lower urinary tract can be the cause of recurrent urinary tract infections (UTI) and vesico-ureteral reflux (VUR) in children. The purpose of our research was to evaluate the frequency of occurrence of bladder instability in children with UTI.

Methods: The research involved 133 children (11 boys, 122 girls), ranging in age from seven months to 14 years. Group A consisted of 78 children with a history of recurrent UTI, while Group B included 55 children with recurrent UTI and VUR. Urodynamic tests (cystometry) were performed on all the children.

Results: Abnormal functioning of the lower urinary tract was found in 98 children (73.1%) from Group A and 41 children (78.8%) from Group B. The most common dysfunction was detrusor-sphincter dyssynergia (DSD), which was found in 54% of all subjects, 46.2% of patients in Group A and 60% of patients in Group B (p<0.05). Unstable bladder was found in 42 (33%) children with no significant difference between the two groups. In 17 children (12.6%) DSD was accompanied by bladder instability. In both groups about 20% of the children did not present with symptoms indicative of urination dysfunction, where as 80% reported various symptoms, of which the most common were constipation and urinary urgency. In half of the children from Group A and one-fourth of the children from Group B there were several co-occurring symptoms: frequency, urgency, intermittent voiding, incontinence, dribbling and retention, and constipation.

Conclusions: The most common disturbance of lower urinary tract function in these children with recurrent UTI was DSD, which occurred more often in children with VUR.

Background: It is well known that erectile dysfunction is most commonly associated with diabetes, affecting 35% to 75% of men with diabetes mellitus. Several studies have been carried out to find appropriate strategies for treatment of diabetes-induced erectile dysfunction. The aim of the present study was to investigate the ability of acute administration of the endogenous cannabinoid anandamide in vitro to alter the NANC-mediated relaxation of corpus cavernosum from diabetic rats and the possible role of nitric oxide in this manner.

Methods: Diabetes was induced by the administration of streptozotocin for eight weeks. Corpora cavernosa were isolated in organ baths for measurement of agonist-evoked or electrical field stimulation (EFS)-evoked smooth muscle tensions.

Results: The neurogenic relaxation of phenylephrine (7.5 µM) precontracted isolated corporal strips was impaired in diabetic animals. Anandamide (0.3, 1 and 3 µM) enhanced the relaxant responses to EFS in diabetic strips in a dose-dependent manner. This effect was antagonized by either the selective cannabinoid CB1 receptor antagonist AM251 (1 µM) or the selective vanilloid receptor antagonist capsazepine (3 µM). Concurrent administration of partially effective doses of L-arginine (10 µM) and anandamide (0.3 µM) exerted a synergistic improvement in EFS-induced relaxation of diabetic strips (p<0.001). The relaxant responses to the nitric oxide donor sodium nitroprusside of the subjects in the diabetic and control groups were similar.

Conclusion: For the first time, we demonstrated that acute administration of an endogenous cannabinoid, alone or in combination with L-arginine could improve the NO-mediated relaxation of cavernosal smooth muscle in diabetic rats and this effect was mediated by cannabinoid CB1 and vanilloid VR1 receptors within the tissue.
 

Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Although the short-term results of kidney transplantation have improved greatly during the past decades, the long-term results have not improved according. Graft loss due to chronic allograft dysfunction (CAD) is a major concern in renal transplant recipients (RTRs). There is little data about disease progression in this patient population. In this paper, we investigated history of kidney function as the pattern, waiting time and rate of pass from intermediate stages in RTR with CAD.

Methods: In a single-center retrospective study, 214 RTRs with CAD investigated at the Urmia University Hospital urmia, Iran from 1997 to 2005. Kidney function at each visit assessed with GFR. We apply NKF and K/DOQI classification of chronic kidney disease (CKD) staging system to determine pattern of disease progression per stage in this group of patients.
Results: The pure death-censored graft loss was 26% with mean waiting time 81.7 months. 100% of RTRs passed from stage I to II in mean waiting time 26.3 months. The probability of prognostic factors transition from stage II to III was 88.9% with mean waiting time 25.5 months, transition from III to IV was 55.7% with mean waiting time of 24.9 months and transition for stage 4 to IV was 53.5% with mean waiting time of 18.2 months. In overall rate of transition from stage i to j in patients with stage III at the beginning of the study (time of start CAD's process) was faster than others.
Conclusions: This study revealed, that kidney function in first years after transplantation is one of the most important II to III of survival probability per stage and death-censored graft loss. Therefore care of RTRs in first year could potentially increase long-term kidney survival.

Background: Sexual dysfunction in males is characterized by the inability to achieve or maintain an erection sufficient for a satisfactory sexual activity. Erectile dysfunction is a common disorder in males and intracavernosal injection of papaverine followed by color Doppler ultrasonography of the penis is used to diagnose and treat vascular impotence. In this study, we examined the relationship between changes in peak systolic velocity (PSV) and erectile dysfunction with vascular cause after a cavernosal injection of papaverin.

Methods: We performed this self-controlled clinical trial in Shahid Hasheminejad Hospital in Tehran, Iran during 2010 and 2011. The study population consisted of 90 patients with erectile dysfunction. The peak systolic velocity (PSV) of cavernosal arteries was evaluated before and after injection of 40-80 mg papaverine and it was compared in the patients with and without response to injection.

Results: The mean age of participants was 47.7 13.7 years. Response to papaverine injection was positive in 41(45.5%) patients. The mean PSV values were 14.68+5.65 and 53.74+18.8 cm/s before and after the injection, respectively (P<0.001). A PSV cut-off point of 10 cm/s was determined for the condition before injection. The sensitivity and specificity of the value for diagnosis of arterial erectile dysfunction were calclulated as 50% and 100%, respectively.

Conclusion: A PSV cut-off point of 10 cm/s in flaccid status before papaverine injection has a low sensitivity but high specificity for the diagnosis of arterial erectile dysfunction. Future studies with sufficient cases of arterial erectile dysfunction are necessary for final judgments and suggestion a new cut off point.

Background: Erectile dysfunction is an important problem in men and an organic cause is found in about 50% of cases. When a vasculogenic etiology is suspected, imaging assessments are of great help. Cavernosography is traditionally recognized as an imaging modality for evaluation of venous leakage in men with impotency. We employed CT cavernosography as a novel technique for demonstrating penile venous anatomy and leaking veins.
Methods: In the present case series study, we recruited 45 patients with erectile dysfunction by convenient sampling at Hazrat Rasoul Akram Hospital in Tehran, Iran, during one year (1390). The patients had previously been diagnosed with venous incompetency by Doppler study. After intracavernosal injection of prostaglandin E1, we injected sterile normal saline into the corpora cavernosa to achieve penile erection. Later, we injected contrast media into the corpus cavernosum, which was followed by CT scan of the penis and pelvic area to show the venous anatomy and leakage sites.
Results: The mean age of the patients was 35.8±8.9 years. 36 (80%) patients had venous leakage in crural veins, 27 (60%) in cavernosal veins, 27 (60%) in circumflex veins, 24 (52.3%) in urethral veins, 21 (46.7%) in deep dorsal vein, 3 (6.7%) in para-arterial veins and 3 (6.7%) in corpus spongiosum.
Conclusion: The results of this study show the high prevalence of venous leakage in patients referring for erectile dysfunction. Moreover, CT cavernosography was shown to be a useful method for evaluating penile venous system and its related leakage sites which are important for surgical planning.

Background: Arterial insufficiency is a well-recognized etiology of erectile dysfunction. Moreover, nowadays it is appreciated that it can herald silent coronary artery disease in involved patients. However color Doppler study of penis with intracavernosal injection (ICI) of Papaverin, as a helpful diagnostic study, is somehow time consuming and technically demanding, as a result, radiologists are reluctant to accomplish. Hence, in a search for more plausible parameters, we were determined to validate PSV in flaccid state for predicting possible arterial insufficiency in patients.

Methods: In a cross sectional study to evaluate diagnostic tests, accomplished in Hasheminejad Urology center in Tehran throughout 2011, we studied 59 patients with the complaint of erectile dysfunction. They were referred to our ultrasound clinics by urologists in order to undergo color Doppler study of penis by ICI of Papaverin. They were studied comprehensively before and after injection. Primary and secondary diagnostic criteria of arterial disease in color Doppler and consequently the physiologic event of full erection were designated as gold standard diagnostic considerations. The resulted data were matched and analyzed with SPSS software.

Results: Fifty nine patients underwent the study, with the mean age of 45.6 ± 13.1 (24 to 74 year old). Twenty two cases revealed normal study (non-organic causes as 37.3%), 29 were classified as venous leakage, and eight of them demonstrate arterial insufficiency in the study. A flaccid state PSV of 10.5 cm/s as cut off had a sensitivity of 93.8%, specifity of 91.3% and negative predictive value of 93.8% to predict arterial disease.

Conclusion: A flaccid state PSV of 10.5 has a suitable statistical value to proclaim arterial insufficiency in cavernosal arteries in patients with erectile dysfunction as a complaint.

Background: Although sexual dysfunction is a common problem in patients with obsessive-compulsive disorder (OCD), there are sparse clinical research on the study of the correlation between OCD subtypes and different phases of sexual response cycle. This study was undertaken to assess sexual function and its different phases in a group of Iranian patients with OCD. Methods: This was a descriptive cross-sectional study. The subjects consisted of 56 married OCD patients (36 female, 20 male) who suffered from OCD according to a psychiatric interview and DSM-IV questionnaire based on structured clinical interview for DSM (SCID). Patients were between 18 to 50 year age that had been referred to the outpatient clinic of Roozbeh Psychiatric Hospital and three private psychiatric clinics in Tehran (from September 2011 to February 2013). Five Questionnaires were used in this study: Iranian validated form of Female Sexual Function Index (FSFI), International Index of Erectile Function (IIEF), Maudsley Obsessional Compulsive Inventory (MOCI), Obsessive Compulsive Inventory-Revised (OCI-R) and a questionnaire which has provided demographic data and other relevant information regarding sexual function and OCD. Results: The prevalence of sexual dysfunction among female was 80.6% and the frequency of disorders in different subscales of FSFI including sexual desire, sexual arousal, lubrication, orgasm, satisfaction and sexual pain were 50%, 58.3%, 36.1%, 44.4%, 41.7% and 52.8% respectively. Sexual disorder is reported in 25% of male OCD patients which subscales' evaluation of IIEF shows low sexual desire in 10%, erectile disorder in 20%, orgasmic disorder in 25%, sexual dissatisfaction in 40% and 50% decreased in the total sore of IIEF. Moreover, the correlation coefficients between the total score of OCI-R with erectile and satisfaction subscales of IIEF were statistically significant. The score of washing subscale in OCI-R and sexual satisfaction was significantly correlated. Conclusion: High prevalence of sexual dysfunction in OCD women and significant correlation between male sexual dysfunction and OCD (r= -481.0 between total score of OCI-R with erectile dysfunction and r= -458.0 between total score of OCI-R and sexual satisfaction) could confirm a relation between OCD and sexual disorders. So, evaluation of sexual function in all patients with OCD is recommended.

Background: Sexual dysfunction could be under the influence of some underlying medical problems. The purpose of this study is to examine the relationship between medical problems and sexual function in post-menopausal women.

Methods: This is a community-based, descriptive-correlation study of 405 post-menopausal women residing in Chalus and Nowshahr cities, North of Iran, aged 40 to 65 years old from October 2013 to May 2014. A multistage, randomized sampling was conducted. The data was acquired through interviews using the Female Sexual Function Index (FSFI) questionnaire and a researcher-made questionnaire, and was analyzed using descriptive and analytical tests such as multiple linear regression and logistic regression models.

Results: 51.4% of the subjects had medical conditions. Cardiovascular disorders were the most common diseases among the subjects. 61% of the women were suffering from female sexual dysfunction (FSD). Sexual dysfunction in patients with medical conditions was significantly higher (P= 0.037). Scores of arousal (P= 0.000), orgasm (P= 0.018), and satisfaction (P= 0.026), as well as the FSFI total score (P= 0.005), were significantly lower in subjects with cardiovascular disorders. Scores of desire (P= 0.001), arousal (P= 0.006), lubrication (P= 0.010), orgasm (P= 0.004), and satisfaction (P= 0.022), as well as the FSFI total score (P= 0.017), were significantly lower in subjects with diabetes. Scores of pain were significantly lower in subjects with musculoskeletal disorders (P= 0.041), they experienced more pain during intercourse. In domains of arousal (P= 0.030), satisfaction (P= 0.040), and pain (P= 0.044), the scores of those taking antihypertensive medications were significantly lower than the scores of the rest of the subjects. Scores of desire (P= 0.001), arousal (P= 0.006), orgasm (P= 0.006), and satisfaction (P= 0.048), as well as the FSFI total score (P= 0.006), were significantly lower in those taking antidiabetic drugs. And lastly, the mean satisfaction score in women whose spouse had medical conditions was significantly lower (P= 0.040).

Conclusion: Cardiovascular disorders, diabetes, and musculoskeletal disorders could have a negative impact on sexual function in post-menopausal women. Thus, these diseases must be considered and treated in order to improve women’s health, particularly their sexual function.

Background: Dyspareunia is a pain that is occurs in the genital area before, during or after intercourse and is an important factor for sexual dysfunction. The aim of this study was to evaluate the effect of pelvic floor physical therapy on sexual function and muscle strength and endurance of pelvic floor (as a non-invasive therapy) in women with dyspareunia.

Methods: In this clinical trial study, 32 women in the age range of 20-50-year-old and sexually active with complaints of dyspareunia, before the investigation were examined in terms of genital health and strength and endurance of the pelvic floor muscles. After the confidence of mental health, patients underwent pelvic floor rehabilitation for 10 sessions during 3 months. After assessment, myofascial release techniques and progressive pelvic floor muscles exercise was performed for patients based on their primary strength. Finally, patients were compared in terms of the severity of dyspareunia, sexual performance status (by using female sexual function index questionnaire), improvement of symptoms, pelvic floor muscle strength and endurance before (first session of physiotherapy) and after (after 3 months) investigation.

Results: In the remaining 32 patients with dyspareunia with a mean age of 38±1.24 years, desire index score 0.95 unit, arousal index score 1.01 unit, lubrication index score 0.67 unit, orgasm index score 0.71 unit, satisfaction index score 1.03 unit, pain index score was increased 1.05 unit, strength index score 2.44 unit, endurance index score 7.06 unit were increased in comparison to before the investigation that showed a significant different with P< 0.0001.

Conclusion: According to obtained results, pelvic floor physical therapy had a significant effect in women with dyspareunia. So that the severity of dyspareunia, pelvic floor muscle strength and endurance had clinically significant improvement after pelvic floor physiotherapy.

Background: The ability to recognize the severity of the disease in those who their survival depend entirely on admission to the intensive care unit, is very valuable clinically. This study aimed to evaluate the clinical effectiveness of modified sequential organ failure assessment (MSOFA) scale to predict mortality and length of stay in intensive care unit patients respectively.

Methods: This was a retrospective cross-sectional study conducted on hospital records of patients admitted to the intensive care unit. All patients’ records who admitted to the intensive care unit of Kowsar Hospital, Semnan city (the capital of the province), Iran, in 2015 considered as the sample. Collecting data were done during 4 weeks in April and May 2016. The data collection tool was a demographic questionnaire and modified sequential organ failure assessment scale. Exclusion criteria included discharge in the first 24 hours after admission, the patient died a few hours after admission and incomplete information to complete the modified sequential organ failure assessment form.

Results: The study of 105 patients' records of the intensive care unit showed that 45.7% of patients were died, 15.2% and 39% were discharged and moved to other wards respectively. The results of logistic regression analysis and receiver operating characteristic (ROC) curve showed that this criterion had moderate sensitivity and specificity for prediction of mortality and length of stay in ICU patients (Area=0.635, CI= 0.527-0.743) and each unit increase in modified sequential organ failure assessment score is accompanied by increasing 32 percent chance of death (OR=1.325; 95% CI:1.129,1.555; P= 0.001(. Also each unit increase in modified sequential organ failure assessment (MSOFA) score accompanied by increasing 19% length of stay in ICU (OR=1.191; 95% CI: 1.034, 1.371; P= 0.015(.

Conclusion: The results of this study showed that the modified sequential organ failure assessment scale is not useful tool to predict the length of stay and mortality of patients admitted to the intensive care unit.