OBJECTIVE: We aimed to evaluate the treatment options in patients with glanular type megameatus intact foreskin.
MATRERIAL and METHODS: Between 2011 and 2021, more than 5000 circumcision procedures were performed in our clinic. The treatment options of 70 cases with glanular type megameatus, which we encountered incidentally when the foreskin was retracted during the circumcision procedure and sometimes we did not know exactly what to do at that moment, were found to be treated retrospectively. Glans approximation procedure (GAP) was applied to 14 of 24 patients who accepted hypospadias surgery. Meatal advancement and glanuloplasty procedure (MAGPI) was performed in 10 of them. The mean age, duration of surgery and surgical intervention results of the cases were evaluated.
RESULTS: The mean age of the patients who underwent the GAP procedure was 4.7±1.9, and the duration of surgery was 59.1±6.3 minutes. Urethral stenosis was seen in 1 of 14 cases and urethral fistula complication was observed in 1 of them. The mean age of the patients who underwent the MAGPI procedure was 4.3±1.4, and the duration of surgery was 64.3±3.03 minutes. Urethral stenosis was seen in 1 of 10 cases and unsuccessful surgical complication was observed in 1 of them. Complications developed in 4 (16.66%) of 24 patients. 4 patients underwent re-operation. There was no significant difference in the mean age, duration of surgery and complication rates between the two techniques.
CONCLUSION: Intact foreskin conceals clinical findings and megameatus can usually be detected at circumcision attempt. Although the surgery for the glanular type, which is the mildest form of megameatus, is controversial, satisfactory results can be obtained with the appropriate surgical method. In addition, detailed interviews should be made with families before surgery and it should be explained that the operation is controversial.

OBJECTIVE: This study aims to evaluate the relationship between varicocele and inflammation using hematological inflammatory parameters in patients with varicocele and systemic immune inflammation (SII) index, and to contribute to the etiopathogenesis of varicocele.
MATRERIAL and METHODS: The study included 56 healthy volunteers, and 59 patients who were diagnosed to have varicocele in the urology clinics of Erzurum City Hospital between May 2018 and December 2021. Patient files were retrospectively investigated and the data of whole blood analysis were recorded. Parameters obtained from whole blood analysis and systemic immune inflammation index were compared between groups.
RESULTS: A total of 59 adult male who have diagnosed as varicocele were included in the patient group and 56 healthy adult volunteers were included in the control group. When the two groups were compared in terms of body mass index and mean age, there was no statistically significant difference. (p=0,915 and p=0.25, respectively). Lymphocyte count was significantly reduced in the patient group (p<0.001). Neutrophil/Lymphocyte ratio (NLR), Monocyte/Lymphocyte ratio (MLR), Platelet/Lymphocyte ratio (PLR) and SII index were found to be significantly higher in the patient group when compared for both groups (p<0.001, p=0.033, p<0.001 and p=0.005, respectively). There was no relation between the grade of varicocele and hematological inflammatory parameters or systemic inflammation index in the patient group. When we examined the relationship between semen parameters and SII index in patients with varicocele, we found that lymphocyte count, neutrophil count, NLR and SII index were significantly higher in patients with abnormal semen parameters compared to patients with normospermic varicocele (respectively; p=0.004, p=0.003, p< 0.001 and p<0.001) SII has the best predictive power in predicting Impaired Semen Quality in varicocele patients among inflammatory parameters.
CONCLUSION: SII index and hematological inflammatory parameters can show that inflammation is one of the factors playing a role in varicocele pathogenesis. Our study has important results showing the relationship between hematological inflammatory parameters and especially SII index and semen parameters in patients with varicocele. Prospective, randomized studies with larger numbers of patients and control groups should be conducted in order to investigate whether SII index and hematological inflammatory parameters can be used in the diagnosis, follow-up and treatment of varicocele.

OBJECTIVE: There are SRY (sex-determining region Y) region, which plays a role in testicular development, and genes related to spermatogenesis on the Y chromosome. Its long arm contains the azoospermia factor (AZF) region (AZFa, AZFb, and AZFc subregions). Microdeletions in this region are responsible for azoospermia and oligospermia and cause male infertility. The aim of this study was to analyze the incidence of microdeletion in the AZF region of the Y chromosome in male patients with primary infertility with azoospermia and oligospermia.
MATRERIAL and METHODS: A total of 206 male patients were analyzed between December 2020 and December 2022. The diagnosis of azoospermia and oligospermia was made based on semen analysis. Patients with normal karyotype were included in the study. For the definitive diagnosis of microdeletions in the AZF region, 20 different sequence tagged sites (STS) were used, including the recommendation of the European Academy of Andrology (EAA) and the European Molecular Genetics Quality Network (EMQN). Each region was amplified by polymerase chain reaction (PCR) method and analyzed by fragment method in ABI 3500 DNA Sequence instrument.
RESULTS: Microdeletion was detected in the AZF region of the Y chromosome in 17 of 206 patients (%8,3) with normal karyotype. With the study, we identified the deletions of each subregion of AZF in our population. The presence of microdeletions in the AZFc region was most common. b2/b4 complete AZF/c microdeletions were higher than the g/gr partial AZF/c deletion.
CONCLUSION: The study confirmed that the incidence of microdeletion of AZF subregions in primary infertile male patients was %8,3 and was prognostically significant. The frequency of Y chromosome microdeletion was found to be consistent with the literature.

OBJECTIVE: The aim of the study was to determine the level of knowledge of male military personnel about Human Papillomavirus, screening tests, and vaccination.
MATRERIAL and METHODS: The descriptive cross-sectional study was conducted with 390 male military personnel working in Provincial Gendarmerie Command between December 2022 and January 2023. Data were obtained using the Descriptive Information Form and the Human Papillomavirus Knowledge Scale. Mann-Whitney U test and Kruskall Wallis test were used to evaluate the data.
RESULTS: The mean the Human Papillomavirus Knowledge Scale total score of the male military personnel included in the study was 4.89±6.43. In the study, it was found that the total score of the Human Papilloma Virus Knowledge Scale varied significantly according to marital status, educational status, place of residence, presence of reproductive organ cancer in first-degree relatives or themselves, having received previous education about sexually transmitted diseases and having information about human papillomavirus and sexually transmitted diseases
CONCLUSION: It was found that the total score of the human papillomavirus knowledge scale of male military personnel was quite low. Health professionals who play an important role in protecting and promoting health should plan awareness trainings on human papillomavirus infection and vaccine for military personnel who are among the risky groups and lead the establishment of human papillomavirus vaccination programs for the male population.

OBJECTIVE: The aim of this study is to evaluate the effect of duloxetine treatment, used in the treatment of Stress Urinary Incontinence (SUI), on female sexual functions and coital incontinence (CI).
MATRERIAL and METHODS: Patients who applied to the urology outpatient clinic with complaints of SUI between January 2018 and July 2021 and used Duloxetine 2*40 mg (Nexetin, Nobel İlaç, Turkey) for 12 weeks were included in the study. Demographic characteristics of the patients were recorded. Medical and sexual histories of the patients were taken. In order to evaluate the sexual functions of the patients, the Female Sexual Function Index (FSFI) consisting of 19 questions was filled. It was asked whether there was CI or CI during penetration.
RESULTS: A total of 64 patients were included in the study. The mean age of the patients was 43.64±11.08(35-58), and the mean BMI was 27.86±6.43(21.55-34.67) kg/m2. A significant improvement was observed in the patients’ total FSFI score, desire, arousal, lubrication and orgasm subscales after treatment (p<0.001 for each). While 49 patients described CI during sexual intercourse before treatment, CI persisted in 26 patients after 12 weeks of treatment. There was a significant improvement in CI rates after treatment (p<0.001).
CONCLUSION: Duloxetine, which is used for the treatment of SUI, improves female sexual functions and reduces coital incontinence.

OBJECTIVE: In this study, we aimed to evaluate the genital organ anomaly rates detected during circumcision examination in the light of the literature.
MATRERIAL and METHODS: 5427 circumcision operations were performed in our clinic for 11 years. The genital organ anomaly data detected in the circumcision examination were obtained by examining the patient files retrospectively. The obtained data were evaluated in the light of the literature.
RESULTS: The number of patients with genital anomalies during a total of 5427 circumcision examinations was 324 (5.97%). The most frequently detected anomalies are respectively; undescended testis (1.47%), intact foreskin megameatus(1.27%), retractile testis (0.88%), hypospadias (0.69%), inguinal hernia (0.68%) and other anomalies (0.98%).
CONCLUSION: It was concluded that families should be educated and conscious about the importance of circumcision examination, and physicians should be more careful in circumcision examination. We would like to state that physicians should be more careful about intact foreskin megameatus, which cannot be detected in physical examination and is detected when the circumcision procedure is started.

OBJECTIVE: Although increased inflammation causes endothelial dysfunction and the role of monocytes and high-density lipoproteincholesterol in inflammation has been demonstrated, there are surprisingly few publications examining the relationship between monocyte-tohigh- density lipoprotein-cholesterol ratio and erectile dysfunction. In this study, we both summarized the actors of the inflammation process and examined the relationship between the monocyte-to-high-density lipoprotein-cholesterol ratio and erectile dysfunction in terms of whether it can be a prognostic or predictive marker.
MATRERIAL and METHODS: Between January and September 2021, 143 patients with erectile dysfunction and 140 control patients who applied to the urology outpatient clinic and had no systemic disease were selected. Complete blood count, biochemical parameters, and hormone samples were obtained from all patients under appropriate conditions. Erectile dysfunction was diagnosed with the five-item version of the International Index of Erectile Function questionnaire. Statistical comparisons were made between the groups with the obtained data.
RESULTS: Age, height, white blood cell, platelet, lymphocyte, creatinine, fasting plasma glucose, triglyceride, follicle-stimulating hormone, luteinizing hormone, and total testosterone variables were indifferent among the groups. Body mass index, weight, total cholesterol, low-density lipoprotein-cholesterol, neutrophil count, monocyte-to-high-density lipoprotein-cholesterol ratio, and neutrophil-to-lymphocyte ratio variables were significantly high in the case group. International Index of Erectile Function - 5 scores and low-density lipoprotein-cholesterol levels were significantly high in the case group. A significant negative correlation was observed between the monocyte-to-high-density lipoprotein-cholesterol ratio and the International Index of Erectile Function - 5 score.
CONCLUSION: The monocyte-to-high-density lipoprotein-cholesterol represents inflammation and endothelial damage and can be used as a readily and inexpensive predictor or severity indicator of erectile dysfunction, caused by these impairments.

Benign prostatic hyperplasia (BPH) is histological changes in the prostate that result in increased prostate volume and lower urinary tract symptoms. Although there are several reasons for the development of LUTS in BPH, the most important reason is the enlargement of the prostate gland. In addition, it has not been clarified why prostate size differs between individuals and why similar sizes cause different severity of LUTS. The aging of the world population has made BPH one of the most common diseases in men. The increase in the incidence of BPH has increased its socioeconomic cost. However, since its pathophysiology has not been fully elucidated, a new medical treatment alternative has not been established for years. In this review, possible different mechanisms that cause BPH to occur were examined and the literature on these mechanisms was reviewed.

Oral phosphodiesterase 5 (PDE 5) inhibitors, vacuum pumps, intraurethral drugs, intracavernosal injections, and penile prosthesis implantation are currently accepted treatments for erectile dysfunction (ED). In 2010, low-intensity extracorporeal shock wave therapy (Li- ESWT) was introduced by Vardi as a noninvasive method for the treatment of ED. Since the important mechanism of ED is vascular endothelial dysfunction and Li-ESWT can stimulate the expression of angiogenesis-related factors such as vascular endothelial growth factor (VEGF) to support vascular regeneration, the use of Li-ESWT in the treatment of ED is becoming widespread. Currently, there is no standard treatment protocol for Li-ESWT. Li-ESWT appears to have the potential to be an option for the treatment of ED, particularly in patients who respond poorly to oral medications and do not want more invasive procedures. On the other hand, further studies are needed to understand which patients may benefit most from the treatment and which protocol will produce the best results.

Peyronie’s disease is a condition characterized by progressive fibrosis in the tunica albuginea, resulting in deformities such as penile shortening and curvature. This situation not only causes sexual problems, but also can cause an increase in sexual performance anxiety, difficulty in relationship and depression. The course of the disease consists of two periods, acute and chronic. In the acute phase and in the stable disease period, while non-surgical treatments are used to relieve symptoms and regress fibrosis, surgical treatments are on the agenda, especially after serious deformities develop. Non-surgical treatment methods are oral treatments, intralesional injection treatments, topical treatments, vacuum and traction devices and shock wave treatments. Intralesional clostridium histolyticum collagenase treatment has been approved by the US-FDA and it’s indicated in patients with noncalcified plaques. For multimodal treatments, there is no clear consensus yet.

Varicocele, which is the most frequently treatable pathology of male infertility, is detected in approximately 15 % of the normal population. The fact that it is detected at such high rates in the general population and that only 20% of the men are infertile and the remaining 80% of them are unaffected, has brought up new research issues in the evaluation of the pathophysiological processes between varicocele and infertility. Conventionally, the possible pathophysiological effect of varicocele on male reproductive system is evaluated by five different mechanisms. These mechanisms are reported as hyperthermia, hypoxia, reflux of toxic cyclical metabolites, hypogonadism and cadmium accumulation.

Ejaculation disorders are a complex and multifactorial condition that can significantly impact individuals’ quality of life. Alpha blockers, which are used in the treatment of benign prostatic hyperplasia (BPH), are associated with various sexual side effects, including changes in ejaculation. In this review, the physiological mechanisms and clinical outcomes of the effects of alpha blockers on ejaculation, as documented in the literature, are discussed.

OBJECTIVES: The long-term use of esomeprazole, a commonly prescribed proton pump inhibitor, has been associated with a decrease in sperm count and motility, as well as infertility in recent studies. We aimed to present the case of reversible azoospermia developed due to the use of esomeprazole in this study.
CASE REPORT: In our study, we examined a 25-year-old unmarried male patient with a desire for children who had been using esomeprazole (40 mg/ day) for approximately two years due to gastroesophageal reflux disease. The patient presented to our clinic intermittently with a dull scrotal pain, which was present in both testicles and resolved spontaneously after a short period. The physical examination of the patient revealed no pathological findings, and the testicular volumes and serum hormone parameters were within the normal reference values. The result of scrotal color doppler ultrasound performed on the patient in an external center was reported as scrotal color doppler ultrasound examination within normal limits. Upon the initial presentation of the patient, the semen analysis reported azoospermic pellet positivity. Subsequently, a repeat semen analysis was requested from the patient at a 4-week interval, and the result was once again reported as azoospermic pellet positive. As a result, we discontinued the use of esomeprazole for the patient, and during the first and fourthmonth follow-ups, there was a gradual improvement in sperm parameters. The semen analysis parameters evaluated in the fourth month were observed within the normal reference values.
CONCLUSIONS: We aimed to emphasize the necessity of considering the use of esomeprazole, which is frequently preferred for gastrointestinal system disorders in our country, as a potential etiology of azoospermia, in a young patient who had been using it for a long time and experienced improvement after discontinuation of the medication.