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  Eur Urol Suppl 2010;9(6):584 the results of the surgery. 9 patients engaged in sexual intercourse regularly. All patients have maintained their penile length. Conclusions: Prolonged ischemic priapism results in cavernosal brosis and a subsequent loss of penile length. The immediate insertion of a penile prosthesis in this situation is simple and maintains penile length. The complication rate is low and the subsequent outcome excellent. S106 POOR PENILE ARTERIAL INFLOW IS SIGNIFICANTLY CORRELATED WITH IMPAIRED AORTIC ELASTIC PROPERTIES IN MEN WITH METABOLIC SYNDROME Sakelariou G. 1 , Ioakeimidis N. 2 , Papazoglou J. 1 , Drenidis G. 1 , Vlachopoulos C. 2 , Rompolis D. 1 , Rempelakos A. 1 1 Ippokrateion Hospital, Dept. of Urology, Athens, Greece, 2  Ippokrateion Hospital, Dept. of Cardiology, Athens, Greece Introduction & Objectives: Men with metabolic syndrome (MetS) have an increased prevalence of erectile dysfunction (ED). MetS confers an incremental unfavourable eect on aortic elastic properties. Aim of the study was to investigate the impact of MetS on penile vasculature and aortic elastic properties in ED patients. Material & Methods: Carotid-femoral pulse wave velocity (PWV) as an index of aortic stiness and peak systolic velocity (PSV) as a reliable parameter of penile vascular disease were measured in 179 consecutive men with ED. Lower Doppler velocities indicate impaired arterial function and vice versa. PSV below 25 cm/sec was considered to indicate severe arterial insuciency (SAI). Results: Patients with SAI (n=56) compared to patients with higher Doppler velocities (n=123), were older (61 vs 57 yrs, P<0.05) and had increased prevalence of MetS (49 vs. 32 %, P<0.05), lower testosterone level (3.7 vs.4.2 ng/ml, P<0.05) and increased PWV (9.0 vs 8.1m/s, P<0.001). ED patients with MetS (n=67) compared to men without MetS (n=112) had increased prevalence of SAI (40 vs.18 %, P<0.05), lower Doppler velocities (36.7 vs 30 cm/s, P<0.01), testosterone level (3.9 vs.4.4 ng/ml, P<0.05) and higher PWV values (9.4 vs 8.3m/s, P<0.001), whereas the two groups did not dier regarding age. Among patients with MetS, PSV values decreased (P<0.05) and prevalence of SAI increased (21 vs 50 vs 55%, P<0.01) as the number of MetS components increased, after adjustment for age. The subgroup of men with MetS and SAI (n=27) exhibited the higher PWV values compared with the subgroups of SAI patients without MetS (n=20), MetS patients without SAI (n=39), and   men without MetS and SAI (n=93) (9.7 vs. 8.7 vs. 8.7 vs. 7.9 m/s, respectively, overall P < 0.001). Analysis of covariance revealed that the aforementioned   dierences among the four study subgroups remained statistically   signicant even after adjusting for age, blood pressure, body mass index, smoking status,   total testosterone level and medications (ACE inhibitors and statins) (P < 0.001, for all). Conclusions: Aortic stiness is further increased by the coexisting severe penile vascular disease in subjects with MetS. Our ndings provide a possible marker of risk for cardiovascular disease in patients with MetS and SAI. S107 EFFECTS OF MICRONISED PURIFIED FLAVONOID FRACTION AND OXERUTIN ON PAIN, SPERMIOGRAM AND SCROTAL COLOR DOPPLER PARAMETERS IN PATIENTS WITH PAINFUL VARICOCELE Soylemez H. 1 , Beytur A. 2 , Kilic S. 3 , Oguz F. 1 , Karademir I. 4 , Koplay M. 5 1 Mujde Hospital, Dept. of Urology, Malatya, Turkey, 2  Inonu University, Dept. of Urology, Malatya, Turkey, 3 Dunya Hospital, Dept. of Urology, Batman, Turkey, 4 Izmir Military Hospital, Dept. of Radyology, Izmir, Turkey, 5  Selcuk University, Dept. of Radyology, Konya, Turkey  Introduction & Objectives: Micronised puried avonoid fraction (MPFF) is a phlebotropic drug improving venous tone, elasticity and lymphatic drainage, decreasing venous distensibility, venous emptying times, reux time of venous blood and capillary hyperpermeability, and having antioxidant activities. Oxerutins has been used to treat chronic venous insuciency (CVI) and signs/symptoms associated with varicose veins and deep venous disease. Since varicocele is a venous pathology, we evaluated the eects of MPFF and oxerutin on pain, spermiogram and color Doppler parameters in patients with painful varicocele. Material & Methods: 60 varicocele patients with normal sperm concentration (>20 million/ml) were involved in the study. They were divided into three groups such as MPFF (Daon, 1000 mg/day, orally), Oxerutin (Venoruton, 1000 mg/day, orally),and placebo group (Pankreooat granul, 2 gr/day, orally).Semen analyses and Doppler sonography were performed in all patients before and after the treatment (at 1, 3 and 6 months) Also pain score was performed at the same times and one more time in the 12th month after treatment. Pain change was assessed with visual analogue scale scored between 0 and 10. Patient satisfaction with outcome and side eects were recorded. Results: In the rst group, mean pain scores at 1, 3, 6 and 12 months were 1.80±1.32, 1.15±0.93, 1.05±0.95 and 0.95±0.89 respectively, all being signicantly lower (p<0.001 for each) than baseline (5.25±1.0). In the second group, it was the same as in the rst group; Mean pain scores at 1, 3, 6 and 12 months were 2.05±1.47, 1.55±1.19, 1.35±1.14 and 1.25±1.07 respectively, all being signicantly lower (p<0.001 for each) than baseline (4.90±1.07). Pretreatment or after treatment granulocytes (PMN) a large amount of proteases such as elastase. The enzyme elastase, has been suggested as a sensitive and quantitative marker of genital tract infection. Material & Methods: There were 60 infertile men with and 30 fertile men in this study. The infertile men were divided in sub group A (Number of Leucocytes below 1 mil,) and subgroup (leucocytes over 1mil) Elastase is determined by heterogeneous enzymatic assay who specically detects elaste from polymorph nuclear leucocytes. The measurement of elastase was in ug/l. Results: In the infertile group of men elevated level of seminal elastase was detected in 46.7 %, but in fertile group there was no elevated seminal elastase level. In subgroup A (Le < 1mil) elevated seminal plasma elastase was identied in 33 %, and normal values in 67%. In sub group B ( Le > 1 mil) elevated elastase was in 6o % and this is a signicant dierence between these two groups ( p< o.001 ) In the group of patients with lower sperm motility ( < 25% progressive motility) elevated seminal elastase was detected in 73/7% patients, and normal elastase levels were in 26.3 %. Conclusions: The nding shows that higher number of leucocytes and their elevated products as elastase inuence sperm motility in those patients. This nding is of importance in evaluating and treating infertile men. S104 ACUPUNCTURE VERSUS PAROXETIN FOR THE TREATMENT OF PREMATURE EJACULATION: A RANDOMIZED CLINICAL TRIAL Sunay D. 1 , Sunay M. 2 , Aydoğmuş Y. 2 , Bağbacı S. 2 , Arslan H. 3 , Karabulut A. 2 , Emir L. 2 1 Ministry of Health, Ankara Training and Research Hospital, Dept. of Family Medicine, Ankara, Turkey, 2  Ministry of Health, Ankara Training and Research Hospital, Dept. of 1st Clinic of Urology, Ankara, Turkey, 3 Ministry of Health,  Ankara Training and Research Hospital, Dept. of Acupuncture, Ankara, Turkey  Introduction & Objectives: To investigate the eect of acupuncture on premature ejaculation (PE) treatment by comparing with paroxetin. Material & Methods: Sixty patients with PE based on clinician diagnosis using DSM-IV-TR were randomly assigned into acupuncture and paroxetin groups, and received acupuncture twice a week and paroxetin 20mg/day for 4 weeks, respectively. Intravaginal ejaculation latency times (IELT) before and after treatment were evaluated by the patients using chronometer. The eciency of treatments were assessed by using IELT and self-reported PE diagnosis tool designed from the main elements of DSM-IV TR; control, frequency, minimal sexual stimulation, distress and interpersonal diculty. Data obtained were analyzed statistically. Results: Mean IELT of the acupuncture and paroxetin groups were 41.0 and 28.7 seconds before treatment, and 84.2 and 137.0 seconds after treatment, respectively. IELT were signicantly increased both with acupuncture and with paroxetin therapies (p<0.001 and p<0.001, respectively). When the groups compared IELT increase was signicantly higher in paroxetin group than acupuncture group (p<0.05). Self-reported PE diagnosis tool scores were signicantly decreased with paroxetin therapy (p<0.01). Self-reported PE diagnosis tool scores were signicantly decreased with acupuncture therapy (p<0.01), except distress (p=0.13). Conclusions: Acupuncture seems as eective as paroxetin in PE treatment, however larger studies will be needed for denitive conclusions. S105 THE IMMEDIATE INSERTION OF A PENILE PROSTHESIS FOR PROLONGED ISCHEMIC PRIAPISM Razzaghi M.R. , Rezaei A., Javanmard B., Mazloomfard M.M., Lot B. Medical Laser Application Research Center, Shaheed Beheshti University of Medical Science, Dept. of Urology, Tehran, Iran Introduction & Objectives: Priapism is an uncommon condition that is classied into low-ow (ischemic), or high-ow (non-ischemic). Failure to treat low-ow priapism in long term results in cavernosal brosis, with resultant penile induration, shortening and erectile dysfunction. At this stage the subsequent insertion of a penile prosthesis can be dicult due to presence of brosis, requiring extended or double corporotomies and the use of special cavernotomes with subsequent high complication rates. We evaluate the outcome of patients who have undergone the immediate insertion of a penile prosthesis as a treatment for prolonged ischemic priapism. Material & Methods: A total of 14 patients presented with prolonged ischemic priapism that was unresponsive to conventional treatment treated by the following protocol. Doppler ultrasonography and cavernosal blood-gas analysis performed in all patients, which conrmed a low-ow priapism with ischemic features in all. All patients had evidence of cavernosal smooth muscle necrosis and, therefore, underwent an immediate insertion of a penile prosthesis in the acute setting after shunting. Immediate management consisted of the insertion of a malleable prosthesis. Results: The mean age of the patients was 44 years (range: 29–55 yr) with the mean duration of priapism at presentation 78 hours (range 27–112) and in all patients, conservative management had failed. Penile prosthesis oered to the patients preoperatively after counseling. After a median follow-up of 13.9 mo (11– 38 mo), infection did not occur in any prosthesis and all patients were satised with
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