URINARY STONE DISEASE IN TURKEY - AN UPDATED EPIDEMIOLOGIC-STUDY

In a nationwide survey conducted in 14 provinces on 1,500 individuals, an overall prevalence of 14.8% and an incidence of 2.2% for the year 1989 are found for urinary stone disease in Turkey. The male:female ratio was 1.5:1. The prevalence showed a geographical distribution with higher figures in southern and south-eastern parts of the country. Low socioeconomic and educational status were associated with a higher prevalence rate, while there was no significant difference between people living in rural areas or in cities. Similarly, occupation had no significant impact on the incidence of urinary stone disease. Urolithiasis is a severe problem in Turkey and more detailed epidemiological studies are needed to enlighten the pathogenetic factors of stone formation and its geographical variations

Does the positive intracavernous papaverine test always indicate a normal penile vascular system?

Objective: A positive intracavernous papaverine test has been presumed to determine normal erectile hemodynamics. Recently, positive erectile responses to intracorporeal injection tests were reported in patients with penile arterial insufficiency. Methods: This hypothesis was assessed by obtaining hemodynamic data using color Doppler ultrasonography in 417 patients with erectile dysfunction aged between 20 and 73 years (mean 43.06 +/- 13.66). A normal penile vascular system was found in 95 patients (22.79%), veno-occlusive dysfunction in 76 (18.22%), arteriogenic erectile dysfunction (ED) in 113 (27.10%) and mixed-type ED in 133 (31.89%). Results: A positive erection response was achieved in 176 patients with combined intracavernosal injection of 60 mg papaverine and self-manual genital stimulation (CIS) test, while a negative response was observed in the remaining 241 (57.79%). Color Doppler ultrasonography combined with pharmacological erection has proved a normal penile vascular system in 94 (53.41%) and penile arterial insufficiency in 82 (46.59%) patients of those who gave a positive response to the CIS test. Also, a positive CIS test response was observed in all patients with unilateral arterial insufficiency (n = 31) and in 51 patients (62.19%) out of 82 with bilateral arterial insufficiency. Conclusion: A positive intracavernous papaverine test indicates veno-occlusive dysfunction competence but does not necessarily signify a normal penile arterial system. The CIS test should be combined with color Doppler ultrasonography in order to determine the vascular component of ED, since the differentiation is not possible between slight penile arterial insufficiency and psychogenic or neurogenic impotence with the CIS test

COMBINED INTRACAVERNOUS INJECTION OF PAPAVERINE AND STIMULATION (CIS) TEST

The inhibitory effect of the overactivity of the sympathetic nervous system that results from outpatient clinical conditions leads to poor erectile response to intracavemous injection of papaverine. The effects of self manual genital stimulation for improvement of erectile quality in insufficient papaverine response were investigated in 171 impotent men. Twenty-nine (63.04%) of 46 patients who had a normal vascular system showed partial response to papaverine. Following self manual genital stimulation, full erection was achieved in all of them. Better erections were achieved in 28 of 42 patients with arterial disease. In patients subclassified as having slight, moderate, and severe arterial disease, improved erections were noted in 100%, 71.42%, and 64.28%, respectively. In the mixed vascular (arterial + venous) disease group (n = 46), the combined intracavernous injection of papaverine and stimulation (CIS) test led to a better erection in only 41.30%, whereas in the pure venogenic group (n = 37), this percentage was 66.66%. The inhibitory effect of the overactivity of the sympathetic nervous system is significantly reduced by the CIS test