AMAÇ: Prostat kanseri nedeniyle 3-port ve konvansiyonel yöntemle ekstraperitoneal laparaskopik radikal prostatektomi (eLRP) uygulanan hastalarýn postoperatif erken dönem erektil fonksiyonlarýný karþýlaþtýrmayý amaçladýk.
GEREÇ ve YÖNTEMLER: Eylül 2016 ve Ekim 2018 arasýnda prostat kanseri nedeni ile eLRP yapýlan hastalarýn verileri retrospektif olarak deðerlendirildi. Tüm hastalar 3 port ile eLRP yapýlan ve konvansiyonel eLRP yapýlanlar olarak iki gruba ayrýldý. Hastalarýn erektil fonksiyonlarýný deðerlendirmek için preoperatif ve postoperatif 6. ayda uluslararasý erektil fonksiyon indeksi-5 (IIEF-5) formu kullanýldý. IIEF-5 skoru >21 olan hastalar potent, IIEF-5 skoru <11 ise ciddi erektil disfonksiyon (ED) olarak kabul edildi. Preoperatif dönemde potent olan hastalardan 3-port eLRP ve konvansiyonel eLRP yapýlanlarýn postoperatif 6. aydaki IIEF-5 skorlarý karþýlaþtýrýldý.
BULGULAR: Toplamda eLRP uygulanan 92 hasta çalýþmaya dahil edildi. Bunlardan 23’ü 3-port eLRP, 69’u konvansiyonel eLRP hastasý idi. Ortalama hasta yaþý 63,4±6,10 yýl, tanýdaki ortalama prostat spesifik antijen (PSA) deðeri 10,7±8,55 ng/dL olarak bulundu. Gruplar arasýnda yaþ, PSA, preoperatif ve postoperatif Gleason skoru, klinik ve patolojik evre, nörovasküler demet korunma oraný, cerrahi sýnýr pozitiflik oraný ve postoperatif kontinans ve 6. ayda erektil fonksiyon açýsýndan 3-port ve konvansiyonel teknik açýsýndan istatistiksel olarak anlamlý farklýlýk saptanmadý.
SONUÇ: Onkolojik, cerrahi ve erken dönem fonksiyonel sonuçlar bakýmýndan konvansiyonel yöntemle benzer olan 3-port eLRP, daha iyi kozmetik sonuçlarla erektil fonksiyonlarý da koruyarak prostat kanserinin tedavisinde minimal invaziv cerrahi yaklaþým olarak güvenle tercih edilebilir.

OBJECTIVE: We aimed to compare the early postoperative erectile functions of patients who underwent extraperitoneal laparascopic radical prostatectomy (eLRP) with 3-port and conventional methods for prostate cancer.
MATRERIAL and METHODS: We reviewed the medical records of the patients who underwent radical prostatectomy between September 2016 and October 2018 retrospectively. The patients were divided into two groups as 3-ports eLRP and conventional eLRP. International erectile function index-5 (IIEF-5) form was used preoperatively and postoperatively at the 6th month to evaluate the erectile function of the patients. Patients with IIEF-5 score >21 were considered as potent, and IIEF-5<11 was considered as severe erectile dysfunction (ED). IIEF-5 scores of preoperatively potent patients who underwent 3-port eLRP and conventional eLRP were compared at postoperative 6th month.
RESULTS: In total, 92 patients who underwent eLRP were included in the study. Of these, 23 were 3-port eLRP, 69 were conventional eLRP patients. Mean age was 63.4±6.10 years, mean prostate specific antigen (PSA) was 10.7±8.55 ng/dl. There were no statistically difference between compared groups in terms of age, PSA, preoperative and postoperative Gleason score, clinical and pathological stage, neurovascular bundle protection, positive surgical margin, postoperative continence status and postoperative erectile function 6th month.
CONCLUSION: The 3-port eLRP, which is similar to the conventional method in terms of oncologic, surgical and early functional results, can be preferred as a minimally invasive surgical approach in the treatment of prostate cancer by maintaining erectile functions with better cosmetic results.

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AMAÇ: Bu araþtýrma erkeklerin gebelik sürecine iliþkin cinsel mitlerini belirlemek amacýyla planlandý.
GEREÇ ve YÖNTEMLER: Tanýmlayýcý nitelikte planlanan araþtýrma Ýstanbul ilinde yer alan iki eðitim ve araþtýrma hastanesinde Aralýk 2018Ocak 2019 tarihleri arasýnda araþtýrma kriterlerine uyan 134 erkek ile yapýldý. Araþtýrma verileri araþtýrmacýlar tarafýndan literatür taramasý sonrasý hazýrlanan bilgi formu ve ‘Cinsel Mitler Ölçeði’ kullanýlarak toplandý.
BULGULAR: Araþtýrmaya katýlan 133 baba adayýnýn %50,4’ü 19–31 yaþ aralýðýnda, bir iþ çoðunluðun yaþamýnýn uzun bir süresini ilde (%87,2) geçirdiðini ifade etti. Erkeklerin neredeyse yarýsý (%47,4) ilk cinsel bilgiyi internetten öðrendiðini, %91,0’ý gebelikte cinsel birlikteliðin olabileceðini ve sadece 17,3’ü cinsel birlikteliðin bebeðe zarar verebileceðini düþündüðünü belirtti. Erkekler gebelik süresince eþiyle cinsel birliktelik yaþasalar da %93’ü gebelik sürecinde cinsel birlikteliðin “ayýp” olduðunu düþünmekteydi. Erkeklerin neredeyse tamamýnýn (%99,2) normal doðumun cinsel yaþamý etkilemeyeceðini ve sonraki dönemde cinsel yaþamlarýný olumsuz etkilemeyeceðini ifade etti. Cinsel Mitler Ölçeði’ne bakýldýðýnda; her erkek eþine nasýl zevk vereceðini bilmeli (%96,2), eðer çiftler birbirlerini seviyorlarsa seksten de zevk almasýný bilir (%96,2) þeklindedir. Mitlerin çoðu ile eðitim durumu, aile tipi, aylýk gelir durumu ve uzun süre yaþadýðý yer arasýnda anlamlý bir fark saptanmadý (p≥0,05). Ancak yüksek eðitimli ve uzun süre ilde yaþamýþ erkeklerin mitleri onaylama oraný daha düþük bulundu.
SONUÇ: Araþtýrmaya katýlan erkeklerin gebelikte cinsel mitlere inanma oranlarýnýn yüksek olduðu belirlendi. Erkeklerin cinsel mitlere inanma oranýnýn eðitim düzeyi ve yaþadýðý yer ile iliþkili olduðu saptandý.

OBJECTIVE: This study was planned to determine the sexual myths of men during pregnancy.
MATRERIAL and METHODS: The descriptive study was conducted between December 2018 and January 2019 with 134 men who met the research criteria in two training and research hospitals in Istanbul. Research data were collected by using the information form prepared by the researchers after the literature review and ‘Sexual Myths Scale’.
RESULTS: Of the 133 fathers who participated in the study, 50.4% were 19–31 years of age. In the first quarter of the year, a business majority spent a long period of life in the province (87.2%). Almost half of the men (47.4%) said that they learned the first sexual information online, 91.0% stated that sexual intercourse may occur during pregnancy and only 17.3 thought that sexual intercourse could harm the baby. Although men had sexual intercourse with their spouse during pregnancy, 93% thought that sexual intercourse during pregnancy was a shame. Almost all of the males (99.2%) stated that normal birth would not affect sexual life and would not adversely affect sexual life in the future. When the Sexual Myths Scale was examined; every man should know how to give pleasure to his wife (96.2%), if couples love each other knows that they also enjoy sex (96.2%). There was no significant difference between most of the myths and education, family type, monthly income and long-term place of residence (p≥0.05). However, higher educated and long-lived men had a lower rate of confirmation of myths.
CONCLUSION: It was determined that the sexual myths of the men who participated in the study were high in pregnancy. It was found that the rate of male belief in sexual myths was related to education level and place of residence.

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AMAÇ: Robot-yardýmlý (RYRP) ve retropubik (RRP) radikal prostatektominin fonksiyonel sonuçlarýný karþýlaþtýran çok sayýda çalýþma olmasýna raðmen, yüksek-riskli hasta grubu gibi seçilmiþ bir hasta grubunda karþýlaþtýran çalýþma sayýsý kýsýtlýdýr. Bu çalýþmada, yüksek-riskli prostat kanserli (PK) hastalarda bu iki yöntemin ereksiyon sonuçlarýnýn karþýlaþtýrýlmasý amaçlandý.
GEREÇ ve YÖNTEMLER: Yüksek-riskli PK nedeniyle RRP uygulanan 84 hasta ve RYRP uygulanan 60 hasta çalýþmaya dahil edildi. Hastalarýn demografik verileri, perioperatif veriler, hastaya ve hastalýða özgü faktörler, preoperatif ve postoperatif 3. ay Uluslararasý Erektil Fonksiyon Ýndeksi (IIEF) skorlarý, hasta dosyalarýndan retrospektif olarak kaydedildi. Çalýþmanýn birincil amacý, iki yöntem arasýnda erektil fonksiyondaki deðiþimin karþýlaþtýrýlmasýydý; ikincil amacý ise iki yöntem arasýndaki perioperatif verilerin ve onkolojik sonuçlarýn karþýlaþtýrýlmasýydý. Ýstatistiksel anlamlýlýk için 0,05’den küçük p deðerleri kabul edildi.
BULGULAR: Ýki grubun demografik ve histopatolojik verileri benzerdi. Ýki grupta da postoperatif 3. ayda bakýlan IIEF skorunda belirgin azalma mevcuttu (birinci grupta -10,42±2,72 ve ikinci grupta -9,82±1,86 puan, p=0,330). Bununla uyumlu þekilde her iki grupta da orta ve ileri düzeyde erektil disfonksiyonu olan hasta oranýnda artýþ mevcuttu ancak bu oranlar arasýnda anlamlý bir farklýlýk yoktu. Her iki grupta da hastalarýn yaklaþýk yarýsýnda potens korunmuþtu. Ayrýca, operasyon süresi RRP lehine bulunurken (p=0,024), postoperatif kateterizasyon süresi ve tahmini kan kaybý, RYRP lehine bulundu (sýrasýyla, p=0,019 ve p=0,036).
SONUÇ: Radikal prostatektomi, yüksek-riskli PK hastalarýnda düþük komplikasyon oranlarý ve erken dönem kabul edilebilir potens oranlarýyla güvenle uygulanabilir. Açýk ve robotik teknik arasýnda yüksek-riskli PK hastalarýnda erken dönem erektil fonksiyonlarýn korunmasýnda önemli bir fark saptanmamýþtýr.

OBJECTIVE: The number of studies comparing the functional results of robot-assisted (RARP) and retropubic (RRP) radical prostatectomy, in a high-risk group of patients, is limited. In this study, we compared the erectile function results of these two methods in patients with high-risk prostate cancer (PCa).
MATRERIAL and METHODS: Eighty-four patients who underwent RRP and 60 patients who underwent RARP for high-risk PCa were included in this study. Demographic data, perioperative data, patient and disease specific factors, preoperative and postoperative 3rd month International Index of Erectile Function (IIEF) scores were recorded retrospectively from hospital registration system. The primary aim of the study was to compare the change in erectile function between two methods; the secondary aim was to compare the perioperative data and oncologic results between the two methods. P values less than 0.05 were accepted for statistical significance.
RESULTS: Demographic and pathological data of the two groups were similar. There was a significant decrease in the IIEF score in the postoperative 3rd month in both groups (-10.42±2.72 in the first group and-9.82±1.86 in the second group, p=0.330). Consistent with this finding, there was an increase in the number of patients with intermediate and advanced erectile dysfunction in both groups, but there was no significant difference between these groups. In both groups, the potency was preserved in approximately half of the patients. In addition, the mean operation time was found in favor of RRP (p=0.024), while mean postoperative catheterization time and estimated blood loss were found in favor of RARP (p=0.019 and p=0.036, respectively).
CONCLUSION: Radical prostatectomy can be performed safely in patients with high-risk PCa with low complication rates and acceptable early potency rates. There was no significant difference between the open and the robotic technique for the preservation of short-term erectile function.

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AMAÇ: Çeþitli hematolojik parametrelerin inflamatuar süreçlerde rol aldýðý bilinmektedir. Son zamanlarda bu konuda en çok araþtýrýlan parametrelerden olan nötrofil-lenfosit oraný (NLR) ve trombosit-lenfosit oranýnýn (PLR) semen parametreleri ile iliþkisi hakkýndaki bilgiler sýnýrlýdýr. Biz bu çalýþmamýzda, normospermik bireylerde semen parametreleri ile NLR ve PLR arasýndaki iliþkiyi araþtýrmayý amaçladýk.
GEREÇ ve YÖNTEMLER: Hastanemiz androloji laboratuarýnda Ocak 2017 – Aralýk 2017 tarihleri arasýnda yapýlmýþ semen analizleri retrospektif olarak tarandý. Kayýtlarda hemogram sonucu mevcut olan normospermik bireyler çalýþmaya dahil edildi. Hemogram sonucu ile semen analizi arasýnda 6 aydan fazla süre olan olgular çalýþma dýþýnda býrakýldý. Hastalarýn trombosit sayýsý, ortalama trombosit hacmi (MPV), nötrofil sayýsý, lenfosit sayýsý kayýt edildi ve NLR, PLR hesaplandý. Veriler semen parametreleri ile karþýlaþtýrýldý.
BULGULAR: Çalýþmaya dahil edilen 90 hastanýn yaþ ortalamasý 31,50±7,04 yýl idi. Hastalarýn hemogram parametrelerinde ortalama trombosit sayýsý 237,89±59,58, MPV 7,53±0,91, nötrofil sayýsý 4046±1277, lenfosit sayýsý 2277±692; semen parametrelerinde semen hacmi 2,80±0,96 mL, konsantrasyon 69,08±31,87, toplam motil sperm sayýsý 41,07±21,36, idi. Hemogram parametreleri, semen parametreleri ile karþýlaþtýrýldýðýnda aralarýnda istatistiksel olarak anlamlý korelasyon saptanmadý (Tablo 1).
SONUÇ: Bu çalýþmanýn sonuçlarý, saðlýklý normospermik bireylerde semen parametreleri ile NLR ve PLR arasýnda iliþki olmadýðýný ve öngördürücü bir belirteç olarak kullanýlamayacaðýný göstermektedir.

OBJECTIVE: It is known that various hematological parameters are involved in inflammatory processes. The data about relationship between semen parameters and neutrophil-lymphocyte ratio (NLR) or platelet-lymphocyte ratio (PLR), which are recently the most researched parameters in this regard, is limited. In this study, we aimed to investigate the relationship between semen parameters and NLR & PLR in normospermic individuals.
MATRERIAL and METHODS: Semen analysis performed in our hospital andrology laboratory in between January 2017 and December 2017 were retrospectively reviewed. Normospermic individuals who had hemogram test in records, were included in the study. Subjects with a duration of more than 6 months between hemogram results and semen analysis were excluded from the study. Patients’ platelet count, mean platelet volume (MPV), neutrophil count, lymphocyte count were recorded and NLR, PLR were calculated. The data were compared with the semen parameters.
RESULTS: Ninety patients included in the study and the mean age was 31.50±7.04 years. Mean platelet counts of the patients were 237.89±59.58, MPV 7.53±0.91, neutrophil count 4046±1277, lymphocyte count 2277±692; in semen parameters, semen volume 2.80±0.96 mL, concentration 69.08±31.87 and total motile sperm count was 41.07±21.36. There was no statistically significant correlation between hemogram parameters and semen parameters (Table 1).
CONCLUSION: The results of this study show that there is no relationship between semen parameters and NLR&PLR in healthy normospermic individuals and NLR&PLR can not be used as a predictive marker.

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AMAÇ: Gecikmiþ testis torsiyonu olgularýnda klasik orþiyektomi, erkeklerde ciddi psikososyal sorunlara neden olmaktadýr. Orþiyektomili erkeklerde psikolojik travmanýn etkisini en aza indirmek için kullanýlan testis protezlerinin tedavi maliyeti hala yüksektir. Bu protezler ameliyathanelerde stoklanamadýðýndan ve orþiyektomi sýrasýnda ayný seansta implantasyonu mümkün olmadýðýndan, yerleþtirilmesi ayrý bir seansta ek müdahale gerektirir. Bu deneysel gecikmiþ testis torsiyonu yapýlmýþ rat modelinde, subkapsüler orþiyektomi sýrasýnda ulaþýlmasý oldukça kolay olan, testise benzer ovoid þekil verilmiþ olan bone-wax parafinin testis protezi olarak kullanýlabilirliðini araþtýrdýk.
GEREÇ ve YÖNTEMLER: Eriþkin erkek ratlar her biri 15 rat içeren iki gruba randomize edildi. Grup 1 ratlarýn sað testislerine 360 ° deneysel torsiyon uygulandý ve bu ratlar 1a, 1b ve 1 c alt gruplarýna randomize edilerek bunlarýn torsiyone sað testisleri sýrasýyla 12, 24 ve 48 saat sonra cerrahi olarak detorsiyone edildi. Benzer þekilde Grup 2 ratlarýn sað testislerine 720 ° deneysel torsiyon uygulandý ve bu ratlar 2a, 2b ve 2 c alt gruplarýna randomize edilerek bunlarýn da torsiyone sað testislerine sýrasýyla 12, 24 ve 48 saat sonra cerrahi detorsiyon uygulandý. Her iki gruptaki ratlarýn cerrahi detorsiyon yapýlan nekrotik sað testislerine subkapsüler orþiyektomi yapýldý ve tunika albuginea içerisine ovoid þekil verilmiþ bone-wax protezi yerleþtirildi. Otuz gün sonra tüm ratlara bilateral orþiyektomi yapýldý ve örnekler fiziksel ve histopatolojik olarak incelendi.
BULGULAR: Ratlarda torsiyon süresi ve derecesine bakýlmaksýzýn bonewax kullanýlan sað testislerinin tunika albuginealarýnda minimal kalýnlaþma, histiyositik reaksiyon ve yer yer yabancý cisim granulasyon dokusu gözlendi. Gecikmiþ testis torsiyonunda testis parankiminde nekroz gözlense de tunika albugineanýn minimal etkilendiði, kullanýlan bu materyale karþý ciddi bir yabancý cisim reaksiyonu geliþmediði, bone-wax protez materyalinin tunika albuginea içinde çok iyi uyum saðlayarak testisi kozmetik olarak iyi taklit ettiði görüldü.
SONUÇ: Bu deneysel çalýþmada, gecikmiþ testis torsiyonu modelinde, klasik orþiyektomiye alternatif olarak, subkapsüler orþiyektomi sonrasý testis protezi amacýyla bone-wax parafin implantasyonu uygulamasýnýn sonuçlarý cesaret verici bulunmuþtur.

OBJECTIVE: Classical orchiectomy, which is the only treatment option for delayed testicular torsion, causes serious psychosocial problems in men. Standard testicular prostheses to be implanted to minimize the impact of psychological trauma have high treatment costs. Because standard testicular prostheses cannot be stocked in the operating room, it is impossible to implant it during orchiectomy. Hence, these implants are placed with additional intervention. In this experimental rat model, during subcapsular orchiectomy, we investigated the results of implantation of ovoid-shaped bone-wax paraffin as a testicular prosthesis which could easily be reached almost every operating room.
MATRERIAL and METHODS: Mature male rats were randomized to two groups, each containing 15 animals. Three hundred and sixty-degree experimental right testicular torsion was applied in Group 1 rats and subsequently randomized to 1A, 1B and 1C subgroups according to their surgical detorsion time 12, 24 and 48 hours later, respectively. Similarly, 720-degree experimental right testicular torsion was applied in Group 2 rats and subsequently randomized to 2A, 2B and 2C subgroups according to their surgical detorsion time 12, 24 and 48 hours later, respectively. Necrotic testicular parenchyma was removed using the subcapsular orchiectomy technique in the groups, ovoid-shaped bone-wax was placed in the tunica albuginea. Thirty days later, bilateral orchiectomy was done all the rats and, specimens were physically and histopathologically examined.
RESULTS: Regardless of the duration and degree of torsion, light microscopic examination showed minimal thickening, histiocytic reaction and rare foreign body granulation reaction in the tunica albuginea. Although parenchymal necrosis was detected, tunica albuginea was minimally affected with no serious foreign-body reaction. Bone-wax material mimicked the testis as a testicular prosthesis.
CONCLUSION: This experimental study showed that, as an alternative to classical orchiectomy, the results of bone-wax paraffin implantation as a testicular prosthesis after subcapsular orchiectomy were found encouraging in delayed testicular torsion model.

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AMAÇ: Çok tanrýlý antikçaðda hayatýn her alaný tanrý ve tanrýçalarýn yönetimi ve gözetimi altýnda idi. Tanrý ve tanrýçalarýn yeteneklerini veya özelliklerini gösteren sembolleri vardý. Ýnanýlan ibadet edilen ve çareler istenilen bu tanrý ve yarý tanrýlar arasýnda açýkta penisi veya fallusu ile tasvir edilenler mevcuttu. Bu çalýþma çok tanrýlý dönemde penis veya falluslarý ile sembolize edilmiþ mitolojik tanrý, yarý tanrý ve kahramanlarý ile ifade ettiklerini androlojik bakýþ açýsý ile ortaya koymayý amaçlamýþtýr.
GEREÇ ve YÖNTEMLER: Antik Yunan, Roma, Mýsýr ve Asya mitolojisi, ithifallik tanrýlar ve fallik kült ile ilgili literatür araþtýrýldý, arkeolojik web siteleri, yurt içi ve yurt dýþýnda arkeoloji müzeleri, arkeolojik kitap ve dergilerde sembolü penis-fallus olan ithifallik tanrý, yarý tanrý ve mitolojik aktörler araþtýrýldý.
BULGULAR: Erekte haldeki penise fallus adý verilmiþtir. Antik Yunan ve Roma döneminde Dionysos, Hermes, Priapos, Narcissus, Orthannes, Konisalos, Tykhon, Pan, Silenos ve Satyrler, antik Asya’da Shiva, antik Mýsýr’da Min gibi tanrý, yarý tanrý ve kahramanlar açýkta duran penis veya falluslarý ile tasvir edilmiþ, cinsellik, erkeklik, cinsel güç, seks, dölleme, doðurganlýk, üreme, bereket ve verimlilikle iliþkili fallik inanç temsilcileri olmuþlardýr. Heykel, figür, seramik kaplar, fresk, rölyef, resim, mozaik ve antik paralar baþlýca tasvir araçlarý olmuþtur. Priapizm hastalýðýndaki penisin Tanrý Priapos’un penisi ile iliþkilendirilmesi ve priapizmin adýný Priapos’tan almasý merak uyandýrmýþtýr.
SONUÇ: Antik dönemde cinsellik,erkeklik,cinsel güç,seks,dölleme,üreme ve verimlilikle iliþkilendirilen fallus,erkek cinsel organýna tapýnma olarak ifade edilen bir fallik inanç ve fallik kültün doðmasýna neden olmuþ,sembolü penis-fallus olan mitolojik tanrý ve kahramanlarýn himayesinde geliþmiþtir.Ýthifallik tanrý ve kahramanlara tapýnma ile erkek cinselliði ve üreme ile ilgili her alanda,hatta tüm evrende verim ve bereket saðlanýlacaðýna inanýlmýþtýr.Tanrý Priapos ve onun fallusu ile iliþkili efsane günümüze dek ulaþmýþ,týp literatüründeki priapizm, ismini Priapos’tan almýþtýr.

OBJECTIVE: In the polytheistic antiquity, every area of life was under the direction and supervision of gods and goddesses. The gods and goddesses had symbols showing their abilities or attributes. Among those gods and demigods who were believed, worshiped and expected for remedies, there were those depicted in the open with his penis or phallus. This study aimed to reveal mythological gods, demigods and heroes symbolized by penis or phallus and their expressions in andrological point of view in polytheistic period.
MATRERIAL and METHODS: The literature on ancient Greek, Roman, Egyptian and Asian mythology, ithyphallic gods and phallic cult was investigated. The ithyphallic gods, demigods and mithologic actors with penis-phallus symbol in archeological websites, archeological museums in Turkey and abroad, archaeological books and magazines were investigated.
RESULTS: Erect penis is called phallus. The gods, demigods and heroes like Dionysus, Hermes, Priapus, Narcissus, Orthannes, Conisalos, Tychon, Pan, Silenus and Satyrs in ancient Greece and Rome, Shiva in ancient Asia, Min in ancient Egypt were depicted with exposed phallus or phallus, representing phallic beliefs associated with sexuality, masculinity, sexual power, sex, fertilization, fecundity, reproduction, fertility and productivity. Sculptures, figures, ceramic pots, frescoes, reliefs, paintings, mosaics and ancient coins were the main means of depiction. The fact that the penis in priapism is associated with the penis of God Priapos and that the priapism was named after Priapus arouses curiosity.
CONCLUSION: The phallus, which was associated with sexuality, masculinity, sexual power, sex, fertilization, reproduction and productivity in the ancient period, led to the emergence of a phallic belief and phallic cult, expressed as worship of the male genitals, and developed under the auspices of mythological gods and heroes whose symbol is the phallus. It is believed that worship of ithyphallic God and heroes will provide yield and fertility in all areas of male sexuality and reproduction, even in the entire universe. The myth of God Priapos and his phallus has survived, and priapism in the medical literature is named after Priapos.

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Peyronie hastalýðý (PH) peniste tunika albuginea’nýn (TA) progresif lokalize fibrotik hastalýðýdýr. Fibröz, elastik olmayan skar formasyonu ve kalsifiye plak oluþumuyla sonuçlanan bir yara iyileþme bozukluðu olarak da kabul edilmektedir. Klinik olarak bu plaklar, peniste eðrilik, kýsalma ve daralma gibi deformitelere ve aðrýya neden olabilir. Peyronie hastalýðý için etiyolojik faktörlerin tam spektrumu bilinmemesine raðmen, travma, bozulmuþ fibrin klirensi, otoimmün ve genetik faktörler dahil olmak üzere birçok etiyolojik mekanizma ileri sürülmüþtür. Penise tekrarlayan mikrotravmalar ile bilaminar yapýdaki TA’nýn delaminasyonunun ve sonrasýndaki enflamatuvar sürecin peyronie plaklarýnýn geliþimine neden olduðu düþünülmektedir. Travma sonrasý enflamatuar süreç, myofibroblast persistansýna ve sonrasýnda anormal kollajen birikiminine neden olur. Beraberinde anormal fibrin birikimi ve elastik liflerin düzensiz bir hal almasýyla, karakteristik tunikal fibröz plak ve skar oluþumu gerçekleþir ve enflamatuar süreç tamamlanýr. PH’nin patogenezi hayvan modellerinde, hücre kültürlerinde ve klinik çalýþmalarda ortaya konulmaya çalýþýlmýþtýr. Bu hastalýðýn etyopatolojisinin daha iyi anlaþýlmasý tedavi stratejilerinin geliþtirilmesi için önemlidir.

Peyronie’s disease (PD) is a progressive localized fibrotic disease of tunica albuginea (TA) in the penis. It is also considered as a wound healing disorder with fibrous and non-elastic scar formation and calcified plaque formation. Clinically, these plaques can cause deformities such as curvature, shortening and contraction of the penis and pain. Although the complete spectrum of etiologic factors for PD is unknown, multiple mechanisms have been proposed including trauma, impaired fibrin clearance, autoimmune and genetic factors. It is thought that delamination of bilaminar TA in the penis with repetitive microtrauma and subsequent inflammatory process may cause the development of the Peyronie plaques. The post-traumatic inflammatory process causes myofibroblast persistence and subsequent abnormal collagen accumulation. Accompanying abnormal fibrin accumulation and irregular form of elastic fibers, characteristic tunical fibrous plaque and scar formation occur and the inflammatory process is completed. Pathogenesis of PD has been tried to be demonstrated in animal models, cell cultures and clinical studies. A better understanding of the etiopathology of this disease is important for the development of treatment strategies.

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AMAÇ: Ýnfertil bireylere taný iþlemleri için uygulanan testler, tedavi seçeneklerine iliþkin karar verememe, tedavi sürecine iliþkin yeterli bilgilendirilmeme, tedaviler ve sonuçlarý ile ilgili yaþanan anksiyete ve ambivalan duygular, taný ve tedavi sürecinde yaþanan fiziksel sýkýntýlar ve aðrý gibi nedenler infertil bireylerin yaþam kalitesini olumsuz olarak etkilemektedir. Bu derlemenin amacý infertil bireylerde yaþam kalitesi ile ilgili yapýlmýþ ve yayýnlanmýþ çalýþmalarýn gözden geçirilmesi ve sistematik olarak incelenmesidir.
GEREÇ VE YÖNTEM: Sistematik derleme türündeki bu çalýþmada anahtar kelime olarak “infertility and quality of life”kullanýlarak Pubmed, Science Direct ve Medline veri tabanlarý taranmýþtýr. Ocak 2014-Þubat 2019 tarihleri arasýnda uluslararasý dergilerde yayýnlanmýþ çalýþmalar deðerlendirilmiþ olup tarama sonucunda 495 çalýþma elde edilmiþtir. Dahil etme/ dýþlama kriterlerine uygun 12 çalýþma derleme kapsamýna alýnmýþtýr.
BULGULAR: Ýncelenen çalýþmalarýn sonucuna göre infertil bireylerin fertil bireylere göre yaþam kalitelerinin daha düþük olduðu belirlendi. Ýnfertil bireyler cinsiyet yönünden karþýlaþtýrýldýðýnda infertil kadýnlarýn infertil erkeklere göre yaþam kalitesinin daha düþük olduðu belirlendi. Yaþ, eðitim, kültürel farklýlýklar ve önceki tedavilerden olumsuz sonuç almak gibi faktörlerin yaþam kalitesi üzerine etkili olduðu görüldü. Ayný zamanda tamamlayýcý alternatif týp yöntemleri ve maneviyatý kullanma gibi baþetme mekanizmalarýnýn yaþam kalitesini artýrdýðý belirlendi. Sonuç: Üreme fonksiyonunu yerine getirememek ve ebeveyn olamamak gibi toplumsal rollerini yerine getiremediðini düþünmek gibi faktörler ve tedavi süresince yaþananlarýn (yoðun ilaç kullanýmý, oosit toplanmasý gibi invaziv iþlemlere maruz kalma, semen verme, gebelik sonucunun yarattýðý beklenti ve kaygýlarýn artmasý vb.) etkisiyle yaþam kalitesi düþmektedir. Bu nedenle hemþirelerin, infertil bireylere bakým verirken taný ve tedavi sürecinin her aþamasýnda bireylerin yaþam kalitesini deðerlendirmesi önemli ve gereklidir.

OBJECTIVES: The tests performed for diagnostic procedures, lack of decision about treatment options, insufficient information about treatment process, anxiety and ambivalent feelings about the treatment and results, physical problems experienced during the diagnosis and treatment process and pain, negatively affect the quality of life of infertile people. The aim of this study is to systematically review the published studies about quality of life in infertile people.
METHODS: In this systematic review; Pubmed, Science Direct and Medline databases were examined by using “infertility and quality of life” as the keyword. Studies published in international journals between January 2014 and February 2019 were evaluated and 495 studies were obtained. 12 studies complying with the inclusion/ exclusion criteria were included in the study.
RESULTS: According to the results of the studies, it was determined that infertile people had lower quality of life than fertile people. Infertile women were found to have lower quality of life than infertile males. Factors such as age, education, cultural differences and negative results from previous treatments were found to be effective on quality of life. It was also found that coping mechanisms such as complementary alternative medicine methods and the use of spirituality increased the quality of life.
CONCLUSION: Quality of life decreases due to factors such as unable to perform reproductive function and social roles, and experienced during the treatment period (intense medication use, exposure to invasive procedures such as oocyte retrieval, semen administration, increased expectation and anxiety caused by pregnancy, etc.). Therefore, it is important for nurses to assess the quality of life of individuals at every stage of the diagnosis and treatment process while providing care to infertile people.

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Spermatogenez, birçok hormonal ve parakrin faktörle düzenlenen, dinamik bir süreçtir. Bu süreç, otokrin, parakrin ve endokrin etkenlerin güdümünde ve aþamalý bir süreçtir ve gonadotropinlerin etkisi altýndadýr. Hareketli spermatozoanýn meydana geldiði spermiyogenez ise, spermatogenezin nihai basamaðýdýr. Bu basamakta, Sertoli hücrelerinin önemli bir düzenleyicisi olduðu, hücre-iskeleti yapýsý önemlidir. Sertoli hücreleri, germ hücrelerinin geliþimi için destekleyici ortamý saðlarlar ve dinamik bir hücre iskeletine sahiptirler. Gonadotropinler, testosteron, östrojen ve büyüme hormonunun spermatogenezde önemli rolleri vardýr ve bunlarýn yokluðunda önemli defektler görülebilmektedir. Ýnfertilite, yaygýn görülen ve çiftlerde önemli psikososyal problemlere neden olan bir problemdir. Azoospermi, erkek faktörünün yaklaþýk %10’undan sorumludur ve bu durumda hormonal tedavinin baþarýsý sýnýrlýdýr. Bu tedavilerle hedeflenen sonuç, immatür germ hücrelerini, oositi döllemeye yetkin olgun hücreler haline getirmektir. Bu kapsamda, gonadotropinlerin etki mekanizmalarýnýn ve Leydig-Sertoli hücreleri ve germ hücreleri arasýndaki etkileþimin aydýnlatýlmasý, kritik öneme sahiptir. Spermatogenez basamaklarýnda rol oynayan lokal ve sistemik faktörlerin daha iyi anlaþýlmasýyla ve genetik bazlý farklýlýklarýn ortaya çýkartýlmasýyla immatür germ hücrelerinin olgun hücreler haline getirilmesi yoluyla infertilite tedavisinde yeni ufuklar açýlabilir.

Spermatogenesis is a dynamic process which is managed with various hormonal and paracrine factors. Spermatogenesis is a stepwise process guided by autocrine, paracrine and endocrine factors and is under the influence of gonadotropins. The spermiogenesis, in which the motil spermatozoa occur, is the final step of spermatogenesis. In this step, the cell-skeleton structure, in which the Sertoli cells are important regulators, is fundamental. Sertoli cells provide a supportive environment for the development of germ cells and have a dynamic cytoskeleton. Gonadotropins, testosterone, estrogen and growth hormone have important roles in spermatogenesis and considerable defects may be considered in the absence of these. Infertility is a common problem that causes significant psychosocial challenges in couples. Azoospermia is responsible for approximately 10% of the male factor and the success of hormonal therapy is limited in this case. The targeted result with these treatments is to transform immature germ cells into mature cells capable of fertilizing oocytes. In this context, the mechanisms of action of gonadotropins and the clarification of the interaction between LeydigSertoli cells and germ cells are critical. With the better understanding of local and systemic factors involved in the spermatogenesis steps and by revealing genetic-based differences, new horizons may be opened in infertility treatment by transforming immature germ cells into mature cells.

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Kadýn cinsel fonksiyon bozukluðu; “istek, uyarýlma, orgazm ve çözülme dönemlerinden oluþan cinsel yanýt döngüsünün bozulmasý ve/veya cinsel iliþki sýrasýnda aðrý duyulmasý” olarak tanýmlanmaktadýr. Diagnostic and Statistical Manual of Mental Disorders V’te cinsel istek/uyarýlma bozukluðu, kadýn orgazm bozukluðu ve genitopelvik aðrý/penetrasyon bozukluðu þeklinde sýnýflandýrýlmaktadýr. Tedavide bu alanlarý hedef alacak þekilde planlanmaktadýr. Kanýta dayalý tedaviler, tedaviye karar verirken en iyi kanýtlarýn, dikkatli, açýk ve akýllýca kullanýlmasý esasýna dayanan uygulamalardýr. Bu kapsamda günümüzde kadýn cinsel fonksiyon bozukluklarýnda kanýta dayalý tedaviler son derece sýnýrlýdýr. Hipoaktif cinsel istek bozukluðunda FDA onaylý tek ilaç flibanserindir. Postmenopozal genito-üriner sendroma baðlý disparoni için FDA onaylý birkaç ürün vardýr. Kadýnlarda cinsel uyarýlma ve/veya orgazm bozukluklarý için onaylanmýþ farmasötik bir ürün yoktur. Halen kadýn cinsel iþlev bozukluðunu hedef alan tedavilerin çoðu ilaçlarýn endikasyon dýþý kullanýmlarý þeklindedir.

Female sexual dysfunction is defined as disruption of the sexual response cycle consisting of desire, arousal, orgasm and resolution and/or pain during sexual intercourse. Female sexual dysfunction is classified as female sexual interest or arousal disorder, female orgasmic disorder and genitopelvic pain or penetration disorder in DSM V. The treatment is planned to target these areas. Evidence-based therapies are based on the careful, clear and wise use of the best evidence when deciding treatment. In this context, evidence based therapies in female sexual dysfunction are extremely limited. The only FDA approved drug in hypoactive sexual desire disorder is flibanserin. There are several FDA approved products for the dyspareunia associated with postmenopausal genito-urinary syndrome. There is no pharmaceutical product approved for sexual arousal and/or orgasmic disorders in women. Most of the treatments currently targeting female sexual dysfunction are off-label use.

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