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    Comparison of the results of stop-start technique with stop-start technique and sphincter control training applied in premature ejaculation treatment
    (Public Library Science, 2023) Dogan, Kazim; Kece, Cem
    BackgroundThe aim of this study is to compare the results of stop-start technique with stop-start technique together with sphincter control training applied in the treatment of premature ejaculation. MethodsThis research was conducted as a pre-test post-test quasi-experimental study. The sample of the study consisted of 80 men. The study was conducted on men who applied to the urology outpatient clinic of LIV Hospital, a private hospital, in Gaziantep, Turkey, between 01 October 2021 and 01 March 2022. Personal Information Form, Intravaginal Ejaculation Latency Time (IELT), Fold Increase Intravaginal Ejaculation Latency Time (F-IELT) Premature Ejaculation Diagnostic Tool (PEDT) Questionnaire and Arabic Index Premature Ejaculation (AIPE) were used as the data collection tools. Behavioral therapy, consisting of a total of 6 sessions, was applied once every two weeks, with each session lasting for 45 minutes. After 3rd and 6th months from the beginning of the application, the data collection tools were applied again. Stop-Start Technique (Group A) and Stop-Start Technique and Sphincter Control Training (Group B) were used in the treatment. ResultsIn both groups, the IELT and AIPE values after 3rd and 6th months from the beginning of the application were statistically higher than those obtained before (p<0.05). IELT and AIPE values increased more in Group B than Group A (p<0.05). F-IELT values after 6th months from the beginning of the application were found to be statistically significant with a low level of effect size than those obtained before (p<0.05, Cohen's d = 0.027). In both groups, the PEDT values in the 3rd and 6th months after the application were statistically lower than those seen before (p<0.05). PEDT value decreased more in Group B than Group A (p<0.05). The differences between the two groups' IELT (Cohen's d = 0.011), AIPE (Cohen's d = 0.044), and PEDT (Cohen's d = 0.066) values in the 3rd month after the application and IELT (Cohen's d = 0.025), AIPE (Cohen's d = 0.048), and PEDT (Cohen's d = 0.024) values in the 6th month after the application were found to be clinically weak. ConclusionsIt was determined that the stop-start technique given to men with premature ejaculation increased the time spent in the vagina and eliminated the problem of premature ejaculation. It was determined that the stop-start technique in combination with sphincter control training were more effective than the stop-start technique alone.
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    The efficacy of artificial intelligence in urology: a detailed analysis of kidney stone-related queries
    (Springer, 2024) Cil, Gokhan; Dogan, Kazim
    PurposeThe study aimed to assess the efficacy of OpenAI's advanced AI model, ChatGPT, in diagnosing urological conditions, focusing on kidney stones.Materials and methodsA set of 90 structured questions, compliant with EAU Guidelines 2023, was curated by seasoned urologists for this investigation. We evaluated ChatGPT's performance based on the accuracy and completeness of its responses to two types of questions [binary (true/false) and descriptive (multiple-choice)], stratified into difficulty levels: easy, moderate, and complex. Furthermore, we analyzed the model's learning and adaptability capacity by reassessing the initially incorrect responses after a 2 week interval.ResultsThe model demonstrated commendable accuracy, correctly answering 80% of binary questions (n:45) and 93.3% of descriptive questions (n:45). The model's performance showed no significant variation across different question difficulty levels, with p-values of 0.548 for accuracy and 0.417 for completeness, respectively. Upon reassessment of initially 12 incorrect responses (9 binary to 3 descriptive) after two weeks, ChatGPT's accuracy showed substantial improvement. The mean accuracy score significantly increased from 1.58 +/- 0.51 to 2.83 +/- 0.93 (p = 0.004), underlining the model's ability to learn and adapt over time.ConclusionThese findings highlight the potential of ChatGPT in urological diagnostics, but also underscore areas requiring enhancement, especially in the completeness of responses to complex queries. The study endorses AI's incorporation into healthcare, while advocating for prudence and professional supervision in its application.
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    The efficacy of systemic inflammatory response and oxidative stress in erectile dysfunction through multi-inflammatory index: a prospective cross-sectional analysis
    (Oxford Univ Press, 2023) Taskiran, Mehmet; Dogan, Kazim
    Background Systemic inflammation and oxidative stress increase the possibility of erectile dysfunction (ED) through a coordinated response to vascular endothelial damage. Aim The study aimed to evaluate the status of oxidative stress and systemic inflammation in ED. Methods The analysis was a prospective, cross-sectional, single-center study. The study included non-ED (n = 54) and ED (n = 104) groups. The study analyzed demographics, clinical outputs, oxidative stress (total antioxidant status [TAS], total oxidant status [TOS], oxidative stress index [OSI]), and an inflammatory condition (multi-inflammatory index 1 [MII-1], MII-2). Outcomes Oxidative stress and systemic inflammation were evaluated together in ED, which was evaluated with the help of the International Erectile Function Index (IIEF) scale. Results TAS significantly decreased in the ED group compared with the non-ED group (2.25 +/- 0.83 mmol Trolox equivalents/L vs 1.45 +/- 0.65 mmol Trolox equivalents/L; P = .001). TOS increased in the ED group (14.1 +/- 6.2 mu mol H2O2 equivalents/L) compared with non-ED group (11.05 +/- 6.8 mu mol H2O2 equivalents/L) (P = .002). OSI was as low as 0.74 +/- 0.33 in the non-ED group and as high as 2.38 +/- 0.85 in the ED group (P = .001). Both MII-1 (273 +/- 398 vs 745 +/- 1311; P = .012) and MII-2 (4.66 +/- 5.02 vs 19.7 +/- 29.4; P = .031) increased in the ED group compared with the non-ED group. IIEF was negatively correlated with MII-1 (r = -0.298; P = .009), MII-2 (r = -0.341; P = .006), and OSI (r = -0.387; P < .0001), while TAS had a strong positive correlation with the IIEF (r = 0.549; P = .0001). OSI was correlated with MII-1 (r = 0.304; P = .001) and MII-2 (r = 0.334; P = .001). OSI was the strongest parameter in predicting ED (P = .0001; area under the curve, 0.795; 95% confidence interval, 0.696-0.855). The cutoff was 0.71 at 80.5% sensitivity and 67.2% specificity. Clinical Implications OSI showed diagnostic potential for ED as an oxidative stress indicator, while MII-1 and MII-2 showed the effectiveness. Strengths and Limitations MIIs, a novel indicator of systemic inflammatory condition, were analyzed for the first time in patients with ED. The long-term diagnostic efficacy of these indices was lacking, as all patient data did not include long-term follow-up. Conclusion Considering their low cost and easy applicability compared with OSI, MIIs could be essential parameters in the follow-up for ED for physicians.
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    A randomized controlled trial of combined low-intensity extracorporeal shockwave therapy and Dapoxetine use in the management of lifelong premature ejaculation
    (Mre Press, 2023) Dogan, Kazim; Taskiran, Mehmet
    We aimed to evaluate the efficacy of combined low-intensity extracorporeal shockwave therapy (LI-ESWT) and dapoxetine administration for the treatment of lifelong premature ejaculation (LPE) in comparison to LI-ESWT and dapoxetine alone. In the randomized controlled trial, 212 men diagnosed with LPE were enrolled. The participants were randomized into four subgroups: control (n = 50), dapoxetine (n = 56), LI-ESWT (n = 50) and LI-ESWT + dapoxetine (n = 56). The intravaginal ejaculation latency (IELT), premature ejaculation profile (PEP), and Global Impression of Change (GIC) were evaluated. There were substantial improvements in the fold-increase of the IELT (F-IELT), and PEP and GIC-I scores in both the dapoxetine (p < 0.001) and LI-ESWT + Dapoxetine (p < 0.001) groups than in the control and LI-ESWT groups. Although the LI-ESWT group demonstrated a minor improvement in the F-IELT score (p = 0.04), there were no noticeable improvements in the PEP (p = 0.12) and GIC-I ( p = 0.15) scores. In conclusion, a combination of dapoxetine administration and LI-ESWT might be more effective in treating LPE than LI-ESWT or dapoxetine alone, indicating a potential synergistic effect.