RESUMEN
The aim of this study was to evaluate one possible reason why men do not seek help for erectile dysfunction. For this study, 500 men that visited their family doctors were stratified into one of three groups based on the reasons for their visits and their overall health statuses. A questionnaire was used to ask each participant about his willingness to seek help for erectile dysfunction should it occur during his lifetime. The statistical analysis of their answers showed that the men with serious chronic illnesses and malignancies were less interested in sexual activity, and they were less likely to seek help for erectile dysfunction when compared to otherwise healthy men and men with mild chronic diseases. Better patient education and reassurance could increase the proportion of men with chronic illnesses and malignancies who seek treatment for erectile dysfunction.
Asunto(s)
Enfermedad Crónica , Disfunción Eréctil/etiología , Disfunción Eréctil/psicología , Neoplasias/complicaciones , Aceptación de la Atención de Salud/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Aceptación de la Atención de Salud/psicología , Educación del Paciente como Asunto , Conducta Sexual/estadística & datos numéricos , Eslovenia , Encuestas y CuestionariosRESUMEN
PURPOSE: To compare the efficacy of two bulking agents, Dextranomer-Hyaluronic Acid (DxHA) and Polyacrylate-Polyalcohol Copolymer (PPC) used for endoscopic treatment of vesicoureteral reflux (VUR). MATERIALS AND METHODS: We endoscopically treated 125 patients (89 girls and 36 boys) diagnosed with VUR grades I-V, comprising a total of 174 refluxing ureters (RUs). Patients were categorized into two groups, 99 (56,9%) RUs were treated with DxHA (Group 1) and 75 (43,1%) RUs with PPC (Group 2). RUs treated with both bulking agents were excluded. The success of treatment was evaluated with postoperative VCUG at 3- and 12-months after the endoscopic procedure, only complete resolution of VUR was considered as treatment success. Data was collected and analyzed retrospectively. Statistical calculations were performed using the Chi-square test. RESULTS: After a single injection 80,0% (60/75) and 68,7% (68/99 RUs) of RUs resolved completely when treated with PPC and DxHA, respectively (P = .094). A second injection of PPC healed another 10 RUs (total 93,3%), whereas DxHA resolved additional 16 RUs (total 84,8%) (P = .097). A third injection was needed for 1 RU, treated with PPC and another 3 RUs with DxHA. Twelve months post-operatively, we achieved a total resolution rate of 94,7% (71/75 RUs) with PPC, while DxHA successfully treated 87,9% (87/99) of RUs (P = .125). CONCLUSIONS: DxHA and PPC showed no statistically significant differences neither in the number of injections needed nor in the total success rate after 12 months of follow-up.
Asunto(s)
Resinas Acrílicas/uso terapéutico , Cistoscopía , Dextranos/uso terapéutico , Ácido Hialurónico/uso terapéutico , Polímeros/uso terapéutico , Reflujo Vesicoureteral/tratamiento farmacológico , Reflujo Vesicoureteral/cirugía , Preescolar , Femenino , Humanos , Masculino , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
BACKGROUND: To compare intermittent treatment (IT) versus continuous treatment (CT) using cyproterone acetate (CPA) in bone metastatic prostate cancer patients, we conducted an open-label, multicenter randomized trial. Continuous androgen deprivation therapy is the standard treatment in metastatic prostate cancer. Intermittent treatment might maintain efficacy while toxicity and costs are reduced. METHODS: Patients received CPA 100 mg tid in the prephase. Patients with a PSA decline of ≥ 90 % or PSA <4 ng/ml were randomized. If patients were progressive, LHRH analogues were added. Primary end point was time to PSA progression. RESULTS: A total of 366 patients were recruited; 258 reached a good response after 3 or 6 months and were randomized. A total of 131 patients randomized to IT and 127 to CT. Patients on IT had an average of 1.7 episodes on CPA, before LHRH analogues were started. The mean time without treatment in IT was 463 days versus 422 days on treatment. There were statistical significant differences between IT and CT in 3 of the 5 functional scales of EORTC QLQ C 30; however, the clinical relevance of this finding appears modest. Symptom and potency scales showed significant advantages for IT. There were no differences in time to PSA progression on CPA, time to PSA and/or clinical progression on LHRH analogues and time to cancer-specific and overall survival. CONCLUSIONS: IT by CPA is associated with less symptoms and modest advantages in QOL domains. There were no differences in time to PSA progression, clinical progression or survival.
Asunto(s)
Antagonistas de Andrógenos/administración & dosificación , Neoplasias Óseas/tratamiento farmacológico , Neoplasias Óseas/secundario , Acetato de Ciproterona/administración & dosificación , Neoplasias de la Próstata/patología , Anciano , Humanos , MasculinoRESUMEN
OBJECTIVE: To evaluate treatment success and tolerability of solifenacin among women with urinary urgency (UU) and urgency urinary incontinence (UUI). METHODS: In a prospective, observational, multicenter pilot study in Slovenia and Croatia, 100 women with UU and UUI were enrolled between January 2011 and July 2011. Patients received 5mg of solifenacin once daily for 12 weeks and completed a 3-day bladder diary, urgency questionnaire, Urogenital Distress Inventory (UDI), and Incontinence Impact Questionnaire (IIQ). RESULTS: Overall, 91 women completed 12 weeks of treatment. Severity, frequency, and bother of UU significantly had decreased at weeks 4 and 12 (P<0.001). Improvement in UU led to an improvement in mean IIQ score: a reduction in UU frequency had the greatest impact (P=0.006). The mean treatment success rate was 74.2% (by visual analog score) and was closely related to the mean change in irritative UDI score (r=0.39; P<0.001). Treatment success was greatest for patient perception of intensity of urgency scale (PPIUS; P=0.003), UU bother (P=0.017), and micturition frequency (P<0.026). Dry mouth occurred in 35.2% of women at 4 weeks, and 27.7% at week 12. CONCLUSION: Solifenacin treatment was effective and well-tolerated among women with UU and UUI. All overactive bladder symptoms had improved by week 12.
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Antagonistas Muscarínicos/uso terapéutico , Quinuclidinas/uso terapéutico , Tetrahidroisoquinolinas/uso terapéutico , Incontinencia Urinaria de Urgencia/tratamiento farmacológico , Adulto , Anciano , Femenino , Humanos , Persona de Mediana Edad , Satisfacción del Paciente/estadística & datos numéricos , Proyectos Piloto , Estudios Prospectivos , Succinato de Solifenacina , Resultado del TratamientoRESUMEN
AIM: To analyze differences in effect of intracavernosally applied alprostadil (prostaglandin PGE 1) on men with different underlying causes of erectile dysfunction. METHODS: Forty eight men with erectile dysfunction lasting for at least six months were stratified according to the etiology of erectile dysfunction into one of 4 groups comprising 12 patients. The groups were the following: psychogenic, arteriogenic, veno-occlusive, and neurological erectile dysfunction group. All men filled out International Index of Erectile Function (IIEF)-5 questionnaire, which is a 5-question version of International Index of Erectile Function Questionnaire, underwent clinical examination including neurological assessment, were tested for nocturnal penile tumescence, and had Doppler color sonography of penile arteries. Intracavernosal alprostadil was then applied to the patients, starting with a 5 mug dose and then increased in 5 microg increments until the final dose of 20 microg was reached. We measured the time from the moment of application until the start of erection and time of erection duration. For statistical analysis, non-parametric Friedman test for significant differences between repeated measurements in small groups and Wilcoxon test for differences between doses were used. RESULTS: Significant relation was found between the applied dose of intracavernosal alprostadil and the duration of erection in all 4 groups of men with erectile dysfunction. In patients with arteriogenic erectile dysfunction, mean (+/-standard deviation) duration of erection for consecutive doses of alprostadil 5 microg, 10 microg, 15 microg, and 20 microg were 40.0+/-20.6, 54.6+/-23.6, 65.0+/-29.6, and 82.1+/-35.4 minutes, respectively, with significant increase for each dose. In patients with veno-occlusive dysfunction, mean durations of erection significantly increased from 8.2+/-7.8 minutes at 10 microg to 17.3+/-9.5 minutes at 20 microg. In patients with neurogenic erectile dysfunction, mean durations of erection were 40.4+/-16.6, 61.7+/-24.7, 82.5+/-34.4, and 101.0+/-28.5 minutes respectively, with significant increase for each dose. In patients with psychogenic erectile dysfunction, mean durations of erection were 32.4+/-15.4, 45.8+/-15.1, 69.9+/-23.5, and 98.3+/-37.9 minutes respectively, with a significant increase for each dose. CONCLUSION: Men with different underlying cause of erectile dysfunction show different response to the intracavernosally applied alprostadil. In order to achieve the optimal result, the treatment should be started with the smallest doses which are gradually increased until the maximum effect is reached.
Asunto(s)
Alprostadil/administración & dosificación , Disfunción Eréctil/diagnóstico , Disfunción Eréctil/tratamiento farmacológico , Erección Peniana/efectos de los fármacos , Adolescente , Adulto , Relación Dosis-Respuesta a Droga , Esquema de Medicación , Humanos , Inyecciones Intralesiones , Masculino , Persona de Mediana Edad , Satisfacción del Paciente , Probabilidad , Recuperación de la Función , Medición de Riesgo , Índice de Severidad de la Enfermedad , Estadísticas no Paramétricas , Factores de Tiempo , Resultado del TratamientoRESUMEN
A 55-year-old woman with stress urinary incontinence underwent a tension-free vaginal tape (TVT) procedure. Two months after the procedure she complained of suprapubic pain occurring at the end of micturition. Not until 8 months after surgery was the pain found to be due to intramural position of the prolene tape. The operative method used to remove the tape, thus eliminating this late complication of an otherwise successful procedure, is also described.