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OBJECTIVE: To evaluate the efficacy and safety of combination therapy of sildenafil plus vacuum erection devices in men with type 2 diabetes mellitus with moderate to severe erectile dysfunction who are dissatisfied with the results of using sildenafil alone. METHODS: The study included 66 diabetes mellitus patients presenting erectile dysfunction for at least 6 months and dissatisfied with the use of 100 mg sildenafil monotherapy. The patients were randomized in two groups. Those in group A (n = 33) were instructed to use a vacuum erection device only, whereas those in group B (n = 33) were treated with combination therapy, including sildenafil 100 mg and a vacuum erection device. Erectile function was evaluated subjectively using the International Index of Erectile Function, Sexual Encounter Profile questionnaire questions 2 and 3 at visit 1 (baseline; study entry), visit 2 (4 weeks after baseline), and visit 3 (12 weeks after baseline; study end). RESULTS: There were no significant differences in average patient age, duration of diabetes, duration of erectile dysfunction, baseline International Index of Erectile Function scores, hypertension, blood testosterone, smoking and alcohol consumption between two groups. Mean International Index of Erectile Function scores were significantly higher for group B at the 1-month (14.86 ± 2.17 vs 12.41 ± 2.63; P < 0.0001) and 3-months (17.53 ± 2.95 vs 14.29 ± 2.81; P < 0.0001) visits. Men in group B had better successful penetration (73.3% vs 46.6%) and successful intercourse (70% vs 46.6%) at 3 months compared with group A. CONCLUSION: Combined use of sildenafil and vacuum erection device therapy significantly enhances erectile function, and it is well tolerated by diabetes mellitus patients not responding to first-line sildenafil alone.

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OBJECTIVE: In this paper, we analyze the clinical efficacy of a simultaneous saline irrigation method in treating upper-mid ureteral stone migration and evaluate its effectiveness during ureteroscopic lasertripsy. METHODS: We prospectively evaluated 78 patients with a total of 95 upper-mid ureteral stones, which were treated with holmium:YAG lasertripsy. These patients were randomized into 2 groups. In Group 1 (39 cases with 44 ureteral stones), conventional ureteroscopic lasertripsy was performed. In Group 2, (39 cases with 51 ureteral stones), the simultaneous saline irrigation method was used during lasertripsy. There was no significant difference between the groups with regards to stone site, size or state of the upper urinary tract by spiral computed tomography or excretory urography. Data were analyzed regarding stone migration, lengths of time, and ureteral clearing for various stages of each procedure. RESULTS: One patient in Group 2 (2%) experienced upward stone migration, while this occurred in 8 patients in Group 1 (20%). The operative time in Group 1 ranged from 35 to 55 minutes (mean: 44.8 ± 5.3), while in Group 2 it ranged from 40 to 69 minutes (mean: 50.4±3). There was no significant different in the operative times between the two groups (p < 0.05). Ureteral perforation, urinoma and urosepsis were not seen in both groups. CONCLUSION: The simultaneous saline irrigation method demonstrated a statistically significant advantage over conventional methods. The operation can be performed persistently under clear vision, and since the stones cannot move upward, fragmented portions are easily flushed out. Our data suggest that this method is simple, safe and effective in preventing proximal stone migration during ureteroscopic lasertripsy.

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OBJECTIVES: To report and discuss the role of the treatment of ipsilateral renal and upper middle ureteral stones in patients by combing retroperitoneal laparoscopic surgery with tubeless mini-percutaneous nephrolithotomy. PATIENTS AND METHODS: Eleven patients associated with ipsilateral renal and upper middle ureteral stones underwent combing retroperitoneal laparoscopic surgery with tubeless mini-percutaneous nephrolithotomy after failure of shockwave or ureteroscopy lithotripsy. Their data were analyzed retrospectively including stone burden, perioperative complications and outcomes. RESULTS: All the patients underwent retroperitoneal laparoscopic ureterolithotomy and tubeless mini-percutaneous nephrolithotomy successfully. Surgical time ranged from 80 to 160 min with a mean of 118 min. The mean hospital stay was 4 days (3-7 days). The mean length of retroperitoneal urinary drainage was 3 days (2-6 days). There were minor complications in 3 (27.2%) patients. The stone-free rate was 82% (9 patients). Two patients had a residual calyceal fragment that was treated with shockwave lithotripsy. All of them were followed up for 3-24 months. Renal function was improved in different degree. CONCLUSION: In carefully selected patients, combining retroperitoneal laparoscopic surgery with tubeless mini-percutaneous nephrolithotomy can treat ipsilateral renal and upper middle ureteral calculi by a single procedure with advantages of high stone-free rate, safety, reliability, rapid recovery and less complications.

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