RESUMEN
BACKGROUND: Erectile dysfunction is defined as inability to achieve or maintain penile erection sufficient for sexual satisfaction. It is a serious problem that increases by age. The physiology of penile erection depends mainly on nitric oxide release. OBJECTIVES: Compare the efficacy and safety of oral sildenafil 50 mg alone or in combination with l-arginine 3 g/day orally on the treatment of erectile dysfunction. MATERIAL AND METHODS: Randomized controlled study with two parallel groups of erectile dysfunction patients; One group received sildenafil 50 mg every other day, while the other group received a combination of sildenafil (every other day)/l-arginine on a daily base. Efficacy was assessed using International Index of Erectile Function-5 score at the baseline and after 8 weeks. Side effects were evaluated across the two groups. RESULTS: The mean age was 56.3 ± 5 and 56.2 ± 4.4 years in sildenafil and combination groups, respectively. International Index of Erectile Function-5 score was comparable between the two groups at the baseline (p value 0.44). International Index of Erectile Function-5 score was improved from 15.3 ± 2.5 at baseline to 19.2 ± 2.3 after treatment, and this was statistically significant with p value <0.0001. The score was slightly better in combination group in which the average International Index of Erectile Function-5 score was (19.8 ± 2.2) vs. (18.5 ± 2.3) in sildenafil group with p value 0.05. Side effects were more or less the same between the two groups except for gastritis which was more common on combination group. CONCLUSION: Adding l-arginine to sildenafil demonstrated more efficacy than sildenafil alone for treatment of erectile dysfunction patients.
Asunto(s)
Arginina/uso terapéutico , Disfunción Eréctil/tratamiento farmacológico , Inhibidores de Fosfodiesterasa 5/uso terapéutico , Citrato de Sildenafil/uso terapéutico , Anciano , Quimioterapia Combinada , Humanos , Masculino , Persona de Mediana Edad , Resultado del TratamientoAsunto(s)
Síndrome de Down , Hidradenitis Supurativa , Estudios Transversales , Hidradenitis , Humanos , Prevalencia , FumarRESUMEN
PURPOSE: Evaluation of the role of the long-acting alpha-adrenergic blocker, terazosin, in the treatment of vesicosphincter dyssynergia (VSD) in spinal cord-injured male patients. PATIENTS AND METHODS: Sixty spinal cord-injured male patients with VSD were recruited prospectively. Their mean age was 37 years (range 15-70 years). Baseline evaluation included a thorough medical history, clinical examination, blood pressure measurement, intravenous urogram, and videourodynamics. The patients received terazosin for a 90-day period. Videourodynamic evaluation after completion of the study included cystometrogram, sphincter electromyography, maximum urethral pressure gradient (MUPG), and measurement of post voiding residual (PVR) urine volume. The findings were compared with the pretreatment values. RESULTS: Of the 60 patients, 35 completed the study. According to response to treatment, two groups were identified: Group A = responders (N = 17; 49%) and Group B = nonresponders (N = 18, 51%). In Group A, there was a significant decrease in the maximum detrusor pressure, from a mean of 105.3 to 73.9 cm H(2)O, and in MUPG, from a mean of 84.7 to 54.1 cm H(2)O. The bladder capacity and PVR did not change significantly in either group. The time since injury was significantly longer in Group A than in Group B. CONCLUSIONS: Terazosin in a dose of 10 mg/day was well tolerated and effective in reducing bladder outlet obstruction in many spinal cord-injured patients, as reflected by a decrease in maximum detrusor pressure and MUPG in 49% of the patients. Patients with a weak or negative response initially may respond later. Terazosin should be considered a first-line treatment of VSD prior to contemplating surgery.
Asunto(s)
Antagonistas Adrenérgicos alfa/uso terapéutico , Ataxia/tratamiento farmacológico , Prazosina/análogos & derivados , Prazosina/uso terapéutico , Traumatismos de la Médula Espinal/complicaciones , Traumatismos de la Médula Espinal/terapia , Enfermedades Urológicas/tratamiento farmacológico , Adolescente , Adulto , Anciano , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Factores de Tiempo , Uretra/efectos de los fármacosRESUMEN
OBJECTIVES: To determine whether the results of anastomotic biopsy for prostate-specific antigen (PSA) recurrence after radical prostatectomy could be predicted by either PSA, PSA velocity, digital rectal examination (DRE), transrectal ultrasound (TRUS), or the interval from prostatectomy to biopsy. METHODS: TRUS with biopsy of the anastomosis was performed for 91 postprostatectomy patients who had either an abnormal DRE or detectable PSA (greater than 0.2 ng/mL). The biopsy results were correlated with the findings of DRE, TRUS, PSA, PSA velocity, interval to PSA recurrence, and with the pathologic stage. RESULTS: Of 131 examinations, there were 50 positive biopsy specimens for a detection rate of 38%. Of 34 patients with PSA 1.0 ng/mL or less, 8 (24%) had positive biopsy (P = 0.02). A negative DRE lowered (but did not eliminate) the probability of a positive biopsy. Of 100 patients with normal DRE, 28 (28%) had positive biopsy. None of the 11 patients with a negative DRE and a PSA of 0.5 ng/mL or less had a positive biopsy (P = 0.02). The mean interval between prostatectomy and biopsy was significantly greater in patients who had a positive biopsy (45 +/- 39) than in patients with a negative biopsy (27 +/- 21) (P = 0.001). The pathologic stage, Gleason score, and PSA velocity were not helpful in predicting the results of biopsy. CONCLUSIONS: Although patients with a negative DRE can have a positive biopsy and patients with a PSA of 1.0 ng/mL or less can have a positive biopsy, no patient with a negative DRE and a PSA of 0.5 ng/mL or less has a positive biopsy.