[Pediatric endourology].

OBJECTIVE: To assess the outcome of pediatric patients treated by an endourological approach for various urinary tract pathologies. METHODS AND MATERIALS: Thirty-seven children (median age 5 years, range 0.3-14 years) were endoscopically treated for ureteropelvic junction obstruction (UPJO) (n= 6), ureteral strictures (n=5), upper urinary tract calculi (n=21) and bladder calculi (n = 5). RESULT: Upper urinary tract calculi were approached by ureteroscopy (n=12), retrograde intrarenal surgery (n=6) and percutaneous nephrolithotomy (n = 3). The average stone burden was 11 mm (range 5-35 mm) and operative time was 40 minutes (range 15-120 minutes). Bladder calculi were treated percutaneously in 3 cases and transurethrally in 2 cases for an average stone burden of 34 mm (range 7-120 mm). The overall stone-free rate after one procedure was 96%. UPJOs were retrogradely approached in an average operative time of 40 minutes (range 30-50 minutes). Successful clinical and functional outcome was maintained after an average follow-up of 15 months (range 6-30 months). The 5 ureteral strictures included 2 located in the middle ureter and 3 at the ureterovesical junction. The success rate in this group was 80% and the average follow-up 24 months (range 6-40 months). The median hospitalization time for the entire series was 1 day (range 0-7 days). There were no intraoperative complications. Three (8%) patients developed post-operative urinary tract infections. Delayed anterior urethral stricture occurred in 1 case. No additional complications occurred after an average follow-up of 11 months (range 4-36 months). CONCLUSION: Endourology in children is safe and highly effective. It appears that the indications for endourological treatment in children emulate those of adults.

The role of phosphodiesterase type 5 inhibitors in the management of premature ejaculation: a critical analysis of basic science and clinical data.

OBJECTIVES: To assess the usefulness of the phosphodiesterase type 5 inhibitors (PDE5-Is) in the treatment of premature ejaculation (PE) and to describe possible mechanisms to explain their effect. METHODS: A MedLine search was performed for peer-reviewed articles on the role of PDE5-Is in managing PE. No meta-analysis method was used. RESULTS: Five manuscripts that examined the efficacy of PDE5-Is in the treatment of PE were retrieved. Three studies used sildenafil as monotherapy and two used it in combination with a serotonin selective reuptake inhibitor (SSRI). Three studies demonstrated a beneficial effect of sildenafil in the treatment of PE, as measured by intravaginal ejaculatory latency time (IELT) and by different questionnaires assessing the patients' subjective feelings of ejaculatory control, sexual satisfaction, and anxiety. One study showed the superiority of sildenafil compared to other modalities. Two studies showed that combination therapy of paroxetine and sildenafil was better than paroxetine alone. One study did not demonstrate a beneficial effect of sildenafil in prolonging IELT, but showed that sildenafil improved patients' perception of ejaculatory control. Another study showed that topical anesthetics were better than sildenafil in the treatment of PE but did not use IELT or a validated questionnaire to measure the efficacy of treatment. Several possible mechanisms could explain effectiveness of the PDE5-Is for treatment of PE: centrally, through the effect on the nitric oxide/cyclic guanosine monophosphate pathway; peripherally by causing relaxation of smooth muscle in the vas deferens, seminal vesicles, prostate, and urethra and inhibition of adrenergic transmission; or locally by inducing peripheral analgesia. Another possibility might be prolongation of the duration of erection. CONCLUSIONS: Encouraging evidence supports the role of PDE5-Is for treating PE. Possible therapeutic mechanisms of action of PDE5-Is are multiple and complex and include central and peripheral effects. A large population, multicenter, randomized, double-blind, placebo-controlled study is needed to elucidate the efficacy of PDE5-Is in the treatment of PE.