Tadalafil versus solifenacin for persistent storage symptoms after prostate surgery in patients with erectile dysfunction: a prospective randomized study.

OBJECTIVES: The occurrence of residual storage symptoms after surgical relief of bladder outlet obstruction as a result of benign prostatic enlargement (BPE) underlines the intricate mechanism involved in lower urinary tract symptoms (LUTS). The aim of the present study was to compare tadalafil with solifenacin in modifying symptoms and uroflowmetric parameters in patients with erectile dysfunction (ED) and residual storage symptoms after prostate surgery. METHODS: From May 2007 to April 2009, we evaluated 68 patients who had undergone prostate surgery at least 6months earlier, and presented with ED and persistence of storage symptoms. A total of 56 patients were randomized to receive tadalafil 5mg (group 1) or solifenacin 5mg (group 2), both given daily for 12weeks. International Prostate Symptoms Score (IPSS), IPSS Quality of Life, International Index of Erectile Function-5 (IIEF-5) and uroflowmetry parameters were collected at baseline and after 12weeks of treatment. RESULTS: A total of 26 patients in group 1 and 25 patients in group 2 completed the study. Each group showed a significant and comparable improvement of urinary symptoms with a decrease of IPSS value. Only in group 1 did the treatment with tadalafil result in a significant increase of IIEF-5. No statistically significant variations were noted in uroflowmetric parameters in both groups. CONCLUSIONS: In patients suffering from ED and storage symptoms after surgical treatment for LUTS-BPE, tadalafil 5mg given once daily for 12weeks provided a comparable improvement in IPSS to solifenacin 5mg given for the same period of time.

Body mass index, urinary incontinence, and female sexual dysfunction: how they affect female postmenopausal health.

OBJECTIVE: The aim of this study was to evaluate the relationship between body mass index (BMI) and female sexual dysfunction (FSD) among perimenopausal and postmenopausal women with urinary incontinence (UI). METHODS: From 2005 to 2008, we enrolled 208 consecutive women affected by UI; all underwent a comprehensive history including two validated questionnaires, physical examination, and urodynamic evaluation. Based on BMI, participants were grouped into normal weight, overweight, and obese. RESULTS: A total of 158 participants completed both questionnaires (76% response rate); 41 (26%) were normal weight, 73 (46%) were overweight, and 44 (28%) were obese. The increasing Urogenital Distress Inventory score had a direct correlation with age (P < 0.01), year of menopause onset (P < 0.05), and BMI (P < 0.01). FSD was diagnosed in 97 women (61%): 31 (32%) with hypoactive sexual desire, 20 (21%) with sexual arousal disorder, 7 (7%) with orgasmic deficiency, and 39 (40%) with sexual pain disorder. BMI greater than 30 kg/m was independently associated with an increased risk of FSD (odds ratio [OR], 2.02) and UI (OR, 2.03). With adjustment for BMI, the OR for FSD was 1.22 for overweight women and 1.56 for obese women, with respect to healthy participants. The total Female Sexual Function Index score correlated with BMI (r = -0.82, P = 0.0001); in particular, arousal (r = -0.82), orgasm (r = -0.72), lubrication (r = -0.61), and satisfaction (r = -0.63, all P < 0.001) showed an inverse correlation with BMI, whereas desire and pain did not. CONCLUSIONS: Increased BMI early in menopause represents a risk both for UI and for sexual dysfunction. Weight control has an essential role in postmenopause and should be considered early in perimenopause to safeguard female quality of life as well as to prevent or improve UI and female sexual dysfunction symptoms.

Ejaculatory duct obstruction caused by a right giant seminal vesicle with an ipsilateral upper urinary tract agenesia: an embryologic malformation.

OBJECTIVE: To report our experience with TURED in infertile men with EDO associated with abnormal development of the mesonephric or Wolffian duct, causing a contemporary malformation of the ipsilateral upper urinary tract. DESIGN: Retrospective clinical study. SETTING: Infertile men in an hospital environment. PATIENT(S): Seven patients affected by Zinner syndrome, from March to September 2005, were selected. INTERVENTION(S): Underwent TURED. MAIN OUTCOME MEASURE(S): Semen analysis, endocrine profile, transrectal ultrasonography and seminal vesicles aspiration, excretory urography, computerized tomography (CT), or magnetic resonance imaging (MRI). RESULT(S): Before surgery, the patients experienced a decreased intensity and force of ejaculation and a low motile sperm count. The detection of the ipsilateral upper urinary tract malformation by the patients was incidental. After surgery, all patients reported having a projectile ejaculation, an increase in the average postoperative volume, and of the total motile sperm count. CONCLUSION(S): A seminal vesicle cyst combined with ipsilateral renal agenesis, described as Zinner syndrome, is a rare urological anomaly. It is frequently asymptomatic or else characterized by infertility, symptoms of bladder irritation, or pain in the scrotum and perineum. In selected patients, TURED can improve semen quality with subsequent ability to impregnate. The upper urinary tract malformation should be treated in symptomatic cases only.