[Efficacy and safety of phosphodiesterase inhibitors for erectile dysfunction in diabetic men: A meta analysis].

OBJECTIVE: To evaluate the clinical efficacy and safety of phosphodiesterase 5 (PDE-5) inhibitors for erectile dysfunction (ED) in patients with diabetes mellitus and provide some evidence for the clinical treatment of the disease. METHODS: We searched MedMed, EMbase, Cochrane Library, CNKI, Wan Fang Data, VIP and ZADL for randomized controlled trials on PDE-5 inhibitors for ED in diabetic men and evaluated the methodology of the included trials with the Jadad scale. We used the erectile function domain in the IIEF (IIEF-EF), IIEF questions (IIEF-Q) 3 and 4, SEP-2 and -3, and Global Assessment Questions (GAQ) as the main evaluation indexes and employed the Review Manager 5. 1. 0 software for meta analysis. RESULTS: A total of 13 studies were included, which were all high quality trials with Jadad score > 3. The IIEF-EF scores in 10 of the included studies were subjected to meta analysis using the random-effect model (REM), with a weighted mean difference (WMD) of 5.64 (95% CI 4.41 - 6.83, P < 0.001). The fixed-effect model (FEM) analysis of the IIEF-Q scores in 6 of the studies showed the WMD to be 0.96 (95% CI 0.83 -1.08, P < 0.001) for IIEF-Q3 and 1.11 (95% CI 0.98 - 1.25, P < 0.001) for IIEF-Q4. FEM analysis of the SEP-2 scores showed WMD = 17.67 (95% CI 12. 38 - 22. 97, P < 0.001) in 2 of the studies, and that of the SEP-3 scores WMD = 23.64 (95% CI 17. 49 - 29.79, P < 0.001) in 5 of the studies. The GAQ scores in 11 of the studies were subjected to REM analysis, with OR = 6. 20 and 95% CI 3.65 - 10.52 (P < 0.001). REM analysis was performed on the adverse reactions in 11 of the studies, with OR = 7.43 and 95% CI 4.11 - 13.44 (P < 0.001). CONCLUSION: PDE-5 inhibitors can effectively and safely improve erectile function in patients with diabetes mellitus.

[High ligation of the spermatic vein and sperm DNA fragmentation].

OBJECTIVE: To investigate the effect of high ligation of the spermatic vein (HLSV) on DNA fragmentation in varicocele (VC) patients. METHODS: Thirty-four VC patients underwent HLSV. Sperm motion indexes and the results of papanicolaou staining and DNA fragmentation detection were analyzed before and 3 months after the operation according to the WHO guidelines. RESULTS: Compared with pre-operation, HLSV achieved a significant increase in the percentage of morphologically normal sperm (P < 0.01), and remarkable decreases in DNA fragmentation, sperm deformity index (SDI) and multiple anomalies index (MAI) (P < 0.01). The patients also showed significant increases in sperm concentration and the percentages of grade b sperm (P < 0.05) and grade a and a + b sperm (P < 0.01) after the operation. The post-operative percentages of sperm DNA fragmentation in those with grades I - III VC were markedly lower (P < 0.01), but showed no significant difference from that in those with subclinical VC (P > 0.05). The percentage of big-halo sperm was significantly increased (P < 0.01), while those of the medium-, small- and non-halo sperm remarkably decreased (P < 0.01) after HLSV. CONCLUSION: HLSV can effectively improve the sperm quality of VC patients.

[Transurethral unroofing in seminal vesicle cyst].

OBJECTIVE: To investigate the effects of transurethral unroofing in treatment of seminal vesicle cyst. METHODS: Seven patients seminal vesicle cyst 2.1 cm x 3.0 cm x 3.3 cm - 5.5 cm x 6.3 cm x 10.2 cm in size, aged 36 (21 - 65), with the symptoms of hematospermia (4 cases), hematuria (3 cases), epididymitis (2 cases), dysuria (1 case), bladder irritation symptoms (1 case), bloody mucus of urethral orifice after miction (1 case), perineal discomfort (2 case), and infertility (3 cases), underwent transurethral unroofing of seminal vesicle cyst. RESULTS: Operation was performed successful on all 7 patients. The mean operative time was 20 min, the mean estimated operative blood loss was 5 ml, and the mean hospital stay was 3 d. Follow-up was conduced for 28.3 months (8 months-10 years). All patients were free of symptoms after surgery, without recurrence and complications that needed further therapy. Two of the 3 patients with infertility succeeded in fertilization 1 year after surgery, and 1 patient with retrograde ejaculation underwent intracytoplasmic sperm injection and succeeded in fertilization 6 months after operation. CONCLUSION: Transurethral unroofing provides an effective approach to the seminal vesicle cyst with minimal invasion, short hospitalization, and rapid recovery.

[Etiology, diagnosis and management of spontaneous per renal hemorrhage].

OBJECTIVE: To investigate the etiology, diagnosis, and management of spontaneous perirenal hemorrhage (SPH). METHODS: The clinical data of 35 patients, 10 males and 12 females, aged 35.9 (12-77), with the diagnosis of SPH, without history of trauma, anticoagulant use, dialysis, and renal transplantation, were analyzed. RESULTS: The underlying disease of SPH included angiomyolipoma (18 cases), renal cell carcinoma (7 cases), kidney cyst (2 cases), renal artery aneurysm (3 cases), rupture of renal artery aneurysm accompanied with pregnancy (2 cases), renal pheochromocytoma (3 cases 2 of which accompanied with pregnancy), congenital stricture of pelvic ureter junction (1 case), and liver cancer (1 case). The most common underlying diseases were nephrogenic (96%) with angiomyolipoma ranking first (54%) followed by renal cell carcinoma (21%). The underlying diseases were diagnosed correctly in 23 cases (69%). CT helped in diagnosis of 34 cases. Surgery was performed on most of the cases. CONCLUSION: The most common causes of SPH is renal neoplasms more than 50% of which are benign. Renal artery aneurysm and pheochromocytoma tend to rupture during pregnancy. CT is the first method of choice in diagnosis.