An up-to-date overview of the pharmacotherapeutic options for premature ejaculation.

INTRODUCTION: Premature ejaculation (PE) is a sexual dysfunction of unknown etiology affecting a substantial number of males and deteriorating sexual health and quality of life of the patient and his partner. Treatment still remains challenging; however, pharmacotherapy is considered the mainstay of therapy with behavioral and psychosexual interventions being particularly important as adjudicate procedures, within the context of a holistic approach. AREAS COVERED: The authors review the literature on the available medications for PE, both officially registered and non-registered. Currently, only dapoxetine and an anesthetic spray containing lidocaine and prilocaine (Fortacin™) are officially approved, with the rest being used off-label. Herein, updated data regarding the efficacy and safety of the pharmaceutical agents are presented. EXPERT OPINION: On-demand dapoxetine is reportedly efficacious and safe in treating lifelong PE and is the first medication to be approved for this purpose. Fortacin has also shown considerable efficacy and may be reliably used on-demand. Phosphodiesterase type 5 inhibitors (PDE5Is) have been found to be effective in the treatment of PE and are therefore recommended either as monotherapy or combined with other therapies (i.e. dapoxetine). Adverse events of any therapy should be taken under consideration. Physicians should encourage patients to discuss their needs and expectations and grade any improvement of their condition with treatment.

Vitamins as primary or adjunctive treatment in infertile men with varicocele: A systematic review.

OBJECTIVE: To investigate the usage and the efficacy of vitamins as primary or adjuvant treatment in infertile men with varicocele. METHODS: A systematic search in PubMed, the Medical Literature Analysis and Retrieval System Online (MEDLINE) and Cochrane Library with the terms (varicocele) AND (vitamins) was performed. We searched for studies: a) reporting the administration of vitamins (individually or as part of a complex) in men with varicocele and infertility, b) primarily or adjuvant to invasive treatment, and c) reporting the impact on semen parameters and/or pregnancy rates. Exclusion criteria were animal, adolescent and non-English studies, grey literature and trials reporting abstracts only. RESULTS: Seven studies were identified eligible for qualitative analysis. All studies were randomised except one (case series). Vitamins were administered dominantly as part of antioxidant complex and only two studies used vitamins (C and E, respectively) as sole agent. In two studies, vitamin monotherapy resulted in improvement in semen quality, but the effect on pregnancy rates is unknown. One study reported no efficacy of adjuvant multivitamin treatment after embolisation in terms of both semen quality and pregnancy rates. Finally, four studies reported a positive effect of vitamins on semen parameters after varicocelectomy, but the effect on pregnancy rates is conflicting; one study reported improved pregnancy rates with adjuvant treatment, two studies did not evaluate the pregnancy rates, and in one study the outcome was unclear due to missing data. CONCLUSIONS: Vitamins have been used mostly as part of an antioxidant panel for the management of infertile men with varicocele. Most studies have found a positive impact on semen parameters in selected men with varicocele and infertility, as primary or adjuvant treatment. However, the clinical benefit of vitamins administration on pregnancy rate is under-evaluated and should be the target of future research.

L-carnitine as primary or adjuvant treatment in infertile patients with varicocele. A systematic review.

BACKGROUND: Varicocele has been found to impair the function of the epididymis resulting in subfertility whereas the varicocelectomy can resolve the phenomenon. L-carnitine is regarded as a biomarker for the function of the epididymis and has been found in reduced concentrations in infertile patients of various causes, including infertile men with varicocele. It seems that Lcarnitine and varicocele share clinical significance and the area of research looks promising. OBJECTIVE: To identify the role of L-carnitine in the treatment of varicocele. MATERIALS AND METHODS: A systematic search was performed in Pubmed/Medline with the terms (L-carnitine) and (varicocele) and (L-carnitine) and (varicocelectomy). Inclusion criteria were studies reported outcomes of L-carnitine administration alone or in duet, as primary or adjuvant treatment to varicocele. Exclusion criteria were non-English language and animal studies. Studies using L-carnitine as part of a panel of therapeutic agents were avoided. RESULTS: Only four suitable studies were identified for discussion. In one randomized study, the combination of L-carnitine and cinnoxicam improved semen parameters in patients with non-high-grade varicocele compared to L-carnitine alone and had a favourable effect on pregnancy rates but the effect of grade is unknown. In another study, as an adjuvant treatment to varicocelectomy, L-carnitine showed no clear benefit. Finally, in comparison to surgery, the results are inconclusive; two studies showed some benefit might be expected in low-grade or subclinical varicocele, but surgery appears superior. CONCLUSIONS: The evidence regarding the role of L-carnitine as a primary or adjuvant treatment of varicocele is sparse. The pathophysiological significance of L-carnitine implicates a potential role of the molecule in the management of varicocele, but the evidence so far is controversial for any recommendations. L-carnitine might be taken into consideration in selected cases; however, further search is needed in order the optimal role of L-carnitine in infertile patients with varicocele to be clarified.

Pharmacotherapeutic advances for recurrent urinary tract infections in women.

INTRODUCTION: Treatment of recurrent Urinary tract infections (UTIs) has become challenging because of the dramatic increase in the rates of recurrent infection andof multidrug-resistant (MDR) infections. AREAS COVERED: The authors review recurrent UTIs(rUTI) management in women. EXPERT OPINION: Continuous or post-coital prophylaxis with low-dose antimicrobials or intermittent self-treatment has all been demonstrated to be effective in managing rUTIs in women. Intravaginal estrogen therapy , shows potential toward preventing rUTI. Oral vaccine Uro-Vaxom seems to reduce the number of UTIs. There is evidence that other therapies (e.g. cranberry, Methenamine hippurate, oral D-mannose) may decrease the number of symptomatic UTIs. The treatment of CRE-UTIs is focused on a colistin backbone. Carbapenems are considered first-line agents for UTIs caused by ESBL, but their use is associated with increased MDR. The usage of non-carbapenem for the treatment of ESBL UTIs is necessary. Cefepime, Piperacillin-Tazobactam, Ceftolozane-Tazobactam, and Ceftazidime-Avibactam are justified options. Oral therapy with Pivmecillinam, Fosfomycin, and Nitrofurantoin can be used against uncomplicated UTIs due to ESBL infection.

Established and recent developments in the pharmacological management of urolithiasis: an overview of the current treatment armamentarium.

Introduction: Urolithiasis is a common, highly recurrent disease with increasing prevalence worldwide. There are many dietary and pharmacological measures to prevent kidney stones.Areas covered: Herein, the authors explore medical expulsive therapy as well as pharmacological therapies to prevent/treat urolithiasis.Expert opinion: All stone formers should be advised to increase their fluid intake sufficiently to achieve a urine volume of at least 2.5 L/day. In the case of hypercalciuria, a thiazide diuretic should be prescribed while in cases of hypocitraturia, potassium citrate should be given. In the case of hyperoxaluria, the treatment depends on the type of hyperoxaluria. Pyridoxine or calcium supplements with a meal can be offered. For uric acid stone formers, alkali therapy is the standard of care whereas allopurinol can be beneficial in hyperuricosuric stone formers. For cystine stone formers, increased fluid intake, restriction of sodium and animal protein ingestion, and urinary alkalinization are the standard therapies used. Cystine binding thiol drugs such as tiopronin and D-penicillamine are reserved for patients where a conservative approach fails. For struvite stone formers, optimal management is the complete stone removal. Acetohydroxamic acid may be offered only after surgical options have been exhausted, for patients with residual stones but it has many side effects.

Hyberbaric oxygen as sole treatment for severe radiation - induced haemorrhagic cystitis

ABSTRACT Purpose To examine the safety and efficacy of hyperbaric oxygen as the primary and sole treatment for severe radiation-induced haemorrhagic cystitis. Materials and methods Hyperbaric oxygen was prospectively applied as primary treatment in 38 patients with severe radiation cystitis. Our primary endpoint was the incidence of complete and partial response to treatment, while the secondary endpoints included the duration of response, the correlation of treatment success-rate to the interval between the onset of haematuria and initiation of therapy, blood transfusion need and total radiation dose, the number of sessions to success, the avoidance of surgery and the overall survival. Results All patients completed therapy without complications with a mean follow-up of 29.33 months. Median number of sessions needed was 33. Complete and partial response rate was 86.8% and 13.2%, respectively. All 33 patients with complete response received therapy within 6 months of the haematuria onset. One patient needed cystectomy, while 33 patients were alive at the end of follow-up. Conclusions Our study suggests the early primary use of hyperbaric oxygen for radiation-induced severe cystitis as an effective and safe treatment option.

Hyberbaric oxygen as sole treatment for severe radiation - induced haemorrhagic cystitis.

PURPOSE: To examine the safety and efficacy of hyperbaric oxygen as the primary and sole treatment for severe radiation-induced haemorrhagic cystitis. MATERIALS AND METHODS: Hyperbaric oxygen was prospectively applied as primary treatment in 38 patients with severe radiation cystitis. Our primary endpoint was the incidence of complete and partial response to treatment, while the secondary endpoints included the duration of response, the correlation of treatment success-rate to the interval between the onset of haematuria and initiation of therapy, blood transfusion need and total radiation dose, the number of sessions to success, the avoidance of surgery and the overall survival. RESULTS: All patients completed therapy without complications with a mean follow-up of 29.33 months. Median number of sessions needed was 33. Complete and partial response rate was 86.8% and 13.2%, respectively. All 33 patients with complete response received therapy within 6 months of the haematuria onset. One patient needed cystectomy, while 33 patients were alive at the end of follow-up. CONCLUSIONS: Our study suggests the early primary use of hyperbaric oxygen for radiation-induced severe cystitis as an effective and safe treatment option.

The current role of percutaneous chemolysis in the management of urolithiasis: review and results.

The treatment of urolithiasis has changed dramatically over the past several decades. Novel technologies have led to new management protocols. Percutaneous chemolysis as a primary or adjuvant treatment for urinary tract stones has widely been neglected. We present our own experience with it and discuss it in the light of an extensive literature review. From a MEDLINE search on percutaneous chemolysis we evaluated the most important studies, a total of 58 articles, 43 case series and 15 review articles. In our unit between 2001 and 2011, 29 patients (mean age 62 years) with infectious staghorn calculi were treated with adjuvant percutaneous chemolysis post-percutaneous nephrolithotripsy. There were 17 women, with 10 complete and 14 partial staghorn stones (mean size 32 mm). Patients were generally deemed at high risk to undergo another procedure in the future. Suby G solution was used following an established protocol. Sixteen patients (55.1 %) were stone free after chemolysis, eight stones showed partial dissolution, half of them with so-called "insignificant" residual fragments <4 mm. Patients with residual stones underwent SWL. Mean follow-up was 5.25 years (1-11). One stone-free patient (6 %) and three of eight patients (37.5 %) with residual fragments post local chemolysis, developed new stones during follow-up. The often neglected percutaneous chemolysis represents a significant and effective.

Tamsulosin versus transurethral resection of the prostate: effect on nocturia as a result of benign prostatic hyperplasia.

Our objective was to compare the effect of tamsulosin versus transurethral resection of the prostate (TURP) for the management of nocturia in previously untreated men with lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH) and no other predisposing factors for nocturia. The study group included 66 patients (mean age 68.9 years, range 52-81) randomized to receive either tamsulosin 0.4 mg per os daily (n = 33) or TURP (n = 33). Nocturia was assessed at baseline, after 3 months and after 1 year, by the number of nocturnal awakenings and hours of undisturbed sleep (HUS) obtained from a 72-h Frequency Volume Chart (FVC). Furthermore, the International Prostate Symptom Score (IPSS), the International Consultation on Incontinence Questionnaire Nocturia (ICIQ-N) and the International Consultation on Incontinence Questionnaire Nocturia Quality of Life (ICIQ-NQoL) were recorded. At baseline, there were no statistically significant differences between the two groups. ICIQNQoL and ICIQ-N scores correlated with the number of awakenings and HUS, respectively. Both tamsulosin and TURP improved all examined parameters during the follow up. TURP was associated with a statistically significant improvement in the number of nocturnal awakenings and in the IPSS, ICIQ-N and ICIQ-NQol scores in comparison with tamsulosin. HUS increased in both groups, but without any statistically significant difference. In conclusion, TURP is superior in comparison with tamsulosin for the management of BPH-related nocturia.