The role of diallyl thiosulfinate associated with nuciferine and diosgenin in the treatment of premature ejaculation: A pilot study.

OBJECTIVE: To assess the efficacy and safety of an association of diallyl thiosulfinate with nuciferine and diosgenin in the treatment of a group of patients suffering from premature ejaculation (PE), primary or secondary to erectile dysfunction (ED). MATERIALS AND METHODS: From July 2015 to October 2016, 143 patients (mean age 25.3; range 18-39) affected by PE completed the study and were finally analyzed in this phase I study. All patients, after clinical assessment and laboratory evaluation were asked to take an association of diallyl thiosulfinate with nuciferine and diosgenin as oral tablet, once a day, on alternate days, for three months. At the baseline and after three months of treatment, each patient was asked to complete the following questionnaires: International Index of Erectile Function (IIEF-5), Premature Ejaculation Diagnostic Tool (PEDT), Male Sexual Health Questionnaire (MSHQ). RESULTS: A statistical significant improvement in terms of erectile function, comparing the IIEF-5 value at baseline and follow- up visit was found (respectively IIEF-5: 8.7 vs 14.01; p < 0.001). Moreover, at follow-up visit, 97/143 men (67.8%) referred a subjective improvement of the erection quality and a better control of the ejaculation (PROs). The IELT improved too between the baseline evaluation and the follow-up visit (p < 0.001). CONCLUSION: In conclusion, our study, even if supported by preliminary results, showed how Diallyl Thiosulfinate, Nuciferine and Diosgenin is able to improve the control of ejaculation in patients suffering from PE, primary or secondary to ED without any significant adverse effects.

Uro-gramma: the importance of updating the predictive model.

OBJECTIVES: Uro-gramma is a probabilistic predictive model of pathological staging of prostate cancer (Pca) from preoperative parameters (PSA, clinical Gs, clinical stage) published in 2000. Aim of this study is to improve Uro-gramma, updating it, to take into account the continuous evolution of the population. MATERIALS AND METHODS: From 1998 to 2000, 991 Pca patients have undergone radical prostatectomy in several Italian urological centers. Inclusion criteria were: preoperative PSA < 50 ng/ml, clinical stage < or = T3c, availability of a bioptic Gs and pathological staging. A predictive model has been estimated for each year and its behaviour on the following years tested, using Hosmer and Lemeshow tests, which compare the expected rate with the observed one. RESULTS: The mean age was 66.3 years. Pca familiarity was present in 3.2% of the patients in 1998, 2.6% in 1999 and 7.4% in 2000. PSA values < 10 have increased (from 41% to 47%) and those > 10 decreased (from 59% to 53%). The mean number of bioptic samples per patient has increased from 4.9 to 6, while clinical and pathologic Gs have remained stable. An increase in the rate of organ confined Pca has been noticed, either clinically (87.4% in 1998, 92% in 2000) or pathologically (55.2% in '98, 57% in 2000). Staging lymphadenectomy has been performed in 88% of the pts in 1998, 94.2% in 1999 and 94.5% in 2000, whereas the % of N+ patients has moved from 11.3% in 1998 to 9.8% in 2000. CONCLUSIONS: Uro-gramma update results show that the mean estimate error has fallen from 6.4% to 1.2%. The new model strengthens the previous one and confirms its validity, but it also underlines the need of a constant update to take into account the continuous evolution of the population and of the methods of diagnosis and staging.

Rehabilitation therapy and urinary incontinence after radical retropubic prostatectomy. A critical review of the literature.

INTRODUCTION: To assess the efficacy and evidence-based data in the literature about rehabilitation therapy in patients with post-prostatectomy urinary incontinence. MATERIALS AND METHODS: An analysis of published full-length papers identified by a Medline search from 1990 through 2004 was carried out. Abstracts published in peer-reviewed journals in the same period of time were also considered. RESULTS: Efficacy, tolerability and safety of rehabilitation therapy were evaluated, according to the available data in the literature, with special regard to randomized controlled trials in order to define a clear-cut, evidence-based efficacy of this form of therapy. CONCLUSIONS: Rehabilitation therapy is a simple and safe way of managing post-prostatectomy urinary incontinence. Nonetheless, few randomized controlled studies have been carried out so far to establish its evidence-based efficacy and it is thus not possible to be scientifically sure of its value. It is therefore necessary to undertake well-designed randomized controlled studies, with a large number of patients, a well-matched control group and an adequate follow-up.