¿Puede el diseño del catéter ureteral reducir la sintomatología de los pacientes? Estudio controlado, aleatorizado y simple ciego, que compara el catéter ureteral de superficie lisa con el catéter ureteral de diseño acanalad / Can ureteral stents with a different format reduce patients’ symptomatology? A single-blinded, randomized, controlled study comparing smooth-walled and grooved ureteral stents

Introducción: Los verdaderos beneficios de la colocación perioperatoria de un catéter doble J (CDJ) están siendo ampliamente estudiados debido a sus conocidos efectos secundarios. Sin embargo, todavía no se ha llegado a un consenso en la literatura sobre el diseño óptimo del catéter. Por este motivo, este estudio prospectivo, aleatorizado y simple ciego, tuvo como objetivo comparar la sintomatología asociada a 2 diseños de catéter: el de superficie lisa y el de diseño acanalado.Materiales y métodosEl estudio recogió prospectivamente los datos de 42 pacientes que se sometieron a la colocación de un CDJ entre julio de 2019 y agosto de 2020. Los pacientes se dividieron aleatoriamente en 2 grupos según el diseño del catéter utilizado: en el primer grupo se utilizó el catéter de superficie lisa (control) y en el segundo, el catéter de diseño acanalado (intervención). Después de la cirugía, todos los pacientes completaron el Cuestionario de Síntomas del Catéter Ureteral validado en portugués en 3 momentos del postoperatorio (días 7 y 30 después del procedimiento quirúrgico, y día 30 después de la retirada del catéter).Resultados: No se encontraron diferencias significativas en cuanto al sexo, la edad, la mediana de índice de masa corporal, la lateralidad, el tipo de procedimiento quirúrgico (ureteroscopia flexible, semirrígida o mixta). Los CDJ de superficie lisa se asociaron a una mayor incidencia de dolor en el flanco (52,38 vs. 10%; p=0,006) y de dolor suprapúbico (57,14 vs. 30%; p=0,04) el día 7 después del procedimiento. La regresión lineal mixta mostró, de forma significativa, menos dolor en el flanco (p<0,001) y suprapúbico (p<0,01), y un rendimiento sexual significativamente mejor en el grupo de intervención (p=0,03).ConclusionesLos CDJ con diseño acanalado se asocian a una menor incidencia de dolor en el flanco y suprapúbico, y tienen un impacto menor en el rendimiento sexual de los pacientes. (AU)

Introduction: The true benefits of perioperative JJ stent placement are being widely studied due to its known side effects. However, no consensus has been reached in the literature regarding the best type of stent. This prospective, randomized, single-blinded study therefore aimed to compare the symptomatology associated with two JJ stent designs: smooth-walled and grooved.Materials and methodsThe study prospectively recruited 42 patients who underwent JJ stent placement between July 2019 and August 2020. The patients were randomly divided into two groups according to the JJ stent design used: the smooth-walled stent (control) and grooved stent (intervention) groups. After surgery, all patients completed the Portuguese-validated Ureteral Stent Symptom Questionnaire at three timepoints (days 7 and 30 post-surgical procedure, and day 30 post-stent removal).Results: No significant differences in gender, age, median body mass index, laterality, type of surgical procedure (flexible, semi-rigid or mixed ureteroscopy) were found. Smooth-walled JJ stents were associated with a higher incidence of flank pain (52.38% vs. 10%, P=.006) and suprapubic pain (57.14% vs. 30%, P=.04) on the 7th. post-procedure day. Linear mixed regression showed significantly lower flank (P<.001) and suprapubic pain (P<.01), and significantly better sexual performance in the intervention group (P=.03).ConclusionsUreteral stent with a grooved format are associated with a lower incidence of flank and suprapubic pain and had less impact on the sexual performance of patients. (AU)

Can ureteral stents with a different format reduce patients' symptomatology? A single-blinded, randomized, controlled study comparing smooth-walled and grooved ureteral stents.

INTRODUCTION: The true benefits of perioperative JJ stent placement are being widely studied due to its known side effects. However, no consensus has been reached in the literature regarding the best type of stent. This prospective, randomized, single-blinded study therefore aimed to compare the symptomatology associated with two JJ stent designs: smooth-walled and grooved. MATERIALS AND METHODS: The study prospectively recruited 42 patients who underwent JJ stent placement between July 2019 and August 2020. The patients were randomly divided into two groups according to the JJ stent design used: the smooth-walled stent (control) and grooved stent (intervention) groups. After surgery, all patients completed the Portuguese-validated Ureteral Stent Symptom Questionnaire at three timepoints (days 7 and 30 post-surgical procedure, and day 30 post-stent removal). RESULTS: No significant differences in gender, age, median body mass index, laterality, type of surgical procedure (flexible, semi-rigid or mixed ureteroscopy) were found. Smooth-walled JJ stents were associated with a higher incidence of flank pain (52.38% vs. 10%, P = .006) and suprapubic pain (57.14% vs. 30%, P = .04) on the 7th post-procedure day. Linear mixed regression showed significantly lower flank (P < .001) and suprapubic pain (P < .01), and significantly better sexual performance in the intervention group (P = .03). CONCLUSIONS: Ureteral stent with a grooved format are associated with a lower incidence of flank and suprapubic pain and had less impact on the sexual performance of patients.

Electrical nerve stimulation therapy in refractory primary monosymtomatic enuresis - A sistematic review.

OBJECTIVE: To analyze the effect of electrical nerve stimulation on urinary symptoms in pediatric patients with monosymptomatic primary enuresis refractory to conventional treatment. METHODS: Three databases (Medline, Embase, and Cochrane) were searched and 160 studies were identified by July 15, 2020. After establishing and applying the inclusion and exclusion criteria, a step-by-step analysis was performed using the title, abstract and full text. The Cochrane Collaboration Tool was then used to analyze the biases of the selected studies. RESULTS: Of the 160 articles found, 03 were selected for this systematic review. In 02 studies there was a significant reduction in the number of wet nights/week after electrical nerve stimulation. Urodynamic pattern was evaluated in 01 study, with improvement of maximum cystometric capacity in the intervention group. About maximum voided volume, there was no improvement in 01 study, but in other, there was increase in the intervention group. CONCLUSION: Electrical nerve stimulation might promote improvement in partial and total response scores over the number of dry nights, with no improvement in urodynamic parameters, and could be considered as an feasible option in the management of refractory monosymptomatic primary enuresis. However, it is worth emphasizing the need to conduct more RCTs with a larger sample for better evaluation of the role of neurostimulation.

Y chromosome microdeletions and varicocele as aetiological factors of male infertility: A cross-sectional study.

The pathogenic mechanisms by which varicocele disrupt spermatogenesis are not clearly understood. Over 30% of male infertility cases resulting from spermatogenic problems are associated with genetic abnormalities, and Y chromosome microdeletions are the second most frequent genetic cause. Here, we aimed to evaluate the frequency of Y chromosome microdeletion in infertile men with varicocele. A cross-sectional study comprising 51 infertile men with varicocele presenting spermatogenesis failures was performed. Y chromosome microdeletion research was made using polymerase chain reaction. Of the 51 men with infertility and varicocele, 35.3% (18/51) had nonobstructive azoospermia and 64.7% had severe oligozoospermia. Y chromosome microdeletion was found in two cases (3.9%): one patient had nonobstructive azoospermia and complete microdeletion of the AZFb and AZFc regions, and another patient had severe oligozoospermia and complete microdeletion of the AZFc region. Although in recent years, a genetic aetiology related to Y chromosome microdeletions has become a major cause of infertility in males with spermatogenesis failures, in this study, the varicocele was the clinical cause of seminal abnormalities that could lead to infertility, suggesting that both varicocele and Y chromosome microdeletion aetiologies can present, alone or combined, as factors of male infertility.

A prospective, randomized, single - blind study comparing intraplaque injection of thiocolchicine and verapamil in Peyronie's Disease: a pilot study

ABSTRACT Objectives: To compare the response to tiocolchicine and verapamil injection in the plaque of patients with Peyronie's disease. Materials and Methods: Prospective, single-blind, randomized study, selecting patients who have presented Peyronie's disease for less than 18 months. Thiocolchicine 4mg or verapamil 5mg were given in 7 injections (once a week). Patients who had received any treatment for Peyronie's disease in the past three months were excluded. The parameters used were the International Index of Erectile Function (IIEF-5) score, analysis of the curvature on pharmaco-induced erections and size of the plaque by ultrasonography. Results: Twenty-five patients were randomized, 13 received thiocolchicine and 12 were treated with verapamil. Both groups were statistically similar. The mean curvature was 46.7° and 36.2° before and after thiocolchicine, respectively (p=0.019) and 50.4° and 42.08° before and after verapamil, respectively (p=0.012). The curvature improved in 69% of patients treated with thiocolchicine and in 66% of those who received verapamil. Regarding sexual function, there was an increase in the IIEF-5 from 16.69 to 20.85 (p=0.23) in the thiocolchicine group. In the verapamil group the IIEF-5 score dropped from 17.50 to 16.25 (p=0.58). In the thiocolchicine group, the plaque was reduced in 61% of patients. In the verapamil group, 8% presented decreased plaque size. No adverse event was associated to thiocolchicine. Conclusion: The use of thiocolchicine in Peyronie's disease demonstrated improvement on penile curvature and reduction in plaque size. Thiocolchicine presented similar results to verapamil in curvature assessment. No significant side effects were observed with the use of tiocolchicine.

A prospective, randomized, single - blind study comparing intraplaque injection of thiocolchicine and verapamil in Peyronie's Disease: a pilot study.

OBJECTIVES: To compare the response to tiocolchicine and verapamil injection in the plaque of patients with Peyronie's disease. MATERIALS AND METHODS: Prospective, single-blind, randomized study, selecting patients who have presented Peyronie's disease for less than 18 months. Thiocolchicine 4mg or verapamil 5mg were given in 7 injections (once a week). Patients who had received any treatment for Peyronie's disease in the past three months were excluded. The parameters used were the International Index of Erectile Function (IIEF-5) score, analysis of the curvature on pharmaco-induced erections and size of the plaque by ultrasonography. RESULTS: Twenty-five patients were randomized, 13 received thiocolchicine and 12 were treated with verapamil. Both groups were statistically similar. The mean curvature was 46.7º and 36.2º before and after thiocolchicine, respectively (p=0.019) and 50.4º and 42.08º before and after verapamil, respectively (p=0.012). The curvature improved in 69% of patients treated with thiocolchicine and in 66% of those who received verapamil. Regarding sexual function, there was an increase in the IIEF-5 from 16.69 to 20.85 (p=0.23) in the thiocolchicine group. In the verapamil group the IIEF-5 score dropped from 17.50 to 16.25 (p=0.58). In the thiocolchicine group, the plaque was reduced in 61% of patients. In the verapamil group, 8% presented decreased plaque size. No adverse event was associated to thiocolchicine. CONCLUSION: The use of thiocolchicine in Peyronie's disease demonstrated improvement on penile curvature and reduction in plaque size. Thiocolchicine presented similar results to verapamil in curvature assessment. No significant side effects were observed with the use of tiocolchicine.

The use of alpha-1 adrenergic blockers in children with distal ureterolithiasis: a systematic review and meta-analysis

Introduction: Urinary lithiasis is the main urologic cause of emergency treatment in adult patient. In the past years, the incidence in children population has increased. However, literature about the use of alpha-1 adrenergic blockers in pediatric population with distal ureterolithiasis is still scarce. The drug acts by decreasing ureter contractions, especially in the distal portion, facilitating calculus expulsion. Objective: This review has the objective to evaluate the use of alpha-1 adrenergic blockers as medical expulsive treatment in children with distal ureterolithiasis. Evidence Acquisition: An electronic literature search was performed using the MEDLINE, COCHRANE, and LILACS databases. We further searched manually the references of the primary studies. Searches were concluded on October 4th, 2014. Articles were selected, independently and in pairs, by the respective titles and summaries. Any divergence was resolved by consensus. Evidence Synthesis: Alpha-1 adrenergic antagonists increased the probability of calculus expulsion by 27% (NNT=4). Calculi smaller than 5mm, increased by 33% (NNT=3). Larger than 5mm, increased by 34% (NNT=3). Conclusion: Alpha-1 adrenergic blocker use is related with a greater incidence of expulsion of ureteral calculi, smaller or greater than 5mm, and fewer episodes of pain when compared to ibuprofen. However it is necessary larger samples to enhance the power analysis of the expulsion of ureteral calculi larger than 5mm and the episodes of pain. Patient Summary: This review analyzed the outcome of alpha adrenergic antagonist in children with ureteral calculi. We conclude that it is the best medicine for use, since it helps the expulsion of the stone.

Adrenergic α-blockers: an infrequent and overlooked cause of priapism.

A systematic review of the literature about the causal relationship between priapism and adrenergic α-blockers used for the treatment of lower urinary tract symptoms (LUTS) and arterial hypertension was accomplished. While opportunely describing a case of tamsulosin-induced priapism, we reviewed the literature using MEDLINE, COCHRANE and LILACS libraries, selecting all the articles until the present time addressing the association between priapism and α-blockers. Our patient was a healthy 32-year-old man who reported LUTS. His prostate was firm and moderately enlarged on digital rectal examination, measuring 30 grams on transabdominal ultrasound. Empirical treatment with tamsulosin was initiated and he developed priapism the day after the first dose of the drug. Erection was reverted by aspiration of the corpora and intracavernosal injection of adrenaline. Despite the late presentation (40 h of erection), he had no ED on follow-up. In the systematic review, among 2157 articles on priapism, only 13 similar cases reported α-blockers as the etiology of priapism. Therefore, adrenergic α-blockers are effective and safe drugs, with few serious adverse reactions. Nevertheless the association with priapism is well documented and related to substantial morbidity, this is an infrequent event and should not preclude their use, considering that the patient be sufficiently informed.

[Conservative treatment of Peyronie's disease: colchicine vs. colchicine plus vitamin E]. / Tratamiento conservador de la enfermedad de Peyronie: colchicina versus colchicina más vitamina E.

OBJECTIVE: To retrospectively review the response of patients with Peyronie's disease (PD) treated with colchicine as monotherapy and colchicine plus Vitamin E. MATERIAL AND METHODS: We evaluated 100 men with PD. A dose of 1.5 mg/day oral Colchicine as monotherapy (CCM) was given to 59 patients and 1.5/800 mg/day oral Colchicine/Vitamin E (CCVE) to 41. Response was categorized as follows: Good response, when at least 2 of the following conditions were achieved: Decrease/stabilization of curvature and/or plaque and/or pain relief. Partial response if one of the former conditions were observed. No response and worsening. No statistical differences between groups were found. RESULTS: Good response was observed in 39% vs 41% in the CCM and CCVE groups respectively. When looking at each variable, we observed improvement on the plaque's size in 36 vs 29%, pain relief in 46 vs 57% and curvature 32 vs 33% in the CCM and CCVE respectively. None of these differences were statistically significant. CONCLUSION: Oral conservative treatment with CCVE failed to show statistically significant differences in efficacy in pain relief, penile curvature or plaque size against CCM in this study. However, there is slight evidence of a positive prognostic effect on the conservative treatment when history of previous unsuccessful PD treatment was recorded, this was statistically significant in the CCVE group, supporting the theory of a combined treatment. A randomized double blind placebo controlled study with a sample size calculation should be performed to confirm our results.

Tratamiento conservador de la enfermedad de Peyronie: colchicina versus colchicina más vitamina E / Conservative treatment of Peyronie's disease: Colchicine vs. colchicine plus vitamin E

Objetivo: Revisar de manera retrospectiva la respuesta de pacientes con enfermedad de Peyronie (EP) tratados con colchicina como monoterapia (CM) o combinada con vitamina E (CVE). Material y métodos: Evaluamos 100 pacientes con EP. La CM por vía oral en dosis de 1,5mg/día fue recibida por 59 pacientes, y la CVE en dosis de 1,5/800mg/día fue recibida por 41 pacientes. La respuesta fue definida de la siguiente manera: respuesta buena, cuando al menos 2 de las siguientes condiciones fueron alcanzadas: disminución/estabilización de la curvatura y/o tamaño de la placa y/o alivio del dolor; respuesta parcial, cuando se alcanzó al menos una de las condiciones anteriores. Así como ausencia de respuesta o empeoramiento. No hubo diferencias significativas en los grupos. Resultados: Hubo buena respuesta en el 39 y el 41% de los pacientes del grupo CM y CVE, respectivamente. Mejora por variable: tamaño de la placa en el 36 vs. el 29%, alivio del dolor en el 45 vs. el 57%, curvatura en el 32 vs. el 33% en los grupos CM y CVE, respectivamente. Ninguna de estas diferencias fue estadísticamente significativa. Conclusiones: La CVE no demostró diferencias estadísticamente significativas en la eficacia del alivio del dolor, curvatura y tamaño/consistencia de la placa vs. el grupo control. Sin embargo, existe ligera evidencia de un efecto pronóstico positivo en el tratamiento conservador de la EP si hay antecedente de tratamiento previo fallido, que fue estadísticamente significativo en el grupo CVE, fomentando la teoría del tratamiento combinado. Un estudio aleatorizado, doble ciego controlado con placebo debe realizarse para confirmar estos resultados (AU)

Material and methods: We evaluated 100 men with PD. A dose of 1.5mg/day oral Colchicine as monotherapy (CCM) was given to 59 patients and 1.5/800mg/day oral Colchicine/Vitamin E (CCVE) to 41. Response was categorized as follows: Good response, when at least 2 of the following conditions were achieved: Decrease/stabilization of curvature and/or plaque and/or pain relief. Partial response if one of the former conditions were observed. No response and worsening. No statistical differences between groups were found. Conclusion: Oral conservative treatment with CCVE failed to show statistically significant differences in efficacy in pain relief, penile curvature or plaque size against CCM in this study. However, there is slight evidence of a positive prognostic effect on the conservative treatment when history of previous unsuccessful PD treatment was recorded, this was statistically significant in the CCVE group, supporting the theory of a combined treatment. A randomized double blind placebo controlled study with a sample size calculation should be performed to confirm our results (AU)

[Testicular components volume density alteration associated to cis-platinum: can antioxidants offer protection?]. / Alteración de la densidad del volumen de los componentes testiculares asociada con el cisplatino: ¿pueden los antioxidantes ofrecer protección?

OBJECTIVES: Cis-platinum based chemotherapy agents are widely used in treatment of testicular cancer and its deleterious effects on spermatogenesis are well known. Therefore an extensive survey was undertaken to evaluate the effects of antioxidants in combination with Cis-platinum in an attempt to minimize its effects upon spermatogenic function of adult rats. METHODS: A short-term prospective study (thirteen days) including twenty-four adult male Wistar rats was performed. Animals were assigned into one of three groups (eight per group): GI-control, GII-Cis-platinum treated and GIII-Cis-platinum plus superoxide dismutase and catalase. Histological analyses included germ cell counts, germ to Sertoli cell ratios and estimation of volume density components as well as the determination of the sperm reserves. Data was examined through one-way analysis of variance at 5% level of significance. RESULTS: Germ cell numbers, germ cell to Sertoli cell ratios, organ weights (except body weight) and sperm reserves presented no differences among groups. However, the volumetric proportion of some components (tubular epithelium, tunica propria, Leydig cell nuclei and stroma) were affected (p<0.05) by treatment. The most prominent testicular component, the seminiferous epithelium was reduced (p<0.05) in Cis-platinum treated animals (GII). CONCLUSION: The use of antioxidant in association with Cis-platinum did not affect sperm production (germ cell numbers, germ to Sertoli cell ratios and sperm reserves) of adult rats. However, the deleterious effect of Cis-platinum on the seminiferous tubule epithelium was minimized by antioxidants.

Alteración de la densidad del volumen de los componentes testiculares asociada con el cisplatino: ¿pueden los antioxidantes ofrecer protección? / Testicular components volume density alteration associated to cis-platinum: can antioxidants offer protection?

Objetivos: Los agentes quimioterapéuticos basados en el cisplatino se utilizan ampliamente en el tratamiento del cáncer testicular, y sus efectos perjudiciales sobre la espermatogénesis se conocen bien. En consecuencia, se emprendió un amplio estudio para evaluar los efectos de los antioxidantes en combinación con el cisplatino en un intento de reducir sus efectos sobre la función espermática de ratas adultas. Métodos: Se realizó un estudio prospectivo a corto placo (13 días) sobre 24 ratas Wistar macho adultas. Se asignó a los animales a uno de 3 grupos (8 por grupo): GI-control, GII-tratado con cisplatino y GIII-cisplatino más superóxido dismutasa y catalasa. Los análisis histológicos incluyeron recuentos de células germinales, relaciones entre células germinales y de Sertoli y estimación de la densidad de volumen de los componentes, así como determinación de las reservas de espermatozoides. Los datos se examinaron mediante análisis de la varianza de una vía al nivel de significación del 5%. Resultados: No se hallaron diferencias entre los grupos en el número de células germinales, las relaciones entre células germinales y de Sertoli, el peso de los órganos (excepto el peso corporal) y las reservas de espermatozoides. Sin embargo, el tratamiento afectó (p<0,05) a la proporción volumétrica de algunos componentes (epitelio tubular, túnica propia, núcleos y estroma de células de Leydig). El componente testicular más prominente, el epitelio seminífero, se redujo (p<0,05) en los animales tratados con cisplatino (GII). Conclusión: El uso de antioxidante en asociación con cisplatino no afectó a la producción de espermatozoides (número de células germinales, relaciones entre células germinales y de Sertoli y reservas de espermatozoides) de ratas adultas. Sin embargo, los antioxidantes limitaron el efecto perjudicial del cisplatino sobre el epitelio de los túbulos seminíferos (AU)

Objectives: Cis-platinum based chemotherapy agents are widely used in treatment of testicular cancer and its deleterious effects on spermatogenesis are well known. Therefore an extensive survey was undertaken to evaluate the effects of antioxidants in combination with Cis-platinum in an attempt to minimize its effects upon spermatogenic function of adult rats. Methods: A short-term prospective study (thirteen days) including twenty-four adult male Wistar rats was performed. Animals were assigned into one of three groups (eight per group): GI-control, GII-Cis-platinum treated and GIII-Cis-platinum plus superoxide dismutase and catalase. Histological analyses included germ cell counts, germ to Sertoli cell ratios and estimation of volume density components as well as the determination of the sperm reserves. Data was examined through one-way analysis of variance at 5% level of significance. Results: Germ cell numbers, germ cell to Sertoli cell ratios, organ weights (except body weight) and sperm reserves presented no differences among groups. However, the volumetric proportion of some components (tubular epithelium, tunica propria, Leydig cell nuclei and stroma) were affected (p<0.05) by treatment. The most prominent testicular component, the seminiferous epithelium was reduced (p<0.05) in Cis-platinum treated animals (GII). Conclusion: The use of antioxidant in association with Cis-platinum did not affect sperm production (germ cell numbers, germ to Sertoli cell ratios and sperm reserves) of adult rats. However, the deleterious effect of Cis-platinum on the seminiferous tubule epithelium was minimized by antioxidants (AU)

Anxiety and high plasma catecholamines do not impair pharmaco-induced erection of psychogenic erectile dysfunctional patients.

The aim of this study was to assess the influence of anxiety and plasma catecholamines on the pharmaco-induced erection of psychogenic erectile dysfunction (ED) patients. A total of 23 patients with psychogenic ED aged from 19 to 43 y were submitted to: (1) anxiety evaluation by the Spielberger's State and Trait Anxiety Inventory-STAI; (2) intracavernous injection of PGE1 10 microg+phentolamine 1 mg with the response monitored by Rigiscan; (3) blood sampling from cavernous bodies and cubital vein for adrenaline and noradrenaline levels determination by high performance liquid chromatography. The whole procedure was done in a single clinical setting at the same day. We found no significant correlation between the erection rigidity and the cavernous or peripheral catecholamines or between erection rigidity and anxiety scores. Some patients showed rigid erections despite high anxiety scores or penile catecholamine levels while others, with incomplete erections, had much smaller levels. These results are suggestive of a more complex mechanism controlling the penile sympathetic responsiveness in psychogenic ED patients.

Efficacy and safety of flexible-dose oral sildenafil citrate (Viagra) in the treatment of erectile dysfunction in Brazilian and Mexican men.

A 12-week, double-blind, placebo-controlled, multicenter study evaluated the efficacy and safety of flexible-dose sildenafil citrate (Viagra) treatment (25, 50 or 100 mg) in Brazilian and Mexican men with erectile dysfunction (ED) of broad-spectrum etiology. Efficacy was assessed on the basis of responses to the 15-item International Index of Erectile Function (IIEF) questionnaire, completed at baseline and after 12 weeks of treatment. At end point, mean scores for all IIEF domains of sexual function (erectile function, orgasmic function, sexual desire, intercourse satisfaction and overall satisfaction) were significantly (P<0.0001) higher in the sildenafil group (n=109) than in the placebo group (n=105). These findings confirm the significant increases in frequency of penetration and frequency of maintained erections reported previously. Sildenafil treatment was well tolerated. The most common adverse events were headache and flushing. In conclusion, sildenafil is a well-tolerated and effective treatment for ED of broad-spectrum etiology in Latin American men.

Erectile dysfunction: prevalence and associated variables in patients with chronic renal failure.

Patients with chronic renal failure (CRF) experience a significant decrease in quality of life, due both to the limitations imposed by the disease as well as the demands of the treatment that they receive. Some side effects of both illness and treatment contribute to increase the morbidity of these patients. Among them, erectile dysfunction (ED) is notable. One hundred and nineteen patients received clinical and laboratory evaluation. The following clinical data were observed: age, education, income, race, period of dialysis, period of complaints of ED, etiology of ED, use of erythropoietin, presence of arterial hypertension and/or diabetes mellitus, use of antihypertensive drugs, use of cigarettes, and psycho-emotional state of the patients. Assessment of complaints of ED was achieved using the International Index of Erectile Function (IIEF). The following laboratory data were analyzed: hemoglobin, hematocrit, free testosterone, gonadotrophin levels (FSH and LH), HDL-cholesterol, total cholesterol, prolactin, and parathyroid hormone. Statistical analysis of the means of continuous variables was performed through use of the Student's t-test. Analysis of significance of category variables was performed using the chi(2) test. Descriptive analysis was obtained through use of the clinical and socio-demographic data. A multivariate model was created and the odds ratio calculated. The average age of the patients was 47.3+/-15.9 y. The mean duration of erectile dysfunction complaints was 4 y. The average duration of dialysis was 66.2+/-58.9 months. Prevalence of erectile dysfunction in this population was 57.9%. The main known etiology of chronic renal failure was glomerulonephritis. The main variables associated with erectile dysfunction were age, psycho-emotional state, and levels of HDL-cholesterol. This study showed a high prevalence of erectile dysfunction in the group of patients examined. Factors such as age, anxiety and depressive complaints, and dyslipidemy seem to play an important role in the origin of erectile dysfunction in such patients.

The value of a second injection on the pharmaco-induced erection test.

In order to test the capability of a reinjection to improve an incomplete pharmaco-induced erection, we submitted 30 impotent patients, with incomplete erectile responses to 10 micrograms PGE1 + 1 mg phentolamine, to a second injection of 15 micrograms PGE1 + 1.5 mg phentolamine + 30 mg papaverine, fifteen minutes after the first injection. Twenty-one patients improved their erection including nine who achieved complete rigidity. We conclude that incomplete pharmaco-induced erections can frequently be improved by reinjection.