Study UNICO: Perception of Urologists and Andrologists, in Spain, about the Use of Sildenafil Oral Suspension in Patients with Erectile Dysfunction.

OBJECTIVE: To describe the profile of patients with erectile dysfunction (ED), attending to consultation and satisfaction using sildenafil oral suspension, from the specialist's perception. MATERIALS AND METHODS: This is a nationwide multicenter, epidemiological, descriptive and observational study, with the studied population as the unit of study. Thirty urologists and/or andrologists completed a questionnaire with questions about ED patients' profile attending to their practice, sildenafil oral suspension perception of effectiveness and safeness, and their opinion about patients' satisfaction after sildenafil oral suspension treatment. Aggregate data were collected for the last 6 patients treated or on treatment with sildenafil oral suspension. RESULTS: Overall, 40.9% and 24.9% of patients had moderate or severe ED, respectively. Among the patients, 73.6% were older than 50 years. The disease progression was approximately one year (11.8 months). ED etiology was mostly organic (38.1%) and mixed (31.8%). Cardiovascular comorbidities were present in 57.4%, mental health problems in 16.4% and hormonal disorders in 10.2% of the patients. The main reason for choosing sildenafil oral suspension was the ease of dose adjustment. The specialists considered that 73.4% of the patients responded satisfactorily to treatment. They also rated the perceived effectiveness and safeness of the product as very good or good. CONCLUSIONS: Urologists and andrologists consider that most patients with ED achieve a high degree of satisfaction with sildenafil oral suspension. The main advantage of the treatment is the possibility of adjusting the dose according to patient's needs and circumstances.

Study UNICO: Perception of Urologists and Andrologists, in Spain, about the Use of Sildenafil Oral Suspension in Patients with Erectile Dysfunction

Objective: To describe the profile of patients with erectile dysfunction (ED), attending to consultation and satisfaction using sildenafil oral suspension, from the specialist’s perception. Materials and methods: This is a nationwide multicenter, epidemiological, descriptive and observational study, with the studied population as the unit of study. Thirty urologists and/or andrologists completed a questionnaire with questions about ED patients’ profile attending to their practice, sildenafil oral suspension perception of effectiveness and safeness, and their opinion about patients’ satisfaction after sildenafil oral suspension treatment. Aggregate data were collected for the last 6 patients treated or on treatment with sildenafil oral suspension. Results: Overall, 40.9% and 24.9% of patients had moderate or severe ED, respectively. Among the patients, 73.6% were older than 50 years. The disease progression was approximately one year (11.8 months). ED etiology was mostly organic (38.1%) and mixed (31.8%). Cardiovascular comorbidities were present in 57.4%, mental health problems in 16.4% and hormonal disorders in 10.2% of the patients. The main reason for choosing sildenafil oral suspension was the ease of dose adjustment. The specialists considered that 73.4% of the patients responded satisfactorily to treatment. They also rated the perceived effectiveness and safeness of the product as very good or good. Conclusions: Urologists and andrologists consider that most patients with ED achieve a high degree of satisfaction with sildenafil oral suspension. The main advantage of the treatment is the possibility of adjusting the dose according to patient’s needs and circumstances (AU)

Manejo terapéutico del linfedema de pene subagudo y secundario a erisipela mediante colgajos cutáneos / Therapeutic approach of subacute penile lymphoedema secondary to erysipela by means of cutaneous flaps

Presentamos la revisión clínica de un paciente de 38 años remitido a nuestro centro por linfedema de pene secundario a infección por Streptococcus pyogenes (erisipela) de 6 meses de evolución que como secuela presenta edema de consistencia gomosa sin lesiones dérmicas asociadas limitado al pene que imposibilita las relaciones sexuales y dificulta el vaciado vesical. La linfogammagrafía no evidenció acúmulo del radiofármaco a nivel genital mientras que la RMN mostró marcado engrosamiento cutáneo y subcutáneo alrededor de cuerpos cavernosos y glande con predominio del tejido fibroso. Se realizó resección quirúrgica del tejido fibroso cubriendo el defecto con colgajos laterales de piel peneana. El estudio anatomopatológico con utilización de marcadores específicos CD-31 y D2-40 confirmó la presencia de linfáticos infiltrados. El postoperatorio cursó sin complicaciones, mostrando aspecto cosmético satisfactorio sin presencia del edema ni síntomas urinarios y recuperando la función sexual a los 6 meses (AU)

Clinical review of a 38 years old patient referred to our hospital with penile lymphoedema secondary to a Streptococcus pyogenes (erysipela) infection 6 month ago. Physical exam revealed an uncircumcised penis with a soft consistency edema and no skin lesions. The patient was unable to maintain intercourse and had urine dripping caused by obliteration of the foreskin. Lymphogammagraphy revealed the absence of drug accumulation at genital area. MRI showed skin strengthening around the cavernous corpora and glans with fibrous tissue predominance. We performed a surgical resection of the fibrous tissue with lateral penis cutaneous flaps. There were no complications during the intervention and the post-operative period. The pathology report revealed the presence of lymphatic vessels with specific coloring DC-31 and D2-40. Six months after the intervention we observed an absence of edema with satisfactory cosmetic appearance, without urinary symptoms, and patient was able to maintain erections and perform intercourse (AU)

Evaluation of a severity score to predict the prognosis of Fournier's gangrene.

OBJECTIVE: To determine the validity of a Fournier's gangrene severity index (FGSI), developed to assign a numerical score describing the severity of FG, and evaluate factors in the survival of patients with FG. PATIENTS AND METHODS: We retrospectively reviewed 51 patients diagnosed with FG between 1994 and 2006. Data were collected on their medical history, which included vital signs (temperature, heart and respiratory rates) and metabolic variables (sodium, potassium, creatinine, bicarbonate levels, haematocrit, and white blood cell count). We computed a score relating to the severity of the disease at the time, and compared it to other features according to whether the patient survived or died. The different prognostic factors were assessed by univariate analysis with the Mann-Whitney U and Kendall A-B tests. RESULTS: Of the evaluated 51 inpatients, eight died (16%) and 43 survived (84%). The median (range) age was 63 (17-85) years and the median time from the onset of the symptoms until the admission to the emergency room was 7.8 (1-60) days. The mean hospital stay was 33 (2-90) days and 17 patients were admitted to the intensive-care unit for a mean of 4.5 days. There was no statistically significant difference between the groups. Body surfaces involved were the scrotum in five patients (10%), the penis and scrotum in 11 (22%), the scrotum and perineum in 30 (59%) and the abdominal wall in five (10%). There was no statistically significant difference in the distribution in those who survived or died (P = 0.131). The median age of 60 (17-81) years in the survivors was significantly lower than that of 73.5 (50-85) years in those who died (P = 0.02). There was no significant difference (P = 0.06) between the number of repeated debridements in the survivors (3.23) and those who died (5.25). The mean (range) FGSI score for survivors was 6.7 (0-14), vs 8.7 (6-13) for those who died (P = 0.12). The only laboratory variables associated with death were serum bicarbonate (P = 0.04) and serum sodium (P = 0.02) levels. CONCLUSIONS: FG is an unpredictable disease process with wide variability in its presentation. In our experience, the FGSI gives no indication of the likelihood of survival, but the risk factors for predicting the severity of FG seem to be greater in older patients and those with high sodium and low bicarbonate levels.

Cuerpos extraños en pene / Penile foreign bodies

OBJETIVO: Mostrar 8 casos de cuerpos extraños en pene.MÉTODOS/RESULTADOS: Realizamos una presentación fundamentalmente visual de variados artilugios o cuerpos extraños de ubicación peneana.CONCLUSIONES: Raramente la existencia de cuerpos extraños peneanos se debe a accidentes. Los cuerpos extraños en pene son colocados por muy diversas razones, destacando principalmente dentro de actividades eróticas o autoeróticas, pudiendo tener consecuencias desde leves, a casos en los que puede acabar en amputación peneana(AU)

OBJECTIVE: To describe 8 cases of penile foreign bodies.METHODS/RESULTS: We provide an essentially visual overview of various objects or foreign bodies affecting the penis.CONCLUSIONS: The presence of penile foreign bodies is rarely due to an accident. These objects are placed for a wide variety of reasons, but primarily for erotic or self-arousal purposes. The consequences of penile foreign bodies can be mild or very severe, resulting in penile amputation(AU)

[Primary bladder adenocarcinoma in unreconstructed exstrophic bladder]. / Adenocarcinoma vesical primario en extrofia vesical no corregida.

We report a 60-years-old patient with a not repaired exstrophic bladder, who develops an adenocarcinoma on his bladder and review of the literature.

Adenocarcinoma vesical primario en extrofia vesical no corregida / Primary bladder adenocarcinoma in unreconstructed exstrophic bladder

Presentamos el caso clínico de un paciente de 60 años con extrofia vesical no corregida en su infancia, que desarrolla un adenocarcinoma vesical y revisión de la literatura (AU)

We report a 60 years old patient with a not repaired exstrophic bladder, who develops an adenocarcinoma on his bladder and review of the literature (AU)