[Efficacy and tolerability of dapoxetine in the treatment of premature ejaculation].

OBJECTIVE: To investigate the efficacy and adverse effects of dapoxetine in the treatment of premature ejaculation. METHODS: We randomly assigned outpatients with premature ejaculation in the proportion of 2:1 to receive 30 mg dapoxetine on demand (n =78) or 50 mg sertraline qd for one month (n = 39). Follow-up was accomplished in 95 cases, 63 in the dapoxetine group and 32 in the sertraline group. We recorded the intravaginal ejaculatory latency time (IELT), clinical global impression of change (CGIC) score, and adverse reactions of the patients and compared them between the two groups. RESULTS: IELT was significantly increased in both the dapoxetine (from [0.87 ± 0.31] to [2.84 ± 0.68] min, P < 0.05) and the sertraline group (from [0.84 ± 0.28] to [2.71 ± 0.92] min, P < 0.05) after medication. Based on the CGIC scores in premature ejaculation, the rate of excellence or effectiveness was 36.5% in the dapoxetine and 37. 5% in the sertraline group, and the rate of improvement was 63.5% in the former and 71.9% in the latter. The incidence rates of dizziness, nausea, headache, and diarrhea were slightly higher (P > 0.05) while those of fatigue, somnolence, and dry mouth significantly higher (P < 0.05) in the sertraline than in the dapoxetine group. CONCLUSION: On-demand oral medication of dapoxetine is effective and well-tolerated for the treatment of premature ejaculation.

Shock wave induced kidney injury promotes calcium oxalate deposition.

PURPOSE: Extracorporeal shock wave lithotripsy is the preferred treatment for upper urinary tract renal calculi. However, this treatment is associated with a high rate of recurrent renal calculi. Shock wave therapy can result in renal epithelial cell injury, which in turn is a most important factor in calculus formation. We investigated the influence of kidney damage secondary to shock waves on Ca oxalate crystal retention in the kidney. MATERIALS AND METHODS: A total of 32 rats were randomly divided into 4 groups, including group 1--controls, group 2--sham treated rats given 25 ml 0.75% ethylene glycol per day for 14 days, group 3--rats given 15 kV 1 Hz shock waves 500 times to the left kidney, followed by 25 ml 0.75% ethylene glycol daily for 14 days, and group 4--rats with the same treatment as group 3 except the number of impacts was increased to 1,000. The 2 kidneys were removed at the end of the experiment. Ca oxalate crystals were observed by surgical microscopy in kidney sections stained with hematoxylin and eosin. Crystal morphology was determined using polarizing microscopy. Acidified kidney tissue homogenate was examined for Ca and oxalate content by colorimetry (Sigma). RESULTS: Kidney sections showed that kidneys that did not receive shock waves had fewer crystals than kidneys with shock waves, which had crystals in major areas. In the left kidney in groups 2 to 4 the mean +/- SD quantity of Ca was 16.88 +/- 6.41, 28.58 +/- 7.54 and 40.81 +/- 15.29 micromol/gm wet kidney and the mean quantity of oxalate was 8.44 +/- 6.80, 20.52 +/- 7.70, 31.76 +/- 14.14 micromol/gm wet kidney, respectively. Ca oxalate density increased with the number of shock wave impacts. CONCLUSIONS: Kidney damage caused by shock wave treatment can increase Ca oxalate crystal retention in the kidneys of rats in this stone model.

[The protective effect of Chinese herbs for supplementing shen to eliminate stone on renal injury induced by extracorporeal shockwave lithotripsy in patients with renal calculus].

OBJECTIVE: To study the protective effect of Chinese herbs for supplementing Shen to eliminate stone on renal injury induced by extracorporeal shockwave lithotripsy (ESWL) in patients with renal calculus. METHODS: Sixty patients with diagnosis of renal calculus confirmed by X-ray film or CT combined with abdominal B ultrasonography but showing no obvious symptoms, were randomized into the treated group and the control group. They all were scheduled to receive ESWL treatment. To the patients in the treated group, prescribed Chinese herbs was orally administered in the three days before and after ESWL, patients in the control group ate and drank as usual. Changes of blood levels of nitric oxide (NO), endothelin-1 (ET-1), superoxide dismutase (SOD), malondialdehyde (MDA), tumor necrosis factor alpha (TNF-alpha), urinary levels of N-acetyl-D-glucosaminidase (NAG), gamma-glutamyltransferase (gamma-GT) and beta 2-microglobulin (beta 2-MG) before and after ESWL were observed. RESULTS: Blood levels of NO, ET-1, MDA and TNF-alpha significantly increased after ESWL in the control group, higher than the levels in the treated group (P < 0.05); and level of SOD decreased gradually in the control group reaching the valley 72 h after ESWL (P < 0.05), while in the treated group it was unchanged and remained at the level higher than that in the control group (P < 0.05). As for the urinary levels of NAG, gamma-GT and beta2-MG, after ESWL, they were all higher in the control group than those in the treated group, showing statistical significance (P <0. 05). CONCLUSION: ESWL could induce renal damage in patients with renal calculus and the Chinese herbs for supplementing Shen to eliminate stone can reduce the renal tubular damage by way of anti-oxidation and regulating the renal hemorrheologic disorder and the release of inflammatory mediators.

[Papillary cystadenocarcinoma in a Müllerian duct cyst: report of a case with literature review].

OBJECTIVE: To study the diagnosis and treatment of Müllerian duct cysts and their involvement with malignancy. METHODS: A 44-year-old male patient with papillary cystadenocarcinoma involving a Müllerian duct cyst was presented. The presentation treatment, and pathological and radiological appearances were retrospectively analysed and discussed with literature review. The main manifestation was intermittent episode of hemospermia accompanying terminal hematuria and infertility for 15 years. Final diagnosis was determined by the findings of transrectal ultrasound scan, CT scan, MRI imaging, cystoscopic examination and biopsy. RESULTS: Exploratory laparotomy was performed through a suprapubic retrovesical approach. The finding that a duct-like wedge of tumor tissue passed through the prostate near cyst neck to the posterior urethra without affecting the adjacent prostatic tissue during tylectomy confirmed that it arises from Müllerian duct system. Pathohistologic examination disclosed a papillary cystadenocarcinoma and it infiltrated the wall of the cyst. Both seminal vesicles and ejaculatory duct had no carcinoma invasion. CONCLUSION: Müllerian duct cyst involving with malignancy is exceedingly rare, the diagnosis is based on the findings of transrectal ultrasound scan, CT scan, MRI imaging, cystoscopic examination. The final diagnosis depends on the pathohistologic examination. Lumpectomy is effective and have a good outcome.

Astragalus membranaceus reduces free radical-mediated injury to renal tubules in rabbits receiving high-energy shock waves.

BACKGROUND: Recent studies have revealed the important role of free radicals in renal damage induced by high-energy shock waves (HESW). This study aimed at investigating the effects of Astragalus membranaceus, a traditional Chinese medicinal herb, on free radical-mediated HESW-induced damage to renal tubules in a live rabbit model. METHODS: Forty-five healthy male New Zealand white rabbits were randomly divided into three groups: control group (n = 15), sham group (n = 15), and herb-treated group (n = 15). Three days prior to HESW application, the controls received verapamil (0.4 mg/kg), the shams received physiological saline (20 ml), and the herb-treated animals received Astragalus membranaceus (2.4 g/kg) intravenously. HESW (1500 shocks, 18 kV) was applied to the right kidneys of all anesthetized rabbits. We measured superoxide dismutase (SOD) and malondialdehyde (MDA) levels before and after shock treatment in blood and kidney homogenates. Histopathological changes were also observed. RESULTS: MDA levels increased and SOD activity decreased significantly in the sham group (P < 0.05 for both) after shock treatment. MDA levels showed a much less increase in the controls (P < 0.05) and did not increase to statistically significant levels in the group receiving Astragalus membranaceus (P > 0.05). SOD values were significantly higher in the controls than in the shams (P < 0.05). By contrast, SOD levels recovered rapidly in the rabbits receiving Astragalus membranaceus, reaching a nadir within 24 hours, and returning to baseline more quickly than in control and sham rabbits (P < 0.05). Histopathological examinations showed that renal tubular damage in the controls was less severe than in the shams, while damage in the Astragalus membranaceus group was even more mild, with rapid recovery in comparison with the controls. CONCLUSION: This study provides preliminary evidence indicating that Astragalus membranaceus has strong protective effects on free radical-mediated renal tubular damage induced by HESW and that these effects are superior to the effects of verapamil.

[The protective effects of three components isolated from Astragalus membranaceus on shock wave lithotripsy induced kidney injury in rabbit model].

OBJECTIVE: Extracorporeal shock wave lithotripsy (ESWL) is has been shown to reduce renal parenchymal injury subject to application of shock wave lithotripsy in our pervious study. To investigate the protective action of three main components from Astragalus membranaceus, including total saponins of astragalus (TSA), total flavonoids of astragalus (TFA) total polysaccharide of astragalus (TPA) in alleviating shock wave induced kidney damage. METHODS: Sixty four male rabbits were randomly assigned to a control group or to 3 groups that were premedicated with TSA TFA and TPA respectively prior to application of ESWL. Each group of animals underwent shock wave lithotripsy (18 kV) to the right kidneys and received a total of 1500 shocks. Peripheral blood samples were collected to evaluate the levels of plasma endothelin-1 (ET-1), plasma nitric oxide (NO) and serum malondialdehyde (MDA) before and after shock wave treatment. The concentrations of these markers in the treated kidney tissues were also detected 3 days, 7 days and 14 days after application of ESWL. The changes of histopathology and cells ultrastructure were observed through light microscope and electron microscope. Untreated contralateral kidneys were evaluated as controls. RESULTS: In control serials the levels of ET-1 and MDA were elevated significantly while the level of NO was significantly decreased after application of shock wave lithotripsy (P < 0.05). The comparison between the controls and premedicated groups demonstrated that all these three components especially TSA and TFA significantly inhibited shock wave induced increasing of ET-1 and MDA (P < 0.05). TSA also significantly suppressed the decrease of NO and made the recovery time earlier compare to the results of controls (P < 0.05). However, TFA and TPA had almost no effects on the change of NO. (P > 0.05). The results in histopathology showed noticeably damage of glomerular and tubular epithelial cells in the treated kidneys in the controls. The histological alterations in the TPA group were similar to those of the controls. These alterations were significantly milder in the TSA and TFA particular the TSA group. CONCLUSION: TFA and TSA, especially TSA seemed to play the key role in alleviating ESWL induced kidney damage.

[Age-specific reference ranges for serum prostate-specific antigen in Chinese men].

OBJECTIVE: To evaluate the age-specific reference ranges for serum prostate-specific antigen in Chinese men. METHODS: Serum tPSA and fPSA were measured by enzyme-linked immunosorbent assay (ELISA) and fPSA/tPSA ratio was calculated in 1,096 health Chinese men of 23 - 85 years old. The relationship between age and PSA indexes was analyzed with simple linear regression. RESULTS: The recommended age-specific reference range (95th percentile) for serum PSA for Chinese were: 1.20 microg/L for 20-29 years; 1.21microg/L for 30-39 years; 1.23 microg/L for 40-49 years; 2.35 microg/L for 50-59 years; 3.20 microg/L for 60-69 years; 3.39 microg/L for >or= 70 years. The serum PSA concentration correlated directly with age. The age-specific reference range was lower for Chinese men than not only for white and black men, but also for Japanese and Koreans men. CONCLUSION: The age-specific reference ranges for serum PSA are lower significantly for Chinese men than for black, white men, even for Japanese and Koreans men. Study the normal upper limit of PSA and the age-specific reference ranges for serum prostate-specific antigen in Chinese men is very important.