Combined transurethral electroresection and neodymium:YAG laser therapy for obstructing prostatism

Transurethral resection of the prostate gland (TURP) utilizes electrosurgical technique for resection of prostate tissue and to control bleeding. Indwelling catheter time and bladder irrigation is usually determined by the degree and length of time postoperative bleeding persists. By combining the traditional TURP with neodymium:YAG laser photocoagulation of residual tissue, there was reduction of postoperative bleeding and reduced volume and frequency of bladder irrigation, resulting in earlier removal of indwelling catheters and a shortened postoperative stay

Priapism associated with intranasal cocaine abuse

Cocaine abuse has escalated to epidemic proportions in the United States. In addition to the social and economic problems associated with the recreational use of this agent, a variety of medical complications have been reported. The occurrence of priapism with intranasal use has not been documented previously. We report a case of priapism secondary to intranasal cocaine abuse and describe the possible neurochemical etiology for this phenomenon

Early detection of stage A prostate carcinoma: Combined use of prostate- specific antigen and transrectal ultrasonography

We prospectively studied 103 men who had normal results on digital prostate examinations but had bladder outlet obstruction secondary to prostatic hypertrophy and needed transurethral prostatectomy. All men underwent a preoperative transrectal ultrasonographic examination of the prostate and prostate-specific antigen (PSA) level determination. A total of 30 cancers were ultimately detected, 22 (73%) of which were detected preoperatively by either an abnormal ultrasonogram or elevated PSA levels (or both). Eight of these men were spared transurethral prostatectomy and had definitive treatment based on transrectal biopsy and appropriate staging evaluation. For PSA and ultrasonography combined, the sensitivities and negative predictive values for cancer (92% and 94%, respectively) were superior to the specificities and positive predictive values (71% and 64%, respectively). The combined use of both studies is recommended to rule out cancer in candidates for prostatectomy but not to routinely screen the general male population older than 40 years

Factors Influencing Fluoroscopy use During Ureteroscopy at a Residency Training Program.

INTRODUCTION: Ionizing radiation is used throughout urologic surgery and is known to cause a greater cancer risk with increasing exposure. The ICRP states that it is the control of radiation dose that is important, no matter the source. However, there are few reports on the amount of radiation used by Urology residents during ureteroscopy (URS). We present the largest database evaluating fluoroscopy (fluoro) use during URS at a resident training program. Our objective is to assess the amount of fluoro use at varying levels of experience and to identify factors that lead to increased fluoro use. METHODS: Retrospective data from 242 URS performed at two resident training sites were collected. 105 surgeries were done by 2 attending physicians without and 137 with residents (Uro1-Uro3). Patient data were collected from the EMR. Statistical analyses included ANOVA, Spearman correlations, and multiple linear regression (MLR). RESULTS: Comparisons between Yr1 and Yr2 revealed significantly (p\u3c0.05) decreased fluoro time (20.0 s) and operative time (12.2 m) for the Yr2 resident. Total operative time was significantly (p\u3c0.05) decreased (11.1 m) for attending physicians operating on their own compared to a Yr1 resident. Significant (p\u3c0.05) correlations with fluoro time were demonstrated for operative time, stone size, ureteral dilation, ureteral access sheath use, presence of a preoperative stent, resident year, and resident month. Operative time, ureteral dilation and a preoperative stent placement were significant predictors of fluoro time on MLR (p\u3c0.05). CONCLUSION: Fluoro time during retrograde URS was significantly reduced as residents gained more experience in the operating room. An increase in fluoro time was also associated with ureteral dilation, access sheath use, increasing stone size, and lack of pre-stenting. With knowledge of these factors, emphasis can be placed on using and teaching techniques that limit radiation exposure

Avanafil for the treatment of erectile dysfunction: A multicenter, randomized, double-blind study in men with diabetes mellitus

Objective: To prospectively assess the safety and effectiveness of the investigational phosphodiesterase 5 inhibitor avanafil to treat erectile dysfunction in men with diabetes mellitus. Patients and Methods: This 12-week, multicenter, double-blind, placebo-controlled study conducted between December 15, 2008, and February 11, 2010, randomized 390 men with diabetes and erectile dysfunction 1:1:1 to receive avanafil, 100 mg (n=129), avanafil, 200 mg (n=131), or placebo (n=130). Coprimary end points assessed changes in the percentage of sexual attempts in which men were able to maintain an erection of sufficient duration to have successful intercourse (Sexual Encounter Profile [SEP] 3), percentage of sexual attempts in which men were able to insert the penis into the partner\u27s vagina (SEP 2), and International Index of Erectile Function erectile function domain score. Results: Compared with placebo, least-squares mean change from baseline to study end in SEP 3, SEP 2, and International Index of Erectile Function erectile function domain score were significantly improved with both avanafil, 100 mg (P==.002), and avanafil, 200 mg (P\u3c.001). Additional analyses indicated that successful intercourse could be initiated in 15 minutes or less through more than 6 hours after avanafil dosing. Adverse events most commonly reported with avanafil treatment were headache, nasopharyngitis, flushing, and sinus congestion. Conclusion: Avanafil was safe and effective for treating erectile dysfunction in men with diabetes and was effective as early as 15 minutes and more than 6 hours after dosing. The adverse events seen with avanafil were similar to those seen with other phosphodiesterase 5 inhibitors. Trial Registration: clinicaltrials.gov Identifier NCT00809471. © 2012 Mayo Foundation for Medical Education and Research

Transurethral microwave hyperthermia in the treatment of chronic nonbacterial prostatitis

Chronic nonbacterial prostatitis is an ill-understood and difficult-to-diagnose disease. Symptoms of chronic nonbacterial prostatitis are similar to those of chronic prostatitis and include low back pain, frequency, dysuria, perineal discomfort, and painful ejaculation. In view of uncertainty about etiology, treatment of chronic nonbacterial prostatitis remains speculative. Most treatment is aimed at relieving symptoms and not at curing the disease. Because of the troublesome nature of chronic nonbacterial prostatitis and the poor results obtained from traditional treatment methods, a new modality of transurethral microwave hyperthermia was investigated. Six patients were treated from January 1994 through June 1995 by use of transurethral microwave hyperthermia. These men were treated four times during a 2-week period. Their average symptom score decrease was 74.9% and was associated with minimal morbidity. Based on this result, it is concluded that transurethral microwave hyperthermia is a safe and effective treatment modality for chronic nonbacterial prostatitis

An open-label, long-term evaluation of the safety, efficacy and tolerability of avanafil in male patients with mild to severe erectile dysfunction

Aim: Determine the long-term efficacy, safety and tolerability of avanafil, a highly specific, rapidly absorbed phosphodiesterase type 5 inhibitor in male patients with mild to severe erectile dysfunction (ED), with or without diabetes. Methods: This was a 52-week, open-label extension of two 12-week, randomised, placebo-controlled, phase 3 trials. Patients were assigned to avanafil 100 mg, but could request 200 mg (for increased efficacy; \u27100/200-mg\u27 group) or 50 mg (for improved tolerability). Primary end points included percentage of sexual attempts ending in successful vaginal penetration [Sexual Encounter Profile 2 (SEP2)] and intercourse (SEP3) and erectile function domain score per the International Index of Erectile Function (IIEF-EF). Results: Some 712 patients enrolled; 686 were included in the intent to treat population and contributed to the data. All primary end points showed sustained improvement. SEP2 and SEP3 success rates improved from 44% to 83% and from 13% to 68% (100-mg group) and from 43% to 79% and from 11% to 66% (100/200-mg group), respectively. Mean IIEF-EF domain scores improved from 13.6 to 22.2 (100-mg group) and from 11.9 to 22.7 (100/200-mg group). Avanafil was effective in some patients = 15 min and \u3e 6 h postdose. Sixty-five per cent (112/172) of \u27nonresponders\u27 to avanafil 100 mg responded to the 200-mg dose. The most common (= 2%) treatment-emergent adverse events were headache, flushing, nasopharyngitis and nasal congestion; \u3c 3% of patients discontinued therapy because of adverse events. Conclusions: The long-term tolerability and improvement in sexual function, coupled with rapid onset, suggest that avanafil is well suited for the on-demand treatment of ED. © 2013 Blackwell Publishing Ltd

A randomized, double-blind, solifenacin succinate versus placebo control, phase 4, multicenter study evaluating urinary continence after robotic assisted radical prostatectomy.

PURPOSE: Bladder dysfunction influences recovery of urinary continence after radical prostatectomy. We performed a multicenter, randomized, double-blind study evaluating solifenacin vs placebo on return to continence in patients who were still incontinent 7 to 21 days after catheter removal after robot-assisted radical prostatectomy. MATERIALS AND METHODS: A wireless personal digital assistant was given to patients the day of catheter removal. Encrypted answers were transmitted daily to dedicated servers. After a 7 to 21-day treatment-free washout period, patients requiring 2 to 10 pads per day for 7 consecutive days were randomized (1:1) to 5 mg solifenacin daily or placebo. The primary end point was time from first dose to continence defined as 0 pads per day or a dry security pad for 3 consecutive days. Secondary end points included proportion of patients continent at end of study, average change in pads per day number and quality of life assessments. RESULTS: A total of 1,086 screened patients recorded personal digital assistant information. Overall 640 patients were randomized to solifenacin vs placebo and 17 failed to take medication. There was no difference in time to continence (p=0.17). Continence was achieved by study end in 91 of 313 (29%) vs 66 of 309 (21%), respectively (p=0.04). Pads per day change from baseline was -3.2 and -2.9, respectively (p=0.03). Dry mouth was the only common adverse event seen in 6.1% and 0.6%, respectively. Constipation rates were similar. The overall rate of continence in the entire population from screening to end of study was 73%. CONCLUSIONS: There was no effect on primary outcome but some secondary end points benefited the solifenacin arm. The study provides level 1B clinical evidence for continence outcomes after robot-assisted radical prostatectomy

Efficacy of Avanafil 15 Minutes after Dosing in Men with Erectile Dysfunction: A Randomized, Double-Blind, Placebo Controlled Study

Purpose: We examined the therapeutic effects of avanafil 15 minutes after dosing in men with mild to severe erectile dysfunction. Materials and Methods: This randomized, double-blind, placebo controlled, 12-week study (4-week run-in and 8-week treatment) randomized 145 men to placebo, 147 to avanafil 100 mg and 148 to avanafil 200 mg on demand. The primary efficacy variable was the per subject proportion of sexual attempts during the treatment period in which subjects achieved erection sufficient for vaginal penetration within approximately 15 minutes after dosing as measured by a stopwatch. The attempt had to enable successful completion of sexual intercourse according to SEP question 3. Results: Significantly greater mean per subject percentages of successful intercourse attempts within approximately 15 minutes after dosing were observed for avanafil 100 mg (mean 25.9%, LS mean ± SE 24.7% ± 2.9%) and 200 mg (mean 29.1%, LS mean 28.2% ± 2.9%) vs placebo (mean 14.9%, LS mean 13.8% ± 2.9%, p= 0.001 and \u3c0.001, respectively). After treatment we noted a statistically significant difference between avanafil and placebo in the average per subject proportion of successful intercourse attempts according to SEP question 3 as early as 10 minutes in the 200 mg group and 12 minutes in the 100 mg group. Treatment emergent adverse events included headache, upper respiratory tract infection andnasal congestion, and most such events were mild or moderate in severity. Conclusions: Avanafil was efficacious within approximately 15 minutes of dosing compared to placebo. Astatistically significant treatment difference in the percentage of successful sexual attempts was demonstrated as early as 10 minutes after treatment. © 2015 American Urological Association Education and Research, Inc