randomized, double-blind, placebo-controlled, crossover trial of "on-demand" tramadol for treatment of premature ejaculation

The objective of this study is to assess the dose-related effects of tramadol on a group of patients with premature ejaculation [PE]. During the period of months between June 2010 and July 2012, 180 PE patients presented to outpatient clinic of our hospital. Patients were randomized in a 1:1:1 fashion to receive different sequences of the three medications: placebo, 50 mg of tramadol and 100 mg of tramadol. Every patient received 10 doses of each medication for 2 months. Intra-vaginal ejaculatory latency time [IELT] was recorded in seconds initially and for each arm. Successful treatment of PE is defined if IELT exceeded 120 s. Side-effects of medications were reported. Of patients enrolled, 125 [69.4%] continued the study. Patients' age range was 20-55 years with PE complaint of 1 to 10 years duration. Mean IELT was 72 at presentation, 82 for placebo, 150 for tramadol 50 mg, and 272 for tramadol 100 mg [P < 0.001 for all comparisons]. PE was successfully treated in only 2.4% of patients with placebo, in contrast to 53.6% and 85.6% with 50 and 100 mg tramadol, respectively [P < 0.001 for all comparisons]. On multivariate logistic regression analysis, baseline IELT was the only predictor of successful treatment of PE with both tramadol 50 mg [odds ratio [OR]: 1.05, 95% confidence interval [CI]: 1.03-1.07, P < 0.001] and tramadol 100 mg [OR: 1.07, 95% CI: 1.04-1.11, P < 0.001]. Postmicturition dribble annoyed 12.8% of those who received 50 mg tramadol and 33.6% of those who received 100 mg tramadol [P < 0.001]. Weak scanty ejaculation was the main complaint in 7.2% versus 21.6% of those using 50 and 100 mg tramadol, respectively [P = 0.002]. Two patients discontinued tramadol 100 mg due to side-effects. Tramadol hydrochloride exhibits a significant dose-related efficacy and side-effects over placebo for treatment of PE

Percutaneous nephrolithotomy in children: a preliminary report

The recurrence of pediatric nephrolithiasis, the morbidity of repeated open surgical treatment as well as our experience in percutaneous nephrolithotomy [PNL] in adult patients, all derived us to shift to PNL for managing renal stones >1.5 cm in pediatric patients. Our aim of this study is to evaluate the safety and efficacy of PNL in pediatric patients. During the period of the month between May 2011 and April 2013, 38 children [47 renal units] underwent PNL for renal stones 1.5-5 cm in length. Patient demographics, stone characteristics, and clinical outcome were prospectively studied. Data of those who underwent conventional and tubeless PNL were compared. Median follow-up period was 12 months [range: 6-24]. The median age at presentation was 8-year [range: 3-12]. The operative time ranged from 30 to 120 min [median [0]. Overall stone clearance rate was [1.5% after single PNL. The median hospital stay was 3 days. Auxiliary procedures were successful for the remaining 4 patients [nephroscopic clearance in one and shockwave lithotripsy in 3]. Tubeless PNL was performed in 17 renal units with a comparable outcome to conventional ones. The perioperative complications were noted in 5/47 [10.6%] of all procedures [Clavien Grade II in 4 and Clavien Grade IIIa in 1] and were managed conservatively. Percutaneous nephrolithotomy for renal stones in pediatric patients is safe and feasible if performed by a well-experienced endourologist. Tubeless PNL is a better choice for children

Uronephrological outcomes of patients with neural tube defects

To review the uronephrological outcomes of myelomeningocele [MMC] patients attending a Spina Bifida Clinic. We retrospectively reviewed the medical records of all patients from the combined Spina Bifida Clinic, at King Khalid University Hospital, Riyadh, Saudi Arabia between 1999 and 2009 who had at least one year of follow-up with us. We examined their demographic data, uronephrological status at presentation, most recent follow-up, and the rate of surgical intervention. During the 10-year period, 188 patients were actively followed-up. The mean age at presentation was 5.3 years +/- 3.6 SD. At their last follow-up, 109 patients [58%] were using clean intermittent catheterization, 44[23%] had received BotoxR injections, and 26 [14%] had undergone bladder reconstruction. Most [66%] patients were older than 3 years when they presented to us; this group had a significantly higher rate of surgical intervention [BotoxR or reconstruction] compared with those who came to us earlier [p=0.003 for patients receiving BotoxR injections, and p=0.025 for patients undergoing bladder reconstruction].Our multidisciplinary Spina Bifida Clinic is an integral part of MCC management to reach a safe urological outcome. Early presentations to our clinic resulted in a lesser need for surgical intercession compared with those who presented at more than 3 years old.

False fracture of the penis: different pathology but similar clinical presentation and management

Penile fracture is the most common presentation of acute penis. Rupture of the superficial dorsal penile vein [s] may mimic penile fractures with similar clinical presentation but with intact corporeal bodies. Our aim of the study is to highlight superficial dorsal penile vein [s] injury as true emergency with better prognosis. Sixty-eight patients with suspected penile fractures presented to our hospital between June 2007 and January 2013. Out of these, 11 patients showed intact tunica albuginea on exploration with injured dorsal penile vein [s] identified. Records of such 11 cases were reviewed regarding age, etiology, symptoms, physical signs, findings of surgical exploration and post-operative erectile function. All 11 patients were injured during sexual intercourse and presented with penile swelling and ecchymosis and gradual detumescence. Mild penile pain was encountered in 5 cases and the "snap" sound was noted in 2 cases. Examination revealed no localized tenderness, or tunical defect. All the patients regained penile potency without deformity after surgical ligation of the severed vessels. One patient developed penile hypoesthesia. Although the classic "snap" sound and immediate detumescence are usually lacking in the symptomology of dorsal penile vein rupture, its clinical presentation can be indistinguishable from true penile fracture. Surgical exploration is still required to avoid missing tunical tear with possible future complications. The long-term outcome and prognosis are excellent

Management of symptomatic ureteral calculi during pregnancy: experience of 23 cases

To present our experience in the management of symptomatic ureteral calculi during pregnancy. Twenty-three pregnant women, aged between 19 and 28 years presented to the obstetric and urology departments with renal colic [17 cases, 73.9%] and fever and renal pain [6 cases, 26.1%]; suggesting ureteric stones. The diagnosis was established by ultrasonography [abdominal and transvaginal]. Outpatient follow-up consisted of clinical assessment and abdominal ultrasonography. Follow-up by X-ray of the kidneys, ureter, and bladder [KUB], or intravenous urography [IVU] was done in the postpartum period. Double J [DJ] stent was inserted in six women [26%] with persistent fever followed by extracorporeal shock wave lithotripsy [ESWL] one month post-partum. Ureteroscopic procedure and pneumatic lithotripsy were performed for 17 women [distal ureteric stone in 10, middle ureter in 5, and upper ureteric stone in 2]. Stone-free rate was 100%. No urologic, anesthetic, or obstetric complications were encountered. Ureteroscopy, pneumatic lithotripsy, and DJ insertion could be a definitive and safe option for the treatment of obstructive ureteric stones during pregnancy