The role of noninvasive penile cuff test in patients with bladder outlet obstruction

PURPOSE: The aim of this study was to compare the penile cuff test (PCT) and standard pressure-flow study (PFS) in patients with bladder outlet obstruction. MATERIALS AND METHODS: A total of 58 male patients with moderate to severe lower urinary tract symptoms (LUTS) were selected. Seven patients were excluded; thus, 51 patients were finally enrolled. Each of the patients underwent a PCT and a subsequent PFS. The sensitivity (SE), specificity (SP), positive predictive value (PPV), negative predictive value (NPV), and likelihood ratio were calculated. Chi-square and Fisher exact test were used to evaluate relationships between PCT results and maximal urine flow (Qmax); a p<0.05 was considered statistically significant. RESULTS: The mean (±standard deviation) age of the study group was 65.5±10.4 years. Overall, by use of the PCT, 24 patients were diagnosed as being obstructed and 27 patients as unobstructed. At the subsequent PFS, 16 of the 24 patients diagnosed as obstructed by the PCT were confirmed to be obstructed, 4 were diagnosed as unobstructed, and the remaining 4 patients appeared equivocal. Of the 27 patients shown to be unobstructed by the PCT, 25 were confirmed to not be obstructed by PFS, with 13 equivocal and 12 unobstructed. Two patients were diagnosed as being obstructed. For detecting obstruction, the PCT showed an SE of 88.9% and an SP of 75.7%. The PPV was 66.7% and the NPV was 93%. CONCLUSIONS: The PCT is a beneficial test for evaluating patients with LUTS. In particular, this instrument has an acceptable ability to reject obstruction caused by benign prostatic hyperplasia.

Tacrolimus rescue therapy for corticosteroid-resistant and polyclonal antibody-resistant kidney allograft rejections

The conventional treatment of acute kidney allograft injection consists of high-dose corticosteroids and polyclonal antibodies. We report our experience of tacrolimus rescue therapy in patients with acute rejections refractory to corticosteroids and polyclonal antibodies. A total of 34 patients with a mean age of 42.3 years and clinical diagnosis of acute kidney allograft rejection underwent tacrolimus rescue therapy when treatment with corticosteroids and polyclonal antibodies failed. Kidney allograft biopsy results were available in 21 patients. All of the patients received tacrolimus, 0.1 mg twice daily, and in those who responded to the therapy after 4 to 6 months, tacrolimus was replaced with cyclosporine. Pathologic examination of 21 biopsy specimens of the kidney allografts showed acute vascular rejection in 7 patients [33.3%, acute humoral rejection in 6 [28.6%], acute cellular rejection in 3 [14.3%], and accelerated acute rejection in 3 [14.3]. Twenty-six patients [76.5%] responded to rescue therapy with tacrolimus and discharged with a mean serum creatinine level of 1.4 mg/dL [range, 1.1 mg/dL to 1.7 mg/dL]. Allograft nephrectomy was done in 8 patients [23.5%] because of no response to treatment of rejection, the pathology reports of which consisted of acute vascular rejection in 5 patients and extensive necrosis in 3. Tacrolimus therapy is able to salvage kidney allograft with acute refractory injection. We recommend that tacrolimus be used as an alternative to the conventional drugs used for antirejection therapy. However, severe infectious complications as a result of overt immunosuppression must be considered

Sexual dysfunction in aging men with lower urinary tract symptoms

Our aim was to evaluate the relationship between lower urinary tract symptoms [LUTS], age, and sexual dysfunction in the Iranian men aged 50 to 80 years. A total of 357 men aged 50 to 80 years presenting at the urological clinic were enrolled in this study. The International Prostatic Symptom Score [IPSS] and the International Index of Erectile Function [IIEF] questionnaires were used to assess the LUTS and sexual function, respectively. The questionnaires were completed by face-to-face interview. Logistic regression model was used for multivariate analysis of the risk factors of sexual dysfunction and its domains assessed by the IIEF. Of the patients, 332 [93%] were sexually active with a median sexual attempts of 4.6 times per month. Frequency of sexual attempts was inversely related to LUTS severity [P < .001]. Advanced age was positively associated with LUTS severity [r = 0.534, P < .001]. Sexual dysfunction, defined as IIEF score of 20 and less, was present in 68.2% of the patients. All IIEF domain scores and the overall score were correlated with age [P < .001] and the IPSS [P < .001]. In a multivariate analysis, age, diabetes mellitus, and the IPSS were strong independent predictors of the overall IIEF score. Sexual activity as an important component of the quality of life continues in the majority of men over 50 years. However, their sexual function can be severely affected by LUTS and its severity