Paradoxical Air Embolism during Percutaneous Nephrolithotomy: A Case Report

Air embolism is a rare complication of percutaneous nephrolithotomy. Patent foramen ovale, which is necessary in fetal circulation, is a potential route for emboli arising from the venous system to enter the systemic arterial circulation, resulting in paradoxical air embolism syndrome. A case of paradoxical air embolism during percutaneous nephrolithotomy is presented. To our knowledge, this is the first report of paradoxical air embolism associated with patent foramen ovale during percutaneous nephrolithotomy.

The Effectiveness of Non-contrast Computerized Tomography (CT) in Evaluation Ofresidual Stones after Percutaneous Nephrolithotomy / 대한비뇨기과학회지

PURPOSE: The sensitivity of antegrade pyelogram (AGP), plain film radiography (KUB) and non-contrast, thin cut abdomen computerized tomography (CT) were prospectively compared for the detection of residual stones following a percutaneous nephrolithotomy. MATERIALS AND METHODS: Fifty patients (53 renal units), who had undergone a percutaneous nephrolithotomy for radiopaque renal pelvis stone, as well as a non-contrast abdomen CT 1 month postoperatively, were prospectively evaluated. The number and size of residual fragments, as determined by immediate postoperative AGP, postoperative 1 month KUB and abdomen CT, were compared. RESULTS: The stone-free rates according to the AGP, KUB and non-contrast CT were 73.6 (39/53), 62.3 (33/53) and 20.8% (11/53), respectively. In terms of clinically insignificant residual fragments (CIRFs), the success rates were 84.9 (45/53), 83.0 (44/53) and 41.5% (22/53), respectively. With respect to the residual stones (22 cases), which were detected by CT, but not by KUB, 45.5% (10 cases) were more than 4mm in size on CT, with a mean size of 7.4mm. The sensitivity for the detection of residual fragments was 47.6% for KUB compared to 100% for non-contrast CT. Seven patients received additional extracorporeal shock wave lithotripsy (ESWL) for residual stones following CT. CONCLUSIONS: Non-contrast, thin cut abdomen CT is the most accurate imaging modality for determination of the stone-free rate following a PCNL. Non-contrast abdomen CT gives accurate information for the selection of patients who may benefit from additional ESWL treatment and for follow-up planning.

Long-term Outcome of Endopyelotomy for the Treatment of Ureteropelvic Junction Obstruction / 대한비뇨기과학회지

Purpose: The treatment outcome of endopyelotomy is now being re-evaluated in the era of laparoscopic pyeloplasty. This study was performed to evaluate the long-term success rate of an endopyelotomy for the treatment of an ureteropelvic junction obstruction (UPJO). Materials and Methods: Between January 1995 and December 2003, 77 patients with an UPJO (mean age 35.2+/-13.89) underwent 85 endopyelotomies, with a percutaneous approach in 10 and a retrograde approach in the other 75 cases. The mean number of the procedure was 1.14, with 69 patients undergoing a single procedure. Endopyelotomies were performed using either a cold knife (n=26), Ho:YAG laser (n=47) or a hook electrode (n=12). Treatment success was defined as symptomatic relief, with radiographic resolution or stabilization of renal function in the excretory and/or diuretic renograms. A Kaplan-Meier curve of the long-term success was generated, and the preoperative hydronephrosis and renal function correlated with the success rate. Results: With a median follow-up of 37.1 months (3-98), the overall success rate was 67.5%. The median time to failure was 7.7 months (1-50). The Kaplan-Meier estimates of success were 87.8, 76.9, 72.2, 68.7, 64.8 and 61.6% at 1, 12, 18, 24, 36 and 60 months, respectively. The success rate was not significantly affected by the etiology, the approach and the incisional methods. The degree of hydronephrosis and renal function showed no significant correlation with the success rate. Conclusions: The success rates of an endopyelotomy decreased with increasing follow-up period. In our conclusion, a long-term follow-up, at least as long as 36 months, is mandatory in patients having undergone an endopyelotomy for an ureteropelvic junction obstruction, although the majority of failures were found within 1 year.

Early Experiences of the Transurethral Needle Ablation(TUNA) in BPH / 대한비뇨기과학회지

PURPOSE: TUNA is a new minimally invasive treatment modality for the patients with benign prostatic hyperplasia of prostate utilizing low levels of radiofrequency energy. We presented our early experiences of TUNA for the treatment of BPH to evaluate its clinical outcome. MATERIALS AND METHODS: From July 1995 to March 1997, 36 patients were treated with TUNA(15 with manual system, 21 with automatic system). Mean age of the patients was 63.5 years. All patients were evaluated preoperatively with PSA, AUA symptom score, uroflowmetry and transrectal ultrasonography(TRUS). AUA symptom score at 1, 3, 12 month and uroflowmetry at 1, 3 month postoperatively were available for analysis. RESULTS: Mean PSA value was 3.4ng/ml and mean prostate volume by TRUS was 35.5gram preoperatively. Nine out of 36 procedures were performed with local anesthesia. Mean operating time was 45.6 minutes. At postoperative 3 and 12 month, symptom score was improved from 22.0+/-1.5 to 11.7+/-1.6 and 11.0+/-1.9(p<0.05), respectively and maximal flow rate was increased from 11.2+/-0.7ml/sec to 14.4+/-1.5ml/sec at postoperative 3 month(p<0.05). Results have been far better since using automatic system. Complications were observed in one patient with clot retention and in 11 patients with postoperative urinary retention. CONCLUSIONS: TUNA is a simple, safe, efficacious and minimally invasive treatment procedure with short hospital stay, less morbidity for treatment of the patients with BPH. It could also be performed with local anesthesia. We suggest that TUNA would be a new promising treatment modality for BPH.

Growth Inhibitory Effects and Mechanisms of Ceramides in Renal Cell Carcinoma Cells / 대한비뇨기과학회지

PURPOSE: Because metastatic renal cell carcinoma responds to various forms of therapy with low remission rates, safe therapeutic agents is urgently needed. Ceramide is a potent and specific suppressor of cell growth and an inducer of apoptosis via an intracellular mediation of the sphingomyelin cycle. The present study was designed to assess the growth inhibitory effects and their mechanisms of C2-ceramide and C6-ceramide in renal cell carcinoma cells. MATERIALS AND METHODS: A standard microculture tetrazolium(MTT) assay was used to measure the cytotoxicity of C2-ceramide and C6-ceramide in renal cell carcinoma cell line A498. Apoptosis was confirmed by DNA fragmentation assay using agarose gel and TdT-mediated biotin-dUTP nicked-end labelling(TUNEL) technique. C2-ceramide and C6-ceramide were injected to the A498 tumor which was formed after A498 cells were implanted subcutaneously in athymic mice. Growth inhibitory effects of ceramides were examined biweekly. RESULTS: The survival fractions of A498 cells were 92.6+/-6.0, 82.8+/-14.0, 66.4+/-11.3, 41.8+/-9.6 and 24.3+/-6.3% for the concentrations of C2-ceramide 2, 4, 6, 8 and 10microM, repectively. IC50 of C2-ceramide was approximately 6.7microM. The survival fractions of A498 cells were 60.9+/-5.0, 23.4+/-3.0, 8.7+/-2.1, 5.0+/-1.2 and 3.3+/-0.6% for the concentrations of C6-ceramide 2, 4, 6, 8 and 10microM, respectively. IC50 of C6-ceramide was about 2.3microM. There were DNA fragmentations in A498 cells treated with C2-ceramide or C6-ceramide on the agarose gel and apoptotic tumor cells were also identified after treatment of C2-ceramide and C6-ceramide in TUNEL method. In in vivo study using athymic mice, the growth of A498 tumors was significantly suppressed by C2-ceramide and C6-ceramide. In vivo tumor suppressive effect was more prominent with C6-ceramide than with C2-ceramide. There`s no toxicity-related death of ceramide-treated athmic mice for 3 months. CONCLUSIONS: C2-ceramide and C6-ceramide have the growth inhibitory effects in human renal cell carcinoma cell line A498 by apoptosis mechanism in vitro and they have the in vivo tumor suppressive effects in athymic mice. C6-ceramide was more effective than C2-ceramide in both in vitro cytotoxicity test and in vivo animal experiment of growth inhibition. Therefore, ceramides may be used to treat metastatic renal cell carcinoma in the future.

Prevalence of Stress Urinary Incontinence and Bladder Irritative Symptoms in Women: a Community Based Survey / 대한비뇨기과학회지

PURPOSE: The interest has been growing in the investigation and management of lower urinary tract symptoms, but their prevalence in the general population has so far been based on the estimates made in selected groups of women in Korea. The object of this study was to determine the prevalence of stress urinary incontinence and bladder irritative symptoms of women in rural region in Korea through a community based survey. Also, we investigated the relationship between age, parity, oral contraception, smoking, menopause and obesity and the prevalence of stress urinary incontinence. MATERIALS AND METHODS: A questionnaire survey was performed in a sample of randomly selected 1162 women aged 30 years and over, in 31 villages in the town of Jeong-Eup, Korea. From February 4th to February 22nd, 1997, trained field workers visited every home and interviewed every eligible individual with the questionnaires, which included data on stress urinary incontinence, bladder irritative symptoms, quality of life, reproductive and menstrual history, and use of oral contraceptives. Among 1162 women, 857 responded to questionnaires, and 827 questionnaires were available for analysis. The response rate was 73.5%. The prevalence of stress urinary incontinence was defined as the proportion of the women in the population surveyed who experienced stress urinary incontinence at least twice a week. We defined diurnal frequency as the episodes of voiding again within 2 hours after initial voiding in the series of 5 consecutive voidings during one month period. The urgency was defined as she found it difficult to hold urination, once or more in the series of 5 consecutive voidings and nocturia twice or more per night. RESULTS: The prevalence of stress urinary incontinence was 20.4%. Only seven(4.1%) women carried a sanitary towel or diaper as protection against urinary leakage. The prevalence of stress incontinence among age groups revealed no significant difference. Statistically significant correlation was noted between obesity and the prevalence of stress incontinence. Diurnal frequency was recorded by 375 women(45.3%); 171(20.6%) experienced this symptom more than three times. Urgency was reported by 268 women(32.4%) and 63(7.6%) were always troubled by this symptom. Nocturia 3 times or more every night was recorded by 341 women(42.2%) and 83(10.0%) had nocturia 5 times or more. The severity of nocturia increased significantly with age. CONCLUSIONS: The prevalence of stress urinary incontinence and irritative symptoms in this study is similar to previous studies performed in other countries while the rate of nocturia is much higher in this study. Although stress urinary incontinence and bladder irritative symptoms are relatively common in this community, only few people are seeking for care of these symptoms. Therefore, it is very important to educate the public and promote awareness of this medical problem in this community.

Two-year Experiences of Ureteral Stones: SWL Versus Ureteroscopic Manipulation / 대한비뇨기과학회지

PURPOSE: Shockwave lithotripsy(SWL) and ureteroscopic manipulation became the standard treatments for ureteral stones in recent years. There still exists significant debate as to the most appropriate treatment modality for ureteral stone management. MATERIALS AND METHODS: From January 1994 to December 1995, 651 patients of ureteral stones were treated and 589 patients were retrospectively reviewed excluding 62 patients for incomplete follow ups. Four hundred and forty-two patients were treated with SWL using MPL 9000 with ultrasonic guidance, 115 patients with ureteroscopic manipulation using 7.9 to 11.5Fr rigid and semirigid ureteroscopes. RESULTS: In SWL treatments, overall stone free rate was 74.7% with one session, Stone free rate was significantly affected by the size of stones. Stone free rate was 83.6% when the stone was smaller than 1.0cm and 42.1% when the stone was larger than 1.0cm Stone free rate after second SWL session was 84.4% and 90.3% after third session. The stone free rates according to the site of stones were 72.4(proximal), 70.0(mid), 80.2(distal), respectively. In ureteroscopic manipulation, overall stone free rate of 87.8% was obtained regardless of the size of stones. The success rates according to the location of stones were 75.0(proximal), 94.6(mid), 86.4%(distal), respectively. Open ureterolithotomy was performed in 32 patients with 100% success rate. CONCLUSIONS: In our study, the size of stones was the most important factor influencing the success rate of SWL treatment for ureteral stones. We consider ureteroscopic manipulation as the first line treatment modality when the stone is larger than 1.0cm, especially in distal ureter, Proper selection of patients for in situ SWL or ureteroscopy would improve the results of initial treatment.

Use of Serum PSA in Comparison of Biopsy Gleason Score with Radical Prostatectomy Gleason Score / 대한비뇨기과학회지

PURPOSE: The Gleason score of needle biopsies of the prostate and preoperative serum level of prostate-specific antigen(PSA) are two useful factors in predicting the final pathological staging of patients with prostate cancer treated by radical prostatectomy. Unfortunately, the Gleason score of the biopsy cores often differs from the Gleason score of radical prostatectomy specimen. We evaluated the role of Gleason scores of biopsy cores and the influence of PSA in predicting the Gleason scores of prostatectomy specimens and final pathological staging. MATERIALS AND METHODS: The records of 52 patients with prostate cancer treated by radical prostatectomy from June 1990 to June 1997 were reviewed. The patients were divided into three groups according to the sum of the Gleason scores, i.e. well differentiated(Gleason score 2-4), intermediate(5-7) and poorly differentiated tumors(8-10). The concordance between Gleason score of biopsy and prostatectomy specimen was analysed according to the Gleason score of tumor in biopsy specimen. Furthermore, we evaluated the different level of PSA could affect the concordance rate between Gleason scoreofbiopsyandprostatectomyspecimen. RESULTS: In well-differentiated tumors(Gleason score 2-4) in biopsy specimen, the concordance rate was 55.6%, In intermediate(5-7) differentiated cancers the Gleason score remained the same in 68%. In poorly differentiated tumors, the concordance rate was 72.2%. When PSA was less than 10ng/m1, concordance rate of well differentiated tumors and poorly differentiated tumors was 75%, 40%, respectively. Whereas the concordance rate of well differentiated tumors was 50% and that of poorly differentiated tumors was 90% when the PSA was higher than 20ng/m1. Using linear regression analysis, the preoperative PSA highly correlated with radical prostatectomy Gleason score(correlation coefficient(r)=0.38, p =0.005). CONCLUSIONS: The Gleason score of prostatectomy specimen was upgraded in 44.4% when the biopsy Gleason score was well differentiated, especially when preoperative PSA was higher than 20ng/m1. Therefore, the significance of biopsy Gleason score in the clinical application must be used cautiously when it is used to predict the pathological stage or biological potential of the cancer especially when it is low Gleason score with high PSA( > 20ng/m1). In the meantime, the level of PSA plays an significant role in determining organ confined disease, while high Gleason scone reflect the Iymph node positive disease.

Recovery from Abnormal Spermatogenesis after Exposure to Solvent 5200 / 대한비뇨기과학회지

PURPOSE: Solvent 5200(heptane 1.97%, 2-bromopropane 97.92% and 1,2-dibromopropane 0.02%) is a widely used detergent in electronic industries. The toxic effect of this chemical on spermatogenesis were investigated. MATERIALS AND METHODS: Eight employees who showed abnormal semen analyses after exposure to Solvent 5200 for one year to eleven years underwent hormonal tests, semen analyses, testicular biopsies one month after cessation of exposure and then three consecutive semen analyses during 8 months follow-up period. RESULTS: All patients(mean age: 33 years old) had decreased sperm count including azoospermia in one Patient. Five patients also had decreased sperm motility. One azoospermic and two oligospermic patients had elevated serum FSH level. Histology of testes in six patients showed abnormal histologic findings such as atrophy of seminiferous tubules, thickening of the basement membrane and hyperplasia of Leydig cells. Follow-up semen analysis during eight months period after cessation of exposure to Solvent 5200 revealed increased sperm count in all patients including four patients recovering to normal range. Conclusion: Our studies suggest that Solvent 5200 could induce histolcgic change of testes as well as impairment of spermatogenesis and this process could be reversed by avoidance of exposure to this chemical substance.

Prevalence of Stress Urinary Incontinence and Bladder Irritative Symptoms in Women: A Community Based Survey

No abstract available.

Role of Clinical Stage, PSA and Gleason`s Score in Predicting Pathologic Outcome in Prostate Cancer / 대한비뇨기과학회지

Preoperative clinical staging in the prostate cancer does not always accurately predict the surgical-pathological outcome. We evaluated how the clinical staging, and other clinical parameters including preoperative PSA and Gleason`s score could reflect on the surgicopathological findings in 30 patients with prostate cancer, who underwent radical prostatectomy. Twelve of 24 patients with clinical T1 or T2 disease were understaged by clinical staging determined by digital rectal examination, bone scan, and radiologic studies including CT and MRI with endorectal coil. MRI with endorectal coil accurately reflected the extracapsular disease only in 59.1% of 22 patients studied. At the same time, it also showed low sensitivity (50%) with high specificity (100%) in detecting lymph node metastasis. Preoperative levels of PSA in patients with P2, P3, and N+ disease were 17.8 +/- 4.5, 47.9 +/- 11.3, 93.5 +/- 20.5ng/ml, respectively. The level of PSA was less than 20ng/ml in 9 of 12 patients with P2 disease, while they were greater than 20ng/ml in 9 of 12 patients with P3 disease. PSA may have a role to rule out lymph node metastasis when its level is less than 10ng/ml, although it did not reach the statistical significance because of small sample size. Gleason`s scores in patients with P2 disease were quite similar to those in patients with P3 disease (5.92 +/- 0.69 vs 5.67 +/- 0.56), whereas Gleason`s scores in all 6 patients with N+ disease were 9 or greater. Neoadjuvant hormonal therapy with LH-RH analogue and androgen receptor blocker for 1.5 to 3 months had no impact on the reduction of margin positivity or downstaging in 10 patients. PSA failure rate in patients with P2 and P3 disease was 25% at 1 year after operation. PSA is a good marker for differentiating between P2 and P3 disease (,p=0.0214) and can safely rule out N+ disease if its level is below 10ng/ml, while Gleason`s score may reflect the lymph node metastasis when it is 9 or greater (p=0.0012). Among the candidates for radical prostatectomy, selection of the patients on the basis of PSA and Gleason`s score might improve the surgical-pathological outcome.

Trigger Point Injection of Bupivacaine Hydrochloride for Chronic Nonvisceral Pelvic Pain in Women / 대한비뇨기과학회지

Enigmatic chronic pelvic pain is the persistence of unexplained pain in the low abdomen and pelvic lesions without evidence of active disease. One of the most frequent causes is the nonvisceral pain such as myofascial and postsurgical incisional origin. We evaluated the trigger point injection of bupivacaine hydrochloride as a treatment option for chronic nonvisceral pelvic pain. From March, 1995 to May, 1996, 35 female patients (16 to 68 years old, mean 43.7 years ) with localized chronic pelvic pain for 6 months to 10 years were managed by trigger point injection. After confirming the absence of intraabdominal pathology by physical examination and Carnett`s test, 3 to 5 ml of 0.25% bupivacaine hydrochloride was injected to the most hyperpathic foci with 22 gauge, one and half inch needle percutaneously. The mean followup time was 9.7 months. The results were assessed by Visual Analogue Scale(VAS) and subjective symptoms. Twenty six patients had nonincisional pain and 9 had incisional pain. Twenty two patients were treated by only one session while others needed two or more sessions(maximum 4 sessions). The sites of pain were hypogastrium, suprapubic area and iliac fossa in the order of frequency. The mean VAS value at the time of last followup was reduced to 1.7 cm(0 - 5.7 cm) from 6.7 cm(4.9 - 9.1 cm). The improvement of pain occurred mostly within 1 week after treatment and was maintained thereafter. Eighty percent of patients expressed more than 50% reduction of pain by VAS. Sixteen patients(45.7%) responded ""pain free"", 10(28.6%) ""occasional"", 6(17.1%)"" present but better"", and 3(8.6%) ""no change"". The successful responses were noted in 74.3%. No significant complications were identified. These results demonstrated that the trigger point injection is an easy, safe and effective treatment option for chronic nonvisceral pelvic pain.

Trigger Point Injection of Bupivacaine Hydrochloride for Chronic Nonvisceral Pelvic Pain in Women / 대한비뇨기과학회지

Enigmatic chronic pelvic pain is the persistence of unexplained pain in the low abdomen and pelvic lesions without evidence of active disease. One of the most frequent causes is the nonvisceral pain such as myofascial and postsurgical incisional origin. We evaluated the trigger point injection of bupivacaine hydrochloride as a treatment option for chronic nonvisceral pelvic pain. From March, 1995 to May, 1996, 35 female patients (16 to 68 years old, mean 43.7 years ) with localized chronic pelvic pain for 6 months to 10 years were managed by trigger point injection. After confirming the absence of intraabdominal pathology by physical examination and Carnett`s test, 3 to 5 ml of 0.25% bupivacaine hydrochloride was injected to the most hyperpathic foci with 22 gauge, one and half inch needle percutaneously. The mean followup time was 9.7 months. The results were assessed by Visual Analogue Scale(VAS) and subjective symptoms. Twenty six patients had nonincisional pain and 9 had incisional pain. Twenty two patients were treated by only one session while others needed two or more sessions(maximum 4 sessions). The sites of pain were hypogastrium, suprapubic area and iliac fossa in the order of frequency. The mean VAS value at the time of last followup was reduced to 1.7 cm(0 - 5.7 cm) from 6.7 cm(4.9 - 9.1 cm). The improvement of pain occurred mostly within 1 week after treatment and was maintained thereafter. Eighty percent of patients expressed more than 50% reduction of pain by VAS. Sixteen patients(45.7%) responded ""pain free"", 10(28.6%) ""occasional"", 6(17.1%)"" present but better"", and 3(8.6%) ""no change"". The successful responses were noted in 74.3%. No significant complications were identified. These results demonstrated that the trigger point injection is an easy, safe and effective treatment option for chronic nonvisceral pelvic pain.

Diagnostic Efficacy of Biochemical Studies and MIBG Scan in Pheochromocytoma / 대한비뇨기과학회지

We evaluated the role of clinical symptoms, biochemical studies and metaiodobenzylguanidine (MIBG) scan in the diagnosis of pheochromocytoma. From August 1991 to June 1997, 42 patients with complaints of hypertension or adrenal mass were evaluated with MIBG scan, 24 hour urinary vanillylmandelic acid (VMA), serum and 24 hour urinary catecholamine and radiologic studies such as CT, MRI or ultrasonography. Initial 9 patients were evaluated with 131 I-MIBG scan and the rest 33 patients with 123 I-MIBG scan. Of 42 patients, histologic diagnosis was obtained in 32 patients including 23 patients with pheochromocytoma or paraganglioma and 9 patients with other adrenal or extra-adrenal tumors. Remaining 10 patients had no evidence of adrenal disease on radiologic studies. Paroxysmal symptoms or hypertension was noted in 14 patients with pheochromocytoma or paraganglioma, while it was also found in 12 out of 19 patients without pheochromocytoma or paraganglioma. Sensitivity, specificity and positive predictive value (PPV) of each diagnostic modality were 60.9%, 92.9% and 93.3% in 24 hour urinary VMA, 61.9%, 75.0%, and 81.3% in 24 hour urinary catecholamine, 82.6%, 94.7%, and 95.0% in MIBG scan, respectively. Sensitivity and specificity were improved to 86.9% and 100% when 24 hour urinary VMA and MIBG scan were combined. In conclusion, MIBG scan was the most useful single screening method for the diagnosis of pheochromocytoma, and combination of MIBG scan and 24 hour urinary VMA would enhance the diagnostic accuracy.

Fluoxetine as a Treatment for Premature Ejaculation: A Double-Blind, Randomized, Placebo-Controlled Study / 대한비뇨기과학회지

Premature ejaculation is the most common male sexual dysfunction and defined as persistent or recurrent occurrences of ejaculation before or shortly after penetration. But there has never been any effective oral agents for the patients with premature ejaculation. Recently, fluoxetine, a potent serotonin reuptake inhibitor, being used as antidepressant, has been suggested to be helpful for the patients with premature ejaculation. Twenty three male outpatients with premature ejaculation were randomly divided into fluoxetine (n=12) and placebo (n=11) group. In the fluoxetine group, the dose of fluoxetine was 20 mg/day for the first one week and 40 mg/day for the remaining 5 weeks. Patient and his female partner were interviewed separately before starting medication, three weeks and six weeks after medication. The mean intravaginal ejaculation latency time increased to 187.5 seconds after 3 weeks and 254.2 seconds after 6 weeks front 46.7 seconds before treatment (p<0.05). Only 1 out of 12 patients in the fluoxetine group was able to have thrusts over 30 times before treatment. After 3 weeks of Treatment, 8of 12 patients and after 6 weeks of treatment, 7 patients were able to have thrusts over 30 times. There was no significant improvement of intravaginal ejaculation latency time and number of thrusts in the placebo group. Symptomatic improvement was noticed in 75% with fluoxetine group and 18.2% with placebo group. Side reactions of fluoxetine, fatigue and yawning, were noticed in 41% of the patients, but they did not interfere with their daily activities. These findings suggest that fluoxetine can be safely used as a good pharmacotherapeutic treatment for the patients with premature ejaculation.