effectiveness of tramadol in treatment of premature ejaculation on-demand basis

Premature ejaculation [PE] is a worldwide problem. Selective serotonin reuptake inhibitors [SSRIs] are widely used "off label" as pharmacotherapeutic agents in the treatment of PE. Assess the efficacy of Tramadol for on-demand treatment of PE. During the period December 2008 through November 2009, 60 married men visited the surgical specialties hospital urology outpatient and consultancy clinics complaining of premature ejaculation were enrolled in this study. Intravaginal ejaculation latency time [IVELT] was used as an objective tool to assess the efficacy of the investigated treatment. Single-blind, placebo-controlled therapeutic trial was conducted on 60 patients with lifelong PE. PE was defined as IVELT of <2 minutes in at least 80% of intercourse episodes. The patients cohort was randomised into 2 equal sized groups. The intervention group [n=30] used 50 mg tablet of Tramadol hydrochloride, while the control group [n=30] used a placebo tablet for 8 weeks. Drugs were taken 1-2 hours before sexual activity, and sexual intercourse was required at least once per week. IVELT was timed by a stopwatch at each intercourse. The mean IVELT after tramadol and placebo significantly increased from 73.1 and 67.9 seconds to approximately 442.1 and 113.3 seconds, respectively [P < 0.001]. Sexual satisfaction was used to assess the cut-off values of IVELT in defining the minimal and best clinical response to treatment. There was no withdrawal symptoms recorded following the use of tramadol or placebo, but more adverse events were associated with tramadol treatment. Tramadol seems to provide significantly better results in terms of IVELT and intercourse satisfaction versus placebo. Further studies are required to draw final conclusions on the efficacy of this drug in premature ejaculation.

role of addition of diclofenac sodium to imipramine in treating children with nocturnal enuresis

Nocturnal enuresis presents a common medical problem all over the world, over many years various therapeutic options have been tried; none was proved to be superior, because the defect occurs at many levels in the urinary tract and its neuronal control. Nowadays prostaglandins have been proved to play a role at renal, bladder, urethral and sympathetic control of urinary system. We evaluated the role of diclofenac sodium when added to the conventional imipramine therapy in treating patients with primary nocturnal enuresis. 70 children complaining of nocturnal enuresis were enrolled in this study, half of them were given imipramine alone and the other half were given a combination of imipramine and diclofenac sodium at night before retiring to bed, and the number of wet nights per week was recorded on a calendar sheet by the parents over 4 weeks, those who showed more than 50% reduction in the number of wet nights a week were regarded as responders, who were followed after cessation of treatment over another 6 weeks to look for relapse. Of the patients treated with imipramine alone 57.14% [20/35] showed more than 50% decrease in the number of wet nights weekly compared to those treated by imipramine and diclofenac sodium who showed 84.84% [28/33] response rate [> 2.5 SE of difference between responding proportions]. The relapse rate after stopping treatment was 60% [12/20] in the first group compared to 32.1% [9/28] which exactly two times the SE of difference between relapsing proportions. The addition of diclofenac sodium to imipramine in treating patients with primary nocturnal enuresis might have caused a highly significant higher response rate and a fairly significant lower relapse rate after cessation of treatment