Evaluation of the effect of sildenafil and/or doxazosin on Benign prostatic hyperplasia-related lower urinary tract symptoms and erectile dysfunction

To verify the association between lower urinary tract symptoms [LUTS] and erectile dysfunction [ED] and evaluate the influence of sildenafil and doxazosin either as single agents or combined on both symptoms. A prospective randomized study including 150 patients presented with LUTS caused by BPH in association with clinically diagnosed ED, with age equal or more than 45 years from April 2010 to April 20011. They were categorized into three comparative groups each one containing 50 patients. These groups were comparable regarding pretreatment international prostate symptoms score [IPSS] and international index of erectile function [IIEF]. The patients of the first group were given sildenafil 50 mg as monotherapy, those of the second group were given doxazosin 2 mg and those of the third group were given combination of both drugs for 4 months for each group. The main post-treatment parameters for assessment and comparison include assessment of patient's symptoms by repeated IPSS and IIEF, uroflowmetry and assessment of PVR. The statistics was done by use of the chi-square test Pre-treatment parameters were assessed and compared between the three groups. After 4 months of treatment, the comparative parameters were applied to all groups and the differences were measured post-treatment regarding IPSS, erectile function score, uroflowmetry, and post-void residual [PVR] urine. Sildenafil alone caused mild improvement in IPSS, more improvement in IIEF score, and little effect on flow rate and PVR urine. Doxazosin alone caused more improvement in IPSS, flow rate and PVR urine and less improvement in IIEF score. A combination of both sildenafil and doxazosin caused more improvement in all of the comparative parameters than when each drug was given alone. There is a strong relationship between LUTS and ED. Doxazosin or sidenafil as a single drug could be used in treating mild or mild to moderate symptoms but more severe symptoms may usually need a combination of both drugs

Extension of complete penile disassembly for repair of incontinent epispadias

This study aimed to utilize the technique of complete penile disassembly of the epispadias phallus into three discrete components to straighten the penile shaft, ventralize the tabularized urethral plate and to tighten the incompetent bladder neck and evaluate the results of this technique. Five male patients aged five to thirty- five years were presented for repair of epispadias [three patients were coming for primary repair and two had previous failed attempted repair]. Primary cases had classic penopubic epispadias and were partially or totally incontinent. Follow up for three-ten months revealed a conical glands in four patients, straight penile shaft angulated downward during standing in five cases with apical meatus in four and reasonable dry interval in five with occasional bed wetting in two. Glands separation occurred in one patient and dorsal coronal fistula in another one and was successfully repaired. The neourethra was of even calibre and easily catheterizable without stenosis or stricture formation

Multiple tissue transfer to minimise fistulization of hypospadias repair

In this study, various tissue flaps from local donor sites were used to minimize fistulization of the reconstructed urethra in 45 cases with complex hypospadius repair. Primary one stage repair was performed in 28 cases and secondary reconstruction was done for 17 cases with previous failed repairs. For redo cases, wrapping of the reconstructed urethra by pedicled tunica vaginalis flap was performed for eight cases and by scrotal dartos flap in nine cases. In the remaining 28 cases, primary urethral reconstruction was performed in the usual way [onlay island preputial flaps with intact urethral plate in 18 cases and tubularized pedicled preputial flaps with division of the plate in 10 cases]. After urethral reconstruction, the splayed spongiosum was mobilized distally and wrapped around the repaired urethra in those cases with intact urethral plate. The redundant pedicles of the preputial flaps were used for additional wrapping of the neourethra in all 28 cases. With tunica vaginalis wrapping, two cases developed fistula and meatal stenosis in one patient with glans channel. In the scrotal dartos wrapping group, one case of permanent fistula, one urethral stricture and one meatal stenosis were recorded. In the preputial and penile dartos wrapping of primary repair, the rate of fistula markedly dropped. The overall incidence of fistula in both redo and primary cases was four out of forty-five cases approximating the ideal goal of very low rate of fistula