Sildenafil citrate for erectile dysfunction in patients with end stage renal disease

OBJECTIVE: To assess the available literature evaluating the safety and efficacy of sildenafil citrate in improving erectile function in patients with end stage renal disease.METHODS: From the period of 1990-June 2016, the authors assessed the Cochrane Register of Controlled Trials and Medline for randomized controlled trials evaluating the safety and efficacy of sildenafil citrate for the treatment of erectile dysfunction in patients with chronic renal disease. Review authors selected articles for inclusion, extracted data and assessed trial quality. Risk ratios were determined and reported for dichotomous data and mean differences with 95% confidence intervals for continuous data.RESULTS: Three randomized control trials involving a total of were identified. All trials investigated the safety and efficacy of sildenafil citrate in patients with chronic renal disease. Pooled analysis of the trials showed statistically significant improvement in the IIEF score with sildenafil citrate on the study as well as on the meta-analysis level. Pooled analysis of all three trials shows no statistical difference with regards to side effects between the treatment arms on the meta-analysis level. Common side effects include nausea, headache and palpitation.CONCLUSION: Based on the meta-analysis of the available literature, oral sildenafil citrate is an effective and safe treatment for erectile dysfunction in patients with chronic kidney disease.

The clinical safety and efficacy of upper pole access percutaneous nephrolithotomy (uPPCNL) for inferior pole stones

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> Traditionally, percutaneous nephrolithotomy (PCNL) for a lower pole stones are directly removed through an inferior polar access. The authors preferentially treated inferior pole calculi with an upper polar access and evaluated the clinical outcomes.<br /><strong>METHODS:</strong> Between January 2010 and April 2016, 32 patients with inferior calyceal stones were treated uPPCNL. All stones were diagnosed using an unenhanced CT scan. The efficacy (stone-free rate) was determined by comparing the preoperative and postoperative imaging. Clinical safety was assessed based on intraoperative parameters pertaining to operative time, blood loss, urinary extravasation, calyceal injury, pelvic perforation and other untoward events. These complications were summarized using the Clavien-Dindo grading system.<br /><strong>RESULTS:</strong> The male to female ratio is 1.1:1. All stones included in the study were pure inferior calyceal in location. The average stone size was 1.65±0.84cm (Range:0.6-4.4) with a mean durility of 936±298HU (Range: 350-1500). Stone-free rate was 96.8% (31/32) after a single session of PCNL. The mean operative time was 97±43 minutes (Range:40-230). According to the Clavien-Dindo classification, 26(81.3%) had no complication, 5 (15.6%) had Grade 1 (fever), and 1 (3.1%) had Grade 2.<br /><strong>CONCLUSION:</strong> uPPCNL is effective and safe for patients with inferior calyceal stones and confers the following advantages 1) shorter skin-to-calyceal distance 2) straight line to the UPJ and inferior pole 3) a panoramic view of the collecting system 4) less stone migration 5) minimal torque of the nephroscope. This minimally invasive procedure achieves a high stone clearance rate with acceptably low complication rates.</p>