Preference for erectile dysfunction treatments: Assessment by means of consumers preference analysis techniques.

INTRODUCTION: Patient preference for erectile dysfunction (ED) treatments is of great importance for satisfaction and adherence. We have assessed the usefulness of the main technique for assessing consumer preferences (conjoint analysis) to analyze preferences towards these treatments. We also assessed the influence of age, frequency of sexual intercourse, co-morbidities, ED severity or having testosterone deficiency syndrome (TDS). MATERIAL AND METHOD: Observational, cross-sectional, multicenter study in 626 men aged ≥18 years that had recently taken at least two different PDE5i, one being vardenafil orodispersible (ODT). Seven selected features of ED treatments were tested. Different series of scenarios (cards) were created by combining these features: two series of 4 features (9 cards), another one series of 7 (16 cards). Short series were tested in Primary Care, and the long series in Urology/Andrology offices. Influences were tested by rank ordered logistic regression analysis. RESULTS: The feature «administration form¼ was consistently given the most relative importance; the ODT form was given the greatest utility. Consensus towards the most and least preferred treatment was achieved only in one of the short series tested. Only severity of TDS symptoms, or having the most frequent symptoms, influenced treatment preference. Influence was mild. CONCLUSIONS: Conjoint analysis is a valid method for assessing preferences for ED treatments. A short series of highly selected attributes is advisable. Easiness and convenience of administration are of great importance for users. TDS symptomatology mildly affects preference.

[Effectiveness and treatment satisfaction in patients with erectile dysfunction in Spain: EDOS study]. / Efectividad y satisfacción con el tratamiento en pacientes con disfunción eréctil en España: estudio EDOS.

INTRODUCTION: Erectile dysfunction (ED) is a worldwide health problem with an ever increasing prevalence, affecting the quality of life of many patients. OBJECTIVE: The aim of this study was to describe treatment effectiveness and patient satisfaction with ED treatment in the Spanish cohort of the EDOS study. MATERIAL AND METHODS: This observational, pan-European study, assessed treatment effectiveness and patient satisfaction with ED treatment under routine clinical settings, using standard questionnaires. Men > or =18 years about to initiate or change ED treatment were enrolled. Patients were assessed at baseline, 3 and 6 months. RESULTS: A total of 1,029 patients were analyzed (12.8% of the total European sample). In general, the Spanish population characteristics are consistent with the overall population. At baseline 56.6% of patients received tadalafilo, 16.6% sildenafilo, 19.6% vardenafilo, and 7.2% received other treatments. At 3 months, a higher proportion of patients on tadalafil reported improved erections (GAQ 1: 96.5% tadalafil, 85.7% sildenafil and 87.2% vardenafil), satisfaction with treatment (EDITS: 84.2% tadalafil, 75.0% sildenafil and 76.0% vardenafil), and sexual self confidence (SF-PAIRS: 2.73 tadalafil, 2.39 sildenafil and 2.55 vardenafil), in comparison with sildenafil and vardenafil. At 6 months, differences between treatments were not significant. The mean+/-SD time elapsed from drug intake to sexual intercourse was higher for patients on tadalafil (18.6+/-26.4 h) compared to sildenafil (3.6+/-7.5) and vardenafil (8.6+/-19.4). CONCLUSION: The longer duration of action for tadalafil, and thus, the longer period of time between dosing and sexual intercourse may contribute to enhance sexual spontaneity, patient satisfaction with the treatment and greater self-confidence.

Efectividad y satisfacción con el tratamiento en pacientes con disfunción eréctil en España: Estudio EDOS / Effectiveness and treatment satisfaction in patients with erectile dysfunction in Spain: EDOS study

Introducción: La disfunción eréctil (DE) es un problema de salud mundial con una prevalencia creciente que afecta la calidad de vida de muchos pacientes. Objetivo: Analizar la efectividad y satisfacción con el tratamiento en la cohorte española de pacientes con DE incluidos en el estudio observacional de disfunción eréctil. Material y método: Estudio observacional, paneuropeo, que analizó la efectividad y satisfacción de los tratamientos para la DE en la práctica clínica habitual, utilizando cuestionarios estándares. Participaron varones ≥18 años que iniciaron o cambiaron su tratamiento para la DE. Los pacientes fueron evaluados en la visita basal, a los 3 y 6 meses. Resultados: Se analizaron 1.029 pacientes (12,8% de la muestra europea total). En general, las características de la población española son consistentes con las de la población global. En la visita basal 56,6% recibió tadalafilo, 16,6% sildenafilo, 19,6% vardenafilo y 7,2% otros tratamientos. A los 3 meses, una mayor proporción de pacientes con tadalafilo experimentó mejorías en la erección (cuestionario de evaluación global 1: 96,5% tadalafilo, 85,7% sildenafilo, 87,2% vardenafilo), se observó una mayor satisfacción con el tratamiento (inventario de satisfacción con el tratamiento para la DE: 84,2% tadalafilo, 75,0% sildenafilo y 76,0% vardenafilo) y mayor autoconfianza (escalas psicológicas y de relaciones interpersonales: 2,73 tadalafilo, 2,39 sildenafilo y 2,55 vardenafilo). A los 6 meses, las diferencias entre tratamientos no resultaron significativas. El tiempo medio±desviación estándar entre la toma del fármaco y la relación sexual fue mayor en los pacientes con tadalafilo (18,6±26,4h) vs. sildenafilo (3,6±7,5) y vardenafilo (8,6±19,4). Conclusiones: La mayor duración del efecto de tadalafilo y en consecuencia el mayor tiempo medio entre la toma y la relación sexual podría contribuir a aumentar la espontaneidad en las relaciones sexuales, la satisfacción con el tratamiento y mayor autoconfianza (AU)

Introduction: Erectile dysfunction (ED) is a worldwide health problem with an ever increasing prevalence, affecting the quality of life of many patients. Objective: The aim of this study was to describe treatment effectiveness and patient satisfaction with ED treatment in the Spanish cohort of the EDOS study. Material and methods: This observational, pan-European study, assessed treatment effectiveness and patient satisfaction with ED treatment under routine clinical settings, using standard questionnaires. Men ≥18 years about to initiate or change ED treatment were enrolled. Patients were assessed at baseline, 3 and 6 months. Results: A total of 1,029 patients were analyzed (12.8% of the total European sample). In general, the Spanish population characteristics are consistent with the overall population. At baseline 56.6% of patients received tadalafilo, 16.6% sildenafilo, 19.6% vardenafilo, and 7.2% received other treatments. At 3 months, a higher proportion of patients on tadalafil reported improved erections (GAQ 1: 96.5% tadalafil, 85.7% sildenafil and 87.2% vardenafil), satisfaction with treatment (EDITS: 84.2% tadalafil, 75.0% sildenafil and 76.0% vardenafil), and sexual self confidence (SF-PAIRS: 2.73 tadalafil, 2.39 sildenafil and 2.55 vardenafil), in comparison with sildenafil and vardenafil. At 6 months, differences between treatments were not significant. The mean±SD time elapsed from drug intake to sexual intercourse was higher for patients on tadalafil (18.6±26.4 h) compared to sildenafil (3.6±7.5) and vardenafil (8.6±19.4). Conclusion: The longer duration of action for tadalafil, and thus, the longer period of time between dosing and sexual intercourse may contribute to enhance sexual spontaneity, patient satisfaction with the treatment and greater self-confidence (AU)

[Synchronous bilateral renal cell carcinoma]. / Carcinoma de células renales bilateral sincrónico.

Until very recently, bilateral renal cell carcinoma was considered to be of very poor prognosis due to the poor results obtained with either radiotherapy or chemotherapy, which were completely ineffective in this type of tumours. In 1952, Krumbach performed the first radical nephrectomy and partial nephrectomy to a patient with bilateral synchronic renal cell carcinoma. This aggressive approach to bilateral renal cell carcinoma definitely changed the prognosis of these patients. Other authors with broad series of patients have clearly demonstrated that aggressive treatment of these tumours is the only approach that can offer patients a life opportunity with a significant 5-year survival ranging between 60-77.8% from the time of surgery.

[Megacalycosis complicated with stenosis of the pyeloureteral junction]. / Megacaliosis con estenosis de la unión pieloureteral sobreañadida.

Contribution of a case report of megacalycosis in a nine and a half-year old male child, in whom the disorder was diagnosed by our team when he was only four. The intense colic pains experienced by the child together with the isotopic renogram non responsive to seguril typical of obstruction, raised the diagnosis of superimposed stenosis of the pyeloureteral attachment. As a result, an Anderson-Hynes pyeloplasty was performed. Post-operative status after four years is absolutely normal from both a clinical and scintiscan point of view.

[Stasis priapism secondary to PGE1: transformation into high-flow priapism]. / Priapismo de éstasis secundario a PGE1: transformación en priapismo de alto flujo.

Since vasoactive agents were first introduced for the diagnosis and treatment of Erectile Dysfunction (ED), the most feared side effect has been priapism. The arrival of Prostaglandin E1 (PGE1) limited to a large extent the incidence of this complication due to its fast systemic and intracavernous metabolism. A case of stasis priapism following a low dose PGE1 injection (10 mcg) after 48 hours evolution and its surprising conversion to high flow priapism after the surgical procedures performed to solve this complication is presented here.

[Cyst of the seminal vesicle. Importance of transrectal echography in this type of malformations]. / Quiste de vesícula seminal. Importancia de la ecografía transrectal en este tipo de malformaciones.

Presentation of one case of seminal vesicle cyst with no associated anomalies. Review of diagnostic procedures useful in this type of disease, illustrating the relevance of transrectal ultrasound scanning due to its high specificity and low morbidity. Comments on the therapeutical options for this entity.