Comparison of the efficacy of desmopressin fast-melting formulation and enuretic alarm in the treatment of monosymptomatic nocturnal enuresis.

BACKGROUND: Primary monosymptomatic nocturnal enuresis (MNE) is a common pediatric condition and there are two firstline, evidence-based treatments available; desmopressin and the enuresis alarm. Although there are many studies comparing enuresis alarm and desmopressin treatments in the literature, most were conducted using old formulations of desmopressin. OBJECTIVE: To compare the efficacy of desmopressin MELT formulation and enuresis alarm therapy in patients with MNE. STUDY DESIGN: A total of 130 patients who had primary MNE were included in the study. The patients were divided into two groups using simple randomization; desmopressin MELT (Group 1, n = 66) and enuresis alarm (Group 2, n = 64). The patients were invited for a follow-up visit at the fourth, 12th and 24th weeks of treatment. Treatment response and compliance were evaluated using bed-wetting diary and ICSS criteria. RESULTS: The mean age of the patients Group 1 and 2 was 11.2 + 3.3 and 10.2 + 3.4 years, respectively (p = 0.104). Complete response rate was similar at 4th week (53% vs. 37.3%, p = 0.162) and at 12th week (68.4% vs. 68.2%, p = 0.257). The relapse rate was significantly higher in the desmopressin MELT group than in the enuresis alarm group (48.9% vs 20.5%, p = 0.007). At the end of the study ten patients were excluded from the study because of loss to follow-up and/or side effects. The overall complete response rate was significantly higher in the enuresis alarm group than in the desmopressin MELT group at the end of the study (41.3% vs 64.9%, p = 0.035). When the intention to treat analysis population was considered, similarly the complete response rate was significantly higher in the enuresis alarm group than in the desmopressin MELT group (40.9% vs 64.1%, p = 0.027). DISCUSSION: With regard to the management of children with MNE, our study revealed that desmopressin MELT and enuresis alarm both have high efficacy rates in primary MNE treatment both at 4th and 12th week. However, overall complete response rate was better in enuresis alarm treatment at 24th week. In addition, enuresis alarm treatment also presents as a more favorable relapse rate. CONCLUSIONS: Enuresis alarm presented a more permanent treatment response and a lower relapse rate than desmopressin MELT formulation.

Comparison of the treatment efficacies of paroxetine, fluoxetine and dapoxetine in low socioeconomic status patients with lifelong premature ejaculation.

INTRODUCTION: To assess the treatment efficacies of paroxetine, fluoxetine and dapoxetine in patients with lifelong premature ejaculation (PE). MATERIAL AND METHODS: One hundred and seventy male patients with lifelong PE were included in our study. Premature ejaculation profile (PEP) and Intravaginal ejaculation latency times (IELT) were recorded. Paroxetine 20 mg/d was given in Group 1 (n = 64), fluoxetine 20 mg/d was given in Group 2 (n = 47) and dapoxetine 30 mg on demand (at least two times/week) was given in Group 3 (n = 59) patients. After 1 month of treatment, the patients' IELT, PEP and patient reported clinical global impression of change (CGIC) were completed. RESULTS: The mean age was 36 ±9.2 years. There was no difference between the groups' age, PEP and IELT before treatment (p >0.05). PEP and IELT improved in all three groups (p <0.001). The changes in the 1st and 3rd questions of PEP was significantly higher in group 1 than in the other groups (pPEP-1 = 0.042, pPEP-3 = 0.001). The changes in the 2nd and 4th questions of PEP were similar between groups (pPEP-2 = 0.444, pPEP-4 = 0.442). In group 1 and 3 IELT changes were better than group 2 (pIIEL1-3 = 0.297, pIIEL1-2 = 0.017, pIIEL2-3 = 0.100). There was no difference between CGIC scores (p = 0.087). The treatment was terminated by 8 patients in Group 1 and 9 patients in Group 2 because of side effects. CONCLUSIONS: While paroxetine treatment seemed to be better than the other medications, dapoxetine 30 mg treatment has less side effects than the two others and its' on demand usage makes it more prominent than the others.

The relationship between prostate cancer and presence of metabolic syndrome and late-onset hypogonadism.

OBJECTIVE: To investigate the relationship between prostate cancer (PCa), presence of metabolic syndrome (MetS), and late-onset hypogonadism (LOH). MATERIALS AND METHODS: One hundred seventy patients who underwent transrectal ultrasonography-guided prostate needle biopsy were included in this study. For the diagnosis of MetS, American Heart Association/National Heart, Lung, and Blood Institute criteria were used. For the diagnosis of LOH, Androgen Deficiency in Aging Males questionnaire and serum total and free testosterone levels were used. Patients were divided into 4 groups according to the presence of MetS and LOH: group 1, MetS and LOH; group 2, with MetS but without LOH; group 3, with LOH but without MetS; and group 4, with neither MetS nor LOH. RESULTS: The mean age of the patients was 63.7 ± 7.2 years. In group 1, 12 patients (37.5%); in group 2, 5 patients (25%); in group 3, 11 patients (26.8%); and in group 4, 14 patients (18.2%) were diagnosed with PCa. Aggressive PCa was determined in 7 patients in group 1 (21.9%), 2 patients in group 2 (10%), 5 patients in group 3 (12.2%), and 5 patients in group 4 (6.5%). There was a statistically significant difference only in between groups 1 and 4 in terms of detection of PCa (37.5% vs 18.2%, P = .031) and aggressive PCa (21.9% vs 6.5%, P = .019). CONCLUSION: These results highlight the fact that coexistence of MetS and LOH increases the risk of PCa and aggressive PCa.

Comparison of different scoring systems for outcome prediction in patients with Fournier's gangrene: experience with 50 patients.

OBJECTIVE: The aim of this study was to evaluate effective factors in the survival of patients with Fournier's gangrene (FG) and compare three different validated scoring systems for outcome prediction: Fournier's Gangrene Severity Index (FGSI), Uludag Fournier's Gangrene Severity Index (UFGSI) and age-adjusted Charlson Comorbidity Index (ACCI). MATERIAL AND METHODS: Fifty men who underwent surgery for FG between July 2005 and August 2012 were included in the study. Data were collected on medical history, symptoms, physical examination findings, vital signs, admission and final laboratory tests, timing and extent of surgical debridement, and antibiotic treatment used. The FGSI, UFGSI and ACCI were evaluated stratified by survival. Admission and final parameters were measured using the Mann-Whitney test. RESULTS: The results were evaluated for two groups: survivors (n = 43) and non-survivors (n = 7). Survivors were younger than non-survivors (median age 58 vs 68.5 years, p = 0.017). The median extent of body surface area involved in the necrotizing process in patients who survived and did not survive was 2.3% and 4.8%, respectively (p = 0.04). No significant differences in laboratory parameters were found between survivors and non-survivors at the time of admission, except for haemoglobin, haematocrit, serum urea and albumin levels. Only UFGSI, but not FGSI or ACCI, had any meaning or predictive value in disease severity or patients' survival. CONCLUSION: Only the UFGSI score could predict the disease severity and the patients' survival. The findings did not support previous findings that an UFGSI threshold of 9 is a predictor of mortality during initial evaluation.

Comparison of local anesthetic effects of lidocaine versus tramadol and effect of child anxiety on pain level in circumcision procedure.

OBJECTIVE: To compare the local anesthetic effects of tramadol hydrochloride with those of lidocaine in circumcision procedures. We also investigated the effect of child anxiety on pain level. PATIENTS AND METHODS: A total of 70 children were included in this study. The children were randomized into 3 groups. Group 1 (n = 26) received lidocaine hydrochloride + epinephrine and they underwent circumcision using Ali's clamp(®). Group 2 (n = 35) received lidocaine hydrochloride + epinephrine and group 3 (n = 12) 5% tramadol. The last two groups underwent conventional circumcision. RESULTS: The mean anxiety score was 22.6. We did not find significant differences in terms of anxiety score among the groups (p = 0.761). When the pain scores of the groups during injection were compared, it was found that there were no significant differences. However, the pain score of the third group was significantly high when it was compared with the first and second group 2 and 10 min after injection. In the correlation analysis, we found a positive correlation between children's anxiety scores and the pain degree during injection (r = 0.373, p = 0.001). CONCLUSION: Tramadol may not provide effective local anesthesia in male circumcision. The child's anxiety before the circumcision seems to have a negative effect on pain level.

The impact of metabolic syndrome on retinal findings in patients with erectile dysfunction.

OBJECTIVE: In the present study, we investigated the association between metabolic syndrome (MS) and retinal findings in patients presenting with erectile dysfunction (ED) complaints. MATERIAL AND METHODS: A total of 102 patients with ED were included in this study. The patients were divided into two groups according to the National Cholesterol Education Program Adult Treatment Panel - III consensus definition: patients with MS (Group 1, n=62) and patients without MS (Group 2, n=40). The severity of ED was determined according to the first five versions of the International Index of Erectile Function. A detailed fundus examination was performed to evaluate the patients for retinopathy. The patients' retinopathy grades were classified according to the Early Treatment Diabetic Retinopathy Study. RESULTS: The mean age of the patients was 51.4 years. Twenty-two patients (35.5%) in Group 1 and nine (22.5%) in Group 2 had severe ED (p=0.241). Ten (16.1%) patients in Group 1 and one (2.5%) patient in Group 2 had any degree of retinopathy (p=0.047). The logistic regression analysis of the correlation between severe ED and MS risk factors revealed that a fasting glucose level (FBG) of >110 mg/dL increased the risk of severe ED by 2.5 times (95% CI 1-6.2, p=0.058). Additionally, the logistic regression analysis of metabolic risk factors showed that only the FBS level was strongly associated with retinopathy, with the relative risk increased to 10.6 (95% CI 1.2-93, p=0.033). CONCLUSION: Our results showed that elevated FBG levels were the most critical MS component in the development of severe ED and retinopathy.