[Efficacy and tolerability of dapoxetine in the treatment of premature ejaculation].

OBJECTIVE: To investigate the efficacy and adverse effects of dapoxetine in the treatment of premature ejaculation. METHODS: We randomly assigned outpatients with premature ejaculation in the proportion of 2:1 to receive 30 mg dapoxetine on demand (n =78) or 50 mg sertraline qd for one month (n = 39). Follow-up was accomplished in 95 cases, 63 in the dapoxetine group and 32 in the sertraline group. We recorded the intravaginal ejaculatory latency time (IELT), clinical global impression of change (CGIC) score, and adverse reactions of the patients and compared them between the two groups. RESULTS: IELT was significantly increased in both the dapoxetine (from [0.87 ± 0.31] to [2.84 ± 0.68] min, P < 0.05) and the sertraline group (from [0.84 ± 0.28] to [2.71 ± 0.92] min, P < 0.05) after medication. Based on the CGIC scores in premature ejaculation, the rate of excellence or effectiveness was 36.5% in the dapoxetine and 37. 5% in the sertraline group, and the rate of improvement was 63.5% in the former and 71.9% in the latter. The incidence rates of dizziness, nausea, headache, and diarrhea were slightly higher (P > 0.05) while those of fatigue, somnolence, and dry mouth significantly higher (P < 0.05) in the sertraline than in the dapoxetine group. CONCLUSION: On-demand oral medication of dapoxetine is effective and well-tolerated for the treatment of premature ejaculation.

Photoselective Vaporesection of the Prostate with a Front-firing Lithium Triborate Laser: Surgical Technique and Experience After 215 Procedures.

BACKGROUD: Although photoselective vaporization of the prostate (PVP) is considered one of the most promising alternatives to transurethral radical prostatectomy, a longer operative time, an unsatisfactory tissue removal rate, and the absence of postoperative pathology samples remain the main criticisms for this procedure. OBJECTIVE: To describe the novel technique of photoselective vaporesection of the prostate (PVRP) with a front-firing lithium triborate (LBO) laser and to report our initial experience. DESIGN, SETTING, AND PARTICIPANTS: This is a prospective study of 215 patients undergoing PVRP between November 2011 and March 2013. Their average age, prostate size, and International Prostate Symptom Score (IPSS) were 70.3 ± 7.3 yr, 70.4 ± 34.0 ml, and 24.9 ± 5.0, respectively. SURGICAL PROCEDURE: The operative technique is detailed in the accompanying video. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Perioperative data were collected. The patients were followed up at 3, 6, 12 mo after PVRP, and functional outcomes and complications were assessed. RESULTS AND LIMITATIONS: The mean operation time was 44.1 ± 22.6 min. The mean hemoglobin decrease was 0.37 ± 0.21 g/dl. The catheterization time was 23.9 ± 15.2 h and the postoperative hospital stay was 1.8 ± 0.8 d. Significant improvements were observed in maximum flow, IPSS, and postvoid residual urine at each follow-up time point. Compared to preoperative values, prostate volume and serum prostate-specific antigen fell by 67% and 63%, respectively, at 3 mo after PVRP. No major complications were noted. Application of a hemostat for a front-firing LBO laser makes it easy to handle intractable intraoperative bleeding. The main limitation of this study is the short follow-up period. The influence of PVRP on sexual function and the learning curve remain to be evaluated. CONCLUSIONS: PVRP is a novel technique that is effective and safe for treatment of benign prostatic hyperplasia. This technique retains the excellent hemostatic property of LBO lasers and has a short operation time and a high tissue removal rate. The problem of the lack of postoperative tissue samples for PVP is also overcome in PVRP. PATIENT SUMMARY: We have developed a novel technique named photoselective vaporesection of the prostate (PVRP) with a front-firing green laser. Our results show that PVRP retains the excellent hemostatic property of a green laser, but has a much shorter operation time and a higher rate of tissue removal than photoselective vaporization of the prostate (PVP). This technique also solves the problem of the lack of postoperative tissue specimens and the difficulty of handling intractable intraoperative bleeding. According to our initial results, PVRP is a novel technique superior to PVP in the treatment of benign prostatic hyperplasia.

[Etiology and treatment of bladder spasm associated with benign prostatic hyperplasia].

OBJECTIVE: To investigate the etiology and treatment of bladder spasm associated with benign prostatic hyperplasia (BPH). METHODS: Urodynamic tests were performed in 102 cases of BPH before operation. The correlation of bladder spasm with aging, international prostate symptom score (IPSS), quality of life, prostatic volume, operation methods and urodynamic indexes was studied by t and chi2 tests. RESULTS: The incidences of bladder spasm in the lower compliant bladder and unstable bladder were 32.1% (9/28) and 42.5% (13/20), and those after suprapubic prostatectomy and transurethral resection of the prostate (TURP) were 50.9% (26/51) and 23.3% (12/51). There was significant difference between operation methods (P < 0.05). CONCLUSION: Bladder spasm easily develops in the lower compliant bladder and unstable bladder, especially after suprapubic prostatectomy. TURP might decrease the incidence of bladder spasm after BPH operation.