A randomised, double-blind study comparing the efficacy and tolerability of controlled-release doxazosin and tamsulosin in the treatment of benign prostatic hyperplasia in Brazil.

Brazilian patients with benign prostatic hyperplasia were randomised in a 12-week, double-blind, double-dummy study to receive doxazosin gastrointestinal therapeutic system (GITS) 4 mg q.i.d. (n = 82) or tamsulosin 0.4 q.i.d. (n = 83). Primary endpoints were the absolute and percentage change from baseline in symptoms measured by International Prostate Symptom Score (IPSS). Secondary endpoints included IPSS, quality-of-life (QOL) question from the IPSS, and questions 6 and 7 of the Sexual Function Abbreviated Questionnaire (SFAQ) at weeks 4 and 12. Doxazosin GITS and tamsulosin improved IPSS with no significant differences between groups at week 12. During weeks 4-8, tamsulosin-treated patients demonstrated a slower improvement (p < 0.001) in IPSS than doxazosin GITS-treated patients. The proportion of satisfied patients was observed earlier with doxazosin GITS (p = 0.006) vs. tamsulosin. At week 12, the proportion of patients with little or no difficulty at ejaculation (Q6 of SFAQ) was higher in the doxazosin GITS group (p = 0.019). Both treatments were well tolerated.

Long-term results of penile vein ligation for erectile dysfunction due to cavernovenous disease.

PURPOSE: We now know that outflow restriction is essential for maintaining a rigid erection, which can be achieved after satisfactory smooth muscle relaxation. The aim of this study was to assess retrospectively the efficacy of penile vein surgical ligation in patients with a follow-up of at least 3 years. MATERIALS AND METHODS: Thirty-two men with impotence due to cavernovenous occlusive disease underwent penile vein ligation for management of organic erectile dysfunction. Cavernovenous occlusive disease was diagnosed by gravity cavernosometry. RESULTS: Long-term evaluation revealed sustained potency without adjunctive therapy in only 7 patients (21.87%). Twenty-five patients (78.12%) did not show any improvement in the erectile mechanism. Associated complications included penile shortening in 4 (12.5%), hypoesthesia of the glans area in 2 (6.25%), and Peyronie's disease in 1 (3.2%). CONCLUSION: Based on these data, we conclude that the long-term success of penile vein ligation is poor.

Tamoxifen versus placebo in the treatment of Peyronie's disease.

PURPOSE: We evaluated the effects of oral tamoxifen and placebo in patients with Peyronie's disease. MATERIALS AND METHODS: We selected 25 patients with Peyronie's disease who did not have calcified plaque for treatment in the andrology outpatient clinic. A medical history was obtained, and physical examination, penile x-ray, penile ultrasound and pharmacologically induced erection with prostaglandin E1 were performed. Patients were randomly divided into group 1--those who received 20 mg. tamoxifen twice daily for 3 months and group 2--those who received placebo for the same period. The same evaluations were done 4 months later and results were compared. Qualitative (chi-square test) and quantitative (Student's t test) results were analyzed using the Yates correction factor with p <0.05 considered significant. RESULTS: Pain subsided in 66.6 and 75% of the patients treated with tamoxifen and placebo, respectively (p >0.05). In groups 1 and 2 a reduction in the penile deformity was noticed by 46.1 and 41.7% of the patients (p >0.05), and a decrease in plaque size was noticed by 30.7 and 25%, respectively. On the other hand, objective measurements did not reveal any difference in plaque area or curvature angle. CONCLUSIONS: This study did not show significant improvement in pain, curvature or plaque size in patients with Peyronie's disease who were treated with tamoxifen compared with those treated with placebo.

Endoscopic suspension of the prolapsed vaginal dome.

Complete prolapse of the vaginal dome post hysterectomy is uncommon. However, complications such as urinary incontinence, recurrent urinary infections, and ureteral obstruction leading to anuria and loss of renal function may result. A modified technique for endoscopic suspension of the bladder neck and vaginal prolapse, performed in six patients, is presented. The positive results achieved after a 64-month of follow-up suggest that this procedure is another safe alternative to correct vaginal prolapse and its complications.

Does intratesticular testosterone administration modify the evolution of transitory testicular ischemia in pre-pubertal rats?

PURPOSE: Testicular torsion followed by ischemia results in variable degrees of infertility and until now there appears to be no effective way to recover it. Testosterone participation in the maintenance of male sexual organs and spermatogenesis led us to hypothesize that intratesticular administration could recover ischemic injury. MATERIALS AND METHODS: We divided 40 Wistar rats in 2 groups, of 20 each. One group was control and the other underwent a 120-minute testicular ischemia by means of a vascular clamp on the left spermatic cord. Each group was further subdivided in 2 subgroups. The first one was observed and the second received intratesticular testosterone 25 mg. starting on the third day after injury and during the next 7 consecutive days. Half the animals were sacrificed 30 days after injury and the remaining ones after 60 days. Weight, volume, number of seminiferous tubules, histology and spermatogenesis of the same side and contralateral testes were examined. For statistical analysis ANOVA and Fisher's tests were applied. RESULTS: It was found that testosterone was capable of acting upon volume and weight of the left testis (p=0.0001). The animals receiving intratesticular testosterone showed lower testicular weight and volume after 30 and 60 days, respectively. This subgroup also showed a higher number of seminiferous tubules, modified histology and absent spermatogenesis suggesting testicular atrophy. CONCLUSIONS: We concluded that intratesticular injection of testosterone 25 mg. once a day during 7 consecutive days after transitory testicular ischemia causes ipsilateral testis atrophy. The animals in control group showed testicular histological recovery 60 days after injury. There were no significant histological differences in the contralateral testes.

Suprarenal aorta reconstruction using a saphenous spiral graft: case report.

We report a case of gunshot wound to the suprarenal aorta with restoration of blood flow through a saphenous spiral graft in an 18-year-old man. He was followed for a period of 27 months. The follow-up showed a progressive dilatation of the graft. This original technique for wounds of the aorta seems a reasonable alternative for trauma cases in which there is no vascular prosthetic graft.