ObjectivesTo compare the clinical efficacy of the on-demand use of four drugs in the management of patients with premature ejaculation (PE), as the off-label use of selective serotonin-reuptake inhibitors and topical penile anaesthetics is frequently indicated for the management of patients with PE, and tramadol HCl and sildenafil citrate were also tried for managing this disorder, but with recommendations based on weak evidence.Patients and methodsThis was a single-centre, single-blind, placebo-controlled clinical trial conducted on 150 patients who had PE for >1 year. Patients were randomised equally into five groups. On-demand tramadol, sildenafil, paroxetine, local lidocaine gel or placebo was given for patients in groups 1–5, respectively. During the month before treatment, the intravaginal ejaculation latency time (IELT) and sexual satisfaction scores (on a 0–5-point scale) were measured and compared to the mean IELT and sexual satisfaction scores recorded during 4 weeks of on-demand drug administration, with monitoring of any possible side-effects.ResultsTramadol-treated patients had a significantly longer mean (SD) IELT, of 351 (119) s, than the other groups. Local anaesthetic was significantly better than paroxetine in prolonging the IELT, at 278 (111) vs. 186 (65) s, respectively. The improvement in sexual satisfaction was significantly better in the sildenafil group, with a mean (SD) improvement of 2.9 (1) points, than in the paroxetine and local anaesthetic groups, at 2.2 (0.9) and 1.9 (0.9) points, respectively.ConclusionsThe four drugs significantly improved IELT values over placebo. Tramadol was associated with significantly longer IELT values, whilst sildenafil induced significantly better sexual satisfaction than the other drugs. The four drugs had tolerable side-effects.

Background: Central nervous system changes, circulatory and electrolyte imbalances are the main complications of endoscopic transurethral resection of the prostate (TURP) which is known as transurethral resection (TUR) syndrome, which occurs as result of excessive absorption of irrigating fluid. We compare glycine 1.5% versus glucose 5% and normal saline 0.9% as irrigating solutions during TURP in patients with moderate to severe bladder outlet obstruction due to benign prostatic hyperplasia (BPH). Methods:Three hundred sixty patients with symptomatic BPH were randomized into a prospective, controlled trial comparing the three irrigation modalities. One-hundred twenty patients used glycine 1.5% solution as irrigating fluid (glycine group), 120 patients used glucose 5% solution (glucose group) and 120 patients used normal saline 0.9% solution (saline group). Patient's demographics, operation time, hospital stay, postoperative amino acid glycine assay, postoperative serum cardiac troponin I and perioperative complications were noted. Results:No difference was found between the groups in the immediate postoperative levels of hemoglobin and hematocrite. A high glycine level was associated with the TUR syndrome. Seventeen patients had TUR syndrome; all were in glycine group and they had the highest postoperative amino acid glycine levels. Slight increase in serum sodium (142.6 ± 12.6 mmol/l) was detected in saline group. Transient Hyperglycemia (170 ± 35.9 mg/dl) and hypokalemia (3.67 ± 0.92 mmol/l) occurred in the immediate postoperative period in the glucose group. Conclusion:Endoscopic TURP performed using either glucose 5% or saline 0.9% irrigating solution during and after surgery is associated with lower incidence of TUR syndrome, lower catheterization period, shorter hospital stay and no cardiac toxicity in comparison with glycine 1.5% solution.Trial Registration: This clinical trail had been approved and registered in PACT Registry; with identification number for the registry is ATMR2010010001793131. BackgroundMany endoscopic surgical procedures require the use of an irrigating fluid to dilate the operating field and to wash away debris and blood. A potential complication of such irrigation is a systemic absorption of the fluid to the extent that overt symptoms are produced [1]. The ideal irrigant for endoscopic resection would be a userfriendly, non-conductor medium that does not interfere with diathermia, has a high degree of translucency, has similar osmolarity to the serum and causes only minimal

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INTRODUCTION AND OBJECTIVES:We have evaluated silodosin as a new treatment option for premature ejaculation (PE). Silodosin, a highly selective a1A-adrenoceptor antagonist, demonstrates excellent clinical efficacy for LUTS and has a strong suppressive action on ejaculation. This suppressive action is able to be applicable to treatment for PE. Our previous study demonstrated favorable effects on alleviation of PE symptoms (Sato et al. Int J Urol 2012). In this study, We compared efficacy of silodosin and naftopidil that has the weakest suppressive actions among a1 blockers as a control drug on PE.METHODS: Twenty seven patients who suffered with PE were enrolled in this study. PE was defined as IELT is about 3 minutes or less and patients felt the inability to delay ejaculation and negative personal consequences due to the ISSM recommendation in 2014. Subjects had a mean age of 50.6years, reported having had PE for an average of 6.0 years. Eleven patients (41%) suffered with ED and had received treatment by phosphodiesterase type 5 inhibitors before starting treatment for PE. Patients administrated silodosin 4 mg or naftopidil 25 mg 1 hours before intercourse in turn at least 3 times each. Intravaginal ejaculatory latency time (IELT), premature ejaculation profile item, clinical global impression change in PE, and systemic adverse events were evaluated. IELT measured using a watch by the patient. RESULTS: 1) Mean IELTs were 1.9, 4.1 and 7.6 minutes at baseline and with control and with silodosin, respectively. Silodosin significantly prolonged IELT compared to that at baseline and with control drug (p<0.01 table1). 2) Efficacy: Ten patients (37%) reported improvement for own PE problems under silodosin administration compared to baseline condition by the CGCI. Silodosin showed significantly higher efficacy rate compared to that with control drug (p¼0.003). 3) Silodosin significantly improved ejaculation control and satisfaction of sexual intercourse compared to those at base line and with control (p <0.01). 4) Reduced semen volume and orgasm: Twelve patients (46%) experienced significant reduction of semen volume on silodosin administration. This rate was significantly higher than with control (p¼0.017). Six patients (23%) considered reduced semen volume with silodosin as a significant problem. However, four patients achieved adequate IELT and normal ejaculation with satisfied orgasm by dose reduction (2mg-silodosn). 4) No systemic adverse effects were reported with silodosin.CONCLUSIONS: Silodosin significantly improved PE related problems than control drug. Reduced semen volume with silodosin was able to manage by dose reduction. Our current results confirmed the potential of silodosin as a new treatment option for PE. INTRODUCTION AND OBJECTIVES: Premature ejaculation(PE) is one of the most common male sexual disorders and has been estimated to occur in 20% to 40% of men. Selective serotonin reuptake inhibitors (SSRIs) commonly used in treatment of PE. However, the use of sildenafil combined with dapoxetine to ...