Krisada Ratana-Olarn

Management of acute urinary retention: a worldwide survey of 6074 men with benign prostatic hyperplasia

Study Type – Therapy (symptom prevalence)

Follow-up of Long-term Treatment with Clean Intermittent Catheterization for Neurogenic Bladder in Children

OBJECTIVES To assess the results of long-term clean intermittent catheterization (CIC) treatment for neurogenic bladder in children born with myelomeningocele, and to compare the long-term results between the early treatment group (< 1 year old) and late treatment group (> 3 years old). METHODS Thirty-six paediatric patients with myelomeningocele who were treated in the first year of life (Group 1) and 31 cases who were treated after the age of 3 years (Group 2) were followed regularly for at least 11 years. All medical records were reviewed and long-term results of treatment, including increases in blood urea nitrogen (BUN) and serum creatinine, development of hydronephrosis, recurrent upper urinary tract infection, and the number of augmentation cystoplasties needed, were noted. Kaplan-Meier methods were used to analyse time-to-event data. RESULTS Mean age at start of treatment was 6.88 months (range, 3-1 months) in Group 1 and 44.97 months (range, 37-60 months) in Group 2. Increases in BUN and serum creatinine were found in 12 cases (33.3%) in Group 1 and 19 cases (61.3%) in Group 2. Patients in Group 2 showed earlier renal deterioration and worse renal function at the last follow-up. Hydronephrosis was found in 10 cases (27.8%) in Group 1 and 18 cases (58.1%) in Group 2. Patients in Group 2 also had earlier and more severe hydronephrosis. Augmentation cystoplasty was needed in five cases (13.9%) in Group 1 and 10 cases (32.3%) in Group 2. The results of surgery were better in Group 1 than in Group 2, and surgery was needed earlier in Group 2 compared with Group 1. There was no significant difference regarding upper urinary tract infection between the two groups. CONCLUSIONS For most patients and with close long-term follow-up, early treatment of neurogenic bladder using CIC in children born with myelomeningocele yields better results than late treatment. In our experience, treatment is recommended as soon as possible, especially during the first year of life.

Efficacy and tolerability of vardenafil in Asian men with erectile dysfunction

AIM To evaluate the efficacy and tolerability of vardenafil, a phosphodiesterase type-5 (PDE-5) inhibitor, in men of Asian ethnicity with erectile dysfunction (ED). METHODS In this prospective, double-blind, multinational study, Asian men were randomized to receive vardenafil (10 mg) or placebo (4:1 ratio) for 12 weeks. The primary efficacy variables were the International Index of Erectile Function erectile function domain (IIEF-EF), and Sexual Encounter Profile (SEP) questions related to penetration and intercourse completion. Significant mean improvements were required in all three measures to show positive benefits of vardenafil treatment. Secondary efficacy variables included the Global Assessment Question (GAQ) on erection improvement. RESULTS Least-squares mean baseline IIEF-EF domain scores (vardenafil 14.6, placebo 13.4) were consistent with moderate ED. After 12 weeks, vardenafil treatment was associated with significant increases from the baseline in IIEF-EF domain scores compared with the placebo (22.4 vs. 14.3; P<0.001). Vardenafil was associated with significant improvements from baseline in least squares (LS) mean success rates for SEP-2 (vardenafil 82.2 vs. placebo 43.6; P<0.001) and SEP-3 (vardenafil 66.1 vs. placebo 24.0; P<0.001). Positive GAQ responses were reported by 81.8% of vardenafil recipients vs. 24.3% of placebo recipients. Adverse events were reported by 25.4% of the vardenafil group, the majority mild and transient. CONCLUSION Vardenafil (10 mg) is a highly effective and well-tolerated treatment for moderate ED in Asian men. These results add to the increasing amount of data demonstrating the safety and efficacy of vardenafil for the treatment of ED in a range of patient populations.

Treatment with a Uroselective α1‐Blocker Improves Voiding and Sexual Function: A Study in Thai Men with Lower Urinary Tract Symptoms

INTRODUCTION Lower urinary tract symptoms (LUTS) and erectile dysfunction (ED) negatively affect quality of life. The α1-blockers are effective for LUTS suggestive of benign prostatic hypertrophy. AIM To analyze the effect of a uroselective α1-blocker on both voiding and sexual dysfunction in Thai men with LUTS. METHODS Of 488 men with LUTS who received 10 mg alfuzosin monotherapy once daily (OD) at a mens health clinic, 313 men (64%) completed 8 months of alfuzosin treatment and filled the International Prostate Symptom Score (IPSS) and the International Index of Erectile Function (IIEF)-5 questionnaires. MAIN OUTCOME MEASURE The relationships among the IPSS, IIEF-5 score, and select clinical characteristics were analyzed using multiple regression analysis. To identify changes from the baseline, the chi-square or Fishers exact test was used for categorical or dichotomous variables and a paired Students t-test was used for continuous variables. RESULTS The 313 men were followed up for a mean (standard deviation [SD]) of 35.6 (2.2) weeks. LUTS were categorized by IPSS as moderate in 100 patients (31.9%) and severe in 213 patients (68.1%). ED was graded according to the IIEF-5 as normal in 46 patients (14.7%), mild in 29 patients (9.3%), mild to moderate in 81 patients (25.9%), moderate in 47 patients (15.0%), and severe in 110 patients (35.1%). ED is associated with LUTS (P=0.008). After 8 months of alfuzosin treatment, the mean (SD) IPSS and IIEF-5 score significantly improved from 19.95 (6.4) to 11.13 (4.6) (P<0.001) and from 11.5 (6.9) to 14.9 (5.7) (P<0.001), respectively. However, the IIEF-5 score did not improve significantly in patients with severe LUTS as determined using the IPSS. The most common adverse event with alfuzosin treatment was mild (dizziness, 2.2%). CONCLUSION Treatment with 10 mg alfuzosin OD is safe and effective in improving voiding and sexual function in Thai men with LUTS and ED.

Laparoscopic management of a single system ectopic ureterocele with transitional cell carcinoma in the distal ureter

Abstract  Single system ectopic ureterocele associated with transitional cell carcinoma in the ureter has not been described previously. Only two cases of transitional cell carcinoma in a single ectopic ureter have been reported in the published literature. With the development of minimally invasive surgery, we report the first case of single system ectopic ureterocele with transitional cell carcinoma in the distal ureter that was successfully managed by laparoscopic surgery.