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Prostate cancer (PCa) is a highly prevalent disease worldwide. PCa screening by digital rectal examination and measurement of PSA in men from the age of 50 or 45 years old is recommended in the presence of risk factors. This paper reviews the most relevant current scientific evidence. There has beem progress mainly in the management of advanced disease. The recommendation of active surveillance, however, remains controversial. We discuss risk factors and epidemiology, etiology, diagnosis, and treatment options for early and advanced disease and provide updated information. For general practitioners the most important is to know when to refer a patient to a specialist. For urologists, the challenge is integrating scientific advances into the reality of patients to offer the best possible follow-up. [ABSTRACT FROM AUTHOR]

Objectives: In this study, we present safety and efficacy data for a surgical alternative for the treatment of postprostate surgery urinary incontinence, based on the use of the periurethral constrictor, a two-part device—constrictor cuff and self-sealing valve with a tube—activated by injection of saline solution. Methods: From May 2001 to October 2007, 30 patients with postprostate surgery urinary incontinence were submitted to implantation of the periurethral constrictor. Results: The mean follow-up was 42.1 months (range, 13-72). Twenty-two (73.3%) of the patients had functional devices and were socially continent. Among them, 20 patients voided spontaneously, whereas two performed intermittent catheterization. Revisions to exchange leaking valves were necessary in 4 cases, and since then these patients have been socially continent. In this series, with the exception of 4 cases of erosion, 3 cases of infection that required complete removal of the devices, and 1 case of detrusor hyper-reflexia, there were no other major complications. Conclusion: The results of this retrospective study suggest that the implantation of the periurethral constrictor appears to be safe and effective as an alternative to the treatment of postprostate surgery urinary incontinence. [Copyright &y& Elsevier]

Introduction. Psychosocial manifestations of erectile dysfunction (ED) differ across cultures. Understanding the treatment response to ED medications within cultural groups can aid in resource allocation and in developing treatment strategies. Aim. Evaluate the effect of sildenafil treatment on self-esteem, confidence, and sexual relationship satisfaction in Brazilian men with ED. Main Outcome Measure. The Self-Esteem and Relationship (SEAR) questionnaire, a validated, 14-question instrument developed to specifically address self-esteem and relationship issues within the context of ED. Methods. Men aged 18 years or older with a clinical diagnosis of ED (≤21 on the Sexual Health Inventory for Men) and in a stable relationship with a partner during the study were eligible. The primary end point was a change from baseline in the self-esteem subscale of the SEAR questionnaire. Thirteen Brazilian sites participated in a randomized, double-blind, placebo-controlled trial of sildenafil treatment for ED. Patients were randomized to receive either 50 mg of sildenafil (adjustable to 25 mg or 100 mg based on patient response) or matching placebo approximately 1 hour before anticipated sexual activity but not more than once a day. Results. At the end of double-blind treatment, 63 and 66 patients in the placebo and sildenafil groups, respectively, from 13 Brazilian sites were assessed for efficacy. Brazilian patients receiving sildenafil had significantly greater improvements in their scores on the SEAR self-esteem subscale (42.9 [95% confidence interval 35.7–50.0]) compared with placebo (21.1 [95% confidence interval 13.7–28.6]; P < 0.0001). Effect sizes ranged from 0.91 to 1.25 for individual SEAR components. Conclusions. The psychosocial parameters in Brazilian men with ED assessed by the SEAR questionnaire showed significant improvements in self-esteem, confidence, and relationships after treatment with sildenafil. Glina S, Damião R, Abdo C, Afif-Abdo J, Tseng L-J, and Stecher V. Self-esteem, confidence, and relationships in Brazilian men with erectile dysfunction receiving sildenafil citrate: A randomized, parallel-group, double-blind, placebo-controlled study in Brazil. J Sex Med 2009;6:268–275. [ABSTRACT FROM AUTHOR]

This article presents the case of an asymptomatic patient with ascending PSA and suspected prostate cancer, who underwent two MRI-targeted prostate biopsies, both of which were negative for this neoplasm. PSMA PET/CT revealed secondary bone implant, while the biopsy of the metastatic lesion showed prostate adenocarcinoma. Docetaxel-based chemotherapy associated with androgen deprivation was performed. Despite the high accuracy of MRI-targeted prostate biopsy, diagnosis can occasionally be difficult, and PSMA PET/CT can help to detect distant lesions and aid the diagnosis. [ABSTRACT FROM AUTHOR]

To assess the feasibility, safety, and predictive factors for the success of holmium laser enucleation of the prostate (HoLEP) with catheter removal and hospital discharge on the same day of the procedure. This prospective study included 34 patients who underwent HoLEP using a 60-W holmium laser device and the Wolf Piranha morcellation system. Surgeries began at 10:30 am and the patients were expected to be discharged by 5 pm on the same day. The patients underwent a voiding trial to remove the urinary catheter before hospital discharge. Functional outcomes were assessed 90 days after the procedure. Mean (range) age, prostate-specific antigen value, and prostate weight were as follows: 63.4 (50-80) years, 4.81 (0.19-14) ng/mL, and 89.3 (33-258) g, respectively. The mean (range) enucleation and morcellation times were 56.2 (29-91) minutes and 14.67 (3-45) minutes, respectively. Thirty-one patients (91.1%) were discharged on the same day of the procedure after urinary catheter removal. The performance of HoLEP is safe on an outpatient basis. Same-day catheter removal is feasible and does not affect hospital discharge. [ABSTRACT FROM AUTHOR]

Introduction: Radical prostatectomy is the gold standard treatment for localized prostate cancer, and videolaparoscopic prostatectomy represents a new leap forward. However, the latter approach adds great technical complexity and entails a long and very slow learning curve that can be successfully completed by only a small number of highly skilled surgeons. These factors have significantly hampered a more widespread uptake of this technique. Robotic-assisted laparoscopic surgery democratized laparoscopic radical prostatectomy by allowing many surgeons, even the least experienced ones, to perform this procedure with the same expertise as experienced surgeons. Nevertheless, the high cost of this technology greatly limits its more widespread use, especially in countries in the global south. Methodology: In 2015, a discussion began on the possibility of using some concepts from laparoscopic prostatectomy to improve open prostatectomy. Based on a study of the various techniques performed using the open, laparoscopic and robotic route, we developed an innovative technique to reproduce robotic prostatectomy openly, without recourse to any new special instruments or materials. This technique is called "Open Anterograde Anatomic Radical Retropubic Prostatectomy" (AORP). Results: AORP was superior to Open Radical Prostatectomy in critical parameters: a median estimated blood loss of 300mL versus 500mL (p=0.0003); more rapid urethrovesical anastomosis, at 20min versus 25min (p=0.005); shorter duration of indwelling vesical catheterization, at 7 versus 14 days; increased surgeon perception of nerve-sparing, at 101 (87.8%) versus 71 (67.6%) (p=0.0009); increased early urinary continence, at 70 (60.9%) versus 45 (42.0%); fewer complications (p=0.007) and equivalent oncological control. Discussion: We understand that the gains of robotic surgery depend not only on the introduction of technology but also on improvements in the technique of dissection, preservation and reconstruction that can be reproduced in open surgery, thus enabling similar operations with improved procedures but without access to robotic technology. [ABSTRACT FROM AUTHOR]

Introduction: Peyronie's disease (PD) is a common condition that can cause penile curvature and/or deformities, thereby affecting the male sexual function. The most effective treatment for clinically significative and stable penile curvature due to PD is reconstructive surgery that involves techniques that do not shorten penile length. Among the techniques for the correction of curvature and restoration of penile length, the incision and/or excision of the plaque, followed by reconstruction of the defect with a graft, remains the gold standard. Although several materials have been used as a graft in the treatment of penile curvature due to PD, none have shown results good enough to be considered as the first choice. Herein, we aimed to evaluate the results of the surgical treatment of patients with penile curvature due to PD using a new biograft. Methodology: We performed the surgical management with graft technique in twelve men suffering from penile curvature due to PD. Penile curvature was measured before and one year after the reconstructive procedure. The graft of choice was bovine pericardium graft segment treated with L-Hydro aldehyde-free technology. Erectile function was evaluated by the IIEF questionnaire and penis length was measured by a rigid ruler during a pharmacologically induced erection test. Results: The overall success rate of correction of the penile curvature was 90.9% and the patients' satisfaction rate was 91.7%. No serious adverse events were found and the erectile function was impaired in 18.2% of cases. There was an increase in penile length, ranging from 0.7 to 3.0cm in 91.7% of cases. Conclusion: Correction of penile curvature due to Peyronie's disease using the technique of incision and/or excision of the plaque with an aldehyde-free bovine pericardium graft presents high success rates, both in terms of penile shaft rectification and patient satisfaction. L-hydro bovine pericardium graft is easy to handle surgically, allows a tight anastomosis and does not present serious postoperative complications. Furthermore, it can be used simultaneously with penile implants and appears to play a role in restoring penile length. [ABSTRACT FROM AUTHOR]

Resumo: O presente estudo relata o caso de uma paciente do sexo feminino de 56 anos, transplantada renal há 20 anos devido à hipertensão arterial sistêmica (HAS), que apresentou dor abdominal intensa no flanco esquerdo e vômitos. A tomografia computadorizada (TC) e a ressonância magnética nuclear (RNM) revelaram uma massa tumoral no rim nativo esquerdo, confirmada como lesão suspeita. A nefrectomia por videolaparoscopia foi realizada para a remoção completa do órgão. A imunossupressão crônica associada ao transplante renal aumenta o risco de desenvolvimento de tumores, especialmente no rim nativo. A prevalência de tumores renais em pacientes pós-transplante varia de 0,34% a 5%, sendo 90% destes Carcinomas de Células Renais (CCR). O rastreio regular por meio da ultrassonografia é fundamental para o diagnóstico precoce de neoplasias em pacientes transplantados, permitindo intervenções oportunas e melhorando os resultados clínicos. Este relato de caso destaca a importância da vigilância para a detecção precoce de tumores renais em pacientes pós-transplante, permitindo o manejo adequado desses tumores em suas fases iniciais. Introdução: A imunossupressão crônica, utilizada para prevenir a rejeição do órgão transplantado, aumenta o risco de desenvolvimento de tumores, especialmente no rim nativo de pacientes pós-transplante renal. Essa maior suscetibilidade se deve à supressão do sistema imunológico, que impede a eliminação eficaz de células cancerígenas. Além disso, os rins nativos inativos desses pacientes apresentam lesão crônica, tornando-os mais propensos à progressão neoplásica. Relato de caso: A paciente I. C. M. L., do sexo feminino, 56 anos, foi submetida a transplante renal há 20 anos devido à HAS, tendo sua irmã como doadora viva. No dia 01/06/2024, a paciente apresentou dor abdominal intensa no flanco esquerdo e vômitos. A TC realizada na emergência identificou uma massa tumoral no rim nativo esquerdo, e a RNM confirmou a suspeita de lesão. A nefrectomia por videolaparoscopia foi realizada para a remoção completa do órgão. Discussão: A literatura científica demonstra que a imunossupressão associada ao transplante renal contribui para o aumento do risco de câncer. A prevalência de tumores renais no rim nativo varia de 0,34% a 5% em pacientes pós-transplante, sendo 90% destes CCR. Este relato de caso destaca a importância do rastreio em pacientes transplantados para a detecção precoce de neoplasias. A vigilância regular por meio da ultrassonografia é essencial para o diagnóstico antecipado dessas lesões tumorais, permitindo intervenções oportunas que podem melhorar os resultados clínicos. Conclusão: Compreender os casos de tumores renais em pacientes pós-transplante renal é crucial para orientar a prática clínica, fornecer entendimento sobre a evolução da doença e estabelecer diretrizes para a vigilância, permitindo o manejo adequado desses tumores em suas fases iniciais. [ABSTRACT FROM AUTHOR]

Resumo: A nefrolitíase em rins transplantados, embora rara, pode levar à perda da função renal se não for tratada adequadamente. O estudo apresenta o caso de um paciente masculino de 63 anos que desenvolveu cálculo renal 8 anos após o transplante renal. O diagnóstico foi realizado por tomografia e o tratamento inicial com cateter duplo J e tentativa de ureterorrenolitotripsia flexível retrógrada não obteve sucesso. O paciente aguarda litotripsia percutânea. A nefrolitíase do enxerto requer abordagem individualizada e direcionada, considerando a anatomia específica de cada implante. Exames de imagem de rotina, como USG de vias urinárias, são essenciais para o diagnóstico precoce e acompanhamento, permitindo o tratamento oportuno e a prevenção de complicações. Cálculos menores que 4 mm podem ser tratados conservadoramente, enquanto que os maiores exigem tratamento multimodal e individualizado, sendo o acesso anterógrado percutâneo geralmente preferido por apresentar menor dificuldade técnica. A nefrolitíase, quando diagnosticada e tratada corretamente, não contraindica a doação renal nem afeta a sobrevida do rim transplantado. Introdução: A nefrolitíase em rins transplantados, apesar de rara, pode levar à perda da função renal se não for tratada adequadamente. Sua incidência varia entre 0,2% e 3%, e quando ocorre em até 6 semanas após o transplante, é provável que o cálculo tenha sido transferido do doador para o receptor. Já após 6 semanas, a formação do cálculo é mais provável no próprio paciente transplantado. Fatores de risco para a formação de cálculos no receptor incluem sobrepeso, dieta rica em lipídios, cálcio e bebidas açucaradas, refluxo e estase urinária, acidose tubular renal, hipercalciúria, hiperparatireoidismo e hiperuricemia. Apresentação do caso: Um paciente masculino de 63 anos foi submetido a transplante renal em 2015. Em dezembro de 2023, desenvolveu infecção urinária e a tomografia revelou hidronefrose e um cálculo de 1,8 cm na junção ureteropiélica. Cateter duplo J foi colocado em dezembro de 2023, mas a tentativa de ureterorrenolitotripsia flexível retrógrada em março de 2024 não teve sucesso devido à dificuldade de passagem do aparelho na anastomose uretero-vesical. O paciente foi transferido para urologia da UERJ com indicação de litotripsia percutânea e aguarda o procedimento. Discussão: A nefrolitíase do enxerto, embora rara, pode ter consequências graves se não for tratada adequadamente. Para evitar essas complicações, é crucial realizar exames de imagem de rotina, principalmente USG de vias urinárias, a fim de monitorar o aparecimento e desenvolvimento de cálculos renais e orientar o tratamento quando necessário. Cálculos menores que 4 mm podem ser tratados conservadoramente e acompanhados, enquanto que os maiores exigem tratamento multimodal e individualizado. O acesso anterógrado percutâneo é geralmente preferido por apresentar menor dificuldade técnica. É importante ressaltar que a nefrolitíase não é mais um impeditivo para o transplante renal. Se diagnosticada e tratada corretamente, não contraindica a doação nem afeta a sobrevida do rim transplantado. [ABSTRACT FROM AUTHOR]

In recent years, the development of new imaging techniques and scoring systems have improved the diagnosis and management of small renal masses. Imaging-based nephrometry scoring systems play an interesting role in the planning of nephron-sparing surgery, providing surgeons with the information necessary to determine the complexity of the renal mass, to deliver the appropriate postoperative care, and to predict adverse outcomes. The aim of this study was to review nephrometry scoring systems, evaluating their characteristics and the relationships among them. The urology and radiology communities should decide which nephrometry scoring system will prevail and be used in daily practice. [ABSTRACT FROM AUTHOR]

ABSTRACT Introduction. Penile curvature is one of the most common male conditions, affecting nearly 10% of men, and can impair sexual intercourse. Tunica albuginea (hTA) plays a key role in penile curvature, and reconstructive procedures may be necessary for its substitution. Although several grafts have been proposed for hTA repair, the ideal graft is not yet available. Aim. The aim of this article is to evaluate a new human tunica albuginea acellular matrix (hTAAM) as potential graft for penile reconstructive procedures. Methods. Twelve penises were obtained during sex reassignment surgeries from male-to-female transsexual patients. After dissection, hTAs were assigned into two groups according to the decellularization methods: polyethylene glycol (PEG) 1000 method following ultraviolet-C radiation, and Triton X-100 modified method. Main Outcome Measures. Structural analyses were assessed by hematoxilin and eosin, Masson's trichrome, Weigert's, and picrosirius-polarization staining methods. Total protein, total glycosaminoglycan (GAG), and nucleic acid (DNA and RNA) concentrations were assessed by specific biochemical analyses. Uniaxial strength tests were performed to evaluate biomechanical properties. Results. All hTAAMs presented no nuclear or cellular remnants. Total protein concentration was significantly higher in PEG 1000 hTAAM. Despite GAG concentration decreased significantly in hTAAM, Triton X-100 hTAAM retained the highest GAG concentration (1.0 ± 0.42 µg HexUr/mg dry tissue, P > 0.05). All decellularization methods were efficacious to remove nucleic acids. The maximal break point presented no difference between hTA and hTAAM groups ( P > 0.05). Conclusions. PEG 1000 and Triton X-100 decellularization methods provide equally successful hTAAMs, preserving original structural and biochemical properties. da Silva FG, Filho AM, Damião R, and da Silva EA. Human acellular matrix graft of tunica albuginea for penile reconstruction. J Sex Med 2011;8:3196-3203. [ABSTRACT FROM AUTHOR]

OBJECTIVE To compare the effectiveness, safety and tolerability of sildenafil and apomorphine in Brazilian patients with erectile dysfunction (ED) of various causes. PATIENTS AND METHODS In all, 108 patients (mean age 55 years,sd 11) and documented ED for ≥6 months were included in 12 centres in Brazil. The patients were initially followed for 2 weeks and then randomized to initial treatment with apomorphine or sildenafil, taken before sexual intercourse, no more than once a day. The initial dose (2 mg apomorphine and 50 mg sildenafil) could be adjusted (to 3 mg apomorphine, or to 25 or 100 mg for sildenafil) depending on the effectiveness and tolerability during the first 4 weeks of treatment. The patients were re-evaluated after 8 weeks on treatment and, after a wash-out period of 2 weeks (no treatment), received the other study drug (other than that received in the first phase), and then had the same procedures as in the first phase. RESULTS In all, 97 patients were evaluated for therapeutic effectiveness, the overall effectiveness being assessed using two questions; sildenafil had a significantly higher proportion of affirmative answers for both ( P < 0.001). Likewise, the estimates for the mean (sd) proportion of successful sexual intercourse, of 83.3 (4.7)% vs 40.3 (4.7)% and the total ED Inventory of Treatment Satisfaction score, of 86.7 (2.9) vs 56.9 (2.9) ( P < 0.001) were higher for sildenafil. At the end of the study, 93.8% of the patients randomized to initial therapy with apomorphine declared a preference for sildenafil, and 81.3% of those initially treated with sildenafil declared a preference for that drug. The two drugs were well tolerated, and the main adverse events for apomorphine were nausea, vomiting, headache, taste perversion and dizziness; for sildenafil they were headache, flushing or vasodilatation, abdominal pain or dyspepsia and nasal congestion. CONCLUSIONS Sildenafil is more effective than apomorphine for treating ED, in the domains of erectile function, satisfaction with sexual intercourse and overall satisfaction, and was the drug preferred by most of the patients. [ABSTRACT FROM AUTHOR]

Introdução: Estudos sobre diferentes abordagens para complicações de transplantes renais intervivos têm acompanhado este tipo de cirurgia desde o seu surgimento, sendo uma importante ferramenta para superar resultados pós-operatórios indesejáveis uma vez que procedimentos cirúrgicos desafiadores podem estar envolvidos em alguns casos dependendo da anatomia do enxerto e do paciente receptor. Apresentação do caso: Este relato de caso descreve uma abordagem possível e inovadora para necrose de enxerto no polo renal inferior com fístulas calicinais em mulher de 28 anos pós-transplante renal diagnosticada com doença renal crônica (DRC) secundária a nefrite classe-IV devido a lúpus eritematoso sistêmico (LES) que foi submetida a um transplante renal de doadora viva haploidêntica (irmã). Uma ultrassonografia Doppler de rotina do enxerto pós-operatório não mostrou fluxo no polo inferior do enxerto renal, o que foi confirmado por angiorressonância magnética, e uma fístula foi encontrada após dosagem de creatinina por aumento de líquido quantificado no dreno. Discussão: Variações anatômicas no enxerto representam um obstáculo real para os urologistas pois aumentam a complexidade do procedimento e a possibilidade de complicações pós-operatórias. No caso presente, o enxerto polar apresentava uma artéria renal secundária de aproximadamente 2 mm, tornando a anastomose vascular um desafio. Fístulas urinárias ocorrem em 0-9.3% dos casos, com necrose ureteral e falha na anastomose sendo suas causas mais importantes. Realização de nefrostomia em pacientes com fístulas urinárias após transplante renal foram relatadas, incluindo o uso de um cateter de Foley para otimizar o tratamento, sendo esse de preço mais acessível e amplamente disponível na maioria dos hospitais. Este relato de caso descreve uma nefrostomia com uso de calibre de cateter progressivamente diminuído para garantir a cicatrização completa da área da fístula, a boa evolução do quadro e encurtar a permanência hospitalar como uma abordagem inovadora para uma complicação rara pós-transplante renal, sendo um novo caminho para melhorar a sobrevida do enxerto renal e o desfecho de inúmeros casos. [ABSTRACT FROM AUTHOR]

Objetivo: Descrever o caso de um paciente com Síndrome de Prune-Belly submetido a transplante renal e os desafios enfrentados ao longo do processo. Introdução: A Síndrome de Prune-Belly é uma afecção congênita rara que afeta o sistema urinário e abdominal. Pacientes com essa síndrome frequentemente apresentam necessidade de transplante renal. Apresentação do caso: Paciente masculino de 25 anos com Síndrome de Prune-Belly e histórico de diversas cirurgias urológicas. O paciente foi submetido a transplante renal em julho de 2023 e apresentou diversas complicações no pós-operatório, incluindo estenose do implante ureteral e pielonefrite no enxerto. Discussão: O manejo de pacientes com Síndrome de Prune-Belly no transplante renal é desafiador devido ao histórico de intervenções urológicas prévias, disfunção miccional e maior risco de infecções urinárias. É necessário um cuidado individualizado e multidisciplinar para garantir o sucesso do transplante e a sobrevida do enxerto. [ABSTRACT FROM AUTHOR]

Objective: To compare ultrasonographic patterns of 2-dimensional perineal ultrasonography in men in the preoperative and postoperative periods after transobturator sling deployment for the treatment of urinary incontinence after radical prostatectomy. Radiotherapy and radical prostatectomy are the primary treatments for localized prostate cancer. Studies comparing anatomic changes in men before and after radical prostatectomy based on perineal ultrasonography are scarce in the literature.Methods: Thirty-one patients from 2 centers were selected for examination and surgery. They were allocated into mild and/or moderate and severe incontinence groups who underwent the transobturator sling procedure between August 2014 and August 2018. Perineal ultrasonography was performed in the preoperative period for 21 of these patients and 3-6 months postoperatively after the transobturator sling procedure for 30 patients. Hypermobility of the proximal urethra and voluntary contraction of the pelvic floor were evaluated during the Valsalva maneuver, perineal contraction and at rest.Results: Clinical improvements of >50% were significantly more frequent in the mild and/or moderate vs severe incontinence group after male sling surgery (P = .035). Patients who demonstrated clinical improvement >50% showed a significantly greater displacement of the posterior portion of the bladder neck during contraction than those with clinical improvement <50% (P = .024).Conclusion: The most important finding of this study was the significant difference in the posterior displacement of the bladder neck during contraction in patients who showed an improvement >50% compared with those with an improvement <50%. These data support the use of perineal ultrasonography in evaluating and selecting patients for the male sling procedure. [ABSTRACT FROM AUTHOR]

Background: In the LATITUDE trial, addition of abiraterone acetate plus prednisone to androgen deprivation therapy (ADT) improved overall survival compared with placebos plus ADT in patients with newly diagnosed, high-risk, metastatic castration-naive prostate cancer. Understanding the effects of treatments on patient-reported outcomes (PROs) and health-related quality of life (HRQOL) is important for treatment decisions; therefore we aimed to analyse the effects of ADT plus abiraterone acetate and prednisone versus ADT plus placebos on PROs and HRQOL in patients in the LATITUDE study.Methods: In the multicentre, international, randomised, phase 3 LATITUDE trial, eligible patients were aged 18 years or older, had newly diagnosed, high-risk, metastatic castration-naive prostate cancer confirmed by bone scan (bone metastases) or by CT or MRI (visceral, soft tissue, or nodal metastases), and an Eastern Cooperative Oncology Group (ECOG) performance status score of 2 or less. Patients from 235 clinical sites in 34 countries were randomly assigned (1:1) following a country-by-country scheme done by permuted block randomisation (with two blocks) and stratified by the presence of visceral metastasis and ECOG performance status to receive ADT plus 1000 mg oral abiraterone acetate and 5 mg oral prednisone once daily or ADT plus placebos. Selection of ADT, chemical or surgical, was at the investigator's discretion. The co-primary endpoints of the trial, overall survival and radiographic progression-free survival, have been published. PRO data were collected directly on electronic tablet devices at the clinical sites during screening and before any other visit procedure on day 1 of cycles 1-3, monthly during cycles 4-13, and then every 2 months until the end of treatment, by use of the Brief Pain Inventory-Short Form (BPI-SF), Brief Fatigue Inventory (BFI), Functional Assessment of Cancer Therapy Prostate scale (FACT-P), and the EuroQol (EQ-5D-5L) questionnaires. PRO analyses were an exploratory endpoint. Analyses were by intention-to-treat. Results from the first pre-planned interim analysis (Oct 31, 2016), are presented here. This ongoing study is registered with Clinicaltrials.gov, number NCT01715285.Findings: Between Feb 12, 2013, and Dec 11, 2014, 1199 patients were randomly assigned: 597 to ADT plus abiraterone acetate and prednisone and 602 to ADT plus placebos. Median follow-up was 30·9 months (IQR 21·2-33·2) in the ADT plus abiraterone acetate and prednisone group versus 29·7 months (1·4-43·5; 16·1-31·3) in the ADT plus placebos group. Median time to worst pain intensity progression assessed by the BPI-SF score was not reached in either group (ADT plus abiraterone acetate and prednisone, not reached [95% CI not reached to not reached]; 25th percentile 11·07 months [95% CI 9·23-18·43]; ADT plus placebos group, not reached [95% CI not reached to not reached]; 25th percentile 5·62 [95% CI 4·63-7·39]; hazard ratio [HR] 0·63 [95% CI 0·52-0·77]; p<0·0001). Median time to worst fatigue intensity was not reached in either the ADT plus abiraterone acetate and prednisone group (not reached [95% CI not reached to not reached]; 25th percentile 18·4 months [95% CI 12·9-27·7]) or the ADT plus placebos group (not reached [95% CI not reached to not reached]; 25th percentile 6·5 months [95% CI 5·6-9·2]; HR 0·65 [95% CI 0·53-0·81], p=0·0001). Median time to deterioration of functional status assessed by the FACT-P total score scale was 12·9 months (95% CI 9·0-16·6) in the ADT plus abiraterone acetate and prednisone group versus 8·3 months (7·4-11·1) in the ADT plus placebos group (HR 0·85 [95% CI 0·74-0·99]; p=0·032).Interpretation: The addition of abiraterone acetate plus prednisone to ADT in patients with newly diagnosed, high-risk metastatic castration-naive prostate cancer improved overall PROs by consistently showing a clinical benefit in the progression of pain, prostate cancer symptoms, fatigue, functional decline, and overall HRQOL.Funding: Janssen Research & Development. [ABSTRACT FROM AUTHOR]

Purpose: The use of minilaparoscopic instruments has gained interest in recent years, permitting a less invasive treatment for many surgical procedures. Its application in urological surgeries has not been established yet. Methods: Between November 2012 and December 2014, 32 patients underwent minilaparoscopic surgeries, using 3.5-mm instruments. The procedures performed included pyeloplasties (16 cases), radical nephrectomies (2), simple nephrectomies (4), renal cyst decortication (5), ureterolithotomy (2) ureteral reimplantation (2) and partial ureterectomy (1). Results: All the procedures were performed minilaparoscopically, except for one simple nephrectomy and one renal cyst decortication that were converted to a standard laparoscopic approach, due to intensive perioperative bleeding. One pyeloplasty had to be reoperated for a urinary fistula repair. All the patients had good-to-excellent cosmetic outcomes, except for one patient who developed keloids at her scars. Functional results were comparable to the ones described in the literature. Conclusion: Minilaparoscopy is a feasible option for patients and physicians searching for a even less invasive procedure compared with the laparoscopic approach, with better cosmetic and the same functional and oncologic outcomes. [ABSTRACT FROM AUTHOR]

Background This analysis was performed to further characterise treatment-emergent hypocalcaemia in patients with bone metastases receiving denosumab. Methods Laboratory abnormalities and adverse events of hypocalcaemia in patients with metastatic bone disease were analysed using data from three identically designed phase 3 trials of subcutaneous denosumab 120 mg ( n = 2841) versus intravenous zoledronic acid 4 mg ( n = 2836). Results The overall incidence of laboratory events of hypocalcaemia grade ⩾2 was higher with denosumab (12.4%) than with zoledronic acid (5.3%). Hypocalcaemia events were primarily grade 2 in severity and usually occurred within the first 6 months of treatment. Patients who reported taking calcium and/or vitamin D supplements had a lower incidence of hypocalcaemia. Prostate cancer or small-cell lung cancer, reduced creatinine clearance and higher baseline bone turnover markers of urinary N-telopeptide of type I collagen (uNTx; >50 versus ⩽50 nmol/mmol) and bone-specific alkaline phosphatase (BSAP; >20.77 μg/L [median] versus ⩽20.77 μg/L) values were important risk factors for developing hypocalcaemia. The risk associated with increased baseline BSAP levels was greater among patients who had >2 bone metastases at baseline versus those with ⩽2 bone metastases at baseline. Conclusion Hypocalcaemia was more frequent with denosumab versus zoledronic acid, consistent with denosumab’s greater antiresorptive effect. Low serum calcium levels and potential vitamin D deficiency should be corrected before initiating treatment with a potent osteoclast inhibitor, and corrected serum calcium levels should be monitored during treatment. Adequate calcium and vitamin D intake appears to substantially reduce the risk of hypocalcaemia. [ABSTRACT FROM AUTHOR]

Background Previous studies have reported on prognostic factors for castration-resistant prostate cancer (CRPC); however, most of these studies were conducted before docetaxel chemotherapy was approved for CRPC. Objective To evaluate the prognostic value of multiple parameters in men with bone metastases due to CRPC using a contemporary dataset. Design, setting, and participants The analysis included 1901 patients with metastatic CRPC enrolled in an international, multicenter, randomized, double-blind phase 3 trial conducted between May 2006 and October 2009. Outcome measures and statistical analysis We developed multivariate validated Cox proportional hazards models and nomograms to estimate 12-mo and 24-mo survival probabilities and median survival time. Results and limitations The median (95% confidence interval) overall survival was 20 (18, 21) mo. The final model included 12 of the 15 potential prognostic variables evaluated (concordance index 0.72). Seven bone-related variables were associated with longer survival in the final model: alkaline phosphatase ≤143 U/l ( p < 0.0001); bone-specific alkaline phosphatase (BSAP) <146 U/l ( p < 0.0001); corrected urinary N-telopeptide (uNTx) ≤50 nmol/mmol ( p = 0.0008); mild or no pain (Brief Pain Inventory—Short Form [BPI-SF] score ≤4) ( p < 0.0001); no previous skeletal-related event (SRE; p = 0.0002); longer time from initial diagnosis to first bone metastasis ( p < 0.0001); and longer time from first bone metastasis to randomization ( p < 0.0001). Other significant predictors of improved survival included prostate-specific antigen (PSA) level <10 ng/ml ( p < 0.0001), hemoglobin >128 g/l ( p < 0.0001), absence of visceral metastases ( p < 0.0001), Eastern Co-operative Oncology Group (ECOG) score ≤1 ( p = 0.017), and younger age ( p = 0.008). Nomograms were generated based on the parameters included in the final validated models (with/without uNTx and BSAP). One limitation was that lactate dehydrogenase (LDH) levels, a known prognostic factor, were not available in this study. Conclusions Bone-related parameters are strong prognostic variables for overall survival in patients with bone metastases from CRPC. Patient summary Survival time is variable in patients with bone metastases from prostate cancer. We found that factors related to bone help to predict how long a patient will live. [ABSTRACT FROM AUTHOR]

Purpose: To investigate whether ultrasonographic bladder wall thickness (BWT) correlates with urodynamic parameters in patients with spinal cord injury (SCI). Methods: Two hundred and seventy-two patients with SCI were enrolled in the study. All of the patients underwent bladder ultrasonography and urodynamic study. The anterior bladder wall was measured and compared to urodynamic data. Results: The mean age of the patients was 37.4 years. The mean BWT was 3.9 mm. BWT was significantly higher in the patients with neurogenic detrusor overactivity associated with detrusor sphincter dyssynergia (NDO/DSD) compared to those without sphincter dyssynergia (4.2 vs. 3.6 mm, respectively, p < 0.001) and in those with compliance <20 ml/cm HO. Nevertheless, ROC curve analysis [ROC = 0.624, 95 % CI (0.530, 0.718), p = 0.011] showed that no meaningful BWT measurement cutoff could be made to predict an elevated detrusor pressure in the storage phase. Conclusions: Increased BWT was present in patients with low bladder compliance and NDO/DSD. No BWT cutoff value to predict an elevated detrusor pressure was found. Therefore, the measurement of BWT has no clinical role in patients with SCI and cannot replace urodynamic evaluation. [ABSTRACT FROM AUTHOR]

Objective: The 2nd to 4th digit length (2D:4D) is inversely related to androgen exposure during the fetal period, which may represent a risk factor for several steroid-related diseases. We aimed to evaluate the relationship between 2D:4D ratio and the risk of developing prostate cancer (PCa). Subjects and Methods: We assessed the 2D:4D ratio of 474 men >40 years old, stratified into three groups: group 1 (n = 222) patients with PCa, group 2 (n = 82) subjects with high risk of PCa, and group 3 (n = 170) men with low risk of PCa. Subjects were submitted to a digital picture of the ventral surface of the right hand and 2nd and 4th fingers measurements were determined by the distance from the proximal crease to the tip using computer-assisted analysis. Results: The mean serum prostate-specific antigen level was 7.5 ng/ml in the high-risk group and 0.92 ng/ml in the low-risk group (p < 0.05). The mean 2D:4D ratios were 0.96 ± 0.04, 0.97 ± 0.04 and 0.96 ± 0.04 for the PCa, high-risk and low-risk groups, respectively, and no difference was found among the three groups (p = 0.12). Conclusion: Anthropometry of the hand using the 2D:4D ratio is not a predictor of PCa. © 2013 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Purpose: To assess influence of penile biometric characteristics on surgical outcome of tubularized incised plate (TIP) repair for hypospadias. Methods: We prospectively studied 42 boys with distal hypospadias that underwent TIP urethroplasty. Biometric assessment prior to surgery consisted of classifying glans shape, urethral plate (UP) length and width, prepuce vascularization and penile size, using a caliper rule, according to previous definitions. Surgical outcome was assessed according to the occurrence of dehiscence, fistula or urethral stricture. Results: There was no statistical difference among groups concerning postoperative complications. Glans shape: grooved (24/57 %), shallow (9/21 %) and conical (9/21 %). UP width: <10 mm (26/62 %) and ≥10 mm (16/38 %). UP length was evaluated in 29 patients: <10 mm in (12/41 %) and ≥10 mm (17/59 %). Prepuce vascularization: one predominant blood vessel (17/41 %), two predominant blood vessels (8/19 %), H-like form with communication between two well-developed blood vessels (6/14 %) and net-like form with no predominant blood vessels (11/26 %). Penile size was measured in 28 patients under 50th percentile (25/89 %). Conclusion: Glans shape, UP width, UP length, prepuce vascularization and penile size do not significantly affect the complication rate of TIP repair in distal hypospadias. Most of the patients with distal hypospadias presented with penile size under mean length for age suggesting some form of mild hypogonadism. [ABSTRACT FROM AUTHOR]

Objective: To describe the penile length after radical prostatectomy (RP) in a long-term follow-up. Materials and Methods: We evaluated prospectively the penile length of 105 patients with localized prostate cancer treated by open RP. Participants using therapy for penile rehabilitation were excluded from statistical analysis. Measurements of the stretched penis were taken preoperatively and at 3, 6, 12, 24, 36, 48, and 60 months postoperatively. The International Index of Erectile Function-Erectile Function (IIEF-EF) questionnaire was used to evaluate erectile function. The penile anthropometric measure used was the stretched length of the flaccid penis, from the pubopenile skin angle to the end of the glans, after the prepubic fat was depressed under maximum manual traction. Results: The mean stretched penile length 3 months after RP decreased an average of 1 cm from baseline (P <.001). This mean difference persisted until 24 months. At 36 months, the penile length differed 0.6 cm. At 48 months (−0.3 cm) and 60 months (+0.4 cm), the mean differences in penile length before and after RP were not significant (P = .080 and P = .065, respectively). Erectile function was a predictor for early return of penile length. Conclusion: Nearly 1 cm of penile shortening after RP may be expected up to 12 months. However, a trend toward recovery of penile length occurs after 24 months of follow-up and is completely re-established after 48 months. The preserved erectile function after RP is a predictor for penile length recovery. [ABSTRACT FROM AUTHOR]

The article presents a study on the use of denosumab, a monoclonal antibody, for the prevention of bone metastasis in men with prostate cancer. The study covered 1432 participants with non-metastatic castration-resistant prostate cancer and were selected using the placebo controlled trial and received 120 milligrams (mg) of denosumab every four weeks. The study reveals that bone-metastasis-free survival were increased by 4.2 months and delayed the time for first bone metastasis.

The article presents a randomised, double-blind study which compares denosumab with zoledronic acid for prevention and treatment of skeletal-related events in male patients with bone metastases from castration-resistant prostate cancer. An interactive voice response system was employed to assign patients to receive certain dosage of one of the two drugs. The study concludes that denosumab is better than zoledronic acid in preventing skeletal-related events.

Objectives: To evaluate lower urinary tract dysfunction (LUTD) based on questionnaire symptom scoring and ultrasound assessment of bladder wall thickness (BWT) in children with cerebral palsy (CP). Methods: A total of 97 children with CP were enrolled in the study. The patients were either symptomatic or asymptomatic with respect to lower urinary tract symptoms. All children underwent a urinary questionnaire and renal ultrasonography. Ultrasound assessment of BWT was completed in 72 cases. Results: A total of 47 patients were female and 50 were male. The mean age was 8 years 8 months (SD 3 years 1 month), with a range of 5-18 years. Urinary incontinence was present in 43 patients (44.3%). Based on the questionnaire, LUTD was found in 59 patients (60.8%). The mean BWT was 2.30 mm. There was no statistically significant difference between continent and incontinent children (2.46 vs 2.19 mm) or between children with and without LUTD (2.43 vs 2.12 mm). Conclusions: LUTD is common in children with CP and occurred in 60.8% of the patients assessed. BWT did not correlate with the presence of bladder dysfunction or incontinence. Ultrasound assessment of BWT was not relevant for diagnosis of lower urinary tract dysfunction. [ABSTRACT FROM AUTHOR]

Introduction. This is a phase III, prospective, randomized, double-blind, placebo-controlled clinical trial on lodenafil carbonate (LC), a novel phosphodiesterase 5 inhibitor developed in Brazil. Aim. Expanding information on LC efficacy and safety. Main Outcome Measures. International Index of Erectile Function (IIEF) erectile domain, positive answers to the sexual encounter profile (SEP)-2 and SEP-3 questions and incidence of adverse events (AEs). Methods. A total of 350 men with erectile dysfunction (ED) of all degrees were randomized to placebo, LC 40 mg or LC 80 mg and followed for 4 weeks. They completed the IIEF and answered the SEP questions 2 and 3 after each intercourse without and with the use of LC. Results. IIEF Erectile Domain scores without and with the use of medication were the following (mean [M] ± standard deviation [SD]): placebo = 13.9 ± 5.2 and 14.8 ± 7.8; LC 40 mg = 13.6 ± 5.3 and 18.6 ± 8.0; LC 80 mg = 13.4 ± 4.9 and 20.6 ± 7.7 (analysis of variance [anova] P < 0.01). Positive answers to SEP-2 without and with the use of medication were the following (M ± SD): placebo = 55.3 ± 43.2% and 52.1 ± 41.4%; LC 40 mg = 46.4 ± 44.3% and 63.5 ± 42.0%; LC 80 mg = 50.2 ± 40.9% and 80.8 ± 32.3% (anova P < 0.01). Positive answers to SEP-3 were the following: placebo = 20.2 ± 32.3% and 29.7 ± 38.1%; LC 40 mg = 19.6 ± 34.3% and 50.8 ± 44.4%; LC 80 mg = 20.8 ± 33.2% and 66.0 ± 39.3% (anova P < 0.01). The patients with at least one AE were placebo = 28.7%, LC 40 mg = 40.9%, and LC 80 mg = 49.5%. AEs whose incidence was significantly higher with LC than with placebo included rhinitis, headache, flushing, visual disorder, and dizziness. Conclusions. LC showed a satisfactory efficacy–safety profile for oral therapy of ED. Glina S, Fonseca GN, Bertero EB, Damião R, Rocha LCA, Jardim CRF, Cairoli CE, Teloken C, Torres LO, Faria GE, da Silva MB, and Pagani E. Efficacy and tolerability of lodenafil carbonate for oral therapy of erectile dysfunction: A phase III clinical trial. J Sex Med 2010;7:1928–1936. [ABSTRACT FROM AUTHOR]

Abstract: Background: Combination therapy with dutasteride and tamsulosin provides significantly greater benefit than either monotherapy for various patient-reported outcomes in men with moderate-to-severe lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) and prostatic enlargement. Objective: To investigate whether combination therapy is more effective than either monotherapy in reducing the relative risk for acute urinary retention (AUR), BPH-related surgery, and BPH clinical progression over 4 yr in men at increased risk of progression. Design, setting, and participants: The Combination of Avodart® and Tamsulosin (CombAT) study was a 4-yr, multicenter, randomised, double-blind, parallel-group study in 4844 men ≥50 yr of age with a clinical diagnosis of BPH, International Prostate Symptom Score ≥12, prostate volume ≥30cm3, prostate-specific antigen 1.5–10ng/ml, and maximum urinary flow rate (Qmax) >5 and ≤15ml/s with minimum voided volume ≥125ml. Intervention: Oral daily tamsulosin, 0.4mg; dutasteride, 0.5mg; or a combination of both. Measurements: The 4-yr primary end point was time to first AUR or BPH-related surgery. Secondary end points included BPH clinical progression, symptoms, Qmax, prostate volume, safety, and tolerability. Results and limitations: Combination therapy was significantly superior to tamsulosin monotherapy but not dutasteride monotherapy at reducing the relative risk of AUR or BPH-related surgery. Combination therapy was also significantly superior to both monotherapies at reducing the relative risk of BPH clinical progression. Combination therapy provided significantly greater symptom benefit than either monotherapy at 4 yr. Safety and tolerability of combination therapy was consistent with previous experience with dutasteride and tamsulosin monotherapies, with the exception of an imbalance in the composite term of cardiac failure among the three study arms. The lack of placebo control is a study limitation. Conclusions: The 4-yr CombAT data provide support for the long-term use of dutasteride and tamsulosin combination therapy in men with moderate-to-severe LUTS due to BPH and prostatic enlargement. Clinicaltrials.gov identifier: NCT00090103 (http://www.clinicaltrials.gov/ct2/show/NCT00090103). [Copyright &y& Elsevier]

Introduction. Randomized clinical trials (RCT) remain the gold standard in providing scientific evidence in medical practice in spite of the significant placebo effect in the treatment of several disorders. Although the first-line therapy for erectile dysfunction (ED) is oral phosphodiesterase type-5 inhibitor (iPDE5), the placebo effect in RCT of iPDE5 for ED occurs at a rate as high as 50%. Aims. To evaluate the role of therapeutic illusion in the oral treatment for ED. Methods. A prospective, controlled, single-blind, parallel-group study was performed at single-center. One hundred and twenty-three patients with ED were randomly assigned into three groups and received different letters: Group 1 (G1) was informed to be receiving a substance for ED treatment; Group 2 (G2) was informed that they could be receiving an active drug or placebo; Group 3 (G3) was conscious to be using placebo. Starch capsules were dispensed to all patients. Median follow up was 12 weeks. Main Outcome Measures. ED improvement was assessed after 8 weeks of the intervention by the erectile function domain of the International Index of Erectile Function (IIEF) and the Quality of Erection Questionnaire. ED severity was classified by the IIEF erectile function (IIEF-EF) domain score into five categories: no ED (score of 26–30), mild (22–25), mild to moderate (17–21), moderate (11–16), and severe (6–10). Improvement in IIEF-EF domain was considered as a change in category of severity. Results. ED severity improved in all three groups (G1 = 31.7%, P = 0.039; G2 = 36.8%, P = 0.028; G3 = 36.8%, P = 0.002) and no difference was found among groups ( P = 0.857). Improvement of quality of erection score was only significant in G2 ( P = 0.005) and G3 ( P < 0.001). Conclusions. Written-suggested therapeutic illusion for patients with ED has no major influence in the outcomes. However, treatment of ED with oral placebo capsules demonstrates clinical effects, improving erectile function and quality of erection. de Araujo AC, da Silva FG, Salvi F, Awad MC, da Silva EA, and Damião R. The management of erectile dysfunction with placebo only: Does it work? J Sex Med 2009;6:3440–3448. [ABSTRACT FROM AUTHOR]

Objective: To evaluate potential in vitro relaxant actions of sildenafil on human isolated bladder neck smooth muscle. Methods: Bladder neck strips were sampled from patients (aged 55-77 years) submitted to prostatic surgery (6 adenomectomies and 1 radical prostatectomy). These were carefully dissected into 1-2 × 0.5-cm pieces and suspended in an organ bath containing 30 mL of a modified Krebs Henseleit solution, bubbled with 95% O2/5% CO2. After tissue stabilization and viability test with KCl, the tissue was precontracted with phenylephrine, and a concentration–response relaxant curve to sildenafil was constructed. The effect of sildenafil was also assessed in tissues treated with Nω-nitro-L-arginine methyl ester (l-NAME) or 1H-[1,2,4]oxadiazolo[4,3-a]quinoxaline-1-one (ODQ) (inhibitors of nitric oxide synthase and guanylyl cyclase, respectively). Result: Sildenafil induced significant bladder neck relaxation at all concentrations tested. The maximum relaxation was 86.97% ± 6.69%, obtained with a high concentration of sildenafil (5.1 × 10−4 M). Both l-NAME and ODQ significantly reduced sildenafil-induced relaxation. Conclusions: Sildenafil was effective in inducing bladder neck smooth muscle relaxation in vitro. This effect was almost abolished by l-NAME and ODQ, clearly demonstrating a dependence of the nitric oxide–cyclic guanosine monophosphate pathway. Our in-vitro results suggest that sildenafil might be useful in improving lower urinary tract symptoms due to benign prostatic hyperplasia. [Copyright &y& Elsevier]

Abstract: Background: Knowledge of baseline factors that influence outcomes for men with benign prostatic hyperplasia (BPH) receiving medical therapy may help to improve outcomes and cost effectiveness. Objectives: To examine the influence of baseline parameters on changes in International Prostate Symptom Score (IPSS) and maximum urinary flow rate (Qmax) in men with BPH receiving dutasteride, tamsulosin, or a combination of the two using 2-yr Combination of Avodart and Tamsulosin (CombAT) study data. Design, setting, and participants: CombAT is an ongoing, 4-yr, multicentre, randomised, double-blind study in 4844 men aged ≥50 yr with clinical diagnosis of BPH, IPSS ≥12, prostate volume ≥30cm3, prostate-specific antigen (PSA) 1.5–10ng/ml, and Qmax >5 and ≤15ml/s with minimum voided volume ≥125ml. Intervention: Daily tamsulosin 0.4mg, dutasteride 0.5mg, or the combination. Measurements: Post hoc analyses of mean IPSS and Qmax changes from baseline by treatment group and by baseline prostate volume, PSA, age, body mass index (BMI), IPSS, IPSS quality of life (QoL) score, BPH Impact Index score, Qmax, and previous BPH medical therapy. Results and limitations: Combination therapy was more effective than either monotherapy after 24 mo in improving IPSS in all baseline subgroups, with benefit onset varying by baseline prostate volume. Combination therapy was also more effective in improving Qmax versus tamsulosin in all subgroups and versus dutasteride in 10 of 18 subgroups. At 24 mo, dutasteride monotherapy resulted in significantly greater IPSS improvements versus tamsulosin in men with lower age, worse symptoms, worse QoL, less bother, higher BMI, greater Qmax, higher prostate volume, and higher PSA at baseline. Post hoc analyses, the lack of placebo control, and the exclusion of men with unsuccessful medical BPH treatment are study limitations. Conclusions: Combination therapy with tamsulosin and dutasteride affords the greatest and the most rapid symptomatic benefit among men with higher baseline prostate volume and is effective regardless of previous BPH medical therapy. Dutasteride monotherapy is more effective than tamsulosin in men with higher baseline prostate volume or PSA and worse symptoms. [Copyright &y& Elsevier]

OBJECTIVE To investigate the effects of sildenafil on noradrenaline- and potassium-induced contractions of isolated human seminal vesicles (SVs), as premature ejaculation is a relatively common male sexual dysfunction that currently lacks an adequate therapy, and recent in vitro tests showed that sildenafil induces relaxation of rodent isolated SVs, but it is not known whether it also inhibits isolated human SV. MATERIAL AND METHODS Isolated strips of human SVs were suspended in an organ bath and cumulative concentration-response curves to either noradrenaline or KCl were constructed in the presence and absence of sildenafil to evaluate its inhibitory actions. RESULTS Sildenafil (25–100 µm) induced concentration-dependent inhibitory effects on the human SV contracted by either noradrenaline or KCl. These actions of sildenafil do not therefore appear to be mediated via a competitive antagonism of α-adrenoceptors and are consistent with its recognized ability to inhibit phosphodiesterase-5. CONCLUSIONS The present results show an important inhibitory action of sildenafil in the isolated human SV, supporting the therapeutic indication of this drug for treating premature ejaculation. [ABSTRACT FROM AUTHOR]