1.Meta-analysis with meta-regression and systematic review of the efficacy of on-demand tramadol for the treatment of lifelong premature ejaculation.
Philippine Journal of Surgical Specialties 2013;68(3):109-120
<p style="text-align: justify;">This is a systematic review and meta-analysis on the efficacy of ondemand tramadol for the treatment of lifelong premature ejaculation.p><p style="text-align: justify;">METHODS: A systematic review and meta-analysis with metaregression of trials evaluating the use of tramadol to treat premature ejaculation using intravaginal ejaculation latency time as a measure.Relevant studies were identified using PubMed, Ebscohost,MEDLINE, EMBASE and the Cochrane Collaboration Library.p><p style="text-align: justify;">RESULTS: This analysis included 8 publications. Study of the intravaginal ejaculation latency time (IELT) among 599 patients showed that tramadol was effective in subjects with premature ejaculation as seen by the significant difference in mean IELT of tramadol treated patients versus those receiving placebo (mean difference 2.43 minutes; 95% CI 0.93-3.93; P=0.002). The effect on IELT between tramadol and paroxetine was not statistically significant (mean difference -0.58; 95% CI -5.81 to 4.65; P=0.83).Meta-regression analysis showed that the lower the dose of tramadol,the higher its benefit in the prolongation of IELT, however, there was no significant difference (95% CI regression coefficient -0.0956 to 0.0322). There was a significant difference in adverse effects profile of tramadol versus placebo (risk ratio 2.48; 95% CI 1.55-3.98; overall effect Z= 3.79; P<0.0002) and overall therapeutic effectiveness between tramadol compared to placebo (risk ratio 0.55; 95% CI 0.46-0.67; P<0.00001).p><p style="text-align: justify;">CONCLUSION: On-demand tramadol is an effective treatment for lifelong premature ejaculation. It significantly prolongs the intravaginal ejaculation latency time. The overall adverse events and overall therapeutic effectiveness are significantly greater during treatment with tramadol.p>
Human
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Female
;
Premature Ejaculation
;
Ejaculation
;
Tramadol
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Paroxetine
;
Medline
;
Pubmed
2.Survival outcomes among men with clinically localized prostate cancer treated with radical prostatectomy, brachytherapy, cryosurgical ablation and intensity-modulated radiotherapy: A single surgeon local experience.
Martinez Marlon P. ; Letran Jason L.
Philippine Journal of Urology 2014;24(1):10-17
<p style="text-align: justify;">OBJECTIVE: Radical prostatectomy (RP), brachytherapy, cryosurgical ablation and intensity-modulated radiotherapy (IMRT) are accepted treatment options for localized prostate cancer. The objectives of this study were to determine the overall survival (OS), disease specific survival (DSS) and biochemical no evidence of disease (BNED) rates of the patients who underwent these different treatment modalities.p>
<p style="text-align: justify;">MATERIALS AND METHODS: A total of 485 patients with localized prostate cancer treated with RP (n=235), brachytherapy (n=202), cryosurgical ablation (n=33), and IMRT (n=15) were identified from the database of a single urological practice. Analysis of variance (ANOVA) was used to compare means of patients. Chi-square test was used to compare percentages. Kaplan-Meier survival analysis was used to determine if the outcome parameters significantly differed according to the methods. P-values less than 0.05 indicate significant difference. All the statistical tests were performed using SPSS 20.0.p>
<p style="text-align: justify;">RESULTS: The OS rate after RP, brachytherapy, cryosurgical ablation and IMRT were 97.9%, 89.1%, 93.9% and 93.3%, respectively. The DSS rate was 99.6%, 98.0% and 97.0%. respectively. No mortality from prostatic cause was reported from IMRT. The BNED rate was 90.6%, 88.1%, 78.8% and 93.3%, respectively.p>
<p style="text-align: justify;">CONCLUSION: The overall and disease specific survival were comparable among all treatment modalities. Although radical prostatectomy and IMRT showed an overall better BNED outcomes, this advantage disappeared when the patients were analyzed according to their respective risk stratification into low, moderate and high risk group.p>
Human
;
Male
;
Aged 80 and over
;
Aged
;
Middle Aged
;
Adult
;
Neoplasms
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Prostatic Neoplasms-therapeutics, therapy
;
Survival
3.A comparative study on the operative outcomes of a novel technique of continuous versus interrupted vesicourethral anastomosis in open radical retropubic prostatectomy.
Martinez Marlon P. ; Bisnar Carlo C. ; Letran Jason L.
Philippine Journal of Urology 2014;24(1):18-26
<p style="text-align: justify;">OBJECTIVE: Vesicourethral anastomosis (VUA) is the most technically challenging part in open radical retropubic prostatectomy (ORRP). Traditionally, it is accomplished using interrupted anastomotic sutures. The objective of this study is to describe our surgical technique of continuous VUA and compare its outcomes with that of interrupted VUA as performed by a single surgeon.p>
<p style="text-align: justify;">MATERIALS AND METHODS: A total of 235 patients with clinically localized prostate cancer who underwent ORRP since February 2000 to June 2013 were included. They were divided into Group 1 (n=121) using interrupted VUA and Group 2 (n=114) using our technique of continuous VUA. Primary outcome measures to be evaluated include several operative parameters with respect to operative time, blood loss, anastomotic integrity, hospital stay, continence, potency and occurrence of VUA stenosis. Analysis was done using Welch's t-test and Fisher's exact test. All the statistical tests were performed using SPSS 20.0. P-values less than 0.05 indicate statistically significant difference.p>
<p style="text-align: justify;">RESULTS: Patients who underwent continuous VUA (Group 2) had significantly less operative time (210.05 ± 1.91 vs 251.37 ± 2.74 mins, P<0.001), anastomotic time (20.86 ± 0.49 vs 41.46 ± 0.58 mins, P<0.001), estimated blood loss (510.81 ±10.11 vs 623.89 ±26.60 ml, P<0.001), need for transfusion (7.89% vs 27.27%, P<0.001), number of days prior to drain removal (3.13 ± 0.05 vs 6.15 ± 0.11, P<0.001), number of days of hospital stay (3.44 ± 0.06 vs 6.36 ± 0.11, P<0.001), leakage per voiding cystourethrogram (0.88% vs 5.76%, P=0.035), number of days prior to urethral catheter removal (10.05 ± 0.12 vs 14.94 ± 0.2, P<0.001) and number of weeks to gain continence (7.05 ± 0.26 vs 12.46 ± 0.31, P<0.001). There were two cases of VUA stenosis for each of the two groups. There was no reported occurrence of pelvic infection, urinoma and acute urinary retention after catheter removal.p>
<p style="text-align: justify;">CONCLUSIONS: Our technique of continuous VUA for ORRP provides better outcome compared to standard interrupted VUA.p>
Human
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Male
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Aged
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Middle Aged
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Neoplasms
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Prostatic Neoplasms
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Anastomosis, Surgical
;
Prostatectomy
4.Male infertility practice among Filipino urologists: A road less traveled.
Janssen Dion T. Unas ; Marlon P. Martinez
Philippine Journal of Urology 2022;32(2):57-69
INTRODUCTION:
Advancement in male infertility were evident during the past several decades where ashift to evidence-based management is becoming apparent. However, there is still a knowledge gapamong training urologists in the said field where the Philippines is no exception. This is the first studythat would determine the current trend of practice in male infertility among Filipino urologists andrecommend solutions to this problem.
MATERIALS AND METHODS:
A 42-item self-administered survey questionnaire was carried out using theSurvey Monkey. This Institutional Review Board (IRB)-approved online survey consisted of 3 parts:demographics, adherenceto the guidelines andclinical practice.The authors contacted thePhilippineUrological Association (PUA) via email and requested for confidential distribution of an online survey.The participants were given 4 weeks from the date of initial mailing until end of the survey process.STATA 15.0 was used for data analysis.
RESULTS:
A total of 131 respondents participated in the survey. Only 13% responded that they are “veryinterested” in the specialty of male infertility. About 84% of respondents see less than 5 male infertilitycases per month with 67% of them reporting that male infertility constitutes less than 10% of theirpractice. For the treatment, 36% of them prescribe testosterone for empiric medical therapy of maleinfertility which is contraindicated in the treatment of male infertility and only 5% of respondents offerthe gold standard microsurgical varicocoelectomy in patients with varicocoele. Only 8% of respondentsare affiliated with IVF centers, which is troubling with regards to how men with poor reproductivepotential are treated especially in azoospermic men. Two percent of the respondents rated their exposureto male infertility during residency as “excellent” while only 3% of them rated their knowledge asexcellent. With this, responders suggest more exposure to the specialty, more postgraduate courses,lectures, and webinars, more training opportunities, a local guideline for Filipino urologists to follow,and more exposure to professional networks.
CONCLUSION
Practice of male infertility in the Philippines is inadequate in terms of knowledge andtreatment for these patients. Most respondents follow the male infertility guidelines available, but itdoes not translate into practice, highlighting their own preferences in diagnosis and treatment. Eventhough they consider it as a necessary part of Urology, lack of exposure to cases, surgical loads, andresearch makes it a challenge when faced with these cases in their clinics. A change in the residency,postgraduate, and national level are recommended to have the best clinical outcome and well-beingfor these patients.
5.Controversy and Consensus on the Management of Elevated Sperm DNA Fragmentation in Male Infertility: A Global Survey, Current Guidelines, and Expert Recommendations
Ala’a FARKOUH ; Ashok AGARWAL ; Taha Abo-Almagd Abdel-Meguid HAMODA ; Parviz KAVOUSSI ; Ramadan SALEH ; Armand ZINI ; Mohamed ARAFA ; Ahmed M. HARRAZ ; Murat GUL ; Vilvapathy Senguttuvan KARTHIKEYAN ; Damayanthi DURAIRAJANAYAGAM ; Amarnath RAMBHATLA ; Florence BOITRELLE ; Eric CHUNG ; Ponco BIROWO ; Tuncay TOPRAK ; Ramy Abou GHAYDA ; Rossella CANNARELLA ; Nguyen Ho Vinh PHUOC ; Fotios DIMITRIADIS ; Giorgio I. RUSSO ; Ioannis SOKOLAKIS ; Taymour MOSTAFA ; Konstantinos MAKAROUNIS ; Imad ZIOUZIOU ; Shinnosuke KURODA ; Marion BENDAYAN ; Raneen Sawaid KAIYAL ; Andrian JAPARI ; Mara SIMOPOULOU ; Lucia ROCCO ; Nicolas GARRIDO ; Nazim GHERABI ; Kadir BOCU ; Oguzhan KAHRAMAN ; Tan V. LE ; Christine WYNS ; Kelton TREMELLEN ; Selcuk SARIKAYA ; Sheena LEWIS ; Donald P. EVENSON ; Edmund KO ; Aldo E. CALOGERO ; Fahmi BAHAR ; Marlon MARTINEZ ; Andrea CRAFA ; Quang NGUYEN ; Rafael F. AMBAR ; Giovanni COLPI ; Mustafa Emre BAKIRCIOGLU
The World Journal of Men's Health 2023;41(4):809-847
Purpose:
Sperm DNA fragmentation (SDF) has been associated with male infertility and poor outcomes of assisted reproductive technology (ART). The purpose of this study was to investigate global practices related to the management of elevated SDF in infertile men, summarize the relevant professional society recommendations, and provide expert recommendations for managing this condition.
Materials and Methods:
An online global survey on clinical practices related to SDF was disseminated to reproductive clinicians, according to the CHERRIES checklist criteria. Management protocols for various conditions associated with SDF were captured and compared to the relevant recommendations in professional society guidelines and the appropriate available evidence. Expert recommendations and consensus on the management of infertile men with elevated SDF were then formulated and adapted using the Delphi method.
Results:
A total of 436 experts from 55 different countries submitted responses. As an initial approach, 79.1% of reproductive experts recommend lifestyle modifications for infertile men with elevated SDF, and 76.9% prescribe empiric antioxidants. Regarding antioxidant duration, 39.3% recommend 4–6 months and 38.1% recommend 3 months. For men with unexplained or idiopathic infertility, and couples experiencing recurrent miscarriages associated with elevated SDF, most respondents refer to ART 6 months after failure of conservative and empiric medical management. Infertile men with clinical varicocele, normal conventional semen parameters, and elevated SDF are offered varicocele repair immediately after diagnosis by 31.4%, and after failure of antioxidants and conservative measures by 40.9%. Sperm selection techniques and testicular sperm extraction are also management options for couples undergoing ART. For most questions, heterogenous practices were demonstrated.
Conclusions
This paper presents the results of a large global survey on the management of infertile men with elevated SDF and reveals a lack of consensus among clinicians. Furthermore, it demonstrates the scarcity of professional society guidelines in this regard and attempts to highlight the relevant evidence. Expert recommendations are proposed to help guide clinicians.
6.Male Oxidative Stress Infertility (MOSI): Proposed Terminology and Clinical Practice Guidelines for Management of Idiopathic Male Infertility
Ashok AGARWAL ; Neel PAREKH ; Manesh Kumar PANNER SELVAM ; Ralf HENKEL ; Rupin SHAH ; Sheryl T HOMA ; Ranjith RAMASAMY ; Edmund KO ; Kelton TREMELLEN ; Sandro ESTEVES ; Ahmad MAJZOUB ; Juan G ALVAREZ ; David K GARDNER ; Channa N JAYASENA ; Jonathan W RAMSAY ; Chak Lam CHO ; Ramadan SALEH ; Denny SAKKAS ; James M HOTALING ; Scott D LUNDY ; Sarah VIJ ; Joel MARMAR ; Jaime GOSALVEZ ; Edmund SABANEGH ; Hyun Jun PARK ; Armand ZINI ; Parviz KAVOUSSI ; Sava MICIC ; Ryan SMITH ; Gian Maria BUSETTO ; Mustafa Emre BAKIRCIOĞLU ; Gerhard HAIDL ; Giancarlo BALERCIA ; Nicolás Garrido PUCHALT ; Moncef BEN-KHALIFA ; Nicholas TADROS ; Jackson KIRKMAN-BROWNE ; Sergey MOSKOVTSEV ; Xuefeng HUANG ; Edson BORGES ; Daniel FRANKEN ; Natan BAR-CHAMA ; Yoshiharu MORIMOTO ; Kazuhisa TOMITA ; Vasan Satya SRINI ; Willem OMBELET ; Elisabetta BALDI ; Monica MURATORI ; Yasushi YUMURA ; Sandro LA VIGNERA ; Raghavender KOSGI ; Marlon P MARTINEZ ; Donald P EVENSON ; Daniel Suslik ZYLBERSZTEJN ; Matheus ROQUE ; Marcello COCUZZA ; Marcelo VIEIRA ; Assaf BEN-MEIR ; Raoul ORVIETO ; Eliahu LEVITAS ; Amir WISER ; Mohamed ARAFA ; Vineet MALHOTRA ; Sijo Joseph PAREKATTIL ; Haitham ELBARDISI ; Luiz CARVALHO ; Rima DADA ; Christophe SIFER ; Pankaj TALWAR ; Ahmet GUDELOGLU ; Ahmed M A MAHMOUD ; Khaled TERRAS ; Chadi YAZBECK ; Bojanic NEBOJSA ; Damayanthi DURAIRAJANAYAGAM ; Ajina MOUNIR ; Linda G KAHN ; Saradha BASKARAN ; Rishma Dhillon PAI ; Donatella PAOLI ; Kristian LEISEGANG ; Mohamed Reza MOEIN ; Sonia MALIK ; Onder YAMAN ; Luna SAMANTA ; Fouad BAYANE ; Sunil K JINDAL ; Muammer KENDIRCI ; Baris ALTAY ; Dragoljub PEROVIC ; Avi HARLEV
The World Journal of Men's Health 2019;37(3):296-312
Despite advances in the field of male reproductive health, idiopathic male infertility, in which a man has altered semen characteristics without an identifiable cause and there is no female factor infertility, remains a challenging condition to diagnose and manage. Increasing evidence suggests that oxidative stress (OS) plays an independent role in the etiology of male infertility, with 30% to 80% of infertile men having elevated seminal reactive oxygen species levels. OS can negatively affect fertility via a number of pathways, including interference with capacitation and possible damage to sperm membrane and DNA, which may impair the sperm's potential to fertilize an egg and develop into a healthy embryo. Adequate evaluation of male reproductive potential should therefore include an assessment of sperm OS. We propose the term Male Oxidative Stress Infertility, or MOSI, as a novel descriptor for infertile men with abnormal semen characteristics and OS, including many patients who were previously classified as having idiopathic male infertility. Oxidation-reduction potential (ORP) can be a useful clinical biomarker for the classification of MOSI, as it takes into account the levels of both oxidants and reductants (antioxidants). Current treatment protocols for OS, including the use of antioxidants, are not evidence-based and have the potential for complications and increased healthcare-related expenditures. Utilizing an easy, reproducible, and cost-effective test to measure ORP may provide a more targeted, reliable approach for administering antioxidant therapy while minimizing the risk of antioxidant overdose. With the increasing awareness and understanding of MOSI as a distinct male infertility diagnosis, future research endeavors can facilitate the development of evidence-based treatments that target its underlying cause.
Antioxidants
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Classification
;
Clinical Protocols
;
Diagnosis
;
DNA
;
Embryonic Structures
;
Female
;
Fertility
;
Health Expenditures
;
Humans
;
Infertility
;
Infertility, Male
;
Male
;
Membranes
;
Ovum
;
Oxidants
;
Oxidation-Reduction
;
Oxidative Stress
;
Reactive Oxygen Species
;
Reducing Agents
;
Reproductive Health
;
Semen
;
Spermatozoa
;
Subject Headings