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Introduction Premature ejaculation (PE) is a sexual dysfunction with high prevalence. According to some reports, it is present in about 20-30% of the male population. Since 2009 PE has been treated with a novel inhibitor of serotonin re-uptake, Dapoxetine, which has been reported to be specifically active for PE.Materials and Methods 59 patients have been selected among the patients affected by PE observed at the outpatient department of Urology and Andrology of the “Paolo Giaccone” University Policlinic Hospital of Palermo. Diagnosis was confirmed unequivocally in all patients, who were suitable for drug treatment and accepted to participate in the study. They were divided in 2 groups: one receiving Dapoxetine (41 patients), another (18 patients) receiving Citalopram. Patients were followed up by telephone at monthly intervals, in order to compare compliance, efficacy and side effects.Results Compliance to treatment was obtained in 56% of patients treated with Dapoxetine and in 61% of those treated with Citalopram. In the Dapoxetine group side effects were reported in 14.6% versus 38.4% in the Citalopram group. Benefit from the treatment was reported in 82% and 69.2%, respectively.

Introduction and objective Cytokines may be involved in the pathogenesis of Peyronie's disease (PD). In this case, biological drugs, acting on specific cytokines, could be adopted in the pharmacological treatment of the disease.Materials and Methods Twenty PD patients and 8 patients affected by congenital recurvatum penis (control group) who underwent corporoplasty were enrolled in the study Histological examination and measurement by Real Time PCR of the expression of the encoding genes for IL-2, IL-4, IL-6, IL-10, IL-13, TGF-β, TNF-α and IFN-γ were performed on the removed tunica albuginea (TA). For the normalization of data GAPDH (glucerldehyde-3fosfatehydrogenase) and GUSB (β-glucuronidase), housekeeping genes were used. The analysis of the data was performed using the comparative method of ΔCt. The results were reported with the Fold of induction (FOI) method.Results The histological exams of TA showed only fibrous tissue without cavernous tissue. The analysis of gene expression of IL-6, IL-10, IFN-γ and TGF-β1 showed in all samples very low levels. The levels were lower in PD patients although the differences were not statistically significant. An exception was represented by TGF-β that showed a higher level in PD patients, although not statistically significant. The expression of IL-4, IL-13 and TNF-α was undetectable.Conclusions The expressions of cytokines in TA of PD patients compared to those of the controls do not show any significant difference. A bias of our study is that the groups were not age-matched. This is a bias already present in similar experiences and due to the different pathogenesis of the diseases. Cytokines promoting inflammation resulted undetectable and do not seem to be involved in PD pathogenesis. The higher level of TGF-β, a pro-fibrotic cytokine, detected in PD could explain the presence of fibrotic tissue. Presently, there is no data suggesting a possible role of biological drugs in PD.

Introduction and Objectives We treated a 45 years old patient, suffering from diabetes mellitus since childhood, with retinal, neurovascular and kidney complications. In 1988, for erectile dysfunction (ED) resistant to medical injective treatment, the patient underwent ligation of the dorsal vein of the penis without any result. In 1989 a Flexiflate®hydraulic prosthesis was implanted with resolution of ED. In 2005 the patient underwent simultaneous kidney and pancreas transplant with a trans-laparotomic approach for end stage renal disease and diabetes mellitus. In 2009, because of the Flexiflate®Surgitek malfunction, the patient underwent explantation of the Flexiflate®prosthesis and simultaneous implantation of a Titan®Alpha 1 prosthesis with a double surgical approach.Material and Methods After a penoscrotal incision and the explant of the Flexiflate®Surgitek, a Titan®Alpha 1 prosthesis was implanted with a double incision technique. The placement of two inflatable cylinders and the pump was performed by penoscrotal approach. Instead, the prosthesis’ reservoir was placed with a separate infra-pubic incision to avoid possible injury from a single trans-inguinal approach, due to the previous laparotomy.Results After follow-up at 9 months and 1 year the prosthesis was working well and the patient satisfied.Conclusions We couldn't find any related paper in the literature and as far as we know this is the only report on a simultaneous explant/implant of penile prosthesis with a double surgical approach in a patient with kidney and pancreas transplant.

Purpose Intralesional therapy is a less invasive method for the treatment of Peyronie's disease. The objective of this study was to evaluate safety and tolerability of intralesional injections of lloprost (I2 Prostacyclin analogue) for its property to suppress in fibroblasts CTFG (Connective tissue growth factor) production, which acts in concert with TGF-β to stimulate the fibrotic process.Methods Nineteen patients with Peyronie's disease were preliminarily evaluated by considering the degree of penile curvature, plaque size and local and systemic symptoms. Each patient then received weekly intralesional injections of 200ng of lloprost in 1 ml of normal saline for 4–5 weeks. If tolerated, the single dose increased weekly to the maximum of 400 ng (2 mL).Results The treatment has shown that all patients seem to well tolerate a 200 ng lloprost dose; 7 of them reached a 300 ng dose and 6 tolerate a 400 ng dose without showing side effects. There was no placebo control group in this study. To evaluate the efficacy of the treatment, the absence of objective parameters (except for the auto-photograph of penis in erection) led us to develop a subjective questionnaire that was given to all patients to assess sexual function, pain reduction, ecc.Conclusions Due to the relatively small size of the sample, the efficacy evaluation has been restricted to check the questionnaire reliability. Iloprost is well tolerated to a dose of 400ng in the local treatment of Peyronie's disease.