Aims: To investigate the effect of sildenafil on uroflowmetry values of patients with lower urinary tract symptoms (LUTS) suggestive of benign prostatic enlargement (BPE). Methods: Thirty-eight consecutive patients and 15 control subjects without voiding symptoms were enrolled in the study. All patients underwent uroflowmetry testing thrice on different occasions. The highest maximum urinary flow rate (Q_max) values with a sufficient voided volume (≧150 ml) were evaluated. The patients and controls were seen the day after the initial uroflowmetry measurements and were given 100 mg sildenafil. Afterwards uroflowmetry was repeated. The uroflowmetry values of both groups before and after sildenafil were compared. Results: Of the 38 patients, 29 (76%) showed improvement in flow rates. The mean Q_max was 11.4 ± 0.39 and 15.7 ± 0.74 ml/s before and after sildenafil, respectively (p < 0.0001). The mean percentage difference in Q_max was +38% higher after sildenafil. The mean average flow rate (Q_ave) and the mean voiding time values were also significantly improved. The mean voided volumes of the patients before and after sildenafil were 241 ± 78 and 264 ± 72 ml, respectively (p = 0.07). There were no significant differences in the Q_max, Q_ave and voided volumes of the control group. Conclusions: Sildenafil exhibits a significant improvement in Q_max and Q_ave rates in men with LUTS.

The objective of the study was to investigate the effect of a long acting local anesthetic infiltration around nephrostomy tract on pain control after percutaneous nephrolithotomy. Forty-six patients with kidney stones of >2 cm undergoing single access subcostal percutaneous nephrolithotomy (PCNL) were enrolled in the study. Patients were randomized to levobupivacaine (Group I) and saline (Group II) infiltration groups. Group I patients (n = 23) had 75 mg/30 cc levobupivacaine infiltration around the access site after placement of nephrostomy catheter. Group II patients had 30 cc saline infiltration. Postoperatively the patients were given narcotics on demand. Pain scores were collected using a visual analog scale (VAS) at 2, 4, 6, 8, 12 and 24 h postoperatively. The VAS scores, time to analgesic demand, ambulation, and duration of nephrostomy tube were compared between two groups. The mean age was 44 and 45 years in group I and II patients. There were no significant differences between the two groups with regard to demographics, surgery or stone characteristics. Comparison of pain scores at all postoperative time points was not statistically significant between the two groups. Time to first analgesic demand and total narcotic analgesic dose per patient were 1.2 ± 1.05 and 4.04 ± 1.57 h; and 96 and 112 mg for group I and II patients (p = 0.009 and p = 0.41, respectively). Ambulation time and duration of nephrostomy tube were also similar. Infiltration of nephrostomy tract site with levobupivacaine does not have a superior effect compared to saline on postoperative pain control in patients undergoing PCNL.To prolong analgesia, the effect of intermittent tract injections or continuous infusion of local anesthetics for the postoperative maintenance of the local anesthetic effect seems worth to investigate in future studies.

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