Purpose: To compare the effi cacy and safety of available selective serotonin reuptake inhibitors (SSRIs) in order to fi nd the most effective drug with the least number of side effects in treatment of premature ejaculation (PE). Materials and Methods: This study was a randomized clinical trial. Four hundred and eighty patients with PE in the 4 groups referred to Imam Reza hospital Tehran, Iran from July 2018 to February 2019 were enrolled in the study. The patients received sertraline 50mg, fl uoxetine 20mg, paroxetine 20mg and citalopram 20mg, every 12 hours daily. The intravaginal ejaculatory latency time (IELT) before treatment, fourth and eighth weeks after treatment was recorded by the patient's wife with a stopwatch. Results: Mean IELT before, 4 and 8 weeks after treatment in four groups were: sertraline 69.4±54.3, 353.5±190.4, 376.3±143.5; fl uoxetine 75.5±64.3, 255.4±168.2, 314.8±190.4; paroxetine 71.5±69.1, 320.7±198.3, 379.9±154.3; citalopram 90.39±79.3, 279.9±192.1, 282.5±171.1 seconds, respectively. The ejaculation time signifi cantly increased in all groups (p <0.05), but there was no signifi cant difference between the groups (P=0.75). Also, there was no signifi cant difference in drugs side effects between groups (p >0.05). The most common side effects were drowsiness and dyspepsia, which were not severe enough to cause discontinuation of the drug. Conclusions: All available SSRIs were effective and usually had no serious complications. In patients who did not respond to any of these drugs, other SSRI drugs could be used as a salvage therapy.

Background: Nowadays, parents are paying more attention to the penis size of their children, especially obese children. Objectives: The aim of this study was to investigate the correlation between obesity, testosterone, and estradiol in prepubertal non-obese and obese children with micropenis. Methods: This case-control study was done on 58 non-obese and 86 obese micropenis children aged 8 - 13 years at Golestan Hospital, Tehran, Iran, from June 2018 to May 2020. The body mass index (BMI), testosterone and estradiol levels, stretched penile length (SPL), and the correlation between these were studied. Results: The mean age of children in non-obese and obese groups was 10.2 ± 1.34 and 10.5 ± 1.6 years, respectively. SPL in non-obese and obese subjects was 3.1 ± 1.3 and 2.9 ± 1.22 cm, respectively. SPL in both groups was significantly correlated with height and testosterone (height: r = 0.239, P = 0.009; testosterone: r = 0.344, P = 0.001) but not with BMI, weight, and estradiol. After the adjustment for age, BMI, weight, and estradiol, adjusted odds ratio with confidence interval 95% for penile length across to height and testosterone levels in non-obese group was 1.52 (0.91 - 1.83; P = 0.001) and 0.56 (0.36 - 0.98; P = 0.001), respectively and in the obese group was 1.42 (0.81 - 1.66; P = 0.001) and 0.75 (0.51 - 0.87; P = 0.001), respectively. Conclusions: Penile length is positively correlated with height and testosterone but not with weight and estradiol in non-obese and obese children. It is probably not essential and obligatory to recommend weight loss for this issue and weight loss should not be concerned by children and their parents.

Background: Most issues of micropenis boys include poor body image and quality of life. Objectives: The purpose of this assay was to survey the relationship of anthropometric measures, testosterone, estradiol, gonadotropins and prolactin with stretched penile length (SPL) and flaccid glans-pubis length (GPL) in pre-pubertal boys with true small penis. Methods: This was prospective a cross-sectional observational study that was conducted in Imam Reza Hospital, Tehran, Iran from February 2015 to May 2020. The pre-pubertal children 7 - 14 years who referred with small penis size were evaluated by a pediatrician and urologist and, if they had true micropenis, they were enrolled in the study (n = 236). The anthropometric and hormonal measurements, SPL, GPL, and relationship of these variables were evaluated. Results: Mean ages of children were 11.65 ± 1.59 years. Mean SPL and GPL were 2.95 ± 1.23 and 2.29 ± 1.06 cm, respectively. There was a significant relationship between SPL and GPL (r = 0.976, P = 0.000). SPL and GPL were not correlated with BMI (r = -0.182, P = 0.054; r = -0.161, P = 0.089, respectively). A significant correlation was found between SPL and GPL with height, FSH, LH, Testosterone and T/E ratio (P < 0.01) but no correlation with weight, estradiol and prolactin (> 0.05). Conclusions: According to the finding of present study, the flaccid measurement can be as helpful as stretched measurement if it is done from pubic bone to tip of glans. Retraining of primary health workers about age-related penile length may be reducing the misdiagnosis of micropenis and concerns of parents, especially in obese boys. The penile length in prepubertal children was not related to BMI and weight but was significantly related to height. Furthermore, Estradiol level is not related to penile length in children with micropenis.

Objective The intravaginal ejaculatory latency time (IELT) may increase less in on-demand compared to daily intake, but may fulfill a suitable treatment for specific patients. We decided to compare the efficacy and safety of on-demand and daily use of sertraline in order to find the most effective and least complicated method in treatment of premature ejaculation (PE). Methods This study was parallel or concurrent control randomized clinical trial. Two hundred and forty patients with PE diagnosed by urologist in the two groups of 120 from July 2017 to February 2019 enrolled in the study. In the first group, it is prescribed 50 mg sertraline each 12 h daily and the second group received 50 mg 4 h before coitus for 4 and 8 weeks. The IELT before treatment and during all coitus after treatment were recorded by the patient's wife with a stopwatch. Results Mean IELT before, 4 and 8 weeks after treatment in two groups were: On-demand group 101.62±65.44 s, 208.75±128.02 s and 265.87±145.70 s; daily use group 102.50±81.22 s, 276.87±181.08 s and 353.75±176.45 s, respectively. The ejaculation time increased significantly in both groups ( p <0.05). However, increase in ejaculation time in daily use group was significantly higher than the on-demand group in 4 weeks ( p =0.036), especially in 8 weeks ( p =0.009). The percent of side effects in daily use group (26.7%) was higher than on-demand group (20%) ( p <0.05). Drowsiness, diarrhea and vertigo were significantly higher in the daily use than on-demand ( p <0.05). Conclusions On-demand and daily use of sertraline are effective and usually have no serious complications, but the on-demand method is considerably more tolerable. In patients who did not tolerate to daily use of this drug, on-demand could be used as a salvage therapy.

ObjectiveEvidence about the negative caffeine effect on enuresis in children remains understudied or poorly understood. The study aimed to investigate the effect of caffeine restriction on the improvement and severity of primary monosymptomatic nocturnal enuresis (PMNE).DesignRandomised clinical trial.SettingTwo referral hospitals in Tehran, Iran, from 2021 to 2023.PatientsFive hundred and thirty-four PMNE children aged 6–15 years (each group 267).InterventionsAmount of caffeine consumption was recorded by the feed frequency questionnaire and was estimated by Nutrition 4 software. Caffeine consumption per day in the intervention group was <30 mg, and in the control group, 80–110 mg. All children were asked to return 1 month later to check the recorded data. The ordinal logistic regression analysis was used to assay the effects of caffeine restriction on PMNE by relative risk (RR) at a 95% CI.Main outcome measuresThe effect of limited caffeine consumption on the improvement and severity of PMNE.ResultsThe mean age of the intervention and control groups was 10.9±2.3 and 10.5±2.5 years, respectively. The mean number of bed-wetting before caffeine restriction in the intervention and control group was 3.5 (SD 1.7) times/week and 3.4 (SD 1.9) times/week (p=0.91) and 1 month after intervention were 2.3 (SD 1.8) times/week and 3.2 (SD 1.9) times/week, respectively (p=0.001). Caffeine restriction significantly reduced the severity of enuresis in the intervention group. Fifty-four children (20.2%) improved (dry at night) in caffeine restriction and 18 children (6.7%) in the control group with RR 0.615 at 95% CI 0.521 to 0.726, p=0.001. The caffeine restriction significantly reduced the enuresis in children with a number-needed-to-treat benefit 7.417. It means you must treat 7.417 PMNE children with caffeine limitation to improve one child with enuresis (become dry).ConclusionCaffeine restriction can be helpful in reducing PMNE or its severity. Constructive limitation of caffeine is suggested as one of the first-line treatments in the management of PMNE.Trial registration numberIRCT20180401039167N3.