Viagra

Viagra is the market leader in the treatment of erectile dysfunction. Scientists of the Institute of urology of the United States in 2018, an experiment was conducted in the treatment of erectile dysfunction. To do this, 100 patients were selected who had never taken ED drugs and had a problem of erectile dysfunction. Prior to the experimentation the effectiveness of Viagra was tested the potency of the patients (with the introduction of the drug, increases the potency) and it has been established that indeed all had problems with potency. After that, each patient was discharged Viagra within a month.



Have all patients been prescribed one dose of Viagra?

No! After all, the selection of the dosage of Viagra 50 mg or Viagra 100 mg depends on many factors such as : how long the patient has a gap with potency, whether there are diseases such as stroke or severe heart problems and the age of the patient. For 80% Picanto was issued Viagra 50 mg because this dosage is softer, for the other 20% was issued Viagra 100 mg.

The result of the use of Viagra.

According to the test of the effectiveness of Viagra, it was found that 95% of patients were able to significantly improve their condition and their potency improved significantly without Viagra! 5% of patients either stopped taking the drug for side effects or because of low efficiency, or because of the beginning of alcohol consumption. Indeed, we have noticed that Viagra should not be taken with alcohol, although most reviews of Viagra online say that taking this drug with alcohol and not half the side effects - it is doubtful, because any drug is critical to take alcohol as it has a negative effect on the liver. Viagra is indeed the most effective drug in 2018 and will be effective in 2019.


More articles about urology and men's health

Use of Hyperbaric Oxygen Therapy in Pediatric Urology Practice: A review and case series

Objectives:
            Hyperbaric oxygen (HBO) therapy, which increases the amount of oxygen dissolved in the blood and that carried to tissues, is used in the treatment of several disorders. HBO therapy may be a useful adjunctive treatment in the management of some of challenging conditions encountered in pediatric urology practice. In this paper, we report our experience on the use of HBO therapy in children with urologic problems and review the literature on this subject.
Methods:
            We reviewed our department’s records to identify pediatric patients who received HBO therapy between 2011 and 2014. All patients were evaluated at the department of underwater and hyperbaric medicine and informed consent was obtained from the patient or his/her parents. Total number of HBO sessions was determined based on patient’s clinical response to HBO therapy.
Results:
            Eleven patients received HBO therapy during the study period. All of them were male. The mean age was 8.63±5.53(1-17 years). Indications of HBO therapy were necrosis after hypospadias and epispadias repair, penile glans necrosis, circumcision caused penile skin necrosis, sickle cell crisis induced priapism, and testicular torsion. The average number of HBO sessions was 6.72±2.53(4-11). Nine patients (81%) healed after HBO therapy, but 2(19%) patients did not.
Conclusion:
            We used HBO therapy with some success in children with impaired wound healing after hypospadias and epispadias repair, penile glans necrosis, penile skin necrosis after circumcision, sickle cell crisis induced priapism, and testicular torsion. Further randomized controlled studies are needed to confirm the effectiveness of HBO and its’ use.

Key words
Hyperbaric Oxygen Therapy, Pediatric Urology
Introduction
Hyperbaric oxygen (HBO) therapy involves intermittent administration of 100% oxygen at a pressure higher than 1 atmosphere absolute (ATA).1, 2 Arterial oxygen pressure reaches around 2000 mmHg during HBO therapy at 3 ATA. 3 HBO therapy restores tissue oxygenation in hypoxic tissues and also causes supra-physiologic levels of partial oxygen pressure in tissues. HBO induced hyperoxia increases bacterial killing ability of leukocytes, stimulates fibroblast proliferation and angiogenesis, preserves intracellular ATP, decreases leukocyte adhesion to endothelium after reperfusion injury, increases flexibility of red cells, and increases antioxidant enzyme activity 3-5
The indications for HBO therapy are decompression sickness, air embolism, severe carbon monoxide poisoning, necrotizing infections (Clostridial myonecrosis, Fournier’s gangrene), radionecrosis and chronic wounds.6 In urological practice, HBO therapy is mostly used for the treatment of Fournier’s gangrene. 2, 7 Other clinical or experimental uses of HBO in urology practice includes testicular torsion, prevention of renal ischemia-reperfusion injury, benign prostatic hyperplasia, penile replantation after pseudomonas infection, hypoxia after penile prosthesis implantation, radiation induced hemorrhagic cystitis, and interstitial cystitis/painful bladder syndrome2, 8 There are limited data on HBO treatment in pediatric urologic conditions.
In this report, we wanted to review the possible use of HBO in pediatric urology practice and report our cases. 
Methods
We retrospectively reviewed our department’s records to identify pediatric patients who received HBO therapy for any urological problem between 2011 and 2014. Patient characteristics, number of HBO sessions and treatment outcome were recorded. All patients received HBO therapy at the department of underwater and hyperbaric medicine in our hospital.
A total of 100 PubMed studies were analyzed, and only 23 of them were thought to be related to pediatric urology practice with their experimental or clinical aspects.
There are two types of hyperbaric chambers: monoplace chambers, with room for a single patient only, and multi place chambers with room for two or more patients. Patients received HBO therapy either in a monoplace chamber or multiplace chamber. Each HBO therapy session consisted of 75-90 minutes of oxygen breathing at 2.4 ATA. Total number of HBO sessions was determined based on patient’s clinical response to HBO therapy. Informed consent was obtained from the patient’s parents.
Success is defined as recovery of the tissues having diminished oxygen supply, and the failure is defined as loss of the tissues.
Descriptive statistics are presented with mean ± standard deviation, minimum and maximum.
         Results
         Eleven patients in pediatric age group had received HBO therapy. All patients were male. The mean age of the patients was 8.63 ± 5.53 (1-17 years). Eight of them had penile lesions and three of them had testicular lesions. The average number of HBO sessions was 6.72 ± 2.53 (4-11). Nine patients (81%) healed after HBO therapy, but 2 (19%) patients did not. 
         Our first patient was a 1-year-old boy with distal hypospadias. After hypospadias repair, necrosis at the ventral region of penis and penile glans occurred, and he was directed to our HBO center. He had 4 sessions of HBO therapy. After 4 HBO sessions, necrotic tissue had the recovery and patient was discharged without any complications (Table).
Our second patient was a 6-year-old boy. He had proximal hypospadias with ventral penile cordie. Two-stage hypospadias repair was planned. At first stage, dorsal on-lay island flaps were used to obtain a sustained urethral plate and to achieve the straight appearance of penis. At postoperative 1. day, flaps became necrotic and patient was directed for HBO therapy. He had 6 sessions of HBO therapy. After 6 HBO sessions, no improvements were detected at necrotic tissue and necrotic tissue debrided under general anesthesia. (Table) (Figure 1a, b).
Our third patient was a 6-year-old male patient. He had penoscrotal hypospadias. After hypospadias repair, necrosis occurred at ventral region of penis. Ha had 4 sessions HBO. After HBO, necrotic tissues healed without any complications (Table). 
Our forth patient was 10-year-old male patient. He had penile skin necrosis after epispadias repair. Patient was directed to our HBO center, and he had 7 sessions of HBO therapy. After 7 HBO sessions, necrotic penile glans became normal and patient was discharged without any complications (Table).
Our fifth patient was a 7-year old male patient. He had penile glans necrosis after a penile trauma. Patient was directed to our HBO center, and he had 9 sessions of HBO therapy. After 9 HBO sessions, necrotic penile glans became normal and patient was discharged without any complications (Table) (Figure 2a, b).
Our sixth and seventh patients were 1 and 6 year old male patients. After circumcision by using plastic penile clamps, their penile skins became necrotic and these necrotic circular tissues caused diminished blood supply of penile glans. Glans became gangrenous. After surgery including debridement of necrotic tissues and revision of the circumcision, patients had 8 and 7 sessions of HBO therapy. After HBO sessions, penile skin became normal and glans had the normal color. Patients were discharged without any complications (Table) (Figure 3a, b, c, d, e, f).  

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