The Role of Testosterone in Amplifying the Effect of a Phosphodiesterase Type 5 Inhibitor After Pelvic Irradiation.

BACKGROUND: After radiotherapy, the risk of hypogonadism increases, and the incidence of erectile dysfunction increases with time. AIM: We investigated the effect of testosterone and a phosphodiesterase type 5 inhibitor (PDE5I) on erectile tissue after radiotherapy. METHODS: 12 male Wistar rats were assigned to each of 5 groups (group C: control; group R: radiation; group RPT: radiation, testosterone, and a PDE5I; group RP: radiation and a PDE5I; and group RT: radiation and testosterone). A 12.5 Gy/fraction dose was administered to the rectum in groups R, RPT, RP, and RT. Udenafil (20 mg/kg) was administered daily via nasogastric tubes in group RPT and group RP for 4 weeks starting 1 day after radiotherapy. Testosterone enanthate (25 mg/kg, IM) was administered immediately after radiotherapy in group RT and group RPT. 6 rats from each group were used to evaluate endothelial nitric oxide synthase (eNOS), neuronal nitric oxide synthase (nNOS), and NOX2, and cavernosal pressure was evaluated in the other 6 rats in each group. OUTCOME: Testosterone enhanced the effect of PDE5I on penile tissue after radiotherapy by amplifying the nitric oxide synthase activity. RESULTS: eNOS mRNA expression increased in response to either testosterone replacement or PDE5I administration after radiotherapy. nNOS mRNA expression did not significantly increase in response to testosterone replacement, but testosterone significantly enhanced the effect of PDE5I on nNOS mRNA expression. Testosterone significantly amplified the effect of PDE5I on both eNOS and nNOS protein expression. Both testosterone and PDE5I reduced NOX2 protein expression. The intracavernosal pressure during electrical stimulation showed that testosterone alone did not significantly enhance erectile function. CLINICAL TRANSLATION: Clinicians should consider both hypoxic tissue damage and hypogonadism during and after radiation, and the combination of testosterone and PDE5I could be more beneficial for preserving erectile tissue than either individual treatment. STRENGTHS & LIMITATIONS: This study describes the role of testosterone in amplifying the effect of a PDE5I on pelvic radiotherapy-induced hypogonadism. However, we did not show the time-dependent effects of testosterone and PDE5I. CONCLUSIONS: Despite the fact that the intracavernosal pressure during electrical stimulation did not significantly increase with testosterone replacement after radiotherapy, important changes in nitric oxide synthase activity and superoxide regulation might have amplifying effects on erectile tissue. Therefore, we recommend that physicians monitor testosterone levels and should not hesitate to combine testosterone and PDE5I in cases of radiation-induced hypogonadism if testosterone replacement is not contraindicated. Lee DS, Sohn DW. The Role of Testosterone in Amplifying the Effect of a Phosphodiesterase Type 5 Inhibitor After Pelvic Irradiation. J Sex Med 2020;17:1268-1279.

Impact of Sleep Deprivation on the Hypothalamic-Pituitary-Gonadal Axis and Erectile Tissue.

INTRODUCTION: It is unclear how sleep deprivation (SD) exerts a negative effect on men's health in terms of hypogonadism. AIM: To evaluate the hypothalamic-pituitary-gonadal (HPG) axis in subjects with SD and ultimately to evaluate the erectile tissue in response to the hormonal changes. METHODS: 56 male Wistar rats were used. First, 16 rats (16 weeks old) were subjected to 72 hours of SD, and the following were compared with 16 control rats: (i) levels of gonadotropin-releasing hormone (GnRH), luteinizing hormone (LH), follicle-stimulating hormone (FSH), testosterone (T), and cortisol; (ii) the expression of the kisspeptin mRNA in the brain; and (iii) assessment of immunohistochemistry (IHC) of brain and testis. To further investigate whether testosterone reduction due to SD could affect erectile tissue, an additional 24 rats were divided into 3 groups (control, SD, and SD with T supplementation [SDT]) and compared: (i) T and cortisol levels were quantified, and (ii) endothelial nitric oxide synthase (eNOS)/ neuronal nitric oxide synthase (nNOS)/NOX-2 expression in cavernosal tissue was assessed by measuring mRNA levels and performing Western blotting and IHC. MAIN OUTCOME MEASURE: Compared with the levels in the control group, the LH level was markedly decreased, and T levels were subsequently decreased in the SD group, whereas the level of the kisspeptin mRNA and IHC for kisspeptin, GnRH, and FSH were not different. RESULTS: In cavernosal tissues, levels of the eNOS/nNOS mRNAs and proteins tended to be lower, and NOX-2 levels (mRNA and protein) tended to be higher in the SD group than those in the control group and SDT group. IHC for eNOS/nNOS revealed lower-intensity staining in the SD group than in the control and SDT groups, whereas the NOX-2 intensity was higher in the SD group than in the other groups. A lower cortisol level was observed in the control group than in the SD and SDT groups, whereas the level was similar between the SD and SDT groups. The intracavernosal pressure/mean arterial blood pressure (%) values were also decreased in the SD group but not on testosterone injection. CLINICAL IMPLICATIONS: Even short-term SD can produce secondary hypogonadism, which impairs men's health. STRENGTH & LIMITATIONS: To the best of our knowledge, this study is the first to show the effects of SD on the whole HPG axis. The weakness is that this study only investigated acute SD. CONCLUSION: Based on the findings from this study, acute SD causes pituitary hypogonadism, and reduced T levels decrease erectile function by inducing superoxide accumulation in the cavernosal tissue and inhibiting nitric oxide synthase activity. Lee DS, Choi JB, Sohn DW. Impact of Sleep Deprivation on the Hypothalamic-Pituitary-Gonadal Axis and Erectile Tissue. J Sex Med 2019;16:5-16.

Pelvic floor musculature and bladder neck changes before and after continence recovery after radical prostatectomy in pelvic MRI.

PURPOSE: To evaluate the changes in pelvic floor anatomy using MRI before and after continence recovery after radical prostatectomy (RP). MATERIALS AND METHODS: Thirteen men with prostate cancer who underwent RP (mean age, 67.4 ± 8.8 years) volunteered for this study. Prostate MRIs were performed during the preoperative (i), incontinent (ii), and continent (iii) periods. The membranous urethra length (MUL), puborectalis muscle (PRM) thickness, and the position of the bladder neck in relation to the pubic bone (Dx) and the pubococcygeous line (Dy) were measured. We compared all parameters in the preoperative, incontinent, and continent periods. RESULTS: MUL2 and MUL3 was significantly longer compared with MUL1, although no difference was found between MUL2 and MUL3. PRM3 thickness was significantly increased compared with PRM2 thickness. The Dx of the continence period was shorter than that of the incontinence period. The Dy of the continence period was longer than that of the incontinence period. CONCLUSION: The PRM thickened and the bladder neck moved upward and forward during the continence period. The changes in PRM thickness and the position of bladder neck may play an important role in the recovery of continence after RP.

Microbiological and clinical characteristics in acute bacterial prostatitis according to lower urinary tract manipulation procedure.

We conducted a retrospective analysis of acute bacterial prostatitis (ABP) secondary to manipulation to document clinical features, management and microbiology based on the route of prior manipulation, which can be divided into two subgroups: transrectal and transurethral procedure. The medical records of 158 cases compatible with a confirmed diagnosis of ABP secondary to manipulation from 7 urological centers between 2001 and 2012 were reviewed. When subcategorized according to route of prior manipulation of the lower urinary tract, there were distinct differences between transrectal and transurethral manipulation group with regard to clinical and microbiological features. Escherichia coli was the most common causative bacterium in both groups, but Pseudomonas spp. were much more dominant pathogens in the group by transurethral manipulation than transrectal manipulation group. The susceptibilities to second-, third- and fourth-generation cephalosporins, amikacin, carbapenem and aztreonam were shown to be very low in the transurethral manipulation group. Therefore, it will take account the difference in antibiotic selection in the patients with ABP secondary to manipulation according to the manipulation route.

Treatment of paraffin-induced lipogranuloma of the penis by bipedicled scrotal flap with Y-V incision.

OBJECTIVES: The authors aimed to report 5 cases of patients with penile lipogranuloma-induced full necrosis of penile skin, wherein they obtained good results from simultaneous implementation of Y-V incision to prevent the shortening of penile length together with bipedicular scrotal flap. METHODS: The full excision of penile lipogranuloma and a bipedicled scrotal flap was performed. After finishing the scrotal flap, for extension in length, the authors performed the inverted V incision on the upper skin of followed by partial resection of suspensory ligament and sutured up to subcutaneous tissue in the inverted Y shape, extending the dorsal portion skin toward the penis. RESULTS: There was no shortening in length of the penis or reduction in girth and the resulting penis had no difference to normal skin of penis, with almost no contraction of the scrotum, and all patients were satisfied with the visual postoperative shape of the penis. CONCLUSIONS: The authors had performed a complete excision of paraffinoma in patients with penile paraffinoma with concurrent skin necrosis and obtained good outcomes of preventing the shortening of penile length by performing a bipedicled scrotal flap with Y-V incision using the scrotal skin.

Comparative analysis of periprostatic implantation and intracavernosal injection of human adipose tissue-derived stem cells for erectile function recovery in a rat model of cavernous nerve injury.

BACKGROUND: We compared periprostatic implantation (PPI) and intracavernosal injection (ICI) of human adipose tissue-derived stem cell (ADSC) to facilitate recovery of erectile function in a rat model of cavernous nerve (CN) injury. METHODS: Bilateral CN dissection (BCND) was induced in Sprague-Dawley rats. After BCND 10 rats each were treated with PPI and/or ICI of ADSCs. After 4 weeks erectile responses to electric pelvic ganglion stimulation were studied. Each penis was evaluated in terms of the expression of neuronal nitric oxide synthase and smooth muscle content. RESULTS: The ratio of maximal intracavernosal pressure to mean arterial pressure was significantly decreased in the BCND group (24.5%) compared to the sham group (64.2%). PPI and ICI significantly improved erectile function (46.7% and 47.9%, respectively) compared to the BCND group. A combination of PPI and ICI (42.5%) did not afford any incremental effect on erectile function. After stem cell therapy, the expression of neuronal nitric oxide synthase increased slightly in the ICI group without statistical relevance, whereas the PPI and combination groups showed marginally significant increases (P = 0.08). In both the PPI and ICI groups, the smooth muscle content was similar to the sham group. The combination group showed remarkable increase in smooth muscle content to an extent greater than that seen when either treatment was given alone, although statistically not significant. CONCLUSION: PPI or ICI of ADSCs in a rat model of CN injury were equally effective in recovering penile erection, but may address different types of pathophysiology.

Risk factors for recurrent cystitis following acute cystitis in female patients.

We conducted a retrospective analysis of acute cystitis (AC) patients to evaluate the risk factors of recurrent cystitis (RC) patients following AC. The clinical records of 254 subjects with a confirmed diagnosis of AC and 90 healthy subjects who visited the Health Promotion Center between 2008 and 2012 were reviewed. A patient was diagnosed with RC if she was treated for three or more symptomatic episodes of cystitis over a 12-month period. Results were analyzed according to three groups: normal control (group A, n = 90), AC (group B, n = 121), and RC (group C, n = 133). Women in the cystitis groups (groups B and C) were more likely to have diabetes, be menopausal, have a history of catheterization or sexually transmitted infections (STI), have a low daily water intake, have frequent sexual intercourse, and to use contraception more frequently than the normal control group (P < 0.05). In groups B and C, Escherichia coli was the most common uropathogen, followed by Staphylococcus saprophyticus, Enterococcus species, and Klebsiella species. There were no differences between groups in the detection rates of these uropathogens. Factors that affected progression to RC were diabetes, catheterization history, STI history, sexual intercourse more than four times per month, sexual intercourse in the last month, and the use of contraceptives (P < 0.05). The identification of these factors may help develop preventive, diagnostic, and therapeutic strategies for treating RC that has progressed from AC.

Xanthogranulomatous pyelonephritis: clinical experience with 21 cases.

In this retrospective study, a review of the features of 21 recent cases of xanthogranulomatous pyelonephritis (XGP) is presented and compared with current published reports to improve the preoperative diagnosis. The clinical, laboratory, and radiological features, preoperative diagnoses, and operative methods of 21 patients with XGP were retrospectively reviewed. Mean age of the patients was 52.1 years; the female:male ratio was 2.5:1. All patients were symptomatic, and most common symptoms were flank pain and fever greater than 38 °C. The laboratory results showed anemia in 71.4% of cases, leukocytosis in 61.9%, and pyuria in 81.0%. In radiologic examinations, renal or ureter stone in 9 patients, hydronephrosis in 12 patients, a renal mass in 2 patients, and kidney enlargement in 9 patients were observed. For the patient who was suspected as having XGP before surgery, partial nephrectomy was performed; for 2 patients who were suspected as renal cell carcinoma, radical nephrectomy was performed; and for the remaining 18 patients, simple nephrectomy was performed. Among patients complaining of flank pain and fever, if the patients have a urinary tract infection and show the signs of anemia or leukocytosis and have staghorn calculi or a urinary tract obstruction and renal mass by radioactive examination, it is believed that the possibility of XGP should be considered.

Risk factors of infectious complication after ureteroscopic procedures of the upper urinary tract.

Ureteroscopic procedures are being commonly performed in urology, but only a few clinical studies have been conducted on infectious complications after these procedures, and overall understanding on the preoperative use of prophylactic antibiotics is insufficient. This study examined the incidence rate of infectious complications and the risk factors affecting incidence after ureteroscopic procedures. We retrospectively reviewed the medical records of 531 patients who underwent ureteroscopy and ureteroscopic lithotripsy in our hospital, including age, sex, past history, comorbidity, urine analysis, urine culture, blood test, hydronephrosis, urethral catheter or ureteral stent, and percutaneous nephrostomy placement from January 2002 to December 2011. A total of 20 patients (3.8%) contracted infectious complications after various procedures in the upper urinary tract. Preoperative bacteriuria, hydronephrosis, and the placement of a urethral catheter or ureteral stent, and percutaneous nephrostomy are significant risk factors of infectious complication. No significant differences were shown in the types and start time of prophylactic antibiotics. Diagnostic ureteroscopy exhibited a higher incidence rate of infectious complications compared to ureteroscopic lithotripsy.

Urethra-Sparing Robot-Assisted Simple Prostatectomy for Postoperative Antegrade Ejaculation.

BACKGROUND: We report a comparative analysis of extraperitoneal urethra-sparing robot-assisted simple prostatectomy (EUS-RASP) versus robot-assisted simple prostatectomy (RASP) using the Freyer approach for patients with a large prostate volume greater than 80 mL. METHODS: A total of 32 patients underwent EUS-RASP, and 30 underwent RASP from April 2018 to November 2021. All the perioperative data and 6-month follow-up data were collected prospectively. We retrospectively evaluated baseline characteristics and functional outcomes, including International Prostate Symptom Scores (IPSSs) and quality of life (QOL), maximum flow rate, and post-void residual volume, between the two groups. Sexual function was analyzed in the EUS-RASP group. RESULTS: The patients undergoing EUS-RASP and RASP had comparable baseline characteristics and functional outcomes. The EUS-RASP group showed a shorter operative time (123.4 ± 15.2 min vs. 133.7 ± 21.4 min, p = 0.034), length of hospital stay (2.9 ± 1.5 days vs. 4.6 ± 1.5 days, p = 0.001), and catheterization time (2.4 ± 1.7 days vs. 8.1 ± 2.4 days, p < 0.001). A total of 14/32 (43.8%) patients reported normal preoperative ejaculatory function in the EUS-RASP group, and 11/14 (78.6%) maintained antegrade ejaculation postoperatively. CONCLUSIONS: Extraperitoneal urethra-sparing RASP is an effective and feasible procedure that can improve voiding function and allow for the maintenance of ejaculatory function in patients with large prostates.

Preventive effect of ginsenoid on chronic bacterial prostatitis.

Empirical antibiotic therapy is the preferred primary treatment modality for chronic bacterial prostatitis (CBP). However, this method of treatment has a low success rate and long-term therapy may result in complications and the appearance of resistant strains. Therefore a new alternative method for the prevention of CBP is necessary. There are several reports that ginsenoid has a preventive effect on urinary tract infection (UTI). To evaluate the preventive effect of ginsenoid on CBP compared to conventional antibiotics, we carried out an experiment in a rat model of the disease. Four groups of adult male Wistar rats were treated with the following medications: (1) control (no medication), (2) ciprofloxacin, (3) ginsenoid, and (4) ciprofloxacin/ginsenoid. All medications were given for 4 weeks, and then we created a CBP model in the animals by injecting an Escherichia coli Z17 (O2:K1;H(-)) suspension into the prostatic urethra. After 4 weeks, results of microbiological cultures of prostate and urine samples, as well as histological findings of the prostate in each group were analyzed. The microbiological cultures of the prostate samples demonstrated reduced bacterial growth in all experimental groups compared with the control group. Histopathological examination showed a significantly decreased rate of infiltration of inflammatory cells into prostatic tissue and decreased interstitial fibrosis in the ginsenoid group compared with the control group. Inhibition of prostate infection was greater in the group receiving both ginsenoid and antibiotic than in the single-medication groups. Although the findings of this study suggest a preventive effect of ginsenoid, preventive methods for CBP are still controversial.

Radiofrequency ablation using real-time ultrasonography-computed tomography fusion imaging improves treatment outcomes for T1a renal cell carcinoma: Comparison with laparoscopic partial nephrectomy.

PURPOSE: To determine whether real-time ultrasonography-computed tomography (US-CT) fusion imaging can improve technical feasibility versus B-mode US and provide comparable outcomes of radiofrequency ablation (RFA) for T1a renal cell carcinoma (RCC) compared with laparoscopic partial nephrectomy (LPN). MATERIALS AND METHODS: Between June 2013 and August 2016, biopsy- or pathologically confirmed stage T1a RCCs were retrospectively reviewed. Of these, 39 cases were included in the RFA group, and 46 cases were included in the LPN group. In the RFA group, we evaluated tumor visibility and technical feasibility before RFA on a four-point scale on B-mode US and US-CT fusion images. After RFA, hospital days, creatinine value, complications, and disease-free survival rate were compared between the two groups. All results were analyzed by use of the Mann-Whitney U-test and Kaplan-Meier method. RESULTS: Compared with B-mode US alone, real-time US-CT fusion significantly improved the tumor visibility score and overall mean technical feasibility grade (p<0.001). The 5-year disease-free survival rate was 97.4% and 97.8% in the RFA and LPN groups, respectively, and there was no statistically significant difference between groups (p=0.1). Mean periprocedural creatinine levels were significantly lower in the RFA group than in the LPN group. The number of hospital days was shorter in the RFA group. Minor complications were present in 5.1% of the RFA group and 13.0% of the LPN group, with no major complications. CONCLUSIONS: US-CT fusion-image-guided RFA improved tumor visibility scores and overall mean technical validity and resulted in a comparable disease-free survival rate to LPN.

Anti-inflammatory and antimicrobial effects of nanocatechin in a chronic bacterial prostatitis rat model.

Chronic bacterial prostatitis (CBP) is one of the most common relapsing urinary tract infection (UTI) in males. Catechin, an extract of green tea, is known to have anti-inflammatory and antimicrobial effects against various bacteria. However, catechin can be easily degenerated during digestion, and this may result in decreased absorption into the body. Nanocatechin is catechin coated with hydroxypropyl methyl cellulose by nanotechnology. It reduces degeneration during digestion and enhances absorption of catechin into the body. We evaluated the anti-inflammatory and antimicrobial effect of nanocatechin on CBP and also analyzed plasma concentration of catechins to evaluate absorptivity in an animal model. Forty rats demonstrating CBP were randomly divided into four groups: control, ciprofloxacin, catechin, and nanocatechin. After treatment, the results of microbiological culture of prostate and urine samples as well as histological findings of the prostate in each group were analyzed. Plasma concentration of catechins in catechin and nanocatechin groups was compared. The use of ciprofloxacin, catechin, and nanocatechin showed statistically significant decrease in bacterial growth and improvement in prostatic inflammation compared with the control group. The nanocatechin group showed statistically significant decrease in bacterial growth and improvement in prostatic inflammation compared with the catechin group. Plasma concentrations of epicatechin, gallocatechin gallate, and epigallocatechin gallate were significantly higher in the nanocatechin group than those in the catechin group. These results suggest that nanocatechin has better antimicrobial and anti-inflammatory effects on rat CBP than catechin due to higher absorption into the body.

Do Escherichia coli extract and cranberry exert preventive effects on chronic bacterial prostatitis? Pilot study using an animal model.

Traditional first-line treatment of chronic bacterial prostatitis (CBP) is administration of empirical antibiotics. However, the efficacy rate is low and long-term antibiotic therapy can result in adverse events and bacterial resistance. For these reasons, a new treatment or preventive modality that can replace traditional antibiotic therapy is required. There are several reports that E. coli extract has a preventive effect on recurrent urinary tract infection (UTI). Cranberries are also known to have beneficial effects in preventing UTI. To evaluate the preventive effect of E. coli extract and cranberries on CBP, 48 rats were randomly divided into 4 groups; control, ciprofloxacin, E. coli extract, and cranberry groups. All drug treatments were conducted for 3 weeks, and then we developed a CBP rat model. After 4 weeks, the results of microbiological culture of prostate and urine samples as well as histological findings for the prostate were analyzed for each group. The infection rate in the ciprofloxacin group was significantly lower than that in the control group. The microbiological cultures of the prostate and urine samples demonstrated reduced bacterial growth in all experimental groups compared with the control group. Histopathologic examination showed significantly decreased prostatic inflammation in all groups compared with the control group. These results suggest that E. coli extract has a potential preventive effect on the development of CBP, and cranberry also exhibits promising activity in this context.

Does finasteride have a preventive effect on chronic bacterial prostatitis? Pilot study using an animal model.

AIM: To evaluate the preventive effect of finasteride on chronic bacterial prostatitis (CBP), Wistar rats were divided into four groups: control, ciprofloxacin, finasteride, and ciprofloxacin/finasteride. METHODS: All drug pretreatments were conducted for 4 weeks, and then experimental CBP was induced by instillation of a bacterial suspension (Escherichia coli Z17 O2:K1;H-). RESULTS: After 4 weeks, results of microbiological cultures of prostate and urine samples as well as histological findings of the prostate in each group were analyzed. Finasteride significantly reduced bacterial infection and decreased inflammatory cell infiltration in prostatic tissue compared with the control group. The group given both finasteride and antibiotic showed a greater inhibition of bacterial infection in the tissue than those given either finasteride or antibiotic alone. CONCLUSION: Our experiments suggest the possibility that finasteride has a preventive effect on development of CBP, although there is as yet no consensus on the mechanism of this effect.

Association between Nocturnal Frequency and Erectile Function in Eugonadal Men with Benign Prostatic Obstruction: A Cross Sectional Study.

PURPOSE: We aimed to evaluate the association between nocturnal frequency and erectile dysfunction in patients with benign prostatic obstruction. MATERIALS AND METHODS: To evaluate the association, we simultaneous evaluated urodynamic study, prostate ultrasound, nocturnal tumescence test (nocturnal penile tumescence) for sleep-related erection (SRE) and two questionnaires, international prostate symptom score (IPSS) and 5-item version of the international index of erectile function (IIEF-5). Patients with hypogonadism or nocturnal polyuria were excluded. RESULTS: Forty-six patients were registered over 4 years. The mean age, prostate size, IPSS score, and IIEF-5 score were 67.65±5.51 years, 65.10±22.12 mL, 24.67±7.89, and 9.50±7.01, respectively. Among the IPSS subscores, nocturia was most significantly related to the total IIEF-5 score (p<0.001). More severe nocturia was associated with less frequent SRE (p=0.003) and shorter total duration of SRE (p=0.002), which in turn elucidated that nocturia was significantly related to the total amount of rigidity signals (rigidity activity unit, RAU) or tumescence signals (tumescence activity unit, TAU). Among objective urodynamic parameters, bladder compliance also correlated to RAU and TAU. Individual subjective erectile function (IIEF-5) was significantly related to both RAU and TAU. CONCLUSIONS: Sleep fragmentation due to benign prostate obstruction related nocturnal frequency caused by reduced bladder compliance could decrease the frequency and duration of SRE, which decreases the total amount of SRE and reflects the patient's relevant erectile function.

Gliomatosis peritonei of the scrotal sac associated with an immature gastric teratoma.

A male infant presented with bilateral scrotal masses 7 months after removal of an immature gastric teratoma. After surgical excision, histology showed gliomatosis peritonei. We report an unusual presentation of gliomatosis peritonei arising from a rare lesion of immature gastric teratoma.

Elevation of intracavernous pressure and NO-cGMP activity by a new herbal formula in penile tissues of spontaneous hypertensive male rats.

AIM OF THE STUDY: We created a new herbal formulation that mainly consists of the seeds of Lycium chinense, Cornus officinalis, Rubus coreanus, Cuscuta chinensis and Schizandra chinensis. These materials have been long used by Korean people as they are known to be good for health and sexual function; hence we could say that their safety have been proven in a certain sense. We investigated the effects of this herbal formulation on the penile erection and corpus cavernosum of spontaneous hypertensive male Rats (SHRs). MATERIALS AND METHODS: We used male SHRs aged 16 weeks as a model of hypertension. The treatment groups received once a day oral doses of KH-204 at either 100 or 300mg/kg per day for 4 weeks. Distilled water was administered to the control group. To investigate the penile erection, the intracavernosal pressure (ICP) and mean arterial pressure (MAP) were recorded in all groups. We analyzed the distribution of NOS by immunohistochemical staining and the expressions of nNOS and eNOS in the isolated corpus cavernosum were measured by Western blotting. RESULTS: In the control group, the ICP/MAP ratio was 14.9+/-1.4% after pelvic nerve stimulation. The ICP/MAP ratio was markedly increased in the treatment group with KH-204 100 or 300mg/kg, compared with the control group. Immunohistochemical staining for NOS showed that eNOS and nNOS were stained as a brown color. Compared with the control group, the NOS activities of KH-204 100 or 300mg/kg were significantly increased. Also, the penile expression levels of nNOS and eNOS in the KH-204 100 and 300mg/kg treatment groups were more increased, and this was significant, than those of the control group, as was determined by Western blotting. CONCLUSIONS: This study showed that the KH-204 herbal formulation enhances intracavernous pressure and NO-cGMP activity in penile tissues of SHR male rats.

Anti-inflammatory and Antimicrobial Effects of Anthocyanin Extracted from Black Soybean on Chronic Bacterial Prostatitis Rat Model.

OBJECTIVE: To investigated the anti-inflammatory and antimicrobial effects of anthocyanins extracted from black soybean on the chronic bacterial prostatitis (CBP) rat model. METHODS: The Sprague-Dawley rats were divided into 4 groups, including control, ciprofloxacin, anthocyanins and anthocyanins with ciprofloxacin groups (n=8 in each group). Then, drip infusion of bacterial suspension (Escherichia coli Z17 O2:K1:H-) into Sprague-Dawley rats was conducted to induce CBP. In 4 weeks, results of prostate tissue, urine culture, and histological analysis on the prostate were analyzed for each group. RESULTS: The use of ciprofloxacin, anthocyanins, and anthocyanins with ciprofloxacin showed statistically significant decreases in bacterial growth and improvements in the reduction of prostatic inflammation compared with the control group (P<0.05). The anthocyanins with ciprofloxacin group showed a statistically significant decrease in bacterial growth and improvement in prostatic inflammation compared with the ciprofloxacin group (P<0.05). CONCLUSIONS: These results suggest that anthocyanins may have anti-inflammatory and antimicrobial effects, as well as a synergistic effect with ciprofloxacin. Therefore, we suggest that the combination of anthocyanins and ciprofloxacin may be effective in treating CBP to obtain a higher rate of treatment success.

Evaluation of the Efficacy of Solifenacin for Preventing Catheter-Related Bladder Discomfort After Transurethral Resection of Bladder Tumors in Patients With Non-Muscle Invasive Bladder Cancer: A Prospective, Randomized, Multicenter Study.

BACKGROUND: Catheter-related bladder discomfort (CRBD) secondary to an indwelling urinary catheter is worse after transurethral resection of a bladder tumor (TUR-BT). We evaluated the incidence of CRBD and the efficacy of solifenacin for preventing CRBD after TUR-BT in patients with non-muscle invasive bladder cancer. PATIENTS AND METHODS: In the present prospective, randomized, multicenter trial, we enrolled 148 patients with non-muscle invasive bladder cancer who underwent elective TUR-BT under general anesthesia. The patients were randomized to group S (n = 72) or group C (n = 76). The primary outcome was evaluable for 134 patients, who were included in the final analysis. Group S received solifenacin (5 mg orally) on the day before, the day, and the day after TUR-BT. The control group (group C) received standard care. CRBD was assessed at 1 and 2 hours postoperatively. Pain was assessed for 3 days starting 6 hours after TUR-BT using the visual analog scale. RESULTS: The incidence rates of CRBD in groups C and S were 72.2% and 64.5% at 1 hour and 68.1% and 53.2% at 2 hours, respectively. The incidence rates and severity of CRBD at 1 and 2 hours were not different between the 2 groups (P > .05 for both). The visual analog scale scores and the postoperative consumption of analgesics were not different between the 2 groups (P > .05 for both). None of the patients who received solifenacin experienced an adverse event. CONCLUSION: Pretreatment with solifenacin (5 mg) failed to decrease the incidence and severity of CRBD after TUR-BT.