Metformin restores the penile expression of nitric oxide synthase in high-fat-fed obese rats.

Obesity is a well-known risk factor for erectile dysfunction, which is associated with reduced penile nitric oxide synthase (NOS) expression. Recently it was reported that metformin activates AMP-activated protein kinase (AMPK), which increases the expression of neuronal (n) NOS and endothelial (e) NOS. Thus, to evaluate whether metformin restores NOS expression in penile tissue, we measured penile expression of nNOS and eNOS after 4 weeks of metformin treatment (300 mg/kg/d) in 5-month-old high-fat-fed obese (HFO) rats. HFO rats have increased fat accumulation in visceral areas and marked suppression of nNOS and eNOS expression in penile tissue. However, metformin treatment decreased visceral fat deposition and restored nNOS and eNOS expression in penile tissue. The levels of AMPK and phosphorylated AMPK were also decreased in HFO rats but were subsequently elevated by metformin treatment. These results suggest that expression of NOS was suppressed by the high-fat diet but restored by metformin treatment. The effect of metformin on the expression of NOS may be associated with its activation of AMPK.

Transurethral resection of the prostate with a bipolar tissue management system compared to conventional monopolar resectoscope: one-year outcome.

The purpose of the present study was to evaluate the efficacy and safety of bipolar transurethral prostatectomy (TURP) using the Gyrus PlasmaKinetic System compared with conventional monopolar TURP. This study included 102 patients with benign prostatic hyperplasia (BPH) who underwent TURP from January 2003 to March 2005. In all, 49 consecutive patients had bipolar and 53 had monopolar TURP. All patients were assessed by preoperative and postoperative International Prostate Symptom Score (IPSS), uroflowmetry, transrectal ultrasonography, operative time, weight of resected tissue, change in serum sodium and hemoglobin, duration of catheter use, length of hospital stay, and complication rates. Significant improvement was seen postoperatively in both groups, and no difference was observed in the resection time, weight of resected tissue, change in serum sodium and hemoglobin, improvement of IPSS and peak flow rate (Qmax), or complication rates over the 12-month follow-up in both groups. There was, however, a significant difference in duration of catheter use and hospital stay. Duration of catheter use (2.28 days vs. 3.12 days) and hospital stay (3.52 days vs. 4.27 days) were shorter in the bipolar group (p = 0.012 vs. p = 0.034, respectively). Our results demonstrate that bipolar TURP using the Gyrus Plasma Kinetic System is as effective as conventional monopolar TURP with the additional advantage of reduced length of catheter use and hospital stay. Bipolar TURP is a promising new technique that may prove to be a good alternative to conventional TURP in the future.

Three-year outcomes of the innovative replacement of incontinence surgery procedure for treatment of female stress urinary incontinence: comparison with tension-free vaginal tape procedure.

Innovative replacement of incontinence surgery (IRIS) is a polypropylene tape that is placed beneath the midurethra to restore urinary continence. We evaluated the long-term efficacy and safety of the IRIS procedure and compared it with tension-free vaginal tape (TVT) for the treatment of female stress urinary incontinence. We included all 66 consecutive women who underwent IRIS (n=34) or TVT (n=32) between February 2002 and April 2003 and followed them up for at least 3 yr postoperatively. The 3-yr success rate was 94.1% for the IRIS and 93.8% for the TVT, and the satisfaction rates were 91.2% and 90.6%, respectively. Intraoperative complications for the IRIS group included 3 cases of bladder perforation, and there were 3 cases of bladder perforation in the TVT group. The postoperative complications for the IRIS group included 2 patients with de novo urgency and one patient with mesh erosion. Three patients with TVT developed de novo urgency. One case of each group showed temporary voiding difficulty. On the basis of our results, the IRIS may be an effective and safe procedure as compared to TVT, with a high success rate and a low complication rate.