Management of nocturnal enuresis in Taiwan: Consensus statements of the Taiwan enuresis expert committee.

Nocturnal enuresis causes significant psychological distress to affected children and their family and requires appropriate management. A 12-member expert committee of pediatric urologists and pediatric nephrologists in Taiwan with extensive experience in treating enuresis was established to develop consensus statements and a recommended treatment algorithm for the management of patients with nocturnal enuresis in Taiwan after careful consideration of current evidence, existing guidelines, and expert opinion as well as local practice and culture. The finalized consensus statements were reviewed by and have received endorsement from the Taiwan Urological Association and the Taiwan Pediatric Association. Patients with suspected enuresis should undergo a thorough initial assessment to fully evaluate urinary signs and symptoms and to rule out underlying causes of diurnal and nocturnal incontinence. Behavioral therapy is recommended throughout the course of management. Desmopressin in the fast-melting formulation is the recommended first-line pharmacological treatment. Combination therapy may be effective in patients who have failed first-line treatment. These consensus statements and a recommended treatment algorithm were created by the expert committee to provide practical support for clinical decision making by physicians in Taiwan.

Correlation between clinical manifestations of nocturnal enuresis and attentional performance in children with attention deficit hyperactivity disorder (ADHD).

BACKGROUND/PURPOSE: Children with attention deficit hyperactivity disorder (ADHD) tend to be more vulnerable to various forms of voiding dysfunction and nocturnal enuresis (NE). We attempt to compare the clinical manifestations and attentional performance between ADHD children with NE and those without NE. METHODS: We consecutively enrolled children diagnosed with ADHD in child and adolescent psychiatric clinics. The questionnaires for evaluation of ADHD symptoms and voiding dysfunction symptoms were administered to all study participants. All participants also received the Test Battery for Attention Performance (TAP) for assessment of attentional function. RESULTS: A total of 53 children were enrolled in this study, comprising 47 boys and six girls. The prevalence rate of NE was 28.3%. Children in the NE group had statistically significant higher dysfunctional voiding symptom score (5.40 ± 3.66 vs.3.16 ± 2.74; p = 0.018) and two subscales of "When I wet myself, my underwear is soaked" (p < 0.001) and "I miss having a bowel movement every day" (p = 0.047). There were no significant differences with regard to all psychiatric evaluations between the NE and non-NE groups. In the TAP test, the NE group showed a significantly shorter reaction time in the domain of inhibitory control, working memory, and auditory sustained attention than the non-NE group. CONCLUSION: Children with ADHD have a high prevalence of NE. ADHD children with NE had a significantly higher dysfunctional voiding symptom score and shorter reaction time in most domains of the TAP test. Further study is needed to discern the impact of NE on the neuropsychological function of ADHD children.

Factors associated with delayed pediatric hypospadias surgery in Taiwan: a population-based, nationwide analysis.

BACKGROUND/PURPOSE: Current guidelines recommend that hypospadias repair should be performed before age 18 months. This study aims to investigate the trends of surgical timing and to determine what factors are associated with age at surgery. METHODS: The present study utilized a subset of the National Health Insurance Research Database, known as Longitudinal Health Insurance Database 2005, which contains the data of all paid medical benefit claims over the period from 1997 to 2007 for a subset of one million beneficiaries randomly drawn from the population of 22.72 million individuals in NHI program during any part of calendar year 2005. We analyzed claims data for all subjects with the diagnoses of hypospadias. RESULTS: Among 52,705 live male newborns, 218 were diagnosed with hypospadias and thus were included as subjects in our study. Among them, 89 received repair surgery. Approximately 60.6% of the study subjects received repair after the age of 18 months. Multivariate analysis showed that several factors were significantly associated with age at hypospadias surgery: specialty of clinics where first diagnosis was made; specialty of physician making the first diagnosis, age of physician making the first diagnosis; specialty of surgeon performing the surgery; number of years since surgeon's board certification; urbanization level of subject's residence; modality of surgery; concomitant cryptorchidism; concomitant prematurity and low birth weight; age at diagnosis; and number of well-baby clinic visits. CONCLUSION: This study addresses an important issue of delayed hypospadias surgery in Taiwan, which provides a potential opportunity for improvement in quality of care.

Clear cell carcinoma of female urethral diverticulum--a case report.

Primary malignancies of female urethral diverticulum are rare. A well-documented female patient with primary clear cell carcinoma of the urethral diverticulum is presented here. A 65-year-old woman presented with frequency and voiding difficulty for 2 months. Physical examination showed a 4-cm mass protruding from anterior vaginal wall. Intravenous urography, magnetic resonance imaging, and cystoscopy showed a polypoid mass in urethral diverticulum. She then underwent anterior exenteration with ileal conduit diversion and urethrectomy. Pathology confirmed the diagnosis of clear cell adenocarcinoma with bladder neck invasion. She had no disease recurrence at 2-year follow-up. Careful clinical examination and image studies are helpful in making the preoperative diagnosis for the rare disease. Early radical surgery can achieve better survival.

Correlation between symptoms of voiding dysfunction and attention deficit disorder with hyperactivity in children with lower urinary tract symptoms.

PURPOSE: We clarified correlations between symptoms of attention deficit disorder with hyperactivity and voiding dysfunction in children. MATERIALS AND METHODS: The study sample consisted of 92 boys and 38 girls 4 to 14 years old who presented at pediatric urology clinics with untreated lower urinary tract symptoms. Parents completed the Swanson, Nolan and Pelham-IV scale. Each subject with a combined score in the first 2 subscales (inattention, hyperactivity/impulsivity) at or above the 90th percentile was classified as having symptoms of attention deficit disorder with hyperactivity. All other cases were classified as nonattention deficit disorder. Voiding dysfunction symptoms were assessed by the Dysfunctional Voiding Symptom Scale. Sleep quality was assessed by the Pediatric Sleep Questionnaire. We then analyzed correlations between Dysfunctional Voiding Symptom Scale and symptoms of attention deficit disorder with hyperactivity. RESULTS: The group with symptoms of attention deficit disorder with hyperactivity had significantly higher scores on the Dysfunctional Voiding Symptom Scale overall and in the "cannot wait" subscale compared to the group without attention deficit disorder, as well as poorer sleep quality and lower voiding volumes. Overall Dysfunctional Voiding Symptom Scale scores were significantly correlated with overall Swanson, Nolan and Pelham-IV scale scores and also significantly correlated with each of the 3 Swanson, Nolan and Pelham-IV subscales (inattention, hyperactivity/impulsivity and oppositional defiant). Overall Dysfunctional Voiding Symptom Scale scores and scores on the "cannot wait" and "hurt when pee" subscales were significantly higher for males than for females. CONCLUSIONS: Boys with higher scores of attention deficit disorder with hyperactivity symptoms tend to have higher Dysfunctional Voiding Symptom Scale scores. Lower urinary tract symptoms were significantly correlated with overall Swanson, Nolan and Pelham-IV scores and significantly correlated with each of the 3 subscales. Evaluation of concomitant symptoms of attention deficit disorder with hyperactivity in children with lower urinary tract symptoms is an important clinical concern.

Finasteride upregulates expression of androgen receptor in hyperplastic prostate and LNCaP cells: implications for chemoprevention of prostate cancer.

BACKGROUND: Although finasteride is recognized for its role as a chemopreventive agent for prostate cancer, higher grades of malignancy have been reported. It is questioned whether blocking of testosterone conversion to dihydrotestosterone (DHT) by finasteride in prostate tissue will change expression of androgen receptor (AR). Therefore, this study evaluated the effects of finasteride on AR expression in prostate tissue and in the LNCaP cell line. METHODS: Between January and December 2006, we retrospectively selected and evaluated 47 cases of benign prostatic hyperplasia treated with variable duration of finasteride (5 mg QD) before transurethral resection of the prostate. AR expression in prostate tissue was semiquantified by immunostaining and compared with duration of finasteride treatment. An androgen-dependent prostate cancer cell line (LNCaP) was cultured in charcoal/dextran-treated FBS with DHT or testosterone, and treated with finasteride for 1-3 weeks. Samples of total RNA were collected to analyze expression of AR by real-time quantitative reverse transcription polymerase chain reaction. RESULTS: Immunohistochemical study revealed significant upregulation of ARs by finasteride treatment for 30-180 days. In cell line study, quantitative real-time reverse transcription polymerase chain reaction revealed significant upregulation of ARs treated by finasteride. CONCLUSIONS: In our study, finasteride influenced AR expression in benign prostate tissue and prostate cancer cell. Before we can use finasteride in chemoprevention with confidence, we still need to clarify the influence of finasteride in ARs and its regulation pathway.

Epidemiology of hypospadias and treatment trends in Taiwan: a nationwide study.

PURPOSE: We investigated the rate of diagnosis and treatment trends of hypospadias in Taiwan within the first 3 years of life. MATERIALS AND METHODS: We used a subset of the Taiwan National Health Insurance Research Database, which contains data on all inpatient and outpatient medical benefit claims, for the period 1997 through 2008 for a sample of 1 million individuals randomly drawn from the population of 25.68 million who held membership in the National Health Insurance program during any part of the calendar year 2005. We analyzed claims data for all subjects who were diagnosed with hypospadias through age 3 years. RESULTS: Among 52,705 newborns (individuals whose claims included live birth) 178 were diagnosed with hypospadias within 3 years of birth. Thus, mean incidence was 33.8 per 10,000 live male births. The hypospadias repair rate was 14.3 per 10,000 live male births. There was no significant tendency toward increase or decrease in rates of diagnoses or repairs, or proportion of severe hypospadias. There were significant associations between rates of hypospadias diagnoses and urbanization level of the community where the diagnosis was made. Approximately 54% of patients who underwent surgical repair did so after age 18 months. CONCLUSIONS: The nationwide incidence of hypospadias in children younger than 3 years in Taiwan is similar to that reported in previous studies. Delayed diagnosis and treatment of hypospadias are important clinical concerns that warrant further investigation.

Appropriate cut-off value for follicle-stimulating hormone in azoospermia to predict spermatogenesis.

BACKGROUND: This study was undertaken to determine the optimal cut-off value for FSH to predict the presence of spermatogenesis in patients with non-obstructive azoospermia. METHODS: A total of 206 non-obstructive azoospermic men were enrolled in this prospective study. By using receiver operating characteristic (ROC) curves, we determined the optimal cut-off value for FSH and evaluated whether the test could adequately predict successful sperm retrieval. RESULTS: There were 108 non-obstructive azoospermic patients who had evidence of spermatogenesis (group A) and achieved success in sperm retrieval. Another 98 non-obstructive azoospermic patients (group B) failed in sperm retrieval. The mean value of serum FSH in group B was significantly higher than in group A (28.03 +/- 14.56 mIU/mL vs 7.94 +/- 4.95 mIU/mL, p < 0.01; respectively). The area under the receiver operating characteristic curves were 0.939 +/- 0.02 and a cut-off value of 19.4 mIU/mL discriminated between group A and B with a sensitivity of 70%. The positive predictive value for failed sperm retrieval (group B) can reach 100%. CONCLUSIONS: Elevated plasma levels of FSH of more than 19.4 mIU/mL could be used as a reliable criterion for a trial of sperm retrieval from testes in artificial reproductive techniques.

Lower urinary tract symptoms in women with irritable bowel syndrome.

OBJECTIVES: To investigate lower urinary tract symptoms (LUTS) in women with irritable bowel syndrome (IBS) and to evaluate risk factors associated with the psychiatric morbidity of these patients. METHODS: The study group included 52 female patients with a diagnosis of IBS. Fifty-five women without gastrointestinal symptoms were used as controls. LUTS were evaluated using the American Urological Association Symptom Index questionnaire. Psychiatric morbidity was evaluated using a 12-item version of the Chinese Health Questionnaire. Multiple logistic regression analysis was performed to identify the risk factors associated with psychiatric morbidity in IBS patients. RESULTS: There were no significant differences between the two groups in any of the demographic variables. The most common LUTS in patients with IBS were storage symptoms. These patients had significantly higher scores of frequency, nocturia, urge incontinence, lower maximal flow rate and lower voiding volume (P < 0.05). In addition, significantly higher storage and total American Urological Association Symptom Index questionnaire scores were also noted in IBS patients (P < 0.05). The prevalence of psychiatric morbidity in IBS patients was 28.8%, which was significantly higher than in the control group (20%). The urinary storage symptom score (odds ratio: 1.518; 95% confidence interval: 1.17-1.96; P = 0.002) was significantly correlated with psychiatric morbidity. CONCLUSIONS: LUTS are common in IBS patients and have a negative impact on their psychiatric status. Healthcare providers should be aware of the psychological consequences of LUTS in these patients.

Predictive factors for ureteral double-J-stent-related symptoms: a prospective, multivariate analysis.

BACKGROUND/PURPOSE: Whether the length of stent affects stent-related symptoms after urological procedures remains controversial. We aimed to evaluate the predictive factors for stent-related urinary tract symptoms after uncomplicated ureteroscopic lithotripsy (URSL). METHODS: We prospectively recruited a total of 59 patients who underwent URSL and 6-Fr double-J ureteral stent placement. The demographic and perioperative data and stent characteristics, including the length (22, 24 or 26 cm), position of proximal end (upper calyx or pelvis), position of distal end (crossing midline or not), and configurations of both ends (complete or incomplete curl) were recorded. All patients completed a self-administered questionnaire to evaluate the stent-related urinary symptoms, bladder pain, flank pain and hematuria 1 week after the procedure. All variables were analyzed by a proportional odds logistic regression model. RESULTS: Twenty-two male (37.3%) and 37 (62.7%) female patients were enrolled in this study. Their mean age was 53.7 ± 12.9 years. The mean body height was 161.9 ± 7.9 cm (range, 145.9-178 cm). In multivariate analysis, the 26-cm stent was independently associated with the severity of frequency, urgency, and nocturia symptoms. Crossing the midline of the distal end was significantly associated with urge incontinence. The 24-cm and 26-cm stents were both very strongly associated with the severity of hematuria. Crossing the midline of the distal end was significantly associated with bladder pain. CONCLUSION: The length of stent and crossing the midline of the distal end were significantly associated with stent-related symptoms after URSL. Selection of the proper length of double-J stent is the most important factor in minimizing stent-related symptoms.

Choosing the ideal length of a double-pigtail ureteral stent according to body height: study based on a Chinese population.

OBJECTIVE: We conducted this study to determine the ideal stent length according to body height, as data are limited. PATIENTS AND METHODS: A total of 408 patients undergoing ureteroscopic lithotripsy and stent insertion (22, 24 or 26 cm) were enrolled. The appropriateness of the stent length was determined according to the plain films and was further compared among patients with different body heights and stent lengths. RESULTS: In patients <160 cm, the use of a 22-cm stent was significantly more appropriate than a 24- or 26-cm stent (86.5, 51.9 and 46.4%). In patients between 160 and 175 cm, a 22- or 24-cm stent was significantly more appropriate than a 26-cm stent (79.2, 66.7 and 46.3%), while the difference between the use of a 22- and 24-cm stent was not significant. In patients >175 cm, a 24- or 26-cm stent might be more appropriate. CONCLUSIONS: Body heights can predict the ideal stent length. Based on a Chinese population, a 22-cm stent length is more appropriate for those <175 cm. A longer, 24- or 26-cm stent may be suitable for those >175 cm.

An alternative access technique under direct vision for preperitoneoscopic pelvic surgery: easier for the beginners.

BACKGROUND: We present an alternative access technique to facilitate preperitoneoscopic (extraperitoneal laparoscopic) approach for radical prostatectomy, herniorrhaphy, and other pelvic procedures. METHODS: A 0 degrees telescope was mounted into a Visiport Optical Trocar (Visiport), and via a periumbilical incision it was advanced under direct vision at first vertically through different layers of the anterior abdominal wall. Immediately before the posterior rectus sheath, it was redirected caudally and horizontally toward the symphysis pubis. The Visiport was withdrawn and replaced by a dissection balloon that was inflated for developing the working space, then it was substituted with a 12-mm trocar to begin the pneumo-extraperitoneum. The surgical procedures are detailed in the attached video. RESULTS: This technique was used in 168 of 179 patients undergoing preperitoneoscopic surgery (97 radical prostatectomies, 80 totally extraperitoneal herniorrhaphies, and 2 urinary bladder diverticulectomies). Operative parameters were compared with 11 preceding patients approached with the open Hasson technique. All of the procedures to create the preperitoneoscopic space were successfully with no complications. For radical prostatectomy, there was a significantly faster access to the preperitoneal space (38 +/- 12 vs 540 +/- 69 seconds) and a faster setup of the whole operative space (15 +/- 5 vs 29 +/- 9 minutes, both P < .05) with the new technique. Less pericannular CO(2) leakage was experienced during the preperitoneoscopy with our technique. CONCLUSION: This alternative technique offers a simple, safe, quick, and effective access for creating a preperitonescopic working space.

Dermatomyositis associated with bilateral ureteral spontaneous rupture.

Dermatomyositis associated with genitourinary malignancies is not uncommon. However, only a few cases associated with ureteral stricture have been reported, and ureteral rupture is even rarer. A 56-year-old woman with dermatomyositis who had been treated with prednisolone, cyclophosphamide, and azathioprine for 2 months presented with fever, hematuria, and abdominal pain for 2 days. Radiographic imaging revealed bilateral ureteral spontaneous rupture and intraperitoneal urinoma formation. Urine cytology and endourologic examinations showed no evidence of genitourinary malignancy. Ureteral urine leakage was managed successfully by drainage through percutaneous catheter and bilateral double-J ureteral stenting. The stents were removed 9 months later. Follow-up intravenous urography 12 months after ureteral stent placement showed good renal function with left mild hydronephrosis and hydroureter above the previous rupture site. Bilateral ureters were patent and there was no evidence of contrast medium extravasation from either ureter. Diuretic renal scanning also showed bilateral nonmechanical obstruction with left-side mild hydronephrosis without urine extravasation. Dermatomyositis can be complicated with spontaneous ureteral rupture. Conservative management with urinary diversion and stenting is feasible.

Initial 10-year experience of sperm cryopreservation services for cancer patients.

Offering sperm cryopreservation to preserve the fertility of male cancer patients is a relatively recent service in Asia. This study analyzed the types of cancer, timing of collection, sperm quality, and utilization for reproductive services by patients during a 10-year period at a medical center in Taiwan. A total of 75 oncology patients elected to freeze sperm for fertility preservation at our medical center during the initial 10 years of the availability of this service. The mean age of the patients was 25.7 years. Storage was discontinued in 13 (17%) patients and their survival duration was 13.1 +/- 11.1 months. The utilization rate of sperm cryopreservation was 2.8% (75/2642). The types of cancer varied, with leukemia (35%), lymphoma (25%), and testicular cancer (13%) comprising the largest groups. A significantly lower sperm count was found in patients with chronic myelogenous leukemia, suggesting the need for earlier sperm collection after initiation of cancer treatment. Only three (4%) patients utilized their specimens for reproductive purposes. There was no clinical pregnancy during the study period, although one biochemical pregnancy was achieved. The low rates of sperm cryostorage for fertility preservation in cancer patients in this study suggest that there is a need for greater emphasis of this option for male oncology patients whose fertility is likely to be affected by chemotherapeutic treatment.

Penile tuberculosis associated with monoclonal gammopathy of undetermined significance.

Mycobacterium tuberculosis (TB) infection of the penis is a rare but serious problem. We report a case of penile TB in a 75-year-old man who presented with fever and dyspnea. No active lung lesions except pleural and pericardial effusion were found on chest X-ray. Monoclonal gammopathy of undetermined significance was diagnosed after serum and urine electrophoresis studies, and repeated bone marrow studies. Genital examination showed diffuse papulonecrotic skin ulcers involving the whole penile shaft, extending ventrally to the median raphe of the scrotum. Pus smear showed positive acid-fast stain, and culture yielded M. tuberculosis. Culture of pleural and pericardial effusion was also positive for M. tuberculosis. Anti-TB treatment was given with isoniazid, ethambutol, rifampin and pyrazinamide, and the cutaneous lesion was noted to be healed at follow-up 6 months later. Although rare, the possibility of TB as a cause of genital ulcer should be kept in mind.

The progression of the penile vein: could it be recurrent?

Our aim was to study retrospectively the destiny of the deep dorsal vein of the penis in the event of its stripping surgery or its simple ligation in patients diagnosed with venoocclusive dysfunction 17 years ago. From June 1986 to May 1987, a total of 31 men were seen for erectile dysfunction due to venous leakage resulting from priapism, aging, or congenital or idiopathic factors. Of these, 23 men underwent venous stripping of the deep dorsal vein and are referred to as the stripping group. The remaining 8 patients received a simple ligation of the deep dorsal vein and are classified as the ligation group. A total of 21 patients (16 of the 23 and 5 out of the 8) were available for follow-up by using the abridged 5-item version of the International Index of Erectile Function (IIEF-5) scoring system and cavernosograms. In the ligation group, the imaging demonstrates some compensatory veins that are commensurate with impotence postoperatively. In the stripping group, however, the follow-up cavernosograms disclosed no venous recurrence, but residual ones that were not crucial to the rigidity. The IIEF-5 scoring in the ligation group changed from a preoperative mean IIEF-5 score of 10.0 +/- 4.5 to 9.8 +/- 3.6 postoperatively. In the stripping group, however, the mean preoperative IIEF-5 score of 9.8 +/- 4.1 increased to a mean postoperative IIEF-5 score of 18.9 +/- 2.1. Although there was no significant difference between the 2 groups' preoperative IIEF-5 score, there was a statistically significant difference between treatments (P <.001). The penile venous vasculature bears no evidence of regeneration even as long as 17 years after their removal. This finding is in contrast to what is commonly believed, that erectile dysfunction will recur about 2 years after ligation of the deep dorsal vein. We therefore believe that the clinical recurrence may not be due to venous regeneration, and penile venous surgery, if properly performed, may be durable, although larger studies will be required.

Distal ligament in human glans: a comparative study of penile architecture.

To elucidate the anatomic distal ligament of the human glans penis and associated clinical implications, we compared the structures of the glans penis and corpora cavernosa in dogs, rats, and humans. From May 2001 to March 2003, gross dissection, microscopic examinations, and stains for elastic fibers and collagen subtypes were made in the penises of 11 adult human male cadavers, 7 dogs, and 5 rats. A distal ligament in the human glans penis replaces the os penis that is present in dogs or rats, also termed the baculum, but retains collagen types I and III as common structural and interlocking components, respectively. The intercavernosal septum is complete, and intracavernosal pillars (ICPs) are abundant in dogs, absent in rats, and moderately developed in humans. A tunica with numerous elastic fibers exists to fulfill the requirements of erectile function in humans but not in dogs or rats, since it is essential for establishing tissue strength to serve as a buttress. We may conclude that in dogs and rats, the strong os penis is designed for ready intromission and is associated with a pair of well-developed nonelastic corpora to serve as a buttress for the os penis. These structures are necessary for the rigorous coitus observed in dogs. The less compliant corpus cavernosum is suitable for the flipping action observed in a mating male rat. These specific anatomic designs may provide explanations for the individual requirements for the specific physiologic functions that differ from species to species. Although there is no os in the human glans, a strong equivalent distal ligament is arranged centrally and acts as a supporting trunk for the glans penis. Without this important structure, the glans could be too weak to bear the buckling pressure generated during coitus and too limber to serve as a patent passage for ejaculation, and it could be too difficult to transmit the intracavernosal pressure surge along the entire penis during ejaculation. Given the common histologic nature of the distal ligament, which is associated with the tunica albuginea and serves a similar function as the os penis observed in the dog and the rat, one may ask whether the healing process of a tunica may take as long as that required in a bony structure. Further research is required to answer this question.

In vitro gene expression changes of androgen receptor coactivators after hormone deprivation in an androgen-dependent prostate cancer cell line.

BACKGROUND AND PURPOSE: Androgen receptor (AR) coactivators modulate the transcriptional activity of AR and may activate AR-associated genes upon androgen deprivation. Changes of expression patterns may help reveal the role of AR cofactors in androgen-independent prostate cancer. This study investigated changes of expression patterns of several AR coactivators after androgen deprivation in an androgen-dependent prostate cancer cell line (LNCaP). METHODS: LNCaP cells were cultured in RPMI medium with charcoal/dextran-treated fetal bovine serum for 28 days. Samples of total RNA collected at 1-week intervals were analyzed using a non-isotopic multi-probe ribonuclease protection assay system with a human AR multi-probe template set. Expression changes of 10 mRNAs of interest (AR, Rb, ARA160, ARA24, ARA54, ARA55, ARA70, BRCA1, F-SRC-1, and RAC3) were analyzed simultaneously as AR and AR-associated cofactors in 1 hybridization reaction. RESULTS: Seven of 10 cofactors tested were expressed in LNCaP cells. Only Rb, ARA55 and BRCA1 were not detected. LNCaP cells cultured in charcoal-treated serum for 28 days clearly showed more than 1.5-fold increases in AR, ARA160, and ARA70 expression, while expression of ARA24 and ARA54 increased less than 1.5-fold. Only RAC3 and F-SRC-1 decreased in RNA expression. Cell morphology features changed gradually into neuron-like shapes with elongated cytoplasm during the culture period. Cell growth almost ceased 28 days after the start of culture. CONCLUSION: The changes in expression pattern of AR and AR cofactors and in particular the remarkable increase in AR, ARA160 and ARA70 support the role of AR cofactors in modulating prostate cancer cell growth from androgen dependence to androgen independence.

Penile venous anatomy: an additional description and its clinical implication.

The human penile venous system has been well studied and described but the demonstration of extra venous channels in imaging films prompted us to seek refinement of our anatomical knowledge of this venous system. Cavernosography in 37 patients who had venous stripping surgery and now suffered recurrent erectile dysfunction consistently showed an independent vein, smaller than the deep dorsal vein, running almost in the same position of the deep dorsal vein even though the latter had been removed unequivocally in previous surgery. Cavernosography in 9 patients who underwent intraoperative films also demonstrated the presence of this cavernosal vein in addition to the deep dorsal vein. Meticulous dissection of the penis under the microscope was then performed in 21 male cadavers and we found a cavernosal vein coursing along each corpus cavernosum all the way distally to the glans and draining directly into the Santorini's plexus in 19 subjects. This is in contrast to the previous description that this cavernosal vein was a short vein in the penile hilum. Two sets of para-arterial veins, which have not been reported in the literature, were found to accompany each dorsal artery in all 21 subjects. This more extensive and extra venous drainage might have important implication for venous stripping surgery in the treatment of erectile dysfunction.

Anatomy of the human penis: the relationship of the architecture between skeletal and smooth muscles.

To investigate the anatomy of the ischiocavernosus muscle, bulbospongiosus muscle, and tunica albuginea and to determine their relationships to smooth muscle, which is a key element of penile sinusoids, we performed cadaveric dissection and histologic examinations of 35 adult human male cadavers. The tunica of the corpora cavernosa is a bilayered structure that can be divided into an inner circular layer and an outer longitudinal layer. The outer longitudinal layer is an incomplete coat that is absent between the 5-o'clock and 7-o'clock positions where 2 triangular ligamentous structures form. These structures, termed the ventral thickening, are a continuation of the anterior fibers of the left and right bulbospongiosus muscles. On the dorsal aspect, between the 1-o'clock and 11-o'clock positions, is a region called the dorsal thickening, a radiating aspect of the bilateral ischiocavernosus muscles. In the corpora cavernosa, skeletal muscle contains and supports smooth muscle, which is an essential element in the sinusoids. This relationship plays an important part in the blood vessels' ability to supply the blood to meet the requirements for erection, whereas in the corpus spongiosum, skeletal muscle partially entraps the smooth muscle to allow ejaculation when erect. In the glans penis, however, the distal ligament, a continuation of the outer longitudinal layer of the tunica, is arranged centrally and acts as a trunk of the glans penis. Without this strong ligament, the glans would be too weak to bear the buckling pressure generated during coitus. A significant difference exists in the thickness of the dorsal thickening, the ventral thickening, and the distal ligament between the potent and impotent groups (P < or =.01). Together, the anatomic relationships between skeletal muscle and smooth muscle within the human penis explain many physiologic phenomena, such as erection, ejaculation, the intracavernous pressure surge during ejaculation, and the pull-back force against the glans penis during anal constriction. This improvement in the modeling of the anatomic-physiologic relationship between these structures has clinical implications for penile surgeries.