Cross-Sectional Association of Metabolic Syndrome and Its Components with Serum Testosterone Levels in a Korean-Screened Population

Antibiotic prophylaxis with intravenous ceftriaxone and fluoroquinolone reduces infectious complications after transrectal ultrasound-guided prostatic biopsy

PURPOSE: To assess the rates of infectious complications before and after the change of prophylactic antibiotic regimens in prostate needle biopsy. MATERIALS AND METHODS: The records of 5,577 patients who underwent prostate needle biopsy at Asan Medical Center between August 2005 and July 2012 were retrospectively reviewed. Group 1 (n=1,743) included patients treated between 2005 and 2009 with fluoroquinolone for 3 days, group 2 (n=2,723) included those treated between 2009 and 2012 with ceftriaxone once before the biopsy and fluoroquinolone before biopsy and continue therapy for 3 days, and group 3 (n=1,111) received the same treatment for more than 7 days after the biopsy. Univariable and multivariable logistic regression models addressed risk factors associated with infectious complication after prostate needle biopsy. RESULTS: Infectious complication after prostate needle biopsy developed in 18 (group 1), seven (group 2), and two patients (group 3) (p=0.001). In group 1, seven patients with infectious complication had positive blood cultures and harbored fluoroquinolone-resistant Escherichia coli, four had ceftriaxone susceptible isolates, and three had extended spectrum beta-lactamase-positive E. coli. Two patients in group 1 required intensive care because of septic shock. In multivariable analysis, the patients with combination of fluoroquinolone and ceftriaxone had significantly lower infectious complication rate than the fluoroquinolon alone (p=0.003). CONCLUSIONS: Antibiotic prophylaxis with ceftriaxone and fluoroquinolone before prostate needle biopsy decreased the risk of potentially serious infectious complications.

Is Intravesical Bacillus Calmette-Guerin Therapy Superior to Chemotherapy for Intermediate-risk Non-muscle-invasive Bladder Cancer?: An Ongoing Debate

The objective of this study was to evaluate the risk of recurrence in patients with intermediate-risk non-muscle-invasive bladder cancer (NMIBC) after intravesical instillation with chemotherapeutic agents or Bacillus Calmette-Guerin (BCG) therapy. A cohort of 746 patients with intermediate-risk NMIBC comprised the study group. The primary outcome was time to first recurrence. The recurrence rates of the transurethral resection (TUR) alone, chemotherapy, and BCG groups were determined using Kaplan-Meier analysis. Risk factors for recurrence were identified using Cox regression analysis. In total, 507 patients (68.1%), 78 patients (10.5%), and 160 (21.4%) underwent TUR, TUR+BCG, or TUR+chemotherapy, respectively. After a median follow-up period of 51.7 months (interquartile range=33.1-77.8 months), 286 patients (38.5%) developed tumor recurrence. The 5-yr recurrence rates for the TUR, chemotherapy, and BCG groups were 53.6%+/-2.7%, 30.8%+/-5.7%, and 33.6%+/-4.7%, respectively (P<0.001). Chemotherapy and BCG treatment were found to be predictors of reduced recurrence. Cox-regression analysis showed that TUR+BCG did not differ from TUR+chemotherapy in terms of recurrence risk. Adjuvant intravesical instillation is an effective prophylactic that prevents tumor recurrence in intermediate-risk NMIBC patients following TUR. In addition, both chemotherapeutic agents and BCG demonstrate comparable efficacies for preventing recurrence.

Efficacy and Safety of the Selective alpha1A-Adrenoceptor Blocker Silodosin for Severe Lower Urinary Tract Symptoms Associated With Benign Prostatic Hyperplasia: A Prospective, Single-Open-Label, Multicenter Study in Korea

PURPOSE: To evaluate the efficacy and safety of silodosin 8 mg once daily in a 12-week treatment of subjects with severe lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH). MATERIALS AND METHODS: A total of 100 subjects from 10 urology centers in Korea were included in this study. The inclusion criteria were as follows: age > or =50 years, International Prostate Symptom Score (IPSS) > or =20, quality of life (QoL) score > or =3, urine volume > or =120 mL and maximal urinary flow rate (Qmax) <15 mL/s, and postvoid residual volume (PVR) <100 mL. We assessed the improvement of LUTS with change in IPSS, QoL score, Qmax, PVR, and adverse events at baseline and 4 and 12 weeks after treatment with silodosin 8 mg once daily. RESULTS: The IPSS values were 23.27+/-3.34, 15.89+/-6.26, and 13.80+/-6.31 at baseline, 4, and 12 weeks, respectively, with significant improvements (p<0.0001, p=0.0214, respectively). QoL scores were 4.44+/-0.85, 3.38+/-1.20, and 3.04+/-1.20 at baseline, 4, and 12 weeks, respectively, and the differences were statistically significant (p<0.0001). There was a significant difference in Qmax between baseline and 12 weeks (p<0.0001) but not in PVR (p=0.9404) during the clinical trial. The most frequent adverse event in this study was ejaculation failure with 13 cases. However, no subject dropped out because of ejaculation failure, and in 12 of the 13 cases it was fully resolved without further treatment. CONCLUSIONS: Silodosin 8 mg once daily may be effective and safe in Korean patients with severe LUTS associated with BPH.

Medical Profession's Awareness and Attitude Toward the Sexuality of Cancer Patients in South Korea / 대한남성과학회지

PURPOSE: To investigate the practice and attitude of healthcare professionals toward the sexuality of cancer patients. MATERIALS AND METHODS: The subjects were comprised of doctors and nurses who served at two medical centers. Questionnaires consisted of five domains and fourteen questions were disseminated via emails in March 2009. The first domain (3 questions) pertained the recognition of sexual dysfunction in cancer patients, the second (2 questions) pertained cancer patients' experience of sexual dysfunction, the third (3 questions) pertained the attitude to cancer patients with sexual dysfunction, the fourth (3 questions) pertained capacity for sexual dysfunction treatment, and the fifth (3 questions) pertained problems or difficulties encountered when facing cancer patients' sexual dysfunction. RESULTS: Three hundred and twenty-six men and women completed the questionnaires, giving a response rate of 85.4%. The mean age was 33.6 years. The proportion of doctors and nurses were respectively 48.2% and 51.8%. The proportion of males and females were 29.8%, and 70.2%, respectively. Ninety point five per cent (90.5%) of respondents answered that cancer patients' sexual dysfunction is important to quality of life. However, fewer medical professionals (27.4%) give an affirmative answer that patients requested sexual dysfunction therapy. The occurred particularly less frequently in physicians (13.2%) than in surgeons (55.6%). Fifty-four point six (54.6%) percent of respondents said that they tried to resolve the problem when patients asking for treatment of sexual dysfunction. Only 38.3% of respondents experienced little or no difficulty in behaving naturally when counseling cancer patients about their sexual dysfunction. Female doctors and nurses more often experience embarrassment when addressing sexuality with patients. In addition, most respondents (84.0%) felt that theoretical knowledge on cancer patients' problems is needed. CONCLUSIONS: Most healthcare professionals agreed that sexual problems of cancer patients were important for quality of life. However, they frequently felt a lack of communicating skills and theoretical knowledge. Education programs on this issue and an appropriate contact system with specialists should be established.

Changes in Serum Prostate-Specific Antigen Levels after Potassium-Titanyl-Phosphate (KTP) Laser Vaporization of the Prostate

PURPOSE: The prostate-specific antigen (PSA) level decreases after transurethral resection of the prostate (TURP). However, changes in the PSA level after potassium-titanyl-phosphate (KTP) laser vaporization of the prostate are not well known. The aim of this study was to investigate the effect of KTP laser vaporization of the prostate on PSA levels in patients with benign prostatic hyperplasia (BPH). MATERIALS AND METHODS: Serum PSA levels were checked before and 1, 3, 6, and 12 months after the procedure in patients who underwent KTP laser vaporization between October 2004 and August 2008. Patients with prostate cancer, a history of urinary retention, or prostatitis during the follow-up period were excluded. The results for 278 patients were studied. RESULTS: The mean age of the patients was 69.0+/-6.7 years (range, 50-91 years) and the mean preoperative PSA level was 2.72+/-2.93 ng/ml. The PSA level tended to be increased at 1 month after the operation (3.18+/-3.23 ng/ml, p=0.032) but decreased within 3 months and became stabilized after 6 months at 1.79+/-1.82 ng/ml (p<0.001). CONCLUSIONS: PSA levels may increase after KTP laser vaporization for a certain period of time, but eventually decrease and become stabilized after 6 months. Therefore, it may be appropriate to wait up to 3 months if the PSA level rises after the procedure, and further investigation should be considered if the PSA level still remains high after 6 months.

Interactive Effects of Forward, Backward Walking Exercise and Pelvic Floor Muscle Exercise on Sexual Function and Functional Fitness in the Elderly Male Population

BACKGROUND: To assess the effect of forward, backward walking exercise and pelvic floor muscle exercise on sexual function and functional fitness in elderly males. METHODS: Twenty two elderly males participated in this study. They were divided into two groups. The Complex Exercise(CE) group(n=11) performed the forward, backward walking exercise(3 days/week, 12 weeks) and pelvic floor muscle exercises(PFME; 5 days/week, 12 weeks). The PFME group(n=11) only performed PFME(5 days/week, 12 weeks). Both groups performed the PFME in the same manner. Outcomes were evaluated by IIEF-5(5-item version of the interna- tional index of erectile function), 6min walk, and 30sec & 1min sit-to-stand before exercise training, and at week 4, week 8, and week 12. RESULTS: Total scores and erectile function scores had significant interaction effect(p<0.05) in group and period. 6min walk wassignificantly different(p<0.05) in exercise period and 30sec(p<0.001) & 1min sit-to-stand(p<0.01) had signi- ficant interaction effectin group and period. CONCLUSION: Three months of forward, backward walking and pelvic floor muscle exercises did not have significant positive effects on sexual function and functional fitness in elderly males.

The Preoperative Risk Factors that Influence the Postoperative Renal Function in Living Donor Nephrectomy: The Impact of Dominant Kidney Nephrectomy / 대한비뇨기과학회지

PURPOSE: We wanted to investigate the effect of dominant kidney nephrectomy on the postoperative renal function and we wanted to determine the preoperative risk factors that influence the postoperative renal function in living donor nephrectomy. MATERIALS AND METHODS: A total of 297 living kidney donors(159 males and 138 females) who underwent nephrectomy were included in this study. Renal function was measured by the serum creatinine levels and (99m)Tc-diethylenetriamine penta-acetic acid(DTPA) renal scanning. Using univariate and multivariate analyses, the following independent variables were evaluated to predict a postoperative serum creatinine level 1.5mg/dl or higher: removal of a functionally dominant kidney or a larger kidney according to the DTPA renal scan or CT, age, gender, body mass index (BMI), comorbidity, preoperative serum creatinine and the preoperative glomerular filtration rate(GFR). RESULTS: Of the 297 subjects, 134(55%) underwent donor nephrectomy on the left side, and 163(45%) underwent donor nephrectomy on the right side. Univariate analysis showed that gender and the preoperative creatinine level were significantly associated with postoperative serum creatinine elevation(1.5mg/dl or higher)(p<0.05). Multivariate analysis showed that the preoperative creatinine level(p<0.001), the preoperative GFR (p=0.015) and removal of a functionally dominant kidney(p=0.049) were significant factors. The cut-off values from the receiver operating characteristics(ROC) curves were 1.0mg/dl for the preoperative creatinine level, 90.24ml/min/1.73m2 for the preoperative GFR, and 10.94% for the difference of the relative renal function on DTPA. CONCLUSIONS: The preoperative serum creatinine level and the preoperative GFR are critical predictive factors for renal function after living donor nephrectomy. The impact of removing a functionally dominant kidney on the postoperative renal function should be cautiously interpreted in patients where the function of the nondominant kidney is favored.

Efficacy and safety of oral SK3530 for the treatment of erectile dysfunction in Korean men: a multicenter, randomized, double-blind, placebo-controlled, fixed dose, parallel group clinical trial / 亚洲男科学杂志(英文版)

<p><b>AIM</b>To evaluate the efficacy and safety of SK3530, a newly developed type 5 phosphodiesterase inhibitor (PDE5I), in Korean men with erectile dysfunction (ED).</p><p><b>METHODS</b>A total of 119 patients were randomized at 10 centers in Korea to receive either SK3530 (50, 100, or 150 mg; n = 89) or placebo (n = 30) taken l h before anticipated sexual activity for an 8-week period. The patients were evaluated at baseline and 4 and 8 weeks after beginning therapy. Efficacy was assessed using the International Index of Erectile Function (IIEF), Sexual Encounter Profile (SEP), and the Global Assessment Question (GAQ). Safety was analyzed by adverse events, laboratory values and vital signs.</p><p><b>RESULTS</b>At the end of the study, all the primary and secondary efficacy end-points were statistically significantly improved by SK3530 compared with placebo (P<0.05). Of the 89 patients in the treatment arm, 36 (42.3%) achieved normal erectile function after treatment, including six patients with severe ED. Treatment-related adverse events occurred in 32 patients. The most common adverse events were flushing, headache, dizziness and eye redness (10.9%, 7.6%, 2.5% and 2.5%, respectively), and most were mild. Only two patients discontinued treatment during the study period because of adverse events.</p><p><b>CONCLUSION</b>The results of our phase II study have confirmed the efficacy and safety of SK3530 in a broad population of men with ED of various etiologies and severity. The optimal doses in terms of efficacy and safety were determined to be 50 mg and 100 mg, respectively.</p>

Comparison of Treatment Outcomes between Photoselective Vaporization and Transurethral Resection of the Prostate for Benign Prostatic Hyperplasia / 대한비뇨기과학회지

PURPOSE: We prospectively compared the treatment outcomes of photoselective vaporization of the prostate (PVP) with those of the gold standard transurethral resection of the prostate (TURP). MATERIALS AND METHODS: Between October 2004 and April 2006, a prospective clinical trial was performed with 131 and 41 patients treated by PVP and TURP, respectively. The efficacy of the two procedures were compared in terms of the International Prostate Symptom Score, quality of life score, peak urinary flow rate, postvoid residual volume, complications and perioperative outcomes at 1, 3, 6 and 12 months following treatment. RESULTS: The baseline characteristics of the two groups were similar. The operative times, catheter indwelling times and hospital stays were significantly shorter in the PVP group. All efficacy parameters were significantly improved in both groups compared to those obtained preoperatively. In addition, the degrees of improvement in the efficacy parameters were similar between the two groups within 12 months. With respect to the prostatic volume reduction, the difference between the pre- and post-PVP volumes during the study period was less than that of the TURP group (p<0.001). There were no differences in the overall complications between the two groups, with the exception of more common bleeding reguiring a transfusion and capsule perforation in the TURP group. CONCLUSIONS: PVP provides excellent intraoperative and postoperative safety, and facilitates immediate relief from obstructive voiding symptoms; similarly to TURP, but has the advantages of shorter hospital stays and catheter indwelling times. The short-term treatment outcomes 12 months after PVP and TURP were comparable, with the exception of the prostatic volume reduction.

Comparison of the Efficacy, Safety and Patient Preference of the Phosphodiesterase Type 5 Inhibitors for the Patients with Erectile Dysfunction / 대한비뇨기과학회지

PURPOSE: To compare the clinical efficacy and safety of three phosphodiesterase type 5 (PDE5) inhibitors in the treatment of mele erectile dysfunction according to patient preference. MATERIALS AND METHODS: Between January 2004 and August 2005, 113 male erectile dysfunctional patients were enrolled to this randomized, prospective, comparative, open-label, triple-crossover study of three PDE5 inhibitors. Patients were assigned to one of six medication schedules, and were prescribed a full dose of the drugs for 8 weeks, with a week of washout period prior to the next drug cycle. The International Index of Erectile Function (IIEF) scores and side effects related with each medication were obtained at the end of study. 48 patients finished all the medications, and completed the study with a global assessment questionnaire on their drug preference and reasons for that preference. RESULTS: The mean age of the patients was 54.6 (33-73) years. The mean pre-treatment IIEF and EF domain scores (+/-S.D.) were 28.2+/-14.7 and 10.6+/-6.6, respectively. The scores were significantly improved, to 47.9+/-14.6 and 19.9+/-6.6 with sildenafil, to 49.7+/-12.3 and 21.3+/-5.8 with vardenafil, and to 47.9+/-14.9 and 19.8+/-7.2 with tadalafil (p < 0.01). There were no significant differences in the scores or frequencies of side effects between the drugs. The preference percentages were 29.2, 29.2 and 35.4% for sildenafil, vardenafil and tadalafil, respectively. Patient preference was mainly due to improvement in erectile function (70.9%), such as rigid erection, prolonged erection and fast erection, and not to the infrequent rate of side effects (20.8%). CONCLISIONS: There were no significant differences of the efficacy and safety among the three PDE5 inhibitors. The preference for a drug for the treatment of erectile dysfunction was mainly related to the efficacy on the improvement of erectile function rather than the less frequent side effects.

Treatment preferences in men with erectile dysfunction: an open label study in Korean men switching from sildenafil citrate to tadalafil / 亚洲男科学杂志(英文版)

<p><b>AIM</b>To evaluate patient preferences for sildenafil citrate or tadalafil (PDE-5 inhibitors available for the treatment of erectile dysfunction [ED]) and assess potential reasons for these preferences.</p><p><b>METHODS</b>This open-label study was conducted on Korean men taking sildenafil, at least 6 weeks prior to study entry, for ED. Following screening, patients continued sildenafil treatment for 4 weeks, then after a 1-week washout period, switched to tadalafil for 8 weeks. Patients then continued with their treatment of choice during an extension phase. Psychosocial factors (time concern, spontaneity, sexual self-confidence) were evaluated using Psychological and Interpersonal Relationship Scales (PAIRS), while timing of dose to sexual attempt patterns were assessed from patient diaries.</p><p><b>RESULTS</b>The present study enrolled 160 Korean men (mean age 55 years) with prior median sildenafil use of 585 days. During the extension phase, 73.7% of patients elected to take tadalafil, whereas 26.3% chose sildenafil (P < 0.001). After switching from sildenafil to tadalafil, mean PAIRS time concern scores decreased from 2.54 to 2.42 (P = 0.002), with no statistically significant differences observed between the sildenafil and tadalafil assessment phases in sexual spontaneity and self-confidence scores. Sexual attempts made > 4 h to =/< 36 h post-dose occurred in 4.5% of patients during the sildenafil assessment phase compared with 17.5% during the tadalafil assessment phase.</p><p><b>CONCLUSION</b>After experiencing both sildenafil and tadalafil, the majority of patients exhibited a preference for tadalafil. This preference might be influenced by psychosocial factors, such as decreased time concerns, and a broader window of opportunity available for sexual activity.</p>

Recovery of the Spontaneous Erections after Radical Prostatectomy with Early Tadalafil Treatment / 대한남성과학회지

PURPOSE: We evaluated the efficacy of tadalafil for the treatment of erectile dysfunction after nerve-sparing radical prostatectomy. MATERIALS AND METHODS: From April 2004 to February 2005, 28 patients who underwent nerve-sparing radical prostatectomy agreed this study and were enrolled. The subjects were divided into 2 groups: tadalafil group(n=15) and control group(n=13). The tadalafil group started medication(20 mg, 2 or 3 times a week) when daily pad requirement was less than 1(pad-free point, mean 74th day postoperatively). Efficacy assessments included the score on the International Index of Erectile Function(IIEF), erectile function domain(EF domain) and Sexual Encounter Profile questions 2(SEP2), and 3(SEP3). Questions were administered in the preoperative phase, pretreatment, and 6 months post-treatment. RESULTS: The preoperative score for the IIEF and EF domain were 46.0 and 18.5 in the tadalafil group and 44.8 and 17.9 in the control group, respectively(p>0.05, p>0.05). At pad-free point, the IIEF and EF domain scores in the tadalafil group were 9.8+/-7.5, 2.7+/-2.7 and in the control group 10.0+/-6.8, 3.1+/-2.5. The scores were reduced significantly at the pad-free point compared to the preoperative phase, but there was no significant difference between the 2 groups. At 6 months after treatment, the scores for the tadalafil group were 26.6+/-18.2, 10.3+/-7.3 and had increased significantly(p<0.05, p<0.05). There was a borderline difference in the EF domain score between the 2 groups(p=0.085). Four patients in the tadalafil group(26.7%) and 1 patient in the control group(7.7%) could penetrate successfully. CONCLUSIONS: Although there was no statistical significance between the 2 groups, early tadalafil treatment after nerve-sparing radical prostatectomy may enhance the early recovery of erectile function.

Vardenafil Improves Lower Urinary Tract Symptoms in Patients of Erectile Dysfunction / 대한남성과학회지

PURPOSE: It is well known that male erectile dysfunction and lower urinary tract symptoms are common in aging men. We evaluated whether treatment for erectile dysfunction with vardenafil might improve lower urinary tract symptoms. MATERIALS AND METHODS: From January 2004 to May 2005, 34 patients with erectile dysfunction attending the outpatient clinic were treated with vardenafil and followed up 1, 3, and 6 months after the treatment. They completed the International Index of Erectile Function (IIEF) and the International Prostate Symptom Score (IPSS) questionnaire at baseline and at each follow-up (1, 3, 6 months). RESULTS: After treatment with vardenafil, IIEF and IPSS were significantly improved at 1 month compared to baseline,and the improvement was maintained during the 3 to 6 month follow-up period. There was no correlation between IPSS and IIEF score either before or after treatment. There was no statistical significance between the severity of IPSS and the response to vardenafil. There were mild side effects, including 2 patients with headache, 2 patients with facial flushing, and 1 patient with eye discomfort. CONCLUSIONS: Vardenafil appears to improve not only erectile function but also lower urinary tract symptoms in men with erectile dysfunction. However, the severity of IPSS does not appear to predict the response to vardenafil therapy.

Combination Therapy of Androgen Replacement and Alpha-blockers in Patients with PADAM and Severe LUTS / 대한남성과학회지

PURPOSE: Severe LUTS (lower urinary tract symptoms) have been considered to be a contraindication to ART (androgen replacement therapy) in PADAM (partial androgen deficiency in aging male) patients. But increasing numbers of patients presenting with PADAM have also LUTS due to the enlarged prostate. We investigated the effect of ART to the prostate in whom LUTS are controlled with alpha-blockers. MATERIALS AND METHODS: Of those patients who visited our clinic for PADAM symptoms and had decreased serum levels of total testosterone( <2.8 ng/ml, Biodata, Italy), men with severe voiding symptoms(IPSS 20~35) were recruited. Oral androgen(testosterone undecanoate 160 mg/day) and doxazosin(2~4 mg/day) were administered. IPSS score, prostate volume by TRUS, and serum PSA were assessed. RESULTS: A total of 25 patients were enrolled. Mean patient age was 63.5(51~89) years and median duration of follow-up was 754 days. Initial prostate volume by TRUS was 34.50+/-10.22 ml. Voiding symptoms evaluated by IPSS score improved significantly from 24.12+/-2.54 to 14.64+/-6.01(p <0.01). Serum PSA level showed no significant change from 1.20+/-0.54 ng/ml to 1.30+/-1.05 ng/ml. CONCLUSIONS: PADAM patients with severe voiding symptoms could be treated with a combination of androgen therapy and alpha-blockers. Further studies with longer follow-up would be required to confirm our results.

Diagnosis and Treatment of Andropause / 대한내과학회지

No abstract available.

Risk Factors for Development of Long-term Complications after Surgical Repair of Penile Fracture / 대한남성과학회지

PURPOSE: The aim of this study was to review clinical features of penile fracture and to characterize risk factors for the development of long-term complications after its surgical correction. MATERIALS AND METHODS: We retrospectively reviewed the cases of 10 patients who underwent surgical therapy for penile fracture between June 1995 and September 2003. Patient age at presentation ranged from 17 to 54 years (mean 32 years). All patients underwent surgical therapy in an emergency setting. The time between the injury and surgery ranged from 7 to 240 hours (mean 44.5 hours). Radiologic work-up included penile ultrasonography for 9 patients and retrograde urethrography for patients suspected of having concomitant urethral injury. We investigated multiple clinical features to characterize risk factors relevant to the development of long-term complications. The mean follow-up was 36.5 month. RESULTS: Penile ultrasonography revealed defects in the tunica albuginea in seven patients, including six in whom the defect was identical to the injury site. At surgery, the size of the injury was between 3 mm and 50 mm. Two patients with concomitant urethral injury showed larger defects than those with an intact urethra. Long-term complications such as penile curvature and erectile dysfunction were found in two men with large defects involving the urethra and three with long lapses from injury to surgical correction. CONCLUSIONS: Long-term complications after surgical therapy for penile fracture are likely to occur in patients with a large defect in the tunica albuginea involving the urethra or with delayed surgical correction.

Multicenter Study on the Efficacy and Safety of Intracavernous 'TM' (Standro(R)) for the Treatment of Erectile Dysfunction in Korean / 대한비뇨기과학회지

PURPOSE: To evaluate the efficacy and safety of an intracavernous injection of lyophilized papaverine/phentolamine/alprostadil (Standro(R)) for the treatment of erectile dysfunction (ED) in Koreans. MATERIALS AND METHODS: 249 men (>20 years old), with ED (>6 month duration), were enrolled from 14 clinical centers. The intracavernous 'TMs' were titrated in a stepwise fashion at the clinic, from 0.05-0.25ml (17.64mg papaverine, 0.6mg phentolamine, and 6mug alprostadil per ml), with increment of 0.02-0.05ml, according to the etiology and severity of the ED and the patients' ages. RESULTS: Of the 249 men, 238 completed the dose titration, and progressed to home treatment of 3 months duration. Of these 238, 193 (psychogenic 13.0%, organic 75.5%, mixed 11.5%) completed the home treatment (4 or more self-injections), with the other 45 dropping out (lost to follow-up in 24, patient refusal in 9, no chance to have intercourse in 7 and omitted recording of patient diary in 2). The success rate per trial (a total number of sufficient erection for vaginal intromission/a total number of injections) and per patient (number of patients who had one or more sufficient erections for vaginal intromission/the enrolled patients at beginning or 193 patients), and the satisfaction rate per patient (number of patients who had both patient and partner satisfaction with erection/193 patients) were 74.1, or 91.2 and 75.1%, respectively. The adverse reactions were prolonged erections in 3, urethral pain in 1 and penile skin edema in 2. Three patients complained of penile pain during an erection, but there was no dropout due to the pain. No significant changes in laboratory tests were found after the home treatment. CONCLUSIONS: A 'TM' seems to be effective and safe for an intracavernous injection for the treatment of men with erectile dysfunction.

Correlation between Calculated Bioavailable Testosterone and Free Testosterone by Direct Immunoassay / 대한남성과학회지

PURPOSE: We investigated whether free testosterone measured by direct immunoassay(aFT) reflects aging as well as bioavailable testosterone(free testosterone index; cBT) calculated from serum testosterone(T) and sex hormone-binding globulin(SHBG). MATERIALS AND METHODS: Serum T, SHBG, and aFT were measured in sera of 414 patients who presented with erectile dysfunction and partial androgen deficiency symptoms but no serious medical comorbidities. Their mean age was 52.5 years(or=50: 262). The cBT was obtained by calculation from T and SHBG. The mean values of T, aFT, SHBG, and cBT were compared according to the age range. We analyzed the correlation between cBT and aFT and calculated the correlation coefficient. RESULTS: The mean values of T(ng/mL), aFT(pg/mL), SHBG(nmol/L), and cBT(nmol/L) were 3.39, 13.08, 24.3, and 6.04, respectively, in the 3rd and 4th decades; 4.34, 14.72, 23.36, and 7.74 in the 5th and 6th decades; and 4.05, 13.83, 27.32, and 5.96 in the 7th and 8th decades. The SHBG increased and T/aFT/cBT declined as age increased from the 5th and 6th to the 7th and 8th decades. The change was statistically insignificant only for aFT. The correlation between cBT and aFT was weak, with a correlation coefficient of 0.391. CONCLUSIONS: Because free testosterone measured by direct immunoassay did not reflect the age-related changes of SHBG, a single measurement is not a reliable index of bioavailable testosterone.

Long-Term Follow-Up of Abnormal Spermatogenesis after Exposure to Solvent Containing 2-Bromopropane / 대한남성과학회지

PURPOSE: Solvent containing 2-bromopropane has been widely used as a detergent in the electronic industries. The long-term toxic effects of this chemical on spermatogenesis were investigated. MATERIALS AND METHODS: All eight employees (mean age 33 years) who were exposed to the solvent underwent semen analysis, hormonal tests, and testicular biopsies 2 to 3 months after cessation of the exposure. The patients' semen quality had been followed at regular intervals for 1 year as long as the results remained abnormal. We monitored the long-term outcome of 3 patients whose semen remained abnormal during 1 year of follow-up. RESULTS: All patients had decreased sperm counts, with azoospermia being found in one patient. Six patients showed abnormal histologic findings such as atrophy of the seminiferous tubules, thickening of the basement membrane, and hyperplasia of Leydig cells. Of 8 patients, 5 (mean age 37.3 years) showed complete recovery of semen quality during the year after exposure ceased. These patients initially had sperm numbers more than 75 104/mL and a normal serum concentration of FSH. Of 3 patients with abnormal serum FSH and sperm numbers below 3,000/mL, 2 recovered normal sperm numbers at 18th and 24th months after cessation of exposure. Their ages and initial serum FSH concentration were 29 and 26 years and 19.6 and 74.7 mIU/mL, respectively. One patient (37 years old) with relatively normal testicular histology and a serum FSH concentration of 23.7 mIU/mL still had abnormal findings at the last semen analysis, performed 6 years after cessation of exposure. CONCLUSIONS: Solvent containing 2-bromopropane can impair spermatogenesis. This process may be reversed by avoidance of the exposure to this chemical substance. However, an abnormally elevated serum FSH concentration after exposure is an ominous sign for recovery of semen quality.