The Correlation between Body Mass Index and Routine Parameters in Men Over Fifty

PURPOSE: This study aimed to investigate the relationships between body mass index (BMI) and prostate-specific antigen (PSA) levels, international prostate symptom score (IPSS), quality of life (QoL), and prostate volume (PV). MATERIALS AND METHODS: Height, weight, PSA levels, PV, and IPSS were analyzed in 15,435 patients who underwent a prostate examination between 2001 and 2014. Patients aged <50 years or with a PSA level ≥10 ng/mL were excluded. The relationships between BMI and PSA, IPSS, QoL, and PV were analyzed by a scatter plot, one-way analysis of variance, and the Pearson correlation coefficient. RESULTS: The mean age was 71.95±7.63 years, the mean BMI was 23.59±3.08 kg/m2, the mean PSA level was 1.45±1.45 ng/mL, the mean IPSS was 15.53±8.31, the mean QoL score was 3.48±1.25, and the mean PV was 29.72±14.02 mL. PSA, IPSS, and QoL showed a tendency to decrease with increasing BMI, and there were statistically significant differences for each parameter (p≤0.001). PV showed a significant tendency to increase with BMI (p < 0.001). In the correlation analysis, BMI showed a statistically significant correlation (p < 0.001) with PSA, IPSS, and QoL, although the correlations were very weak. In contrast, BMI showed a significant correlation with PV (p < 0.001), with a meaningful Pearson correlation coefficient of 0.124. CONCLUSIONS: Higher BMI was associated with lower PSA levels and higher IPSS and QoL scores. Meanwhile, PV increased with BMI. Although obese individuals had a greater PV, obesity did not aggravate lower urinary tract symptoms.

Long-Term Safety and Longevity of a Mixture of Polymethyl Methacrylate and Cross-Linked Dextran (Lipen-10(R)) after Penile Augmentation: Extension Study from Six to 18 Months of Follow-Up

PURPOSE: The goal of this study was to investigate the long-term efficacy and safety of a mixture of polymethyl methacrylate (PMMA) and cross-linked dextran Lipen-10(R) used for penile augmentation under the physical impact generated during sexual intercourse. MATERIALS AND METHODS: From March 2010 to October 2011, a total of 20 patients with a mean age of 44 years (interquartile range, 20~70 years) who requested penile augmentation participated in this study. Lipen-10(R) filler is a mixture of 75% cross-linked dextran, 15% PMMA, and 10% hypromellose solution. With the patient in the supine position, Lipen-10(R) was injected into the subcutaneous tissue between the dartos fascia and Buck's fascia of the penis using a fanning technique. Penile length and circumference were measured before the procedure and six, 12, and 18 months after the procedure. Values were compared using the Student's t-test and the paired t-test. RESULTS: A total of 15 patients completed this study. The increases in circumference and length observed six months after the procedure were found to have been maintained without change at 12 and 18 months of follow-up. At 12 and 18 months of follow-up, no abnormal findings were observed. Pelvic magnetic resonance imaging conducted at 18 months of follow-up showed no trace of the injected filler having migrated to other sites, and the volume was well maintained. CONCLUSIONS: Lipen-10(R), a mixture of PMMA and cross-linked dextran, showed good durability and tolerability over 18 months of follow-up during which the participants were sexually active.

Leptin Enhances Nitric Oxide-Dependent Relaxation of the Clitoral Corpus Cavernosum

PURPOSE: The effects of leptin on female sexual behaviors are controversial, and studies on this topic are limited. The objectives of this study were to evaluate the direct effects of leptin on clitoral vasoreactivity in vitro and to determine the mechanism of action. MATERIALS AND METHODS: Isometric tension studies were conducted to determine the effects of pretreatment with leptin (10(-8) M) on the contractile responses of rabbit clitoral corpus cavernosal smooth muscle strips. The effects of leptin were assessed on precontraction induced by phenylephrine (PE; 10(-9)-10(-4) M) and KCl (35-140 mM). We also examined the effect of leptin on relaxation induced by acetylcholine (ACh; 10(-9)-10(-4) M), verapamil (10(-10)-10(-6) M), and sodium nitroprusside (10(-9)-10(-4) M) in PE-precontracted (10(-5) M) strips. RESULTS: Leptin enhanced ACh-induced relaxation in PE-precontracted strips. L-NAME pretreatment significantly reduced the effect of leptin on ACh-induced relaxation, whereas L-arginine potentiated the effect of leptin. Leptin decreased the KCl-induced contractile responses. Leptin increased verapamil-induced relaxation responses. The relaxation effects of leptin on KCl-induced contraction were inhibited by 10(-5) M methylene blue and L-NAME pretreatment. CONCLUSIONS: A high concentration of leptin enhances ACh-dependent relaxation in clitoral cavernosal smooth muscles. These relaxation effects of leptin may occur through an NO-dependent mechanism and voltage-dependent calcium channel blockade.

Changes in Sexual Function in Benign Prostatic Hyperplasia Patients Taking Dutasteride: 1-Year Follow-Up Results

PURPOSE: Sexual adverse events (AEs), a major cause for discontinuing 5alpha-reductase inhibitor (5ARI) therapy for benign prostatic hyperplasia (BPH), are known to occur most frequently early in therapy and appear to decline over time. The aim of this study was to investigate the changes in sexual function occurring with dutasteride treatment during a 1-year follow-up period in Korean men. MATERIALS AND METHODS: Using the International Index of Erectile Function, we prospectively evaluated, after 1, 3, 6, 9, and 12 months of treatment, the changes in sexual function of 55 outpatients (mean age 62.3+/-7.2 years) with BPH (mean volume 48.9+/-16.0 g) who had relatively good erectile function (EF) and were treated with dutasteride for at least 1 year. RESULTS: EF scores showed the most significant decrease at 1 month (p<0.01). Function gradually recovered thereafter but was still significantly decreased after 12 months of treatment (p<0.05). The scores for orgasmic function and sexual desire also showed the most significant reduction at 1 month but were restored to the baseline level at 6 months. No significant correlation was observed between changes in sexual function and prostate-specific antigen level, prostate volume, or International Prostate Symptom Scores. CONCLUSIONS: After 1 month of treatment, dutasteride therapy resulted in a significant reduction in all investigated sexual functions. Overall, recovery in sexual function was noted at 3 months, and orgasmic function and sexual desire were restored to baseline levels at 6 months. However, EF was still significantly reduced at 12 months.

The Effects of 5-alpha Reductase Inhibitor on Contr action of Erectile Tissue and Secretion of Seminal Fluid in Male Rabbits: Preliminary Study / 대한남성과학회지

PURPOSE: Adverse sexual experiences such as erectile dysfunction (ED), loss of libido, and ejaculation disorders have been consistent side effects of 5-alpha reductase inhibitors (5ARI). The aim of this study was to evaluate the effects of 5ARI (finasteride) treatment on semen parameters and contraction of the corpus cavernosum and seminal vesicles in male rabbits. MATERIALS AND METHODS: Adult male New Zealand White rabbits (n=10) were randomized into 2 groups: finasteride-treatment (5ARI) group and vehicle-treatment (control) group. The 5ARI group received daily oral finasteride (10 mg/day) by gavage for 4~6 weeks, and the control group received the same concentration of the vehicle. The semen volume and semen parameters between the 2 groups were compared; thereafter, contraction or relaxation responses of smooth muscle strips of the corpus cavernosum and seminal vesicles were observed in an organ bath. RESULTS: Semen magnesium (14.2 vs 5.1 mg/dl) and protein (2.2 vs 1.6 g/dl) concentrations were significantly lower in the 5ARI group than in the control group. The concentrations of other parameters such as electrolytes (Na/K/Cl), fructose, and citrate did not differ between the 2 groups. The contractile responses to norepinephrine (NE) significantly increased in the 5ARI group compared to the control group and the relaxation responses to acetylcholine (ACh) or sodium nitroprusside (SNP) also increased in the 5ARI group. The contractile responses of the seminal vesicular strips to NE significantly decreased in the 5ARI group compared with the control group. CONCLUSIONS: The results suggest that finasteride may decrease contraction of seminal vesicle tissue and alter semen parameters. The effect of finasteride on erectile tissue was double-faced; enhancing both contraction and relaxation. Further study is needed in this respect.

Men's Lower Urinary Tract Symptoms Are Also Mental and Physical Sufferings for Their Spouses

Lower urinary tract symptoms (LUTS) in men may have an adverse effect on spouse health-related quality of life (HRQL), and these effects are probably influenced by cultural and perceptional differences. This study was conducted to explore the impact of LUTS in Korean men on their spousal HRQL in relation to symptom severities and other demographic parameters. A total of 130 spouses, whose husbands had a nocturia, frequency of greater than once per night, who shared a bed with their husbands, and accompanied husbands at consultation, were subsequently enrolled and asked to complete a structured questionnaire. Almost all spouses (98%) suffered one or more inconveniences that affected HRQL to some degree. Sleep disturbance was rated to be most inconvenient. The sleep disturbances were significantly correlated with nocturia frequency and husband co-morbidity. Husband's LUTS caused partners to feel fatigued (62%), embarrassed (79%), concerned about the possibilities of cancer (69%) and surgery (81%), sexual life deteriorated (58%), and dissatisfied, unhappy, or terrible (36%). Spouse's perception on HRQL was found to be well correlated with husband's quality of life. Men with LUTS need to understand that their LUTS is also mental and physical sufferings for their spouses.

Sexual Attitude and Perception on Erectile Dysfunction Treatment among Patients with Erectile Dysfunction and Patients' Spouses / 대한남성과학회지

It has generally been assumed that erectile dysfunction (ED) is a shared sexual dysfunction that is distressing both for the men with ED and for their partners. Many ED men feel discouraged, disappointed or depressed. An oriental concept that the man has a leading role and full responsibility for sex may cause the impact of ED to be more serious for men than for women A woman's response to ED will vary depending on whether or not she desires to have intercourse with her male partner. If the woman desires intercourse, then she will fine herself frustrated, interpreting he no longer loves her and she will usually be quite hostile and become depressed. However, in case she is no longer interested in having intercourse with him, she may be secretly pleased at his sexual dysfunction and do nothing to alter the situation. Men with ED are reluctant to talk about their sexual problems to their partners mainly because of their pride and their reluctant to go to hospital due to the belief that ED is a natural process of aging or it is an occasional symptom with the hope that the problem will get better on its own, and it is not serious enough to go to the hospital. However, the number of patients seeking medical treatment of ED has increased since the launch of Viagra. ED treatment improves confidence, it brings a sense of emotional stability and vitality of life and marital life, and it improves the family and personal relations both for ED patients and their female partners.

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>

Testosterone Relaxes Rabbit Seminal Vesicle by Calcium Channel Inhibition

Recent studies have documented that testosterone relaxes several smooth muscles by modulating K+channel activities. Smooth muscles of seminal vesicles play a fundamental role in ejaculation, which might involve testosterone. This study was aimed to assess the role of testosterone in seminal vesicular motility by studying its effects on contractile agents and on the ion channels of single vesicular myocytes in a rabbit model. The contractile responses of circular smooth muscle strips of rabbit seminal vesicles to norepinephrine (10 micrometer), a high concentration of KCl (70 mM), and testosterone (10 micrometer were observed. Single vesicular myocytes of rabbit were isolated using proteolytic enzymes including collagenase and papain. Inside-out, attached, and whole-cell configurations were examined using the patch clamp technique. The applications of 10 micrometernorepinephrine or 70 mM KCl induced tonic contractions, and 10 micrometertestosterone (pharmacological concentration) evoked dose-dependent relaxations of these precontracted strips. Various K+channel blockers, such as tetraethylammonium (TEA; 10 mM), iberiotoxin (0.1 micrometer), 4-aminopyridine (4-AP, 10 micrometer, or glibenclamide (10 micrometer rarely affected these relaxations. Single channel data (of inside-out and attached configurations) of BK channel activity were also hardly affected by testosterone (10 micrometer). On the other hand, however, testosterone reduced L-type Ca2+currents significantly, and found to induce acute relaxation of seminal vesicular smooth muscle and this was mediated, at least in part, by Ca2+current inhibition in rabbit.

The Effects of Vasopressin and Desmopressin on the Contractile and Relaxation Responses of Rabbit Cavernosal Smooth Muscle / 대한비뇨기과학회지

PURPOSE: This study aimed to investigate the effects of vasopressin and desmopressin on the contractile and relaxative responses of rabbit cavernosal smooth muscle. MATERIALS AND METHODS: Isometric tension studies were conducted to investigate the effects of vasopressin(10(-14)-10(-8)M) and desmopressin(10(-14)- 10(-8)M) on the contraction and relaxation responses of rabbits cavernous muscle strips in an organ bath. The effects of pretreatment with phenylephrine(10(-5)M), L-NAME(10(-5)M) and indomethacin(10(-5)M) on the contraction and relaxation responses of the vasopressin and desmopressin were also investigated. The statistics were analyzed by Student's t-test and ANOVA. RESULTS: Vasopressin contracted the strips in a dose-dependent manner, while desmopressin did not. The phenylephrine-induced contraction was dose-dependently increased by vasopressin, but it was dose-dependently relaxed by desmopressin. L-NAME pre-treatment did not block the relaxation response, but indomethacin pre-treatment did. Vasopressin- induced contraction occurred the via V(1) receptor, while desmopressin- induced relaxation occurred via the V(2) receptor. CONCLUSIONS: Vasopressin, in pathophysiological circumstances, would worsen erectile dysfunction. On the contrary, desmopressin, which may induce an endothelium-dependent relaxation of the cavernous smooth muscles, would be good for erectile function.

Sexual Attitude and Perceptions of Sexual Relationships and Erectile Dysfunction Treatment among the Wives of Long-Term Users of Sildenafil (Viagra(R)) / 대한남성과학회지

PURPOSE: This study aimed to investigate the sexual attitudes and perception of sexual relationships and erectile dysfunction treatment among the wives of the long-term users of sildenafil (Viagra(R)). MATERIALS AND METHODS: The study was conducted as a market survey with using random face-to-face interviews and a structured questionnaire on a population of 31 wives (mean age; 49.8 years) of long-term sildenafil users who had first taken sildenafil 5 years or more previously and they continued its use in the previous 6 months. RESULTS: All the wives said 'It is desirable to have sex even though I am getting old, if I am healthy' and 84% had sex not for their satisfaction but for husband's satisfaction. Forty five percent perceived that having sex 1~2 times a week was ideal and 35% said having sex once per two weeks was ideal, and this was not different from happened in their real lives. Ninety four percent and 90% perceived that erectile dysfunction and women's sexual dysfunction should be treated, respectively, and 35% took a form of hormonal replacement therapy. The most influencing factors of sildenafil use on the overall satisfaction of wives' sexual and marital life were the increased frequency and intensity of orgasm and they became more intimate with their husbands, followed by the disappearance of depressed or annoying moods (p<0.01). They also felt the improved rigidity of their husband's erection after initial sildenafil use was maintained after more than 5-year use. CONCLUSIONS: Wives of long-term sildenafil users had positive, but husband-oriented sexual attitudes. They had an intercourse-focused perception on their sexual relationship, and they ranked the increased frequency and intensity of their orgasms and becoming more intimate with husbands as the most influential factors for their sexual and marital life, and they also felt that their husbands' erection rigidity was maintained after more than 5-year use of sildenafil.

Correlation of the Serum Testosterone Level with Insulin Resistance and Metabolic Syndrome in Patients of Erectile Dysfunction and Benign Prostatic Hyperplasia / 대한비뇨기과학회지

PURPOSE: Testosterone deficiency has recently captured attention as a possible risk factor for metabolic syndrome. This study was conducted to investigate a correlation of the serum testosterone level with insulin resistance(IR) and metabolic syndrome(MS). MATERIALS AND METHODS: The metabolic risk factors, the blood pressure, the waist circumference and the fasting serum levels of glucose, triglyceride and high density lipoprotein cholesterol were measured for a total of 215 patients(mean age; 61.04+/-0.54 years) with erectile dysfunction(ED) or/and symptomatic benign prostatic hyperplasia(BPH). The serum total testosterone and insulin were measured at the same time, and the free testosterone, bioavailable testosterone and IR were calculated. RESULTS: The prevalence of MS and the number of associated MS risk factors were significantly higher in the insulin resistance group(IRG) than in the insulin sensitive group(ISG). The serum testosterone level significantly decreased with more risk factors. The IRG showed a significantly lower level of serum testosterone than the patients with ED and the total patients. CONCLUSIONS: The negative correlation of a decrease in the serum testosterone level with IR and MS suggests that late onset hypogonadism might be a risk factor of MS.

Developmental Toxicity by Exposure to Bisphenol A Diglycidyl Ether during Gestation and Lactation Period in Sprague-dawley Male Rats / 예방의학회지

OBJECTIVES: Bisphenol A diglycidyl ether (BADGE) is the major component in commercial liquid epoxy resins, which are manufactured by co-reacting bisphenol A with epichlorohydrin. This study was performed to show the developmental effects of prenatal and postnatal exposures to BADGE in male rat offspring. METHODS: Mated female rats were divided into four groups, each containing 12 rats. The dosing solutions were prepared by thoroughly mixing BADGE in corn oil at the 0, 375, 1500 and 3000 mg/kg/day concentrations. Mated females were dosed once daily by oral gavage on gestation day (GD) 6 - 20 and postnatal day (PND) 0 - 21. Pregnant female dams were observed general symptoms and body weight. Also, male pups were observed the general symptoms, body weight, developmental parameters (e.g. anogenital distance, pina detachment, incisor eruption, nipple retention, eye opening, testis descent), organ pathologic changes and hormone levels of plasma. RESULTS: Pregnant rats treated with BADGE died at a rate of about 70% in the 1500 mg/kg/day group and all rats treated with 3000 mg/kg/day died. Body weight, for male pups treated with doses of 375 mg/kg/day, was significantly lower than in the control group at PND 42, 56, and 63 (p<0.05). Evaluation of body characteristics including; separation of auricle, eruption of incisor, separation of eyelid, nipple retention, descent of testis, and separation of the prepuce in the BADGE treated group showed no difference in comparisons with the control group. AGD and adjusted AGD (mm/kg) for general developmental items in BADGE 375 mg/kg/day treated pups tended to be longer than in controls, however, these differences were not statistically significant. Relative weights of adrenal gland, lung (p<0.05), brain, epididymis, prostate, and testis (p<0.01) were heavier than in control in measures at PND 9 weeks. There were no significant changes in comparisons of histological findings of these organs. Loss of spermatids was observed in the seminiferous tubule at PND 9 weeks, but no weight changes were observed. The plasma estrogen levels were similar in the control and treatment groups at PND 3, 6 and 9 weeks. The plasma testosterone levels in the control group tended to increase with age. However, in the BADGE 375 mg/kg/day treated male pups it did not tend to increase. CONCLUSIONS: These findings suggest that BADGE is a chemical that has developmental effects consistent with it being an endocrine disruptor.

Validation of Korean Version of International Prostate Symptom Score: a Comparison of Physician versus Self-administration / 대한남성과학회지

PURPOSE: The International Prostate Symptom Score(IPSS) is the most commonly used scoring system to evaluate lower urinary tract symptoms(LUTS) in patients with benign prostatic hyperplasia(BPH). A Korean translation of the IPSS, however, has never been clearly confirmed to assess LUTS accurately. The objective of this study was to measure differences in the Korean-language IPSS when administered by the patient versus the physician, and to evaluate causes of the differences. MATERIALS AND METHODS: One-hundred-thirteen patients with symptomatic BPH completed 3 consecutive IPSS questionnaires, one self-administered at the first visit, the second self-administered at the next visit, and the last by a physician interview just after the second self-administration. We compared differences in the symptom scores between the each of the 3 administrations. In addition, the effect of age and education on the scores was analysed. RESULTS: There was no significant difference in the IPSS between the first and the second self-administration. However, physician-administered scores were significantly lower than the two self-administrations(p <0.01) for all questions except #5 regarding urinary stream. The difference in the score was higher in patients whose LUTS were more severe(p <0.01). Age and education did not affect the scores. CONCLUSIONS: There was a significant difference in the IPSS between patient and physician administration, suggesting a need for revision of the Korean version of IPSS.

Regaining of morning erection and sexual confidence in patients with erectile dysfunction / 亚洲男科学杂志(英文版)

<p><b>AIM</b>To investigate how erectile dysfunction (ED) medications affect morning erection in patients with ED and how they respond to the return of morning erection.</p><p><b>METHODS</b>This study was conducted in 120 patients who experienced successful intercourse with either tadalafil or sildenafil. Using a random face-to-face interview and a questionnaire (about the quality and number of days getting morning erection after using the two medications), the impact of the medications on the morning erections was investigated, and the participants were asked about their feelings on regaining morning erection.</p><p><b>RESULTS</b>Of the respondents, 81% (68% of those with sildenafil and 99% of those with tadalafil) experienced morning erections after taking an oral ED medication. The men who took tadalafil mainly for 2 days with one dose, while those who took sildenafil experienced morning erections mainly for 1 day. The major sentiment upon regaining a morning erection was, "having more confidence as a man"(74%). Among the 96 respondents who experienced morning erections with tadalafil, 52% preferred tadalafil over sildenafil, not only because of freedom from concerns about a specific time to have relations, but also regaining morning erection.</p><p><b>CONCLUSION</b>Regaining a morning erection affects the recovery of confidence as a man and influences the preference for tadalafil over sildenafil.</p>

A Randomised, Double-Blind, Parallel, Placebo-Controlled Study of the Efficacy and Safety of Tadalafil Administered On-Demand to Men with Erectile Dysfunction in Korea / 대한비뇨기과학회지

PURPOSE: Tadalafil is a phosphodiesterase type 5 inhibitor that is used for the treatment of erectile dysfunction (ED). Previous clinical trials have assessed its efficacy and safety in Western populations, but this drug has not been investigated in a large clinical trial involving Korean men with ED. Thus, the aim of this study was to assess the efficacy and safety of 20 mg tadalafil in comparison to placebo when it is taken on demand by Korean men suffering with ED over a study period of 12 weeks. MATERIALS AND METHODS: Men more than 18 years of age with mild to severe ED of various etiologies were randomized to receive placebo or tadalafil 20 mg that was taken as needed (maximum once daily). Efficacy assessments included the International Index of Erectile Function (IIEF), the Sexual Encounter Profile (SEP) diary and Global Assessment Questions (GAQ). RESULTS: Tadalafil significantly improved erectile function, as measured by the erectile function domain of the IIEF, compared to placebo (p<0.001). At the endpoint, the patients receiving tadalafil 20mg reported a greater mean per-patient percentage of successful intercourse attempts (SEP3: 71% compared to 31% for placebo) and a greater proportion of improved erections (GAQ: 80% compared to 44%). The most common treatment emergent adverse events were headache (16.3%), flushing (5%) and eye pain (5%), and most of the adverse events were mild or moderate in severity. CONCLUSIONS: Tadalafil was an effective, well-tolerated therapy for Korean men suffering with ED of broad-spectrum severity and etiology.

Insulin Resistance and Erectile Dysfunction / 대한비뇨기과학회지

Insulin resistance is a hallmark of metabolic syndrome, including type 2 diabetes mellitus and obesity which are characterized by endothelial dysfunction. The endothelial dysfunction leads to erectile dysfunction (ED). Thus, understanding of insulin resistance is mandatory for urologists to understand a pathophysiology of ED. There are two distinct features of insulin signal transduction pathway. One is phosphatidylinositol 3-kinase-dependent pathway which regulates glucose uptake in skeletal muscle and nitric oxide (NO) production and vasodilation in vascular endothelium. In cavernous smooth muscles, insulin also induces the endothelium-dependent relaxation, however it may emanate from the direct inhibition of L-type Ca2 channels by prostacyclin in addition to NO production. The other one is mitogen-activated protein (MAP)-kinase pathway which regulates growth and mitogenesis and controls secretion of endothelin-1 in vascular endothelium. Stimulation of sympathetic activity by insulin may also contribute to hemodynamic regulation. A shift in balance between vasoconstrictor and vasodilator actions of insulin may be an important factor in the vascular pathophysology of insulin resistance, leading to ED. Hyperglycemia, elevated free fatty acid levels, and proinflammatory states share mechanisms between insulin resistance and endothelial dysfunction. There is evidence to suggest that testosterone is an important regulator of insulin sensitivity in men and hypotestosteronemia may have a role in the pathogenesis of insulin-resistant states.

Drug Interaction Study of Vardenafil 20mg and Doxazosin 4mg or Tamsulosin 0.2mg in Patients with Benign Prostatic Hyperplasia and Erectile Dysfunction to Evaluate Changes in Blood Pressure / 대한비뇨기과학회지

Purpose: This study aimed at evaluating the expected additive blood pressure (BP) lowering effect of vardenafil when administered in the background of chronic alpha1-blocker therapy. Materials and Methods: Patients (n=90) with symptomatic benign prostatic hypertrophy (BPH) and erectile dysfunction (ED) took vardenafil 20mg in the morning following repeated doxazosin gastrointestinal therapeutic system (GITS) 4mg (n=60) or tamsulosin 0.2mg (n=30) HS a day for 30 days. The standing and sitting BP at baseline, before taking the vardenafil and 30 minutes and 1 hour post vardenafil were measured 3 consecutive times. The data were analyzed by Student's t-test (paired), repeated measures of two-way ANOVA, chi-square tests and Pearson correlation analysis. Results: Doxazosin produced a significant reduction in systolic/diastolic BP ( 12.3/ 6.7mmHg), but tamsulosin did not. In the doxazosin group, the average reductions in BP from baseline ( 24.7/ 15.8mmHg) were significantly higher than that for the tamsulosin group ( 14.6/ 7.5mmHg). However, the average BP change was not different in both group ( 12.4/ 9.1mmHg in the doxazosin group and 11.3/ 6.4mmHg in the tamsulosin group) following a single dose of 20mg vardenafil. The higher the BP was at baseline, the more the reduction in BP was in both the doxazosin and tamsulosin groups. Two patients of tamsulosin showed a sitting systolic BP <85mmHg, but they didn't experience dizziness. Conclusions: We recommend starting Vardenafil treatment in the background of chronic aalpha1 blocker therapy, including tamsulosin, with a low dose and to increase the dose by monitoring the BP, particularly for the patients with hypertension.

The Influence of Treatment-emergent Adverse Reactions on Selecting Phosphodiesterase Type 5 Inhibitors / 대한비뇨기과학회지

PURPOSE: This study was conducted to determine how treatment-emergent adverse reactions (ARs) of each of the phosphodiesterase type 5 inhibitors (PDE5Is) influenced the patient when selecting a drug. MATERIALS AND METHODS: For our study, we recruited a total of 123 patients who were suffering with erectile dysfunction and they randomly took 3 different PDE5Is (sildenafil, tadalnafil, and vardenafil), at least 4 times each and then had successful intercourse after using each PDE5I. We investigated the influence of the treatment-emergent ARs on the patients selecting a PDE5I. RESULTS: Sixty eight out of 123 patients (55.3%) showed more than one AR. Five patients (4.1%) did not select any of the PDE5Is due to their treatment-emergent ARs, and 15 patients (12.2%) did not select the PDE5Is due to the severity and/or duration of the AR. Facial flushing was the most common cause of non-selection; this was followed by headache. Fifteen patients (12.2%) selected one specific PDE5I because they experienced a less severe AR with that drug. The severity and duration of the ARs increased in the group of elderly men and the group of men who took larger doses of the drug. CONCLUSIONS: ARs had an important effect on the patients' selection of a PDE5I, although the impact was quite low compared with its overall occurrence rate. The severity and/or duration of the AR were so variable, depending on the patient, that no PDE5I was better than the others in terms of attributing the selection of a PDE5I to its reduced AR.

Perceptions of Erectile Dysfunction Treatment of Patients Visiting a University Hospital in the Era of Multiple Oral Agents / 대한남성과학회지

PURPOSE: To investigate perceptions of erectile dysfunction(ED) treatment of patients visiting a university hospital in the era of multiple oral agents. MATERIALS AND METHODS: Using a questionnaire, this study was conducted on 103 new outpatients(average age 45.5 years) with ED who visited a university hospital between January 2004 and March 2005. RESULTS: The patients with ages in the 50's, 60's and 70's were 33%, 33%, and 6.8%, respectively. Forty percent indicated that they had discussed their ED with their wives. Prior to visiting the general hospital, only 19% of the patents had visited physicians to seek ED treatment, while 29% had taken oriental or folk medicines, and 26% had used exercise to enhance their potency. The remaining 24% had not attempted any management. Among 71 patients who had experience with phosphodiesterase type 5 inhibitors(PDE5I), 30% had obtained them without prescriptions, and 57% were not aware of the fact that proper sexual stimulation is required for effective drug action. The majority of the patients(83%) had felt embarrassment when they had presented their prescriptions to pharmacists. Fifty five percent of wives were not aware! of their husbands took the PDE5I. Among those wives who were aware, 62% felt favorably toward the treatment. CONCLUSIONS: Aging patients with ED are changing their attitude positively toward seeking treatment. However, their understanding of sexual health and ED treatment is still considerably low, suggesting a need for more active and continuous education. A sense of shame for having ED was still high. Thus, changing men's perception that their sexual problems are not shameful but a medical condition to be solved through discussion with their wives and doctors, is needed to lead to a healthy sexual culture.