Febrile Urinary Tract Infection after Radical Cystectomy and Ileal Neobladder in Patients with Bladder Cancer

Urinary tract infection (UTI) is one of the most common complications after radical cystectomy and orthotopic neobladder reconstruction. This study investigated the incidence and implicated pathogen of febrile UTI after ileal neobladder reconstruction and identify clinical and urodynamic parameters associated with febrile UTI. From January 2001 to May 2015, 236 patients who underwent radical cystectomy and ileal neobladder were included in this study. Fifty-five episodes of febrile UTI were identified in 46 patients (19.4%). The probability of febrile UTI was 17.6% and 19.8% at 6 months and 24 months after surgery, respectively. While, Escherichia coli was the most common implicated pathogen (22/55, 40.0%), Enterococcus spp. were the most common pathogen during the first month after surgery (18/33, 54.5%). In multivariate logistic regression analysis, ureteral stricture was an independent risk factor associated with febrile UTI (OR 5.93, P = 0.023). However, ureteral stricture accounted for only 6 episodes (10.9%, 6/55) of febrile UTI. Most episodes of febrile UTI occurred within 6 months after surgery. Thus, to identify risk factors associated with febrile UTI in the initial postoperative period, we assessed videourodynamics within 6 months after surgery in 38 patients. On videourodyamic examination, vesicoureteral reflux (VUR) was identified in 16 patients (42.1%). The rate of VUR presence in patients who had febrile UTI was not significantly different from those in patients without febrile UTI (50% vs. 39.3%, P = 0.556). Patients with febrile UTI had significantly larger residual urine volume (212.0 ± 193.7 vs. 90.5 ± 148.2, P = 0.048) than those without. E. coli and Enterococcus spp. are common pathogens and ureteral stricture and residual urine are risk factors for UTI after ileal neobladder reconstruction.

Urologists' Perceptions and Practice Patterns in Peyronie's Disease: A Korean Nationwide Survey Including Patient Satisfaction

PURPOSE: A nationwide survey was conducted of Korean urologists to illustrate physicians' perceptions and real practical patterns regarding Peyronie disease (PD). MATERIALS AND METHODS: A specially designed questionnaire exploring practice characteristics and attitudes regarding PD, as well as patient satisfaction with each treatment modality, was e-mailed to 2,421 randomly selected urologists. RESULTS: Responses were received from 385 practicing urologists (15.9%) with a median time after certification as an urologist of 12 years. Regarding the natural course, 87% of respondents believed that PD is a progressive disease, and 82% replied that spontaneous healing in PD occurred in fewer than 20% of patients. Regarding diagnosis of PD, the methods used were, in order, history taking with physical examination (98%), International Index of Erectile Function questionnaires (40%), intracavernous injection and stimulation (35%), and duplex sonography (28%). Vitamin E was most preferred as an initial medical management (80.2%), followed by phosphodiesterase-5 inhibitors (27.4%) and Potaba (aminobenzoate potassium, 20.1%). For urologists who administered intralesional injection, the injected agent was, in order, corticosteroid (72.2%), verapamil (45.1%), and interferon (3.2%). The most frequently performed surgical procedure was plication (84.1%), followed by excision and graft (42.9%) and penile prosthesis implantation (14.2%). Among the most popular treatments in each modality, the urologists' perceptions regarding the suitability of treatment and patient satisfaction were significantly different, favoring plication surgery. CONCLUSIONS: The practice pattern of urologists depicted in this survey is in line with currently available Western guidelines, which indicates the need for development of further local guidelines based on solid clinical data.

The Clinical Effect of Androgen Replacement Therapy for Female Sexual Dysfunction / 이화의대지

OBJECTIVES: Androgen plays an important role in female sexual function, and its insufficiency causes a clinically significant sexual dysfunction. This study examines the association between sex hormones and the clinical effect of testosterone replacement therapy in female sexual dysfunction. METHODS: This study examined 75 female patients who visited our hospital from March 2002 to June 2008 to treat sexual dysfunction. For the rest of the patients, we performed primary treatment and physiotherapy in accordance with the main cause of their sexual dysfunction. We also performed combination treatment of androgen replacement therapy for the patients who did not make medical progress after two months of primary treatment and for the patients whose free testosterone level is in the bottom group out of three normal range groups. RESULTS: The mean age of target patients was 39.6+/-8.7 years (range, 35~66 years) old. 10 patients out of 75 patients were postmenopausal women, and estrogen replacement therapy had been performed without androgen replacement therapy. We performed a combination treatment of androgen replacement therapy for the patients with sexual desire disorder, and 60% of them answered that they had an increased sexual response after they were given combination treatment of androgen replacement therapy. CONCLUSION: The results support the concepts that sex hormones significantly affect sexual response in women with sexual dysfunction. Clinically, it is effective and safe to perform a combination treatment of androgen replacement therapy in treating sexual dysfunction if medication is administered properly and carefully.

Correlation between Metabolic Syndrome and Lower Urinary Tract Symptoms of Males and Females in the Aspect of Gender-Specific Medicine: A Single Institutional Study

PURPOSE: We attempted to examine the correlation between metabolic syndrome and lower urinary tract symptoms (LUTS) in the aspect of gender-specific medicine. MATERIALS AND METHODS: A total of 922 patients participating in a health examination completed the International Prostate Symptom Score (IPSS) questionnaire and the Overactive Bladder Questionnaire Short Form (OABq-SF) symptom bother scale from March 2008 to July 2009. Metabolic syndrome was defined by using the National Cholesterol Education Program Adult Treatment Panel III criteria announced in 2001. We analyzed differences in lower urinary tract symptoms according to the presence of metabolic syndrome and the component elements of metabolic syndrome. RESULTS: The subjects were 538 males and 384 females with a mean age of 48.8+/-6.8 years. Among all patients, the number of patients with metabolic syndrome was 143 (15.5%); there were 110 males (20.4%) and 33 females (8.6%), showing a significant difference. There were no differences in scores on the IPSS or OABq-SF with respect to the presence or absence of metabolic syndrome in males. In females, however, there were significant differences in the IPSS and OABq-SF depending on the presence or absence of metabolic syndrome. In males and females, the IPSS total score was significantly correlated with age. Also, high-density lipoprotein (HDL) cholesterol in males and triglyceride in females was significantly correlated with the IPSS total score. CONCLUSIONS: There are sex differences in the morbidity rate of metabolic syndrome and its effect on lower urinary tract symptoms. Therefore, it is necessary to consider gender-specific medicine in the diagnosis and treatment of LUTS.

Prospective Factor Analysis of Alpha Blocker Monotherapy Failure in Benign Prostatic Hyperplasia

PURPOSE: We aimed to determine the treatment of choice criteria for benign prostatic hyperplasia (BPH) by analyzing the factors causing alpha-adrenergic receptor blocker (alpha-blocker) monotherapy failure. MATERIALS AND METHODS: This retrospective study enrolled 129 patients with BPH who were prescribed an alpha-blocker. Patients were allocated to a transurethral resection of prostate (TURP) group (after having at least a 6-month duration of medication) and an alpha-blocker group. We compared the differences between the two groups for their initial prostate volume, serum prostate-specific antigen (PSA), maximum urinary flow rate (Qmax), International Prostate Symptom Score (IPSS), and postvoid residual urine volume (PVR). RESULTS: Of the 129 patients, 54 were in the TURP group and 75 were in the alpha-blocker group. Statistically significant differences (p<0.05) between the two groups were found in the prostate volume (50.8 ml vs. 34.4 ml), PSA (6.8 ng/ml vs. 3.6 ng/ml), Qmax (6.84 ml/sec vs. 9.99 ml/sec), and IPSS (27.3 vs. 16.8). According to the multiple regression analysis, the significant factors in alpha-blocker monotherapy failure were the IPSS (p<0.001) and prostate volume (p=0.015). According to the receiver operating characteristic (ROC) curve-based prediction regarding surgical treatment, the best cutoff value for the prostate volume and IPSS were 35.65 ml (sensitivity 0.722, specificity 0.667) and 23.5 (sensitivity 0.852, specificity 0.840), respectively. CONCLUSIONS: At the initial diagnosis of BPH, patients with a larger prostate volume and severe IPSS have a higher risk of alpha-blocker monotherapy failure. In this case, combined therapy with 5-alpha-reductase inhibitor (5-ARI) or surgical treatment may be useful.

Prospective Factor Analysis of Alpha Blocker Monotherapy Failure in Benign Prostatic Hyperplasia

PURPOSE: We aimed to determine the treatment of choice criteria for benign prostatic hyperplasia (BPH) by analyzing the factors causing alpha-adrenergic receptor blocker (alpha-blocker) monotherapy failure. MATERIALS AND METHODS: This retrospective study enrolled 129 patients with BPH who were prescribed an alpha-blocker. Patients were allocated to a transurethral resection of prostate (TURP) group (after having at least a 6-month duration of medication) and an alpha-blocker group. We compared the differences between the two groups for their initial prostate volume, serum prostate-specific antigen (PSA), maximum urinary flow rate (Qmax), International Prostate Symptom Score (IPSS), and postvoid residual urine volume (PVR). RESULTS: Of the 129 patients, 54 were in the TURP group and 75 were in the alpha-blocker group. Statistically significant differences (p<0.05) between the two groups were found in the prostate volume (50.8 ml vs. 34.4 ml), PSA (6.8 ng/ml vs. 3.6 ng/ml), Qmax (6.84 ml/sec vs. 9.99 ml/sec), and IPSS (27.3 vs. 16.8). According to the multiple regression analysis, the significant factors in alpha-blocker monotherapy failure were the IPSS (p<0.001) and prostate volume (p=0.015). According to the receiver operating characteristic (ROC) curve-based prediction regarding surgical treatment, the best cutoff value for the prostate volume and IPSS were 35.65 ml (sensitivity 0.722, specificity 0.667) and 23.5 (sensitivity 0.852, specificity 0.840), respectively. CONCLUSIONS: At the initial diagnosis of BPH, patients with a larger prostate volume and severe IPSS have a higher risk of alpha-blocker monotherapy failure. In this case, combined therapy with 5-alpha-reductase inhibitor (5-ARI) or surgical treatment may be useful.

Viral Etiology and Epidemiology of Outpatients with Acute Respiratory Illnesses in Busan: 2007-2008 / 소아감염

PURPOSE: The purpose of this study is to identify the viral etiology of acute respiratory illnesses and to determine epidemiology in outpatients in Busan, Korea. METHODS: We collected nasal wash samples from 990 patients who visited the hospital for acute respiratory illnesses between January 2007 and December 2008. Extracted DNA or RNA from specimens was used for viral detection by an RT-PCR method. RESULTS: Of a total of 990 samples, viruses were detected in 351 cases (35.5%). The ratio of male to female was 1.6:1 and 93.7% were less than 5 years old. Rhinovirus was detected year-round in 202 cases (57.5%), respiratory syncytial virus from October to March in 57 cases (16.2%), adenovirus year-round in 37 cases (10.5%), influenza virus from December to April in 21 cases (6%), bocavirus from January to August in 15 cases (4.3%), parainfluenza virus from April to July in 9 cases (2.6%), coronavirus from January to July in 7 cases (2%), and enterovirus from June to September in 3 cases (0.9%). CONCLUSION: We identified the etiology and epidemiology of viruses that caused the acute respiratory diseases that were prevalent in Busan, 2007-2008. Further surveillance will be necessary.

Aneurysmal Dilatation of Corpus Cavernosum as an Unusual Complication of Dorsal Penile Neurectomy / 대한남성과학회지

A 43-year-old man presented painless protruding mass on left side of penile shaft only during erection. 1 year ago he had a dorsal penile neurectomy for the treatment of premature ejaculation at local clinic. A protruding cavernousal aneurysm about 2 cm in diameter was developed 6 months after surgery and confirmed on penile duplex ultrasonography after PDE5 inhibitor ingestion with visual sexual stimulation. We have observed the lesion every month and found there was slight enlargement for the last 3 months without any other symptoms. We performed cavernosoplasty under the genereal anesthesia. There was a round cavernosal aneurysm on the left side of penile mid-shaft about 4cm in diameter after artificial erection with intracavernosal saline injection. We prevented cavernosal protrusion by covering the aneurismal surface with bovine pericardium patch (Supple Peri-Guard(R)). There was no side effect for 6 months postoperatively. This is an unusual type of complication of dorsal penile neurectomy.

Hematospermia / 대한남성과학회지

Hematospermia, the presence of blood in the semen is a distressing symptom in sexually active men. However, it is usually a self-limiting condition. Although its exact incidence remains unclear, physicians should evaluate such patients closely and thoroughly because of the possibility of underlying malignancy, particularly prostate cancer. Still, confusion remains about how best to evaluate and treat men with hematospermia. The following paper reviews the literature to explain the cause, diagnostic work-up, and management strategies in patients with hematospermia.

Can the PDE5 Inhibitor Replace Intracavernosal Injection as a Method for Inducing a Penile Erection during the Evaluation of Erectile Dysfunction Using Penile Duplex Ultrasonography? / 대한비뇨기과학회지

PURPOSE: To clarify whether vardenafil can be used as a substitute for intracavernosal injection as a method of induction of penile erection, we compared the outcome of penile duplex Doppler ultrasonography using both methods in the same patient with erectile dysfunction. MATERIALS AND METHODS: A total of 23 patients underwent penile duplex ultrasonography twice with a one week interval between procedures. Twelve were randomly selected for intracavernosal injection first with prostaglandin E1(PGE1) 20microgram and the remaining 11 were initially treated with oral vardenafil 20mg 1 hour before the Doppler study and in addition had visual sexual stimulation using a head-mounted display during the study. The peak systolic velocity(PSV), end diastolic velocity(EDV) and the degree of maximum erectile response were measured and compared between the two groups. RESULTS: Measurements from the PGE1 treatment were not significantly different from those with the vardenafil treatment. The percentage of compatibility between the two methods with regard to hemodynamic diagnosis and pharmaceutical erectile response was as high as 83%(19 of 23) and 91%(21 of 23), respectively. Both methods were tolerable and safe without severe complications. However, in 4 patients where the diagnosis was uncertain, the injection method provided a more accurate interpretation of the penile vascular status with duplex ultrasonography. CONCLUSIONS: These results suggest that oral vardenafil can be used as an initial method for inducing penile erection when assessing erectile dysfunction with penile duplex Doppler ultrasonography in selected patients with erectile dysfunction.

Pharmacological Management of Male Sexual Dysfunction

The erectile dysfunction (ED) and premature ejaculation (PE) are common medical conditions of male sexual dysfunction that affects the sexual lives of millions of men. While many drugs are now available for treating ED and PE, oral pharmacotherapy represents the first-line option for most patients. Phosphodiesterase type-5 (PDE5) inhibitors are currently the most widely prescribed oral agent and have a very satisfactory efficacy-safety profile in all ED patients' categories. Continuous treatments using PDE5 inhibitors and new agents including fast acting PDE5 inhibitors or other intracellular modulators are now under investigation. ED patients who do not respond to oral pharmacotherapy or who cannot use it are good candidates for intracavernosal injection therapy of which efficacy is high but the attrition rate remains significant. Since the pathophysiology of PE is still unclear and there is no approved treatment, it remains to be underdiagnosed and under-treated. The first-line pharmacotherapy for most PE patients is selective serotonin reuptake inhibitors (SSRI) because central 5-hydroxy tryptamine has been implicated as a key mediator of ejaculatory control. Topical anesthetics have also shown varying degrees of efficacy and tolerability. New agents being considered for the on-demand treatment of PE include tramadol and dapoxetine. Therapies for ED or PE will continue to develop as the understanding of those conditions expands. The purpose of this review is to describe the major recent novel advances in the field of medical therapy for the treatment of ED and PE.

Analysis of risk factors associated with male lower urinary tract symptoms in the metabolic syndrome

PUROPOSE: The purpose of this study was to evaluate the relationship between lower urinary tract symptoms (LUTS) and the metabolic syndrome in the elderly male. MATERIAL AND METHODS: The metabolic syndrome group of 348 patients (64.4+/-8.6 years old) and the control group of 150 patients (66.0+/-7.0 years old) were included in the study. The voiding factors, such as International Prostate Symptom Score (IPSS), quality of life score, prostate volume, maximal urine flow rate, residual urine volume, and prostate-specific antigen (PSA) were investigated. Waist circumference, blood pressure, fasting glucose, HDL-cholesterol, triglyceride were measured for the evaluation of the metabolic syndrome. RESULTS: Waist circumference (beta=0.025, p<0.001), systolic (beta=0.004, p<0.05) and diastolic blood pressure (beta=0.006, p<0.05) were positively correlated with prostate volume. In the logistic regression analysis of voiding factors according to metabolic syndrome factors, the patients who have central obesity (Odds ratio [OR]=2.931), central obesity and hypertension (OR=3.598), central obesity and diabetes (OR=2.508), hypertension and low HDL-cholesterolemia (OR=2.326), central obesity, hypertension and diabetes (OR=3.083), central obesity, hypertension and low HDL cholesterolemia (OR=3.440) represented a significantly increased age-adjusted risk of benign prostatic enlargement (25g or more). OR of symptomatic benign prostatic hyperplasia (BPH) was 3.178 in the patients with cental obesity, and 2.381 in the patients with both central obesity and hypertension. CONCLUSIONS: In male elderly, the metabolic syndrome was closely related with LUTS and its main risk factor was central obesity, represented as waist circumference.

Laser Doppler Flowmetry: Usefulness in Female Sexual Dysfunction / 대한남성과학회지

Purpose: Various diagnostic tools have been developed to diagnose and differentiate the causes of female sexual dysfunction. In this study, we used laser Doppler flowmetry to measure the genital blood flow and analyzed its usefulness as a diagnostic tool in patients with sexual dysfunctions. Materials and Methods: We enrolled 50 female patients with sexual difficulties(45.8+/-9.8 years old). Ten sexually healthy women were enrolled as a control group. We measured the superficial blood flow of the clitoral glans, vestibule, and anterior wall of the vagina using laser Doppler flowmetry(Periflux 5000, Permed AB, Sweden), and compared these measurements with blood flow measured in response to sexual stimulation induced by an erotic film. Medical and personal histories, physical examinations, and self-reporting questionnaires were taken from the patients for classifying their sexual problems. Results: The patients complained of problems with desire(46 patients, 92%), arousal(41, 82%), orgasm(49, 98%), pain(10, 20%), and satisfaction(32, 64%). Most patients had more than one problem. In patients with sexual dysfunction, baseline blood flows at all measuring sites were significantly lower than in the control group(p<0.05). After the sexual stimulation, the blood flows of the glans, vestibule, and anterior vaginal wall were significantly increased(p<0.0001). In the groups with desire and arousal problems, blood flow changes were significantly less than in the control group. Conclusions: Laser Doppler flowmetry can provide very useful information on whether patients have hemodynamic-based sexual problems. We can approach the causes of sexual difficulties, particularly sexual desire or arousal problems, using this novel technological instrument.

The Long Term Effect of Extracorporeal Magnetic Innervation Therapy with Pelvic Floor Muscle Exercise for Stress Urinary Incontinence / 대한비뇨기과학회지

PURPOSE: Extracorporeal magnetic innervation (ExMI) therapy has been known to be safe and immediately effective in stress urinary incontinence (SUI). However, no long term follow-up results have been reported. Therefore; herein, are reported our results from a two year follow-up study on ExMI therapy, with pelvic floor muscle exercises, for SUI. MATERIALS AND METHODS: The study group was comprised of 94 patients with SUI. ExMI therapy was performed for 20 minutes (10Hz and 50Hz for each 10 minutes), twice a week, for 6 weeks. Thereafter, 44 of the 94 patients underwent pelvic floor muscle exercises. Objective measures (quality-of-life surveys, pad changes, and leak episodes per day) were evaluated before, immediately after and 24 months after the ExMI therapy. RESULTS: After 6-week of ExMI therapy, the quality-of-life score improved from 5.1+/-0.9 to 1.8+/-1.1. The mean frequency of pad changes was reduced from 2.1+/-1.6 to 1.1+/-1.0. The mean frequency of leak episodes was also reduced from 2.8+/-1.8 to 1.7+/-1.5 times. After 24 months, the 44 patients having also undergone pelvic floor muscle exercise had persistent improvements in their leak episodes per day compared to the 50 patients that had not. CONCLUSIONS: When ExMI therapy was followed by pelvic floor muscle exercises, the favorable effect in leak episodes per day after ExMI therapy may persist for at least 24 months.

Xanthogranulomatous Pyelonephritis in an Infant / 대한비뇨기과학회지

Xanthogranulomatous pyelonephritis (XGP) is an uncommon, severe, chronic infection of the kidney, which results in the normal renal parenchyma being replaced by characteristic lipid-laden macrophages (foam cells). It can occur at any age, but is extremely rare in children. Herein, the case of a 6-month-3-week-old girl with XGP, pre-operatively diagnosed with a Wilms' tumor, is reported. This is the youngest age of any patient with such a condition reported in the Korean literatures. Excretory urography, abdominal sonogram, computed tomogram and magnetic resonance imaging revealed a right renal round mass, without any calcifications. Her pathological findings after a radical nephrectomy revealed XGP.

Evaluation of Complementary and Alternative Medicine for Treating Patients with Erectile Dysfunction / 대한비뇨기과학회지

Purpose: The aim of this study was to evaluate complementary and alternative medicines (CAM) employed for treating patients with erectile dysfunction. Materials and Methods: A total of 204 patients with erectile dysfunction who completed a questionnaire between January and June 2005 were evaluated. The questionnaire was composed of 13 questions. This survey employed a broad definition for CAM, including acupuncture, biofeedback, folk remedies, chiropractic, homeopathy, hypnosis, massage, psychotherapy, relaxation, energy healing, imagery, special diet, spiritual healing and herbal medicine. The CAMs used by the patients with erectile dysfunction were divided into processed health foods, natural health foods and other therapies, and these were all analyzed. Results: The mean age was 57.9+/-10.1 years. 78 of the total patients with erectile dysfunction had employed at least one CAM. CAM users were more likely to be high school educated, nonsmokers and exercisers. The CAMs used were processed health foods 62% (48/78), natural health foods 15% (12/78), and other therapies 66% (52/78). The processed health foods were soy 25%, ginseng 23% and mushroom 19%. Of the natural health foods, tomato was 42%, soy was 25% and ginseng was 17%. Of the other therapies, herbal medicine was 45%, acupuncture was 25%, moxibustion and cupping a boil were 17%. 35% (27/78) of the patients with erectile dysfunction had employed more than one of the processed health foods, natural health foods and other therapies. Conclusions: Patients with erectile dysfunction had mainly employed processed health foods more than the natural health foods, herbal medicine and acupuncture. We think that more research is required about the effects and benefits of CAM in association with ED.

Postoperative Urinary Retention in Postanesthesia Care Unit Detected by Ultrasound Scanner / 대한마취과학회지

BACKGROUND: Postoperative urinary retention is a common postoperative complication. Persistent distention of the bladder may affect the function of the detrusor, resulting in impairment of micturition. This study examined the risk factors and incidence of early postoperative urinary retention and distention in PACU (postanesthesia care unit) using an ultrasound scanner. METHODS: The bladder volume was measured in 228 surgical patients before discharge from the PACU using an ultrasound scanner. The postoperative urinary retention was defined as the inability to void at a bladder volume exceeding 500 ml within 30 min. The potential variables of urinary retention were collected including age, gender, type of surgery and anesthesia, duration of anesthesia, amount of perioperative fluid, post operative patient-controlled analgesia, and anticholinergics. The independent risk factors for postoperative urinary retention were identified by multivariate analysis. RESULTS: The incidence of postoperative urinary retention in the PACU was 14.0%. Risk factors of the early postoperative urinary retention in the PACU detected by the ultrasound scanner were age (50 yr, odds ratio = 3.3), spinal anesthesia (odds ratio = 2.6) and the amount of perioperative fluid (700 ml, odds ratio = 4). CONCLUSIONS: It is recommended that early postoperative urinary retention be evaluated routinely using an ultrasound scanner in the PACU, particularly in older patients and patients given a large amount of perioperative fluid after spinal anesthesia.

The Relationship between Benign Prostate Hyperplasia and Erectile Dysfunction: What is Reality? / 대한남성과학회지

Both erectile dysfunction and lower urinary tract symptoms(LUTS) associated with benign prostatic hyperplasia are highly prevalent among men over age 50 years, and both can detract from overall quality of life. While both of these conditions increase with age, it is not clear if they are related beyond this age association. Many recent comprehensive population-based studies have provided epidemiological evidence of a clear and clinically meaningful association between the two conditions. Several underlying mechanisms responsible for this association have been suggested and studied. With our knowledge of the relationship between LUTS and male erectile dysfunction has come a new insight into the evaluation and management of patients with both conditions. Additional basic research and clinical studies are required to gain a better understanding of their relationship, and an appropriate integrated management approach is warranted for men with LUTS and erectile dysfunction.

The Relationship between Benign Prostate Hyperplasia and Erectile Dysfunction: What is Reality? / 대한남성과학회지

Both erectile dysfunction and lower urinary tract symptoms(LUTS) associated with benign prostatic hyperplasia are highly prevalent among men over age 50 years, and both can detract from overall quality of life. While both of these conditions increase with age, it is not clear if they are related beyond this age association. Many recent comprehensive population-based studies have provided epidemiological evidence of a clear and clinically meaningful association between the two conditions. Several underlying mechanisms responsible for this association have been suggested and studied. With our knowledge of the relationship between LUTS and male erectile dysfunction has come a new insight into the evaluation and management of patients with both conditions. Additional basic research and clinical studies are required to gain a better understanding of their relationship, and an appropriate integrated management approach is warranted for men with LUTS and erectile dysfunction.

Long-term Effect of Visual Laser Ablation of the Prostate: According to Follow-up Period / 대한비뇨기과학회지

PURPOSE: Many techniques have evolved to treat benign prostatic hyperplasia (BPH). These techniques attempt to achieve the clinical benefits of transurethral resection of the prostate, while trying to decrease the morbidity associated with this procedure. Visual laser ablation of the prostate (VLAP) has also been used as an effective treatment modality of BPH. The objective of this paper was to evaluate the long term effect of VLAP for patients with symptomatic BPH. MATERIALS AND METHODS: 85 patients with BPH underwent an initial operation, where a VLAP was performed with a neodymium:YAG laser. 65 patients, 6 months after the operation, and 25, 6 years after the operation, were available for follow-up studies. Voiding outcomes, including peak urinary flow rates, residual urine volumes and American Urological Association (AUA) symptom scores, were measured over time. RESULTS: 6 months after the operation significant improvement was seen in the prostatic size, maximal flow rate and post-void residual volume. However, no significant statistical improvement in these parameters was noticed in the subsequent 6 year follow-up (p>0.05). Comparisons of the mean AUA scores, before the operation, and 6 months (p0.05) after, showed significant differences for the different times. With regard to the quality of life due to the urinary symptoms, 87.7% of patients 6 months, and 72.7% 6 years after the operation felt more than mildly satisfied. CONCLUSIONS: There have been numerous reports on the efficacy of VLAP, which show its many advantages, such as low morbidity, high simplicity and good short-term effect. However, according to this study, the long-term therapeutic effect of VLAP was poor, but its exact role for the treatment of BPH remains to be determined.