Non-linear association between testosterone and LDL concentrations in men.

BACKGROUND: Contradictory data have been reported about the association between testosterone levels and the levels of low-density lipoprotein cholesterol (LDL). OBJECTIVES: The aim of this study was to elucidate the association between testosterone and LDL levels. MATERIALS AND METHODS: A cross-sectional study was conducted that included 7268 men who had participated in a health examination. Men who took agents that influence serum lipid profiles within the previous 6 months were excluded. A full metabolic work-up and serum testosterone level checks were performed. The main outcome measures included the testosterone level and testosterone <3.5 ng/ml prevalence of each decile of LDL and their polynomial trendlines and the odds ratio (OR) of testosterone <3.5 ng/ml according to the LDL level. RESULTS: The polynomial trendline suggests the inverse association of testosterone with the deciles of triglycerides, the positive association of testosterone with the deciles of high-density lipoprotein cholesterol and the inverted U-shaped association between testosterone and the deciles of LDL. The polynomial trendline suggests a U-shaped curvilinear relationship between the deciles of LDL and the prevalence of testosterone <3.5 ng/ml. The adjusted ORs of testosterone <3.5 ng/ml in men in the lowest and highest deciles were significantly higher than those of men in the 10th-90th deciles of LDL (OR [95% CI], < 10th LDL: 1.4[1.2-1.8]; 10th - 90th LDL: 1.0 [reference]; >90th LDL: 1.3[1.0-1.6]), which reinforces the U-shaped curvilinear relationship between LDL levels and the prevalence of testosterone <3.5 ng/ml. DISCUSSION AND CONCLUSION: Further research is needed to elucidate the association of very low or very high LDL concentrations with circulating testosterone in men.

Safety and efficacy of tamsulosin 0.4 mg as an initial dose in 1,219 Korean patients with moderate to severe lower urinary tract symptoms: data from a phase IV study.

Background: An initial dose of tamsulosin 0.2 mg is frequently prescribed for Asian men. We investigated the safety and efficacy of tamsulosin 0.4 mg as the initial dose in Korean men with moderate to severe lower urinary tract symptoms (LUTSs) in everyday clinical practice. Materials and methods: A phase IV study was conducted in South Korea. Eligible patients were prescribed tamsulosin 0.4 mg for 6 months. We excluded patients with previous exposure to LUTS drugs and patients with an international prostate symptom score (IPSS) < 8. Results: The mean total IPSS, storage subscore, voiding symptoms subscore, and quality of life significantly decreased from 18.0, 10.8, 7.2, and 3.8 to 12.8, 7.5, 5.3, and 2.6, respectively, after 6 months of treatment. The number of nocturia episodes significantly decreased from 3.0 to 2.2 in patients who reported at least 2 nocturia events at baseline. A mean reduction in the IPSS was quantitatively equivalent in all age groups. The mean reduction in the IPSS was greater in the IPSS ≥ 20 group than in the IPSS < 20 group (mean reduction in the total IPSS: -2.6 in the IPSS < 20 group; -9.4 in the IPSS ≥ 20 group). All treatment-emergent adverse events were mild. The most frequently recorded treatment-emergent adverse event was dizziness, which was reported in 22 patients (1.8%). Conclusion: Treatment of LUTS with tamsulosin 0.4 mg as the initial dose for 6 months in Korean men was effective in improving LUTS and showed a favorable safety profile in a real-life setting.

Testosterone deficiency and the risk of anemia: A propensity score-matched analysis.

OBJECTIVE: There are little data on the endogenous testosterone effect on hemoglobin or hematocrit. Moreover, these data are limited by a cross-sectional study design, a small participant number, and no adjustment for confounding factors. Therefore, the present study was conducted to address the aforementioned limitations of previous studies using a large dataset and propensity score matched analysis. MATERIALS AND METHODS: Men who underwent health check-up were analyzed. Participants were divided into two groups using the cut-off testosterone value of 3.5 or 3.0 ng/ml according to a previous definition of testosterone deficiency. Using the cutoff testosterone value of 3.5 ng/ml, 966 cases (testosterone levels <3.5 ng/ml) and 7402 controls (testosterone level ≥3.5 ng/ml) were included, but following propensity score matching, there were 966 cases and 1932 controls. Using the cutoff testosterone value of 3.0 ng/ml, 444 cases (testosterone levels <3.0 ng/ml) and 7924 controls (testosterone level ≥3.0 ng/ml) were included, but following propensity score matching, there were 444 cases and 888 controls. RESULTS: After matching, the groups were evenly distributed with respect to age, body mass index, estimated glomerular filtration rate, hypertension, and diabetes in both data sets. After matching, the mean Hb and Hct were significantly lower and the incidence of anemia was significantly greater in the case compared to the control in both data sets. The relative risk of anemia in the case was 2.4 compared to the control in both data sets. CONCLUSION: Screening for anemia in patients with testosterone deficiency would be needed and vice versa.

Relationship between erectile dysfunction and moderate to severe prostatitis-like symptoms in middle-aged men: a propensity score-matched analysis.

PURPOSE: We assessed the relationship between chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) and erectile dysfunction (ED) using propensity score matching. METHODS: Data from 8727 middle-aged men who had undergone health checkups were analyzed. The National Institutes of Health Chronic Prostatitis Symptoms Index (NIH-CPSI), the International Index of Erectile Function-5 (IIEF), the Premature Ejaculation Diagnostic Tool (PEDT), testosterone measurement, basic blood chemistry, and metabolic syndrome (MetS) assessment were performed in this study. Of the 8727 men considered, 7181 formed the cohort for propensity score matching, including 597 men with moderate to severe prostatitis-like symptoms (case) and 6584 men with no prostatitis-like symptoms (control); ultimately, however, members of the case and control groups were matched at a 1:1 ratio by propensity score. RESULTS: After matching, the variables of age, testosterone, PEDT and MetS were evenly distributed between the groups. After matching, the mean IIEF score of the case group was significantly lower than that of the control group (17.2 ± 5.5 vs. 14.7 ± 5.3; P < 0.001). Additionally, the severity of ED was significantly greater in the case group (no, mild, mild to moderate, moderate, and severe, respectively: 27.5%, 30.2%, 24.6%, 13.1%, and 4.7% in the control group; 10.7%, 27.0%, 33.0%, 18.9%, and 10.4% in the case group; P < 0.001). Finally, the rate of moderate to severe ED was significantly higher in the case group than in the control group (17.8% vs. 29.3%; P < 0.001). CONCLUSION: Moderate to severe prostatitis-like symptoms were significantly and independently correlated with ED in middle-aged men.

Association of Neutrophil-to-Lymphocyte Ratio, Platelet-to-Lymphocyte Ratio, and Lymphocyte-to-Monocyte Ratio with Benign Prostatic Hyperplasia: A Propensity Score-Matched Analysis.

INTRODUCTION: The neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and lymphocyte-to-monocyte ratio (LMR) have recently been proposed as easily accessible inflammatory biomarkers and as surrogate markers for metabolic disease, cardiovascular disease, and malignancies, including prostate cancer. However, scant studies have investigated the association of NLR, PLR, and LMR with benign prostatic hyperplasia (BPH). METHODS: Data from 8,727 middle-aged men who had participated in a health checkup were analyzed. BPH was defined as prostate volume ≥30 mL, International Prostate Symptom Score > 7, and maximal flow rate <15 mL/s. Propensity score matching was considered for 269 men with BPH (cases), and 7,136 men with no BPH (controls), but ultimately, propensity scores were matched at a 2:1 ratio of controls to cases (538 men in the control group and 269 men in the case group). RESULTS: After propensity score matching, age, International Index of Erectile Function-5, testosterone, and number of metabolic syndrome component variables were evenly distributed and did not differ significantly between the groups. After matching, PLR and LMR were not significantly different between the 2 groups. However, NLR was significantly higher in the case group than in the control group (median [interquartile range]: 1.4 [1.1; 1.8] vs. 1.5 [1.2; 1.9]; p = 0.024) after matching. CONCLUSION: High NLR was significantly associated with the presence of BPH. Our results suggest the possible effect of inflammation on BPH development. A prospective study is needed to investigate the potential role of NLR as a candidate biomarker of BPH.

Relationship Between Chronic Periodontitis and Lower Urinary Tract Symptoms/Benign Prostatic Hyperplasia.

PURPOSE: We investigated the relationship between lower urinary tract symptoms (LUTS)/benign prostatic hyperplasia (BPH) and chronic periodontitis (CP). METHODS: A total of 103 middle-aged men who had received a health checkup were included. All participant data were prospectively collected. CP was defined as a 30% increase in the number of probed sites with a clinical attachment level of ≥4 mm among all probed sites. LUTS/BPH were assessed using transrectal ultrasonography, the International Prostate Symptom Score (IPSS), uroflowmetry, and postvoiding residual urine volume. RESULTS: The median age, IPSS, prostate volume, and maximal flow rate were 55.0 years, 9.0, 29.0 mL, and 20.0 mL/sec, respectively. In addition, the prevalence of CP was 27.2%. The IPSS total, IPSS voiding, IPSS storage, and quality of life (QoL) scores were significantly higher in patients with CP (median [interquartile range, IQR]-IPSS total: 8.0 [5.0-13.5] vs. 12.0 [7.5-20.5], P=0.004; IPSS voiding: 5.0 [2.0-9.0] vs. 8.5 [4.0-15.0], P=0.002; IPSS storage: 3.0 [2.0-5.0] vs. 4.0 [3.0-6.0], P=0.021; QoL: 2.0 [1.0-3.0] vs. 3.0 [2.0-4.0], P=0.015). Additionally, the average flow rate was significantly lower in patients with CP (median [IQR] (mL/sec): 9.0 [8.0-13.0] vs. 8.0 [6.0-11.0], P=0.047). After adjustment for age, testosterone level, prostate volume, glucose level, cholesterol level, and waist circumference, the IPSS total and voiding scores were significantly and positively related to CP (IPSS total: odds ratio [OR], 1.141; 95% confidence interval [CI], 1.045-1.245; P=0.003; IPSS voiding: OR, 1.243; 95% CI, 1.092-1.415; P=0.001). CONCLUSION: Our data suggest that LUTS/BPH is significantly related to CP.

The Relationships between Thyroid Hormone Levels and Lower Urinary Tract Symptoms/Benign Prostatic Hyperplasia.

PURPOSE: We examined the association between thyroid hormone and lower urinary tract symptoms (LUTS)/benign prostatic hyperplasia (BPH). MATERIALS AND METHODS: A total of 5,708 middle aged men were included. LUTS/BPH were assessed using the international prostate symptom score (IPSS), total prostate volume (TPV), maximal flow rate (Qmax), and a full metabolic workup. Thyroid stimulating hormone (TSH) and free thyroxine (FT4) levels were measured using chemiluminescence immunoassay. We divided participants into quartiles based on their TSH and FT4 levels: first to fourth quartile (Q1-Q4). RESULTS: There was a significant increase in the percentage of men with IPSS>7, Qmax<10 mL/s, and TPV≥30 mL with increase of FT4 quartile. The adjusted odds ratio (OR) for TPV≥30 mL and IPSS>7 were significantly different between FT4 quartile groups (ORs; [5-95 percentile interval], p; TPV≥30 mL, Q1: 0.000 [references]; Q2: 1.140 [0.911-1.361], p=0.291; Q3: 1.260 [1.030-1.541], p=0.025; Q4: 1.367 [1.122-1.665], p=0.002; IPSS>7: Q1: 0.000 [references]; Q2: 0.969 [0.836-1.123], p=0.677; Q3: 1.123 [0.965-1.308], p=0.133; Q4: 1.221 [1.049-1.420], p=0.010). In men with above median levels of testosterone, the FT4 correlated positively with TPV, even after adjusting for confounders. However, the FT4 was not correlated with TPV in men with below median levels of testosterone. TSH was not related to LUTS/BPH measurements. CONCLUSIONS: TPV, IPSS, and Qmax were significantly related to FT4. TPV and IPSS were significantly and independently related to FT4. Additionally, the relationship between FT4 and TPV was distinct when testosterone levels are high.

Female urinary incontinence and obesity assessed by anthropometry and dual-energy X-ray absorptiometry: Analysis from the 2008-09 Korean National Health and Nutrition Examination Survey.

OBJECTIVE: In the present study we evaluated the association between obesity, assessed by dual energy X-ray absorptiometry (DEXA), and urinary incontinence (UI). METHODS: The study was performed on 5792 women who had taken part in the Korean National Health and Nutrition Examination Survey. UI was deemed to be present if a woman answered "yes" to the question "Do you have current UI?". Obesity was assessed using anthropometry and DEXA. Data were analyzed using Chi-squared tests, t-tests, receiver operating characteristic curves, and logistic regression analysis. RESULTS: The UI group had significantly higher mean (±SD) waist circumference (78.5 ± 10.0 vs, 82.4±9.1 kg) and body mass index (23.3 ± 3.4 vs. 24.2 ± 3.1 kg/m2 ) than the non-UI group. In addition, total fat mass (18.5 ± 5.3 vs. 19.4 ± 4.9 kg), trunk fat mass (9.3 ± 3.4 vs. 10.1 ± 3.2 kg), the trunk fat/leg fat (mass) ratio (1.58 ± 0.54 vs. 1.73 ± 0.50), total body fat percentage (32.3 ± 5.4% vs. 33.0 ± 5.0%), and trunk fat percentage (32.4 ± 7.3% vs. 33.9 ± 6.6%) were significantly higher in the UI group. Of these parameters, the trunk fat/leg fat ratio showed highest sensitivity (83.6%), with a cut-off value of 1.272. Before and after adjustment, trunk fat/leg fat ratio >1.272 was significantly related to UI and had the highest odds ratio (OR) among all DEXA parameters (adjusted OR 1.807; 95% confidence interval 1.343-2.431). CONCLUSION: Obesity parameters obtained using DEXA are closely related to UI. Of these parameters, the trunk fat/leg fat ratio is the strongest in predicting the presence of UI. In addition, the present study has found a novel trunk fat/leg fat ratio cut-off value for defining obesity related to the UI.

Obesity in Korean Men: Results from the Fourth through Sixth Korean National Health and Nutrition Examination Surveys (2007~2014).

PURPOSE: Obesity is related to many diseases, including urological conditions. We investigated the prevalence, risk factors, and treatment of male obesity. MATERIALS AND METHODS: This study included 17,485 men older than 20 years of age who participated in the fourth, fifth, and sixth administrations of the Korean National Health and Nutrition Examination Survey. Two main cutoff points for obesity were defined: a body mass index (BMI) ≥25 kg/m(2) and a BMI≥30 kg/m(2). Additionally, we defined obesity requiring pharmacotherapy as the presence of a BMI≥30 kg/m(2) or a BMI≥27 kg/m(2) co-occurring with at least one associated comorbid medical condition, such as hypertension, dyslipidemia, or diabetes. RESULTS: The prevalence rates of a BMI≥25 kg/m(2), a BMI≥30 kg/m(2), and obesity requiring pharmacotherapy were 35.7%, 3.4%, and 10.5%, respectively. The prevalence of obesity increased over time for all definitions of obesity. The prevalence of obesity requiring pharmacotherapy was highest in Jeju (12.5%) and lowest in Gangwon-do (7.7%). Having a higher income, being a non-manual worker, and having completed a high level of education were significantly related to obesity requiring pharmacotherapy. More than 70% of patients with obesity requiring pharmacotherapy reported taking diet pills, eating functional foods, or consuming a one-food diet for weight reduction, but only 13.9% reported exercising for this purpose. CONCLUSIONS: Male obesity is a common condition, the prevalence of which is expected to continue to increase over time. A better strategy is required to manage male obesity in Korea.

Incidence of Nitrituria and Its Association With Metabolic Syndrome: Results From the Korean National Health and Nutrition Examination Survey V (2010-2012).

PURPOSE: To investigate the incidence of nitrituria and the relationship between nitrituria and metabolic syndrome (MetS). METHODS: Data from the Korean National Health and Nutrition Examination Survey V were used. A total of 19,083 participants were included. The chi-square test, the Mantel-Haenszel extension, logistic regression analysis, and multiple linear regression were used to analyze the data. RESULTS: A total of 2.0% of the participants had nitrituria. The incidence of nitrituria significantly increased with age (P trend<0.001). In addition, nitrituria in women began to significantly increase in the fifth decade, more than in men, and this difference was maintained in the 60s, 70s, and greater than 70s age groups (P<0.001). After adjusting for confounders, the odds ratio (OR) for nitrituria in the MetS group was significantly increased, as compared to the OR for nitrituria in the group without MetS (MetS: OR, 1.577; 95% confidence interval [CI], 1.134-2.192; P=0.007). The glycosylated hemoglobin of the nitrite positive group was significantly higher than the negative group (adjusted mean ±standard error: 6.108 ±0.081 vs. 5.883±0.065, P<0.001). CONCLUSIONS: An effective health policy for urinary tract infection (UTI) is needed for older age groups and women. Screening or management guidelines for UTI are needed in MetS patients.

Correlation between the visual prostate symptom score and international prostate symptom score in patients with lower urinary tract symptoms.

PURPOSE: To evaluate the correlation between the Visual Prostate Symptom Score (VPSS) and International Prostate Symptom Score (IPSS). METHODS: We enrolled 240 new male patients who had visited National Police Hospital more than twice during a 6-month period starting from July 2013. At initial visit, the Korean version of the IPSS and VPSS, uroflowmetry, and transrectal ultrasonography were used to evaluate urinary symptoms. After medication, IPSS and VPSS questionnaires were issued again. The Spearman correlation test and the Mantel-Haenszel test were used to evaluate the relationship between the IPSS and VPSS. RESULTS: The median age, total prostate volume, total IPSS, and total VPSS were 59.0 years, 28.0 mL, 12, and 9, respectively. Total VPSS, VPSS obstructive symptoms, VPSS irritative symptoms, and VPSS quality of life (QoL) significantly correlated with the total IPSS, IPSS obstructive symptoms, IPSS irritative symptoms, and IPSS QoL, respectively (correlation coefficient, P-value: 0.632, <0.001; 0.431, <0.001; 0.696, <0.001; and 0.799, <0.001; respectively). The change in the total IPSS after treatment also significantly correlated with the change in total VPSS after treatment (correlation coefficient, P-value: 0.364, <0.001). There were significant correlations between maximal flow rate and IPSS/VPSS obstructive symptoms (correlation coefficient, P-value: -0.190, 0.004; -0.269, <0.001, respectively). Additionally, there was a significant increase in the ratio of the maximal flow rate <15 mL/sec to VPSS obstructive symptoms as the severity of the VPSS obstructive symptoms increased (P trend <0.001). CONCLUSIONS: VPSS might be useful in evaluating lower urinary tract symptoms at the initial visit and assessing these symptoms at longitudinal follow-up examinations.

Relationship between benign prostatic hyperplasia/lower urinary tract symptoms and total serum testosterone level in healthy middle-aged eugonadal men.

INTRODUCTION: Scant data are available concerning the relationship between lower urinary tract symptoms (LUTS)/benign prostatic hyperplasia (BPH) and total serum testosterone level (TT) in eugonadal state. AIM: We performed this study to evaluate the relationship between LUTS/BPH and TT in eugonadal men. METHODS: A cross-sectional study was conducted that included a total of 2,308 eugonadal (TT ≥ 3.0 ng/mL) male police officers aged 40-59 years who had participated in a health examination. LUTS/BPH were assessed by prostate-specific antigen level, international prostate symptom score (IPSS), total prostate volume (TPV), maximal flow rate (Qmax), postvoid residual urine volume (PVR), and a full metabolic workup. We then investigated their relationship using the Spearman correlation test, multiple linear regression, and logistic regression analyses. MAIN OUTCOME MEASURES: Associations of TT with IPSS, Qmax, and PVR. RESULTS: The median age and TT level were 49.0 years and 5.37 ng/mL, respectively. The TT level showed significant positive correlations with Qmax (r = 0.043, P = 0.048) and a significant negative correlation with PVR (r = -0.050, P = 0.022). No significant correlation was found between TT and TPV or IPSS. However, Qmax and PVR as well as TPV and IPSS did not significantly correlate with TT after adjusting for age and/or metabolic syndrome. On logistic regression, no significant difference was found in surrogate measures of LUTS/BPH (TPV > 30 mL, IPSS > 7, Qmax < 15 mL/second, and PVR > 50 mL) between the highest quartile TT group (median: 7.07 ng/mL) and the lowest quartile group (median: 3.92 ng/mL). CONCLUSION: In our study, TT was not clearly correlated with LUTS/BPH in middle-aged eugonadal men.

Association of lower urinary tract symptom/benign prostatic hyperplasia measures with international index of erectile function 5 in middle-aged policemen of Korea and the role of metabolic syndrome and testosterone in their relationship.

OBJECTIVE: To evaluate which among the lower urinary tract symptom (LUTS)/benign prostatic hyperplasia (BPH) measures is the most relevant to erectile dysfunction (ED) and elucidate the role of metabolic syndrome (MetS) and testosterone in their relationship. METHODS: A total of 2564 policemen aged 40-59 years who had participated in a health examination were included. LUTS/BPH and ED were evaluated by the international prostate symptoms score (IPSS), transrectal ultrasonography, uroflowmetry, postvoid residual urine volume (PVR), and international index of erectile function questionnaire 5 (IIEF-5). Spearman correlation tests, multiple linear regression tests, and logistic regression analyses were used. RESULTS: The median age was 49.0 years; the median total IPSS and IIEF scores were 9 and 19, respectively. Among the LUTS/BPH measures, IPSS (r = -0.311, P <.001) showed the highest correlation coefficient with IIEF, followed by total prostate volume (r = -0.082, P <.001), PVR (r = -0.080, P <.001), and maximal flow rate (r = 0.049, P = .014). In addition, only IPSS was significantly correlated with the IIEF score after adjusting for age, testosterone, and MetS. The severity of LUTS, as assessed by IPSS, was also significantly correlated with moderate to severe ED (IIEF ≤ 11), after adjusting for age, testosterone, MetS, and other LUTS/BPH measures. On multiple linear regression test, adjustment of Mets changed the P value and beta value of LUTS/BPH measures. However, there were no changes after adjusting testosterone. CONCLUSION: IPSS is the most powerful predictor of ED among the LUTS/BPH measures in middle-aged policemen. In addition, MetS might be a plausible explanation for the relationship between LUTS/BPH and ED.

Relationship of estimated glomerular filtration rate with lower urinary tract symptoms/benign prostatic hyperplasia measures in middle-aged men with moderate to severe lower urinary tract symptoms.

OBJECTIVE: To evaluate the relationship of the glomerular filtration rate (GFR) and lower urinary tract symptoms (LUTS)/benign prostatic hyperplasia measures in middle-aged men. METHODS: A total of 1400 male police officers with moderate and severe LUTS (international prostate symptoms score [IPSS] >7) and aged 40-59 years who had participated in a health examination were included. LUTS/benign prostatic hyperplasia was measured with IPSS, transrectal ultrasonography, uroflowmetry, and postvoid residual urine volume. We estimated the GFR using the Chronic Kidney Disease Epidemiology Collaboration equation. Spearman correlation tests and multiple linear regression tests were used to evaluate the relationship. RESULTS: The median age was 50.0 years, and the median GFR was 85.3 mL/min/1.73 m(2). The GFR showed a significant positive correlation with the maximal flow rate (Qmax; r = .112; P <.001). However, there was no significant correlation of GFR with IPSS (r = -.018; P = .493), total prostate volume (r = -.032; P = .237), and postvoid residual (r = -.066; P = .051). After adjusting for age, body mass index (BMI), and metabolic syndrome, only Qmax showed a positive correlation with GFR (beta = .114; P = .003). CONCLUSION: Qmax demonstrated a significant correlation with GFR in middle-aged men with moderate to severe LUTS in this study. Our data suggest that improved clinical attention is required for patients with LUTS and a low Qmax.

The relationship between lower urinary tract symptoms/benign prostatic hyperplasia and the number of components of metabolic syndrome.

OBJECTIVE: To investigate the relationship between lower urinary tract symptoms (LUTS)/benign prostate hyperplasia (BPH) and a number of components of metabolic syndrome (MetS). METHODS: A total of 1224 male police officers aged 50-59 years who had participated in a health examination were included. LUTS/BPH were assessed by prostate-specific antigen, international prostate symptom score (IPSS), total prostate volume (TPV), maximum urinary flow rate (Qmax), and postvoid residual (PVR) urine volume. Testosterone levels were also examined. MetS was defined using National Cholesterol Education Program-Adult Treatment Panel III guidelines. The subjects were classified into 4 groups according to the number of exhibited MetS components (0, 1-2, 3, and 4-5). We used the Mantel-Haenszel extension test and logistic regression analyses. RESULTS: MetS was diagnosed in 29.0% of the patients. The BPH ratio (IPSS >7, TPV ≥30 mL, and/or Qmax <15 mL/sec), TPV ≥30 mL, and PVR ≥50 mL significantly increased with an increasing number of metabolic abnormalities. The odds ratio (OR) in relation to a TPV ≥30 mL and a PVR ≥50 mL significantly rose as the number of positive MetS components increased after adjusting for age and testosterone. Additionally, the ORs (adjusting for age and testosterone) in relation to BPH also increased as the number of positive MetS components increased, with a suggestive threshold effect associated with 4-5 positive components (BPH: IPSS >7 + TPV ≥30 mL; 4 and 5 components, 3.496, 1.805-6.769, P = .001; BPH: IPSS >7 + TPV ≥30 mL + Qmax <15 mL/sec; 4 and 5 components, 5.458, 1.777-16.764, P = .002). CONCLUSION: According to our results, the cases of LUTS/BPH were positively associated with the number of MetS components.

Preoperative predictors of varicocelectomy success in the treatment of testicular pain.

PURPOSE: We performed the present study to evaluate the prognostic factors for the surgical outcome of varicocelectomy in the treatment of a painful varicocele. MATERIALS AND METHODS: A total of 77 patients undergoing varicocelectomy were enrolled. All the patients were examined for body mass index (BMI), varicocele grade, testosterone, follicle stimulating hormone (FSH), luteinizing hormone (LH), semen analysis, maximal vein diameter, and discrepancy of testicular volume. At a follow-up visit 3~6 months after the surgery, the patient response was graded as a complete response, partial response, or no response. The resolution of pain was defined as a complete or partial response. We used logistic regression analyses to determine the preoperative factors for predicting a complete response and the resolution of pain. RESULTS: Ten subjects were lost to follow-up. The remaining 67 patients were included in this study. The pain was completely resolved in 47.8% of patients, partial resolution was observed in 25.4% of patients, and failure was reported in 26.9% of patients. Among the parameters, only a longer duration of pain (≥3 months) was an independent factor related to the complete response of pain (odds ratio, 7.371; p=0.010) and the resolution of pain (odds ratio, 7.209; p=0.042). The parameters of semen analysis results, testosterone, LH, FSH, BMI, grade, ultrasonography results, and the type of surgical approach did not significantly predict the resolution of pain. CONCLUSIONS: The duration of pain (≥3 months) was an independent prognostic factor for the complete response of pain and the resolution of pain.

Antipsychotic-induced sexual dysfunction and its management.

Sexual dysfunction is a common condition in patients taking antipsychotics, and is the most bothersome symptom and adverse drug effect, resulting in a negative effect on treatment compliance. It is known that hyperprolactinemia is a major cause of sexual dysfunction. Based on the blockade of dopamine D2 receptors, haloperidol, risperidone, and amisulpride are classed as prolactin-elevating antipsychotics, while olanzapine, clozapine, quetiapine, ziprasidone, and aripiprazole are classed as prolactin-sparing drugs. Risperidone and the other typical antipsychotics are associated with a high rate of sexual dysfunction as compared to olanzapine, clozapine, quetiapine, and aripiprazole. With regard to treatment in patients suffering from sexual dysfunction, sildenafil was associated with significantly more erections sufficient for penetration as compared to a placebo. Subsequent studies are needed in order to provide physicians with a better understanding of this problem, thereby leading toward efficacious and safe solutions.

Relationship between Lower Urinary Tract Symptoms/Benign Prostatic Hyperplasia and Metabolic Syndrome in Korean Men.

PURPOSE: To investigate any associations between lower urinary tract symptoms (LUTS)/benign prostate hyperplasia (BPH) and metabolic syndrome (MetS). MATERIALS AND METHODS: In all, 1,224 male police officers in their 50s who had participated in health examinations were included. LUTS/BPH was assessed by serum prostate-specific antigen, International Prostate Symptom Score (IPSS), transrectal ultrasonography, maximum urinary flow rate (Q max), and postvoid residual urine volume (PVR). In addition, testosterone was also examined. The MetS was defined using NCEP-ATP III guidelines. We used the multiple linear regression test and logistic regression analyses to examine the relationships. RESULTS: MetS was diagnosed in 29.0% of participants. There was no significant difference in the percentage of cases of BPH (IPSS >7, Q max <15 ml/sec, and prostate gland volume ≥ 20 ml) (14.2% in the non-MetS group vs. 17.2 in the MetS group; p value=0.178). The total IPSS score and the Q max were not significantly different. The prostate volume and PVR were significantly greater in the subjects with MetS. After adjusting for age and testosterone, the presence of MetS was not associated with BPH (multivariate odds ratio, 1.122; 95% confidence interval, 0.593~2.120). Additionally, MetS was not related to IPSS (Beta, -0.189; p value=0.819), prostate volume (Beta, 0.815; p value=0.285), Q max (Beta, -0.827; p value=0.393), or PVR (Beta, 0.506; p value=0.837). CONCLUSIONS: According to our results, the MetS was not clearly correlated with LUTS/BPH in Korean men in their 50s.