Is There a Difference in the Incidence of Depression between Radiation and Surgical Treatments in Patients with Prostate Cancer?

PURPOSE: Patients with cancer have a high risk of depression. However, a few studies have assessed differences in the incidence of depression among patients with prostate cancer (PC) based on whether they received radiotherapy (RTx) or surgical treatment. MATERIALS AND METHODS: We analyzed data from the National Health Insurance Sharing Service database regarding the entire Korean adult population with PC (n=210,924) between 2007 and 2017. The adjusted hazard ratios (HRs) of depression associated with treatment were estimated using propensity score-matched Cox proportional hazards models and Kaplan-Meier survival analyses. RESULTS: Our final cohort comprised 9,456 patients with PC; of which, 8,050 men underwent surgery. During a mean follow-up duration of 7.1 years, 503 (5.3%) patients were newly diagnosed with depression. A significant difference in the incidence of depression was noted between the RTx and surgery groups (RTx vs. surgery: 5.55% vs. 5.28%; p=0.011) in the unmatched cohort. In the matched cohort, older age (≥70 years, HR: 1.596, p<0.001) and poor Charlson comorbidity index scores (HR: 1.232, p=0.039) were correlated with the risk of depression. In addition, the adjusted HR for depression in the surgery group was 0.843 (p=0.221) compared with that in the RTx group. Kaplan-Meier analyses revealed that no significant difference in the cumulative probability of persistent depression was detected between the RTx and surgery groups in matched cohort (p=0.3386). CONCLUSIONS: In this nationwide population-based study, no significant differences in the risk of depression were observed between the surgical and RTx groups.

The Degree of Hydronephrosis as an Indicator of the Necessity for Ureteric Dilatation during Ureteroscopic Lithotripsy.

During rigid ureteroscopic lithotripsy, it is often encountered that the ureter is difficult to access. Attempts to advance the ureteroscope make the surgery more difficult. This study evaluated the preoperative predictive factors associated with difficult ureteral access (difficult ureter (DU)) during URS and assessed if clinical outcomes differed according to the degree of DU. This study identified 217 patients who underwent rigid ureteroscopic (URS) lithotripsy for the management of ureter stones between June 2017 and July 2021 in a tertiary hospital in Korea. In this group, preoperative factors were identified using univariate and multiple logistic regression analyses that could predict the degree of DU. Additionally, we also evaluated differences in treatment outcomes depending on the degree of DU. In 50 URS cases (22.0%), ureteral access using a ureteroscope was difficult. In the univariate and multivariate analyses, the degree of hydronephrosis was associated with the degree of DU. Treatment outcomes, extended operation times, low stone-free rate, postoperative pain, and secondary treatment were also significantly associated with the degree of DU. Clinicians can counsel patients with a lesser degree of hydronephrosis and approach their management accordingly.

Combining Transurethral Resection of Fibrous Tissue and Temporary Urethral Stent Insertion Is an Optimal Strategy for Minimally Invasive Treatment of Recurrent and Long Urethral Strictures.

This study investigated the optimal strategy for the treatment of chronic recurrent urethral strictures longer than 3 cm, using a temporary urethral stent. Between September 2011 and June 2021, 36 patients with chronic bulbomembranous urethral strictures underwent temporary urethral stent placement. Retrievable self-expandable polymer-coated bulbar urethral stents (BUSs) were placed in 21 patients (group A), and thermo-expandable nickel-titanium alloy urethral stents were placed in 15 patients (group M). Each group was subdivided into those with and without transurethral resection (TUR) of fibrotic scar tissue. The urethral patency rates at 1 year after stent removal were compared between the groups. The patients in group A showed a higher urethral patency maintenance rate at 1 year after stent removal than those in group M (81.0% vs. 40.0%, log rank test p = 0.012). Analysis of subgroups in which TUR was performed due to severe fibrotic scar, showed that the patients in group A showed a significantly higher patency rate than patients in group M (90.9% vs. 44.4%, log rank test p = 0.028). In the treatment of chronic urethral strictures with a long fibrotic scar, temporary BUS combined with TUR of fibrotic tissue seems to be the optimal minimally invasive treatment strategy.

Quisqualis indica extract for men with lower urinary tract symptoms: A randomized, double-blind, placebo-controlled trial.

PURPOSE: To evaluate the efficacy and safety of Quisqualis indica in men with moderate lower urinary tract symptoms (LUTS). MATERIALS AND METHODS: A total of 135 subjects with International Prostate Symptom Score (IPSS) of 8-19 were randomized in 2 centers from June 2018 to April 2019. Patients were assigned into one of the three groups: a low-dose group (LG, 1,000 mg Q. indica), a high-dose group (HG, 2,000 mg Q. indica) or a placebo group (PG). The primary endpoint was the change of IPSS at the end of treatment from baseline. Secondary end points included the changes of prostate specific antigen, testosterone, dihydrotestosterone, maximum urinary flow rate (Qmax), postvoid residual volume (PVR) and International Index of Erectile Function-5 (IIEF-5), with drug safety. RESULTS: 113 patients were able to finish the study. Compared to the PG, total IPSS in the LG and the HG was significantly improved at 6 weeks and 12 weeks. For IPSS subscores, LG showed improvements in all except for urgency and quality of life at 6 weeks. HG showed improvements in incomplete emptying and frequency at 6 weeks and 12 weeks along with improvements in intermittency, straining, and quality of life at 12 weeks. For IIEF-5 subscores, orgasmic function and overall satisfaction improved in HG when compared to PG at 12 weeks. Lastly, increase of Qmax and decrease of PVR was observed at 6 weeks in LG. CONCLUSIONS: 12-week treatment with Q. indica has a therapeutic effect and is well tolerated in patients with LUTS.

Efficacy and Safety of Maca (Lepidium meyenii) in Patients with Symptoms of Late-Onset Hypogonadism: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial.

PURPOSE: To evaluated the efficacy and safety of gelatinized Maca (Lepidium meyenii) for eugonadal patients with late onset hypogonadism symptoms (LOH). MATERIALS AND METHODS: Participants were instructed to receive 1,000 mg of Maca or placebo, two pills at a time, three times per day for 12 weeks before food intake. To evaluate the efficacy of the drug, Aging Males' Symptoms scale (AMS), Androgen Deficiency in the Aging Males (ADAM), International Prostate Symptom Score (IPSS), and International Index of Erectile Function (IIEF) questionnaires, serologic tests (total testosterone and free testosterone, total cholesterol, high density lipoprotein cholesterol, low density lipoprotein cholesterol, triglyceride), body weight, and waist circumference were assessed at 4 and 12 weeks after treatment. RESULTS: A total of 80 participants were enrolled and randomly assigned to Maca treated group (n=41) or the placebo group (n=39). AMS, IIEF, and IPSS were significantly (p<0.05) improved in Maca treated group than in the placebo group. ADAM positive rate was also significantly (p<0.0001) decreased in Maca treated group. CONCLUSIONS: Maca may be considered an effective and safe treatment for eugonadal patients with late onset hypogonadism symptoms.

What are the risk factors for recurrent UTI with repeated ESBL-producing Enterobacteriaceae? A retrospective cohort study.

INTRODUCTION: A previous study has shown that two-thirds of patients with urinary tract infections (UTIs) caused by extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae experience recurrence with the same bacteria on subsequent UTI episodes. However, little is known about which patients suffer from UTI due to ESBL-producing Enterobacteriaceae repeatedly. This study aimed to investigate the risk factors for recurrent UTI due to repeated ESBL-producing organism infections. METHODS: This retrospective, single-center, observational cohort study screened all patients with UTI caused by ESBL-producing strains between January 2012 and April 2019. Among the patients who were followed up, patients who experienced UTI recurrence were enrolled and divided into two groups: ESBL recurrence group and non-ESBL recurrence group. Multivariable Cox proportional hazards regression analyses were performed to evaluate the association between patient characteristics and the development of recurrent UTI caused by ESBL-producing Enterobacteriaceae. RESULTS: A total of 330 patients were followed up after the diagnosis of UTI caused by ESBL-producing organisms. Among the patients, 115 (34.8%) experienced UTI recurrence, and 71 (61.7%) of them experienced subsequent recurrent UTI due to ESBL-producing organisms. Patient's age (hazard ratio [HR], 1.02; 95% confidence interval [CI], 1.00-1.04; P = 0.046) and recurrent UTI history (HR, 1.69; 95% CI, 1.05-2.72; P = 0.031) were significantly associated with an increased risk of recurrence with ESBL-producing Enterobacteriaceae. CONCLUSION: These findings showed that a history of previous frequent UTI recurrence is the risk factor for recurrence of UTI due to repeated ESBL producing Enterobacteriaceae infections.

Is Prostate Urethral Lift Effective in Patients with Multiple Comorbidities?

A prostatic urethral lift (PUL) can be performed under local anesthesia in patients normally at high risk for general anesthesia due to multiple comorbidities. However, the clinical efficacy of PULs in patients with multiple comorbidities remains unknown. Therefore, in this this study, we aimed to evaluate the clinical efficacy of the PUL in patients with a high number of comorbidities by comparing its clinical efficacy in these patients with that in healthy individuals. We performed a retrospective observational cohort study, in which patients who underwent a PUL between December 2016 and January 2019 at a single tertiary care center were categorized into two groups: healthy individuals who wanted to preserve sexual function (Group 1) and patients with a high number of comorbidities who were at high risk for general anesthesia, based on an American Society of Anesthesiologists (ASA) score of ≥3 (Group 2). The International Prostate Symptom Score (IPSS), maximum urinary flow rate (Qmax), and post-void residual urine (PVR) were obtained preoperatively and compared throughout the 2-year follow-up. A total of 66 patients were enrolled, of whom 36 patients were included in Group 1 and 30 in Group 2. In Group 1, IPSS, IPSS quality of life (QoL), and Qmax significantly improved and were then maintained during follow-up, whereas, in Group 2, improvements in these parameters were not maintained during follow-up, except for IPSS QoL. Eleven patients (36%) in Group 2 required additional treatment for the recurrence of lower urinary tract symptoms. In conclusion, patients with a high number of comorbidities had a low therapeutic effect after PUL, suggesting a high rate of treatment failure. Therefore, comorbidity status should be considered when evaluating the potential benefits of the PUL procedure during preoperative counseling.

Efficacy of Low-Intensity Extracorporeal Shock Wave Therapy for the Treatment of Chronic Pelvic Pain Syndrome IIIb: A Prospective-Randomized, Double-Blind, Placebo-Controlled Study.

PURPOSE: There is no definite treatment method for chronic pelvic pain syndrome (CPPS). The purpose of this study was to compare and assess the effectiveness and safety of low-intensity extracorporeal shockwave therapy (Li-ESWT) versus placebo treatment in CPPS IIIb patients. MATERIALS AND METHODS: Thirty participants with CPPS IIIb were included and randomized in this prospective, double-blind, placebo-controlled study. Li-ESWT was performed at the perineum without anesthesia once per week for 8 weeks. CPPS-related symptoms were evaluated using the National Institutes of Health-chronic prostatitis symptom index (NIH-CPSI). Pain and erectile function were appraised using the Visual Analogue Scale (VAS) and International Index of Erectile Function-Erectile Function (IIEF-EF), respectively. The Global Efficacy Assessment Question (GEAQ) was also assessed. The parameters were evaluated immediately after the last Li-ESWT treatment and 4 weeks after Li-EWST treatment. RESULTS: Fifteen subjects each in the Li-ESWT and placebo groups completed this study. Amelioration of NIH-CPSI total, pain, and quality of life score in the Li-ESWT group was found compared to the placebo group (p=0.002, 0.02, 0.001, respectively). Improvement of the VAS score was observed in the Li-ESWT group (p=0.002). The differences in the GEAQ "Yes" responses were also significant in the Li-ESWT group. No patients experienced side effects related to ESWT during therapeutic period or follow-up duration. CONCLUSIONS: Results indicated that Li-ESWT improved the NIH-CPSI score, pain, and the quality of life in CPPS IIIb patients. Li-ESWT could be an effective alternative treatment modality for CPPS IIIb.

Efficacy and Safety of Penile Girth Enhancement Using Hyaluronic Acid Filler and the Clinical Impact on Ejaculation: A Multi-Center, Patient/Evaluator-Blinded, Randomized Active-Controlled Trial.

PURPOSE: We aimed to evaluate the efficacy and safety of penile girth enhancement (PGE) using hyaluronic acid (HA) filler with different physical properties from previous studies. Additionally, we evaluated the clinical impact on ejaculation after PGE. MATERIALS AND METHODS: This was a prospective, patient/evaluator-blinded, randomized, active-controlled, multicenter trial. Patients recruited between December 2017 and March 2018 were randomly assigned to the HA filler or control group (polylactic acid [PLA] filler). Penile girth, satisfaction level, Premature Ejaculation Profile (PEP), and self-estimated intravaginal ejaculation latency time (IELT) were assessed at baseline and at 24 weeks post-injection. RESULTS: Sixty-four subjects (32 in each group) completed the trial. The mean increase in girth was 22.74±12.60 mm and 20.23±8.73 mm in the HA and control groups, respectively. Satisfaction level regarding penile appearance and sexual life significantly increased in both groups. There was no statistically significant difference between the groups in terms of increase in penile girth or change in satisfaction level. Both groups showed significant improvements in PEP index scores. Self-estimated IELT also significantly increased in the HA group (from 5.36±3.51 to 7.86±4.73 minutes, p=0.0001) and control group (from 5.23±3.55 to 6.43±4.22 minutes, p=0.021). No serious adverse events (AEs) were reported. CONCLUSIONS: PGE with HA and PLA fillers resulted in significant enhancement of girth without serious AEs with no significant differences. Furthermore, PGE using filler improved clinical symptoms related to ejaculation.

Single-dose amikacin plus 7 days of amoxicillin/clavulanate to treat acute cystitis caused by extended-spectrum beta-lactamase-producing Escherichia coli: A retrospective cohort study.

PURPOSE: Treatment options for urinary tract infection (UTI) caused by extended-spectrum beta-lactamase (ESBL)-producing organisms are limited other than carbapenem. Accordingly, clinicians should investigate alternative antimicrobial options for limited infection. This study was performed to assess the efficacy of single-dose amikacin and a 7-day oral regimen of amoxicillin/clavulanate for the treatment of acute cystitis caused by ESBL-producing Escherichia coli and Klebsiella pneumoniae. MATERIALS AND METHODS: A single-dose amikacin and 7-day oral amoxicillin/clavulanate regimen was given to all patients with acute cystitis or recurrent cystitis between May 2016 and October 2018. We conducted a retrospective cohort study assessing the efficacy of this regimen for the treatment of UTI due to ESBL-producing organisms. Both clinical and laboratory efficacy were assessed a minimum of 7 days and a maximum of 14 days after the completion of treatment. RESULTS: A total of 47 patients were enrolled in this study. E. coli and K. pneumoniae were isolated in 44 patients (93.6%) and 3 patients (6.4%), respectively. Of the 47 enrolled, 39 patients (83.0%) showed sterile culture results on follow-up. Thirty-seven patients (78.7%) showed improvement of symptoms. Of 8 patients who showed bacterial persistence, 4 patients showed ESBL-producing E. coli, whereas 4 patients showed non-ESBL E. coli on follow-up cultures. During follow-up, 12 patients experienced the recurrence of acute cystitis with a median recurrence period of 2.5 months. CONCLUSIONS: The combination of amoxicillin/clavulanate and amikacin may be an alternative to carbapenem treatment in patients with acute cystitis caused by ESBL-producing Enterobacteriaceae.

Analysis of Sexual Behaviors among Adults in Korea: Results from the "Korean National Survey on Sexual Consciousness".

PURPOSE: This study aimed to understand the characteristics of sexual behaviors among Korean adults to facilitate the development of strategies and policies focused on sexual health in groups categorized by sociodemographic characteristics. MATERIALS AND METHODS: A nationally representative probability sample of 2,500 individuals (1,273 men and 1,227 women) aged 18-69 years obtained using a stratified multiple-stage sampling method based on Statistics Korea (KOSTAT) participated in a cross-sectional online survey. The survey consisted of structured questionnaires comprising questions on demographic information, lifetime sexual behavior, and sexual behavior in the previous 12 months. RESULTS: The mean age at first sexual intercourse was lower in men than in women (21.9±4.4 vs. 24.1±4.4 years, p=0.001). The overall prevalence rate of sexual events with casual partners within previous 12 months was 13.1% (95% confidence interval [CI], 11.6%-14.5%). It was found to more commonly exist among lower age groups and men. The overall regular condom use rates with relationship partner and casual partner were 14.8% (95% CI, 13.2%-16.4%) and 39.6% (95% CI, 33.9%-45.3%), respectively. Condom use rate with casual partners among 20s and 30s men was 51.2%. Overall, only 10.4% of the respondents had received sexual education about sexually transmitted infections. CONCLUSIONS: This study provided contemporary sexual behaviors in Korean adults, and identified socio-demographic factors that seem to influence sexual behaviors. Low condom use rates and low rate of receiving sexual education were concerns. The result of this study would be useful to health professionals to formulate policies and strategies related to sexual health.

Novel Treatment Strategy for Management of Traumatic Bulbar Urethral Rupture Using Temporary Urethral Stent after Primary Realignment; Retrospective Comparison between Thermo-Expandable Urethral Stent and Self-Expandable Polymer-Coated Urethral Stent.

A variety of retrievable and other types of temporarily placed stents are currently being used. However, only a few studies have considered primary endoscopic realignment with temporary urethral stent insertion in the event of traumatic bulbar urethral injury. We aimed to compare the clinical effectiveness and complications between thermo-expandable urethral stents and polymer-coated bulbar urethral stents (BUSs) for the treatment of traumatic bulbar urethral strictures. Between September 2011 and March 2018, 30 patients who had been diagnosed with complete bulbar urethral rupture following blunt trauma underwent temporary urethral stent placement after primary realignment. Thermo-expandable nickel-titanium alloy urethral stents were placed for 15 patients (group M), and retrievable self-expandable polymer-coated BUSs were placed for another 15 patients (group A). All stents were removed within 6 months after placement. The complications and maintained patency rates were compared between the two groups. The mean stent indwelling period was 5.0 ± 2.5 months in group M and 4.9 ± 4.0 months in group A. Both groups maintained high patency rates (Group M 12/15 (80.0%) and group A 13/15 (86.7%)). Five patients who developed urethral stricture underwent direct visual internal urethrotomy (DVIU), and no patients required repeat DVIU or open surgical urethroplasty. Both groups maintained the mean maximal urinary flow rate (Qmax) at 12 months after stent removal. Discomfort (46.7% vs. 6.7%), granulation tissue formation (73.3% vs. 26.7%) and post-void dribbling (80.0% vs. 20.0%) were more frequent in group M than in group A (p = 0.013, p = 0.011 and p = 0.001, respectively). In conclusion, both stents were effective for managing traumatic complete bulbar urethral rupture after primary realignment. However, the thermo-expandable urethral stents had a higher complication rate while the stent was in situ than the BUSs.

Increased incidence of bladder cancer with metabolically unhealthy status: analysis from the National Health Checkup database in Korea.

We assessed the association between metabolic health status and the incidence of bladder cancer using nationally representative data from the National Health Insurance System and National Health Checkups (NHC) databases in South Korea. Data for 11,781,768 men who participated in the NHC between 2009 and 2012 were analysed. The normal-weight and physically obese categories were defined as body mass indexes (BMI) < 25 and ≥25 kg/m2, respectively. Metabolically obese was defined as the presence of ≥3 components of metabolic syndrome. The participants were stratified into metabolically healthy, normal-weight (MHNW); metabolically obese, normal-weight (MONW); metabolically healthy, obese (MHO); metabolically obese, obese (MOO). Multivariate-adjusted Cox regression analysis was conducted to examine the association between metabolic health status and the incidence of bladder cancer. The study participants included 17,777 men newly registered with bladder cancer. Analysis according to metabolic health status classification revealed a higher multivariable-adjusted hazard ratio in the MOO, MONW group than in the MHO group (1.307 [95% CI: 1.258-1.358], 1.183 [95% CI: 1.137-1.231] and 1.066 [95% CI: 1.017-1.119], respectively; hazard ratios given relative to MHNW group) We found an association between metabolic health status and the incidence of bladder cancer, with an increasing risk according to the number of metabolic health status components.

Diagnostic Performance of the Prostate Cancer Antigen 3 Test in Prostate Cancer: Systematic Review and Meta-analysis.

PURPOSE: To explore the diagnostic accuracy of prostate cancer antigen 3 (PCA3) test for the diagnosis of prostate cancer in this systematic review and meta-analysis. PATIENTS AND METHODS: A systematic literature search of Medline, Embase, and Cochrane Library databases up to October 2019 was performed. The sensitivity, specificity, and diagnostic odds ratio with 95% confidence intervals (CIs) were calculated. The summary receiver operator characteristic graph came from individual studies. We also conducted metaregression analysis to identify the moderated factors. RESULTS: Across 54 studies (17,575 patients), the pooled sensitivity, specificity, and diagnostic odds ratio of PCA3 were 0.71 (95% CI, 0.67-0.74), 0.68 (95% CI, 0.63-0.74), and 5.28 (95% CI, 4.28-6.51), respectively. The area under the summary receiver operator characteristic curve was 0.75 (95% CI, 0.71-0.79). CONCLUSION: Pooled data indicated that the PCA3 test had moderate sensitivity and specificity in the diagnosis of prostate cancer. PCA3 could be used as a noninvasive method for the diagnosis of prostate cancer.

Scrotal septum detachment during penile plication to compensate for loss of penile length compared with conventional surgical technique.

Purpose: To evaluate the efficacy and safety of penile elongation featuring simple scrotal septum detachment from the penile base to compensate for the loss of penile length during penile plication in patients with Peyronie's disease compared with conventional penile plication. Materials and Methods: We conducted a retrospective analysis of 38 patients (24-75 years of age) with Peyronie's disease who underwent penile plication with or without our novel technique from January 2009 to May 2018. Penile elongation was achieved by release and detachment of the scrotal septum from the penile base to the level of the scrotal fat tissue. The objective outcome of change in stretched penile length (SPL) and the subjective outcome of patient perception of postoperative penile length were compared between groups. Any postoperative complications were recorded. Results: Of the 38 patients, 16 underwent penile plication with scrotal septum detachment (elongation group) and 22 underwent penile plication only (conventional group). The postoperative mean SPL was increased in the elongation group and decreased in the conventional group (1.2±1.3 cm vs. -0.5±0.3 cm, p<0.001). Fourteen of 16 patients (87.5%) in the elongation group reported perceived penile lengthening after surgery, whereas 17/22 patients (77.3%) in the conventional group complained of penile shortening. We encountered no procedure-related complications such as hematoma, infection, or necrosis in either group. Conclusions: Simple detachment of the scrotal septum from the penile base afforded both objective and subjective penile elongation without any severe complications compared with conventional penile plication.

Treatment persistence with a fixed-dose combination of tadalafil (5 mg) and tamsulosin (0.4 mg) and reasons for early discontinuation in patients with benign prostatic hyperplasia and erectile dysfunction.

Purpose: The primary aim of this study was to assess treatment persistence with a fixed-dose combination (FDC) of tadalafil (5 mg) and tamsulosin (0.4 mg). This study also evaluated the reasons for early treatment discontinuation. Materials and Methods: This retrospective observational study included patients with benign prostatic hyperplasia and erectile dysfunction who started an FDC treatment of tadalafil (5 mg) and tamsulosin (0.4 mg) between July 2017 and February 2018. Treatment persistence and reasons for early discontinuation were evaluated during the first 6 months. The cumulative discontinuation rate and differences in various parameters were assessed using Kaplan-Meier analysis and the log-rank test, respectively. Factors related to persistence were analyzed using a Cox proportional hazard model. Results: Overall, 97 patients were included in the study. The cumulative persistence rate at 30, 90, and 180 days was 88.7%, 66.0%, and 54.6%, respectively. The cumulative persistence over 6 months differed significantly according to the administration of FDC therapy (log-rank p=0.005) and age (log-rank p=0.024). Younger patients (odds ratio, 2.049; p=0.021) and treatment-naive patients (odds ratio, 2.461; p=0.006) were more likely to discontinue therapy within 6 months. The common reasons for discontinuing therapy were side effects (63.6%) and perceived poor efficacy (22.7%). Conclusions: Side effects were reported to be the main reason for treatment discontinuation. Thus, to improve compliance for a once-daily FDC of tadalafil (5 mg) and tamsulosin (0.4 mg), it is recommended to select patients who show adaptation to a combination of α-blockers and phosphodiesterase type 5 inhibitors prior to FDC treatment.

A Comparison Between Hyaluronic Acid and Polylactic Acid Filler Injections for Temporary Penile Augmentation in Patients with Small Penis Syndrome: A Multicenter, Patient/Evaluator-Blind, Comparative, Randomized Trial.

INTRODUCTION: There are only a few studies on the clinical utility of filler injections for penile augmentation (PA) in patients with small penis syndrome (SPS), which is a type of anxiety or body dysmorphic disorder, not a true micropenis. AIM: To compare the clinical outcomes of hyaluronic acid (HA) with polylactic acid (PLA) filler injection for temporary PA in patients with SPS. METHODS: Our prospective, patient/evaluator-blind, comparative, randomized, non-inferiority trial consisted of a single filler injection and a 24-week post-injection period. Seventy-four men with SPS were included between November 2017 and February 2018. Patients were divided into those injected with HA (n = 39) and those injected with PLA filler (n = 35). MAIN OUTCOME MEASURE: The psychological effects of PA, based on the Beliefs about Penis Size Scale, penile girth, and satisfaction, were assessed at baseline and at 4, 12, and 24 weeks post-injection. RESULTS: At 24 weeks, the mean penile girth increases were 2.1 ± 1.0 cm (P < .001) in the HA group and 1.6 ± 0.9 cm (P < .001) in the PLA group, with a mean difference of 0.5 ± 0.2 cm between groups (P = .031). In both groups, satisfaction levels significantly increased at 24 weeks, with 1.8 ± 1.7 and 1.6 ± 1.4 mean increases in the visual analog scale for penile appearance satisfaction in the HA and PLA groups, respectively (each P < .001), and 1.0 ± 1.1 and 0.7 ± 1.2 mean increases in the visual analog scale for sexual life satisfaction in the HA and PLA groups, respectively (each P < .001), with no significant differences between groups (P = .950 and P = .287). The mean Beliefs about Penis Size Scale scores significantly decreased at 24 weeks, with 7.8 ± 8.3 and 5.3 ± 7.2 mean decreases in the HA and PLA groups, respectively (each P < .001), and no significant difference between the groups (P = .920). There were no serious adverse events, but filler injection-related adverse events in the HA and the PLA groups were reported in 2 cases (5.13%) and 5 cases (14.29%), respectively (P = .245). CLINICAL IMPLICATIONS: Our study provides an overview of clinical course after HA and PLA filler injections for PA and suggests that filler injections can be considered an alternative approach in patients with SPS. STRENGTHS & LIMITATIONS: Our study is the first to assess the psychological symptoms in patients with SPS who received the filler injection for PA; however, the follow-up duration was insufficient to prove the long-term outcomes of fillers. CONCLUSION: Without serious adverse events, HA and PLA filler injections for PA significantly resulted in not only an augmentative effect but also improvement of psychological distress, and the clinical utility was comparable between the fillers. Yang DY, Jeong HC, Ahn ST, et al. A Comparison Between Hyaluronic Acid and Polylactic Acid Filler Injections for Temporary Penile Augmentation in Patients with Small Penis Syndrome: A Multicenter, Patient/Evaluator-Blind, Comparative, Randomized Trial. J Sex Med 2020;17:133-141.

Electromagnetic Low-Intensity Extracorporeal Shock Wave Therapy in Patients with Erectile Dysfunction: A Sham-Controlled, Double-Blind, Randomized Prospective Study.

PURPOSE: The aim of the present study was to evaluate the efficacy and safety of the electromagnetic-type low-intensity extracorporeal shock wave therapy (Li-ESWT) in patients with erectile dysfunction (ED). MATERIALS AND METHODS: The randomized, sham-controlled, double-blind prospective study was performed at two referral hospitals. Participants were randomized in a 1:1 ratio to receive sham or Li-ESWT for 6 weeks. ED was evaluated at screening and at 4 and 7 weeks after treatment. Participants were asked to complete the international index of erectile function-erectile function (IIEF-EF) domain questionnaire, erection hardness scale (EHS), and sexual encounter profile questionnaire (SEPQ 2 and 3). The development of complications was investigated. RESULTS: Eighty-one of 96 patients completed the study. The median change in the IIEF-EF score in the Li-ESWT and sham groups was 5.1 and -2.2 (p<0.001), respectively, at the 7-week follow-up; 47.4% (18/38) patients had EHS <3, of which 77.8% (14/18) showed significant improvement in virtue of Li-ESWT treatment (p=0.001). A significant improvement was observed in the percentage of "Yes" responses to SEPQ 2 and 3 in the Li-ESWT group vs. sham group from baseline to 7-week follow-up (91.3% vs. 69.4%; p=0.008 and 50.0% vs. 14.3%; p=0.002, respectively). No patients reported pain or other adverse events during treatment or follow-up. CONCLUSIONS: Thus, Li-ESWT could have a role in improving erectile function. Furthermore, it is safe. We believe that Li-ESWT is an attractive new treatment modality for patients with ED.

Analysis of Patients with Urolithiasis Visiting the Emergency Department between 2014 and 2016 in Korea: Data from the National Emergency Department Information System.

This study investigated the characteristics of patients with urolithiasis visiting an emergency department based on a national database system in Korea. This study spanned a period of three years from January 1, 2014 to December 31, 2016. A retrospective census was conducted using the National Emergency Department Information System for urolithiasis patients. Patient data, including age, sex, insurance type, emergency department visit date and time, discharge date and time, emergency department treatment result, visit flow, and hospitalization route, were extracted and analyzed. Overall, 103,981, 112,083, and 120,647 patients/year during the 2014-2016 study period visited an emergency department with a diagnosis related to urolithiasis. Total monthly emergency department visits ranged from 35,927 in August (highest) to 24,008 in February. Overall, 13.2% of patients were hospitalized and the hospitalization rate was stable (estimated annual percent change) over the study period. Patients aged <9 years or ≥70 years and those with medical aid had higher hospitalization rates. A higher number of visits occurred in the hot season, on weekends, and in the 6 a.m. and 8 p.m. time slots. This nationwide study revealed that the percentage of patients visiting an emergency department with urolithiasis was higher in August, in the early morning, and at weekends.

Evolution of Guidelines for Testosterone Replacement Therapy.

Testosterone is an essential hormone required for the developmental growth and maintenance of the male phenotype during the whole life. With the increasing male life expectancy worldwide and development of adequate testosterone preparations, the prescription of testosterone has increased tremendously. Testosterone replacement should be based on low serum testosterone and related clinical symptoms. In the last two decades, with the accumulation of data, official recommendations have evolved in terms of definition, diagnosis, treatment, and follow-up. In practice, it is better for physicians to follow the Institutional Official Recommendations or Clinical Practice Guideline for an adequate diagnosis and treatment of testosterone deficiency. Currently, four official recommendations are available for diagnosis and treatment of patients with testosterone deficiency. The inconsistencies in the guidelines merely create confusion among the physicians instead of providing clear information. Furthermore, there is no definite method to assess serum testosterone and clinical symptoms. In the era of active testosterone replacement therapy (TRT), physicians' practice patterns should be consistent with the clinical practice guidelines to avoid the misuse of testosterone. In this review, the author introduces the evolution of clinical guidelines to provide a comprehensive understanding of the differences and controversies with respect to TRT.