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BACKGROUND/AIM The purpose of this study was to examine the expression of estrogen receptor α (ERα) and β (ERβ), androgen receptor (AR), SIRT1, SIRT2 and SIRT3 in prostate cancer (PCa). MATERIALS AND METHODS From October 2010 to January 2015, 70 patients who had undergone radical prostatectomy following a PCa diagnosis were enrolled in our study. Normal prostate tissue (NPT) and prostate cancer tissues (PCAT) were separated, and the expression of each receptor in each tissue was analyzed with immunochemical staining. Univariate and multivariate analyses were performed to identify factors affecting the development of PCa. RESULTS ERβ and AR were highly expressed in PCAT compared with NPT (p

We aimed to evaluate the safety and efficacy of robot-assisted simple prostatectomy (RASP) after prostatic arterial embolization (PAE) in large benign prostatic hyperplasia (BPH).This retrospective study included 11 cases of PAE and subsequent RASP, performed on 11 patients with BPH from March 2018 to September 2020. Clinical information on the patients was collected before surgery and 3 months after surgery. For the quantification of lower urinary tract symptoms (LUTS), International Prostate Symptom Scores (IPSSs), prostate-specific antigen (PSA) levels, urinary peak flow rate (Qmax), voided volume (Vvol), and postvoid residual volume (PVR) were measured.PAE and the subsequent RASP were successfully performed in all 11 patients. The mean total prostate volume was 129.7 ± 65.1 mL, and the transitional zone volume was 71.7 ± 5.9 mL. The mean resected prostate volume was 60.8 ± 26.1 mL. The mean hemoglobin level of the patients prior to PAE was 14.2 ± 2.3 g/dL, and one day after RASP, the hemoglobin level was 12.4 ± 1.9 g/dL. The outcome indicated that there was a considerable decline in IPSS and PVR after RASP was performed compared to before PAE (21.6 ± 9.4 vs. 10.6 ± 8.0 and 159.4 ± 145.8 mL vs. 43.9 ± 45.9 mL). Qmax and Vvol significantly improved after RASP was performed (7.6 ± 5.2 mL/s vs. 26.1 ± 12.6 mL/s; 114.2 ± 92.5 mL vs. 192.4 ± 91.8 mL, respectively).This research demonstrated that RASP could be performed safely and effectively after PAE in patients with large BPH.

Introduction and objective: The purpose of this study was to compare the severity of lower urinary tract symptoms (LUTS) between patients with and without premature ejaculation (PE). Materials and method: The relationship between the severity of LUTS and PE was investigated among 825 male subjects, who underwent medical check-up between July 2013 and July 2018 in our hospital. PE was defined by self-reported intravaginal ejaculation latency time (IELT). The severity of LUTS was determined by international prostate symptom score (IPSS), overactive bladder symptom score (OABSS), transrectal ultrasonography (TRUS), and uroflow rate. A total of 825 subjects were classified into three groups: PE-group (N = 60), Self-reported PE-group (N = 353), and Non-PE group (N = 412). Results: In comparison analysis involving the two groups, the PE-group and the Self-reported PE-group were analyzed to be statistically significantly higher in IPSS items and OABSS items, compared to the Non-PE group (P < 0.05). This showed the same results in the univariate analysis (P < 0.05). Multivariate analysis conducted with the PE-group versus the Non-PE group, and the Self-reported PE-group versus the Non-PE group, revealed significant differences in the values of total IPSS (P < 0.05). Conclusion: Comparison between the PE-group, which included the Self-reported PE-group, and the Non-PE group suggest that the severity of LUTS was comparatively higher in the PE-group. Thus, it is thought that being associated with or without PE may be a significant factor to consider, which affects LUTS severity.

We investigated the correlation between the presence of leucocytes in expressed prostatic secretion and the lower urinary tract symptom severity by retrospectively reviewing 699 men with lower urinary tract symptoms. The patients were evaluated by the International Prostate Symptoms Score and the Overactive Bladder Symptoms Score and underwent expressed prostatic secretion testing. Patients were classified into groups 1 and 2 based on the expressed prostatic secretion leucocyte count. The mean total and storage score of the International Prostate Symptoms Score, and mean total Overactive Bladder Symptoms Score were higher in group 1. Urine flow metrics showed that voided volume and maximum flow rate were lower in group 1. The scores for International Prostate Symptoms Score questions 4, 6 and 7 and Overactive Bladder Symptoms Score question 2 were higher in group 1 and showed a weak positive correlation with expressed prostatic secretion. Voided volume and maximum flow rate showed the strongest correlation, although International Prostate Symptoms Score question 7 and Overactive Bladder Symptoms Score question 2 were the only independent predictors of expressed prostatic secretion. Therefore, leucocytes in expressed prostatic secretion are associated with the lower urinary tract symptom severity, particularly nocturnal urination symptoms.

Purpose: To investigate the association of erectile dysfunction (ED), premature ejaculation (PE), and chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) in men with late-onset hypogonadism (LOH). Materials and Methods: We reviewed the data of 408 enrolled men between January 2014 and January 2019. All participants completed the Androgen Deficiency in the Aging Male (ADAM), international index of erectile function-5 (IIEF-5), National Institutes of Health chronic prostatitis symptom index (NIH-CPSI), and premature ejaculation diagnostic tool (PEDT) questionnaires. Participants were divided by ADAM positive (ADAM+: Group 1) and ADAM negative (ADAM–: Group 2). Results: Total of 289 subjects were in Group 1 and 119 were in Group 2. The mean age was 53.8±7.8 years. The mean total testosterone was 4.8±1.2 ng/dL and showed no differences between the groups (p=0.839). In Groups 1 and 2, ED (IIEF≤21) was identified in 233 (80.6%) versus 37 (31.1%), respectively (p

Introduction: We aimed to evaluate the effect of preoperative urethral dilatation during holmium laser enucleation of the prostate (HoLEP) on the prevention of urethral stricture. Methods: A total of 72 patients without urethral stricture underwent HoLEP for benign prostatic hyperplasia (BPH). Recruited patients were randomly divided into two groups (groups A and B). Patients in group A (36 patients, experimental group) received preoperative urethral dilatation and patients in group B (36 patients, control group) did not. Each patient was evaluated at four weeks, 12 weeks, and 24 weeks after surgery. The effectiveness of preoperative urethral dilatation was evaluated based on the International Prostate Symptom Score (IPSS), peak urine flow rate (Qmax), voided volume, and post-void residual (PVR) volume. To diagnose urethral stricture, Qmax

Purpose: To determine the role of metabolic syndrome (MetS) as a risk factor for acquired premature ejaculation (PE) after considering the various risk factors, such as lower urinary tract symptoms, erectile dysfunction, hypogonadism, and prostatitis. Materials and Methods: From January 2012 to January 2017, records of 1,029 men were analyzed. We performed multivari-ate analysis to identify risk factors for PE, including the covariate of age, marital status, International Prostate Symptom Score, International Index of Erectile Function (IIEF) score, National Institutes of Health-Chronic Prostatitis Symptom Index (NIH-CPSI) score, serum testosterone levels, and all components of MetS. Acquired PE was defined as self-reported intravaginal ejacula-tion latency time ≤3 minutes, and MetS was diagnosed using the modified National Cholesterol Education Program Adult Treatment Panel III criteria. Results: Of 1,029 men, 74 subjects (7.2%) had acquired PE and 111 (10.8%) had MetS. Multivariate analysis showed that the IIEF overall satisfaction score (odds ratio [OR]=0.67, p

Background To analyze clinical outcome of CyberKnife (CK) tumor-tracking stereotactic body radiotherapy (SBRT) for prostate cancer (Pca) according to the magnitude of intra-fractional prostate motion. Methods Medical records and daily treatment logs for 71 patients who received CK tumor-tracking SBRT were retrospectively analyzed. Statistical relationships between prostate motion and various outcome results, including local recurrence (LR), biochemical failure (BF), and treatment-related toxicity, were investigated in order to evaluate motion-dependent efficacy of tumor-tracking SBRT for Pca. Results In a total 71 patients, 3 (4.2%) patients with LR, 12 (16.9%) patients with BF, and 22 (31%) patients with grade-II or worse toxicities to rectal or bladder (22 to rectal, 22 to bladder and 8 patients to both) were observed in a median follow-up of 47 months. Magnitudes of intra-fractional tumor motion along superior-inferior, right-left, and anterior-posterior (AP) axes were 0.15 ± 0.31, 0.12 ± 0.19, and 0.73 ± 0.32 mm, respectively. Radial magnitude was estimated to be 1.0 ± 0.35 mm. Intra-fractional movement was not significantly correlated with tumor control. However, it was significant correlated with the incidence of grade-II or worse toxicity to rectum or bladder particularly when tumor motion was in the AP axis. Conclusion Our quantitative results revealed that toxicity related to SBRT treatment was highly sensitive to intra-fractional prostate movements, although local-tumor control was not affected by such movements. Our results demonstrate that precise motion correction is essential in prostate SBRT, even if it seems to be small., Graphical Abstract

Background and objectiveTo evaluate the relationship between erectile dysfunction (ED) and premature ejaculation (PE) among men aged 40–79 years and to compare age-related differences between men aged 40–59 years and 60–79 years.Materials and methodsFrom January 2014 to January 2019, records of 892 men aged 40–79 years were analyzed. We performed correlation analysis using the self-reported intravaginal ejaculation latency time (IELT), premature ejaculatory diagnostic tool (PEDT), Male Sexual Health Questionnaire-ejaculation (MSHQ-EjD), and International Index of Erectile Function5 (IIEF5) questionnaires.ResultsThe mean age of the 892 males was 52.8 ± 7.3 years (40–76). All subjects were divided into group 1 (40–59 years old) and group 2 (60–79 years old). The IIEF5 score of group 1 was significantly higher than that of group 2 (18.7 ± 5.5 vs. 17.7 ± 5.7, p = 0.049). Of the total subjects, 71 (8%) had IELT value of less than 1 min. A total of 51 (6.9%) and 20 (13.5%) were in groups 1 and 2, respectively (p = 0.02). The PEDT total score was higher and more subjects were identified as suffering from PE (PEDT ≥ 9) from amongst the ED subjects (IIEF-5 ≤ 21). In both groups 1 and 2, more PE subjects were identified in ED subjects (IIEF-5 ≤ 21) than normal subjects (IIEF-5 > 21) (all p < 0.01). In the total subjects, group 1 and 2, the IIEF-5 and PEDT score showed a weak negative correlation (r = −0.302, r = −0.361, r = −0.248, all p < 0.01). In group 2,the IELT and MSHQ-EjD score also showed a weak positive correlation between the IIEF-5 score (r = 0.166, p = 0.044 and r = 0.164, p = 0.047, respectively).ConclusionMore subjects defined PE value as less than 1 min on the self-reported IELT in the elderly group ≥60 years than those among the 40–59 years age group; moreover, the lower the IIEF5 total score among subjects ≥ 60 years, the higher the PEDT score and the lower the IELT and MSHQ-EjD scores.

Background and objective The characteristic symptom of chronic prostatitis (CP) is pain. Patients with CP often complain of lower urinary tract symptoms (LUTS); however, the voiding domain of the Chronic Prostatitis Symptom Index of the National Institutes of Health (NIH-CPSI) is not sufficient to evaluate LUTS. Therefore, we studied the relationship between the International Prostate Symptom Score (IPSS) and NIH-CPSI scores in men. Materials and methods We reviewed 870 men who visited our health care center for a general health check-up and com-pleted IPSS and NIH-CPSI questionnaires between January 2014 and January 2019. An NIH-CPSI pain score ≥4 was defined as the presence of a prostatitis-like symptom (Group 1), and an NIH-CPSI pain score less than

In recent reports, an association between altered TRPC channel function and the development of various diabetic complications has drawn the attention of many investigators. The aim of this study was to investigate the expression of TRPC4 channels of corpus smooth muscle (CSM) cells in diabetes, and to evaluate the association between erectile dysfunction (ED) and altered TRPC4 channel function. The expression of TRPC4 in the penile tissue of human, normal and diabetic rat was investigated using RT-PCR, western blotting and immunohistochemistry (IHC). In vivo gene transfer of dominant negative (DN) TRPC4 into the CSM of rat was conducted. In vivo pelvic nerve stimulation was performed to measure erectile function. Expression of TRPC1, TRPC3, TRPC4 and TRPC6 in human and rat CSM tissues was confirmed by RT-PCR, western blot and IHC. In the diabetic rat, the expression levels of mRNA and protein of the TRPC4, and TRPC6 were significantly increased compared to control rats (p < 0.05). The change in TRPC4 expression in the diabetic rats was higher than those of the other TRPC subunits (p < 0.05). The IHC showed that only TRPC4 expression had a higher intensity in the diabetes compared to normal rats (p < 0.05). Gene transfection with TRPC4(DN) into the diabetic rats restored erectile function to levels similar to that of normal controls. Gene expression of TRPC4(DN) in CSM tissue was confirmed by RT-PCR 2 weeks after transfection. This study demonstrated that TRPC4 channel expression increased in the penile CSM cells of diabetic rats. The down-regulation of TRPC4 with DN form restored erectile function in the diabetic rats. The alteration of TRPC4 channel is one of pathophysiology of ED and could be a target for drug development for ED.

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

Purpose: This study discusses the treatment of premature ejaculation (PE) using various approaches with the goal of evaluating the methods of diagnosis and treatment of PE in clinical practice in 2014 in South Korea. Materials and Methods: We surveyed 200 urologists and andrologists who treated patients with PE from July 1, 2014 to July 29, 2014 using an online questionnaire. The questionnaire was composed of 4 parts: disease, comorbidities, diagnosis, and treatment. Using the answers to this survey, current trends in the diagnosis and treatment of PE were investigated using weighted averages. Results: The median number per month of patients who were diagnosed with PE was 14 patients (interquartile range, 7∼24). The time to ejaculation necessary for a diagnosis of PE was considered to be ＜1 minute by 12% of respondents, ＜2 minutes by 27%, ＜3 minutes by 28%, ＜5 minutes by 13%, and 20% stated that diagnosis was based on a patient’s subjective complaint. The treatment methods preferred by PE patients were reported to be pharmacological treatment (87%), surgical treatment (9.5%), and behavioral management (3.5%). The treatment methods used by respondents were pharmacological treatment (77%), surgical treatment (15%), and behavioral management (14%). The most commonly used pharmacological treatment was the oral administration of dapoxetine (97%). Conclusions: In 2014 in South Korea, various methods were used to diagnose and treat PE. The most commonly used treatment for PE was the oral administration of dapoxetine. It was also found that surgical treatment was applied in some cases.

Premature ejaculation (PE) is the most prevalent male ejaculation disorder. The premature ejaculation diagnostic tool (PEDT) was developed to systematically apply the DSM-IV-TR criteria in diagnostic PE.To evaluate the diagnostic value of the PEDT and its association with intravaginal ejaculatory latency time (IELT).(i) Korean validation of PEDT: data was collected from men interviewed by one of the two clinical experts, who made a diagnostic of present or absence of PE, using DSM-IV-TR criteria. A total of 103 patients with PE and 100 men without PE were enrolled into the study and requested to complete the PEDT; and (ii) The correlation between IELT and PEDT: 200 participants were enrolled and each participant was asked to make out PEDT. All participants were requested to measure IELT.Validity and reliability of the PEDT and its association with IELT.The geometric mean IELT of the PE group was 115.37 ± 78.14 seconds. The number of men reporting IELTs of1, 1 to ≤ 2, and2 minutes were 28 (28.6%), 29 (29.6%), and 41 (41.8%), respectively. The Cronbach's alpha score was calculated as 0.93, showing adequate internal consistency. The test-retest correlation coefficients of each item were higher than 0.72 and the correlation coefficients of the total score was 0.88. (P0.001) Sensitivity and specificity analyses suggested a score of ≤ 8 indicated no PE, 9 and 10 probable PE, and ≥ 11 PE. The PEDT total score and IELT showed an adequate negative correlation. (ρ = -0.77, P0.0001) also, the PEDT total score of the PE subgroup (IELT ≤ 2 minutes) and IELT showed a negative correlation. (ρ = -0.6, P0.0001)The PEDT was highly effective in detecting the presence of PE. The result of our study supports its validity as a diagnostic tool in the clinical setting.

Heavy alcohol consumption is associated with an increased risk of erectile dysfunction (ED); however, the acute effects of ethanol (EtOH) on penile tissue are not fully understood. We sought to investigate the effects of EtOH on corporal tissue tonicity, as well as the intracellular Ca(2+) concentration ([Ca(2+)](i)) and potassium channel activity of corporal smooth muscle. Strips of corpus cavernosum (CC) from rabbits were mounted in organ baths for isometric tension studies. Electrical field stimulation (EFS) was applied to strips precontracted with 10 μmol L(-1) phenylephrine as a control. EtOH was then added to the organ bath and incubated before EFS. The [Ca(2+)](i) levels were monitored by the ratio of fura-2 fluorescence intensities using the fura-2 loading method. Single-channel and whole-cell currents were recorded by the conventional patch-clamp technique in short-term cultured smooth muscle cells from human CC tissue. The corpus cavernosal relaxant response of EFS was decreased in proportion to the concentration of EtOH. EtOH induced a sustained increase in [Ca(2+)](i) in a dose-dependent manner, Extracellular application of EtOH significantly increased whole-cell K(+) currents in a concentration-dependent manner (P < 0.05). EtOH also increased the open probability in cell-attached patches; however, in inside-out patches, the application of EtOH to the intracellular aspect of the patches induced slight inhibition of Ca(2+)-activated potassium channel (KCa) activity. EtOH caused a dose-dependent increase in cavernosal tension by alterations to [Ca(2+)](i). Although EtOH did not affect KCa channels directly, it increased the channel activity by increasing [Ca(2+)](i). The increased corpus cavernosal tone caused by EtOH might be one of the mechanisms of ED after heavy drinking.

Introduction Transient receptor potential (TRP) channels play an important role in modulating intracellular Ca2+ ([Ca2+]i) levels. Aim We examined the hypothesis that overexpression of TRPC6DN (dominant negative) may contribute to decreased [Ca2+]i levels in corporal smooth muscle (CSM). We also investigated whether gene transfer of TRPC6DN could restore erectile function in diabetic rats. Methods For the in vitro study, the KCa, KATP, and TRPC6DN channel genes were transferred using cDNA, into cultured human CSM cells and human embryonic kidney cells. For the in vivo study, young adult rats were divided into three groups: normal controls; diabetic controls transfected with vector only; and a diabetic group transfected with pcDNA of the TRPC6DN gene. Main Outcome Measures After gene transfer, the effects of reducing [Ca2+]i levels were assessed by Fura-2-based imaging analysis. The intracavernosal pressure (ICP) response to cavernosal nerve stimulation was assessed after intracorporal injection of TRPC6DN pcDNA. The transgene expression of the TRPC6DN was examined by reverse transcription polymerase chain reaction (RT-PCR) in rats transfected with TRPC6DN pcDNA. Results Gene transfer of ion channels effectively reduced [Ca2+]i. Among these channels, transfer of the TRPC6DN gene resulted in the greatest reduction of [Ca2+]i in human CSM. The mean (±standard error of the mean) ratio of ICP to mean arterial pressure (BP) in the gene-transfer rats was 79.4 ± 2.4% (N=8). This was significantly higher than that in control rats (55.6 ± 3.7% [N=8]), and similar to that in the young control rats (83 ± 2.2% [N=12]). The RT-PCR showed expression of TRPC6DN genes in the transfected rats. Conclusion Gene transfer of TRPC6DN not only reduced [Ca2+]i in human CSM but also restored erectile function in diabetic rats. These results suggest that pcDNA transfer of TRPC6DN may represent a promising new form of therapy for the treatment of male erectile dysfunction in the future. Jung JH, Kim BJ, Chae MR, Kam SC, Jeon J-H, So I, Chung KH, and Lee SW. Gene transfer of TRPC6DN (dominant negative) restores erectile function in diabetic rats.

Introduction Although many reports have shown a relationship between lower urinary tract symptoms (LUTS) and sexual function (SF), it is not known which symptom(s) among LUTS should be treated to improve SF. Aim Thus, the aim of this study was to investigate correlations between LUTS and SF and to determine which symptom(s) should be improved to increase SF. Main Outcome Measure The correlation between the severity of LUTS and erectile dysfunction (ED) was investigated, and changes in LUTS were compared and analyzed to determine which symptom(s) should be eliminated to improve SF. Methods The correlation between LUTS and SF was investigated in 365 men (62.04 ± 8.26) with benign prostatic hyperplasia. To measure the severity of the LUTS and ED, the International Prostate Symptom Score (IPSS), frequency of nocturia, uroflowmetry, residual urine, transrectal ultrasonography, and the International Index of Erectile Function (IIEF)-5 were performed at the first visit. After 3 months of treatment with α-blockers (n = 304), they were assessed again to evaluate the effectiveness of the treatment. Results All parameters of LUTS (IPSS, age, residual urine, uroflow rate, and nocturia) except prostate volume correlated significantly with the total and each domain of IIEF-5 ( P P P Conclusion Among the LUTS parameters, improvement in the IPSS-VD domain, IPSS-QoL, and mean uroflow significantly correlated with an increased score in the IIEF-5 EF domain. Thus, it is expected that the improvement of voiding symptoms and uroflow will be associated with the improvement in erectile function. Jung JH, Jae SU, Kam SC, and Hyun JS. Correlation between lower urinary tract symptoms (LUTS) and sexual function in benign prostatic hyperplasia: Impact of treatment of LUTS on sexual function. J Sex Med 2009;6:2299–2304.

The aim of the present study was to evaluate the efficacy and toxicity of stereotactic body radiation therapy (SBRT) for low- to intermediate-risk prostate adenocarcinoma. Thirty-nine patients were retrospectively reviewed. The SBRT was delivered using the CyberKnife with the fiducial tracking method combined with In-tempo imaging. The gross target volume, which included the prostate only, was delineated on the fused CT/MRI scans. The prescription dose was delivered every other day as 5 fractions of 7.5 Gy. Venous blood was obtained before and after SBRT to assess the prostate-specific antigen (PSA) level. Toxicity was evaluated using the CTCAE, v4.03. The median follow-up time was 30.0 months. The median initial PSA level was 7.7 ng/mL. PSA levels decreased in all patients treated with SBRT, and after 5 months, the median PSA was less than 2 ng/mL. The rate of overall 3-yr actuarial biochemical failure free survival was 93.9%. Acute side effects were generally comparable with those of previous studies. The PSA change and toxicity after SBRT for low- to intermediate-risk prostate adenocarcinoma indicates favorable biochemical responses and tolerable levels of toxicity. Additionally short course treatment may produce cost benefit and convenience to patients.

The therapeutic effects and side effects of androgen deprivation therapy (ADT), which is a main treatment method for metastatic prostate cancer, are well known, but the metabolic effects have only recently been studied. This review describes the effects of ADT on body habitus, insulin resistance, lipid profiles, diabetes, metabolic syndrome, and cardiovascular morbidity and mortality. The review was done by using KoreaMed and PubMed to search the medical literature related to prostate cancer, ADT, body habitus, lipid profile, diabetes, insulin resistance, metabolic syndrome, and cardiovascular disease. ADT increases fat mass and decreases lean body mass. Fat mostly accumulates in the subcutaneous area. ADT increases total cholesterol, triglycerides, and high-density lipoprotein, as well as the risk for insulin resistance and diabetes. ADT also increases the risk for cardiovascular events, but insufficient evidence is available for a correlation with mortality. ADT changes body habitus and lipid profiles and has different characteristics than those of classic metabolic syndrome, but it is related to insulin resistance and diabetes. ADT increases the risk for cardiovascular events. No consistent guidelines have been proposed for treating the metabolic effects of ADT, but the generally recommended treatment methods for lowering the risk of diabetes and cardiovascular disease should be fully understood. Additional studies are necessary.

the subjects. Then, the study investigates the correlation by performing the correlation analysis among each factor. The cases of being diagnosed either higher 10 PSA or prostate cancer and the prostate operation are excluded. RESULTS: The study analyzes a total of 4,736 males. The average age is 68.4 8.4 years old and the subjects consist of 89 in their 40s, 651 in their 50s, 1699 in their 60s, 1868 in their 70s and 429 in their 80s. The average PSA is 1.47 1.52pmol/ml and the average TURS is 27.9 12.60g. The total average of the IPSS is 15.92 8.55 points and the quality of life is 3.41 1.27. The BMI shows negative correlation with the age, IPSS and quality of life (Pearson: -0.228, -0.077 and -0.40, respectively, p 0.01). The size of the prostate shows significant relation with the IPSS, quality of life, PSA, BMI and age (Pearson: 0.146, 0.138, 0.548 and 0.198, respectively, p

Purpose: We studied the effects of alcohol administration on the corpus cavernosum (CC) using an animal model. Materials and Methods: CC sections and the aortic ring of rabbits were used in an organ bath study. After acute alcohol administration, changes in blood alcohol concentration and electrical stimulation induced intracavernosal pressure/mean arterial pressure (ICP/MAP) percentage were compared in rats. Cyclic adenosine monophosphate (cAMP) and cyclic guanosine monophosphate (cGMP) levels in the CC were measured using immunoassays. After chronic alcohol administration, ICP/MAP percentage, cAMP and cGMP were compared in rats. Histological changes were examined using the Masson trichrome stain and the Sircol collagen assay. Endothelial nitric oxide synthase (eNOS) expression was examined using immunohistochemistry and Western blotting. Results: Alcohol relaxed the CC in a dose-dependent manner, and the relaxation response was suppressed when pretreated with propranolol, indomethacin, glibenclamide, and 4-aminopyridine. In rats with acute alcohol exposure, the cAMP level in the CC was significantly greater than was observed in the control group (p＜0.05). In rats with chronic alcohol exposure, however, changes in cAMP and cGMP levels were insignificant, and the CC showed markedly smaller areas of smooth muscle, greater amounts of dense collagen (p＜0.05). Immunohistochemical analysis of eNOS showed a less intense response, and western blotting showed that eNOS expression was significantly lower in this group (p＜0.05). Conclusions: Acute alcohol administration activated the cAMP pathway with positive effects on erectile function. In contrast, chronic alcohol administration changed the ultrastructures of the CC and suppressed eNOS expression, thereby leading to erectile dysfunction.

Introduction Herbal preparations have long been used as folk remedies for erectile dysfunction (ED). Aim This study examined the effects of Tribulus terrestris and Cornus officinalis extracts on relaxation of the smooth muscle of the corpus cavernosum (CC), their mechanisms of action, and the effects of oral administration of a mixture of the herbal extracts on penile erection. Methods The relaxation effects and the mechanisms of action of T. terrestris extract, C. officinalis extract, and the mixture of both extracts on the rabbit CC were investigated in an organ bath. To evaluate whether the relaxation response of the CC shown in an organ bath occurs in vivo, intracavernous pressure (ICP) was calculated in rats after oral administration for a month. Additionally, adenosine 3′,5′‐cyclic monophosphate (cAMP) and guanosine 3′, 5′‐cyclic monophosphate (cGMP) in the CC were measured using immunoassay. Main Outcome Measures Smooth muscle relaxation was expressed as the percent decrease in precontraction induced by phenylephrine. ICP was assessed in rats after the oral administration of a mixture of both extracts for 1 month and changes in cGMP and cAMP concentrations were measured based on the concentration of the mixture of both extracts. Results T. terrestris extract, C. officinalis extract, and the mixture of both extracts showed concentration‐dependent relaxation effects of the CC. In both the endothelium‐removed group and N(G)‐nitro‐L‐arginine methyl ester pretreatment group, T. terrestris extract inhibited relaxation. ICP measured after oral administration of the extract mixture for a month was higher than that measured in the control group, and a significant increase in cAMP was observed in the mixture group. Conclusions T. terrestris extract and C. officinalis extract exhibited concentration‐dependent relaxation in an organ bath. In the in vivo study of the extract mixture, ICP and cAMP was significantly potentiated. Accordingly, the mixture of T. terrestris extract and C. officinalis extract may improve erectile function. Kam SC, Do JM, Choi JH, Jeon BT, Roh GS, and Hyun JS. In vivo and in vitro animal investigation of the effect of a mixture of herbal extracts from Tribulus terrestris and Cornus officinalis on penile erection. J Sex Med **;**:**–**.

INTRODUCTION AND OBJECTIVES: The aims of urinary undiversion is to create a reservoir which allows adequate capacity, low pressure storage and achieve continence. We report out longterm outcomes with this procedure. METHODS: Urinary undiversion was performed on 26 patients (15 males, 11 females) who previously had undergone ileal conduits (17 patients), colonic conduits (3 patients) or ureterostomies (6 patients) over a period of 11 years. The reasons for undiversion were recurrent UTIs in 8 patients, hydronephrosis in 3 and social reasons in 2 patients. In the remaining patients the reasons couldnot be found. The mean patient age was 25.4 years (7-54). Sixteen patients also had an artificial urinary sphincter (AUS) implanted alongwith. undiversion. The mean time period between diversion and undiversion was 14.4 years (3-28). RESULTS: Mean followup was 13.5 years (2-29). Three patients have died of reasons unrelated to undiversion. All 23 patients with complete followup data were unable to void spontaneously. Eightythree percent (19/23) of them were continent and were managed with intermittent self-catheterization. Three patients needed longterm indwelling catheters for incontinence while 1 patient was rediverted back to an ileal conduit due to persistent symptoms. Eighty-three percent (19/23) patients had normal renal function, while 4 needed dialysis. Three of these 4 proceeded to have renal transplantation. Overall 54% (14/26) patients required further procedures. Ten of these were related to AUS, 2 needing revision of augmentation, and 2 had ureteric re-implantation. CONCLUSIONS: Urinary undiversion provides longterm protection of renal function and durable outcome in achieving continence. It can be safely performed where necessary to deal with complications related to diversion. However this is associated with a high incidence of revision procedures.

We investigated the molecular identity and functional activity of STIM1 and ORAI in human cavernous smooth muscle. We also determined whether transferring dominant negative mutants of the STIM1 or ORAI gene would correct diabetes related erectile dysfunction in a rat model.Reverse transcriptase-polymerase chain reaction was done to identify ORAI and STIM in human cavernous smooth muscle. For the in vivo study intracavernous pressure, blood pressure and their ratio were assessed after cavernous nerve stimulation to diabetic rats transfected with pcDNA encoding the ORAI1(DN) or the STIM1(DN) gene.ORAI (1, 2 and 3) and STIM (1 and 2) were identified in human cavernous smooth muscle cells. After [Ca(2+)] depletion by thapsigargin and cyclopiazonic acid we recorded store operated Ca(2+) entry in human cavernous smooth muscle cells. Entry was decreased by the store operated Ca(2+) channel blockers La(3+) and SKF96365. Mean ± SE intracavernous pressure/blood pressure in rats with ORAI1(DN) or STIM1(DN) gene transfer was 78.8% ± 2.2% and 77.1% ± 1.2% in 11 and 10, respectively. This result was significantly higher than that in 10 diabetic controls (51.0% ± 3.7%) and similar to that in 9 normal controls (85.8% ± 2.6%). Using reverse transcriptase-polymerase chain reaction we confirmed transgene expression in rat cavernous tissue.Transfer of ORAI(DN) or STIM1(DN) genes restored erectile function in diabetic rats. It might be applicable to develop new therapy for erectile dysfunction.

In this study, we investigated the effects of a combination of Ginkgo biloba extracts (GBE) and phosphodiesterase type 5 (PDE-5) inhibitors on the muscular tone of the corpus cavernosum and potassium channel activity of corporal smooth muscle cells. Strips of corpus cavernosum from male New Zealand white rabbits were mounted in organ baths for isometric tension studies. After contraction with 1×10⁻⁵ mol l⁻¹ norepinephrine, GBE (0.01-1 mg ml⁻¹) and mirodenafil (0.01-100 nmol l⁻¹) were added together into the organ bath. In electrophysiological studies, whole-cell currents were recorded by the conventional patch-clamp technique in cultured smooth muscle cells of the human corpus cavernosum. The corpus cavernosum was relaxed in response to GBE in a dose-dependent manner (from 0.64%±8.35% at 0.01 mg ml⁻¹ to 52.28% ± 11.42% at 1 mg ml⁻¹). After pre-treatment with 0.03 mg ml⁻¹ of GBE, the relaxant effects of mirodenafil were increased at all concentrations. After tetraethylammonium (TEA) (1 mmol l⁻¹) administration, the increased effects were inhibited (P0.01). Extracellular administration of GBE increased the whole-cell K(+) outward currents in a dose-dependent fashion. The increase of the outward current was inhibited by 1 mmol l⁻¹ TEA. These results suggest that GBE could increase the relaxant potency of mirodenafil even at a minimally effective dose. The K(+) flow through potassium channels might be one of the mechanisms involved in this synergistic relaxation.

INTRODUCTION AND OBJECTIVES: Alcohol consumption is associated with the erectile function. However, the effect of ethanol (ETOH) on penile tissue is not fully understood. We investigated the acute and chronic effects of ETOH on corporal tissue in the rat. METHODS: To examine the acute effect of ETOH, the rats were divided into a control group and four experimental groups (1 hour, 2 hours, 4 hours and 6 hours after injected the ETOH). The intracavernosal pressure/ blood pressure (ICP/BP) response to cavernosal nerve stimulation was assessed after intraperitoneal injection of normal saline in control group and ETOH (15%, 3g/Kg) in the experimental groups. Each the control group and experimental group (the highest ICP/BP), the concentration of released cGMP and cAMP were measured. To examine the chronic effect of ETOH, the rats were divided into a control group (oral intake normal saline, 3g/Kg, 4 weeks) and experimental groups (oral intake 15% ETOH, 3g/kg, 4 weeks). The ICP/BP response to cavernosal nerve stimulation was assessed. And the concentration of released cGMP and cAMP were measured. RESULTS: In acute ETOH study, the percentage of ICP/BP of the normal control group was 71.6 4.8 (N 7), the four experimental groups (1 hour, 2 hours, 4 hours and 6 hours after injected the ETOH) were 79.3 8.3 (N 7), 86.6 7.6 (N 7), 74.6 7.3 (N 7), 75.1 5.2 (N 7). The percentage of ICP/BP of experimental group (2 hours) only was statistically higher than the control group (P 0.05). The concentration of cAMP of experimental group (2 hours) was statistically higher than the control group (control group N 6, 4.56 1.14 pmol/ml Vs. 2 hours 13.30 4.92 pmol/ml) (P 0.05). In chronic ETOH study, the percentage of ICP/BP of the normal control group was 84.0 4.0 (N 6), the experimental group was 88.5 6.5 (N 6) (P 0.05). The concentration of cAMP and cGMP were not statistically higher than the control group (P 0.05). CONCLUSIONS: Acute effect of ETOH was improved the percentage of ICP/BP, and increased cAMP concentration in the corpus cavernosum of the rat. It can be one of the mechanisms for erectile function after alcohol drinking.

INTRODUCTION AND OBJECTIVES: The current widely used method to quantify erectile function is intracavernosal pressure (ICP) assessment in anesthetized animals using cavernous nerve stimulation model which has obviously the drawbacks of the animal being unconscious and assessment being done in a single time point. Telemetric monitoring of ICP and intraspongiosal pressure (ISP) in freely moving rats was introduced to evaluate erectile function under physiological conditions. But there is no report about which one is more suitable for evaluating erection. In the present study, we compared ICP with ISP in normal rat (n 6). METHODS: Adult rats (Sprague-Dawley; 18 weeks aged) were implanted in the corpus cavernosum and corpus spongiosum with a pressure sensor (model C40; Data Sciences, St. Paul, MN) which permitted telemetric monitoring of cavernosal pressure in freely moving animals following subcutaneous injection of a single dose of apomorphine (100 g/kg). First peak after injection(s), number of events, duration(s), maxinum ICP/ISP (ICPMax/ISPMax), area under the curve (AUC), sum area under the curve (sum AUC) recorded during apomorphine erection tests. Also, sexual events were visually identified and video recorded. RESULTS: An erectile event was defined as an episode, which begins by a gradual increase in the cavernosal pressure and followed by multiple supeimposed very brief surges in the pressure, and ends by gradual decline of the pressure to reach baseline levels. As for the ICP recording, Number of penile erectile events for 30 min. was 2.2 0.3, and it corresponded to visually detected penile erections. Latency for the first penile erection event was 307.1 49.8 sec. Mean ICPMax, mean AUC, and mean sum AUC were 193.6 66.4 mmHg, 1401.4 301.3 mmHg s, and 2895.7 827.2 mmHg s, respectively. But, ISP recording showed no typical pressure change as shown in ICP recording. There were only 3.0 1.0 events that include simple 10 peaks without baseline pressure increase ( 450mmHg*s), and it was less than 5 sec. And it was difficult to analysis because its artifact. CONCLUSIONS: ICP recording by using telemetry device provided a consistent and accurate data during erectile events, while ISP recording was difficult to identify changes of intrapenile pressure due to its artifact. Further work is required to establish a standard analysis ISP recording method for more effective evaluation of erectile activity during telemetry recording.

Phosphodiesterase type 5 (PDE5) inhibitors are the most commonly used treatment for erectile dysfunction (ED). Since the launch of sildenafil, several drugs-including mirodenafil, sildenafil citrate (sildenafil), tadalafil, vardenafil HCL (vardenafil), udenafil, and avanafil-have become available. Mirodenafil is a newly developed pyrrolopyrimidinone compound, which is a potent, reversible, and selective oral PDE5 inhibitor. Mirodenafil was launched in Korea in 2007, and an orally disintegrating film of mirodenafil was developed in 2011 for benefitting patients having difficulty in swallowing tablets. This study aimed to review the pharmacokinetic characteristic profile of mirodenafil and report evidence on its efficacy in the case of ED. In addition, we reviewed randomized controlled studies of mirodenafil's daily administration and efficacy for lower urinary tract symptoms.

Purpose: To identify sexual function improvement associated with alfuzosin (10 mg daily for 2 years). Materials and Methods: We enrolled 30 men with lower urinary tract symptom (LUTS) who visited Gyeongsang National University Hospital between 2010 and 2012. At first visit, urinalysis, prostate specific antigen, transrectal ultrasound, and uroflowmetry were performed. The nternational Prostate Symptom Score (IPSS), quality of life (QoL), International Index of Erectile Function (IIEF), and Male Sexual Health Questionnaire Ejaculation Function Domain (MSHQ-EjFD) questionnaires were administered, and the subjects answered the same questionnaires at 1 month, 6 months, 1 year, and 2 years of follow-up. Results: Twelve men completed of the entire study. After administration of alfuzosin, the median IPSS at first visit, 1 month, 6 months, 1 year, and 2 years was 18.00 (interquatile range [IQR]: 14.00∼29.75), 20.00 (IQR: 11.50∼30.00), 15.50 (IQR: 8.50∼25.25), 14.50 (IQR: 9.25∼19.50), and 11.50 (IQR: 5.00∼17.75), respectively, which showed an improvement. The median QoL at the same times was 4.50 (IQR: 4.00∼5.00), 4.50 (IQR: 4.00∼5.00), 3.00 (IQR: 2.00∼4.00), 3.50 (IQR: 2.25∼4.00), and 3.00 (IQR: 1.00∼3.00), respectively, and also showed improvement. Likewise, the median IIEF was 36.50 (IQR: 24.50∼46.75), 37.50 (IQR: 26.75∼47.25), 45.50 (IQR: 35.00∼59.75), 48.50 (IQR: 34.75∼62.75), and 47.50 (IQR: 43.25∼61.00), while the median MSHQ-EjFD was 19.00 (IQR: 12.0∼24.75), 19.50 (IQR: 13.50∼27.75), 23.00 (IQR: 19.25∼32.25), 26.50 (IQR: 18.25∼34.50), 27.00 (IQR: 21.50∼32.50), respectively, with both showing improvement. Conclusions: After administration of alfuzosin (10 mg daily for 2 years), the IPSS, QoL, IIEF, and MSHQ-EjFD all improved significantly. This means long-term administration of 10 mg of alfuzosin daily would be effective not only for LUTS but also erectile function and ejaculation.

Purpose: Previous studies have revealed that tamsulosin is effective in improving lower urinary tract symptoms (LUTS) and erectile functioning but has some inhibitory effects on ejaculation, including decreased ejaculatory volume. However, these inhibitory effects on ejaculation can be beneficial to patients with premature ejaculation (PE). Therefore, this study was conducted to understand the effect of tamsulosin on PE in men with benign prostatic hyperplasia. Materials and Methods: Twenty-nine patients who visited with LUTS were categorized into 2 groups of LUTS-only patients (n=12) and LUTS combined with PE (LUTS+PE) patients (n=17), and 0.4 mg of tamsulosin was administered to the patients of both groups for 12 weeks. Comparative analyses of before and after the treatment were conducted for calculating the International Prostate Symptom Score (IPSS), International Index of Erectile Function-5 (IIEF-5), intravaginal ejaculatory latency time (IELT), premature ejaculation diagnostic tool (PEDT), and premature ejaculation profile (PEP). The patients with an IPSS score of 8 or higher were determined as LUTS patients, and the patients with IELT of less than 2 minutess and a PEDT score of 9 or higher were determined as PE patients. Results: After treatment, the IPSS score significantly decreased in both groups. There was no statistically significant change in the PEDT for the LUTS group, but there was a significant decrease in PEDT (p=0.012; from 12.1±3.31 to 8.4±4.49) in the LUTS+PE group. Conclusions: Tamsulosin not only has a treatment effect for LUTS but also improves the PE of LUTS+PE patients. Therefore, further studies are needed to confirm the effects of tamsulosin on PE.

Purpose: Transrectal ultrasound (TRUS)-guided biopsy of the prostate is usually safe. However, some patients are hospitalized owing to complications from TRUS biopsy. We identified the risk factors for complications and effective preventive measures for treating complications after TRUS biopsy. Materials and Methods: Medical records and radiological images of 1,083 patients who underwent TRUS biopsy of the prostate over 10 years in Gyeongsang National University Hospital were examined retrospectively to investigate the correlation between complications after TRUS biopsy and preventive antibiotics, prebiopsy enema, number of biopsy cores, and pathological findings. Results: Complications occurred in 69 patients (6.4%). The complication rates of the 1,008 patients who received antibiotics and the 75 patients who did not were 6.3% and 8.0%, respectively (p=0.469). Complication rates of the pre-biopsy enema group (n=658) and the group without prebiopsy enema (n=425) were 4.7% and 8.9%, respectively (p=0.007). Complication rates of the 6-core biopsy group (n=41) and the 12-core biopsy group (n=955) were 7.3% and 6.3%, respectively (p=0.891). Complication rates of the prostate cancer group (n=306) and the no prostate cancer group (n=713) were 6.2% and 6.6%, respectively (p=0.740). Conclusions: A prebiopsy enema was associated with a reduced risk of complications after TRUS biopsy. Preventive antibiotics, number of biopsy cores, and pathological findings did not significantly influence the complication rate.