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Purpose: Combination therapy with an α-1-adrenergic blocker and phosphodiesterase type 5 inhibitors (PDE5Is) has shown improvements in lower urinary tract symptoms (LUTS) with negligible side effects. Nonetheless, decisive advantages in symptom improvement were insufficient, and there were no clinical differences between long- or short-acting PDE5Is in combination with combination medication. Methods: To review the studies on α-1-adrenergic blocker monotherapy and combination therapy with long vs. short-acting PDE5Is in their use in LUTS and erectile dysfunction (ED). A search of the MEDLINE, Embase, Cochrane Library, and KoreaMed databases was conducted from 2000 to 2014 using combinations of the relevant terms. Among the 323 relevant references discovered, 10 were selected for meta-analysis. The data showed that 616 men received combination therapy (PDE5Is with α-1-adrenergic blockers) or α-1-adrenergic blocker monotherapy. Results: Meta-analysis of the combination therapy showed it was more effective than α-blockers in improving symptoms, with a mean International Prostrate Symptom Score change difference of –1.93 while those of the long- vs. short-acting PDE5I were –2.12 vs. –1.70. Compared to maximum flow rate (Qmax) value with monotherapy, the Qmax increased more with the combination therapy (mean difference of 0.71) while change values were 0.14 and 1.13 for the long- and short-acting PDE5Is, respectively. Residual urine decreased more with the combination therapy than it did with α-1-adrenergic blocker monotherapy with a mean difference of –7.09 while the mean residual urine change values for long- vs. short-acting PDE5Is were –18.83 vs. –5.93. The International Index of Erectile Function value increased by 3.99, 2.85, and 4.85 following combination therapy, and therapy with long- and short-acting PDE5Is. Conclusions: Our meta-analysis suggests that PDE5Is can significantly improve LUTS in men with benign prostatic hyperplasia/ED. Furthermore, combination PDE5I and α-1-adrenergic blocker could be a more effective treatment than α-1-adrenergic blocker monotherapy, and the differences between long and short-acting agents were minimal.

Purpose Differences in the severity of subjective symptoms have been noted depending on whether a Hunner lesion is present in women with interstitial cystitis/bladder pain syndrome (IC/BPS). In this study, we aimed to identify differences in objective urodynamic parameters in women with IC/BPS according to the presence of a Hunner lesion. Methods This cross-sectional study included a total of 55 patients with IC/BPS. IC/BPS and the presence of a Hunner lesion on cystoscopy were diagnosed according to American Urological Association guidelines. The patients were categorized into a Hunner IC/BPS group and a non-Hunner IC/BPS group according to the presence of a Hunner lesion on cystoscopy. At the initial visit, a medical history was taken from all patients with IC/BPS, and they underwent symptom assessment using a 3-day voiding diary and laboratory tests. A urodynamic study was then performed before any treatment was performed. Baseline characteristics and urodynamic parameters were compared between the 2 groups. Results Of the 55 patients, 23 (41.8%) had a Hunner lesion on cystoscopy. As documented in the voiding diaries, the Hunner IC/BPS group had more frequent voids and a smaller maximal voided volume (P=0.045, P

Purpose: To investigate the protective effect of mirodenafil on bladder function in a rat model of chronic bladder ischemia (CBI). Methods: Twenty-four Sprague-Dawley rats were randomized to three groups: untreated, sham-operated rats (control group); untreated, CBI model rats (CBI group); and CBI rats treated daily with 4 mg/kg mirodenafil (CBI+mirodenafil group). The CBI and CBI+mirodenafil groups underwent endothelial injury to the iliac arteries and were fed a 2% cholesterol diet after injury. Four weeks after surgery, the CBI+mirodenafil group started daily treatment with mirodenafil for four weeks. Eight weeks after surgery, continuous in vivo cystometry and in vivo organ bath studies of detrusor muscle strips were performed. Results: in vivo cystometry revealed that the rats in the CBI group had a significantly higher micturition frequency, lower bladder capacity, and lower compliance than the rats in the control and CBI+mirodenafil groups. The detrusor muscle strip study showed that the magnitude of the carbachol-induced contractile response was significantly lower in the CBI group compared to either the control or CBI+mirodenafil group. Addition of daily mirodenafil after induction of CBI decreased the contractile response, compared to untreated CBI rats. CBI induced submucosal fibrosis and degenerative changes in bladder walls, which was reversed by the addition of mirodenafil. Conclusions: Daily treatment with mirodenafil showed protective effects against bladder dysfunction resulting from CBI in rats.

Purpose: To evaluate disease insight, personal distress, and healthcare-seeking behavior of women with urinary incontinence (UI) to improve women’s health in Korea. Methods: In October 2012, 500 Korean women residing around Seoul, Incheon, and Gyeonggi-do were selected by random sampling for a population-based cross-sectional survey conducted by computer-aided telephone interview. Sixteen questions, which included information on demographic characteristics, information sources, disease insights, and general health-seeking behavior, were used for data collection. Results: Among the responders, 23.8% experienced UI, the prevalence of which increased with increasing age; 83.3% knew about UI through the mass media out of 98.2% apprehended people. Regarding general awareness of UI, 77.2% understood that UI is caused by aging. A total of 48.7% of subjects experienced societal restrictions because of UI. Most women in their 30s (25.6%) acquired UI information from the Internet, while those in their 50s and 60s (50–59 years, 51.1%; 60–64 years, 42.4%) learned about UI through friends. Among subjects who did not have UI, 89.37% intended to see a doctor or consult a professional if they developed UI (83.2%). Among those with UI, however, only 59.0% had talked about UI; 79.7% had talked with friends or associates, whereas only 23.2% had consulted a professional. Conclusions: Most respondents tended to obtain information on UI through the mass media. Subjects who did not have UI expressed their intention to consult a professional if they developed UI, while the percentage of subjects with UI who had consulted a professional was very low. Many women are ashamed of UI in Korea, which may be changed by providing efficient advertising with the right information and establishing a new perception of UI.

Purpose Postoperative voiding dysfunction is a bothersome complication after mid-urethral sling surgery. The current study presents multiple repeated postoperative voiding trials against a urine load of preoperative functional bladder capacity, as estimated by a preoperative frequency volume chart, to identify the relevance of preoperative and immediate factors to the outcome. Methods A total of 180 patients were enrolled from August 2008 to August 2011. Patients received mid-urethral sling surgery with a transobturator tape, with or without concomitant cystocele repair. Patients reported relevant medical histories and a 3-day frequency volume chart and underwent urodynamic studies. After surgery, patients were filled to their maximum bladder capacity as dictated by their frequency volume chart and performed the first voiding trial. Two subsequent voiding trials were performed after natural filling. Failure of any single voiding trial was considered failure. Patients who failed the final voiding trial received intermittent catheterization to follow-up. After screening for relevant factors with the use of univariate analyses, preoperative, surgical, and postoperative factors predicting outcome were estimated by logistic regression analysis. Results The urine load at the voiding trial and the peak flow rate immediately preceding the voiding trial predicted voiding trial success in the multivariate analysis. Urine load and previous trial peak flow rate were relevant when tested against each individual voiding trial. Preoperative and surgical factors, such as age, parity, and concomitant cystocele repair, showed significance in the univariate analysis. Overall, 16.1% of patients who passed the first voiding trial failed on subsequent trials, whereas 36.8% of patients who failed the first voiding trial succeeded. Conclusions Postoperative voiding dysfunction is transient and is associated with the immediate voiding conditions following surgery. Close observation against urine overload in the bladder is important when weaning patients back to normal voiding conditions.

Purpose Antagonists of α1-adrenergic receptors (α1ARs) relax prostate smooth muscle and relieve voiding and storage symptoms. Recently, increased expression of α1ARs with change of its subtype expression has been proved in bladder outlet obstruction (BOO). To search for the evidence of changes in α1ARs subtype expression and activity in the peripheral and spinal routes, the effects of spinal and peripheral administration of tamsulosin (an α1A/D-selective AR), naftopidil (an α1A/D-selective AR), and doxazosin (non-selective AR) on bladder activity were investigated in a rat model with or without BOO. Methods A total of 65 female Sprague-Dawley rats were divided into the BOO surgery group (n=47) and the sham surgery group (n=18). After 6 weeks, cystometry was assessed before and after intrathecal and intra-arterial administrations of tamsulosin, naftopidil, and doxazosin. Results After intra-arterial administrations of all three drugs, bladder capacity (BC) was increased and maximal intravesical pressure (Pmax) was decreased in both BOO and the sham rat models (P

In women, urethral condyloma rarely leads to a bladder outlet obstruction. A 39-year-old woman who presented with frequency, urgency, and residual urine sensation was found to have a condyloma in her urethral meatus. Urodynamic study indicated bladder outlet obstruction. After condyloma excision, she returned to normal voiding, and the free maximum flow rate improved. In women, excision of urethral condylomas that cause obstruction can be an effective treatment with early recovery of voiding function.

Urinary stones are rarely seen in the urethra and are usually encountered in men with urethral stricture or diverticulum. The case of a 52-year-old woman presented, who consulted for weak stream associated with repeated urinary infections. The diverticulum was approached via vaginal route and the extraction was successful. The patient has been well, with no dysuria, dyspareunia, incontinence for 3-month follow-ups.

Purpose: Combination therapy with an a-1-adrenergic blocker and phosphodiesterase type 5 inhibitors (PDE5Is) has shown improvements in lower urinary tract symptoms (LUTS) with negligible side effects. Nonetheless, decisive advantages in symptom improvement were insufficient, and there were no clinical differences between long- or short-acting PDE5Is in combination with combination medication. Methods: To review the studies on a-1-adrenergic blocker monotherapy and combination therapy with long vs. short-acting PDE5Is in their use in LUTS and erectile dysfunction (ED). A search of the MEDLINE, Embase, Cochrane Library, and KoreaMed databases was conducted from 2000 to 2014 using combinations of the relevant terms. Among the 323 relevant references discovered, 10 were selected for meta-analysis. The data showed that 616 men received combination therapy (PDE5Is with a-1-adrenergic blockers) or a-1-adrenergic blocker monotherapy. Results: Meta-analysis of the combination therapy showed it was more effective than a-blockers in improving symptoms, with a mean International Prostrate Symptom Score change difference of -1.93 while those of the long- vs. short-acting PDE5I were -2.12 vs. -1.70. Compared to maximum flow rate (Qmax) value with monotherapy, the Qmax increased more with the combination therapy (mean difference of 0.71) while change values were 0.14 and 1.13 for the long- and short-acting PDE5Is, respectively. Residual urine decreased more with the combination therapy than it did with a-1-adrenergic blocker monotherapy with a mean difference of -7.09 while the mean residual urine change values for long- vs. short-acting PDE5Is were -18.83 vs. -5.93. The International Index of Erectile Function value increased by 3.99, 2.85, and 4.85 following combination therapy, and therapy with long- and short-acting PDE5Is. Conclusions: Our meta-analysis suggests that PDE5Is can significantly improve LUTS in men with benign prostatic hyperplasia/ ED. Furthermore, combination PDE5I and a-1-adrenergic blocker could be a more effective treatment than a-1-adrenergic blocker monotherapy, and the differences between long and short-acting agents were minimal. [ABSTRACT FROM AUTHOR]