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Introduction The method of administration of oral phosphodiesterase-5 inhibitors has been expanded to once-daily repeated administration with lower initial dosage than on-demand administration. Aim The aim of this study was to evaluate the efficacy and safety of once-daily udenafil as a treatment for erectile dysfunction (ED) for intermediate-term period. Methods This multicenter, randomized, double-blind clinical trial included 346 ED patients (placebo, udenafil 50 mg, udenafil 75 mg). Subjects were treated with each medication once daily for 24 weeks. Main Outcome Measures Subjects were asked to complete the International Index of Erectile Function (IIEF)-erectile function (EF) domain at baseline, 12 weeks, and 24 weeks and the development of adverse drug reactions (ADRs) was inspected. Results Both dosages of udenafil induced a significant increase in IIEF-EF compared with placebo at both 12 and 24 weeks. When patients were divided according to the severity of baseline EF score, significant improvement was observed only with udenafil 75 mg regardless of the degree of ED. At 24 weeks, the proportions of patients who reported a return to normal EF (IIEF-EF over 26) were 39.1% for udenafil 50 mg and 47.0% for udenafil 75 mg. In terms of safety, ADRs were observed in 6.1%, 12.9%, and 17.9% for placebo, udenafil 50 mg, and 75 mg, respectively. Although a statistically higher rate of ADRs was observed in the udenafil 75 mg group (P = 0.024), the majority were mild and recovered without treatment. Conclusions Once-daily administration of udenafil 50 mg and 75 mg for 24 weeks resulted in improvement of EF. In particular, udenafil 75 mg improves EF regardless of the baseline degree of ED.

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.

Background The major concern with applying tunical plication procedures for Peyronie curvature is the associated with potential loss of penile length. We describe a novel technique for penile elongation by simple scrotal septum detachment from penile base to compensate penile length loss during penile plication in Peyronie’s disease and evaluated the efficacy and safety of our technique. Methods From January 2014 to May 2017, we evaluated 16 patients (24–63 years old) with Peyronie’s disease underwent penile plication with penile elongation via our novel technique. The penile elongation was performed by release and detachment of scrotal septum from penile base until scrotal fat tissue identified. We assessed the stretched penile length (SPL) preoperatively and 4 weeks postoperatively as objective outcome. The subject outcome was assessed with the patient perception of postoperative penile length. Information regarding complications was obtained during the postoperative hospital stay and at all follow-ups. Results The mean increase in SPL was 1.2±1.3 cm (range, −1.0 to 3.0 cm) and it was a statistically significant (P=0.003). There was no significant correlation between preoperative curvature and increase in SPL. Eleven of 16 patients (68.8%) was reported a perceived penile length increase after surgery. There was no procedure related complication such as hematoma, infection, and tissue necrosis. Conclusions With the simple dissection and detachment of the scrotal septum from penile base, we obtained objective penile elongation and subjective outcomes without complications. We suggest that this is a promising surgical method to compensate the potential penile length loss in patients who undergo plication surgery with Peyronie’s disease.

Background Irritative symptoms including prolonged urgency and dysuria after GreenLight laser photoselective vaporization (PVP) of benign prostatic hyperplasia (BPH) are common complication. We aimed to compare the incidence of postoperative irritative symptoms of GreenLight XPS (GL-XPS) 180W laser system with GreenLight KTP (GL-KTP) 80W laser system for the treatment of BPH and evaluate the risk factors of irritative voiding symptoms. Methods The data of patients, who received GL-KTP 80W PVP from July 2005 to December 2007 and GL-XPS 180W PVP from January 2015 to August 2016 at our institution, were reviewed. The perioperative and postoperative parameters, including laser applied time, hospital stay, International Prostate Symptom Score (IPSS), maximum urinary flow rate (Qmax), post-void residual urine (PVR), prostate volume, prostate specific antigen and incidence of irritative symptoms were collected and compared between GL-XPS and GL-KTP groups. Results GL-KTP 80W PVP was performed in 134 patients and XPS 180W PVP in 100 patients. Preoperative demographic data were similar in both groups. Perioperative parameters were also comparable, except for shorter laser applied time in GS-XPS 180w group. (41.2 vs. 18.5 min, P

Objective To assess the risk factor that influences bladder stone formation in patients with benign prostatic hyperplasia (BPH). Materials and Methods We reviewed the data of 271 consecutive patients with BPH who underwent transurethral resection of the prostate between January 2008 and December 2012. Patients were classified into 2 groups based on the presence of a bladder stone: Group 1 had a bladder stone and group 2 did not. Univariate analysis was performed to determine the association between the presence of bladder stone and the patients' age, body mass index, International Prostate Symptom Score, total prostate volume (TPV), transitional zone volume, intravesical prostatic protrusion (IPP), uroflow parameters, and urodynamic parameters. Results The overall rate of bladder stone in patients with BPH was 9.9%. The patients' body mass index, International Prostate Symptom Score, and urodynamic parameters did not significantly differ between the 2 groups. The patients' age, TPV, transitional zone volume, and IPP were all significantly higher and the Qmax was significantly lower in group 1 than that in group 2. Multivariate analysis revealed that age (hazard ratio [HR] = 1.089; P = .020), IPP (HR = 1.145; P P = .019) significantly affected the presence of bladder stone in patients with BPH. A predictive model using logistic regression for bladder stone in BPH patients was defined as follows: probability = 1/[1 + exp (−8.499 + 0.085 (age) + 0.009 (TPV) + 0.136 (IPP) − 0.143 (Qmax))] with area under the curve of 0.850 obtained from the receiver operating characteristic curve analysis. Conclusion This study demonstrated that older age, longer IPP, and lower Qmax are independent factors that associated with the presence of bladder stone in patients with BPH.

Purpose: This study was performed to investigate the discomfort reported by patients taking phosphodiesterase type 5 inhibitors (PDE5Is) in clinical practice. Materials and Methods: From September 2011 to March 2012, we surveyed patients who were prescribed PDE5Is for erectile dysfunction (ED). The questionnaire elicited information concerning: patient characteristics, medication counseling received and inconveniences experienced in hospitals and at pharmacies, effects of PDE5Is, and the separation of the prescribing and the dispensing of PDE5Is. Results: A total of 237 patients completed the questionnaire (mean age: 58.81±9.14 years). Among the 62 patients (26.0%) who reported having encountered some inconveniences in hospitals, the most frequently expressed concerns ’assistant staff,’ including nurses (38.7%), ‘testing procedures’ (27.4%), and ‘the issuing of prescriptions’ (22.6%). Of the 137 patients (57.8%) who noted inconveniences in obtaining medications from pharmacies, 60.6% cited ‘self-consciousness’ as the most common reason, followed by ‘insufficient medication counseling’ (22.6%), and ‘absence of consultation’ (11.6%). In contrast, 82% of the patients were satisfied with the medication counseling that they had received in hospitals, covering drug usage, side effects, and precautions regarding PDE5Is; this proportion was only 30% for pharmacies. Further, most patients (89%) indicated that they preferred to obtain their prescriptions and medications for ED from the hospital at the same time. Conclusions: Treatment of ED is a highly private matter. According to the survey, ED patients more often felt that obtaining medication from pharmacies was inconvenient. The sociocultural aspects of ED necessitate that exceptions to separating the prescribing and the dispensing of medication be considered.

The purpose of this study is to investigate and compare the effects of 5-mg once-daily tadalafil versus 5-mg alternate-day tadalafil in men with moderate-to-severe erectile dysfunction (ED) and lower urinary tract symptoms (LUTS). Between January 2012 and June 2013, 144 men presenting with an International Index of Erectile Function-5 (IIEF-5) score of18 and an International Prostate Symptom Score (IPSS) of8 were enrolled to the study. Patients were allocated the simple alternate randomization into Group I (5-mg once-daily tadalafil) and Group II (5-mg alternate-day tadalafil). Changes in IIEF scores, Sexual Encounter Profile Question 3 (SEP Q3) percentage, IPSS, uroflowmetry and post void residual at the first visit (V1), week 4 (V2) and week 12 (V3) were compared. No significant difference was found between the baseline patient characteristics of Group I and Group II. Treatment with 5-mg daily tadalafil demonstrated improvement in IIEF, SEP Q3 percentage and IPSS score between V1 and V2, and that between V1 and V3. Patients receiving 5-mg alternate-day tadalafil also showed a significant improvement in IIEF, SEP Q3 percentage, and IPSS score between V1 and V2, and that between V2 and V3. However, no significant improvements were found in any other parameters. There were no significant differences between Group I and Group II apart from IIEF scores in V2 (19.4 versus 17.9, respectively). The SEP Q3 percentage was also higher at the V2 visit for Group I and Group II (35.6 versus 30.9%). Even with no placebo control and short of LUTS medication control, the use of 5-mg once-daily or alternate-day treatment with tadalafil was well tolerated in patients and effectively improved the IIEF score, IPSS score and SEP Q3 percentage. Management of patients with 5-mg alternate-day tadalafil could be adequate for regular use in patients with ED and LUTS.

Primary renal echinococcosis, a rare disease involving the kidney, accounts for 2-3% of human echinococcosis. A 64-year-old female patient from Uzbekistan presented with complaints of left flank pain. A CT scan revealed a cystic mass in the upper to midpole of the left kidney. We regarded this lesion as a renal malignancy and hand-assisted laparoscopic radical nephrectomy was performed to remove the renal mass. The mass consisted of a large unilocular cyst and multiple smaller cysts without any grossly visible renal tissue. The final pathologic diagnosis was a renal hydatid cyst. For patients from endemic areas, hydatid cyst should be included in the differential diagnosis. Here, we present a case of renal hydatid cyst in a female patient who relocated from Uzbekistan to Korea.

To assess the effect of desmopressin on serum testosterone level in men with nocturia and late onset hypogonadism.We prospectively enrolled men with nocturia and symptoms of late onset hypogonadism. Desmopressin (0.1 mg) was administered once daily to patients for 12 weeks, and we then compared serum testosterone levels, electrolytes, frequency volume chart indices, and changes in the International Prostate Symptom Score (IPSS), International Index of Erectile Function, and Aging Male's Symptom scales before and after treatment. Patients with a history of cardiovascular disease or hyponatremia, those using hypnotics, and those who had primary hypogonadism or hypogonadotrophic hypogonadism were excluded from the study.Sixty-two men (mean age, 68.4 years) completed pre- and post-treatment questionnaires and underwent laboratory testing. At the end of the study, the testosterone levels in men with low testosterone levels (3.5 ng/mL) increased after the 12-week desmopressin treatment (2.85 ± 0.58 to 3.97 ± 1.44 ng/mL; P = .001). Mean scores had decreased from 17.7 to 13.9 (IPSS), 3.8 to 3.2 (IPSS-Quality of Life), and 33.7 to 31.1 (Aging Male's Symptom). On the frequency volume chart, nocturnal urine volume, nocturnal polyuria index, actual number of nocturia events, nocturia index, and nocturnal bladder capacity index were significantly decreased.Desmopressin improved nocturia and other urinary symptoms. Moreover, serum testosterone levels increased significantly in men with low testosterone levels after 12-week desmopressin treatment.

Objective It has been hypothesized that women with significant pelvic organ prolapse (POP), particularly of the anterior vaginal wall, may have voiding dysfunction (VD). Rarely, different compartments of the vagina have been examined closely for VD. This study attempts to further elucidate the correlation between POP and VD by using the standardized Pelvic Organ Prolapse Quantification (POP-Q) staging system. Study design The clinical records of 66 women who underwent cystocele (≥POP-Q stage III) repair with concomitant midurethral sling were reviewed. Urodynamic study and POP-Q examination were performed preoperatively. The subjects were divided into two groups according to the presence of VD, which was defined as the presence of at least one of the following criteria: maximal flow rate below 15 mL/s or postvoid residual urine volume (PVR) above 50 mL on preoperative uroflowmetry. Age, parity, uroflowmetry and urodynamic parameters were compared between the two groups. Results Of 66 women, 36 had VD preoperatively. In the VD group, failure in the postoperative voiding trial was more frequent ( p = 0.040), with lower maximal flow rate ( p = 0.007) and higher PVR ( p = 0.034). POP-Q stage was significantly higher ( p = 0.018), and points Aa and Ba were significantly longer ( p = 0.005 and p = 0.006, respectively) in the VD group. POP-Q stage with points Aa and Ba were significantly correlated with the presence of preoperative VD, and moderately correlated with PVR. Conclusion The prevalence of VD in patients with cystocele is high (55%). Points Aa and Ba of POP-Q stage had positive correlations with VD in patients with cystocele.

Introduction Testosterone deficiency syndrome (TDS) is a prevalent disease of the aging male with much confusion to its associated presentation, diagnosis, and comorbidities. Aim We investigated the overall prevalence of TDS and its putative symptoms and associated diseases in a nationwide study on participants recruited from routine checkup. Methods One thousand eight hundred seventy‐five participants seeking biennial health checkup were enrolled from a nationwide distribution of randomly selected registry of primary clinics. Putative symptoms and comorbidities were assessed for serum testosterone‐dependent prevalence change, independent of age. The identified symptoms were then assessed by multivariate backward stepwise binominal regression to determine the optimal reference level of testosterone and the strength of the associated comorbidities. Main Outcome Measures TDS was assessed by serum testosterone, the Aging Males' Symptom scale, and the Androgen Deficiency in Aging Male questionnaire. Patient body habitus measurements and history of associated comorbidities were also described. The dependent variables included the age‐specific prevalence of decreased testosterone and the probability of TDS‐specific symptoms. Results Grossly 10.2% of the participants fell into the criteria for TDS. Testosterone was highly age dependent, and most putative symptoms of TDS showed significant age dependence but was not affected by serum testosterone levels. However, the symptoms of decreased libido and erectile dysfunction, and comorbidities such as hypertension, type 2 diabetes, and obesity showed relevant dependence on serum testosterone levels as well as age above 50 years of age. Furthermore, these symptoms were also affected at different serum testosterone thresholds. Decreased libido increased significantly at serum testosterone levels of 550 ng/dL (odds ratio [OR] = 1.295, 95% confidence interval [CI] = 1.047–1.601), and erectile dysfunction was affected by serum testosterone levels at 250 ng/dL (OR = 1.369, 95% CI = 1.005–1.866). Conclusions Most symptoms and diseases thought to be associated with TDS are primarily age dependent. Few sexual symptoms and diseases such as hypertension, diabetes, and obesity show testosterone dependence only at older ages. Moon DG, Kim JW, Kim JJ, Park KS, Park JK, Park NC, Kim SW, and Lee SW. Prevalence of symptoms and associated comorbidities of testosterone deficiency syndrome in the Korean general population. J Sex Med 2014;11:583–594.

Objective To assess the reliability and negative predictive value of voiding cystourethrogram (VCUG) performed within 24 hours postoperatively. Methods Forty patients (56 ureters) who underwent first injection of dextranomer/hyaluronic acid (Dx/HA) because of vesicoureteral reflux (VUR) were enrolled. Patients with previous reflux operation or neurogenic disorders were excluded. All patients underwent the hydrodistention implantation technique (HIT). Patients underwent VCUG within 24 hours postoperatively and after 6 months. Grade 0 and grade 1 were considered to be cured. Negative predictive values of VCUG performed within 24 hours postoperatively were assessed. Results The mean age of the patient was 98 ± 45.8 months. Twenty-seven patients were male and 13 patients were female. The number of refluxing ureters was 4, 12, 14, 12, and 14 in ascending order of VUR grade. Overall success rate of single injection therapy was 66.07%. Only 2 ureters with grade IV and 1 patient with grade V VUR showed failure on 24-hour VCUG. The success rates on 6 months VCUG were 100%, 83.3%, 78.57%, 50%, and 42.85% according to ascending order of VUR grade.The negative predictive value of 24-hour VCUG were 100%, 83.3%, 78.57%, 60.0%, and 46.15% according to ascending order of VUR grade. VUR grade was the only factor associated with the discrepancy. Positive but weak correlation was noted between the preoperative grade of VUR and the rate of discrepancy on Spearman correlation analysis (Spearman correlation coefficient = 0.303, P value = .018). Conclusion Twenty-four hour VCUG cannot replace follow-up VCUG usually performed beyond 3 months postoperatively. Further studies are needed for confirmation of cure.

There is no conclusive evidence as to whether patients with testosterone deficiency (TD) who benefit from testosterone treatment (TRT) must continue the treatment for the rest of their lives. In some patients, the effect of TRT does not maintained after stopping TRT and, some patients show no significant TD symptoms, with normal testosterone levels after TRT cessation. Therefore, we investigated the predictive factors of response maintenance after TRT cessation. A total of 151 men with TD who responded to TRT were followed up for six months after TRT discontinuation. Ninety-two patients (Group I) failed to show response maintenance, 59 patients (Group II) had a maintained response. The groups did not differ in baseline characteristics or the type of TRT (oral, gel, short/long-acting injectables). However, TRT duration was significantly longer (10.7 vs. 5.2 months), and peak total testosterone (TT) level was significantly higher (713.7 vs. 546.1 ng/dL), in Group II than in Group I. More patients regularly exercised in Group II than in Group I (45.8% vs. 9.8%, p &lt, 0.001). A multivariate logistic regression analysis revealed that exercise (B = 2.325, odds ratio = 10.231, p &lt, 0.001) and TRT duration (B = 0.153, Exp(B) = 1.166, p &lt, 0.001) were independent predictive factors of response maintenance. In men with TD who respond to TRT, longer treatment periods can improve the response durability after TRT cessation, regardless of the type of TRT. Additionally, regular exercise can increase the probability of maintaining the response after TRT cessation.

The purpose of this study was to evaluate whether computed tomography (CT) parameters can predict the success of ureteroscopic lithotripsy (URSL) and establish a model for predicting the success rates of a single URSL procedure for the treatment of a single ureteral stone. We retrospectively reviewed the records of 237 patients who underwent URSL for ureteral stones diagnosed by CT between January 2009 and June 2012. Stone-free status was defined as the absence of stones or residual stone fragments

This study compared crosslinked dextrans in hydroxylpropyl methycellulose (DiHMs, pH 5 or 7) with polymethylmethacrylate in bovine collagen (PMMA) and hyaluronic acid (HA) fillers on soft tissue augmentation and safety in rats. HA tended to maintain its size throughout the experimental period but was moveable and friable because of a lack of thick fibroconnective tissue formation. Although, PMMA induced moderately thick fibroconnective tissue formation, its size was decreased markedly from 3-week postimplantation (PI) and became the smallest at 24-month PI. DiHM (pH 7) elicited strong fibrous encapsulation around the filler. Its size decreased slowly but was still considerably maintained at 24-month PI. In contrast, the rate of the DiHM (pH 5) size decrease was slower than that of PMMA, faster DiHM (pH 7), but comparable to HA. Immunohistochemically, types I and III collagens were deposited inside and outside DiHMs (pH 5 and 7). DiHMs (pH 5 and 7), PMMA, and HA showed no adverse reactions. These results suggest that DiHM (pH 7) assures efficacy and safety and is a good candidate for soft tissue augmentation in both humans and animals.

Objective To analyze whether strains positive for extended-spectrum β-lactamase (ESBL) affected the clinical course and progression to chronic prostatitis in patients with postbiopsy acute prostatitis. Methods From 2002 to 2011, 3657 patients underwent transrectal ultrasound-guided biopsy of the prostate, and 33 patients with acute prostatitis were enrolled. Acute prostatitis was defined as a fever greater than 38°C, pyuria, and tenderness on digital rectal examination. Urine and blood cultures were tested for antibiotic susceptibility. Laboratory and clinical variables according to the presence of ESBL were analyzed. Results Blood or urine culture was positive in 23 patients. The most common strain was Escherichia coli . Sixteen patients showed ESBL-positive and 18 patients were quinolone-resistant. Thirteen of 16 patients with ESBL-positive strains showed quinolone resistance, and 13 of 18 patients with quinolone resistance were ESBL-positive ( P = .621). Besides imipenem, all ESBL-positive patients were susceptible to amikacin and were highly susceptible to cefoxitin and amoxicillin/clavulanic acid. The prevalence of ESBL-positive strains has tended to increase since 2006. Patients with ESBL had higher peak fever, white blood cell count, absolute neutrophil count, and longer duration of fever and hospitalization. The progression rate to chronic prostatitis was significantly higher in ESBL-positive patients (4/16 vs 0/17, P = .044). Conclusion Since 2006, ESBL strains have been increasing, and the presence of ESBL showed more detrimental effects on the clinical course of the patients, resulting in a higher rate of progression to chronic prostatitis.

Purpose: The present study was done to define the degree of intravesical prostatic protrusion (IPP) causing bladder outlet obstruction (BOO) in patients with benign prostatic hyperplasia (BPH)/lower urinary tract symptoms. Materials and Methods: We retrospectively evaluated 239 patients with BPH, analyzing age, IPP, prostate volume, International Prostate Symptom Score (IPSS), and the results from a pressure-flow study. Urethral resistance was quantified by using the BOO index (BOOI), according to the formula BOOI=PdetQmax-2×Qmax (where Pdet is detrusor pressure at the peak flow rate and Qmax is peak flow rate). BOO was defined by a BOOI above 40. Patients with a BOOI below 20 were excluded. Patients were classified into two groups (obstructed and unobstructed groups) by the BOOI. Correlations were determined by logistic regression analysis, and receiver operating characteristic curves were plotted to estimate the optimal cutoff for IPP. Results: There were significant differences in total prostate volume, postvoiding residual urine (PVR), IPP, and Qmax (p＜0.001, p＜0.001, p＜0.001, and p=0.026, respectively) between the obstructed and unobstructed groups, but there were no significant differences in age (p=0.653), IPSS total score (p=0.624), or quality of life score (p=0.138). IPP had a significant prognosis (p＜0.001) but was weakly correlated with prostate volume (p=0.026). The correlation coefficients between IPP and Qmax, PVR, prostate volume, and BOO were 0.551, -0.159, 0.225, and 0.391, respectively. For IPP, the area under the curve was 0.759 (95% confidence interval, 0.657 to 0.861) and the cutoff to indicate BOO was 5.5 mm with 66.7% sensitivity and 80.5% specificity. Conclusions: An IPP exceeding 5.5 mm was significantly associated with BOO.

Uric acid stones are the most readily dissolvable of all types of urinary stones. The present paper describes two patients with uric acid stones in kidney and ureter, whom we have treated successfully only by a combination of increased fluid intake and adequate dietary modification.

To evaluate the effect of listening to music on pain, anxiety, or stress during a urodynamic study (UDS).A total of 74 female and 74 male patients who underwent UDS between March 2013 and October 2013 were prospectively randomized. The patients were divided into 2 groups according to gender (female, n = 74 vs male, n = 74) and into 2 subgroups according to whether they listened to music or not. Music group subjects played their preferred music during UDS. Before and after UDS, all subjects completed the State-Trait Anxiety Inventory (STAI) form and their degree of pain, anxiety, and satisfaction during examination were assessed by the visual analog scale (VAS, 0-10). Basic vital signs were also checked before and after the procedure.In the analysis of anxiety, pain, and stress scores, the mean shame, discomfort, and satisfaction scores (VAS) were significantly higher in female patients, whereas the mean score of willingness to retry the procedure was higher in male patients whether listening to music or not (P .001). In the analysis of differences of STAI total, state anxiety, and trait anxiety, there were no statistical significances between the music group and the no-music group in either gender.In our study, music during UDS did not reduce anxiety, pain, and stress in either gender. In the analysis focusing on gender difference, female patients showed statistically higher levels of pain, anxiety, and stress scores than male patients whether listening to music or not.

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.

Varicocelectomy is a management option for patients with painful varicocele. In this study, we assessed the effectiveness of varicocelectomy for painful varicocele and examined the factors that might be predictive of outcome. All patients who underwent a varicocelectomy for pain between February 2007 and July 2009 were included. A review of patient medical records was conducted; patient age, body mass index (BMI), grade, location of the varicocele, testicular volume, duration and quality of the pain (dull, dragging, throbbing or sharp) and surgical technique (inguinal versus subinguinal) were documented. All parameters were compared with the resolution of pain (complete, partial or failure). We followed up on 53 of 104 patients (51.0%). Complete postoperative resolution of pain was reported by 28 patients (52.8%), whereas 22 (41.5%) reported partial resolution. Only three patients (5.7%) reported failure. No relationship was observed between postoperative pain resolution and age, BMI, grade of varicocele, location of varicocele, ipsilateral testicular hypotrophy, quality of pain or surgical technique. The duration of pain before surgery was the only factor that correlated with postoperative pain resolution (univariate, P50.004; multivariate, P50.002). Our results indicate that varicocelectomy is an effective treatment for painful varicocele in properly selected patients, and that duration of pain before surgery may be predictive of outcome. Asian Journal of Andrology (2011) 13, 754–758; doi:10.1038/aja.2010.87; published online 22 November 2010

Background/Aims/Objectives: We studied the detection rate of prostate cancer (PCa) among Korean men with a prostate-specific antigen (PSA) level of less than 4.0 ng/mL. Methods: A total of 1,680 men with PSA ≤4 ng/mL had a prostate biopsy from January 2004 to December 2014. The differences in clinical factors were analyzed and their independent predictive implications were evaluated. Results: PCa was diagnosed in 331 (19.6%) and 99 of these 331 cancers (14.9%) had a Gleason score of 7 or higher. The detection rate of PCa increased from 6.67% (≤0.5 ng/mL) to 20.36% (3.01-3.9 ng/mL). There were significant differences in age 65.7 vs. 62.1 years, prostate volume 33.4 vs. 38.2 g, PSA density 0.10 vs. 0.08 ng/mL/mL between men with and without PCa. On multivariable analysis, age and prostate volume were the best independent discriminative parameters. When comparing PCa patients with a Gleason score less than 6 to those with a 7 or higher, patients with a Gleason score 7 or higher were older (67.2 vs. 64.8 years). Conclusions: Even when the PSA level is less than 4 ng/mL, PCas, including high-grade cancers, were detected in a significant number of men. In this group, patients with PCa were older and had a smaller prostate volume and high-grade cancers were detected more frequently in older cancer patients.

Once-daily administration of phosphodiesterase type 5 inhibitors has been shown to correct erectile dysfunction (ED).To evaluate the long-term efficacy and safety after once-daily oral administration of udenafil 75 mg in men with ED.This clinical trial was an open-label, fixed-dose, 24-week extension study (DA8159_EDDL_III) of a 24-week double-blinded efficacy and safety study of once-daily udenafil (parent study: DA8159_EDD_III). Subjects received udenafil 75 mg once daily for 24 weeks during this extension study, and the follow-up visit occurred during the 4-week ED treatment-free period.Subjects were asked to complete the International Index of Erectile Function questionnaire and the Global Assessment Questionnaire at the 24-week extension and after the 4-week ED treatment-free period, and the development of adverse drug reactions was investigated.In total, 302 subjects were enrolled in this extension study. Improvement was shown with an increased erectile function (EF) domain score compared with baseline (14.60 ± 4.57) at extension week 48 (23.98 ± 5.44) and a slight increase in EF domain score compared with the last time point (week 24) of the parent study (P .001). The Global Assessment Questionnaire showed a high improvement rate of 95.4% at the extension 48-week time point. For shift to normal, almost half the subjects (45.1%) recovered "normal" EF, and 14.2% of subjects reported normal erections after the 4-week ED treatment-free period. The occurrence rate of adverse drug reactions was 8%, which consisted mainly of flushing and headache.Once-daily dosing of udenafil 75 mg showed excellent efficacy and safety with long-term administration and allowed a more spontaneous sexual life.

Objective It is generally assumed that there is a negative linear association between androgen receptor (AR) sensitivity and the CAG repeat length. However, correlation between CAG repeat length and clinical factors of metabolic syndrome (MS), late onset hypogonadism is unclear. In this study we explored the relationship between AR CAG repeat length polymorphism and MS, late onset hypogonadism (LOH) in a Korean male population. Methods The association between AR CAG repeat length polymorphism and MS was analyzed in 241 Korean men (20–90 years old). MS was diagnosed according to the NCEP criteria (any three or more of the following components were present: abdominal obesity [waist circumference (WC) >102 cm], triglycerides >150 mg/dL, HDL cholesterol 110 mg/dL, or blood pressure of >130/85 mmHg). LOH was diagnosed by serum testosterone level of

Objective To compare short-term outcomes of 180W-XPS GreenLight photoselective vaporization of the prostate (XPS PVP) to transurethral resection of prostate (TURP) on uroflowmetry and IPSS at two months in patients with benign prostatic hyperplasia (BPH) Methods A retrospective chart review was performed of 40 patients with BPH who underwent XPS PVP. Controls were configured with 40 patients who underwent TURP with similar prostate size of XPS PVP group. All parameters were collected retrospectively including maximum urinary flow rate (Qmax), postvoid residual (PVR), prostate specific antigen, IPSS, and complication. Results XPS PVP and TURP were similar in preoperative parameters such as mean age, prostate volume, Qmax, PVR, IPSS and QoL score respectively. The median operative time for XPS PVP was significantly longer than TURP (49.1±19.5 min TURP and 69.9±38.6 min XPS PVP, P=0.001). XPS PVP showed significantly shorter hospital stay (4.5±1.0 vs. 3.0±1.4, P

Objective This study was designed to evaluate the efficacy of combination therapy of Tamoxifen, L-carnitine and daily PDE5 inhibitors and to compare with Potassium para-aminobenzoate (Potaba) monotherapy in the medical treatment of Peyronie’s disease. Methods From January 2011 to December 2014, a total of 104 patients with Peyronie’s disease enrolled in this study. Sixty-eight patients were treated with Tamoxifen 20 mg and Acetyl L-carnitine 330 mg twice a daily in addition to daily PDE5 inhibitors (Tadalafil 5 mg once daily) combination therapy (Group 1), while thirty-four patients were treated with Potassium para-aminobenzoate 12 g daily (Group 2), Pain on erection, impossibility of intercourse, plaque size, penile curvature and IIEF-5 were assessed. Plaque volume was assessed by penile ultrasonography. Results Both groups showed resolution of pain and intercourse satisfaction after treatment. The pre-treatment plaque sizes of both groups were 17.1±7.2, 17.0±5.0 mm, respectively. After treatment, those parameters significantly reduced to 13.2±5.6, 16.2±5.3 mm. In group 1, combination therapy significantly improved the angle of penile curvature, plaque size, and IIEF (P

Objective To evaluate the postoperative outcome of multiple slit on plaque plication technique for the treatment of Peyronie Je Jong Ki. Methods We retrospectively evaluated 22 patients who underwent plaque incision with penile plication for surgical treatment of Peyronieu Geon Moon of tamoxifen, L-l treatment between 2009 and 2014. Patients were grouped by pre-operative degree of penile curvature such as Group I: mild [n=5 (22%)], Group II: moderate [n=11 (50%)], and Group III: severe [n=6 (27%)]. On the thorough review of medical records, we evaluated (I) correction of the curvature; (II) sexual function; and (III) any penile shortening or other complications. Results The mean postoperative follow-up period was 39 months. Complete correction of the curvature was obtained in 21 patients (95%). As inevitable complication, minimal penile shortening (21]. The most frequent complication was the subcutaneous penile edema in three patients (13.6%), which was resolved within about 3 months after surgery. Conclusions As modified technique, multiple slit on plaque with plication is a simple, non-invasive and effective technique for correcting penile curvature regardless of curvature severity. And the degree of penile curvature does not significantly predict the amount of penile length loss.

Current criticisms to penile augmentation are that there are no established procedure, poorly defined indications, unacceptably high reported complications, and no reliable long-term satisfactory results [1–3]. So, it raises speculation regarding the true efficacy and morbidity of these procedures. Vardi et al. reviewed the articles published between 1965 and 2008 regarding penile enhancement [3]. Because of disappointing results, they suggested the development of improved criteria for better patient selection, as well as new and better surgical methods of penile enhancement. The main principle of current PGE techniques is the implantation of various bulking agents into the space between Buck’s and dartos fascias. But these fascial structures and overlying skin are vulnerable according to the nature of the bulking agents, invasiveness of each technique, and the experience of the practitioner. To save debilitated patients from the adverse effects of previous penile augmentation technique and fulfill the request of the patients, it is necessary to develop a new, safer, and more effective technique rather than criticize penile augmentation or regard it as evil magic.

Objective This study was designed to evaluate the efficacy of combination therapy of Tamoxifen, L-carnitine and daily PDE5 inhibitors and to compare with Potassium para-aminobenzoate (Potaba) monotherapy in the medical treatment of Peyronie’s disease. Methods From January 2011 to December 2014, a total of 104 patients with Peyronie’s disease enrolled in this study. Sixty-eight patients were treated with Tamoxifen 20 mg and Acetyl L-carnitine 330 mg twice a daily in addition to daily PDE5 inhibitors (Tadalafil 5 mg once daily) combination therapy (Group 1), while thirty-four patients were treated with Potassium para-aminobenzoate 12 g daily (Group 2), Pain on erection, impossibility of intercourse, plaque size, penile curvature and IIEF-5 were assessed. Plaque volume was assessed by penile ultrasonography. Results Both groups showed resolution of pain and intercourse satisfaction after treatment. The pre-treatment plaque sizes of both groups were 17.1±7.2, 17.0±5.0 mm, respectively. After treatment, those parameters significantly reduced to 13.2±5.6, 16.2±5.3 mm. In group 1, combination therapy significantly improved the angle of penile curvature, plaque size, and IIEF (P value

Unlike meatal advancement with glanuloplasty or glans approximation for hypospadias repair, recently minimal invasive procedures of glans penis augmentation (GPA) have been developed for sexual inferiority. Direct GPA indirect has been recently developed for. Compared to direct enhancement of the dermal layer of the glans penis by superficial injection of filler [1–3], indirect GPA in which implantation of dermofat graft or collagen scaffold between the glans and corporal tip [4] can make general enlargement and elevation of the glans penis. In 2003, Moon DG and colleagues firstly reported novel GPA method using injectable hyaluronic acid gel with the same principle of wrinkle correction [5] and reported three consecutive human studies of GPA for volume effects, premature ejaculation, and long-term follow-up results of 5 years in 2008 [1, 4, 5]. After the development of GPA using injectable HA gel, various kinds of fillers have been used. In 2003, Perovic et al. [2] reported his results of GPA by submucosal injection of hydrogel in nine patients of glans deformity. Shaeer also used polyacrylamide gel injection for enhancing glans size in two patients following implantation of a penile prosthesis with satisfactory results, although short lived, requiring reinjection [3]. Abdallah et al. reported modified GPA using injectable hyaluronic acid gel for premature ejaculation patients by multiple puncture technique for easy and large amount injection [6].

In aspect of the role of the glans penis, besides sexual inferiority, why do so many people want to have big glans penis? What is the role of the glans penis? There is no description about the function of the glans penis in textbooks of andrology, urology, and even anatomy. The penis is the symbol of the male and is a tool for both voiding and sexual intercourse. As a tool for voiding, the essential role of the glans penis can be easily understood based on the purpose of hypospadias repair. The glans penis maintains the straight urinary stream and protects the distal urethra. As a tool for sexual intercourse, the glans penis is a sensory organ for sexual stimuli. Glans erection elongates the underlying elastic rete ridge which exposes more underlying sensory receptors. As a tool for intercourse, the glans penis has a unique function based on its conical shape. The conical glans penis is the proper shape for vaginal dilatation and easy intromission of the penis into the vagina. If the glans size is too small compared to a thick shaft, dilatation or intromission is not so easy and effective. The conical shape of the glans penis is aids in aiming and is effective for transfer of axial cavernosal pressure to the distal tip of the penis. During erection, cushion effects of the glans penis prevent both vaginal trauma and injury of the distal penis. For these reasons, the penis cannot do anything without glans! The penis should look aesthetically normal and relevantly large with respect to the penile body and be as tumescent as the body during erection.

This study was performed in order to determine the value of plasma osteopontin (OPN) levels as a predictive factor of disease stage and recurrence in patients with bladder urothelial carcinoma (UC). Data from 50 patients diagnosed to have bladder UC after transurethral resection of bladder tumor (TURBT) from 2009 to 2010 were evaluated prospectively. Blood tests were performed before and after TURBT, and plasma OPN levels were measured using enzyme-linked immunosorbent assay. Differences in OPN levels according to clinicopathologic variables were analyzed statistically. Significant differences in plasma OPN levels were observed between groups with and without muscle invasion (89.16 vs. 67.08ng/mL, p=0.041). Comparison according to tumor grade found no significant difference between high and low grade groups (p=0.115). Mean plasma OPN levels decreased after TURBT without statistical significance (p=0.571). Between groups with recurrence and those without recurrence, OPN levels of the group with recurrence were higher without statistical significance (p=0.161). Comparison of plasma OPN levels according to performance of radical cystectomy (RC) showed significant differences; patients who underwent RC showed higher levels of plasma OPN (95.58 vs. 70.37ng/mL, p=0.030). Comparison according to T stage after RC showed significant differences in OPN levels (T1: 67.45, T2: 86.60 and T3: 95.23ng/mL, respectively, p=0.006). The group with lymph node invasion showed significantly higher levels of OPN, compared to the group without invasion (153.24 vs. 68.03ng/mL, p=0.017). Preoperative plasma OPN levels correlated to muscle invasion of bladder UC and pathological stage after RC.

Several studies have suggested combination therapy with testosterone supplementation in patients not responding to PDE5 inhibitors. Considering the pathophysiological basis for testosterone supplementation, the present study aims to identify whether combination therapy allows persistence of treatment effect after testosterone discontinuation. Furthermore, we evaluated whether the degree of testosterone depletion affects treatment outcome from combination therapy. Hypogonadal patients (

Objectives: The aim of this study was to compare the efficacy of low (0.2 mg) and intermediate (0.4 mg) dose tamsulosin in treating lower urinary tract symptoms (LUTS). Methods: Patients were treated with low-dose tamsulosin for an initial run-in period of 12 weeks, then divided into two groups based on their clinical improvement. Patients were measured for objective parameters of peak flow rate and postvoid residual urine volume, as well as subjective symptom scores and perceived patient benefit of treatment. The items were then integrated as the LUTS Outcome Score to determine dose increase or maintenance. Overall outcome was determined at 36 weeks. Results: One hundred and seventy-four patients were enrolled and started on 0.2 mg tamsulosin treatment. One hundred and fifty-five patients completed the 36-week study. Sixty patients required dose increase to 0.4 mg at the 12th week. Baseline characteristics showed that a patient who would benefit from 0.4 mg dosage had higher age, daytime frequency, and lower peak urine flow rate. Patients receiving both 0.2 and 0.04 mg both showed improved clinical outcome measures. Higher improvement was found in voiding component symptom scores and urine flow rate improvement in patients receiving an increased dose. Conclusion: Both low- and intermediate-dose tamsulosin are effective treatment regimens. Increasing from low to intermediate dose should follow assessment of both objective and subjective improvements.