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Aim: To assess the relaxation effect of the phosphodiesterase-5 inhibitor udenafil on the bladder and prostatic urethra and its therapeutic potentials for benign prostatic hyperplasia (BPH)/lower urinary tract symptoms (LUTS). Methods: For the in vitro study, muscle strips from urinary bladder and urethra were prepared from male New Zealand rabbits. The strips were mounted in organ baths and connected to force transducers. After stabilization, maximal tissue contractions were obtained by the addition of phenylepinephrine for urethra strips and carbachol for bladder strips. When the contraction was stabilized, a dose-response curve of udenafil was constructed. For the in vivo study using adult male Sprague-Dawley rats, changes of intravesical pressure and urethral perfusion pressure after intraarterial administration of udenafil were monitored. Results: Udenafil significantly relaxed the bladder and urethra strips in a dose-dependent manner. At 10–3 M, udenafil induced a significant relaxation of the bladder strips by 37.3% and of the urethra strips by 44.0%. In the in vivo study, the intercontraction interval was significantly prolonged (p < 0.01) and the duration of urethral relaxation with high-frequency oscillations was significantly prolonged (p < 0.01) after udenafil. Conclusions: Udenafil had relaxant effects on the bladder and prostatic urethral smooth muscle. Clinically, udenafil could be applied as an effective treatment for BPH/LUTS.

The inability to engineer clinically relevant functional muscle tissue remains a major hurdle to successful skeletal muscle reconstructive procedures. This article describes an in vitro preconditioning protocol that improves the contractility of engineered skeletal muscle after implantation in vivo. Primary human muscle precursor cells (MPCs) were seeded onto collagen-based acellular tissue scaffolds and subjected to cyclic strain in a computer-controlled bioreactor system. Control constructs (static culture conditions) were run in parallel. Bioreactor preconditioning produced viable muscle tissue constructs with unidirectional orientation within 5 days, and in vitro-engineered constructs were capable of generating contractile responses after 3 weeks of bioreactor preconditioning. MPC-seeded constructs preconditioned in the bioreactor for 1 week were also implanted onto the latissimus dorsi muscle of athymic mice. Analysis of tissue constructs retrieved 1 to 4 weeks postimplantation showed that bioreactor-preconditioned constructs, but not statically cultured control tissues, generated tetanic and twitch contractile responses with a specific force of 1% and 10%, respectively, of that observed on native latissimus dorsi. To our knowledge, this is the largest force generated for tissue-engineered skeletal muscle on an acellular scaffold. This finding has important implications to the application of tissue engineering and regenerative medicine to skeletal muscle replacement and reconstruction.

To estimate the prevalence of overactive bladder (OAB) in Korean children, 5-13 years of age, and to assess the associated factors for OAB.A randomly selected cross-section study was conducted in 26 kindergartens and 27 elementary schools nationwide in Korea. A total of 19 240 children were included; a parent was asked to complete the questionnaires, which included items about OAB and voiding and defecating habits. OAB was defined as urgency with or without urge incontinence, usually with increased daytime frequency and nocturia (International Children's Continence Society, 2006). Its prevalence and associated factors were also investigated.The response rate for the questionnaires was 85.84%. The overall prevalence of OAB was 16.59%. The prevalence of OAB decreased with age from 22.99% to 12.16% (P = .0001). The overall incidence of wet and dry OAB was 26.97% and 73.03%, respectively. Compared with normal children, those with OAB had a greater prevalence of nocturnal enuresis, constipation, fecal incontinence, urinary tract infection, delayed bladder control, and poor toilet facilities (P.05). The incidence of increased daytime frequency and urge incontinence was 3.69% and 2.31% (P = .009) and 26.97% and 14.78% (P = .0001) in OAB and non-OAB children, respectively. The corresponding prevalence decreased with age from 5.04% to 3.06% and from 45.74% to 18.50% in OAB children (P = .0001).The overall prevalence of OAB in Korean children, 5-13 years of age, was 16.59% and decreased with age. Nocturnal enuresis, constipation, fecal incontinence, history of urinary tract infection, delayed bladder control, and poor toilet facilities might be factors associated with the development of OAB.

Copyright © 2015 Korean Society for Sexual Medicine and Andrology This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons. org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Androgen Deficiency and Testosterone Replacement: Current Controversies and Strategies

Erectile dysfunction (ED) can negatively impact the quality of life among men, and increasingly affects all age strata. This has led to an explosion of health information on ED both for patients and doctors, which may cause potentially harmful effects when misused or abused. Therefore, the necessity of developing a standardized, appropriate guideline for the diagnosis and management of ED is increasing. In this review, the author describes risk factors, diagnosis and treatment guidelines for ED, which can be usefully applied in clinical practice.

After the launch of sildenafil citrate (Viagra®), the last great invention of the 20th century, in 1998, oral phosphodiesterase (PDE)-5 inhibitors were established as first-line treatment for erectile dysfunction (ED), representing a paradigm shift in the diagnosis and treatment of ED [1]. The big success of sildenafil in pharmaceutical research and development led to the subsequent development of the so-called second-generation Viagras, e.g., tadalafil (Cialis®) and vardenafil (Levitra®) in 2003 [2]. Currently, these three PDE5 inhibitors are the most well-known PDE5 inhibitors worldwide. Following the early competition, PDE5 inhibitors have evolved continuously in competition for survival. In Korea, another three kinds of PDE5 inhibitors have been developed: udenafil (Zydena®) in 2005 [3], mirodenafil (Mvix®) in 2007 [4], and avanafil (Zepeed®) in 2011 [5]. In addition, following expiration of the patent on sildenafil in Korea in 2012, 49 companies have released 60 generic versions of sildenafil. Similarly, with expiration of the patent on tadalafil in Korea in 2015, 64 companies have released 160 generic versions of tadalafil. The availability of generic sildenafil and tadalafil has led to less expensive PDE5 inhibitors, which cost as little as 1/5 the cost of the original PDE5 inhibitors. The dosage concept has also evolved from on-demand to daily low-dose and alternative dosages [6]. Approval of daily use was based on the proven safety through long-term use of sildenafil. Hence, the indication for daily low-dose PDE5 inhibitors also broadened beyond ED to pulmonary hypertension for sildenafil and benign prostatic hyperplasia/lower urinary tract symptoms (BPH/LUTS) for tadalafil and penile rehabilitation after radical prostatectomy for both [6]. With the launch of generic PDE5 inhibitors, the preparation also evolved from a tablet to orodispersible film, granule, and chewable forms. The oro-disposable film and chewable are favorable from patients in Korea [7]. In Korea, the recent impact of generic tadalafil has differed completely from that of generic sildenafil in 2012. The long half-life of tadalafil enabled its approval for BPH/LUTS with daily low-dose use. In turn, various preparations of generic tadalafil will also be developed, including orodispersible films and combinations with an antihypertensive for ED and hypertension, a PDE5 inhibitor with alpha blockers for ED and LUTS, and a PDE5 inhibitor with antidepressant for ED and premature ejaculation. Since sildenafil citrate was launched in 1998, PDE5 inhibitors have evolved in various ways, including generics, changes in the dosage concept, broader indications beyond ED, and various preparations. In the future, various combination drugs will emerge for treating cross-risk factors, reducing pill burden and price, and eventually preventing and curing ED.

We assessed the effects of long-term oral desmopressin on serum sodium and baseline antidiuretic hormone secretion in elderly patients with nocturia.A total of 15 elderly male patients with severe nocturia (greater than 3 voids nightly) who did not show hyponatremia within 7 days of administration of 0.2 mg desmopressin were enrolled in this study. Desmopressin (0.2 mg) was administered orally nightly for 1 year. Before and 1 month after the 1-year medication 24-hour circadian studies were performed to monitor changes in antidiuretic hormone. Every 3 months during the 1-year medication serum changes and timed urine chemistry were monitored.Desmopressin significantly decreased nocturnal urine output and the number of nocturia episodes (p0.01). Compared to before treatment desmopressin gradually decreased serum sodium and induced statistically but not clinically significant hyponatremia after 6 months of treatment. After discontinuing desmopressin serum sodium returned to the normal range in all patients. There were no significant differences when baseline and posttreatment endogenous antidiuretic hormone were compared. No serious systemic complications were found during medication.Long-term desmopressin administration gradually decreased the serum concentration and induced significant hyponatremia from 6 months in patients who did not show initial hyponatremia. Long-term administration of desmopressin for 1 year in elderly patients did not affect baseline antidiuretic hormone secretion. For long-term desmopressin administration serum sodium should be assessed regularly, at least every 6 months.

This article presents data based on the responses of more than 100 women who contributed to the development of a Korean version of the Female Sexual Distress Scale (FSDS).The FSDS was developed to measure sexually related personal distress in women. This article aims to test the usefulness and analyze factors of the 20-item version of the FSDS in a Korean female sample.The original two-item FSDS was translated with cultural modifications. A total of 104 healthy, married women were recruited through a survey. A second survey was undertaken after 2 weeks for test-retest reliability. Validity, internal consistency reliability, and test-retest reliability were evaluated. An exploratory factor analysis was also performed.A Korean version of the FSDS.The test-retest coefficients of stability over a 2-week period was 0.99 (P0.01). The 20 items of the FSDS have good internal consistency, with an alpha of 0.96. The FSDS discriminated between women with and without sexually related distress (t = -7.34, P0.01). The optimal cut-off score was 20 (sensitivity 71.4%, specificity 92.2%). By principal axis factoring, the Korean version of the FSDS was found to consist of two factors. A 16-item FSDS had good internal consistency with an alpha of 0.97. The test-retest reliability was good (r = 0.99, P0.01). The items of the 16-item FSDS were somewhat different from the original 12-item FSDS.The Korean version of the FSDS (20-item) might be a useful tool for screening sexually distressed women in Korea. Instead of the 12-item version of the original FSDS, the 16-item FSDS was validated in this study. These results could reflect cultural differences between Eastern Asian and Western societies.

Institutional review board approval and informed consent were obtained. The purpose of the study was to prospectively evaluate magnetic resonance (MR) urethrography for the depiction of obliterative urethral stricture. Twelve patients with obliterative urethral stricture were examined preoperatively with T2-weighted, T1-weighted, and contrast material-enhanced T1-weighted MR imaging of a urethra distended with sterile lubricating jelly. Ten of the 12 patients were examined with conventional retrograde urethrography (RGU) combined with voiding cystourethrography (VCUG) prior to MR imaging. Each imaging result was compared with either a surgical specimen or a description of the surgical findings to determine which method allowed accurate estimation of stricture length. MR measurements of stricture length demonstrated significantly lower errors (P.05) and better linear fit to surgical measurement than did conventional RGU combined with VCUG measurements (r(2) = 0.85, P.001 and r(2) = 0.03, P.05, respectively). MR imaging of the urethra distended with sterile lubricating jelly is an effective tool for evaluating obliterative urethral strictures.

Aim: To present preliminary results on health-related quality of life (QoL), prostate-associated symptoms and therapeutic effects of targeted-cryosurgical ablation of the prostate (TCSAP) with androgen deprivation therapy (ADT) in high-risk prostate cancer (PCa) patients. Methods: Thirty-four men with high-risk PCa features underwent TCSAP, and ADT was added to improve the treatment outcomes. High-risk parameters were defined as either prostatespecific antigen (PSA) ≥ 10ng/mL, or Gleason score ≥ 8, or both. The Genito–Urinary Group of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30) with prostate-cancer-specific module (QLQ-PR25) was used for evaluating morbidities and PSA levels were recorded every 3 months. PSA failure was defined as the inability to reach a nadir of 0.4 ng/mL or less. Results: Although it was not statistically significant, the global health status scores increased after TCSAP with ADT. The scores for five functional scales also became higher after treatment. The most prominent symptom after treatment was sexual dysfunction, followed by treatment-related and irritative voiding symptoms. Conclusion: TCSAP with ADT appears to be minimally invasive with high QoL except for sexual dysfunction. Long-term follow-up of PSA data and survival is necessary before any conclusions can be made on the efficacy of this promising new therapeutic modality in the treatment of PCa. (Asian J Androl 2006 Sep; 8: 629–636 )

OBJECTIVE To investigate the circadian variation of plasma antidiuretic hormone (ADH) and urine output in patients with severe nocturia (> three times per night) and to assess the effect of oral desmopressin on nocturnal urine output in these patients. PATIENTS AND METHODS Twelve patients with severe nocturia and five age-matched controls without were assessed over 24 h (circadian sampling) during a 72-h hospital admission. Blood levels of ADH and changes of urine output were measured in the patients before and after the oral administration of desmopressin (0.2 mg, at 22.00 hours in the second day), and in the controls not treated with desmopressin. RESULTS Compared with the normal control, the patients had no diurnal variation in urine output and greater nocturnal urine production, associated with a lack of nocturnal increase in ADH level. Compared with the baseline urine output, desmopressin significantly decreased night-time (23.00–08.00 hour) urine output in the patients (P

A polyhalogenated aromatic hydrocarbon, 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD), is one of the most potent toxic environmental pollutants. Decreases in spermatogenesis and the ability to conceive and carry a pregnancy to term are the most sensitive signs of reproductive toxicity by TCDD in the mammal, but no report of its effect on the erectile function exists. We performed this study to investigate the effect of TCDD on the erectile function. New Zealand white rabbits were treated intraperitoneally with 1 microg/kg of TCDD. At 4 (Gr I) and 8 (Gr II) weeks after the administration of TCDD, cavernosal tissues were harvested for strip study in the organ bath and testes were prepared for histologic examination. Compared to the maximal amplitude of 17.1+/-4.12 mN in normal control (Gr III), the contractions to cumulative concentrations of NE (10(-8)-10(-4) M) were significantly decreased to 6.57+/-1.34 and 5.45+/-1.01 mN in Groups I and II, respectively. Compared to 51.12+/-7.38% in Gr III, relaxation to cumulative concentration (10(-8)-10(-4) M) of acetylcholine was significantly decreased to 17.25+/-2.17% (Gr I) and 9.73+/-2.17% (Gr II) at a concentration of 10(-4) M, respectively. Compared to 75.12+/-13.18% in Gr III, relaxation to cumulative concentration (10(-8)-10(-4) M) of SNP was significantly decreased to 31.49+/-7.89% (Gr I) and 18.54+/-6.12% (Gr II) at a concentration of 10(-4) M, respectively. Histologically, intracavernosal fibrosis, abnormal subtunical deposition of fat and decreased sinusoidal space with consequent increase of trabecular smooth muscle contents were identified in TCDD-treated groups. In TCDD-treated animals, seminiferous tubules showed a decrease of germ cells with vacuolar degeneration and apoptotic cells. Spermatids were hardly seen. These results suggest that TCDD inhibits spermatogenesis and has a potential harmful effect on erectile function via changes of corpus cavernosum histology and smooth muscle physiology.

Although augmentation phalloplasty is not an established procedure, some patients still need enlargement of their penis. Current penile augmentation is girth enhancement of penile body by dermofat graft. We performed this study to identify the efficacy and the patient's satisfaction of human glans penis augmentation with injectable hyaluronic acid gel. In 100 patients of subjective small penis (Group I) and 87 patients of small glans after dermofat graft (Group II), 2 cm(3) of hyaluronic acid gel was injected into the glans penis, subcutaneously. At 1 y after injection, changes of glandular diameter were measured by tapeline. Patient's visual estimation of glandular size (Gr 0-4) and patient's satisfaction (Grade (Gr) 0-4) were evaluated, respectively. Any adverse reactions were also evaluated. The mean age of patients was 42.2 (30-70) y in Group I and 42.13 (28-61) y in Group II. The maximal glandular circumference was significantly increased compared to basal circumference of 9.13+/-0.64 cm in Group I (P

To identify the sexual, emotional and psychological status of men who augmented their penis with mineral oil injection for their small penis.Men who had penile paraffin were asked to answer the semi-structured questionnaire. The questionnaire was designed to assess the motivation, method of penile injection, changes in erectile function and satisfaction after penile injection. SCL (Symptom checklist)-90-R, STAI (State and Trait Anxiety Inventory) and Zung SDS (Self-rating depression scale) were also included in the questionnaire for psychological evaluation.A total of 357 men completed the questionnaire. The first-ranked motivation of the injection was recommendation by their acquaintances (48.9 %). The majority of the respondents had the procedure by non-medical person (78.0 %). Before injection, 17.2 % had a sense of inferiority in their penis and 32 % worried about their weak erectile function. After injection, 33.0 % have found relief from their sense of inferiority and 17.8 % wish to feel improvement in their erectile function. Most of the respondents (91 %) were not satisfied with their penis and 74 % of them replied that they want to remove the injected material. Only 15.6 % did not experience side effects. Most of the subjects have suffered from various side effects such as inflammation, skin necrosis, pain, etc. No evidence of psychiatric pathology was found in psychological evaluation.The motivations of mineral oil injection were recommendation by their acquaintances or desire to be more mannish. Most of them had suffered from various side effects and only a small number of them felt improvement in their sense of inferiority, in their penis and erectile function. Increased public awareness is needed for the prevention of this physically and psychologically debilitating problem.

Despite extensive research into the toxicity of bisphenol A (BPA), no report of its effect on erectile function exists. We performed this study to investigate the effect of BPA on erectile function. New Zealand white rabbits were treated intraperitoneally with 150 mg/kg of BPA every other day for 12 days (cumulative dose of 900 mg/kg). Four and 8 weeks after administration of BPA, the contractions and relaxation of cavernosal tissue strips were significantly suppressed in the BPA-treated animals compared to the control animals. Histologically, thickening of tunica albuginea, subtunical deposition of fat and decreased sinusoidal space with consequent increase of trabecular smooth muscle content were observed in the BPA-treated animals. These results suggest that xenoestrogen BPA may affect the erectile function through evident histological changes of the penis.

Purpose: A nationwide survey was conducted of Korean urologists to illustrate physicians’ perceptions and real practical patterns regarding Peyronie disease (PD). Materials and Methods: A specially designed questionnaire exploring practice characteristics and attitudes regarding PD, as well as patient satisfaction with each treatment modality, was e-mailed to 2,421 randomly selected urologists. Results: Responses were received from 385 practicing urologists (15.9%) with a median time after certification as an urologist of 12 years. Regarding the natural course, 87% of respondents believed that PD is a progressive disease, and 82% replied that spontaneous healing in PD occurred in fewer than 20% of patients. Regarding diagnosis of PD, the methods used were, in order, history taking with physical examination (98%), International Index of Erectile Function questionnaires (40%), intracavernous injection and stimulation (35%), and duplex sonography (28%). Vitamin E was most preferred as an initial medical management (80.2%), followed by phosphodiesterase-5 inhibitors (27.4%) and Potaba (aminobenzoate potassium, 20.1%). For urologists who administered intralesional injection, the injected agent was, in order, corticosteroid (72.2%), verapamil (45.1%), and interferon (3.2%). The most frequently performed surgical procedure was plication (84.1%), followed by excision and graft (42.9%) and penile prosthesis implantation (14.2%). Among the most popular treatments in each modality, the urologists’ perceptions regarding the suitability of treatment and patient satisfaction were significantly different, favoring plication surgery. Conclusions: The practice pattern of urologists depicted in this survey is in line with currently available Western guidelines, which indicates the need for development of further local guidelines based on solid clinical data.

Purpose: We conducted a retrospective study to investigate causative bacteria of adult epididymitis and their characteristics and resistance in the recent 10 years at a tertiary hospital. Materials and Methods: We reviewed the medical records of 121 patients who were diagnosed with acute epididymitis from 2002 to 2012. Diagnosis was based on symptoms, physical examination, and ultrasonography. We analyzed causative organisms and changes of antibiotic resistance pattern according to time course in the recent 10 years. Results: The most commonly detected bacteria were Pseudomonas aeruginosa and Escherichia coli. Fluouroquinolone resistance has emerged since 2006 and 50% of the patients have resistance to fluouroquinolones. Conclusions: Quinolone resistance composes a major proportion of the causative organism. Therefore, while according to the guidelines, fluoroquinolone may be the first response for elderly men, we recommend that antibiotic resistance should be considered if fever persists, and other antibiotics could be included.

Purpose To evaluate the efficacy and safety of silodosin 8 mg once daily in a 12-week treatment of subjects with severe lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH). Materials and Methods A total of 100 subjects from 10 urology centers in Korea were included in this study. The inclusion criteria were as follows: age ≥50 years, International Prostate Symptom Score (IPSS) ≥20, quality of life (QoL) score ≥3, urine volume ≥120 mL and maximal urinary flow rate (Qmax)

Extraosseous metaplasia of the urinary tract is an uncommon condition first described in 1923 by Phemister. Bone formation can occur anywhere along the urinary tract but most has been described in renal pelvis, calyx or along the urothelial layer. We report a case of extraossesous bone formation within the kidney parenchyma appearing as a calcified multiseptated mass.

Purpose To estimate the prevalence of overactive bladder (OAB) with and without nocturnal enuresis (NE), and to asses the relating factors of OAB in Korea. Material and Methods A randomly selected cross sectional study was conducted in 27 kindergartens and 28 elementary schools (16,516 children: 6–13 years). The questionnaires included items about the OAB and NE. OAB was defined as urgency with or without urge incontinence, usually with increased daytime frequency and nocturia (group A) or increased daytime frequency (>8 times/day) and/or urge urinary incontinence (group B). Results The overall prevalence of OAB was 16.59 % (group A) and 18.79% (group B). In group A and B, prevalence of OAB was decreased with age from 22.99% to 12.16% and from 40.44% to 9.60%, respectively (p = 0.0001). Compared to normal, children with OAB had a higher prevalence of NE (p = 0.0001), constipation (p = 0.002), fecal incontinence (p = 0.0001) and history of urinary tract infection (p = 0.001), and a statistically insignificant relation with delayed bladder control, toilet type, parent's scholarship, double-income family and amount of income. Increased daytime frequency and urge incontinence in group A and normal children,were 3.69%, 2.31% (p = 0.009), and 26.97%, 14.78% (p = 0.0001), respectively. Prevalences of increased daytime frequency and urge incontinence in group A were decreased with age from 5.04% to 3.06% and from 45.74% to 18.50%, respectively (p = 0.0001). Conclusions The overall prevalence of OAB in group A in Korean children was similar to that in group B. NE, constipation, fecal incontinence and history of urinary tract infection may be risk factors of OAB.

Purpose: To evaluate the actual impact of testosterone replacement therapy (TRT) on patients with lower urinary tract symptom (LUTS), without benign prostate hyperplasia (BPH) medication. Materials and Methods: Two hundreds forty-six patients underwent TRT using intramuscular injection of 3 months bases injection of testosterone 100 mg undecanoate over a year. Among them, 17 patients had moderate LUTS with a maximal flow rate of at least 10 ml/s but did not take any BPH-specific medication during TRT. The changes in prostate specific antigen (PSA), International Prostate Symptom Score (IPSS), and uroflowmetery were measured before and after TRT. Results: After TRT, PSA remained unchanged after a year of treatment (p=0.078). Compared with their counterparts (n=229), the patients without BPH medication had similar baseline prostate characteristics in all variables, including prostate volume, IPSS, maximal flow rate, voiding volume, and PSA, except the median amount of residual urine, which was higher in the patients without BPH medication (21 ml vs. 10 ml). In the no-BPH medication group, the total IPSS score was decreased significantly (p=0.028), both in storage symptoms (questionnaire 2, 4, 7) and voiding symptoms (questionnaire 1, 3, 5, 6), while the maximal flow rate and residual urine amount remained unchanged after a year of TRT. During the median follow up of 15.1 months, no patients experienced urinary retention, BPH-related surgery, or admission for urinary tract infection. Conclusions: Over a year of TRT for the no-BPH medication patients with moderate LUTS and maintained a relatively high maximal flow rate and improved both storage and voiding symptoms, without the clinical progression of BPH or rising PSA.

Purpose To investigate the relationship of transrectal ultrasound (TRUS) findings with the pathological characteristics of prostate cancer (PCa). Materials and Methods The study was conducted retrospectively by analyzing the data for 970 patients who underwent prostate biopsies. Gleason scores and other clinical variables were compared between PCa patients with and without hypoechoic lesions on TRUS. Results Of the 970 patients, PCa was diagnosed in 291 (30%). Of these, high-grade PCa (Gleason score of 7 or more) was diagnosed in 190 (65%). The cancer detection rate was higher in patients with hypoechoic lesions (43.9%) than in those without hypoechoic lesions (21.4%, p

Purpose: It has been reported that prostate-specific antigen (PSA) correlates with prostate volume. Recently, some studies have reported that PSA mass (PSA adjusted for plasma volume) is more accurate than PSA at predicting prostate volume. In this study, we analyzed the accuracy of PSA and the related parameters of PSA mass, free PSA (fPSA), and fPSA mass in predicting prostate volume. Materials and Methods: We retrospectively investigated 658 patients who underwent prostate biopsy from 2006 to 2012 and had a confirmed negative biopsy result. International Prostate Symptom Score (IPSS) questionnaire, PSA, fPSA, and prostate volume were investigated. PSA mass and fPSA mass were calculated by use of established formulas. The association between PSA-related parameters and IPSS and prostate volume was assessed by using Pearson correlation coefficient and receiver operating characteristic curves. Results: There was no significant difference between PSA and PSA mass, fPSA, or fPSA mass in predicting prostate volume except in obese patients (p-value of PSA–PSA mass for 40 cm 3 , 0.54; p-value of fPSA–fPSA mass for 40 cm 3 , 0.34). fPSA performed significantly better than PSA at predicting prostate volume (p-value for 40 cm 3 , ＜0.001). IPSS and the aforementioned PSA-related parameters were not significantly correlated. Conclusions: PSA mass was not a better predictive value than PSA for estimating the prostate volume in Korean men except in obese men. This finding was also applicable to the relationship of fPSA and fPSA mass, which appeared to be more accurate predictors of prostate volume than either PSA or PSA mass.

Purpose Parental decisions about the treatment of nocturnal enuresis (NE) are generally based on silent agreement with a physician's recommendation. However, physicians may have an insufficient understanding about parents' concerns and expectations regarding treatment. The aim of this study was to clarify the discrepancies between the perceptions of parents and physicians and to better understand the attitudes related to NE treatment. Materials and Methods A survey was conducted in six centers and included 105 parents and 102 physicians. Two questionnaires, one for parents and another for physicians, were prepared. Each contained items on demographic characteristics, concerns, and NE treatment preferences. The parents completed the questionnaire during their child's first clinical visit, and the physicians completed the questionnaire via e-mail or individual interviews. Results Low self-esteem was the most common concern among both parents and physicians. Parents showed a more serious concern regarding disease progression and sequelae than did physicians. In the parent group, parents of younger children were mainly concerned about growth, whereas parents of children with daytime symptoms were mainly concerned about disease progression and relationships. Treatment outcome preferences differed significantly between the two groups. Physicians preferred treatments yielding immediate results, whereas parents preferred long-term treatments that would result in low recurrence. Conclusions This survey presents the differences between parents and physicians regarding NE concerns and therapeutic preferences. Our study may provide valuable insight for physicians regarding parental attitudes toward NE treatment.

We recently encountered a case of stuttering priapism in a 41-year-old patient with neurosyphilis. Priapism very rarely has a neurogenic cause, and to our knowledge, priapism caused by neurosyphilis has not been reported previously in the literature. Our aim was to report this case and systematically review the related literature.

Purpose: According to previous studies, the prevalence of premature ejaculation (PE) in Korea ranges from 11.3% to 33%. However, the actual practice patterns in managing patients with PE is not well known. In this study, we have endeavored to determine how contemporary urologists in Korea manage patients with PE. Materials and Methods: The e-mailing list was obtained from the Korean Urological Association Registry of Physicians. A specifically designed questionnaire was e-mailed to the 2,421 urologists in Korea from May 2012 to August 2012. Results: Urologists in Korea diagnosed PE using various criteria: the definition of the International Society for Sexual Medicine (63.4%), Diagnostic and Statistical Manual of Mental Disorders (43.8%), International Statistical Classification of Disease, 10th edition (61.7%), or perceptional self-diagnosis by the patient himself (23.5%). A brief self-administered questionnaire, the Premature Ejaculation Diagnostic Tool, was used by only 42.5% of the urologists. Selective-serotonin reuptake inhibitor (SSRI) therapy was the main treatment modality (91.5%) for PE patients. 40.2% of the urologists used phosphodiesterase type 5 inhibitors, 47.6% behavior therapy, and 53.7% local anesthetics. Further, 286 (54.3%) urologists managed PE patients with a surgical modality such as selective dorsal neurotomy (SDN). Conclusions: A majority of Korean urologists diagnose PE by a multidimensional approach using various diagnostic tools. Most urologists believe that medical treatment with an SSRI is effective in the management of PE. At the same time, surgical treatment such as SDN also investigated as one of major treatment modality despite the lack of scientific evidence.

Purpose: Medical treatment of Peyronie’s disease with tamoxifen has been initially proposed as acting upon the early phase of the disease. As recent reports show no significant benefit of tamoxifen, we review the long term results of tamoxifen treatment of Peyronie’s disease. Materials and Methods: Time to progression during tamoxifen treatment of patients showing acute disease and chronic disease was compared. The acute phase was identified by pain during erection. Progression was defined as enlargement of plaque size or appearance of calcification. Results: The average treatment duration was 15.9±013.8 months (range: 3 to 48 months). The median time to progression was 7 months for acute patients and 20 months for chronic patients. Eighty percent of patients in the acute phase showed relief of pain; however, overall progression was 72.1% (78.0% for acute, 66.7% for chronic). Patient history, comorbidities, serum testosterone or initial plaque characteristics, and severity of curvature were not predictive of disease progression. Conclusions: Tamoxifen showed no significant benefit in slowing the progression of Peyronie’s disease in the acute phase over the chronic phase. Peyronie’s disease continued to progress, though at a dampened rate for patient’s in the chronic phase.

Purpose: Retinopathy, neuropathy, and nephropathy are well-known complications of diabetes; they are often expected to occur and, therefore, are usually tested for. However, urogenital complications, such as sexual and voiding dysfunctions, are less well known, and consequently, many patients are not treated appropriately despite their symptoms. Thus, we surveyed diabetic patients with regard to their perception of urogenital complications. Materials and Methods: We designed a survey for patients in our hospital who were being treated for diabetes mellitus (DM). The questionnaire included items on age, sex, treatment duration, treatment options for and the level of perception of urogenital symptoms, the presence of urogenital symptoms, and whether treatment was intended or had been initiated. Results: In total, 275 patients participated in the survey. The perception questions on DM-associated urogenital complications showed that 89 patients (32.4%) had no knowledge, 84 patients (30.5%) had some knowledge, and 102 patients (37.1%) had detailed knowledge about these complications. A total of 124 patients (45.1%) reported urogenital symptoms: 93 patients (75.0%) reported voiding dysfunction and 61 patients (49.2%) reported sexual dysfunction. Common symptoms of voiding dysfunction were urinary frequency, nocturia, sense of residual urine, weak stream, and urinary incontinence. Common symptoms of sexual dysfunction were reduced libido, and erectile and ejaculatory dysfunction. Conclusions: The survey showed that the subjective prevalence rate of urogenital symptoms in diabetic patients was 45.1%. However, only a small percentage (37.1%) of the patients cognized that these symptoms were associated with DM. Therefore, it is necessary to properly inform and educate diabetic patients on possible urogenital complications that may occur.

Purpose: In the endoscopic treatment of vesicoureteral reflux, the relatively high rate of success, the simplicity of the procedure, high patient compliance, and a lack of complications has led to the increased development of injection materials and techniques. We report a method of identifying and maintaining a clear visual field during ureteral and bladder submucosal wall injection of a dextranomer/hyaluronic acid copolymer (Deflux, Oceana, Therapeutics Inc.) by use of the hydrodistention implantation technique (HIT) with the aid of temporary ureteral catheter insertion. Materials and Methods: We prospectively reviewed patients with grade IV or V reflux who received an endoscopic injection of Deflux. Reflux grade was evaluated before and after treatment (3 months) by use of voiding cystourethrograms. Conventional sub-trigonal injection (STING) was performed with injection of Deflux underneath the bladder mucosa at the 6 o’clock position. HIT was performed either with hydrodistention or with guidewire insertion. These techniques increase visualization of the intramural portion of the distal ureteral wall. Patients with treatment failures were offered reinjection up to three times. Results: Sixty-three patients completed endoscopic injection and follow-up of 3 months. The overall resolution rate for conventional STING was 58%, i.e., 67% for grade IV and 43% for grade V. The overall resolution rate for HIT was 80%, i.e., 93% for grade IV and 66% for grade V. The modified methods showed higher resolution rates for overall cure owing to the success in patients with grade IV reflux (p=0.026). Although the success of grade V treatment was higher with the modified method, the success rate was not statistically significant (p=0.27). Conclusions: HIT with the use of either hydrodistention or a guidewire to aid in visualization of the intramural portion of the distal ureter is an effective treatment for high-grade vesico-ureteral reflux.

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.

=A bstract = Testosterone decrease in men with age has become well established. As such, several modes of testosterone replacement therapy have become available, primarily for supplementation to alleviate the effects of age associated hypogonadism, as manifested by frailty, sarcopenia, poor muscle quality, decreased libido and erectile functions. Recent investigations have found significant association between hypogonadism and cardiovascular disease, type 2 diabetes, obesity and dyslipidemia. The association is more clearly presented in patients receiving androgen deprivation therapy for prostate cancer. Furthermore, testosterone supplementation restores arterial vasoreactivity, reduces proinflammatory cytokines, total cholesterol, and triglyceride levels, and improves endothelial function and insulin sensitivity. Future long term trials should be performed to identify persistent benefits and safety of this treatment.

Purpose This study was conducted to investigate the effect of testosterone replacement treatment (TRT) in testosterone deficiency syndrome (TDS) patients with metabolic syndrome. Materials and Methods We reviewed the data of 200 men who were diagnosed with TDS and were undergoing TRT between August 2006 and August 2009. The 200 patients were divided into two groups (group 1: 71 patients with metabolic syndrome, group 2: 129 patients without metabolic syndrome) depending on metabolic syndrome, which was diagnosed according to the NCEP III criteria for Asians. Age, BMI (body mass index), waist circumference, serologic tests, AMS (the Aging Males' Symptoms scale), and IIEF (International Index of Erectile Function) were measured. Results In group 1, waist circumference and fasting glucose were significantly decreased; hemoglobin and total testosterone were increased; and the somatovegetative scale score of the AMS, the total AMS score, the erectile function score of the IIEF, the overall satisfaction score of the IIEF, and the total IIEF score were significantly improved after TRT. On the other hand, in group 2, waist circumference, BMI, total cholesterol, LDL, and fasting glucose were significantly decreased; hemoglobin and total testosterone were increased; and the 2 subscale scores of the AMS (psychologic and somatovegetative), the total AMS score, all subscale scores of the IIEF, and the total IIEF score were significantly improved after TRT. Conclusions Overall, the patients who had TDS with metabolic syndrome showed less improvement in AMS, IIEF, and serum variables. Therefore, the correction of metabolic syndrome, such as diabetes, obesity, and hypertension, should be considered during TRT.

Recent advances in laser technology have provided a varied arsenal for endoscopic treatment of benign prostatic hyperplasia. Laser is a collimated coherent radiation of photons generated by stimulated emission of gain media, allowing transfer of selective, controlled and focused energy to the targeted tissue. The application of laser to prostate surgery developed hand-in-hand with refinements to the equipment. Earlier lasers were low powered modalities with no significant tissue selectivity, aimed at thermal coagulation and resulted in significant side effects and recurrence. Since then, prostate lasers have developed towards a more high-powered and selective modality that allowed complete ablation of the tissue with fewer complications. Fiber technology has also developed to allow efficient and safe transfer of a continuously increasing energy output. It is important for the surgeon to understand these fundamental principles of laser and prostate surgery, not only to select the proper tools, but also to properly implement the technique as well.

156 접수일자: 2011년 8월 10일, 수정일자: (1차) 2011년 8월 19일, (2차) 2011년 8월 22일, 게재일자: 2011년 8월 23일 Correspondence to: Du Geon Moon Department of Urology, Korea University College of Medicine, Korea University Institute for Regenerative Medicine, 80, Guro-dong, Guro-gu, Seoul 152-703, Korea Tel: 02-2626-1320, Fax: 02-2626-1321 E-mail: dgmoon@korea.ac.kr Effect of PDE5 Inhibitor in Nonsurgical Management of Peyronie’s Disease: Preliminary Study

We developed and validated a novel Korean prostate cancer risk calculator (KPCRC) for predicting the probability of a positive initial prostate biopsy in a Korean population. Data were collected from 602 Koreans who underwent initial prostate biopsies due to an increased level of prostate-specific antigen (PSA), a palpable nodule upon digital rectal examination (DRE), or a hypoechoic lesion upon transrectal ultrasound (TRUS). The clinical and laboratory variables were analyzed by simple and multiple logistic regression analysis. The area under the receiver operating characteristic curve (AUC) was computed to compare its performance to PSA testing alone. Prostate cancer was detected in 172 (28.6%) men. Independent predictors included age, DRE findings, PSA level, and prostate transitional zone volume. We developed the KPCRC using these variables. The AUC for the selected model was 0.91, and that of PSA testing alone was 0.83 (P < 0.001). The AUC for the selected model with an additional dataset was 0.79, and that of PSA testing alone was 0.73 (P = 0.004). The calculator is available on the website: http://pcrc.korea.ac.kr. The KPCRC improved the performance of PSA testing alone in predicting the risk of prostate cancer in a Korean population. This calculator would be a practical tool for physicians and patients.