Sleep-Related Erections(SREs) in Chronic Vegetative State Patients / 대한남성과학회지

PURPOSE: To determine whether sleep-related erections(SREs) occur during chronic vegetative state and if so, to investigate what factors are involved. MATERIALS AND METHODS: Twenty-six men in a vegetative state aged 16~65 were selected. Exclusion criteria were the lack of informed consent, mean blood pressure under 90/60 mmHg during last 3 days, erectile dysfunction before brain injury, and a history of any anti-androgen treatment. Serum testosterone, albumin, sex hormone binding globulin(SHBG), and dehydroepiandrosterone sulfate(DHEAS) were assayed, and bioavailable testosterone(cBT) and free testosterone(cFT) were calculated. Nocturnal penile erections were counted and evaluated using the Rigiscan device for72 hours. Data on the number of erections, erection duration, minimal and maximal base tumescence, minimal and maximal tip tumescence, and base and tip rigidity were taken. RESULTS: SREs were noted in 25 patients. The mean erection number was 4.65+/-3.93(1~15), and the mean erection duration was 128.85+/-46.86 minutes(0~478.5). SREs were negatively correlated with age(r=-0.445, p<0.05), systolic BP(r=-0.394, p<0.05) and diastolic BP(r=-0.403, p<0.05), but positively correlated with DHEAS(r=0.395, p<0.05). SREs were not correlated with total testosterone, cBT or cFT. CONCLUSIONS: These preliminary findings suggest that SREs are a normal occurrence in vegetative patients. They contribute to penile blood perfusion if the supraspinal erection control center is intact and serum testosterone level is above the minimum required for SREs.

Expression of Hypoxia-inducible Factor-1alpha and Vascular Endothelial Growth Factor in Corpus Cavernosum of the Type 2 Diabetes Mellitus Rat / 대한남성과학회지

PURPOSE: The expression of hypoxia-inducible factor-1alpha(HIF-1alpha) and vascular endothelial growth factor(VEGF) has been known as important factor of vascular complications in diabetes mellitus. The penile tumescence has variable degree according to vascularity. The aims of this study were to investigate erectile function and cavernosal expression of HIF-1alpha and VEGF in Otsuka Long-Evans Tokushima Fatty(OLETF) rats, which develop NIDDM naturally. MATERIALS AND METHODS: Ten male OLETF rats and ten control male Long-Evans Tokushima Fatty(LETO) rats were included in this study. The development of diabetes mellitus for OLETF were defined by glucose tolerance test at 26 weeks. After 72 weeks, OLETF rats, LETO rats and ten twenty-week male Sprague-Dawley rats were studied. Intracavernosal pressure were measured after cavernous nerve stimulation. Immunohistochemical stain and Western blot analysis were done for HIF-1alpha and VEGF in corpus cavernosum. RESULTS: Cavernous nerve stimulation-induced mean intracavernosal pressure(mmHg) was significantly decreased in the OLETF group(21.6+/-6.7 mmHg) compared to LETO(32.8+/-16.0 mmHg) group and in the LETO group compared to Sprague-Dawley group(47.2+/-11.7 mmHg)(p <0.05). With Western blot analysis, HIF-1alpha and VEGF expressions were higher in the OLETF group compared to other groups. With immunohistochemical stain, HIF-1alpha and VEGF were mainly expressed in corpus cavernosum and endothelium. CONCLUSIONS: We propose that increased HIF-1alpha and VEGF expressions in OLETF rat penile tissue can be found at microvascular injury in corpus cavernosum and are presumed to be associated with vasculogenic erectile dysfunction.

The Usefulness of Ice-water Test in the Patients with Symptomatic Benign Prostatic Hyperplasia (BPH) Associated with Overactive Bladder / 대한비뇨기과학회지

Purpose: A video-urodynamic study is known as the most accurate test to differentiate between benign prostatic hyperplasia (BPH) with overactive bladder and detrusor instability but requires expensive equipment and an expert technique, so is not commonly available. We performed a video- urodynamic study and ice-water test which is easily performed for the diagnosis of a neurogenic bladder in the patients with symptomatic BPH associated with overactive bladder and compared the results. Materials and Methods: The video-urodynamic study using a 10-Fr triple lumen urodynamic catheter was performed in 36 patients with symptomatic BPH associated with overactive bladder that had frequency, weak stream, nocturia, urgency, urge incontinence, dysuria and no clinical neurogenic defect. After the video-urodynamic study, the ice-water test was performed by instilling 4degreesC sterilized water through a catheter at 200ml/ min in the supine position. The volume instilled was about 30% of the bladder capacity. The ice-water test was positive if there was an efflux of water around the catheter during or after water instillation. Results: Thirty two of the 36 symptomatic BPH patients with an overactive bladder were negative on the ice-water test. All 32 patients who had a negative ice-water test were BPH with overactive bladder on the video- urodynamic study. Four of the 36 symptomatic BPH patients with an overactive bladder were positive on the ice-water test. Two of the 4 patients who had a positive ice-water test were BPH with overactive bladder and the other two were detrusor instability on the video-urodynamic study. Conclusions: Therefore, in case of a positive ice water test, a video-urodynamic study is needed to differentiate between BPH with overactive bladder and detrusor instability in patients with symptomatic BPH associated with overactive bladder.

Increased Expression of Hypoxia-Inducible Factor-1alpha in Castrated Rat Penile Tissue / 대한남성과학회지

PURPOSE: Hypoxia-inducible factor 1(HIF-1) is a transcriptional activator of genes whose products are involved in systemic, local, and cellular responses to hypoxia. We investigated the effect of androgen deprivation on the expression of HIF-1alpha and related proteins in the penile corpus cavernosum of castrated rat. MATERIALS AND METHODS: Thirty adult male Sprague-Dawley rats(250~350 gm) were divided into 3 groups of 10 each: sham operation(group 1), bilateral orchiectomy(group 2), and bilateral orchiectomy plus hormone replacement(group 3). Testosterone propionate(2 mg/day for 4 weeks) was used for hormone replacement. At 4 weeks after surgery, serum testosterone and erythropoietin were measured, and the expression of HIF-1alpha and VEGF were examined by immunohistochemical staining and Western blot of corpus cavernosum. RESULTS: There was no significant change in serum erythropoietin among the three groups. HIF-1alpha and VEGF immuno-positive cells were dense in vascular endothelium and cavernosal smooth muscle and showed more intense staining in the orchiectomy group compared with the control and sham operation groups. The amount of HIF-1alpha and VEGF proteins detected by Western blot were also increased in the orchiectomy group compared with the control and sham operation groups. CONCLUSIONS: These results suggest that increased HIF-1alpha expression in the penile tissue of castrated rat results from adaptive responses to hypoxia, and testosterone deprivation may contribute to hypoxic injury in the cavernosal microenvironment.