ABSTRACT
PURPOSE: Some authors have suggested that erectile dysfunction correlates with the level of glycemic control and glycosylated hemoglobin can be used to predict erectile dysfunction in diabetic patients. This study evaluated whether or not glycosylated hemoglobin level can predict the effectiveness of sildenafil citrate, which is a first line therapy for erectile dysfunction. MATERIALS AND METHODS: A consecutive sample of 32 men with type 2 diabetes and erectile dysfunction completed the International Index of Erectile Function (IIEF) and had their glycosylated hemoglobin levels measured. 50mg of sildenafil citrate was prescribed at the first visit, which was then increased to 100mg if the symptom persisted. According to the response, the patients were divided into responders and nonresponders. The pretreatment clinical parameters (age, diabetic duration, erectile dysfunction duration, glycosylated hemoglobin level, body mass index, IIEF, diabetic complications, smoking, alcohol drinking) were recorded. The patients were divided into 3 groups according to the drug dosage (group 1 was 50mg responders, group 2 was 100mg responders, group 3 was nonresponders in any dosage) and the clinical parameters were compared and analyzed. RESULTS: The mean hemoglobin A1c level was 8.68 0.74% and 7.64 1.67% in the nonresponders and responders (p < 0.05), respectively. Diabetic neuropathy and diabetic retinopathy were significantly higher in the nonresponders (p < 0.05). The mean hemoglobin A1c levels of the three groups were 7.36 1.01, 7.78 0.98, and 8.64 0.44%, respectively and group 3 was significantly higher than the other groups (p < 0.05). CONCLUSIONS: High levels of glycosylated hemoglobin suggests a poor response to sildenafil citrate in diabetic patients with erectile dysfunction. Diabetic patients with neuropathy or retinopathy may have a low response for sildenafil citrate.
Subject(s)
Humans , Male , Body Mass Index , Citric Acid , Diabetes Complications , Diabetic Neuropathies , Diabetic Retinopathy , Erectile Dysfunction , Glycated Hemoglobin , Smoke , Smoking , Sildenafil CitrateABSTRACT
PURPOSE: Premature ejaculation is the most common male sexual disorder, affecting perhaps as many as 75% of men, but its cause has not been well established. The objective of this study is to evaluate whether alcohol injection on the dorsal aspect of the penis can induce a desensitization of penile sensory nerve fiber in rats. MATERIALS AND METHODS: Forty-four male Sprague-Dawley rats were divided into 4 groups. Group I of 4 rats, the control group, did not undergo any procedure. Group II of 8 rats, received only an alcohol injection without electrical stimulation. In group III of 4 rats, only electrical stimulation was performed without alcohol injection. In group IV of 28 rats, all rats received an alcohol injection on the dorsal aspect of the penis, and groups of four rats were sacrificed after electrical stimulation on the glans penis at 1, 2, 4, 7, 10, 14, and 21 days after alcohol injection. Spinal cords were sectioned and processed for immunohistochemical staining for c-Fos protein. RESULTS: No c-Fos protein was detected in the normal control group, and either none or few c-Fos protein positive neurons were seen in the alcohol injection only group. The number of c-Fos protein positive neurons in the electrical stimulation only group was 30.25+/-3.53 cells/section. Four days after alcohol injection, the level of c-Fos protein positive neurons was reduced significantly compared with the control group (p<0.05), and was very close to the control group at 10 days after alcohol injection. CONCLUSIONS: Our study demonstrates that alcohol injection in the dorsal aspect of the penis reduces c-Fos protein positive neurons in the spinal cord segment through desensitization of penile sensory nerve fibers.
Subject(s)
Animals , Humans , Male , Rats , Electric Stimulation , Nerve Fibers , Neural Conduction , Neurons , Penis , Premature Ejaculation , Rats, Sprague-Dawley , Spinal CordABSTRACT
PURPOSE: A retrospective analysis was performed to investigate the factors that affect stone recurrence in patients who were stone-free after extracorporeal shock wave lithotripsy(SWL). MATERIALS AND METHODS: From February 1990 to December 1992, 1039 patients were treated by SWL with EDAP LT-01+ lithotriptor. Among them 200 patients were followed up at 60 months. Fifty eight(29.0%) of 200 patients had recurrent stone after SWL. We analysed the patients according to patient age, sex, location, multiplicity and size of the original stones, serum calcium and uric acid level, urinary calcium and uric acid level at presentation, anatomical abnormality and pyuria after SWL as possible factors affecting stone recurrence. RESULTS: Mean age of the patients was 43.6 years(range 7 to 81) and there were 115 male and 85 female patients with sex ratio 1.35:1. Age and sex did not affect stone recurrence. The recurrence rates according to the stone location were 100%(1/1) for staghorn calculi, 28.6%(2/7) for pelvic stones, 26.2%(16/61) for single calyceal stone, 47.8%(11/23) for multiple calyceal stones and 29.7%(41/138) for ureteral stones. Stone location did not affect stone recurrence. 16(47.0%) of 34 renal units with multiple stones had recurrent stones, whereas 55(28.1%) of 196 renal units with single stone recurred. Multiplicity of the stone was the risk factor for stone recurrence(p<0.05). The stone size(renal unit) of less than 20mm were identified in 213 and 64(30.0%) of them had recurrent stones, whereas stone size(renal unit) of more than 20mm were identified in 17 and 7(41.2%) of them had recurrent stones. More than 20mm of the stone size was the risk factor for stone recurrence(p<0.05). Hypercalcemia, hyperuricemia, hypercalciuria, and hyperuricosuria did not affect stone recurrence. 14(28.6%) of 49 patients who had pyuria after SWL had recurrent stones, whereas sterile urine after SWL were noted in 151 and 44(29.1%) of them had recurrent stones. Pyuria after SWL did not affect stone recurrence. Anatomical abnormality was noted in 5 patients and 4(80%) of them showed recurrence, but there was no statistical significance due to small populations. CONCLUSIONS: Multiplicity and size of the stones were the risk factor for stone recurrence. But patient age, sex, location of the original stones, serum calcium and uric acid level, urinary calcium and uric acid level at presentation and pyuria after SWL did not affect stone recurrence.
Subject(s)
Female , Humans , Male , Calcium , Calculi , Hypercalcemia , Hypercalciuria , Hyperuricemia , Lithotripsy , Pyuria , Recurrence , Retrospective Studies , Risk Factors , Sex Ratio , Shock , Ureter , Uric AcidABSTRACT
PURPOSE: There are a variety of open surgical and endoscopic methods to the treatment of urethral injuries. The objective of our study is to evaluate the efficacy of primary endoscopic urethral realignment according to the injury site. MATERIALS AND METHODS: Twenty eight patients with urethral injuries(23 anterior and 5 posterior) were treated by primary endoscopic urethral realignment from March 1990 to August 1997. According to the injury site, age distribution, etiology of injury, associated injuries, time to operation, operating time, duration of urethral Foley catheterization, maximal flow rate, postoperative complications and treatment of post-realignment stricture were reviewed. RESULTS: The age range of our patients was from 20 to 86 years(mean 45.0). Among the 28 patients, 23 were anterior and 5 were posterior urethral injuries. Pelvic bone fracture was associated in 1 patient(20.0%) in the anterior urethral injury group, while 5 patients(100%) in the posterior urethral injury group. The mean time after injury to realignment was 1.9 days (range 0 to 9) and the mean operating time was 53.9 minutes in the anterior urethral injury group(range 20-190) and 79.0 minutes in the posterior urethral injury group(range 25-170). The mean duration of urethral Foley catheterization was 24.5 days in the anterior urethral injury group and 61.4 days in the posterior urethral injury group. The mean maximal flow rate after catheter removal was 31.4ml/sec in the anterior urethral injury group and 24.6ml/sec in the posterior urethral injury group. Of the 23 patients, 9 patients(39.1%) had post-realignment strictures in the anterior urethral injury group and 8 were treated with visual urethrotomy, and only one patient was required open urethroplasty. Of the 5 patients, 4 patients(80.0%) had post-realignment strictures in the posterior urethral injury group and treated with visual urethrotomy. CONCLUSIONS: Primary endoscopic urethral realignment is a safe and simple technique with minimal mobidity regardless of injury site. The stricture formation, impotence and incontinence rates of this technique are comparable to those reported for open surgical methods. Finally, most post-realignment strictures can be treated successfully with visual internal urethrotomy with or without occasional sound dilation.
Subject(s)
Humans , Male , Age Distribution , Catheters , Constriction, Pathologic , Erectile Dysfunction , Pelvic Bones , Postoperative Complications , Urinary CatheterizationABSTRACT
To determine whether the relative proportion of stromal and epithelial hyperplasia is related to the development of symptomatic benign prostatic hyperplasia, we measured the percentage of stroma and gland by quantitative morphometric analysis in the prostate adenomas from men with symptomatic and asymptomatic BPH. Prostate adenomas were obtained from 9 men with asymptomatic BPH undergoing cysto-prostatectomy for invasive transitional cell carcinoma of the bladder (group 1), 15 with symptomatic BPH undergoing transurethral resection of the prostate and 5 with symptomatic BPH undergoing open prostatectomy( = 60g: group 2b). The results obtained were as follows. 1. The prostate adenomas from group 1, 2a and 2b contained 57.1 %, 68.2% and 68.8% of stroma and 19.69t, 14.3% and 13.2% of epithelium and 23.3%, 17.5% and 18.0% of glandular lumen, respectively. The difference in percentage of stroma, epithelium and glandular lumen in the prostate adenoma from men with symptomatic and asymptomatic BPH were statistically significant(P 0.1). 3. The prostate adenomas from 19 men with modified Boyarsky irritative symptom scoring over 7 were compared with 16 men with scores less than 7. The results were 67.6% vs. 69.9%, l3.8% vs. 14.1% and l8.0% vs. 16.2% of stroma, epithelium and glandular lumen, respectively ( P>0.1) . In conclusion, the prostate adenomas from men with symptomatic BPH were composed of more proportion of stroma and lesser proportion of epithelium and glandular lumen than those from men with symptomatic BPH. The histological composition of prostate adenomas were not related to the severity of obstructive or irritative symptom.
Subject(s)
Humans , Male , Adenoma , Carcinoma, Transitional Cell , Epithelium , Hyperplasia , Prostate , Prostatic Hyperplasia , Urinary BladderABSTRACT
Between February 1990 and February 1993, Radiolucent stones of 27 renal units in 22 patients were treated by extracorporeal shock wave lithotripsy(ESWL) using the EDAP LT-01 +. Intravenous urography was done in all patients for the diagnosis of radiolucent stones. Retrograde pyelography, ultrasonography and/or computed tomography was done, if needed. The locations of stones were kidney in 11(40.7%), upper ureter in 8(29.6%), lower ureter in 6(22.2%), bladder in 1(3.7%), ureteropelvic junction in 1(3.7%). The average stone size was 10.9mm with a range of 5 to 32mm in maximum diameter. The average numbers of treatment were 2.7 sessions and average storage required was 34.8 in one session. The average treatment time was 40.4 minutes. All the patients showed complete removal of all calculous materials. Of 17 urinary stones analysed by chemical method, 8(47.1%) were composed of uric acid, 5(29.4%) of uric acid and calcium, 3 of phosphate and 1 of carbonate and phosphate. Therefore, we conclude that ESWL with EDAP LT-01 + lithotriptor is considered to be a effective noninvasive procedure for treatment of radiolucent stones.
Subject(s)
Humans , Calcium , Carbon , Diagnosis , Kidney , Lithotripsy , Shock , Ultrasonography , Ureter , Uric Acid , Urinary Bladder , Urinary Calculi , UrographyABSTRACT
Between January 1985 and December 1991, 32 cases with prostatic carcinoma were admitted to the Department of Urology, Wonkwang University Hospital. The incidence of prostatic carcinoma was 1.0% or all inpatients, 1.4% of male inpatients and 19.5% of all male genitourinary tract tumors. The patient age ranged from 51 to 84 years with a mean of 68.3 years. The most common presenting symptom was prostatism in 28 cases (87.5 %). On digital rectal examination. 14 cases (43.8 %) had a localized hard prostate and 8 cases(25%) had a diffuse hard prostate. Excretory urography revealed elevation of bladder base in 23 cases (88.5 %). Biopsy or cytology of the prostate was performed in 32 cases by transrectal needle biopsy, fine needle aspiration cytology and TUR biopsy. Of the 32 case, 20 cases (62.5 %) were stage D2, 4 cases (12.5 %) stage C, 2 cases(6.3 %) stage B1, 4 cases (12.5 %) stage A1 and 2 cases refused further examination with treatment. Endocrine therapy was performed in 22 cases and radical prostatectomy with pelvic lymphadenectomy was performed in 2 cases. Of all 32 cases were followed for 9 months to 89 months. Of the 4 cases with clinical stage A1, 2 cases died at 10, 24 months after initial treatment, respectively. Six cases with clinical stage B1 and C were proved to be alive. Of the 20 cases with clinical stage D2, 10 cases died and their mean survival period was 21.7 months.
Subject(s)
Humans , Male , Biopsy , Biopsy, Fine-Needle , Digital Rectal Examination , Incidence , Inpatients , Lymph Node Excision , Needles , Prostate , Prostatectomy , Prostatism , Urinary Bladder , Urography , UrologyABSTRACT
Between February 8, 1990 and August 31, 1992, 12 renal units in 11 pediatric patients were treated by extracorporeal shock wave lithotripsy(ESWL) with the EDAP LT-01 + lithotriptor.The results were obtained as follows: 1. The sex ratio was 1.2:1, and the average patient age was 8.5 years with a range of 16 months to 15 years. 2. The locations of stones were renal without staghorn calculi in 1 renal units (33.3%), staghorn calculi in 2 (16.7%). upper ureter in 2(16.7%) and lower ureter in 4 renal units(33.3%). The average stone size was 16.8 mm with a range or 5 mm to 50 mm. 3. The factors predisposing to stone formation were urinary tract infection in 4 patients (36.4%), hypercalciuria in 1 (9.1%), hypoplastic kidney in 1 (9.1%), incomplete duplicated ureter in 1 (9.1%) and unknown factor in 4 (36.4%). 4. Or the 11 patients, 2 patients required I.V. anesthesia, 1 patient required epidural anesthesia and 8 patients were treated without any type of anesthesia. 5. The average number of treatment were 5.1 sessions and average storage required was 22.2 in one session. The average treatment time was 43 minutes. 6. The success rate of treatment-ended 11 renal units (complete removal of stones) were 90.9% 7. Comparing the results of ESWL in the treatment of urolithiasis in adult and children, the average storage of treatment was almost equal in both groups, but the time and numbers of treatment required in children was greater. Therefore, we conclude that extracorporeal shock wave lithotripsy with EDAP LT-01 + lithotryplor is considered to be a safe and effective procedure for treatment of urinary stones in child.
Subject(s)
Adult , Child , Humans , Anesthesia , Anesthesia, Epidural , Calculi , Hypercalciuria , Kidney , Lithotripsy , Sex Ratio , Shock , Ureter , Urinary Calculi , Urinary Tract Infections , UrolithiasisABSTRACT
Cystic lesions of the adrenal are extremely rare. Pseudocysts (39% of all adrenal cysts) are the most common clinically detected cysts and result from hemorrhage into normal adrenal gland due to severe infection and trauma or adrenal neoplasm. Histologically, the lining of adrenal pseudocyst is not covered with epithelium and is composed of connective tissue. We are presenting a case of infected adrenal pseudocyst suffering from right lower chest and upper abdominal pain in a 35-year-old woman with brief review of the literatures.