Effect of Improvement in Lower Urinary Tract Symptoms on Sexual Function in Men: Tamsulosin Monotherapy vs. Combination Therapy of Tamsulosin and Solifenacin

PURPOSE: To evaluate how much the improvement of lower urinary tract symptoms (LUTS) affects sexual function and which storage symptoms or voiding symptoms have the greatest effect on sexual function. MATERIALS AND METHODS: A total of 187 patients were enrolled in this study. Patients were randomly assigned to receive either tamsulosin 0.2 mg (group A) or tamsulosin 0.2 mg and solifenacin 5 mg (group B). At 4 weeks and 12 weeks, the LUTS and sexual function of the patients were evaluated by use of the International Index of Erectile Function-5 (IIEF5), International Prostate Symptom Score (IPSS), Overactive Bladder Symptom Score (OABSS) questionnaire, uroflowmetry, and bladder scan. RESULTS: Both groups A and B showed statistically significant improvements in IPSS, OABSS, and quality of life (QoL). Group A showed improved maximum flow rate, mean flow rate, and residual urine volume by time. Group B did not show an improvement in flow rate or residual urine volume but total voiding volume increased with time. The IIEF5 score was not improved in either group. In group A, the IIEF5 score dropped from 13.66+/-4.97 to 11.93+/-6.14 after 12 weeks (p=0.072). Group B showed a decline in the IIEF5 score from 13.19+/-5.91 to 12.45+/-6.38 (p=0.299). Although group B showed a relatively smaller decrease in the IIEF5 score, the difference between the two groups was not significant (p=0.696). CONCLUSIONS: Tamsulosin monotherapy and combination therapy with solifenacin did not improve erectile function despite improvements in voiding symptoms and QoL. The improvement in storage symptoms did not affect erectile function.

Effect of Improvement in Lower Urinary Tract Symptoms on Sexual Function in Men: Tamsulosin Monotherapy vs. Combination Therapy of Tamsulosin and Solifenacin

PURPOSE: To evaluate how much the improvement of lower urinary tract symptoms (LUTS) affects sexual function and which storage symptoms or voiding symptoms have the greatest effect on sexual function. MATERIALS AND METHODS: A total of 187 patients were enrolled in this study. Patients were randomly assigned to receive either tamsulosin 0.2 mg (group A) or tamsulosin 0.2 mg and solifenacin 5 mg (group B). At 4 weeks and 12 weeks, the LUTS and sexual function of the patients were evaluated by use of the International Index of Erectile Function-5 (IIEF5), International Prostate Symptom Score (IPSS), Overactive Bladder Symptom Score (OABSS) questionnaire, uroflowmetry, and bladder scan. RESULTS: Both groups A and B showed statistically significant improvements in IPSS, OABSS, and quality of life (QoL). Group A showed improved maximum flow rate, mean flow rate, and residual urine volume by time. Group B did not show an improvement in flow rate or residual urine volume but total voiding volume increased with time. The IIEF5 score was not improved in either group. In group A, the IIEF5 score dropped from 13.66+/-4.97 to 11.93+/-6.14 after 12 weeks (p=0.072). Group B showed a decline in the IIEF5 score from 13.19+/-5.91 to 12.45+/-6.38 (p=0.299). Although group B showed a relatively smaller decrease in the IIEF5 score, the difference between the two groups was not significant (p=0.696). CONCLUSIONS: Tamsulosin monotherapy and combination therapy with solifenacin did not improve erectile function despite improvements in voiding symptoms and QoL. The improvement in storage symptoms did not affect erectile function.

Translation and Linguistic Validation of the Korean Version of the Pelvic Pain and Urgency/Frequency Patient Symptom Scale / 대한배뇨장애요실금학회지

PURPOSE: The objective of this study was to achieve a linguistic adaptation of the original version of the Pelvic Pain and Urgency/Frequency (PUF) Patient Symptom Scale into Korean. MATERIALS AND METHODS: Between June 2008 and December 2008, a linguistic adaptation was carried out by 2 native Korean speakers who were also fluent in English. First, the original English version of the PUF was translated into Korean. A panel, which included the 2 translators, reviewed the translations to form a single reconciled forward translation of the Korean version. Then, another bilingual translator, having never seen the original version, back-translated the first draft of the Korean version of the PUF into English, and this back-translation was subsequently assessed for equivalence to the original. The panel discussed all discrepancies and produced a second version. After revising the 2nd version, 10 participants [5 interstitial cystitis (IC) patients and 5 persons from the general population], stratified variously by age, sex, and educational level, answered the PUF and were systematically debriefed afterwards. A summary of the changes from the patient interviews were incorporated into the third version. After the spelling, grammar, layout, and formatting were checked, the third version was verified as the final Korean version of the PUF, without modifications. RESULTS: The multi-step process of forward translation, reconciliation, back-translation, cognitive debriefing, and proofreading of the Korean version of the PUF was completed. CONCLUSIONS: The Korean version of the PUF scale may be helpful for screening IC patients in the Korean population and can now be used in Korea.

Onset of Action of Phosphodiesterase Type 5 Inhibitors in the Treatment of Erectile Dysfunction / 대한남성과학회지

PURPOSE: After the market launch of multiple phosphodiesterase type 5 inhibitors (PDE5Is), a considerable amount of information has emerged regarding the efficacy and the time of initiation of these drugs. In clinical situations, however, many patients with erectile dysfunction (ED) have complained about the onset of erection occurring later than expected or desired. We therefore studied the time course for initiating an erection after usage of PDE5Is. MATERIALS AND METHODS: One hundred forty-one patients who were medicated with PDE5Is > 4 times in the most recent 3 months were included for study. The patients were divided into 3 groups: sildenafil (n=51), vardenafil (n=51), and tadalafil (n=39). The choice of PDE5I was made according to the patient's and/or doctor's preferences. Regardless of the type of drug selected, the patients were recommended to have sexual stimulation 15 minutes after taking the medication. RESULTS: The onset of action of the 3 drug groups were significantly different (sildenafil, 57.0+/-38.5 min; tadalafil, 79.5+/-50.6 min; and vardenafil, 44.4+/-26.6 min; p<0.05). Psychogenic causes of ED resulted in a shorter PDE5I onset of action than organic causes of ED. Other factors, such as body mass index and international index of erectile function erectile function domain score, were shown not to differ with respect to the onset of action of PED5Is. CONCLUSION: In clinical situations, patients need more time for the onset of erections after taking PDE5Is. For restoration of a healthy sexual life, patients needs more time to achieve an erection after taking PDE5Is.

Sildenafil Compliance after Restoration of Erectile Function / 대한남성과학회지

PURPOSE: Regarding for erectile dysfunction(ED), Sildenafil has produced satisfactory clinical results. However, Some patient discontinue sildenafil treatment for a variety of reasons after successful restoration of erectile function. We investigated the reasons for such discontinuations of sildenafil after restoration of erectile function by sildenafil medication. MATERIALS AND METHODS: After sildenafil medication, one hundred fifty six patients whose score of erectile function domain of the 15-item International Index of Erectile Function(IIEF) increased to 26 or more, were included in this study. Six-months after the first sildenafil prescription, compliance to medication and the reason for discontinuity were reviewed by chart or surveyed by telephone. RESULTS: In 156 successfully treated patients, 54(34.6%) discontinued sildenafil medication. The 2 most common reasons for discontinuation were trouble in the partners' or patients' emotional readiness for restoration of sexual activity after long-term abstinence and fear of possible side effects. CONCLUSIONS: After restoration of erectile function, many patients discontinued the use of sildenafil medication. The reasons for discontinuing the medication were primarily emotional or relationship-oriented issues. The counseling of both partners and education about the effects and side effects of the drugs are recommended to promote the successful recovery of sexual activity.

A Synergistic Effect of Apomorphine on Sildenafil Induced Penile Erection in Conscious Rabbits / 대한비뇨기과학회지

PURPOSE: The aim of this study was to demonstrate that the combined systemic administration of apomorphine (APO) and sildenafil have a synergistic effect on the erection in conscious rabbits. MATERIALS AND METHODS: The erections of the male New Zealand White rabbits (2-3kg, n=12) were assessed by measuring the length of the uncovered penile mucosa (LUPM) and duration of the erection, both before and after the intravenous administration of agents. After the injection of APO (0, 0.05, 0.1, 0.4mg/kg), sildenafil was administered intravenously in a dose-response manner (0.5, 1, 5mg/kg), followed by measurements for 0-120 minutes. In additional experiments, the effect of increasing the dosages of sildenafil, combined with APO, on blood pressure were evaluated. RESULTS: The intravenous administration of sildenafil caused a concentration dependent increase in the LUPM. There was a statistically significant increase in the LUPM with the administration of APO compared with no administration. The dosages of sildenafil and APO showing the greatest efficacy of sildenafil potentiation were 1mg/kg and 0.1 mg/kg, respectively. The intravenous administration of APO at a dose of 0.1mg/kg was more effective than those of 0.05 and 0.4mg/kg, with dosages of sildenafil of 0.5 and 1mg/kg. There was no additional increase in the duration of erection on the administration of APO. The intravenous administration of sildenafil caused a concentration dependent decrease in blood pressure, but there was no additional decrease on administration of the APO. CONCLUSIONS: We have shown that apomorphine elicits a stronger response on the erection induced by sildenafil in conscious rabbits, with no additional decrease in blood pressure.

Epidemiologic Study about Varicoceles of 19 Year-old Men in Chung-Nam Province / 대한남성과학회지

PURPOSE: To survey epidemiologic characteristics about varicocele and identified several characteristics in young men. MATERIALS AND METHODS: Between May and December 2001, 2,700 were randomly selected at a 10.0% sampling fraction by census district of 27,202 men aged 19 years. A total of 2,080 (a response rate 77.0%) men underwent a standard evaluation including testicular volume. Of men with unilateral varicocele, testicular atrophy was defined as a testis 25% or more smaller (volume/volume) than its contralateral mate. RESULTS: Among participants, 169 (8.1%) men with 199 varicoceles were observed to have varicoceles on physical examination or had a history of varicocelectomy. The varicocele was on the left side in 136 (80.5%), right side in three (1.8%), and bilateral in 30 (17.7%). Of 125 men with unilateral varicocele, physical examination revealed grade I varicocele in 34 men (27.2%), grade II in 45 (36.0%), and grade III in 46 (36.8%). Testicular volume (13.6 +/- 4.6mL) of affected side in varicocele group was significantly smaller than that of contralateral side (16.3 +/- 4.5 mL) in varicocele group as well as right (15.9 +/- 4.5 mL) or left side (15.3 +/- 4.6 mL) in normal group (p<0.001). Testicular volume of contalateral side in varicocele group was significantly larger than that of left side in normal group (p<0.05). Comparing with testicular parameters according to grades of varicocele, testicular volume of affected side was not dependent on grades of varicoceles. However, rate of testicualr atrophy was dependent on grades of varicocele. However, the ratio of testicular atrophy was present in four (12.9%) of grade I, 14 (29.2%) of grade II, and 19 (41.3%) of grade III. These differences were statistically significant (p=0.028). CONCLUSIONS: The prevalence of varicocele in this population was found to 8.1%. It is important to measure the volume of both testes of an adolescent with a varicocele to determine the effect of varicocele on the testicular volume. Our findings suggest that men with higher grades of varicocele have hypertrophied testis of contralateral side.

Studies on Intracellular Signal Transduction Pathway Involved in Human and Rabbit's Corpus Cavernosal Smooth Muscle Relaxation / 대한남성과학회지

PURPOSE: Nitric oxide (NO) and phosphodiesterases (PDEs) play key roles in mediating relaxation of corpus cavernosal smooth muscle by increasing intracellular cGMP level. Here, we investigated effects of NO-donor (sodium nitroprusside, SNP) and penile specific type-V PDE inhibitor (zaprinast) in human and rabbit corpus cavernosal cells and tissues in vitro. MATERIALS AND METHODS: The cultured smooth muscle cells and tissues of human and rabbit corpus cavernosum were treated with increasing concentrations of SNP or zaprinast for 5 and 20 minutes, respectively, and intracellular cGMP levels were measured by radioimmunoassay. Organ bath study was performed to measure the relaxation effects of drugs on precontracted corpus cavernosal muscle strips. RESULTS: Although both NO-donor and type-V PDE inhibitor effectively stimulated the accumulation of cGMP in a dose-dependent manner, magnitude of cGMP increase and specificity of drug were found to be species-dependent. In human corpus cavernosal tissues, cGMP was increased upto 10- and 5-folds by SNP and zaprinast, respectively. However, magnitude of increase was much less in cultured smooth muscle cells. In rabbit, SNP effect was most prominent in cultured cells and effects of SNP and zaprinast were modest in tissues. Both agents also resulted in effective relaxation of human and rabbit cavernosal tissue strips. Similar patterns of dose-response curves were shown between results from the organ bath studies and cGMP radioimmunoassay with cavernosal smooth muscle cells. CONCLUSIONS: Present results show that effects of SNP and zaprinast are not coincident in different species, suggesting possible species-specificities of these two agents. Measurement of cGMP changes in cultured cavernosal smooth muscles cells could be reflected to the relaxation effects of drugs on corpus cavernosal muscle strips.

The Psychologic Study on the Self Esteem about Penile Size of the Third Decade Men in Korea / 대한남성과학회지

PURPOSE: The penile augmentation operation is becoming popular in Korea, but there is not enough data about psychologic aspects of Korean male's thoughts about their penile size. We investigated the flaccid and stretched penile sizes of young Korean males and their penile size complex or pride. We performed Minnesota Multiphasic Personality Inventory (MMPI) test. This study may be used for better patient consultation in penile augumentation. MATERIALS AND METHODS: After explanation and agreement to the purpose and methods of this study, 123 Korean male in early 20's who visit our institution were studied. We measured their pre-pubic bone fat pad depth, flaccid penile length, flaccid mid-shaft circumferences and stretched length under warm and comfortable private environment. Because the stretched penile length closely correlated with the erect length, we did not measure the erect length. Then they were asked to answer questions of MMPI and other questions including, 'how do you think about your penile size?'. We used the student t-test to analyze our data statistically. RESULTS: In 123 subjects, mean flaccid length, flaccid circumference, stretched length and fat pad depth were 6.9 0.8cm, 8.5+/-1.1cm, 9.6+/-0.8cm and 1.1+/-0.4cm respectively (Table 1). In 123 subjects, the distribution of the answer about penile size was 1 (0.8%) 'very small', 29 (23.6%) 'small', 86 (69.9%) 'normal', 6 (4.9%) 'large', and 1 (0.8%) 'very large'. Compared to the subjects who thought their penis was normal, the subjects who thought their penile size was small, showed high hypochondriasis and psychasthenia scale and the subjects who thought their penile size was large, showed high hysteria scale in MMPI test. Subjects who underestimated their penile size, showed high depression, psychasthenia scale in MMPI test CONCLUSIONS: In consultation of the patient who want penile augmentation, urologist should consider psychologic tendency of the patients about their penile size.