The Study of X Chromosome Inactivation Mechanism in Klinefelter's Syndrome by cDNA Microarray Experiment

To investigate the XIST gene expression and its effect in a Klinefelter''s patient, we used Klinefelter''s syndrome (XXY) patient with azoospermia and also used a normal male (XY) and a normal female (XX) as the control, We were performed cytogenetic analysis, Y chromosomal microdeletion assay (Yq), semi-quantitative RT-PCR, and the Northern blot for Klinefelter''s syndrome (KS) patient, a female and a male control, We extracted total RNA from the KS patient, and from the normal cells of the female and male control subjects using the RNA prep kit (Qiagen), cDNA microarray contained 218 human X chromosome-specific genes was fabricated. Each total RNA was reverse transcribed to the first strand cDNA and was labeled with Cy-3 and Cy-5 fluorescein, The microarray was scanned by ScanArray 4000XL system. XIST transcripts were detected from the Klinefelters patient and the female by RT-PCR and Northern blot analysis, but not from the normal male, In the cDNA microarray experiment, we found 24 genes and 14 genes are highly expressed in KS more than the normal male and females, respectively. We concluded that highly expressed genes in KS may be a resulted of the abnormal X inactivation mechanism.

Successful Pregnancy by ICSI using Spermatozoa Banked Prior to Bone Marrow Transplantation for Severe Apalstic Anemia and Chronic Myelogenous Leukemia / 대한불임학회지

OBJECTIVE: To report tow cases of successful pregnancies following long term cryopreserved spermatozoa prior to bone marrow transplantation (BMT) for chronic myelogenous leukemia (CML) and severe aplastic anemia (SAA). MATERIALS AND MEHTODS: Case report. RESULTS: With the first case, after cryopreservation of semen from 25 year-old man with CML prior to BMT, his wife is being pregnant by intracytoplasmic sperm injection (ICSI) using thawed spermatozoa. With the second case, 28 year-old man with SAA became father by ICSI using banked spermatozoa before BMT. CONCLUSION: These cases support that men with malignancy have the chance of fathering their own genetic children. It is important therefore, to increase the awareness of clinicians especially oncologists and patients themselves to the new developments in preserving fertility for cancer patients.

The Korean Version of the International Index of Erectile Function(IIEF): Reliability and Validation Study / 대한비뇨기과학회지

PURPOSE: The international index of erectile function(IIEF) is a multidimensional scale for assessment of erectile function and detecting treatment-related changes in patients with erectile dysfunction. It was developed by Dr. Rosen in 1997 and composed of 15-item questionnaire of five relevant domains of sexual function(that is, erectile function, orgasmic function, sexual desire, intercourse satisfaction, and overall satisfaction). The IIEF currently is available in more than 30 languages for use in multinational clinical trials, and demonstrates adequate sensitivity and specificity for detecting treatment-related changes in erectile function in patients with erectile dysfunction. For application of the IIEF to Korean, it is inevitable to demonstrate the reliability and validity of Korean version of IIEF, since the cultural background is one of the most important factors which often results in misinterpretation of the questionnaire. MATERIALS AND METHODS: From May 13th to July 20th 1998, a total of 39 patients aged over 30 who visited Andrology Clinic with the complaint of erectile dysfunction were enrolled for the patient group and 40 age-matched volunteers who visited the Department of Family Medicine without erectile dysfunction were enrolled for a control group. Self administered questionnaire survey was performed with linguistically valid Korean version of IIEF for all study subjects and was repeated with the inteval of 10-25 days(between the first and second survey). The results were analyzed statistically by PC-SAS version 6.12. RESULTS: Two separate aspects of scale reliability were evaluated, namely, internal consistency and test-retest repeatability. Internal consistency(Cronbach`s alpha) was computed separately for the five domains in patient and control group. Responses in overall satisfaction was highly consistent with alpha value of 0.96. A satisfactory degree of consistency also was observed for items in the other domains(alpha values greater than 0.70). Test-retest repeatability was assessed by computing correlations between the domain score and total scale scores at the first and the second survey. There was no significant difference in the domain scores and total scale scores between the first and the second survey; nevertheless, test-retest repeatability was relatively low for the orgasmic function(r=0.67) and intercourse satisfaction(r=0.70) domains. Relatively high correlations were observed for the other domains(r value of 0.73 to 0.85), as well as for the total scale scores(r=0.88)(p<0.01). To demonstrate validity, domain scores were compared with the monthly frequency of sexual intercourse(convergent validity) and with scales that measure occupational satisfaction(divergent validity). Siginificant positive correlations were observed between the monthly frequency of sexual intercourse and subscale scores for all five domains. In contrast, none of the correlations between domain scores and measure of occupational satisfaction reached statistical significance. Discriminant validity was assessed by comparing the responses for patients with erectile dysfunction with control group by repeated measures ANOVA. Highly significant differences were observed between the patients with erectile dysfunction and age-matched controls. CONCLUSIONS: Based on the results of this study, the Korean version of IIEF was verified in its reliability and validity. This can be used as a brief and reliable self-administered scale for assessing erectile function and for detecting treatment-related changes in patients with erectile dysfunction. Furthermore, this can be used as universal and objective scale in multinational clinical trial and research field.

Prevalence of Benign Prostatic Hyperplasia in Jeong-Eup Area: Community-based Study / 대한비뇨기과학회지

PURPOSE: There is no consensus about a definition of benign prostatic hyperplasia, but there are various definitions based on a combination of clinical parameters used to describe the properties of BPH: symptoms of prostatism, increase of prostate volume, and bladder outlet obstruction. The prevalence of clinical BPH in Asian was believed to be lower than Caucasian. The lower urinary tract symptoms associated with BPH in Korea was reported by some authors and it was similar to the results of other studies in western countries. We report the prevalence of BPH in Korean men through a community-based study in Jeong-Eup county, Korea. MATERIALS AND METHODS: A total of 653 men aged 50 and over in Jeong-Eup area, Korea was randomly selected for determination of the prevalence of BPH. The definition of BPH in this study was combination of moderate(8-19) to severe(>19) I-PSS, enlargement of the prostate over 30gms on digital rectal examination by one board certified urologist, and decreased peak flow rate below 15ml/sec. Men with abnormal digital rectal examination(DRE) and elevated serum prostate specific antigen(PSA) above 3.5ng/ml were undergone sextant prostate biopsy to exclude the prostate cancer. RESULTS: I-PSS questionnaires were completed in 431 men and the response rate was 66.1%. Based on I-PSS, 162 men(37.6%) had moderate symptoms and 51 men(11.9%) severe symptoms. Of 213 men with moderate to severe symptoms, 35.7% had enlarged prostate by DRE, and 63.1% decreased flow rate. The prevalence of BPH by the definition in this study was 4.3% in their fifties, 13.2% in sixties and 16.3% in seventies and over eighty(overall, 11.1%). The population-adjusted prevalence of BPH in Korean men aged 50 and over was 8.7%. A good correlation was found between the total symptom score and the quality of life score that is included in the I-PSS. CONCLUSIONS: Men with moderate to severe I-PSS was 49.5%, which was similar to the results from other studies in Caucasian and Japanese. The prevalence of BPH in Korea by aforementioned definition was 8.7%, which seems to be lower than Caucasian. This results suggest that approximately 1,600,000 Korean men had moderate to severe urinary symptoms and 300,000 clinical BPH by the definition in this study.

Age-specific Reference Ranges for Prostate Specific Antigen from a Health Center in Korea / 대한비뇨기과학회지

PURPOSE: The PSA is believed to be the most useful tumor marker available for prostate cancer. Several investigations were published which established the role of age-specific reference ranges in screening and early detection of prostate cancer. This study is to determine age-specific reference ranges for serum PSA concentration in a health center of Korea in comparison with those of other races. MATERIALS AND METHODS: Between June, 1996 and May, 1997, a total of 18,928 Korean men aged 40 to 79 years who were examined in the health center of Asan Medical Center had serum PSA screening tests for prostate cancer. There were 9 cases of prostate cancer. Serum PSA concentrations of whom had no prostate cancer were determined with Tandem-R PSA assay (Hybritech). Descriptive statistics, including the median values, 25th, 75th and 95th percentiles of the distribution of serum PSA concentration, were calculated for 5-year and 10-year age-groups from aged 40 through 79. A regression model was used to characterize the distribution of the logarithm of serum PSA concentration by age. RESULTS: The serum PSA concentration correlated directly with age(r=0.19; p<0.05). Adjusted for age, the serum PSA concentration was lower for Korean men than for Caucasian, black men or Japanese men. Thus the recommended age-specific reference ranges(95th percentile) for serum PSA concentration for Korean men of our health center were lower as well; 0.0-2.1 ng/ml for 40-49 years, 0.0-2.5 ng/ml for 50-59 years, 0.0-3.0 ng/ml for 60-69 years, 0.0-3.6 ng/ml for 70-79 years. CONCLUSIONS: These findings suggest that the age-specific reference ranges for serum PSA concentration are lower for Korean men than for Caucasian or black men. Newly proposed age-specific reference ranges by our institute would be more valuable for Korean men.

Prevalence of Stress Urinary Incontinence and Bladder Irritative Symptoms in Women: a Community Based Survey / 대한비뇨기과학회지

PURPOSE: The interest has been growing in the investigation and management of lower urinary tract symptoms, but their prevalence in the general population has so far been based on the estimates made in selected groups of women in Korea. The object of this study was to determine the prevalence of stress urinary incontinence and bladder irritative symptoms of women in rural region in Korea through a community based survey. Also, we investigated the relationship between age, parity, oral contraception, smoking, menopause and obesity and the prevalence of stress urinary incontinence. MATERIALS AND METHODS: A questionnaire survey was performed in a sample of randomly selected 1162 women aged 30 years and over, in 31 villages in the town of Jeong-Eup, Korea. From February 4th to February 22nd, 1997, trained field workers visited every home and interviewed every eligible individual with the questionnaires, which included data on stress urinary incontinence, bladder irritative symptoms, quality of life, reproductive and menstrual history, and use of oral contraceptives. Among 1162 women, 857 responded to questionnaires, and 827 questionnaires were available for analysis. The response rate was 73.5%. The prevalence of stress urinary incontinence was defined as the proportion of the women in the population surveyed who experienced stress urinary incontinence at least twice a week. We defined diurnal frequency as the episodes of voiding again within 2 hours after initial voiding in the series of 5 consecutive voidings during one month period. The urgency was defined as she found it difficult to hold urination, once or more in the series of 5 consecutive voidings and nocturia twice or more per night. RESULTS: The prevalence of stress urinary incontinence was 20.4%. Only seven(4.1%) women carried a sanitary towel or diaper as protection against urinary leakage. The prevalence of stress incontinence among age groups revealed no significant difference. Statistically significant correlation was noted between obesity and the prevalence of stress incontinence. Diurnal frequency was recorded by 375 women(45.3%); 171(20.6%) experienced this symptom more than three times. Urgency was reported by 268 women(32.4%) and 63(7.6%) were always troubled by this symptom. Nocturia 3 times or more every night was recorded by 341 women(42.2%) and 83(10.0%) had nocturia 5 times or more. The severity of nocturia increased significantly with age. CONCLUSIONS: The prevalence of stress urinary incontinence and irritative symptoms in this study is similar to previous studies performed in other countries while the rate of nocturia is much higher in this study. Although stress urinary incontinence and bladder irritative symptoms are relatively common in this community, only few people are seeking for care of these symptoms. Therefore, it is very important to educate the public and promote awareness of this medical problem in this community.

Age-specific Reference Ranges for Prostate-specific Antigen from a Community-based Study / 대한비뇨기과학회지

PURPOSE: To analyze the relationship of age to serum prostate-specific antigen (PSA) levels among Koreans without clinically evident prostate cancer in a community-based study. MATERIALS AND METHOD: A total of 375 healthy men aged 50 to 79, residing in the small farming villages of Jeong-Eup county, Korea were examined with serum PSA(Hybritech Tandem-R) and digital rectal examination. One case of patient with prostate cancer was excluded. RESULTS: The serum PSA concentration is correlated with patient age(In PSA=-1.56+0.0257 x Age, r=0.32, p-value<0.0001). The recommended age-specific reference ranges of serum PSA(95th percentile) for men aged 50-59 years is 0-2.80ng/m1; for 60-69 years,0-3.56ng/m1; and for 70-79 years, 0-4.57ng/m1. CONCLUSIONS: The serum PSA concentration is correlated with patient age in Korean men and the age-specific PSA reference ranges for Korean are lower than those for Caucasian.

Relation Between Lower Urinary Tract Symptoms and Erectile Dysfunction: Epidemiologic Study in Jeong-Eup, Korea / 대한남성과학회지

PURPOSE: Lower urinary tract symptoms and erectile dysfunction both have a profound impact on the quality of life elderly men, but there are few reports that would enable us to clearly elucidate the relation between them. We investigated the prevalence of erectile dysfunction and its correlation with the severity of lower urinary tract symptoms as judged by the International Prostatic Symptom Score (I-PSS). MATERIALS AND METHODS: The total sample was 855 men aged 30 years and older (653 aged over 50) in 31 randomly selected areas of Jeong-Eup, Korea. Two questionnaires were sent. The first, on sexual activities, was based on DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, 4th ed.) and was composed of several questions on the frequency of sexual intercourse, erectile ability, and the degree of any erectile dysfunction. The second, for men over 50 years of age, was the I-PSS. We analyzed the results with multivariate logistic analysis using an SAS program running on a personal computer. RESULTS: The response rate was 71.3% (466/653), and data sexual activities and I-PSS from 304 men were suitable for analysis. The prevalence of erectile dysfunction, defined as inability to achieve an erection sufficient for penetration, was 58.9% (179/304), and increased with age: 37.2% in men in their 50s, 69.2% in men in their 60s, 83.3% in men in their 70s, ans 100% in men over age: 37.2% in men in their 50s, 69.2% in men in their 60s, 83.3% in men in their 70s, and 100% in men over age 80 (p = 0.001). According to the intensity of lower urinary tract symptoms - mild (0-7), moderate (8-19), and severe (20-35) - the prevalence of erectile dysfunction was 46.6% (75/161), 68.8% (75.109), and 85.3% (29.34), respectively, and the prevalence of complete erectile dysfunction was 8.7% (14.161), 20.2% (22.109), and 47.1% (16.34), respectively. After adjustment for age, there was a statistically significant correlation between the severity of lower urinary tract symptoms and erectile dysfunction with the odds ratios being 2.395 and 4.125 in the moderately and severely symptomatic groups. CONCLUSIONS: There was a significant correlation between the presence of lower urinary tract symptoms and erectile dysfunction. We suggest that these two conditions are closed related by pathophysiologic mechanism, although clinical and basic research should be advanced to clarify the relation between them.

Relation Between Lower Urinary Tract Symptoms and Erectile Dysfunction: Epidemiologic Study in Jeong-Eup, Korea / 대한남성과학회지

PURPOSE: Lower urinary tract symptoms and erectile dysfunction both have a profound impact on the quality of life elderly men, but there are few reports that would enable us to clearly elucidate the relation between them. We investigated the prevalence of erectile dysfunction and its correlation with the severity of lower urinary tract symptoms as judged by the International Prostatic Symptom Score (I-PSS). MATERIALS AND METHODS: The total sample was 855 men aged 30 years and older (653 aged over 50) in 31 randomly selected areas of Jeong-Eup, Korea. Two questionnaires were sent. The first, on sexual activities, was based on DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, 4th ed.) and was composed of several questions on the frequency of sexual intercourse, erectile ability, and the degree of any erectile dysfunction. The second, for men over 50 years of age, was the I-PSS. We analyzed the results with multivariate logistic analysis using an SAS program running on a personal computer. RESULTS: The response rate was 71.3% (466/653), and data sexual activities and I-PSS from 304 men were suitable for analysis. The prevalence of erectile dysfunction, defined as inability to achieve an erection sufficient for penetration, was 58.9% (179/304), and increased with age: 37.2% in men in their 50s, 69.2% in men in their 60s, 83.3% in men in their 70s, ans 100% in men over age: 37.2% in men in their 50s, 69.2% in men in their 60s, 83.3% in men in their 70s, and 100% in men over age 80 (p = 0.001). According to the intensity of lower urinary tract symptoms - mild (0-7), moderate (8-19), and severe (20-35) - the prevalence of erectile dysfunction was 46.6% (75/161), 68.8% (75.109), and 85.3% (29.34), respectively, and the prevalence of complete erectile dysfunction was 8.7% (14.161), 20.2% (22.109), and 47.1% (16.34), respectively. After adjustment for age, there was a statistically significant correlation between the severity of lower urinary tract symptoms and erectile dysfunction with the odds ratios being 2.395 and 4.125 in the moderately and severely symptomatic groups. CONCLUSIONS: There was a significant correlation between the presence of lower urinary tract symptoms and erectile dysfunction. We suggest that these two conditions are closed related by pathophysiologic mechanism, although clinical and basic research should be advanced to clarify the relation between them.

Trimix Intracavernosal Injection Therapy in Patients with Erectile Dysfunction: Long-term Follow-up Result / 대한비뇨기과학회지

PURPOSE: Vasoactive pharmacotherapy is now being widely used as practical and reliable method for the treatment of the patients with erectile dysfunction. The synergistic effect and low drug volume of each vasoactive drug in polypharmacotherapy for erectile dysfunction have made it possible to reduce both systemic and local complications with excellent success rate. We evaluated the treatment outcome of intracavernosal injection therapy with Trimix(the mixture of papaverine, phentolamine and prostaglandin E1). MATERIALS AND METHOD: From July 1993 to June 1997, 1000 patients with erectile dysfunction underwent a trial of intracavernous self injection therapy with Trimix(the mixture of papaverine 4.8mg, phentolamine 0.2mg and prostaglandin E1 1.8 microgram in 0.2ml). Underlying diseases were diabetes mellitus (33.1%), hypertension(7.5%) and others(12.3%). 471(47.1%) patients had no underlying disease. The volume of drug used ranged from 0.03 to 0.6ml(average: 0.18ml). RESULTS: After a mean follow-up of 10.9 months(3-44 months), 524 patients stayed on the home injection program. The drop-out rate was 47.6% with most of the cases during early home phase. The reasons for drop-out were inadequate response to medication, failure of injection, return of spontaneous erection, switch to other treatments, priapism, fear of needle or injection, loss of interest and economic reason. 88.3% of patients and 85.3% of the partners were satisfied wilts the result of home injection program. Priapism(3.9%), pain or discomfort(2.4%) and granuloma on injection site(1.5%) were noticeable complications, but corporal fibrosis and systemic side effect were not noticed. CONCLUSIONS: Trimix intracavernosal injection therapy is minimally invasive, simple, relatively safe and most of all, very effective method for the treatment of the patients with erectile dysfunction.