A Case of Extravesical Metastases Occurring after Transurethral Resection of Non-Invasive Bladder Cancer

A transurethral resection of bladder tumor (TURBT) is the primary treatment modality for bladder cancer. The common complications of TURBT include urinary tract infections, a hemorrhage requiring transfusion, and bladder perforation. Extravesical metastasis and intraperitoneal seeding of tumor cells following TURBT are very rarely reported. This report reviews a case of extravesical metastasis occurring after a repeated TURBT of non-invasive bladder cancer.

Anti-inflammatory and Antimicrobial Effects of Anthocyanin Extracted from Black Soybean on Chronic Bacterial Prostatitis Rat Model / 中国结合医学杂志

<p><b>OBJECTIVE</b>To investigated the anti-inflammatory and antimicrobial effects of anthocyanins extracted from black soybean on the chronic bacterial prostatitis (CBP) rat model.</p><p><b>METHODS</b>The Sprague-Dawley rats were divided into 4 groups, including control, ciprofloxacin, anthocyanins and anthocyanins with ciprofloxacin groups (n=8 in each group). Then, drip infusion of bacterial suspension (Escherichia coli Z17 O:K:H) into Sprague-Dawley rats was conducted to induce CBP. In 4 weeks, results of prostate tissue, urine culture, and histological analysis on the prostate were analyzed for each group.</p><p><b>RESULTS</b>The use of ciprofloxacin, anthocyanins, and anthocyanins with ciprofloxacin showed statistically significant decreases in bacterial growth and improvements in the reduction of prostatic inflammation compared with the control group (P<0.05). The anthocyanins with ciprofloxacin group showed a statistically significant decrease in bacterial growth and improvement in prostatic inflammation compared with the ciprofloxacin group (P<0.05).</p><p><b>CONCLUSIONS</b>These results suggest that anthocyanins may have anti-inflammatory and antimicrobial effects, as well as a synergistic effect with ciprofloxacin. Therefore, we suggest that the combination of anthocyanins and ciprofloxacin may be effective in treating CBP to obtain a higher rate of treatment success.</p>

The Changes of Voiding Pattern After Midurethral Sling Between Pure Stress Urinary Incontinence and Stress Urinary Incontinence With Overactive Bladder Group

PURPOSE: The purpose of this study is to compare changes in voiding pattern after midurethral sling surgery (MUS) between the stress urinary incontinence (SUI) group and the overactive bladder (OAB)+SUI group. MATERIALS AND METHODS: From January 2008 to February 2011, a retrospective survey was conducted of 225 female patients who had been diagnosed with SUI and undergone MUS. The subjects were divided into the SUI group and the OAB+SUI group. Changes in the overactive bladder symptom score (OABSS) and American Urological Association-Symptom Index (AUA-SI) before and three months after the MUS were compared. RESULTS: Of the 225 patients, 165 patients (73.3%) were classified as SUI group, and 60 patients (26.7%) were classified as OAB+SUI group. The mean age of the subjects was 54.7 years (range, 31-80 years), and the mean age of patients was 53.9 years (range, 34-80 years), and 56.8 years (range, 31-78 years) in the SUI group and OAB+SUI group. In SUI group, voiding symptom and storage symptom among the AUA-SI were significantly increased (p<0.05). OABSS were slight increased, but was statistically insignificant (p=0.847). In OAB+SUI group, voiding symptom score and OABSS showed a significant increase (p<0.05), but storage symptom score showed an insignificant increase (p=0.790). CONCLUSIONS: OAB may occur in approximately 18% of SUI patients who undergo MUS surgery, and voiding dysfunctions with deteriorated voiding symptom and storage symptom may also occur. The deteriorated OAB was shown in 45% of SUI patients with OAB after the surgery.

Ureteral Substitution Using Appendix for a Ureteral Defect Caused by a Retroperitoneal Rhabdomyosarcoma in a Child

A 7-year-old boy was diagnosed with a recurrent embryonal rhabdomyosarcoma in the retroperitoneum. After resection of the mass, direct end-to-end anastomosis of the ureter was not possible owing to the length of the resected segment. Accordingly, we performed ureteral substitution by using the appendix to repair the ureteral defect.

The Relationship between Clinical Symptoms and Urine Culture in Adult Patients with Acute Epididymitis

PURPOSE: We evaluated adult patients with acute epididymitis to identify the frequency of actual sexual contacts and the causative organism, and compared clinical examinations, degrees of manifested symptoms, and radiological test results. MATERIALS AND METHODS: We reviewed the medical records of 65 patients older than 18 years presenting with acute epididymitis who had been treated between 2002 and 2011. Scrotal ultrasonography, urinalysis, and urine culture were performed to diagnose the acute epididymitis. Patients were divided into negative (n=45) and positive (n=20) urine culture groups. Then the latter groups were subdivided into a sexually transmitted organism (STO) culture group (n=13) and a non-STO (n=7) culture group. Data on any history of sexual contact, scrotal pain and tenderness, symptoms of urethritis (discharge, dysuria, urethral burning, or irritation), and lower urinary tract symptoms (dysuria, frequency, and urgency of urination) were obtained from all of the subjects. RESULTS: Patients in the positive urine culture group were significantly younger than those in the other group (p=0.224) and were more likely to have a history of sexual contact at least two weeks prior to onset of epididymitis (p=0.012). They had also a significantly enlarged epididymal head and significantly more severe complaints of pain or tenderness than those of latter group (p=0.348, p=0.288). However, the difference in these measures between the STO and non-STO group was not significant, except in the case of age (p=0.044). CONCLUSIONS: Patients of the positive urine culture group with acute epididymitis were significantly younger and more sexually active than the others. They also had severe pain or tenderness and an enlarged epididymal head. There was a close association between clinical symptoms, a positive urine culture, and ultrasonographic findings.

Factors That Affect Nosocomial Catheter-Associated Urinary Tract Infection in Intensive Care Units: 2-Year Experience at a Single Center

PURPOSE: This study took a retrospective approach to investigate patients with catheter-associated urinary tract infection (CAUTI) over 2 years at a single hospital's intensive care unit (ICU) to identify meaningful risk factors and causative organisms. MATERIALS AND METHODS: A retrograde analysis was performed on patients with indwelling catheters between January 2009 and December 2010 in Yeouido St. Mary Hospital medical and surgical ICU. CAUTI was defined as isolated bacterial growth of 100,000 colony-forming units or more either 48 hours after transfer to the ICU if a urinary catheter was placed before the transfer or 48 hours after insertion if the catheter was inserted in the ICU. Only the patients whose culture results were negative before ICU admission were included. RESULTS: There were a total of 1,315 patients with indwelling urinary catheters in our hospital's medical and surgical ICU between January 2009 and December 2010. Of these patients, 241 had positive urine culture results, and 61 had CAUTI. Using multivariate logistic regression analysis, those with diabetes were 4.55 (p<0.001) times as likely to have occurrences of CAUTI than were those without and also had a 1.10-fold (p<0.01) longer duration of an indwelling catheter. Upon urine culture, among the 61 patients with CAUTI, Escherichia coli was the most common bacterium grown; it was identified in 24 patients (38.7%). CONCLUSIONS: The factors and causative organisms contributing to the development of CAUTI in the management of ICU patients must be considered to prevent the occurrence of UTIs in this setting.

The Anti-Inflammatory Effects of a New Herbal Formula (WSY-1075) in a Nonbacterial Prostatitis Rat Model

PURPOSE: The aim of this study was to investigate the anti-inflammatory effects of a new herbal formula (WSY-1075) in a nonbacterial prostatitis rat model. MATERIALS AND METHODS: Prostatitis was induced in male Wistar rats (n=32) by treatment with 17 beta-estradiol and dihydrotestosterone for 4 weeks. After the induction of prostatitis, the rats were randomly divided into one of four treatment groups: control (n=8), ciprofloxacin (n=8), WSY-1075 (100 mg/kg) (n=8), and WSY-1075 (400 mg/kg) (n=8). After 4 weeks of treatment, the prostatic proinflammatory cytokine (tumor necrosis factor-alpha, interleukin [IL]-6, and IL-8) levels and histological findings were noted. RESULTS: The ciprofloxacin and WSY-1075 treatment groups showed significantly decreased proinflammatory cytokine levels compared with the control group. Histologically, treatment with ciprofloxacin and WSY-1075 significantly suppressed the severity of prostatitis lesions compared with those in the control group. No differences in the proinflammatory cytokine levels or histologic findings were observed with the dose dependent treatment of WSY-1075. CONCLUSIONS: The new herbal formula, WSY-1075, showed effective anti-inflammatory activities in the prostate and may be useful for the clinical treatment of nonbacterial prostatitis. Our findings suggest that WSY-1075 has a beneficial effect on the prevention and treatment of nonbacterial prostatitis.

The Prevalence and Characteristic Differences in Prostatic Calcification between Health Promotion Center and Urology Department Outpatients

PURPOSE: We evaluated the differences in calculi characteristics and their prevalence according to the presence of lower urinary tract symptoms between adult patients examined at the Urology Department and those examined at the Health Promotion Center (HPC). MATERIALS AND METHODS: The prevalence of prostatic calcification, characteristics of calculi (number, size, and location), and differences in lower urinary tract symptoms were compared and analyzed for 479 subjects who underwent transrectal ultrasonography at the HPC and the Urology Outpatients Department at our hospital from October 2009 to October 2010. RESULTS: Of 479 subjects, 268 patients were examined at the HPC, and 211 were examined at the Urology Outpatients Department. Between the two groups, age, prostate-specific antigen levels, prostate volume transrectal ultrasonography, International Prostate Symptom Score (total, voiding, and storage), quality of life, and the prostatic calcification rate were significantly higher in the patients who visited the Urology Outpatients Department. The prevalence of prostatic calcification was 41.5% (199/479), with 36.1% (97/268) from the HPC and 48.3% (102/211) from the Urology Outpatients Department. When the characteristics of prostatic calcification were compared, there were no significant differences in the appearance, size, or location of the calculi between the two groups. CONCLUSIONS: The prevalence of prostatic calcification was high in patients complaining of lower urinary tract symptoms; however, there were no significant differences in the characteristics of the calculi. This finding leads us to believe that prostatic calcification can aggravate lower urinary tract symptoms but does not result in differences according to the number, size, or appearance of the calculi.

Transplantation of Muscle-Derived Stem Cells into the Corpus Cavernosum Restores Erectile Function in a Rat Model of Cavernous Nerve Injury

PURPOSE: Muscle-derived stem cells (MDSCs) harvested from skeletal muscles have the advantage of providing easier access and do not pose the immunogenic risks of embryonic stem cells. We investigated the effect of intracavernosal transplantation of MDSCs on erectile function in rats with bilateral cavernous nerve injury. MATERIALS AND METHODS: Adult male white rats underwent experimentation in 3 groups: group I, sham operation; group II, bilateral cavernous nerve injury; group III, bilateral cavernous nerve injury with MDSC injection. MDSCs were harvested from the femoral muscle of rats and were then injected into the cavernosum. Survival of MDSCs and measurement of erectile function was studied after 4 weeks. We checked the intracavernosal pressure (ICP) and obtained penile tissue. The expression of cyclic guanosine monophosphate (cGMP) was analyzed. RESULTS: Four weeks after transplantation, PKH-26-labeled MDSCs were identified in the cavernosal tissues of group III. Peak ICP and the drop rate of group II were 52+/-8.7 mmHg and 34+/-6.5 mmHg/min, respectively, whereas peak ICP and the drop rate of group III were 97+/-15.6 mmHg and 17+/-4.9 mmHg/min, respectively, showing that erectile function improved after MDSC transplantation (p<0.05). The expression of cGMP was significantly lower in group II (21.9+/-5.8 fmol/well) than in group I and group III (70.2+/-10.3 and 58.9+/-10.5 fmol/well, respectively). CONCLUSIONS: In a cavernous nerve injury rat model, intracavernosal transplantation of MDSCs showed acceptable survival of MDSCs as well as improvement of erectile function.

Urolithiasis in Patients Suffering from Malignant Hematologic Diseases

PURPOSE: We performed this study in order to evaluate the incidence and characteristics of urolithiasis in patients with malignant hematologic diseases. MATERIALS AND METHODS: Nine hundred one patients who underwent medical treatment for malignant hematologic disease and 40,543 patients who visited the emergency room and without malignant hematologic diseases were included in our study. The patients with malignant hematologic diseases were divided into two groups depending on their primary treatment. Group I included patients with acute and chronic leukemia (AML, ALL, CML, CLL) for which chemotherapy and steroid therapy was necessary, and group II included patients with anaplastic anemia and myelodysplastic syndrome and who had undergone repeated transfusion for treatment. Comparisons were made between the two groups in respect to the incidence of urolithiasis and the stones' radiopacity. RESULTS: Twenty nine patients (3.2%) of the 901 malignant hematologic patients were diagnosed with urolithiasis, compared to 575 patients (1.4%) of 40,543 emergency room patients. There was a significant increase of the incidence of urolithiasis in the malignant hematologic group. Compared to the general patients, the patients with malignant hematologic diseases had a higher rate of radiolucent stones (46.6% versus 16.3%, respectively), and the difference was significant. CONCLUSION: The incidence of urolithiasis for malignant hematologic patients was significantly higher than that for the control group.

Measurement of Bladder Volume Using an Implantable Volume Sensor in Rats / 대한남성과학회지

PURPOSE: Real-time monitoring of urinary bladder volume can not only provide information on urinary bladder function more precisely in laboratories and in the setting of intravesical pressure monitoring, but can also help areflexic neurogenic bladder patients have notice of the timing for optimal urination to prevent secondary complications. Thus we introduce a new implantable bladder volume monitoring device and its usefulness. MATERIALS AND METHODS: Ten male Sprague-Dawley rats were used under intraperitoneal anesthesia. Two microelectrodes produced by a micro-electrical-mechanical systems (MEMS) process were stitched onto each side wall of the urinary bladder and 25 G needles were inserted through the bladder dome. The distances between two microelectrodes converted from capacitances recorded by LCR meter were monitored in real-time during cystometry. Urinary bladder volume was estimated with its shape approximated as a sphere. RESULTS: Estimated bladder volume correlated well statistically with infused volume in (p0.05, repeated measures ANOVA). CONCLUSIONS: In our animal model, an implantable volume-monitoring device produced reliable data. Therefore, we expect that it should be an excellent tool for detecting urinary bladder volume and producing more accurate and useful information during urodynamic laboratory studies with small animals. Furthermore, we expect that this study will be the foundation of research for the clinical application of bladder volume monitoring devices to areflexic neurogenic bladder patients.

Biocompatibility of Parylene-C as a Coating Material of Implantable Bladder Volume Sensor / 대한남성과학회지

PURPOSE: Development of an implantable bladder volume sensor that could reduce complications and improve the quality of life for neurogenic bladder patients is assignment task that falls in the field of urology. Nevertheless, there is lack of research on whether biomaterials are biocompatible to the urinary bladder or not. Polyethylene glycol (PEG), polydimethylsiloxane (PDMS) and parylene-C are well known biocompatible materials in other fields of medicine. Because PEG is biodegradable and PDMS has a relatively low affinity to substrate with less durability than parylene-C, we evaluated the biocompatibility of parylene-C to the urinary bladde,r comparing of it to PEG and PDMS. MATERIALS AND METHODS: Nine rabbits were classified into three groups. Coin shaped aluminum substrates were affixed onto the external wall of the urinary bladder in each rabbit. At this point, the three rabbits which had substrates coated with PEG were assigned to group 1, those with PDMS were assigned to group 2 and those with parylene-C were assigned to group 3. In each group, one rabbit was sacrificed at one week, another rabbit was sacrificed at two weeks and the other rabbit was sacrificed at four weeks. At each time microscopic evaluation was done. To detect macrophages, we used fluorescence microscopy and applied MAC 387 staining. RESULTS: At one week, macrophage accumulation was observed on the external surface of the urinary bladder adjacent to the device no matter which material was used as a coating, but it had almost disappeared by four weeks. In addition, the inflammatory reaction was limited at the external surface of the urinary bladder, and did not expand into the muscular layer. CONCLUSIONS: With respect to biocompatibility, there was no difference among the three biomaterials. With its characteristics of durability and easy affinity regardless of the type of substrate, parylene-C would make an excellent coating material for a bio-device implantable into the urinary bladder.

Prostate Cancer Detection by Transrectal Ultrasound Guided Prostate Biopsy: Urology versus Radiology at a Single Academic Institution / 대한남성과학회지

PURPOSE: Many centers rely on radiologists to detect prostate cancer by transrectal ultrasound guided prostate biopsy. In this study we evaluated transrectal ultrasound guided prostate biopsy by radiologist or urologist, and compared prostate cancer detection rate, pathologic results and pain scrore. MATERIAL AND METHODS: In all, 259 consecutive patients had transrectal ultrasound guided prostate biopsy by one radiologist (group 1) and one urologist (group 2). The indication for prostate biopsies were a raised or rising prostate specific antigen (PSA) level or abnormal digital rectal examination (DRE). All data were collected prospectively. RESULTS: Both group showed comparable demographic data in age, PSA, prostate volume. But pain score showed higher in urologist group (p10 ng/ml. Both groups had similar Gleason score (6.8+/-0.7 vs 6.7+/-0.8) and number of cancer cores (3.0+/-1.7 vs 3.9+/-2.3). Group 1 showed significantly low visual analogue pain scale compared with Group 2 (2.9+/-1.9 vs 4.0+/-2.1)(p<0.05). CONCLUSION: Transrectal ultrasound guided prostate biopsy showed equally reliable datas whether performed by radiologist or urologist. The urologist can effectively perform transrectal ultrasound guided prostate biopsy like radiologist in detecting prostate cancer. Also we recommend to perform anesthesia to relieve pain before prostate biopsy and furthermore future studies with more patients with more datas are needed.

Prostate Cancer Detection Rate According to Prostate Volume and Age With PSA Levels of above 4.0ng/ml / 대한남성과학회지

PURPOSE: We retrospectively investigated the changes of prostate cancer detection rate according to patients prostate volume, age with prostate-specific antigen (PSA) levels of above 4.0ng/ml. MATERIAL AND METHODS: Data were collected from 663 patients who underwent 10 core prostate biopsy for elevated PSA above 4.0ng/ml. The biopsy-proven cancer patient group was compared to the non-cancer patient group according to age, PSA, prostate volume and PSAD. Prostate cancer detection rate was calculated according to prostate volume (less than 40 vs 40 or more 40ml) and age (less than 60, 60-69, 70-79, 80 or more years old). Also we compared prostate cancer detection rate according to PSA levels (4-10 vs 10-20ng/ml). RESULTS: Among the 663 patients who underwent prostate biopsy, prostate cancer was detected in 134 patients (20.2%). There were no stastically difference in mean age, mean prostate volume, and mean PSAD except mean PSA (13.9 vs 11.9ng/ml) between cancer and non-cancer groups. The cancer detection rate in small prostate was significantly higher than large prostate (23.5% vs 16.0%). The cancer detection rate was significantly increased with age: from 14.5% for below 60 year-old patients to 30.3% for the 80 or more year-old patients. There was no significant difference in cancer detection rate between the two PSA groups (19.0 vs 20.5%). CONCLUSION: Prostate cancer detection rate was higher in old patients and patients with small prostate volume. The older age group and the patients with small prostate volume was considered as the important factors to decide whether biopsy of prostate is needed.

Preventive Effect on Inflammation and Anti-Inflammatory and Anti-Microbial Effects of Garlic Extract in a Rat Model of Chronic Bacterial Prostatitis

PURPOSE: Garlic has anti-microbial and anti-inflammatory effects. We investigated its actions and preventive effects on chronic bacterial prostatitis (CBP) using a rat model. MATERIALS AND METHODS: Bacterial suspension was inserted into the prostatic urethra of 75 rats. Then 15 were grouped as garlic group, and 60 as control group. Garlic and saline were given to each group for 4 weeks, respectively. After partial resection of the prostate, microbiological culture and histological examination were done. The incidence of CBP was compared between two groups. To evaluate the anti-microbial and anti-inflammatory effect of garlic, the 41 rats proved as CBP models among the control group were divided into 4 groups randomly: I, control; II, garlic; III, ciprofloxacin; IV, garlic plus ciprofloxacin. After 3 weeks of treatment, microbiological cultures of urine, prostate and histological examination of prostate were done. RESULTS: In study of the preventive effects, 5 rats in garlic treatment group and 41 rats in control group were shown to be CBP models. In anti-microbial and anti-inflammatory evaluation, positive urine culture rate and prostate tissue show no significant difference among four groups, but bacterial growth in urine and prostate tissue were lower in groups II, III, and IV than group I. Bacterial growth was the slowest in prostate tissue of group IV. Histologic findings were more improved in groups II, III and IV than group I, with Group IV being the most improved. CONCLUSIONS: These results show that garlic has preventive and therapeutic effects on CBP. Combination treatment with antibiotics may be considered in the future.

Nationwide Questionnaire Survey on Practice Patterns for Pediatric Hydronephrosis of Korean Urologists at Secondary or University Hospitals

PURPOSE: To evaluate practice patterns for pediatric hydronephrosis of Korean urologists practicing at secondary or university hospitals. MATERIALS AND METHODS: The subjects were asked to complete questionnaires sent by postal mail or e-mail that explored practicing diagnostic and therapeutic strategies in the management of pediatric hydronephrosis and ureteropelvic junction obstruction. The questionnaires of those responding were analyzed according to whether the respondent practiced at a secondary or university hospital, how long they had been urologists, and whether they specialized in pediatric urology or other specific field of urology. RESULTS: Of the 354 questionnaires sent, 97 were returned (response rate 27.4%). Voiding cystourethrography was not routinely recommended by 95.7% of respondents, and diuretic renal scanning was considered necessary for postnatal evaluation of prenatal hydronephrosis by 78.5%. In addition, 72.2% of these doctors did not routinely recommend antibiotic prophylaxis. Follow-up ultrasonography was recommended at 3 to 6 months (61.1%), and follow-up diuretic renal scanning was recommended at 3 to 6 months (38.6%) or 6 to 12 months (32.7%). The reported length of time it took to deem an operation as a success was 3 to 6 months (49.5% and 60.7%) and within 3 months (34.1% and 19.1%) by ultrasonography and diuretic renal scanning, respectively. CONCLUSIONS: This survey documented a certain degree of variability among Korean urologists concerning standard practices of the assessment, follow-up, and treatment for pediatric hydronephrosis. Results from this survey might contribute useful data for establishing proper guidelines for the management of pediatric hydronephrosis.

Changes in Sexual Function after Mid-Urethral Tape Sling Operations for Stress Urinary Incontinence in Korean Women

PURPOSE: We assessed sexual function by using a questionnaire in women who were diagnosed with stress urinary incontinence and underwent mid-urethral tape sling surgery. MATERIALS AND METHODS: A retrospective survey was conducted of 151 women without evidence of detrusor overactivity or concomitant prolapse who underwent surgery (tension-free vaginal tape or tension-free vaginal tape-obturator) for stress urinary incontinence. The participants filled out a questionnaire regarding their preoperative and 6-month postoperative sexual function. Paired t-tests were used to compare changes over time. The generalized McNemar test was used to compare individual preoperative and postoperative findings. We considered a p-value less than 0.05 as significant. RESULTS: Of the 303 women who fulfilled the inclusion criteria, 204 (67.3%) returned the questionnaire. Of those 204 women, 151 were sexually active before and after surgery. No significant differences were observed after surgery in the frequency or appreciation of intercourse or the extent of sexuality. A significant reduction in leakage symptoms was observed after surgery (p<0.01). Of the 151 women, 29 (19.2%) reported an improvement in satisfaction with intercourse and 23 (15.2%) reported a deterioration after the anti-incontinence procedure. Partner discomfort remained unchanged. Of the 151 patients, 26 (17.2%) patients were unsatisfied with the surgical outcome because of persistence or recurrence of stress urinary incontinence and deterioration in satisfaction with intercourse after surgery. CONCLUSIONS: These results suggest that mid-urethral tape sling operations for stress urinary incontinence improved the continence rate, but had little effect on preexisting sexual disturbances. Additional and larger retrospective studies are warranted to support these preliminary findings.

The Correlation between Cardiovascular Risk Factors and Penile Hemodynamic Parameters in Men with Erectile Dysfunction

PURPOSE: The cause of erectile dysfunction (ED) is mostly organic in nature and is associated with cardiovascular disease. Therefore, the presence of ED has been shown to be related to cardiovascular risk factors such as coronary artery disease, hypertension, diabetes mellitus (DM), and hyperlipidemia. This study evaluated the correlation between cardiovascular risk factors and penile hemodynamic parameters in men with ED. MATERIALS AND METHODS: The relationship between vascular risk factors and penile hemodynamic parameters were evaluated in a total of 149 men with ED. The patients were stratified according to the type and number of risk factors present. Each patient underwent a penile duplex Doppler ultrasound study after injections of intracavernous prostaglandin E1 to evaluate penile blood flow parameters. The rates of arterial insufficiency, venoocclusive dysfunction, and nonvascular etiologies were also evaluated. These results were statistically compared with those from patients with ED without vascular risk factors. RESULTS: The poorest blood flow was found in patients with ED with DM. Arterial insufficiency was most prevalent in patients with coronary artery disease and DM (p<0.05). Venoocclusive dysfunction was observed most often in hypertensive patients with ED. Abnormal penile blood flow parameters correlated with the number of vascular risk factors present. CONCLUSIONS: This study shows that cardiovascular risk factors are associated with abnormal penile blood flow. In addition, the number of risk factors is correlated with an increased probability of having abnormal blood flow parameters.

Is it Appropriate to Lower the Prostate Specific Antigen Cut-off Value to 2.5 ng/ml for Prostate Biopsy in Korean? / 대한남성과학회지

PURPOSE: Currently many clinicians have recommendsprostate biopsy when the level of prostate specific antigen (PSA) is higher than 4.0 ng/ml. However, recently the prostate cancer detection rates werereported to be about 20% at PSA level 2.5 to 4.0 ng/ml. Therefore, an increasing amount of hospitals have recommends lowering the PSA cut off level to 2.5 ng/ml. We retrospectively evaluated the prostate cancer detection rate and pathologic characteristics of patients with PSA level of 2.5 to 4.0 ng/ml and we compared this with the patients who had PSA level in the range of 4.1 to 10.0 ng/ml. MATERIAL AND METHODS: We analyzed the data of 515 patients who received prostate biopsy in the range of PSA level 2.5 to 10 ng/ml. The clinical characteristics, cancer detection rate and pathologic findings of the biopsy were compared between the PSA 2.5-4.0 ng/ml group and PSA 4.1-10.0 ng/ml group. RESULTS: Cancer detection rates in patients who underwent biopsy were 18.1% and 22.4% at PSA 2.5 to 4.0 and 4.1 to 10.0 ng/ml, respectively. Mean Gleason scores were found 6.4+/-0.5 and 6.6+/-0.7 and high grade cancers with Gleason score 7 or more were found in 50% and 58.4% of patients with cancer with PSA 2.5 to 4.0 and 4.1 to 10.0 ng/ml, respectively. There were no significant difference between the 2 groups in cancer detection rates and pathologic findings on biopsy including mean Gleason score and high grade cancers with Gleason score 7 or more between two groups. CONCLUSION: There were no significant difference in cancer detection rates and pathologic findings between PSA 2.5-4 ng/ml group and PSA 4.1-10 ng/ml group. These results suggest that a lower PSA cutoff should be considered as an indication for prostate biopsy in the Korean population.

The Effect of Cardiovascular Risk Factors on the Patient with Erectile Dysfunction and Diabetes and the Response to Phosphodiesterase Type 5 Inhibitors / 대한남성과학회지

PURPOSE: Erectile dysfunction (ED) is a common comorbidity with diabetes mellitus (DM). The goal of this study was to evaluate the effect of cardiovascular risk factors (CVRF) on ED patients with DM and the response to phosphodiesterase type-5 (PDE5) inhibitors. MATERIALS AND METHODS: We performed a retrospective study on 32 patients with ED and type II DM. The CVRFs were defined as hypertension, coronary artery disease, hyperlipidemia, smoking and obesity. All the patients were checked for CVRFs and the erectile function was assessed with the International Index of Erectile Function (IIEF) score. Tadalafil (20mg) was taken for 3 months, and then the IIEF score was checked again. The scores of the IIEF-EF, Q3 and Q4 and the number of risk factors were analyzed. RESULTS: The scores of the IIEF-EF, Q3 and Q4 were higher in the non-risk factor group than that in the risk factor group. After Tadalafil treatment, the score of the group that had less than 1 risk factor was significantly improved, but the score of the group that had more than 2 risk factors showed little change. CONCLUSIONS: To treat ED patients with DM, their cardiovascular risk factors must be assessed.