Efficacy and Safety of DA-8010, a Novel M3 Antagonist, in Patients With Overactive Bladder: A Randomized, Double-Blind Phase 2 Study / 대한배뇨장애요실금학회지

Purpose@#DA-8010 is a novel muscarinic M3 receptor antagonist with significant selectivity for bladder over salivary gland in preclinical studies. We evaluated the clinical efficacy and safety of DA-8010 in overactive bladder (OAB) patients. @*Methods@#This phase 2, randomized, double-blind, parallel-group, active reference- and placebo-controlled trial was conducted at 12 centers in South Korea (NCT03566134). Patients aged ≥19 years with OAB symptoms for ≥3 months were enrolled. Three hundred six patients (30.07% male) were randomized to 12 weeks of treatment among 4 groups; 2 experimental groups (DA-8010 2.5 or 5 mg), an active reference group (solifenacin 5 mg), and a placebo group. The change from the baseline of (=∆) 24-hour frequency at 12 weeks (primary endpoint), episodes of urgency, overall/urgency urinary incontinence, average/ maximum voided volume, nocturia, and patients’ subjective responses were analyzed. @*Results@#In the full analysis set, the mean (standard deviation) [median] values for ∆ 24-hour frequency at 12 weeks were -1.01 (2.44) [-1.33] for placebo, -1.22 (2.05) [-1.33] for DA-8010 2.5 mg, and -1.67 (2.25) [-1.67] for DA-8010 5 mg; DA-8010 5 mg showed a significant decrease compared with placebo (P=0.0413). At 4 and 8 weeks, both DA-8010 2.5 mg (P=0.0391 at 4 weeks, P=0.0335 at 8 weeks) and DA-8010 5 mg (P=0.0001 at 4 weeks, P=0.0210 at 8 weeks) showed significant decrease in ∆ 24-hour frequency compared with placebo. DA-8010 5 mg achieved a significant decrease in ∆ number of urgency episodes, compared with placebo at 4 (P=0.0278) and 8 (P=0.0092) weeks. Adverse drug reactions (ADRs) were observed in 3.95% of placebo, 6.67% of DA-8010 2.5 mg, 18.42% of DA-8010 5 mg, and 17.33% of solifenacin 5 mg groups. No serious ADRs were observed in any patient. @*Conclusions@#Both DA-8010 2.5 mg and 5 mg showed therapeutic efficacy for OAB without serious ADRs. Therefore, both dosages of DA-8010 can advance to a subsequent large-scale phase 3 trial.

Diagnostic Value of the Maximum Urethral Closing Pressure in Women With Overactive Bladder Symptoms and Functional Bladder Outlet Obstruction / 대한배뇨장애요실금학회지

Purpose@#Overactive bladder (OAB) is observed in women with functional bladder outlet obstruction (FBOO), as are lower urinary tract symptoms (LUTS). Therefore, we evaluated the urodynamic characteristics of women with storage LUTS and FBOO diagnosed by urodynamic studies (UDS). @*Methods@#Women (n=108) with storage LUTS and FBOO diagnosed by UDS were included in this study. The urodynamic characteristics of women with FBOO were compared with those of women with OAB (n=34) and stress urinary incontinence (SUI, n=78). FBOO was defined as a maximum flow rate (Qmax) 20 cm H2O in a pressure-flow study. The UDS included uroflowmetry, postvoid residual volume determination, a cystometrogram, and a pressure-flow study. @*Results@#Women with FBOO who had storage symptoms showed a higher PdetQmax and maximum urethral closing pressure (MUCP) than women with OAB and SUI. Interstitial cystitis/bladder pain syndrome (IC/BPS) was observed in 17.6% of women with FBOO. MUCP was significantly higher in women with BOO than in women with BOO and IC/BPS (115.6±27.4 and 96.6±14.1 cm H2O, P=0.00). The receiver operating characteristic curve analysis showed that the cutoff values of MUCP in women with FBOO compared to women with OAB and SUI were 87 cm H2O (sensitivity=81.5%, specificity=73.5%) and 36 cm H2O (sensitivity=92.6%, specificity=84.4%), respectively. The cutoff value of MUCP in women with FBOO compared to women with FBOO and IC/BPS was 92 cm H2O (sensitivity=85.4%, specificity=78.9%). @*Conclusions@#MUCP could have predictive value for identifying FBOO in women with complex LUTS.

Chronic bladder diseases: overactive bladder and interstitial cystitis/bladder pain syndrome

Overactive bladder (OAB) and interstitial cystitis/bladder pain syndrome (IC/BPS) are debilitatingchronic bladder diseases that affect patients’ quality of life. Their etiologies and clinical phenotypes vary, and management strategies should be selected after excluding the possibilities of other pathological conditions with careful consideration of a multidisciplinary integrated approach to ensure optimal success.Current Concepts: OAB is a symptom complex characterized by urinary urgency and frequency and nocturia with or without urge incontinence, and its key symptom is urinary urgency. IC/BPS has symptoms similar to lower urinary tract symptoms (LUTS) associated with OAB but also has distinctly different symptoms, including the key symptom of an unpleasant sensation or pain perceived to be related to the urinary bladder associated with LUTS. Recent studies have revealed that these key symptoms of OAB or IC/BPS are also observed in some patients with other diseases. Patients showing no evidence of bacterial infection on urine culture and experiencing LUTS or pain for more than 6 weeks should be considered as having OAB or IC/BPS. Treatment strategies for OAB and IC/BPS focus on managing LUTS and bothersome pain. Noninvasive management should be considered initially, whereas surgical options should be considered only after conservative treatment failure.Discussion and Conclusion: OAB and IC/BPS symptoms overlap considerably in many patients. A more accurate differentiation of symptoms, including LUTS, would help achieve better treatment outcomes.

Necessity and methods of sexual education in the elderly population

Major improvements in health care have allowed people in the modern era to lead longer, healthier, and more active lives. The current generation of over-60s are more active than previous generations at the same age. In South Korea, the elderly population (65 years of age or older) has grown to more than 14% of the general population, meaning that we are already in the era of an ‘aged society’ and are transitioning into a super-aged society. Therefore, health issues in the elderly population cannot be ignored, and should be adequately addressed as soon as possible. Sexual health has become an important issue in the elderly that cannot be neglected, according to studies on sexual attitudes and behavior in older adults. As the quality of health improves in the elderly population, requests for proper sexual education and sexual health-related services have become more common. This pattern of increased sexual activity, partially driven by pharmacological advances in the treatment of sexual dysfunction and hormonal replacement products, has also led to increases in drug use and sexually transmitted infections (STIs). Responses to sexual health and education issues for the elderly currently remain ill-structured, as the significance of these issues is often ignored, largely due to incorrect assumptions about sexuality and sexual health among the elderly. Stronger requirements should be implemented for properly structured education and management systems regarding awareness, risk perception, and preventive strategies for safe sex among the elderly population in Korea.

Necessity and methods of sexual education in the elderly population

Major improvements in health care have allowed people in the modern era to lead longer, healthier, and more active lives. The current generation of over-60s are more active than previous generations at the same age. In South Korea, the elderly population (65 years of age or older) has grown to more than 14% of the general population, meaning that we are already in the era of an ‘aged society’ and are transitioning into a super-aged society. Therefore, health issues in the elderly population cannot be ignored, and should be adequately addressed as soon as possible. Sexual health has become an important issue in the elderly that cannot be neglected, according to studies on sexual attitudes and behavior in older adults. As the quality of health improves in the elderly population, requests for proper sexual education and sexual health-related services have become more common. This pattern of increased sexual activity, partially driven by pharmacological advances in the treatment of sexual dysfunction and hormonal replacement products, has also led to increases in drug use and sexually transmitted infections (STIs). Responses to sexual health and education issues for the elderly currently remain ill-structured, as the significance of these issues is often ignored, largely due to incorrect assumptions about sexuality and sexual health among the elderly. Stronger requirements should be implemented for properly structured education and management systems regarding awareness, risk perception, and preventive strategies for safe sex among the elderly population in Korea.

Influence of Circadian Disruption Associated With Artificial Light at Night on Micturition Patterns in Shift Workers / 대한배뇨장애요실금학회지

Shift workers often experience problems associated with circadian disruption associated with artificial light at night and nocturia is commonly noted in night-shift workers. Nocturia associated with circadian disruption is due to increased urine production of the kidney and decreased storage function of the bladder. A recent discovery of peripheral clock genes in the bladder and their role in contractile property of the bladder support that micturition is closely related to the circadian rhythm. Moreover, there are clinical studies showed that shift workers more often experienced nocturia due to circadian disruption. However, comparing with other health problems, concerns on nocturia and voiding dysfunction associated with circadian disruption are insufficient. Therefore, further studies about voiding dysfunction associated with the circadian disruption in shift workers are necessary.

Pharmacologic management of female sexual dysfunction

In female sexual dysfunction (FSD), psychological and contextual factors significantly influence organic components of sexual response and behavior. The hormonal environment also affects FSD. Therefore, a tailored medical approach to each individual's sexual symptom is inevitable. This paper reviews currently available pharmacological treatment of FSD including the most recent advances and future targets in pharmacotherapy. In hormonal therapies for FSD, efficacy of estrogens and androgens on the treatment of vaginal atrophy, low sexual desire, and small subsets of genital arousal disorder, respectively, have been demonstrated. However, we need more data regarding long-term safety. There are two non-hormonal agents approved by the US Food and Drug Administration. Flibanserin has shown marginal benefit over placebo for the treatment of hypoactive sexual desire disorder. Ospemifen has shown beneficial effect on vulvovaginal pain from hormone related atrophy although it requires a longer period data to assess safety in other female genital organs, such as uterus and ovaries. Controversies still remain regarding hormonal therapies for FSD. Besides, some of the developing drugs still require more reliable safety and efficacy data. However, pharmacologic treatment of FSD is a promising field yet to be explored.

Febrile Urinary Tract Infection after Radical Cystectomy and Ileal Neobladder in Patients with Bladder Cancer

Urinary tract infection (UTI) is one of the most common complications after radical cystectomy and orthotopic neobladder reconstruction. This study investigated the incidence and implicated pathogen of febrile UTI after ileal neobladder reconstruction and identify clinical and urodynamic parameters associated with febrile UTI. From January 2001 to May 2015, 236 patients who underwent radical cystectomy and ileal neobladder were included in this study. Fifty-five episodes of febrile UTI were identified in 46 patients (19.4%). The probability of febrile UTI was 17.6% and 19.8% at 6 months and 24 months after surgery, respectively. While, Escherichia coli was the most common implicated pathogen (22/55, 40.0%), Enterococcus spp. were the most common pathogen during the first month after surgery (18/33, 54.5%). In multivariate logistic regression analysis, ureteral stricture was an independent risk factor associated with febrile UTI (OR 5.93, P = 0.023). However, ureteral stricture accounted for only 6 episodes (10.9%, 6/55) of febrile UTI. Most episodes of febrile UTI occurred within 6 months after surgery. Thus, to identify risk factors associated with febrile UTI in the initial postoperative period, we assessed videourodynamics within 6 months after surgery in 38 patients. On videourodyamic examination, vesicoureteral reflux (VUR) was identified in 16 patients (42.1%). The rate of VUR presence in patients who had febrile UTI was not significantly different from those in patients without febrile UTI (50% vs. 39.3%, P = 0.556). Patients with febrile UTI had significantly larger residual urine volume (212.0 ± 193.7 vs. 90.5 ± 148.2, P = 0.048) than those without. E. coli and Enterococcus spp. are common pathogens and ureteral stricture and residual urine are risk factors for UTI after ileal neobladder reconstruction.

A Retrospective Study of the Management of Vulvodynia

PURPOSE: Vulvodynia is characterized by chronic vulvar pain caused by sexual intercourse and often results in female sexual dysfunction. Because the causes of vulvodynia are not clear, many patients do not receive optimal treatment. Recently, gabapentin and botulinum toxin A have both been shown to be effective treatments for vulvodynia. In this study, we retrospectively analyzed the clinical outcomes of botulinum toxin A and gabapentin treatment for chronic pain in women with this condition. MATERIALS AND METHODS: Seventy-three women with vulvar pain were administered either gabapentin (n=62) or botulinum toxin A (n=11) injections. Effectiveness was measured by use of a visual analogue scale (VAS). We analyzed the treatment method, treatment duration, success of treatment, and side effects or adverse reactions. RESULTS: Pain levels in both groups significantly decreased after treatment. In the gabapentin group, the VAS score decreased from 8.6 before treatment to 3.2 after treatment (p<0.001). The VAS score in the botulinum toxin A group was reduced from 8.1 to 2.5 (p<0.001). Side effects for both therapies were few and subsided with treatment with general antibiotics and nonsteroidal antiinflammatory drugs. CONCLUSIONS: Gabapentin and botulinum toxin A are safe and effective treatments for vulvodynia. This condition can cause sexual dysfunction and affect quality of life. However, with proper management, satisfactory outcomes for women with vulvodynia can be achieved.

Hormone Replacement Therapy in Female Sexual Dysfunction / 대한남성과학회지

Female sexual function is highly complex and deeply influenced by hormonal and non-hormonal factors. As sexual dysfunction becomes a common and important problem for women of all ages with related quality of life issues, we need to understand more about the effect of sex steroid hormones in female sexual function. However, there are limited data about the correlation between the value of sex steroid hormones- testosterone, in particular-and female sexual function. In a certain type of female sexual dysfunction (FSD), hypoactive sexual desire disorder, for example, there is evidence that treatment with androgens or with estrogens is effective. To widen the therapeutic options of hormone replacement therapy in FSD, further research is needed as to the benefits and risks of hormonal treatments in both pre- and post-menopausal women. Although important unanswered questions still exist in hormonal treatment of FSD, new therapeutic strategies are being studied and many ongoing clinical trials are expecting favorable results leading to more successful treatment of FSD.

Efficacy and Safety of Biodegradable Microparticles in the Regeneration of Injured Rabbit Corpus Cavernosum: Primary Report / 대한남성과학회지

PURPOSE: This study analyzed the effectiveness of poly (lactic-co-glycolic acid) (PLGA) as a tissue recovery agent and determines the in vivo safety and efficacy of microparticle-based PLGA. MATERIALS AND METHODS: Fifteen 3-month-old male white rabbits were used. Allogenic adipose tissue derived stromal vascular fraction (SVF) was cultured and labeled with the fluorescent dye PKH26. The rabbits were divided into 4 groups: the SVF group, the PLGA group, the normal control group, and the disease control group. The right corpus cavernosal tissue of the rabbits was surgically removed in the selected portion, except in the normal control group. The defect space of each rabbit was replaced with 10(6) SVF cells in the SVF group and 0.1 g of biodegradable polymer solution in the PLGA group. Microscopic confirmation and analysis of tissue regeneration were performed after 8 weeks. Using confocal microscopy, the nuclei of the smooth muscle cells and SVF migration were examined. The composition of smooth muscle and fibrosis of the injured corpus cavernosum were compared and analyzed by Masson's trichrome stain. RESULTS: There were no signs of migration or rejection of the injected materials in any of the experimental groups. The mean amount of smooth muscle in the normal control group was 15.25+/-1.34 microm2 (right) and 13.90+/-0.703 microm2 (left); in the disease control group it was 11.10+/-0.87 microm2 (right) and 12.80+/-1.01 microm2 (left); in the SVF group it was 13.82+/-4.10 microm2 (right) and 13.96+/-3.94 microm2 (left); and in the PLGA group it was 12.89+/-1.39 microm2 (right) and 13.24+/-1.43 microm2 (left). Only the disease control group showed significant decreased smooth muscle in the left cavernosum (p0.05). Furthermore, no difference was found between any two groups (normal control versus SVF (p=0.705), normal control versus PLGA (p=0.88), SVF versus PLGA (p=0.23). CONCLUSIONS: PLGA microparticles had the same tissue restoring effect when compared with SVF and no adverse effect or migration of particles was found through the injection of PLGA or SVF. PLGA is safe and has the proper tissue recovery effect, saving additional tissue harvesting.

The Clinical Effect of Androgen Replacement Therapy for Female Sexual Dysfunction / 이화의대지

OBJECTIVES: Androgen plays an important role in female sexual function, and its insufficiency causes a clinically significant sexual dysfunction. This study examines the association between sex hormones and the clinical effect of testosterone replacement therapy in female sexual dysfunction. METHODS: This study examined 75 female patients who visited our hospital from March 2002 to June 2008 to treat sexual dysfunction. For the rest of the patients, we performed primary treatment and physiotherapy in accordance with the main cause of their sexual dysfunction. We also performed combination treatment of androgen replacement therapy for the patients who did not make medical progress after two months of primary treatment and for the patients whose free testosterone level is in the bottom group out of three normal range groups. RESULTS: The mean age of target patients was 39.6+/-8.7 years (range, 35~66 years) old. 10 patients out of 75 patients were postmenopausal women, and estrogen replacement therapy had been performed without androgen replacement therapy. We performed a combination treatment of androgen replacement therapy for the patients with sexual desire disorder, and 60% of them answered that they had an increased sexual response after they were given combination treatment of androgen replacement therapy. CONCLUSION: The results support the concepts that sex hormones significantly affect sexual response in women with sexual dysfunction. Clinically, it is effective and safe to perform a combination treatment of androgen replacement therapy in treating sexual dysfunction if medication is administered properly and carefully.

Correlations of Interstitial Cystitis/Painful Bladder Syndrome with Female Sexual Activity

PURPOSE: We investigated how the symptoms of interstitial cystitis/painful bladder syndrome (IC/PBS) are correlated with the sexual activity of these patients. MATERIALS AND METHODS: A total of 87 patients were included in this study; 18 patients were diagnosed with IC and the other 69 had PBS. The diagnosis was made on the basis of the concept of IC/PBS proposed by the ICS in 2002. Patients were asked to fill in a Bristol female lower urinary tract symptom questionnaire, and symptoms were rated on a scale of from 1 to 4 or 5. Pearson's correlation coefficient was used to analyze the correlation of pain and urinary symptoms with quality of life and sexual activity. RESULTS: The average age of the patients was 51+/-14.7 years (range, 28-74 years). Age and vulvodynia were positively correlated with one another (r=0.232), and there was a negative correlation between age and dyspareunia (r=-0.302). Among the items regarding IC/PBS and sexual activity, frequency showed a positive correlation with vulvodynia (r=0.258) in addition to an inhibited sex life (r=0.403). Urgency showed a positive correlation with an inhibited sex life (r=0.346). Vulvodynia showed a positive correlation with an inhibited sex life (r=0.259) and dyspareunia (r=0.401). The main symptoms of IC/PBS (frequency, urgency, and pelvic pain) showed a positive correlation with almost all items related to quality of life (p<0.05). CONCLUSIONS: Frequency, urgency, and various types of pain are negatively correlated with the sexual activity of patients. This suggests that physicians should consider sexual function in the management of patients with IC/PBS.

Baicalein protects HT22 murine hippocampal neuronal cells against endoplasmic reticulum stress-induced apoptosis through inhibition of reactive oxygen species production and CHOP induction

Baicalein is one of the major flavonoids in Scutellaria baicalensis Georgi and possesses various effects, including cytoprotection and anti-inflammation. Because endoplasmic reticulum (ER) stress has been implicated in neurodegenerative diseases, such as Alzheimer's disease, Parkinson's disease, and cerebral ischemia, we investigated the effects of baicalein on apoptotic death of HT22 mouse hippocampal neuronal cells induced by thapsigargin (TG) and brefeldin A (BFA), two representative ER stress inducers. Apoptosis, reactive oxygen species (ROS) production, and mitochondrial membrane potential (MMP) were measured by flow cytometry. Expression level and phosphorylation status of ER stress-associated proteins and activation and cleavage of apoptosis-associated proteins were analyzed by Western blot. Baicalein reduced TG- and BFA-induced apoptosis of HT22 cells and activation and cleavage of apoptosis-associated proteins, such as caspase-12 and -3 and poly(ADP-ribose) polymerase. Baicalein also reduced the TG- and BFA-induced expression of ER stress-associated proteins, including C/EBP homologous protein (CHOP) and glucose-regulated protein 78, the cleavage of X-box binding protein-1 and activating transcription factor 6alpha, and the phosphorylation of eukaryotic initiation factor-2alpha and mitogen-activated protein kinases, such as p38, JNK, and ERK. Knock-down of CHOP expression by siRNA transfection and specific inhibitors of p38 (SB203580), JNK (SP600125), and ERK (PD98059) as well as anti-oxidant (N-acetylcysteine) reduced TG- or BFA-induced cell death. Baicalein also reduced TG- and BFA-induced ROS accumulation and MMP reduction. Taken together, these results suggest that baicalein could protect HT22 neuronal cells against ER stress-induced apoptosis by reducing CHOP induction as well as ROS accumulation and mitochondrial damage.

Correlation between Metabolic Syndrome and Lower Urinary Tract Symptoms of Males and Females in the Aspect of Gender-Specific Medicine: A Single Institutional Study

PURPOSE: We attempted to examine the correlation between metabolic syndrome and lower urinary tract symptoms (LUTS) in the aspect of gender-specific medicine. MATERIALS AND METHODS: A total of 922 patients participating in a health examination completed the International Prostate Symptom Score (IPSS) questionnaire and the Overactive Bladder Questionnaire Short Form (OABq-SF) symptom bother scale from March 2008 to July 2009. Metabolic syndrome was defined by using the National Cholesterol Education Program Adult Treatment Panel III criteria announced in 2001. We analyzed differences in lower urinary tract symptoms according to the presence of metabolic syndrome and the component elements of metabolic syndrome. RESULTS: The subjects were 538 males and 384 females with a mean age of 48.8+/-6.8 years. Among all patients, the number of patients with metabolic syndrome was 143 (15.5%); there were 110 males (20.4%) and 33 females (8.6%), showing a significant difference. There were no differences in scores on the IPSS or OABq-SF with respect to the presence or absence of metabolic syndrome in males. In females, however, there were significant differences in the IPSS and OABq-SF depending on the presence or absence of metabolic syndrome. In males and females, the IPSS total score was significantly correlated with age. Also, high-density lipoprotein (HDL) cholesterol in males and triglyceride in females was significantly correlated with the IPSS total score. CONCLUSIONS: There are sex differences in the morbidity rate of metabolic syndrome and its effect on lower urinary tract symptoms. Therefore, it is necessary to consider gender-specific medicine in the diagnosis and treatment of LUTS.

Prospective Factor Analysis of Alpha Blocker Monotherapy Failure in Benign Prostatic Hyperplasia

PURPOSE: We aimed to determine the treatment of choice criteria for benign prostatic hyperplasia (BPH) by analyzing the factors causing alpha-adrenergic receptor blocker (alpha-blocker) monotherapy failure. MATERIALS AND METHODS: This retrospective study enrolled 129 patients with BPH who were prescribed an alpha-blocker. Patients were allocated to a transurethral resection of prostate (TURP) group (after having at least a 6-month duration of medication) and an alpha-blocker group. We compared the differences between the two groups for their initial prostate volume, serum prostate-specific antigen (PSA), maximum urinary flow rate (Qmax), International Prostate Symptom Score (IPSS), and postvoid residual urine volume (PVR). RESULTS: Of the 129 patients, 54 were in the TURP group and 75 were in the alpha-blocker group. Statistically significant differences (p<0.05) between the two groups were found in the prostate volume (50.8 ml vs. 34.4 ml), PSA (6.8 ng/ml vs. 3.6 ng/ml), Qmax (6.84 ml/sec vs. 9.99 ml/sec), and IPSS (27.3 vs. 16.8). According to the multiple regression analysis, the significant factors in alpha-blocker monotherapy failure were the IPSS (p<0.001) and prostate volume (p=0.015). According to the receiver operating characteristic (ROC) curve-based prediction regarding surgical treatment, the best cutoff value for the prostate volume and IPSS were 35.65 ml (sensitivity 0.722, specificity 0.667) and 23.5 (sensitivity 0.852, specificity 0.840), respectively. CONCLUSIONS: At the initial diagnosis of BPH, patients with a larger prostate volume and severe IPSS have a higher risk of alpha-blocker monotherapy failure. In this case, combined therapy with 5-alpha-reductase inhibitor (5-ARI) or surgical treatment may be useful.

Prospective Factor Analysis of Alpha Blocker Monotherapy Failure in Benign Prostatic Hyperplasia

PURPOSE: We aimed to determine the treatment of choice criteria for benign prostatic hyperplasia (BPH) by analyzing the factors causing alpha-adrenergic receptor blocker (alpha-blocker) monotherapy failure. MATERIALS AND METHODS: This retrospective study enrolled 129 patients with BPH who were prescribed an alpha-blocker. Patients were allocated to a transurethral resection of prostate (TURP) group (after having at least a 6-month duration of medication) and an alpha-blocker group. We compared the differences between the two groups for their initial prostate volume, serum prostate-specific antigen (PSA), maximum urinary flow rate (Qmax), International Prostate Symptom Score (IPSS), and postvoid residual urine volume (PVR). RESULTS: Of the 129 patients, 54 were in the TURP group and 75 were in the alpha-blocker group. Statistically significant differences (p<0.05) between the two groups were found in the prostate volume (50.8 ml vs. 34.4 ml), PSA (6.8 ng/ml vs. 3.6 ng/ml), Qmax (6.84 ml/sec vs. 9.99 ml/sec), and IPSS (27.3 vs. 16.8). According to the multiple regression analysis, the significant factors in alpha-blocker monotherapy failure were the IPSS (p<0.001) and prostate volume (p=0.015). According to the receiver operating characteristic (ROC) curve-based prediction regarding surgical treatment, the best cutoff value for the prostate volume and IPSS were 35.65 ml (sensitivity 0.722, specificity 0.667) and 23.5 (sensitivity 0.852, specificity 0.840), respectively. CONCLUSIONS: At the initial diagnosis of BPH, patients with a larger prostate volume and severe IPSS have a higher risk of alpha-blocker monotherapy failure. In this case, combined therapy with 5-alpha-reductase inhibitor (5-ARI) or surgical treatment may be useful.

Effect of Stress on the Expression of Rho-Kinase and Collagen in Rat Bladder Tissue

PURPOSE: We examined the effect of stress on the pathophysiology of bladder stability in terms of enzyme levels, Rho-kinase, and bladder relaxation. MATERIALS AND METHODS: A total of 48 female Sprague-Dawley rats were studied in scheduled stress environments for 7, 14, and 28 days; 24 rats were in the control group and 24 rats were in the test (stressed) group. RESULTS: Estrogen decreased significantly whereas testosterone and dopamine increased significantly in the stress group (p<0.05). Rho-kinase was significantly increased in the rats exposed to stress stimuli for 14 days (p<0.05). Collagen types I and III in the bladder tissue were significantly higher in rats exposed to stress for 14 days and 28 days (collagen type I in the 14-day group, p<0.01; collagen type I in the 28-day group, p<0.05; collagen type III in the 14-day and 28-day groups, p<0.05). Voiding frequency increased significantly as the duration of stress exposure was prolonged, in addition to a significant decrease in volume per voiding (p<0.05). CONCLUSIONS: The changes observed in micturition pattern, factors that contribute to smooth muscle contraction, and relaxation in the female rat bladder support the hypothesis that stress affects bladder stability.

Prostate Cancer Metastasis to the Stomach

Prostate cancer commonly manifests with bony metastases. Visceral metastasis can also occur in the lungs and liver. However, stomach metastasis related to prostate cancer is rare. Here, we report a case of prostate cancer metastatic to the stomach. A 66-year-old male was diagnosed with prostate adenocarcinoma. He was noted as having abdominal discomfort, nausea, and vomiting 18 months after the diagnosis. A histopathologic examination and an esophagogastroduodenoscopic gastric biopsy revealed stomach-metastatic adenocarcinoma. He was also noted as having cerebellar metastatic lesions, which were identified by using a brain magnetic resonance imaging (MRI) scan. The patient died of cardiovascular complications 5 months after the diagnosis of stomach metastasis.

Correlation between Nocturia and Sleep: A Questionnaire Based Analysis

PURPOSE: This study evaluated the effectiveness and quality of sleep (QoS) in adult patients with nocturnal lower urinary tract symptoms (LUTS) including nocturia and nocturnal polyuria. MATERIALS AND METHODS: A total of 102 patients with nocturia and daytime LUTS were enrolled in this study. All patients completed a questionnaire that included the International Prostate Symptom Score (IPSS), quality of life score (QoL), overactive bladder questionnaire (OABq), and a sleepiness index. The sleepiness index was measured with the Korean Beck Depression Inventory (K-BDI), Insomnia Severity Index (ISI), Epworth Sleepiness Scale (ESS), Berlin Questionnaire (BQ), and the International Restless Legs Syndrome Study Group (IRLSSG). Statistical analyses included the Student's t-test and chi-square test. Differences were considered significant at a p-value of less than 0.05. RESULTS: Nocturia during sleep was experienced by 68 (66.7%) out of 102 patients. There was no significant association between the nocturia- and the sleep-related scales, but with multiple regression analysis for sex and age, the K-BDI score (p=0.05), IPSS score (p=0.05), and OABq (p=0.02) were significantly higher in patients who woke up to void during sleep. A total of 57 (55.9%) patients diagnosed with overactive bladder with nocturia had severe daytime sleepiness on the ESS questionnaire (p=0.019) and more urgency symptoms on the IPSS questionnaire (p=0.007). CONCLUSIONS: Patients with nocturia had a greater risk of being depressive and felt sleepier during the daytime. LUTS including nocturia and sleep quality closely affected each other. Therefore, clinicians should consider patients' LUTS and sleep problems or QoS as well to provide more satisfying outcomes.