Effect of Patient-Optimized Doses of Tamsulosin on Erectile Function in Men With Erectile Dysfunction and Lower Urinary Tract Symptoms

PURPOSE: To investigate the relationship of improvement in erectile function (EF) with improvement in lower urinary tract symptoms (LUTS) and to assess the contribution of tamsulosin dose to the improvement of EF apart from the indirect influence of LUTS improvement in men with LUTS and erectile dysfunction (ED). MATERIALS AND METHODS: Fifty patients received tamsulosin 0.2 mg/d for the first 4 weeks and were subsequently divided into two groups by patient-reported outcomes. Nonescalators were maintained starting dose and escalators increased to 0.4 mg for the remaining 8 weeks. International Prostatic Symptom Score (IPSS) and International Index of Erectile Function (IIEF-5), and underwent uroflowmetry were evaluated at baseline, and weeks 4 and 12. RESULTS: LUTS parameters were significantly improved in both groups but insignificant between the 2 groups. The degree of the improvement in the total IPSS and in the voiding, storage, and quality of life (QoL) subscores were significantly correlated with the degree of the improvement in EF; this was especially prominent in patients successfully treated LUTS. The escalators experienced a significantly greater increase in IIEF-5 scores than did the nonescalators (3.3 vs. 1.5). CONCLUSIONS: Dose escalation provided similar LUTS improvement in patients with refractory to starting dose. The improvements of LUTS were correlated with the improvement of EF. The increase in the IIEF-5 score was significantly higher in escalators. These findings imply that tamsulosin may contribute to the improvement in EF through the improvement of LUTS and QoL and direct relaxation of the corpus cavernosum in a dose-dependent fashion.

Parent and Physician Perspectives on the Treatment of Primary Nocturnal Enuresis in Korea

PURPOSE: Parental decisions about the treatment of nocturnal enuresis (NE) are generally based on silent agreement with a physician's recommendation. However, physicians may have an insufficient understanding about parents' concerns and expectations regarding treatment. The aim of this study was to clarify the discrepancies between the perceptions of parents and physicians and to better understand the attitudes related to NE treatment. MATERIALS AND METHODS: A survey was conducted in six centers and included 105 parents and 102 physicians. Two questionnaires, one for parents and another for physicians, were prepared. Each contained items on demographic characteristics, concerns, and NE treatment preferences. The parents completed the questionnaire during their child's first clinical visit, and the physicians completed the questionnaire via e-mail or individual interviews. RESULTS: Low self-esteem was the most common concern among both parents and physicians. Parents showed a more serious concern regarding disease progression and sequelae than did physicians. In the parent group, parents of younger children were mainly concerned about growth, whereas parents of children with daytime symptoms were mainly concerned about disease progression and relationships. Treatment outcome preferences differed significantly between the two groups. Physicians preferred treatments yielding immediate results, whereas parents preferred long-term treatments that would result in low recurrence. CONCLUSIONS: This survey presents the differences between parents and physicians regarding NE concerns and therapeutic preferences. Our study may provide valuable insight for physicians regarding parental attitudes toward NE treatment.

Testosterone Replacement in Men with Late-onset Hypogonadism Symptoms and Loss of Diurnal Rhythm of Total Testosterone / 대한남성과학회지

PURPOSE: It is known that the loss of diurnal rhythm of testosterone by age is related to late-onset hypogonadism (LOH). Currently testosterone replacement therapy (TRT) has been recommended only in men with hypogonadism. We evaluated the effectiveness and safety of TRT for men with LOH symptoms and the loss of diurnal rhythm of total testosterone but normal values of total testosterone. MATERIALS AND METHODS: We enrolled 62 patients in whom the difference in testosterone between morning and evening was lower than 108 ng/dl, whose morning values were higher than 300 ng/dl, and who were diagnosed with LOH using the Androgen Deficiency in Aging Male (ADAM) questionnaire. Among the 62 patients enrolled, 44 completed the daily application of 1% testosterone gel or the intramuscular injection of long-acting testosterone undecanoate for the full 20-week period. We compared the data at baseline, and the 8th and 20th week using the Aging Males' Symptoms (AMS) scale, the International Index of Erectile Function (IIEF)-15, the International Prostate Symptoms Score (IPSS), and the serum levels of total testosterone, prostate specific antigen (PSA), complete blood cell count (CBC), and lipid profile. RESULTS: The mean age was 54.9+/-7.2 years. Subjects main symptoms were sexual dysfunction and decrease of ejaculate volume. AMS scales before and after TRT were 41.3+/-18.5 and 35.8+/-19.7 (p<0.05). IIEF total scores before and after TRT were 29.7+/-13.7 and 38.9+/-17.4 (p<0.001). However, 18 patients (40.9%) were not satisfied with TRT and only 11% were fully satisfied. Total testosterone and estradiol were higher after TRT but the other values had not changed. The most common adverse event (27.3%) was erythrocystosis (18.2%). CONCLUSIONS: TRT could induce total testosterone to reach the mid-normal level and was relatively effective for aging male symptoms and sexual function. It is essential for physician to inform patients about potential adverse events and the low satisfaction rate associated with TRT even though TRT has generally been effective.