Enhanced recovery after surgery in transurethral surgery for benign prostatic hyperplasia / 亚洲男科学杂志(英文版)

Enhanced recovery after surgery (ERAS) measures have not been systematically applied in transurethral surgery for benign prostatic hyperplasia (BPH). This study was performed on patients with BPH who required surgical intervention. From July 2019 to June 2020, the ERAS program was applied to 248 patients, and the conventional program was applied to 238 patients. After 1 year of follow-up, the differences between the ERAS group and the conventional group were evaluated. The ERAS group had a shorter time of urinary catheterization compared with the conventional group (mean ± standard deviation [s.d.]: 1.0 ± 0.4 days vs 2.7 ± 0.8 days, P < 0.01), and the pain (mean ± s.d.) was significantly reduced through postoperative hospitalization days (PODs) 0-2 (POD 0: 1.7 ± 0.8 vs 2.4 ± 1.0, P < 0.01; POD 1: 1.6 ± 0.9 vs 3.5 ± 1.3, P < 0.01; POD 2: 1.2 ± 0.7 vs 3.0 ± 1.3, P < 0.01). No statistically significant difference was found in the rate of postoperative complications, such as postoperative bleeding (P = 0.79), urinary retention (P = 0.40), fever (P = 0.55), and readmission (P = 0.71). The hospitalization cost of the ERAS group was similar to that of the conventional group (mean ± s.d.: 16 927.8 ± 5808.1 Chinese Yuan [CNY] vs 17 044.1 ± 5830.7 CNY, P =0.85). The International Prostate Symptom Scores (IPSS) and quality of life (QoL) scores in the two groups were also similar when compared at 1 month, 3 months, 6 months, and 12 months after discharge. The ERAS program we conducted was safe, repeatable, and efficient. In conclusion, patients undergoing the ERAS program experienced less postoperative stress than those undergoing the conventional program.

Vasectomy has no obvious longterm influence on the levels of serum androgens in aging males / 中华男科学杂志

Objective@#To explore the longterm influence of vasectomy on the levels of serum androgens in aging males.@*METHODS@#Using stratified random sampling, we conducted a questionnaire survey and physical examinations among 437 adult males aged ≥40 years, 232 with and 205 without the history of vasectomy. In addition, we measured the levels of serum total testosterone (TT), sexhormone binding globulin (SHBG), calculated free testosterone (cFT), testosterone secreting index (TSI), free testosterone index (FTI), and luteinizing hormone (LH).@*RESULTS@#Compared with the nonvasectomy group, the vasectomy group showed significantly increased levels of serum TT (［16.01±5.41］ vs ［17.39±6.57］ nmol/L), SHBG (［58.91±36.89］ vs ［70.28±40.90］ nmol/L), and LH (［8.86±6.49］ vs ［10.85±11.73］ IU/L) (all P0.05), nor after adjustment for relevant factors in TT (β: 1.015, 95% CI: －0.180－2.210), SHBG (β: 5.118, 95% CI: －2.069－12.305), cFT (β: 0.003, 95% CI: －0.011－0.018), FTI (β: －0.012, 95% CI: －0.035－0.011), TSI (β: 0.138, 95% CI: －0.131－0.407), and LH (β: 1.011, 95% CI: －0.811－2.834) (all P>0.05).@*CONCLUSIONS@#Vasectomy has no obvious longterm influence on the levels of serum androgens in aging males.

Aging Male Symptoms Scale (Ams) For Health-Related Quality Of Life In Aging Men: Translation And Adaptation In Malay

The Aging Male Symptoms Scale (AMS) measures health-related quality of life in aging men. The objective of this paper is to describe the translation and validation of the AMS into Bahasa Melayu (BM). The original English version of the AMS was translated into BM by 2 translators to produce BM1 and BM2, and subsequently harmonized to produce BM3. Two other independent translators, blinded to the English version, back-translated BM3 to yield E2 and E3. All versions (BM1, BM2, BM3, E2, E3) were compared with the English version. The BM pre-final version was produced, and pre-tested in 8 participants. Proportion Agreement, Weighted Kappa, Spearman Rank Correlation Coefficient, and verbatim responses were used. The English and the BM versions showed excellent equivalence (weighted Kappa and Spearman Rank Coefficients, ranged from 0.72 to 1.00, and Proportion Agreement values ranged from 75.0% to 100%). In conclusion, the BM version of the AMS was successfully translated and adapted.

Effect of electro-acupuncture on reproductive endocrine and renal contents of SOD and MDA in aging male rats with partial androgen deficiency / 第二军医大学学报

Objective To observe the effect of electro-acupuncture on reproductive endocrine and renal contents of superoxide dismutase (SOD) and malondialdehyde (MDA) in aging male (PADAM) rats with partial androgen deficiency. Methods Forty male rats were randomly divided into normal control group (n = 10) and model group (n = 30). Rats in the model group were injected with cyclophosphamide 20 mg/(kg · d) into the abdominal cavities to establish PADAM model. The 24 successful model rats were further randomized into electro-acupuncture, androlin treatment and blank groups; rats received corresponding treatment for 8 weeks. The general conditions of the animals were observed before and 1 day after modeling and at the end of treatment. Tail suspension experiments and exhaustion swimming tests were performed; and the serum total testosterone (TT) and free testosterone (FT) levels were determined. The contents of SOD and MDA in renal tissues were examined at the end of the experiments by hydroxylamine method. Results After treatment with cyclophosphamide, the serum levels of TT and FT in rats were significantly decreased (P0.05). Conclusion Electro-acupuncture can increase serum TT and FT levels in PADAM rats, improve the depression state, myodynamia and energy in the aging rats, with its effect being equivalent to that of testosterone propionate. Electro-acupuncture can increase SOD level and decease MDA level in PADAM rats, indicating that electro-acupuncture may function by improving the free radicals system of PADAM rats.

<b>Two Cases in which Byakkokaninjinto was Effective for </b><b>General Malaise in Aging Males </b> / 日本東洋医学雑誌

We report 2 cases in which byakkokaninjinto was effective for general malaise in aging males. In 1939, climacterium disorders with general malaise were reported in aging men in America. Later, late-onset hypogo nadism (LOH) was defined, and guidelines for LOH syndrome were made.<BR>We distinguished two cases of climacterium disorder with LOH syndrome in aging males. We used the AMS score (which is a diagnostic criteria for LOH syndrome) at the first medical examination.<BR>Case 1 was a 48-year-old man suffering from serious headaches every day for which he took many analge sics. His AMS score was 27/85 at the first medical examination. Mild LOH syndrome was suspected in this case. Case 2 was a 48-year-old man suffering from frequent daily hot flashes. His AMS score was 42/85 and moderate LOH syndrome was suspected.<BR>General malaise in aging males arises from a decrease in male hormone with aging and is treated with an drogen hormone replacement therapy (androgen HRT), while Kampo treatment is also a consideration. As Kampo treatments, hachimijiougan and kamishouyousan are usually chosen. Byakkokaninjinto was effective these patients who showed thirst and polydipsia.

The detection of the testosterone deficiency syndrome in aging males with erectile dysfunction / Монголын Анагаах Ухаан

Introduction: Erectile dysfunction (ED), also known as impotence, is defined as a consistent or recurrent inability to attain and/or maintain penile erection sufficient for sexual performance [1]. According to recent study results, ED occurs more than 50% over 60 year old males, emphasizing a need to diagnose and treat it at an earlier stage. ED may be assessed in several ways. The most widely used standardized questionnaire is the International Index of Erectile Function (IIEF) with 15 questions, which also exists in a short form with 5 questions [2]. On the other hand, ED is associated with a decreased level of androgens in aging males; the latter is often referred to as a Late Onset Hypogonadism (LOH) or Testosterone Deficiency Syndrome (TDS). In simple terms, LOH or TDS can be defined as a decreased serum testosterone level in aging males [3, 4]Objective: To detect the testosterone deficiency syndrome in aging males with erectile dysfunction. Materials and Methods. 309 males over 40 years of age who received medical care at the ADAM urological and andrological clinic from 2010 to 2011 were included in this study. An approval of the Ethical Committee of MOH was obtained at the commencement of the study. Each study participant signed a consent form at the beginning of the study. Each participant was assigned to either an ED group or a control group depending on results of the IIEF-5 questionnaire. The ED group was further divided into three groups (moderate, severe and very severe) based on a level of ED. The total testosterone (TT) levels were determined in blood serum, using a competitive ELISA analytical system UBI MAGIWELTM TestosteroneQuantitative test (GLS, USA), with C.V. (%) 6.8 and free testosterone (FT) calculated as described by Vermeulen. Test samples were collected between 8.00-11.00 am. The biochemical diagnosis of TDS was based on the Study Aging Male (ISSAM) guidelines of the International Society, particularly, if TT was _3.46 ng/ml or free testosterone FT was ≤0.072 ng/ml [5].Results: ED of moderate, severe and very severe levels were diagnosed in 199 (64.41%) out of 309 participants. There was an inverse association between an erectile function and age (r=-0.380, p <0.01). The average TT was 5.75±2.316 ng/ml and FT was 0.091±0.0084 ng/ml. Compared to the ED group, the control group had a higher TT level: 5.6440±1.177 ng/ml and 5.812±2.316 ng/ml respectively. In the control group the FT level was 0.061±0.0084 ng/ml whereas it was 0.041±0.0076 ng/ml in the ED group. Conclusion: Our study showed that most of aging males who came to the clinic had a moderate to very severe ED (64.55%). The level of TT (5.644±1.177 ng/ml) and FT (0.041±0.0036 ng/ml) was significantly lower in ED patients (p<0.05). The testosterone deficiency syndrome was detected in 24.27% of the ED group.

Bioavailable testosterone and age correlation in aging males / Монголын Анагаах Ухаан

Introduction: With the increasing longevity in men and women, sexual health concerns have become more and more important and demands for help are far more common than in the past. The percentage of aging population is increasing also. The of this study in aging men. Late onset hypogonadism will need the testosterone replacement therapy and we hope that our study result will help to get basic information of testosterone among over 40 yearsold Mongolian men.Goal: To determine the bioavailable testosterone (BT) of aging males and correlate with aging process.Materials and Methods: This study is a part of ongoing study: “Androgen status of aging males” which was supported by Asian Research Center, Korean Foundation for Advanced Studies. We studied 114 healthy males aged above 40 years old, all undergone the General and Urological examination. Bioavailable testosterone was determined by formula suggested by ISSAM.Result: The average bioavailable testosterone level was 2.53±1.48 ng/ml, in 40-49 age group 2.76±1.37 ng/ml, in 50-59 age group 2.60±1.70 ng/ml, in 60-69 age group 2.51±1.56 ng/ml, and over 70’s it was 2.04±1.05 ng/ml. If consider the bioavailable testosterone 100%, in 40-49 age than it is decreasing 94.2% in 50-59, 90.9% in 60-69 ages and 73.9% decreased in over 70s. Respectively, it decreases approximately by 0.9% every year after 40’s.Conclusion: The bioavailable testosterone level was 2.53±1.48ng/ml in aging males and has reverse correlation with aging (r=-0.169, p=0.037).

Attitude of Korean Males toward Late-Onset Hypogonadism: Survey of Males in Their 40s and Above / 대한남성과학회지

PURPOSE: To investigate the frequency of symptoms of late onset hypogonadism(LOH) and the intention for testosterone replacement therapy in Korean males in their 40s and above. MATERIALS AND METHODS: Korean males over age 40 were given a detailed explanation of LOH and the Korean version of Androgen Deficiency in Aging Male(ADAM) questionnaire(Saint Louis University) by e-mail. Positive for ADAM was defined as answering 'yes' to Q3 or Q7 which estimate the decline of sexual desire and erectile dysfunction or answering 'yes' to more than 3 other questions. The men's intention to take testosterone replacement therapy when recommended for symptoms of LOH was also queried. RESULTS: Among 38,502 people who opened the e-mail, 15.1%(5,795) of men responded to the survey. The largest fraction of respondents was males in their 40s(60%). The ADAM questionnaire revealed 64.6% of respondents as positive for LOH. More than 50% of respondents complained of decline in erection, endurance, or sexual desire. When asked about their intention to take testosterone replacement therapy, 96% of those positive for LOH answered that they would accept the treatment. CONCLUSIONS: Although the response ratio was low, 96% of screened LOH men showed high interest in LOH and a positive attitude toward testosterone replacement therapy. Urologists should thoroughly investigate the symptoms of LOH in men in their 40s and above and conduct testosterone replacement therapy as indicated, in order to improve the quality of life for Korean men.

Advances in diagnosis and treatment of PADAM / 基础医学与临床

The old term of PADAM is "male climacteric" or "andropause" with the synoym of "ADAM" or " late hypogonadism".The serum level of testosterone in male progressives declined after the age of 40 while SHBG increased.At age of 70,around 30% of the total testosterone and 40% of the free testosterone lost.The diagnosis of PADAM is based on the low serum level of androgen and the presence of related symptoms.The basic treatment for PADAM is androgen supplementation(TST).Testosterone undecanoate is a common agent for this purpose.The skin patch or gel of testosterone are also recommended.The benefits of TST are improvement of sexual function,increase of lean body mass,decrease of body fat,enhancement of bone formation and cognition function,and decreased the risks of suffering from type 2 diabetes and cardiovascular disease.On the way of TST,it is necessary to monitor erythrocytes,liver function,prostate digital examination and serum PSA regularly.

Urologic Disease in Elderly Men

No abstract available.

Male Climacteric and Kampo / 日本東洋医学雑誌

The authors introduce current problems with regard to the male climacteric, or Partial Androgen Deficiency in Aging Males (PADAM) in Japan. They also emphasize the need for an official guideline for diagnosis and treatment, and new testosterone drugs for PADAM.<br>Dysfunction in the aging male is always a quality of life concern. The authors take this opportunity to focus on the possibilities and expectations with Kampo medicine in Japan, while discussing their view of ideal Kampo treatment for PADAM.

Changes in the Quality of Life after Tansdermal Testosterone (Androderm(R)) Supplement Therapy in the Aging Male / 대한비뇨기과학회지

PURPOSE: This study investigated the changes of quality of life after the supplement of testosterone in the aging male partial androgen deficiency(PADAM). MATERIALS AND METHODS: The changes of subjective symptoms were estimated in 56 cases(experimental group: 48 cases, placebo group: 8 cases) with PADAM over 55 year-old, who were treated with transdermal testosterone(Androderm(R)) or a placebo patch by single blind method from September, 1997 to July, 1998. The 12.2mg testosterone patch was attached daily on the lower abdomen, thigh, upper arm and back on a period of three months. Laboratory tests were done on pretreatment and monthly after treatment, which include serum testosterone, PSA, cholesterol, AST and ALT. Changes in the quality of life were evaluated by the PNUH QOL system, which consisted of 21 questions inquiring the following 7 functions: metabolic, cardiopulmonary, musculoskeletal, gastrointestinal, neurologic, psychiatric and sexual function. RESULTS: The 56 cases showed an age distribution of 55-80 year-old(mean 64.3 year-old). During the follow-up period, the drop-out rate after treatment in the experimental group was 18 cases(37.5%) and 7 cases(14.6%) in the posttreatment 1st and 2nd months, respectively. Serum testosterone was significantly increased in the posttreatment 1st, 2nd, 3rd months when compared to pretreatment levels only in the experimental group(r=0.897, p=0.009). Prior to treatment, sexual dysfunction was inquired the most common problem, and followed by psychiatric, musculoskeletal, metabolic, cardiopulmonary, neurologic and gastrointestinal dysfunction in order. After treatment, sexual dysfunction showed the most improvement, and followed by metabolic, musculoskeletal, cardiopulmonary, psychiatric, gastrointestinal and neurologic dysfunction in order. Except for neurologic and gastrointestinal dysfunctions, other subjective symptoms improved in proportion to duration of treatment. The most common complication was a skin rash, which occured in 36 cases(64.2%) and caused the drop out of 14 cases(25%). CONCLUSIONS: According to the above results, it revealed that testosterone supplement therapy induced the improvement of the quality of life in PADAM. Therefore, treatment proctocols including indication, dosage and duration as well as the exact mechanism of the biological role of testosterone should be prepared to popularize hormonal therapy in PADAM.

The Changes of the Sensory Perception Threshold to the Vibratory and Electrical Current Stimuli of the External Genitalia according to Age / 대한비뇨기과학회지

PURPOSE: Although the aging process does not mean a morbid state, it is reported that the incidence of male erectile dysfunction is higher in the aged than in the young. One of important causes seems to be the functional changes of hormonal, vascular and nervous system. In addition the functional change of the sensory perception of penis can be another major cause of the erectile dysfunction in the aged male. We investigated the changes of the penile sensory perception function in the aged male. MATERIALS AND METHODS: We selected 90 men from age 20 to 76(average 43.6+/-17.0) who had no neuronal defect in past medical history and physical examination and measured the sensory perception threshold after giving the stimuli of vibration using the Biothesiometer and the stimuli of 5Hz, 250Hz, 2000Hz electrical currents using the Neurometer to the penile glans, penile shaft, scrotum, thigh and the index finger. RESULTS: All sensory perception thresholds of electrical stimuli in penile glans and penile shaft had no significant correlation with age(p>0.05). On the other hand, the sensory perception threshold of vibratory stimuli had a significant correlation with age in all of scrotum(r=0.59, p=0.0001), penile glans(r=0.58, p=0.0001), penile shaft(r=0.54, p=0.0001), thigh(r=0.43, p=0.0002) and index finger(r=0.38, p=0.0015), in which the stimuli threshold increased in proportion to age. The vibratory stimuli threshold had a higher significant correlation with age in penis, scrotum, penile glans than in thigh and index finger. CONCLUSIONS: The sensory perception threshold of vibratory stimuli elevated significant in the penile glans, penile shaft and scrotum. However, the sensory perception threshold of electrical stimuli showed no increase by the age. It is supposed that increased vibratory threshold of penile glans, shaft and scrotum may contribute to the pathophysiology of erectile dysfunction in aging male.

Clonical Experience on Non-Scrotal Testosterone Transdermal Patch in the Middle Aged Male / 대한내분비학회지

BACKGROUND: To evaluate metabolic effects of testosterone on whole bodily systems, non-scrotal testosterone transdermal patch was given to middle aged men. METHODS: Sixteen impotent patients with serum testosterone levels between 300 and 500 ng/dL, were recruited for 6 month of treatment with non-scrotal testosterone transdermal delivery system, and six patients dropped during the study. All patients have a non-organic impotence (mean age:48 +/- 7). After 1 month placebo patch running period, patients were given 1 or 2 patches. The parameters were evaluated at each stage; before treatment, after placebo patch, and after testosterone patch for 3 months and 6 months. The evaluation parameters included body weight, blood pressure, heart rate, body mass index (BMI), body fat, haemoglobin, haematocrit, RBC, lipid profiles, Prostatic Specific Antigen (PSA), Transrectal Ultrasonography (TRUS), International Prostatic Symptom Score (IPSS), bone markers such as osteocalcin and Deoxypyridinoline (dPyr), Bone Mineral Density (BMD), psychological evaluation with Questionnaire and hormones such as cortisol, Dehydroepiandrosterone sulfate (DHEA-S), Follicle Stimulating Hormone (FSH), Luteinizing Hormone (LH), prolactin, testosterone and Sex Hormone Binding Globulin (SHBG). Sexual functions were evaluated by means of sexual Questionnaire which has grade systems (high grade means good response) on each domain. RESULTS: Hormonal, hematopoietic, lipid and prostatic parametem were not changed with statistical insignificance. There were no significant changes in BMD. But mean osteocalcin values increased about 31.5% (p<0.05). Bone resorption marker, D-Pyr values were also decreased significantly about 18.6% after 4 montbs treatment, but such changes were not shown after 6 months. Tendencies of improvement in all domains of Sexual Questionnaire were noticed, even though they were not statistically significant except in frequency of coitus and satisfaction with ejaculation (p<0.05), CONCLUSION: Decreased bone resorption was noticed while persistent increased bone formation occurred after 4 months treatment of testosterone. Testosterone supplementation has a beneficial effects on mood and sexual function in the impotent patients with lower borderline testosterone level. And it can be concluded that 6 months testosterone treatment dose not produce any adverse reactions on bodily system.