Relationship between Serum Testosterone and Cardiovascular Disease Risk Determined Using the Framingham Risk Score in Male Patients with Sexual Dysfunction

PURPOSE: The aim of the present study aimed to evaluate the effect of testosterone on cardiovascular disease by using the Framingham Risk Score (FRS) in patients with sexual dysfunction. MATERIALS AND METHODS: A total of 308 men with sexual dysfunction were enrolled in this study. Clinical assessments included the 15-item International Index of Erectile Function (IIEF), blood pressure measurement, and clinical laboratory indexes. The FRS, which predicts the incidence rate of cardiovascular diseases in the next 10 years, was calculated on the basis of age, gender, total cholesterol, smoking status, high density lipoprotein cholesterol, and systolic blood pressure. RESULTS: The mean age of the 308 enrolled patients was 49.42+/-10.73 years, and the patients' mean body mass index (kg/m2) was 25.07+/-3.14. The mean total IIEF score was 28.44+/-18.06. The median total testosterone concentration was 3.2 ng/mL (interquartile range [IQR]: 2.3~3.2 ng/mL). The median calculated free and bioavailable testosterone concentrations were 0.052 ng/mL (IQR 0.039~0.070 ng/mL) and 1.30 ng/mL (IQR: 1.00~1.76 ng/mL), respectively. The mean FRS was 10.47+/-6.45. The FRS tended to show a negative correlation with the total and calculated free testosterone levels, but this was not significant (p=0.064 and p=0.074, respectively). In the multiple linear regression analysis, a significant negative correlation was observed between the total testosterone level and the FRS (p=0.048). CONCLUSIONS: The results suggest that the testosterone level is related to the FRS and that a high testosterone level may decrease the risk of cardiovascular disease.

The Factors Affecting the Success and Quality of Life after a Tension-free Vaginal Tape Procedure in Patients with Stress Urinary Incontinence / 대한비뇨기과학회지

PURPOSE: The factors affecting the success and quality of life following a tension-free vaginal tape(TVT) procedure were investigated in patients with stress urinary incontinence. MATERIALS AND METHODS: We included 79 women with stress urinary incontinence that underwent the TVT procedure and were followed for at least 3 years. Preoperatively, the patients were evaluated by history, physical examination, a 1-hour pad test, and videourodynamics to determine the abdominal leak point pressure(ALPP). In addition, pre- and postoperative quality of life was evaluated by the incontinence quality of life questionnaire(I-QoL). We analyzed factors including patient characteristics, history, 1-hour pad test and ALPP with respect to the success and quality of life after the TVT. A success after the TVT was defined as the absence of any subjective complaint of leakage. RESULTS: The overall 3-year success rate of the TVT was 90%. There was a statistically significant increase in the I-QoL scores postoperatively. There were no significant preoperative factors affecting the success rate and the postoperative I-QoL scores. However, when the postoperative I-QoL scores were compared with the preoperative scores, the increase in the I-QoL scores was significantly higher in the patients with urge incontinence, low ALPP and high-grade incontinence. CONCLUSIONS: The results of this study suggest that the TVT procedure is effective for treating female stress incontinence and improving the quality of life without any independent risk factors. However, for improving the quality of life, the TVT was more effective in women with stress urinary incontinence with urge incontinence, low ALPP and high-grade symptoms.

Sleep-Related Erections(SREs) in Chronic Vegetative State Patients / 대한남성과학회지

PURPOSE: To determine whether sleep-related erections(SREs) occur during chronic vegetative state and if so, to investigate what factors are involved. MATERIALS AND METHODS: Twenty-six men in a vegetative state aged 16~65 were selected. Exclusion criteria were the lack of informed consent, mean blood pressure under 90/60 mmHg during last 3 days, erectile dysfunction before brain injury, and a history of any anti-androgen treatment. Serum testosterone, albumin, sex hormone binding globulin(SHBG), and dehydroepiandrosterone sulfate(DHEAS) were assayed, and bioavailable testosterone(cBT) and free testosterone(cFT) were calculated. Nocturnal penile erections were counted and evaluated using the Rigiscan device for72 hours. Data on the number of erections, erection duration, minimal and maximal base tumescence, minimal and maximal tip tumescence, and base and tip rigidity were taken. RESULTS: SREs were noted in 25 patients. The mean erection number was 4.65+/-3.93(1~15), and the mean erection duration was 128.85+/-46.86 minutes(0~478.5). SREs were negatively correlated with age(r=-0.445, p<0.05), systolic BP(r=-0.394, p<0.05) and diastolic BP(r=-0.403, p<0.05), but positively correlated with DHEAS(r=0.395, p<0.05). SREs were not correlated with total testosterone, cBT or cFT. CONCLUSIONS: These preliminary findings suggest that SREs are a normal occurrence in vegetative patients. They contribute to penile blood perfusion if the supraspinal erection control center is intact and serum testosterone level is above the minimum required for SREs.