Is It Worth Treating Non-Bothering Nocturia? Results of a Multicenter Prospective Observational Study

PURPOSE: The purpose of this study was to evaluate the efficacy of treatment in patients with non-bothering nocturia. MATERIALS AND METHODS: In this prospective multicenter study, patients who visited hospitals for treatment of voiding symptoms were enrolled. Inclusion criteria were: 1) men >45 years, and 2) nocturia ≥2 confirmed by a three-day voiding diary. Subjects were divided into non-bothering and bothering groups based on International Consultation on Incontinence Questionnaire Nocturia (ICIQ-N) question 2b. Changes in voiding symptoms, frequency of nocturia, and bothersomeness were evaluated with international prostate symptom score (IPSS), ICIQ-N, and three-day voiding diary at 4 and 12 weeks after treatment. RESULTS: A total of 48 patients in the non-bothering nocturia group and 50 patients in the bothering nocturia group who completed the 12-week treatment were analyzed. The total IPSS was decreased by 5.8 in the non-bothering group and 5.2 in the bothering group. There was no significant difference in decrease of IPSS between the two groups. Both groups showed significant reduction in discomfort of nocturia. The ICIQ-N 2b score decreased from 3.9 to 2.7 (p=0.01) in the non-bothering group and from 6.9 to 4.6 (p=0.02) in the bothering group. The number of nocturia episodes was significantly decreased in both groups. CONCLUSIONS: Regardless of discomfort associated with nocturia, both groups showed significant improvement in nocturia-related discomfort and voiding symptoms. These results suggest that patients with nocturia who were unaware of its discomfort benefited from treatment.

Erratum: Correction of Title. Correlation Between Lower Urinary Tract Symptoms and Premature Ejaculation in Korean Men Older Than 40 Years Old

In this paper, the title was described incorrectly.

Assessing Quality of Life Related to Voiding Symptoms and Sexual Function in Menopausal Women

PURPOSE: To evaluate the correlation between lower urinary tract symptoms (LUTS) and premature ejaculation (PE) in Korean men older than 40 years. MATERIALS AND METHODS: In total, 258 men older than 40 years completed the International Prostate Symptom Score (IPSS; total score, storage symptoms [ST], and voiding symptoms [VD]), a 5-item version of the International Index of Erectile Function (IIEF-5), and the Premature Ejaculation Diagnostic Tool (PEDT). The study examined the relationship between LUTS and PE. In the PEDT, PE is defined as a score > or =11. RESULTS: The prevalence of PE was 29.1% with the PEDT versus a self-reported value of 49.5%. The prevalence of PE was 30.9% in 40 to 59-year-old men (21.3%) and 28.1% in 60 to 79 year-old men (78.7%). In men 40 to 59 and 60 to 79 years old, the mean PEDT, IPSS, and IIEF-5 scores were 8.65 and 7.88, 13.5 and 12.38, and 15.83 and 13.69, respectively. No significant correlations were observed between the total and subscale scores of the IPSS (p=0.204) and the PEDT (p=0.309) with increasing age, whereas a significant negative correlation was detected between the IIEF-5 and age (p=0.002). The PEDT score was significantly correlated with the IPSS-ST (r=0.326, p<0.001), IPSS-VD (r=0.183, p=0.005), IPSS-total (r=0.310, p<0.001), and IIEF-5 total (r=-0.248, p<0.001). CONCLUSIONS: LUTS, especially storage symptoms, were related to PE. In elderly men, control of both erectile dysfunction and LUTS may play an important role in managing PE.

Testosterone replacement therapy and monitoring for the male patients with testosterone deficiency syndrome

Since the elderly population has been increasing recently in our country, old male patients with testosterone deficiency syndrome (TDS) with a significantly decreasing quality of life are becoming increasingly common. TDS in males is defined as a biochemical syndrome associated with advancing age and characterized by clinical manifestation and a deficiency in the serum testosterone level. These patients should be treated with extrinsic testosterone to improve quality of life. TDS in males should be diagnosed in the case of clinical manifestation with serum total testosterone 12 nmol/L (350 ng/dL). Products for testosterone replacement therapy (TRT) are administrated orally, transdermally, and through injectable preparations. Daily testosterone undecanoate is widely used for oral administration with good results and no hepatotoxicity. Short-acting intramuscular preparations are very effective but show wide swings in the resulting supra-physiological level of serum testosterone. Long-acting intramuscular preparations is also very effective and lasting for 3 months with normal physiologic levels. Many products for TRT on the market are effective and generally safe. However, those have a few significant adverse events each other. The ideal product should have notable effectsand few side effects, (such as selective androgen receptor modulators), be easy to administrate, maintain physiologic serum concentration, and be inexpensive. TDS in males can easily be correct by TRT. However, the advantages and disadvantages of the individual products and follow-up management of complicated adverse events should be understood before starting and maintaining TRT.

A Case of Xanthogranulomatous Prostatitis Concurrent with a Prostatic Abscess / 대한남성과학회지

Xanthogranulomatous prostatitis is a rare inflammatory condition of the prostate. We report a case of xanthogranulomatous prostatitis. An 82-year-old man presented to our emergency department complaining of gross hematuria. A hard, enlarged, non-tender prostate was palpated on digital rectal examination. Urinalysis showed hematuria and pyuria, and the complete blood count (CBC) revealed leukocytosis. The prostate-specific antigen (PSA) level was elevated at 86.8 ng/ml. Computed tomography (CT) showed an enlarged prostate (volume 100 ml) that protruded into the bladder base. In the left lobe of the prostate, a 1.2x1.1-cm abscess was seen. Transurethral resection of the prostate was done. The pathological diagnosis was xanthogranulomatous prostatitis. The natural progression of the disease is unknown because of the paucity of cases and long-term follow-up reports. To evaluate the pathogenesis and long-term features of progression of this disease, more clinical cases should be collected.

A Study Assessing the Quality of Life Related to Voiding Symptoms and Sexual Functions in Menopausal Women

PURPOSE: To investigate the impact of menopause on the quality of life (QoL) of middle-aged and older women, including their general well-being, voiding-related symptoms, and sexual distress. MATERIALS AND METHODS: To assess QoL, we administered a questionnaire that included questions about voiding-related symptoms and female sexual distress and part of the Women's Health Questionnaire. The self-administered questionnaires were completed by 1,679 women in the Korea. Data for 1,262 women were available for analysis, including premenopausal (n=307), perimenopausal (n=240), and postmenopausal (n=715) groups. RESULTS: Voiding-related discomfort increased significantly in perimenopausal and postmenopausal women compared with premenopausal women (p<0.001). General well-being worsened as menopause progressed (p<0.001). Menopausal women who were older (p=0.014), had a hysterectomy (p=0.005), or had urinary incontinence (p=0.001) had more voiding-related symptoms. Hypertension (p=0.026), cardiac disease (p=0.013), and arthritis (p=0.001) resulted in significantly decreased general well-being. Women with a hysterectomy (p=0.017) and those with arthritis (p=0.004) had high sexual distress. In the menopausal group, employed women had better general well-being than did unemployed women. CONCLUSIONS: Menopause negatively affected the QoL of middle-aged and older women because of decreased general well-being and increased voiding-related symptoms. General health, even in menopausal women, was important to maintain a better QoL. To preserve the QoL of women undergoing menopause, control of menopause and underlying disease should be considered.

Early Experience with Hyaluronic Acid Instillation to Assist with Visual Internal Urethrotomy for Urethral Stricture

PURPOSE: The clinical usefulness of hyaluronic acid (HA) instillation during visual internal urethrotomy (VIU) for decreasing the incidence of recurrent urethral stricture was assessed. MATERIALS AND METHODS: Twenty-eight patients were treated by VIU with HA instillation between May 2007 and June 2009. After insertion of a Foley catheter following urethrotomy, HA was instilled via an 18-gauge tube catheter between the urethral lumen and Foley catheter. Seventeen cases were analyzed retrospectively 12 months postoperatively. We evaluated the success rate of this procedure by comparing retrograde urethrography (RGU) results, maximum flow rates, and postvoid residual urine volumes preoperatively and 3 and 12 months postoperatively. Success was defined as either a maximum flow rate of at least 15 ml/s or no visible urethral stricture on RGU at 12 months postoperatively. RESULTS: Total success rates were 76.5% (13/17) and 52.9% (9/17) at 3 and 12 months postoperatively, respectively. By etiology, success rates at 3 and 12 months postoperatively, respectively, were 66.7% and 33.3% for inflammation, 66.7% and 50.0% for trauma, and 83.3% and 66.7% for unknown causes. Success rates were 63.6% for strictures less than 10 mm in length and 33.3% for strictures of 10 mm or more in length at 12 months postoperatively. Success rates were 61.5% for single strictures and 25% for multiple strictures at 12 months postoperatively. CONCLUSIONS: The success rate of VIU with HA instillation was not better than that observed in the literature for conventional VIU.

Short Term Effect and Safety of Antidiuretic Hormone in the Patients with Nocturia / 대한배뇨장애요실금학회지

PURPOSE: To investigate the short-term safety of antidiuretic hormone in elderly patients with nocturnal polyuria, focus on hyponatremia and others electrolytes disturbances and to assess short-term effects on nocturnal urine output and number of nocturnal voids. METHODS: Between June 2005 and August 2006, a total of 34 patients with nocturnal polyuria were orally administered 0.2 mg desmopressin tablet at bedtime for two weeks. Serum sodium, others electrolytes, urine sodium and urine osmolarity were assessed in the third days, one week and two weeks after treatment with desmopressin and compared adult group ( or =65 years of age). We assessed the effect of desmopressin using a frequency-volume charts and analysed. RESULTS: In total 34 patients (20 adult, 14 elderly) were analyzed. Desmopressin treatment did not significantly change serum and urine electrolytes include soduim concentration in elderly patients comparied with adult patients. Serum sodium concentration below normal range was recorded in 2 patients in elderly group, but no serious adverse events occurred and recovered without sequelae. The mean number of nocturnal voids decresed (54% reduction) and nocturnal urine output decreased (57% reduction) after using desmopressin. CONCLUSIONS: Desmopressin was well tolerated and effective in elderly patients with nocturnal polyuria without clinically significant hyponatremia.

A Survey of Understanding of Viagra in primary Physician and General Population / 대한남성과학회지

PURPOSE: Sildenafil citrate(Viagra(R)), a PDE-5 inhibitor in the corpus carvenosum to facilitate penile erection has improved impaired erectile responses in men and has been accepted as a primary treatment of erectile dysfunction. However, complications occurred by Viagra have increased due to its overuse and misuse. Therefore, we have performed a survey to compare physicians and general population in Busan, Korea to assess their understanding of Viagra. Methods and Materials: In 2007, printed surveys were mailed to randomly sampled candidates of 197 primary physicians and 696 individuals from general population, 327 medical students in Busan were surveyed by door-to-door visits. We assessed opinions associated with Viagra eliciting their understanding about its safety, direction, and complications. Data were analyzed using SPSS and were identified by crosstabulation analysis using Ki-square test. RESULTS: Of 1,265 eligible responses, several differences were found between the 3 groups. Compared to general population, the others were more likely to understand the efficacy, directions, and complications of Viagra. Physicians and medical students(43.1% and 39.0%) gave more preference than general population(26.1%) to using Viagra. There were differences in understanding of Viagra with changes of education level. However, it showed no significant differences about idea of illegal Viagra and combination usage with nitrates. Conclusion: The number of patients using Viagra is increasing but their understanding about Viagra is still poor. Moreover, general populations understand Viagra as 'assistant' for erection poorly. Even some medical students understand more than physicians. The ideas of complications would likely affect to negative thinking about usage for Viagra. Therefore more active and continuous educations for proper use of Viagra are suggested for medical efficacy and less complications.

Development of a Korean Version of the Urinary Tract Infection Symptoms Assessment Questionnaire

PURPOSE: The aim of this study was to translate the Urinary Tract Infection Symptoms Assessment (UTISA) questionnaire, which assesses the severity and nuisance of symptoms and signs of uncomplicated urinary tract infection, into Korean with subsequent linguistic validation for clinical use and research. MATERIALS AND METHODS: This self-administered questionnaire is composed of 14 items that cover the 7 most frequent symptoms and signs. After acquiring permission for use of the questionnaire in Korea from Bayer Health Care Pharmaceuticals Global Health Economics and Outcome Research, 2 bilingual linguists individually translated the original English version of the UTISA questionnaire into Korean, and the translations were then reconciled by the linguists and the authors. A preliminary Korean version was translated back into English and reconciled by another bilingual linguist to confirm proper forward translation of the UTISA questionnaire, and then a complete Korean version of the UTISA questionnaire was finished. Ten women with acute cystitis completed the Korean UTISA questionnaire and were then interviewed to confirm the final Korean version through cognitive debriefing. RESULTS: Linguistic validation of the Korean version of the UTISA questionnaire was completed through forward translation and reconciliation, back-translation and reconciliation, cognitive debriefing, and finally, proof-reading of the questionnaire as a instrument for assessing symptoms and signs of uncomplicated urinary tract infection. CONCLUSIONS: The UTISA questionnaire was translated into a Korean, and the translation was validated linguistically. Psychometric validation will be needed in a large set of patients with uncomplicated urinary tract infection.

Treatment preferences in men with erectile dysfunction: an open label study in Korean men switching from sildenafil citrate to tadalafil / 亚洲男科学杂志(英文版)

<p><b>AIM</b>To evaluate patient preferences for sildenafil citrate or tadalafil (PDE-5 inhibitors available for the treatment of erectile dysfunction [ED]) and assess potential reasons for these preferences.</p><p><b>METHODS</b>This open-label study was conducted on Korean men taking sildenafil, at least 6 weeks prior to study entry, for ED. Following screening, patients continued sildenafil treatment for 4 weeks, then after a 1-week washout period, switched to tadalafil for 8 weeks. Patients then continued with their treatment of choice during an extension phase. Psychosocial factors (time concern, spontaneity, sexual self-confidence) were evaluated using Psychological and Interpersonal Relationship Scales (PAIRS), while timing of dose to sexual attempt patterns were assessed from patient diaries.</p><p><b>RESULTS</b>The present study enrolled 160 Korean men (mean age 55 years) with prior median sildenafil use of 585 days. During the extension phase, 73.7% of patients elected to take tadalafil, whereas 26.3% chose sildenafil (P < 0.001). After switching from sildenafil to tadalafil, mean PAIRS time concern scores decreased from 2.54 to 2.42 (P = 0.002), with no statistically significant differences observed between the sildenafil and tadalafil assessment phases in sexual spontaneity and self-confidence scores. Sexual attempts made > 4 h to =/< 36 h post-dose occurred in 4.5% of patients during the sildenafil assessment phase compared with 17.5% during the tadalafil assessment phase.</p><p><b>CONCLUSION</b>After experiencing both sildenafil and tadalafil, the majority of patients exhibited a preference for tadalafil. This preference might be influenced by psychosocial factors, such as decreased time concerns, and a broader window of opportunity available for sexual activity.</p>

Medical Treatment of the Female Sexual Dysfunction / 대한남성과학회지

During the past 10 years, there have been many studies in the field of female sexual function and dysfunction. Studies of genital hemodynamic-related sexual arousal, contractility of the genital tissue, and the effects of sex steroid hormones on sexual function are increasing our understanding of female sexual function and dysfunction, and also are fundamental to the pharmacotherapy of female sexual dysfunction. On the basis of the clinical studies, testosterone is a strongly recommended treatment for women with sexual desire disorder with androgen deficiency. Female sexual arousal disorder with defects in genital hemodynamics is considered as a candidate for drugs that increase genital blood flow, including phentolamine, phosphodiesterase type 5 inhibitors, apomorphine, prostaglandine E1, and VIP derivates. Although many drugs have bee tested in the clinical treatment of sexual symptoms the results of clinical trials with these drugs have not been consistent. Women are largely affected in the initiation of sexual desire and in the process of sexual arousal by psychodynamics like mood or intimacy. However, some of the drugs which have shown inconsistent effects may still offer the promise of significantly improving sexual symptoms, and certainly offer treatment options that go beyond psychological treatment, which has been the only treatment available for many decades. In this review, I will summarize several drugs that have been tried clinically or could be applied theoretically.

Effects of Prostate Volume and Lower Urinary Tract Symptoms on Erectile Function / 대한비뇨기과학회지

PURPOSE: To assess whether the prostate volume and two types of lower urinary tract symptoms independently affect erectile function. MATERIALS AND MATHODS: One hundred and fifty two men, who visited outpatient department of Urology and health examination center, were investigated using validated symptom scales, including International Prostatic Symptom Score (IPSS) and International Index of Erectile Function-5 (IIEF-5). The Prostate volume was measured by one examiner using transrectal ultrasonography (TRUS). The correlations between the IIEF-5, emptying and storage symptoms of IPSS, prostate volume and age were subjected to univariate and multivariate analyses. RESULTS: The mean age, prostate volume, and IPSS and IIEF-5 scores were 54.0+/-10.6 years (31-77), 29.1+/-20.4cm(3) (7.9-170.0), and 15.1+/-9.4 (1-35) and 14.6+/-7.1 (1-25), respectively. From the univariate analysis, significant correlations were found between the IPSS and IIEF-5 scores, and the prostate volume and IIEF-5 score, and the age and IIEF-5. When the data were subjected to a multivariate analysis, statistically significant correlations were still observed between the IPSS and IIEF-5 scores and the age and IIEF-5 score, but not between the prostate volume and IIEF-5 score. Furthermore, the storage symptoms of IPSS affected erectile function, with statistical significance, whereas the emptying symptoms did not. CONCLUSIONS: In patients with benign prostatic hyperplasia, lower urinary tract symptoms, especially storage symptoms and age, caused decreases in erectile function. However, the prostate volume itself did not reduce erectile function.

Comparative Analysis of Clinical Parameters in Acute Pyelonephritis / 대한비뇨기과학회지

PURPOSE: To compare the variable inflammatory parameters of acute pyelonephritis patients treated with inpatient therapy at 13 hospitals, according to the age and gender distributions. MATERIALS AND MATHODS: A total of 3,544 medical records of patients with confirmed acute pyelonephritis, and admitted to hospital between January 2000 and December 2005, were retrospectively analyzed. RESULTS: The mean age of the patients was 43.2+/-16.2 years old, with a male:female ratio of 1 : 5.1. The average duration of hospital admission was 7.9+/-5.3 days. Underlying diseases were found in 23.0% (749/3,252 patient), largely due to diabetes (35.1%). Radiological abnormal findings were found in 13.7%. The leukocyte count, ratio of segmented form, erythrocyte sedimentation rate (ESR), c-reactive protein, pyuria, positive blood culture, positive urine culture were 11,014+/-5,778/mm(3), 74.8+/-14.5%, 44.0+/-32.0 mm/hr, 12.4+/-9.3mg/dl, 83.9%, 10.5% and 46.7%, respectively. E. coli grow in 79% of the urine culture positive patients. In a comparison of 3 age groups (61 years), the elderly patients had a greater number of underlying diseases and more pathogens in cultured blood. When divided into males and females, the elderly male patients had more pathogen in cultured urine, but contrary to the male patients, the elderly female patients had elevated leukocyte count and erythrocyte sedimentation rate. Also, the old patient group had more resistance to ampicillin when they had E. coli as the uropathogen (p=0.021). Patients with higher ESR required longer hospital admission periods. CONCLUSIONS: It was found that variable clinical parameters of acute pyelonephritis patients treated with inpatient therapy differed according to both gender and age group in Korea. Therefore, these factors should be taken into account in the treatment plan.

Effects of Alpha-lipoic Acid on Nitric Oxide Synthase Expression and Ultrastructural Changes in the Bladder of Rats with Streptozotocin-induced Diabetes / 대한비뇨기과학회지

PURPOSE: To evaluate whether alpha-lipoic acid (ALA) is effective at restoring the levels of nitric oxide synthase (NOS) expression and preventing ultrastructural changes in the bladder of rats with streptozotocin- induced diabetes. MATERIALS AND METHODS: Nine-week-old male Sprague-Dawley rats were used. The experimental groups included a control group (n=6), a diabetes group (n=6), and two groups of diabetic rats treated with intraperitoneal injections of ALA (n=12) at either 50 (ALA50) or 100mg/kg/day (ALA100) for 8 weeks after the induction of diabetes. Diabetic oxidative stress was determined based on evaluation of immunohistochemical staining for 8-hydroxy-2-deoxyguanosine (8-OHdG). The measurements of the levels of eNOS and nNOS expressions, as well as an assessment of the ultrastructural changes in detrusor smooth muscle cells were performed. RESULTS: The highest expression of 8-OHdG was observed in the diabetes group; whereas, the 8-OHdG expression in the ALA-treated groups was similar to that in the control group. Both eNOS and nNOS were constitutively expressed in the control group. The expression levels of both eNOS and nNOS proteins were higher in the diabetes group, which had experienced increased oxidative stress, than in the ALA50 and ALA100 groups. Compared with the control group, the diabetes group exhibited severe degeneration of the detrusor muscle cells. In the rats treated with ALA, the detrusor muscle cells showed mild to moderate degeneration. The mean numbers of mitochondria per smooth muscle cell in the control, diabetes, ALA50 and ALA100 groups were 12.6+/-1.5, 5.1+/-0.7, 18.3+/-0.7 and 19.3+/-1.3, respectively (p<0.01). CONCLISIONS: Our data suggest that diabetes enhanced the levels of eNOS and nNOS expressions in the bladder, and ALA inhibited the expressions of eNOS and nNOS. ALA had a protective effect against the degeneration of intracellular micro-organelles produced by diabetic oxidative damage in detrusor muscle cells. This study suggests that early treatment with ALA can reduce the damage caused by diabetic oxidative stress.

Evaluation of Complementary and Alternative Medicine for Treating Patients with Erectile Dysfunction / 대한비뇨기과학회지

Purpose: The aim of this study was to evaluate complementary and alternative medicines (CAM) employed for treating patients with erectile dysfunction. Materials and Methods: A total of 204 patients with erectile dysfunction who completed a questionnaire between January and June 2005 were evaluated. The questionnaire was composed of 13 questions. This survey employed a broad definition for CAM, including acupuncture, biofeedback, folk remedies, chiropractic, homeopathy, hypnosis, massage, psychotherapy, relaxation, energy healing, imagery, special diet, spiritual healing and herbal medicine. The CAMs used by the patients with erectile dysfunction were divided into processed health foods, natural health foods and other therapies, and these were all analyzed. Results: The mean age was 57.9+/-10.1 years. 78 of the total patients with erectile dysfunction had employed at least one CAM. CAM users were more likely to be high school educated, nonsmokers and exercisers. The CAMs used were processed health foods 62% (48/78), natural health foods 15% (12/78), and other therapies 66% (52/78). The processed health foods were soy 25%, ginseng 23% and mushroom 19%. Of the natural health foods, tomato was 42%, soy was 25% and ginseng was 17%. Of the other therapies, herbal medicine was 45%, acupuncture was 25%, moxibustion and cupping a boil were 17%. 35% (27/78) of the patients with erectile dysfunction had employed more than one of the processed health foods, natural health foods and other therapies. Conclusions: Patients with erectile dysfunction had mainly employed processed health foods more than the natural health foods, herbal medicine and acupuncture. We think that more research is required about the effects and benefits of CAM in association with ED.

Effects of the Single Administration of the Anticholonergics, Trospium Chloride, on the Patients with Nocturia

PURPOSE: The aim of this study was to evaluate the effects of the single administration of the anticholonergics, trospium chloride, in the nocturic patients without bladder outlet obstruction for mid-term. MATERIALS AND METHODS: We included the 22 male and 102 female patients with nocturia over 3 times and without bladder outlet obstruction. Exclusion criteria was under 15 ml/sec in maximal flow rate, over 30 ml in post-void residual urine, nocturnal polyuria and medication affecting lower urinary tract symptoms including alpha-blockers, sedatives, muscle relaxants. Based on voiding diary for 3 days, frequency of the nocturia, daytime frequency and frequency of the urgency and urge incontinence were measured at pretreatment, post-treatment 1st month, 3rd month and 6th month. Additionally maximal flow rate and post-void residual urine were also recorded at the same periods. Anticholinergics was administered in flexible dose. RESULTS: In frequency of nocturia, single administration of the anticholonergics improved significantly at post-treatment 1st, 3rd and 6th month compared to pre-treatment level. The more severe the frequency of the nocturia was, the more it was improved by medication but there is no significant difference. Daytime frequency is significantly improved 3 month and 6 month after medication. In urgency and urge incontinence, the significant improvement was also observed at post-treatment 3rd month and 6th month. The significant differences between pre-treatment and post-treatment were not demonstrated in maximal flow rate and post-void residual urine. Dry mouth was the most common side effect but mild and tolerable. CONCLUSION: The single administration of the trospium chloride demonstrated a clinically significant improvement in nocturia as well as symptoms of the overactive bladder and did not affect negatively on bladder contractility.

Psychometric Properties of the Korean Version of the King's Health Questionnaire in Women with Stress Urinary Incontinence

PURPOSE: The purpose of this study is to evaluate the psychometric properties of the Korean version of the King's Health Questionnaire(KHQ) in patients with stress urinary incontinence. MATERIALS AND METHODS: Multicenter prospective study was undertaken in 106 patients with stress urinary incontince. Psychometric properties including discriminant validity, convergent validity were evaluated and the Cronbach's alpha coefficients were calculated. Test-retest analysis was performed and the sensitivity to clinical change before and after treatment was also evaluated. RESULTS: The psychometric properties and clinical validity of the KHQ Korean version were confirmed in 106 study population. The KHQ's good reliability was evidenced by Cronbach's alpha coefficients of>0.60, indicating to change in patients' perception of bladder condition in all domains. CONCLUSION: Our analyses confirm excellent psychometric properties for the Korean version of KHQ, which appears to provide a valid and reliable instrument for clinical usages in Korea.

The Early Experience of Various Treatment Modalities for Female Sexual Dysfunction / 대한비뇨기과학회지

PURPOSE: The aim of this study was to evaluate various medical treatments for the improvement of sexual function in women with sexual dysfunction. MATERIALS AND METHODS: Forty two patients that complained of desire and arousal disorders received treatments with androgen replacement, local administration of prostaglandin E1 (PGE1), administration of apomorphine and phosphodiesterase 5 inhibitor (PDE5I), and the application of a clitoral suction device. The treatment options were applied sequentially in some case. The improvement in sexual function was evaluated with respect to sexual desire, sexual sensation, sexual excitement, vaginal lubrication, orgasm and sexual satisfaction, using the Female Sexual Function Index and a subjective assessment, during masturbation. RESULTS: Androgen replacement over a 3 month period increased the sexual desire and sexual arousal response in 35.7% (5/14) and 21.4% (3/14) of the subjects, with no side effects. The local application of PGE1 improved the vaginal lubrication in 42.8% (3/7). Apomorphine increased vaginal lubrication in 12.5% (2/16) of the subjects. PDE5I improved sexual excitement and vaginal lubrication in 26.3% (5/19) of the subjects. A clitoral suction device improved the sexual sensation in 62.5% (25/40) and vaginal lubrication in 45.0% (18/40) of the subjects. Each treatment modality was more effective in secondary than in primary female sexual dysfunction. All of these modalities tested demonstrated an improvement in at least part of the sexual response, but not in the general sexual satisfaction. CONCLUSIONS: Although no improvement in sexual satisfaction was demonstrated, further studies to develop a proper indication for each treatment modality, due to their partial effectiveness toward each sexual response are warranted. Since female sexual dysfunction is not solved with a simple treatment, various treatment modalities must be applied for a significant time period.

Effect of Extracorporeal Magnetic Innervation Therapy in the Patient with Stress Urinary Incontinence / 대한비뇨기과학회지

PURPOSE: The purpose of this study was to assess the treatment effect of extracorporeal magnetic innervation (ExMI) therapy, and determine how long the effect of this treatment lasts. MATERIALS AND METHODS: Among the demonstrable stress urinary incontinent patients, 28 were selected. Before the ExMI therapy, voiding diary, incontinence episodes, pad test, and quality of life questionnaires were evaluated. The treatment was performed for 30 minutes, 3 times a week, for 6 weeks. All of the evaluations were repeated at the first and sixth months following treatment. The treatment outcomes were classified as: cure, good, fair, poor and failure, according to a new outcome score. RESULTS: The overall cure rate was 35.7% (10/28) by the 1st month and 17.9% (5/28) by the 6th. From further a classification, the cure rate in grade I was 43.8 (7/16) and 25% (4/16) by the 1st and 6th months, respectively, and in grade II were 25 (3/12) and 8.3% (1/12) respectively. Incontinence episode was reduced from 4.2+/-2.8 to 1.5+/-1.5 and 2.8+/-2.3 by the 1st and 6th months, respectively. The urine loss was reduced from 21.0+/-31.4g to 6.0+/-8.2g and 14.0+/-24.7g by the 1st and 6th months, respectively. The results were statistically analyzed using Wilcoxon rank sum and Fisher's exact tests. CONCLUSIONS: It was suggested that the ExMI therapy was an effective treatment for stress urinary incontinence, but its effect decreased over time. In order to sustain, or improve its effect, a regular interval, or prolonged ExMI therapy, would be need