Men's health in South Korea.

Over the last four decades, rapid industrialisation and a Westernized lifestyle have changed disease patterns in South Korea. This study was conducted to review the current state of men's health in South Korea. By reviewing reports of government authorities and domestic and foreign studies related to men's health, we found that in men ≥ 65 years of age, 28.4% considered their health status good, whereas 38.3% considered their health status poor. The prevalence of moderate-to-severe lower urinary tract symptoms was similar to that in Caucasians. The prevalence of erectile dysfunction was higher than the global average. The incidence of cryptorchidism and hypospadias showed a tendency towards increase. The prevalence of diabetes mellitus continuously increased by 10.8% in 2008 and was the fifth leading cause of death in 2008. The prevalence of obesity increased from 26.0% in 1998 to 31.7% in 2007. The prevalence of ischaemic heart disease has continuously increased, with heart diseases causing one of every 12 deaths. The prevalence of chronic obstructive pulmonary disease in 2005 was 17.2% among adults ≥ 45 years of age. The top five prevalent cancers in men, in descending order, were cancers of the stomach, lung, liver, large bowel and prostate, among which the incidence of stomach, lung and liver cancers decreased by 0.7%, 0.6% and 2.2%, respectively, from 1999 to 2007, whereas the incidence of large bowel and prostate cancers increased by 7.0% and 13.2%, respectively. The prevalence of depression, dementia and sleep disorders was estimated as 17.3%, 4.21% and 20.2%, respectively. Together, these findings suggest that disease patterns in South Korean men are becoming Westernized.

Efficacy and safety of oral SK3530 for the treatment of erectile dysfunction in Korean men: a multicenter, randomized, double-blind, placebo-controlled, fixed dose, parallel group clinical trial.

AIM: To evaluate the efficacy and safety of SK3530, a newly developed type 5 phosphodiesterase inhibitor (PDE5I), in Korean men with erectile dysfunction (ED). METHODS: A total of 119 patients were randomized at 10 centers in Korea to receive either SK3530 (50, 100, or 150 mg; n = 89) or placebo (n = 30) taken l h before anticipated sexual activity for an 8-week period. The patients were evaluated at baseline and 4 and 8 weeks after beginning therapy. Efficacy was assessed using the International Index of Erectile Function (IIEF), Sexual Encounter Profile (SEP), and the Global Assessment Question (GAQ). Safety was analyzed by adverse events, laboratory values and vital signs. RESULTS: At the end of the study, all the primary and secondary efficacy end-points were statistically significantly improved by SK3530 compared with placebo (P<0.05). Of the 89 patients in the treatment arm, 36 (42.3%) achieved normal erectile function after treatment, including six patients with severe ED. Treatment-related adverse events occurred in 32 patients. The most common adverse events were flushing, headache, dizziness and eye redness (10.9%, 7.6%, 2.5% and 2.5%, respectively), and most were mild. Only two patients discontinued treatment during the study period because of adverse events. CONCLUSION: The results of our phase II study have confirmed the efficacy and safety of SK3530 in a broad population of men with ED of various etiologies and severity. The optimal doses in terms of efficacy and safety were determined to be 50 mg and 100 mg, respectively.

The effects of interleukin-6 on the contraction and relaxation responses of the cavernous smooth muscle from rats.

The purpose of this study is to elucidate the effect of IL-6 on the vasomotor reactivity of the corpus cavernosum of the rats. The strips were either left untreated or treated with 1 ng/ml of IL-6 for 60 min. By increasing concentrations of phenylephrine, acetylcholine, or sodium nitroprusside, we assessed concentration-contraction or relaxation responses. The IL-6-treated strips were incubated for 30 min with or without L-NAME (N(W)-nitro-L-arginine methyl ester), L-arginine, indomethacin, BQ-123 (an endothelin receptor A inhibitor), or SQ 29,548 (a thromboxane A(2) [TXA(2)] receptor blocker), and the effects on phenylephrine-induced contraction or acetylcholine-induced relaxation of phenylephrine-induced contraction were measured. The contractile responses to phenylephrine were significantly enhanced in the IL-6-treated strips, compared with the IL-6-nontreated strips, and the relaxation responses to acetylcholine were significantly inhibited in the IL-6-treated group compared with the IL-6-nontreated group. But after endothelial denudation, there was no difference between the IL-6-treated strips and the IL-6-nontreated strips on the contraction-relaxation responses to phenylephrine or acetylcholine. The relaxation responses to sodium nitroprusside were not inhibited in both groups. L-NAME completely inhibited the relaxation response to acetylcholine in the IL-6-treated strips, as well as the IL-6-nontreated strips. Indomethacin and SQ 29,548 significantly inhibited the increased contractile responses to phenylephrine in the IL-6-treated strips. But BQ 123 rarely affected the same responses. L-arginine reversed the inhibited relaxation responses to acetylcholine in the IL-6-treated strips. Therefore, IL-6 inhibits endothelium-dependent, NO-mediated relaxation and also enhances alpha(1)-adrenergic receptor-mediated contraction via an endothelium-dependent TXA(2)-mediated mechanism in the corpus cavernosum of the rat.

Current status of experimental therapeutics for prostate cancer.

Hormone refractory prostate cancer (HRPC) is the progression of disease in the presence of castrate serum levels of testosterone with a median survival of approximately 1 year. A variety of strategies have been developed to improve survival for the patients with advanced prostate cancer. Despite such efforts, the effective treatment modality for those patients has not been established other than chemotherapy. New experimental therapeutics such as gene therapy, vaccine therapy and target therapy use various mechanisms to kill tumor cells selectively while sparing surrounding normal tissues. Furthermore, new approaches in the field of chemoprevention are being made. Recent data from landmark studies, in particular vaccines, have shown improvements in overall survival of HRPC patients.

Sexual attitude and perception on sexual relationship among long-term users of sildenafil.

INTRODUCTION: High discontinuation rates of sildenafil were reported in its responders. AIM: To investigate perception on and attitude toward sex among long-term users of sildenafil. METHODS: A survey was conducted using random face-to-face interviews and a structured questionnaire on a population of 105 long-term sildenafil users (mean age; 57.8 years), who first took sildenafil 5 years or more previously and continued its use in the previous 6 months. MAIN OUTCOME MEASURES: Six point-scale of perception on and attitude toward sex and valuation of sildenafil. RESULTS: Among the long-term users, 98% perceived that it is desirable to have sex even though they get old if they are healthy, 93% had a positive attitude toward sex, and 97% had an intercourse-focused perception of sexual relationship; these rates were higher for those with a lower income and less education. And 59% had intercourses and 40% took sildenafil one to two times a week. They ranked prominence in rigidity of erection as the major reason for the long-term sildenafil use. The rigidity was maintained after more than 5-year use. CONCLUSION: An overall majority of the long-term users of sildenafil had a positive attitude toward sex, an active sexual behavior, and an intercourse-focused perception on sexual relationship. Sildenafil provided an optimal fit for the patients' needs. Prominence in rigidity of erection was ranked as the major reason for the long-term use.

Contractile changes of the clitoral cavernous smooth muscle in female rabbits with experimentally induced overactive bladder.

INTRODUCTION: Recently, growing clinical evidence has suggested that sexual dysfunction is more prevalent in women with overactive bladder (OAB). Aims. However, there has been no basic research to clarify the relationship between OAB and female sexual dysfunction. Therefore, we investigated this issue using a rabbit model of OAB. METHODS: Twenty-seven New Zealand white female rabbits were randomly divided into the OAB and control groups. MAIN OUTCOME MEASURES: The contractile responses of clitoral cavernous strips to K(+), phenylephrine (PE), Bay K 8644, and endothelin (ET)-1, and the relaxation responses of acetylcholine (ACh), sodium nitroprusside (SNP), and Y-27632 to PE-induced contraction by measuring isometric tension. Results. The contractile responses to K(+), PE, Bay K 8644, and ET-1 were significantly more increased in the OAB group in a dose-dependant manner than in the control group (P < 0.05), and the responses to ET-1 were more prominent than those to the remaining substances (P < 0.01). The increased contractile responses to ET-1 were blocked by BQ123 (ET(A) receptor antagonist) but not by BQ788 (ET(B) receptor antagonist). Clitoral cavernosal strips from the OAB group were more difficult to relax than those from the control group in terms of ACh- and SNP-induced relaxation (P < 0.05). The Y-27632-induced relaxant responses to PE- and ET-1-induced contraction were less prominent in the OAB group than in the control group. CONCLUSIONS; The results of this study provide evidence that female OAB may deteriorate clitoral engorgement, which is associated with a greater force generation by increased calcium sensitization and subsequently decreased of relaxation. The activation of ET and Rho-kinase system may be crucial to negatively effect the clitoral smooth muscle relaxation in experimentally induced OAB animal model. But whether these vasomotor effects are revived in human clitoris is still debatable.

Developmental toxicity by exposure to bisphenol A diglycidyl ether during gestation and lactation period in Sprague-Dawley male rats.

OBJECTIVES: Bisphenol A diglycidyl ether (BADGE) is the major component in commercial liquid epoxy resins, which are manufactured by co-reacting bisphenol A with epichlorohydrin. This study was performed to show the developmental effects of prenatal and postnatal exposures to BADGE in male rat offspring. METHODS: Mated female rats were divided into four groups, each containing 12 rats. The dosing solutions were prepared by thoroughly mixing BADGE in corn oil at the 0, 375, 1500 and 3000 mg/kg/day concentrations. Mated females were dosed once daily by oral gavage on gestation day (GD) 6 - 20 and postnatal day (PND) 0 - 21. Pregnant female dams were observed general symptoms and body weight. Also, male pups were observed the general symptoms, body weight, developmental parameters (e.g. anogenital distance, pina detachment, incisor eruption, nipple retention, eye opening, testis descent), organ pathologic changes and hormone levels of plasma. RESULTS: Pregnant rats treated with BADGE died at a rate of about 70% in the 1500 mg/kg/day group and all rats treated with 3000 mg/kg/day died. Body weight, for male pups treated with doses of 375 mg/kg/day, was significantly lower than in the control group at PND 42, 56, and 63 (p<0.05). Evaluation of body characteristics including; separation of auricle, eruption of incisor, separation of eyelid, nipple retention, descent of testis, and separation of the prepuce in the BADGE treated group showed no difference in comparisons with the control group. AGD and adjusted AGD (mm/kg) for general developmental items in BADGE 375 mg/kg/day treated pups tended to be longer than in controls, however, these differences were not statistically significant. Relative weights of adrenal gland, lung (p<0.05), brain, epididymis, prostate, and testis (p<0.01) were heavier than in control in measures at PND 9 weeks. There were no significant changes in comparisons of histological findings of these organs. Loss of spermatids was observed in the seminiferous tubule at PND 9 weeks, but no weight changes were observed. The plasma estrogen levels were similar in the control and treatment groups at PND 3, 6 and 9 weeks. The plasma testosterone levels in the control group tended to increase with age. However, in the BADGE 375 mg/kg/day treated male pups it did not tend to increase. CONCLUSIONS: These findings suggest that BADGE is a chemical that has developmental effects consistent with it being an endocrine disruptor.

Effects of L-norgestrel on the endothelium-dependent relaxation response of rabbit clitoral cavernous smooth muscles.

OBJECTIVE: To determine the effect of a popular oral contraceptive, L-norgestrel (a synthetic progestogen), on relaxing response of clitoral cavernous smooth muscles. DESIGN: Prospective, randomized study. SETTING: Academic facility. ANIMAL(S): Thirty adult female New Zealand White rabbits. INTERVENTION(S): We conducted isometric tension studies with norepinephrine, endothelium-dependent (acetylcholine) and endothelium-independent (sodium nitroprusside) vasodilators, and L-norgestrel. The effects of nonspecific nitric oxide synthase inhibitor (N(w)-nitro-L-arginine methyl ester) and the potassium channel blockers (1 and 10 mM tetraethylammonium as well as 10 microM glibenclamide) on the reactivities of clitoral cavernous strips were investigated. MAIN OUTCOME MEASURE(S): Causation and power of developed tension after treatment. RESULT(S): Acetylcholine, sodium nitroprusside, and L-norgestrel produced concentration-dependent relaxation of the norepinephrine-precontracted strips. Both endothelium removal and treatment with 10 microM N(w)-nitro-L-arginine methyl ester completely inhibited the relaxation response to acetylcholine and L-norgestrel, and supplementation with 10 mM L-arginine partially reversed the inhibition. Incubation with either tetraethylammonium (TEA) or glibenclamide reduced the L-norgestrel-induced relaxation in a dose-independent manner. CONCLUSION(S): The L-norgestrel-induced relaxation of the clitoral cavernous smooth muscle is endothelium and nitric oxide dependent and may be related to more than two types of potassium channels activation.

Regaining of morning erection and sexual confidence in patients with erectile dysfunction.

AIM: To investigate how erectile dysfunction (ED) medications affect morning erection in patients with ED and how they respond to the return of morning erection. METHODS: This study was conducted in 120 patients who experienced successful intercourse with either tadalafil or sildenafil. Using a random face-to-face interview and a questionnaire (about the quality and number of days getting morning erection after using the two medications), the impact of the medications on the morning erections was investigated, and the participants were asked about their feelings on regaining morning erection. RESULTS: Of the respondents, 81% (68% of those with sildenafil and 99% of those with tadalafil) experienced morning erections after taking an oral ED medication. The men who took tadalafil mainly for 2 days with one dose, while those who took sildenafil experienced morning erections mainly for 1 day. The major sentiment upon regaining a morning erection was, "having more confidence as a man"(74%). Among the 96 respondents who experienced morning erections with tadalafil, 52% preferred tadalafil over sildenafil, not only because of freedom from concerns about a specific time to have relations, but also regaining morning erection. CONCLUSION: Regaining a morning erection affects the recovery of confidence as a man and influences the preference for tadalafil over sildenafil.

Vasomotor action of insulin on the rabbit normal cavernous smooth muscle.

Investigations on the effects of insulin on the normal vasculature have produced conflicting results. This study was aimed at establishing the vasomotor actions of insulin on normal cavernous smooth muscle. Insulin produced dose-dependent (10(-10)-10(-5) M) relaxation of the norepinephrine-precontracted strips of cavernosum, and of Bay K8644 [methyl-1,4-dihydro-2,6-dimethyl-3-nitro-4-2(trifluoromethylphenyl)pyridine-5-carboxylate]-precontracted strips. Endothelial denudation or indomethacin (10 microM) pre-treatment significantly reduced these insulin-induced relaxations, whereas NG-nitro-L-arginine methyl ester (L-NAME, 5 mM) did not. Moreover, the pre-treatment of the cavernosum strips with a prostacyclin synthesis inhibitor [9,11-diazo-15-deoxy-prostaglandin H2 (U-51605), 10 microM] significantly reduced insulin-induced response, whereas pretreatment with a cyclooxygenase-2 (COX-2) inhibitor (NS-398, 10 microM) did not. In addition, responses to insulin were not inhibited by K+ channel blockers, i.e., tetraethylammonium (TEA, 10 mM) or 4-aminopyridine (4-AP, 10 microM). Moreover, L-type Ca2+ currents were reduced by prostacyclin (2 microM) but not by insulin (10 microM). We conclude that insulin induces the endothelium-dependent relaxation of cavernous smooth muscles and that this relaxation response may emanate from the direct inhibition of L-type Ca2+ channels by prostacyclin.

Sexual activity, prevalence of sexual problems, and associated help-seeking patterns in men and women aged 40-80 years in Korea: data from the Global Study of Sexual Attitudes and Behaviors (GSSAB).

INTRODUCTION: Although there is considerable interest in the prevalence and impact of sexual problems worldwide, to date only male erectile dysfunction has been studied systematically in Asian countries. AIM: To study the prevalence of sexual problems and associated help-seeking patterns, among mature adults in Korea and to compare the results with those obtained in other Southeast Asian and East Asian countries. METHODS: As part of the Global Study of Sexual Attitudes and Behaviors (GSSAB), a survey was conducted in Korea during 2001 and 2002. Sampling was based on an intercept methodology and 1,200 individuals (600 men and 600 women) aged 40-80 years completed the survey out of 3,691 eligible subjects (response rate of 32.5%). MAIN OUTCOME MEASURES: General health, relationships, and sexual behaviors, attitudes, and beliefs. RESULTS: Ninety-one percent of men and 71% of women had engaged in sexual intercourse during the 12 months preceding the interview. Early ejaculation (33%) and erectile difficulties (32%) were the sexual problems most frequently reported by Korean men; these conditions were more common in Korea than in other Asian regions. Increasing age, physical inactivity, smoking, and prostate disease were significant correlates of erectile difficulties. The sexual problems most frequently reported by women in Korea were lack of sexual pleasure (37%) and inability to reach orgasm (31%). Only 2% of men and women in Korea had talked to a medical doctor about their sexual problems. CONCLUSIONS: Middle-aged and older adults in Korea regard sex as an important part of life and report continued sexual activity. Several sexual problems are highly prevalent in this population, but very few individuals seek medical help for these disorders. This is largely due to believing that the problem is not serious, not being bothered by the problem, difficulties regarding access to or affordability of medical care, and/or a lack of awareness of available treatments.

Five years after the launch of Viagra in Korea: changes in perceptions of erectile dysfunction treatment by physicians, patients, and the patients' spouses.

INTRODUCTION: When Viagra was first launched in Korea in 1999, there were high expectations for its efficacy, and strong concerns regarding its safety and potential for misuse. PURPOSE: To research changes in perceptions of erectile dysfunction (ED) treatment 5 years after Viagra was launched. MATERIALS AND METHODS: Participants in the study were drawn from six provinces in Korea. They were 120 physicians, 80 patients with ED who had been treated with Viagra, and 40 women who knew that their husbands were being treated with Viagra. The study was conducted using a random face-to-face interview and a questionnaire. RESULTS: Most physicians responded that since the launch of Viagra, discussions on the topic of sex are more acceptable (92%), and the number of patients seeking medical treatment for ED has increased (92%). They now have a better understanding of ED (98%). They are more confident of treatment (96%), more interested in identifying ED patients (72%), and more comfortable at initiating discussions on ED with patients (80%). Prior to the launch of Viagra, 65% of internal medicine/family medicine doctors did not prescribe any special treatment for ED. However, after Viagra became available, 92% of these doctors prescribed oral medication for ED, thus confirming their position as primary physicians for ED treatment. One of the most distinct changes in perceptions related to Viagra is the higher level of confidence shown by physicians, patients, and patients' spouses in the safety of the drug. CONCLUSION: Five years after the launch of Viagra, the social environment has changed, making discussions of sex more acceptable. A larger number of patients now seek medical treatment for ED, and there is an increased acknowledgment for ED treatment by physicians, patients, and patients' spouses. Moreover, these parties are now more confident about the safety of Viagra.

Relaxation of rabbit cavernous smooth muscle to 17beta-estradiol: a non-genomic, NO-independent mechanism.

AIM: To investigate whether estrogen was involved in relaxation of rabbit cavernous smooth muscle. METHODS: Relaxation response of the rabbit cavernous smooth muscles to 17beta-estradiol (0.3, 3, 30 and 300 nmol/L) were observed in vitro. The response of the muscle strips to estrogen after incubation with either actinomycin D (10 micromol/L) or L-NAME (10 micromol/L) were also evaluated. Inside-out mode of patch clamp in a single smooth muscle cell was applied to investigate the Maxi-K channel activities. RESULTS: Estrogen caused a dose-dependent relaxation of the strips precontracted with norepinephrine. The maximal response was noted about 10 minutes after treatment. The estrogen-induced relaxation was prevented by neither actinomycin D nor L-NAME, suggesting that the response was not mediated by gene transcription or nitric oxide (NO). Application of 17beta-estradiol increased the Maxi-K channel activities. CONCLUSION: 17beta-estradiol may be involved in relaxation of rabbit cavernous smooth muscles via a non-genomic and NO independent mechanism. 17beta-estradiol stimulates Maxi-K channel of the rabbit cavernous myocyte.

Effects of estrogen on the relaxation response of rabbit clitoral cavernous smooth muscles.

We investigated whether estrogen has a peripheral effect on the smooth muscle relaxation response of the clitoris, similar to that of androgens in cavernous tissues of the penis. Forty-two New Zealand White female rabbits (2.3-2.7 kg) were randomly divided into control (sham operation) and bilateral oophorectomy groups (acute and chronic groups with or without estradiol replacement). The acute and chronic groups were killed at 5 days and 12 weeks post-oophorectomy, respectively. Relaxation responses of the clitoral cavernous strips to endothelium-dependent and independent vasodilators and electrical field stimulation (EFS) were observed. Serum total cholesterol and low-density lipoprotein increased significantly and acetylcholine-induced relaxation of the clitoral strips wa significantly attenuated in the oophorectomy group with chronic estrogen deficiency but not in the chronic oophorectomy group with estradiol replacement or in the acute estrogen deficiency group. No significant differences in the relaxation responses of the cavernous strips to sodium nitroprusside or to the non-adrenergic, non-cholinergic-selective relaxation response to the EFS were found among the control, acute and chronic estrogen deficiency groups. These findings suggest that estrogen may not have a direct peripheral effect on clitoral cavernous smooth muscle relaxation. Hypercholesterolemia might be a possible explanation for the impaired endothelium-dependent relaxation of clitoral smooth muscle in chronic estrogen deficiency.