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Introduction In addition to a depletion of androgen, attenuated action of androgen receptor (AR) might also contribute to andropausal symptoms. Aim To evaluate the interaction of AR cytosine adenine guanine (CAG) repeat polymorphism and serum testosterone levels and their effect on andropausal symptoms in aging Taiwanese men. Methods From August 2007 to April 2008, a free health screening for men older than 40 years was conducted by a medical center in Kaohsiung City, Taiwan. All participants received physical examination, answered questionnaires to collect their demographic information and medical histories, completed the Androgen Deficiency in the Aging Male (ADAM) questionnaire, and provided 20‐cm3 whole blood samples for biochemical and genetic evaluation. Main Outcome Measures The ADAM questionnaire was used to evaluate andropausal symptoms. Serum albumin, total testosterone (TT), and sex hormone‐binding globulin levels were measured. Free testosterone level was calculated. AR gene CAG repeat polymorphism was determined by direct sequencing. Results Seven hundred two men with the mean age of 57.2 ± 6.5 years were included. There was no significant association between TT levels and the distribution of AR CAG repeat polymorphism. When TT levels were above 340 ng/dL, subjects with AR CAG repeat lengths ≧25 showed significantly higher risk of developing andropausal symptoms, as compared with those with AR CAG repeat lengths ≦22 (P = 0.006), but this was not observed when TT levels were 340 ng/dL or below. Age and number of comorbidities were also independent risk factors for andropausal symptoms. Conclusion In subjects with normal TT concentration, those with longer AR CAG repeat lengths have a higher risk of developing andropausal symptoms. Age and number of comorbidities can also influence the appearance of andropausal symptoms. In clinical practice, a multifactorial approach to evaluate andropausal symptoms and the interactions between those risk factors is suggested. Liu C‐C, Lee Y‐C, Wang C‐J, Yeh H‐C, Li W‐M, Wu W‐J, Huang C‐N, Bao B‐Y, Huang C‐H, and Huang S‐P. The impact of androgen receptor CAG repeat polymorphism on andropausal symptoms in different serum testosterone levels. J Sex Med 2012;9:2429–2437.

The prevalence of androgen deficiency in men increases with aging. Two common instruments, the Aging Male Symptoms (AMS) scale and the Androgen Deficiency in the Aging Male (ADAM) questionnaire, are often used to screen for androgen deficiency in clinical practice. The aim of this study is to compare the capability of the AMS scale and the ADAM questionnaire to detect androgen deficiency in middle-aged Taiwanese men. In April 2008, a free health screening was conducted by Kaohsiung Medical University Hospital. All participants completed a health questionnaire and had blood samples drawn between 8:00 am and noon. Serum total testosterone (TT), albumin, and sex hormone-binding globulin levels were measured. The level of free testosterone (FT) was calculated. Clinical symptoms associated with androgen deficiency were screened by using the AMS scale and ADAM questionnaire. Androgen deficiency was defined as TT < 300 ng/dL or both TT < 300 ng/dL and FT< 5 ng/dL. In total, 339 men were included in the final analysis, with the mean age of 54.6 ± 4.9 years (range, 47-65 years). Androgen deficiency was found in 75 men (22.1%) based on the criteria of TT < 300 ng/dL, and in 54 men (15.9%) based on the criteria of TT < 300 ng/dL and FT < 5 ng/dL. When detecting participants with both TT < 300 ng/dL and FT < 5 ng/dL, the sensitivity and specificity of the AMS scale were 57.4% and 48.1%, compared with 66.7% and 25.6% for the ADAM questionnaire. In a sample of middle-aged Taiwanese men, neither the AMS scale nor the ADAM questionnaire had sufficient sensitivity and specificity to detect androgen deficiency. In addition to using those 2 screening instruments, a thorough physical and biochemical workup should still be conducted in patients at risk or suspected of androgen deficiency.

Recently, metabolic syndrome (MtS) has received increasing attention. However, investigations regarding the potential impact of MtS and its components on erectile dysfunction (ED) have not been completely clarified.To determine the potential impact of MtS on ED in aging Taiwanese males.The definition of MtS was according to the modified criteria developed by the Bureau of Health Promotion in Taiwan. The presence and severity of ED were evaluated by International Index of Erectile Function 5 (IIEF-5) scores.A total of 639 subjects with a mean age of 60.2 years (range 40-83) were enrolled during a free health screening. All the men had complete clinical data and questionnaires taken. Clinical variables were compared according to MtS and ED prevalence. Multiple logistic regression analysis was used to determine the independent predictors of ED and MtS.Using age-adjusted multivariate logistic regression analysis, our results showed that subjects with ED had significantly higher prevalence of MtS (P0.01, OR=2.30, 95% CI: 1.44-3.69). The presence of MtS had significant correlation with lower IIEF-5 scores (P0.01), which were associated with the increment of MtS components number (P0.01). Among the MtS components, abnormal fasting blood glucose (FBG) was the most significantly independent factor of MtS for ED (P=0.01, OR=1.60, 95% CI: 1.09-2.35). Testosterone levels were significantly lower in subjects with MtS (P=0.05), while inversely correlated with number of MtS components (P0.01).In aging Taiwanese males, the presence of MtS is strongly associated with ED and abnormal FBG is the most independent predictor for ED. Low testosterone level might be viewed as another possible common denominator for various pathologies linking MtS to ED.

This study assessed the possible associations between lower urinary tract symptoms (LUTS) and erectile dysfunction (ED) in aging Taiwanese males and investigated the impact of various aspects of LUTS on ED.A free health screening for aging males (or =40 years old) was conducted in Kaohsiung Medical University Hospital. All the subjects had completed clinical data and answered questionnaires. ED and LUTS were assessed by validated symptom scales: the International Index of Erectile Function-5 (IIEF-5) and the International Prostate Symptom Score (IPSS).A total of 339 eligible patients enrolled in this study with a mean age of 60.1 years old. In multiple logistic regression analysis, age and IPSS (p0.001 and p = 0.013, respectively) were significantly associated with ED after controlling other comorbidities. In a further age-adjusted multiple regression analysis, our results showed that irritative symptoms (p = 0.042) have a more significant association with ED than the obstructive symptoms (p = 0.101).Our results indicate that age and LUTS are the two most independent risk factors for ED. Aging Taiwanese males with LUTS are at increasing risk for ED, especially for those with significant irritative symptoms.

Introduction A number of literature has now identified the role of impaired nitric oxide synthase/nitric oxide pathway in the endothelium as the central to the development of erectile dysfunction (ED) and benign prostate hyperplasia‐related lower urinary tract symptoms (BPH/LUTS). Recently a few studies have reported the associations between endothelial nitric oxide synthase ( eNOS ) G894T gene polymorphisms and ED. However, there has been no report investigating the eNOS G894T genetic susceptibility factor for both ED and BPH/LUTS. Aim To investigate the possible associations among eNOS G894T polymorphism, ED, and BPH/LUTS in a Taiwanese population. Main Outcome Measures Patients with ED were defined as those having a 5‐item International Index of Erectile Function‐5 Methods In all, 372 Taiwanese men underwent a free health screening were enrolled. All the men had complete clinical data and questionnaires taken. The eNOS G894T polymorphisms were determined using the polymerase chain reaction‐restriction fragment length polymorphism method. Results Three hundred seventy‐two men had a mean (standard deviation) age of 60.2 (8.8) years. With multivariate analysis, our data identified that aging, diabetes mellitus (DM), and eNOS G894T gene polymorphism were three independent common risk factors for both ED and BPH/LUTS ( P P = 0.036, and P = 0.039 for ED; P = 0.034, P = 0.004, and P = 0.016 for BPH/LUTS, respectively). The eNOS 894T allele carriers had significantly higher prevalence of ED (77.9% vs. 60.4%, P = 0.012) and higher International Prostate Symptom score (IPSS) (13.3 ± 10.7 vs. 9.3 ± 7.8, P = 0.001) than G allele carriers. Conclusions Our results showed that aging, DM, and eNOS 894T allele carrier gene polymorphism were the three independently common risk factors for both ED and BPH/LUTS in the Taiwanese population. The eNOS 894T allele carriers had significantly higher frequencies of ED and higher IPSS, suggesting that eNOS G894T gene polymorphisms may play an implication as a genetic susceptibility factor for both ED and BPH/LUTS. Lee YC, Wu WJ, Liu CC, Wang CJ, Li WM, Huang CH, Yeh HC, Ke HL, and Huang SP. The associations among eNOS G894T gene polymorphism, erectile dysfunction, and benign prostate hyperplasia‐related lower urinary tract symptoms.

Androgen deficiency in aging men has attracted much medical interest. Most studies on androgen deficiency have been conducted in Caucasian populations, and data from other ethnicities are lacking.To evaluate the prevalence of and risk factors for androgen deficiency and symptomatic androgen deficiency in Taiwanese men over 40 years old.From August 2007 to April 2008, a free health screening was conducted by a medical center in Kaohsiung, Taiwan, and 819 men participated in this health screening. All participants completed a health questionnaire, received a detailed physical examination, and blood samples were drawn between 8:00 and 12:00 am.Serum total testosterone (TT), albumin, and sex hormone-binding globulin levels were measured. The level of free testosterone (FT) was calculated. Clinical symptoms of androgen deficiency were assessed using the Androgen Deficiency in the Aging Male (ADAM) questionnaire.Seven hundred thirty-four men who met the inclusion criteria (mean age 57.4 +/- 6.7 years; range: 43-87 years) were included in this study. The prevalence of androgen deficiency was 24.1% based on the criterion of TT level300 ng/dL, and 16.6% based on the criterion of both TT300 ng/dL and FT5 ng/dL. The prevalence of symptomatic androgen deficiency was 12.0%. Both prevalence of androgen deficiency and symptomatic androgen deficiency increased with age. Older age, obesity, and diabetes mellitus were independent risk factors for androgen deficiency and symptomatic androgen deficiency.In a sample of aging Taiwanese men, a substantial proportion had androgen deficiency and symptomatic androgen deficiency, and the prevalence increased with age. Older age, obesity, and diabetes mellitus were independent risk factors for androgen deficiency and symptomatic androgen deficiency. Those potentially modifiable risk factors like obesity and diabetes mellitus should be prevented to maintain normal testosterone levels during aging in men.

Introduction Vascular etiologies are the most common risk factors for erectile dysfunction (ED). Published studies have reported the associations of GNB3 C825T polymorphism with many vascular diseases. However, there are few reports about the association between this gene polymorphism and ED.

The purpose of this study was to determine the influence of metabolic syndrome (MS) and serum testosterone in patients with erectile dysfunction (ED) and their possible association. A total of 103 men with ED were enrolled. The International Index of Erectile Function (IIEF) questionnaire was used to assess erectile condition. MS was defined according to the criteria formulated by the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) and the International Diabetes Federation (IDF). The mean age of the study population was 57.5 +/- 10.7 years, with an average IIEF of 14.7 +/- 6.7. The age and prevalence of MS using the NCEP ATP III criteria, but not the IDF criteria, were significantly different between mild and moderate/severe ED patients (p = 0.031 and 0.009, respectively). The percentage of hypertension (78.6% vs. 36.2%; p0.001) and raised fasting glucose levels (46.4% vs. 19.1%; p = 0.004) were significantly higher in the moderate/severe ED group, and both differences remained significant in multivariate analysis (p = 0.001 and 0.042, respectively). In addition, serum testosterone levels were significantly lower in ED patients with MS (p = 0.002). In summary, the presence of MS is associated with more severe ED. Among the components of MS, elevated blood pressure and fasting blood glucose were independent risk factors. NCEP ATP III criteria seem to correlate better with the degree of ED than the IDF definition. Our results also indicate that MS is associated with a lower testosterone level in patients with ED.

Aim: To determine efficacy and clinical predictors of stone fragmentation when using slow-rate shock wave lithotripsy (SWL). Patients and Methods: In total, 116 patients with radiopaque urinary tract stones were randomized into two groups: 57 patients were treated with SWL at 90 shocks/min, and 59 patients were treated with SWL at 120 shocks/min. The efficacy of SWL was evaluated within 1 month after treatment. Patient characteristics, features of stones, and SWL conditions were reviewed. Success rates relating to individual parameters were assessed by using chi-square and Student t tests. All factors were further entered into multivariate logistic regression analysis. Results: There were no statistically significant differences between the two groups with regard to age, sex, site and size of the stones, renal function, and total number of shock waves. In univariate analysis, the success rate was significantly related to shock wave frequency (p = 0.023), length and width of the stones (p < 0.001), total number of shock waves (p = 0.047), and age (p = 0.049). In multivariate analysis, however, only shock wave rate and stone length remained statistically significant (p = 0.021 and p = 0.046, respectively). The overall success rate was significantly higher in the group treated with 90 shocks/min (p = 0.02). However, this higher success rate was statistically significant only in patients with a stone length ≧10 mm (50.0 vs. 18.5%, p = 0.019). Conclusion: SWL at 90 shocks/min yielded better outcomes than SWL at 120 shocks/min, particularly in patients with stone lengths ≧10 mm.

A left adrenal incidentaloma was found by abdominal ultrasound and computed tomography (CT) in a 53-year-old woman who had a history of non-insulin dependent diabetes mellitus. Abdominal CT showed a well-circumscribed adrenal mass (5.5 × 4.5 × 3.5 cm) with low density (32 HU) on precontrast scan and heterogeneous enhancement on postcontrast scan. Laboratory examinations revealed a nonfunctional adrenal tumor. As the malignant potential of the tumor could not be ruled out, the patient underwent hand-assisted laparoscopic adrenalectomy. Postoperative recovery was uneventful, and pathologic examination revealed leiomyoma.

Tumors of the epididymis, both primary and secondary, and whether benign or malignant, are very rare. Adenomatoid tumors and leiomyoma are the most frequently diagnosed benign tumors of the epididymis. In a review of the American and European literature, leiomyoma was the second most common neoplasm of the epididymis, representing 6% of primary epididymal tumors. A case of leiomyoma of the epididymis in a 53-year-old patient is reported. The patient presented with a 4-year history of a painless mass in the left scrotum. There were no bother some symptoms except gradual enlargement of the tumor. On surgical exploration, the mass was found to be smooth and well-demarcated. A fresh frozen section showed a benign lesion, and conservative excision of the tumor was performed without any difficulty. The leiomyoma was definitively diagnosed by subsequent histopathologic analysis. The details of this rare case are reported herein with a review of the medical literature.

Spontaneous perirenal hematoma is relatively uncommon but may be life threatening. There are some challenges in early diagnosis due to the lack of specific presentations. We report a case of spontaneous perirenal hematoma in a patient who had histories of systemic lupus erythematosus, hypertension, and uremia with hemodialysis, and initially presented with non-specific flank pain. Dizziness and unstable vital signs were noted in the emergency room. Computed tomography and abdominal ultrasonography revealed a large perirenal hematoma over the left retroperitoneal cavity. The patient received conservative treatment without surgical intervention and had an uneventful recovery.

Chyluria occurs as a result of communication between the lymphatics and the renal pelvis. It is believed that instillation of silver nitrate into the renal pelvis is a safe, minimally invasive and effective treatment for chyluria. We report an unusual complication of acute necrotizing ureteritis following instillation of silver nitrate in a case of chyluria. It resolved completely with non-surgical intervention. The diagnosis and management of chyluria is discussed, with a brief review of the literature.

Priapism is a prolonged penile erection that is unrelated to sexual stimulation. Low-flow priapism has been associated with sickle cell disease and other hemoglobinopathies, neoplastic syndrome, anticoagulant therapy, psychotropic medication, and idiopathic causes. We report the successful treatment of idiopathic low-flow priapism using the Winter procedure. Initial treatment consisted of aspiration and intracavernous irrigation with iced saline and a vasoconstrictive agent, but in vain. We then performed the Winter procedure, in which fistulas between the corpora cavernosa and the glans penis were created. This resulted in the simultaneous detumescence of the penis, without complication. The erectile function of the penis was normal 1 year after the procedure. This case shows that idiopathic low-flow priapism can be successfully treated using the Winter procedure when conservative treatment fails.

Objective: The pathophysiology mechanism of menopause in the metabolic syndrome-associated bladder dysfunction is still not clear. The major aims of the present study were to examine the impact of high-fat-high-sugar diet and surgical menopause-induced metabolic syndrome in overactive bladder (OAB). Methods: Female Sprague Dawley rats were feed with high-fat-high-sugar diet with/without ovariectomy surgery to mimic menopause and to induce metabolic syndrome. At 6 months after high-fat-high-sugar feeding, cystometrogram, physical indicator, and urine and serum biochemistry parameters were measured. Masson's trichrome stain and Western blots were carried out to examine the expressions of interstitial fibrosis, fibrosis-associated proteins, and muscarinic or purinergic receptors. Results: Bladder hyperactivity was induced accompanied by bladder interstitial fibrosis after 6 months of high-fat-high-sugar feeding, while surgical menopause exacerbated these bladder damages and enhanced interstitial fibrosis level. In addition, surgical menopause enhanced bladder dysfunction via overexpression of muscarinic and purinergic receptors. Conclusions: High-fat-high-sugar feeding induced bladder overactivity, while ovary hormone deficiency enhanced bladder interstitial fibrosis, exacerbated OAB syndrome, and increased muscarinic and purinergic receptors expressions.

Since the tumor protein p53 (TP53), a transcription factor, plays a crucial role in prostate cancer development and progression, we hypothesized that sequence variants in TP53 binding sites might affect clinical outcomes in patients with prostate cancer. We systematically evaluated 41 single nucleotide polymorphisms (SNPs) within genome-wide predicted TP53 binding sites in a cohort of 1,024 prostate cancer patients. The associations of these SNPs with prostate cancer characteristics and clinical outcomes after radical prostatectomy for localized disease and after androgen-deprivation therapy (ADT) for advanced disease were assessed by Kaplan–Meier analysis and Cox regression model. ARAP2 rs1444377 and TRPS1 rs722740 were associated with advanced stage prostate cancer. FRK rs171866 remained as a significant predictor for disease progression; DAB2 rs268091 and EXOC4 rs1149558 remained as significant predictors for prostate cancer-specific mortality (PCSM); and EXOC4 rs1149558 remained as a significant predictor for all-cause mortality after ADT in multivariate models that included clinicopathologic predictors. In addition, the numbers of protective genotypes at DAB2 rs268091 and EXOC4 rs1149558 showed a cumulative effect on PCSM (P for trend = 0.002). Our results suggested that SNPs within TP53 binding sites might be valuable biomarkers for prostate cancer outcome prediction.

A mini-invasive system for long-term bladder urine pressure measurement system is presented. Not only is the design cost reduced, but also the reliability is enhanced by using a 1-atm canceling sensing instrumentation amplifier (IA). Because the urine pressure inside the bladder does not vary drastically, both the sleeping and working modes are required in order to save the battery power for long-term observation. The IA amplifies the signal sensed by the pressure sensor, which is then fed into the following analog-to-digital converter. Owing to the intrinsic 1-atm pressure existing inside the bladder, the IA must be able to cancel such a pressure from the signal picked up by the pressure sensor to keep the required linearity and the resolution for pressure measurement of the bladder urine. The pressure range of the proposed system is found out to be 14.7~19.7 Psi, which covers the range of all of the known unusual bladder syndromes or complications.

We report the case of a 56-year-old man who in a motor vehicle collision developed a pelvic fracture and complete urethra rupture. Sudden onset of intermittent severe urethral bleeding occurred and it led to life-threatening blood pressure drop and dyspnea. An angiography of internal iliac artery showed a pseudoaneurysm involving the right obturator artery. Super-selective embolization of the feeding vessel was performed with cessation of the blood flow immediately.

Primary dissecting aneurysms of the renal artery are exceedingly rare. The triad of flank pain, hematuria, and hypertension of acute onset in the absence of urinary obstruction should suggest this rare condition. We report a case of spontaneous dissecting aneurysm of the renal artery treated using conservative medical treatment. The diagnosis, therapeutic management, and outcome are discussed.

Fournier's disease, a form of necrotizing fasciitis, is a rapidly progressing subcutaneous infection of the male genitalia. We report a case of Fournier's disease with the unusual etiology of a perforated duodenum. This patient suffered from progressive right scrotal swelling after percutaneous transhepatic cholangeal drainage. Scrotal exploration revealed a large abscess with muscle necrosis that had spread up to the right retroperitoneal space. Radiologic studies and second abdominal exploration documented the origin as a perforated duodenum. The pus distribution in this case suggested that the infection process differed from that in previous reports. In future cases of Fournier's disease involving previous abdominal events, we recommend that abdominal origins be carefully surveyed before scrotal exploration.

Extrarenal angiomyolipoma is an uncommon disease entity and is rare in the retroperitoneum. We report a case of giant extrarenal retroperitoneal angiomyolipoma mimicking liposarcoma. A 35-year-old woman presented with a history of increased abdominal circumference and urinary frequency. Abdominal computerized tomography demonstrated a 24 × 21 × 16 cm retroperitoneal fatty tumor displacing the right kidney to the left upper quadrant of the abdomen. At laparotomy, the tumor was widely excised and the right kidney was successfully preserved. Final histologic examination identified the tumor as an angiomyolipoma. At 4-month postoperative follow-up, no evidence of tumor recurrence was found and the right kidney was fully functional.

There are numerous reports concerning the presentation of appendicitis as a urologic problem. However, scrotal abscess originating from appendicitis has rarely been described. We report a right scrotal abscess due to a preceding retroperitoneal abscess originating from retrocecal appendicitis. The scrotal abscess developed progressively following appendectomy. Scrotal exploration was carried out under the presumptive diagnosis of abscessed epididymo-orchitis. However, the patient remained febrile and had productive pus drained from the scrotum after exploration. Abdominal computerized tomography demonstrated that a large retroperitoneal abscess had accumulated at the appendectomy site. Percutaneous drainage of the retroperitoneal abscess resulted in resolution of the scrotal abscess. In cases of scrotal abscess following previous abdominal events (e.g. appendectomy), we recommend that abdominal origins should be carefully surveyed before scrotal exploration.

Although most advanced prostate cancer patients respond to androgen-deprivation therapy (ADT), the efficacy is widely variable. We investigated whether the host genetic variations in sex hormone pathway genes are associated with the efficacy of ADT. A cohort of 645 patients with advanced prostate cancer treated with ADT was genotyped for 18 polymorphisms across 12 key genes involved in androgen and estrogen metabolism. We found that after adjusting for known risk factors in multivariate Cox regression models, AKR1C3 rs12529 and AR-CAG repeat length remained significantly associated with prostate cancer-specific mortality (PCSM) after ADT (P ≤ 0.041). Furthermore, individuals carrying two unfavorable genotypes at these loci presented a 13.7-fold increased risk of PCSM compared with individuals carrying zero (P

Several genome-wide association studies (GWAS) have been conducted to identify the common single nucleotide polymorphisms (SNPs) that influence the risk of prostate cancer. It was hypothesized that some prostate cancer-associated SNPs might relate to the clinical outcomes in patients treated for prostate cancer using androgen-deprivation therapy (ADT). A cohort of 601 patients who have received ADT for prostate cancer was genotyped for 29 SNPs that have been associated with prostate cancer in Cancer Genetic Markers of Susceptibility GWAS, and within the genes that have been implicated in cancer. Prognostic significance of these SNPs on the disease progression, prostate cancer-specific mortality (PCSM) and all-cause mortality (ACM) after ADT were assessed by Kaplan-Meier analysis and Cox regression model. Three SNPs, namely CASP3 rs4862396, BMP5 rs3734444 and IRS2 rs7986346, were found to be closely associated with the ACM (P≤0.042), and BMP5 rs3734444 and IRS2 rs7986346 were also noted to be significantly related to the PCSM (P≤0.032) after adjusting for the known clinicopathologic predictors. Moreover, patients carrying a greater number of unfavorable genotypes at the loci of interest had a shorter time to ACM and PCSM during ADT (P for trend

This study aimed to evaluate the influence of the lifestyle, prostate volume (PV), and metabolic syndrome (MS) on lower urinary tract symptoms (LUTS) in the elderly males. A total of 764 men aged greater than 40 years were enrolled. Their severities of LUTS were assessed by the International Prostate Symptom Score questionnaire, while their MS was diagnosed according to the criteria developed by the National Cholesterol Education Program Adult Treatment Panel III. Lifestyle factors, PV, and components of MS were compared between no/mild and moderate/severe LUTS groups. In univariate analysis, age, cigarette smoking, alcohol consumption, physical activity, and PV significantly correlated with the severity of LUTS, but the presence or any components of MS did not. Results of multivariate analysis showed that aging, cigarette smoking, lack of regular exercise, and larger PV were independent predictors for moderate/severe LUTS. Notably, the risk factors for LUTS was influenced by the presence of MS. PV may play a role in determining the severity of LUTS for men without MS, while physical activity was the critical factor for men with MS. It was suggested that healthy lifestyle would be beneficial to lessen the severity of LUTS in the elderly males.

Introduction Accumulated evidences have outlined the potential relation between insulin resistance and endothelial dysfunction. The impaired ability of endothelium to synthesize or release nitric oxide may provide a common pathophysiological mechanism in the development of metabolic syndrome (MtS) and erectile dysfunction (ED). Aim The aim of this article was to investigate the genetic susceptibility of endothelial nitric oxide synthase ( eNOS ) G894T polymorphism underlying the development of both disorders. Methods A total of 590 subjects with a mean (standard deviation) age of 55.3 years (4.1) were enrolled during a free health screening. Complete clinical data and questionnaires were taken for all subjects. Multivariate logistic regression analysis was used to determine the independent predictors of MtS and ED. The eNOS G894T polymorphism was determined using a polymerase chain reaction‐restriction fragment length polymorphism method. Main Outcome Measures The definition of MtS was according to the modified criteria developed by the Bureau of Health Promotion in Taiwan. Patients with ED were defined as those having a five‐item International Index of Erectile Function (IIEF‐5) Results Our results showed that the eNOS 894T allele carriers had significantly higher prevalence of MtS and ED (odds ratio [OR] = 1.64, 95% confidence interval [CI] = 1.05∼2.56, P = 0.02 and OR = 1.76, 95% CI = 1.11∼2.80, P = 0.01, respectively) after adjustment for each other and age. Also the T allele carriers had significantly lower IIEF‐5 score and more MtS components than G allele carriers ( P P P Conclusions The eNOS 894T allele carriers are at greater risk for both MtS and ED, suggesting that eNOS G894T gene polymorphism might play an implication as a common genetic susceptibility factor to develop both disorders. Lee Y‐C, Huang S‐P, Liu C‐C, Yang Y‐H, Yeh H‐C, Li W‐M, Wu W‐J, Wang C‐J, Juan Y‐S, Huang C‐N, Hour T‐C, Chang C‐F, and Huang C‐H. The Association of eNOS G894T polymorphism with metabolic syndrome and erectile dysfunction. J Sex Med 2012;9:837–843.

Sexual activity in older people has become a topic of growing interest. The aim of this study is to investigate the effect of physical health and socioeconomic factors on the sexual activity of middle-aged and elderly Taiwanese men. From August 2007 to April 2008, 744 men older than 40 years were enrolled from a free health screening in Kaohsiung, Taiwan. All participants received detailed physical examination and answered questionnaires that collected demographic and lifestyle information, and medical history as well as answered items from the International Prostate Symptoms Score and five-item version of the International Index of Erectile Function (IIEF-5). Overall, 100 (13.4%) participants reported to be sexually inactive in previous 6 months. Older age, lower education levels, loss of a partner, erectile dysfunction, and increased number of comorbidities were found to be independent predictors for sexual inactivity. In conclusion, most middle-aged and elderly Taiwanese men remain sexually active. In addition to erectile dysfunction and loss of a partner, lower education levels and increased number of comorbidities were found to be predictors for sexual inactivity. Further research would need to elucidate whether improvement of those factors could help to preserve sexual activity.

The purpose of this study was to investigate the impact of hydronephrosis on the treatment outcome of patients with a solitary proximal ureteral stone after extracorporeal shock wave lithotripsy (ESWL). A total of 182 consecutive patients who underwent ESWL for a solitary proximal ureteral stone of between 5 and 20 mm in size in our institution were included in this study. The degree of hydronephrosis was defined by renal ultrasonography. Patient data, stone size, shock wave numbers and shock wave energy were also recorded. Treatment outcome was evaluated 3 months after the first session of ESWL. In multivariate analysis, only the maximal stone length (odds ratio [OR], 0.15; 95% confidence interval [CI], 0.03–0.91; p = 0.04) and the degree of hydronephrosis (OR, 0.40; 95% CI, 0.16–0.98; p = 0.045) were significant predicting factors for stone-free status 3 months after ESWL. For stones ≤ 10 mm, the stone-free rate decreased from 80% in patients with mild hydronephrosis to 56.4% in those with moderate to severe hydro-nephrosis. For stones > 10 mm, the stone-free rate decreased further, from 65.2% in patients with mild hydronephrosis to 33.3% in those with moderate to severe hydronephrosis. In summary, patients with a solitary proximal ureteral stone and a stone > 10 mm, the treatment outcome after ESWL was not good if moderate to severe hydronephrosis was noted on ultrasonography. Alternative treatments, such as ureteroscopic lithotripsy, may be appropriate as initial treatment or after failure of one session of ESWL.

Vascular etiologies are the most common risk factors for erectile dysfunction (ED). Published studies have reported the associations of GNB3 C825T polymorphism with many vascular diseases. However, there are few reports about the association between this gene polymorphism and ED.To investigate the associations among GNB3 C825T polymorphism, ED, and related risk factors in Taiwanese subjects.A total of 155 patients with ED and 81 healthy controls were enrolled. All men had complete clinical histories taken. The 5-item International Index of Erectile Function (IIEF-5) was used to assess erectile conditions. The GNB3 C825T polymorphisms were determined using the polymerase chain reaction-restriction fragment length polymorphism method.Patients with ED were defined as those having an IIEF-5 of21.Two hundred thirty-six men were enrolled with a mean (standard deviation) age of 59.0 (10.2) years. Diabetes mellitus (DM), hypertension, and age were the three most significant independent risk factors for ED in a multiple logistic regression analysis (P = 0.008, 0.003, and 0.007, respectively). The prevalence of DM, hypertension, and body mass index (BMI) was significantly higher in GNB3 825T allele (CT/TT) carriers (P = 0.023, 0.049, and 0.035, respectively). There was no significant difference of ED prevalence between T and C allele carriers (69.1% vs. 56.2%, P = 0.07). However, the T allele carriers had significantly lower IIEF-5 scores (P = 0.02) associated with an increment of the T allele number (16.4[CC] vs. 14.4[CT] vs. 13.2[TT], P = 0.04).In the present study, DM, hypertension, and BMI had significant associations with GNB3 825T allele carriers. Our results failed to show a significant association of the GNB3 C825T polymorphisms with ED prevalence. However, we cannot exclude that the presence of the T allele might influence the risk for ED severity indirectly through an increased risk for some vascular diseases.

OBJECTIVE To investigate the possible correlations among eNOS G894T polymorphism, erectile dysfunction (ED) and related risk factors in a Taiwanese population. MATERIALS AND METHODS In all, 151 patients with ED and 77 healthy controls were enrolled. All the men had a complete clinical history taken and laboratory data was collected. To assess erectile conditions the five-item version of the International Index of Erectile Function (IIEF-5) was used. The eNOS G894T polymorphisms were determined using the polymerase chain reaction-restriction fragment length polymorphism method. RESULTS In all, 228 men were enrolled with a mean (sd) age of 58.6 (9.7) years. In a univariate analysis, age, serum testosterone level, and the prevalence of diabetes mellitus (DM) and hypertension were significantly different between patients with ED and the healthy controls (P

Summary Giant condyloma acuminatum (GCA) is a rare, sexually transmitted disease with a high rate of local recurrence and malignant transformation. However, the optimal treatment for patients in whom GCA coexists with penile cancer is not well defined. We report a case treated successfully with preservation of the penis. Wide tumor excision was performed and the patient received adjuvant intra-arterial chemotherapy with methotrexate. We also evaluate the efficacy and functional outcome of penile preservation management for GCA with penile cancer transformation. In the present case, no recurrence of penile tumor or of condyloma was noted during follow-up for more than 12 months after treatment. The patient is very satisfied with the cosmetic and functional results following preservation of the penis.

As men age, the risk of developing hypogonadism and erectile dysfunction (ED) increases, especially after the age of 40. Previous animal and human studies have provided strong evidence that testosterone plays an important role in erectile function. In clinical practice, it is necessary to screen for the risk of hypogonadism in men with ED, and testosterone therapy might be considered as first-line therapy for those with both ED and hypogonadism. If erections remain insufficient after 3 months of testosterone therapy alone, then the combination of testosterone and phosphodiesterase type 5 (PDE-5) inhibitor may be suggested. In addition, testosterone therapy has been demonstrated to facilitate the effect of PDE-5 inhibitors in men with ED, especially those who have failed to respond to PDE-5 inhibitors alone. However, the minimal threshold level of serum testosterone necessary to maintain erectile function is still unknown and may vary among individuals. In addition, the potential risks and benefits of testosterone therapy should be assessed and discussed with patients before treatment, and the safety and efficacy of testosterone therapy should be monitored regularly during treatment.