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INTRODUCTION AND OBJECTIVE:Urethral stricture is one of the postoperative complications after transurethral resection of the prostate (TURP) for benign prostatic hyperplasia (BPH) and urethral dila...

INTRODUCTION AND OBJECTIVE:Erectile dysfunction (ED) is a common problem whose relation to cardiovascular diseases has been scientifically proven, but it has not been studied sufficiently in patien...

INTRODUCTION AND OBJECTIVE:To investigate the real-world prevalence of repeated prostate-specific antigen (PSA) screening in Korea and its influence on the treatment pattern of the prostate cancer ...

Background and objectiveTo investigate the usefulness of digital rectal examination (DRE), a cost-effective and simple way to mea-sure prostate volume versus transrectal ultrasound (TRUS), and the gold standard method for measuring prostate volume. Material and methodsFrom 2018 to 2019, a total of 580 patients who underwent DRE and TRUS for the initial evaluation of benign prostatic hyperplasia (BPH) were included in this study. DRE was performed twice at two appointments by a single urologist, and TRUS was performed once by a single radiologist. The patients were divided into seven groups according to TRUS-estimated prostate volume (A, 80 cc). We investigated the agreement between the TRUS and DRE measurements. ResultsThere was a high percent agreement of DRE and TRUS in groups B–D (84.6, 84.1, and 79.1%, respectively). The highest over- and underestimations of prostate volume on DRE were 23.1 and 79.5% in groups A and G, respectively. In the Bland–Altman plot, the mean difference between TRUS and DRE in group A–D was closer to zero-line than that in groups E–G. The variability in differences between TRUS and DRE in groups A, B, and C was lower than that in groups D, E, F, and G. ConclusionDRE was accurate in measuring the prostate volume of 30~49 cc. We suggested that DRE remains a simple and cost-effective method for measuring prostate volume.

Purpose To investigate the efficacy, safety, and tolerability of oro-dispersible film (ODF) formulation of mirodenafil 50 mg and 100 mg for the treatment of patients with erectile dysfunction (ED) in Korea. Materials and methods A multicenter, randomized, double-blind, placebo-controlled, parallel-group study of 129 subjects was performed. Subjects were randomized to either placebo or mirodenafil ODF 50 mg or 100 mg to be taken in an "on demand" manner for 8 weeks. The primary efficacy variable was the International Index of Erectile Dysfunction (IIEF)-5 questionnaire. The secondary efficacy variables comprised Sexual Encounter Profile questions 2 and 3 (SEP2 and SEP3), the Global Assessment Question (GAQ), and the Life Satisfaction Checklist (LSC). Results IIEF-5 was significantly increased in all groups after treatment. However, compared to the placebo group, only the mirodenafil ODF 100 mg group showed a significant difference. SEP2 and SEP3 were increased in both mirodenafil groups; however, the increase was not statistically significant for SEP2. In terms of GAQ and LSC, the mirodenafil ODF groups showed significant increases compared with the baseline. Most treatment-associated adverse events were mild and resolved spontaneously. Conclusions Mirodenafil ODF is an effective and well-tolerated agent for the treatment of patients with ED in Korea.

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.

Background Phosphodiesterase type 5 inhibitors and α-adrenergic blocking agents (α-blockers) are widely used for the treatment of erectile dysfunction (ED) and lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH). Aims To assess the efficacy and safety of fixed-dose combinations (FDCs) of tamsulosin and tadalafil compared with tadalafil monotherapy in patients with comorbid BPH-associated LUTS and ED. Methods A randomized, double-blinded, active-controlled trial was conducted of 510 men with BPH-associated LUTS and ED. Patients were treated with FDCs of tamsulosin 0.4 mg plus tadalafil 5 mg (FDC 0.4/5 mg), tamsulosin 0.2 mg plus tadalafil 5 mg (FDC 0.2/5 mg), or tadalafil 5 mg for a 12-week treatment period. For a subsequent 12-week extension period, the patients were administered FDC 0.4/5 mg. Outcomes The primary outcomes were changes from baseline in total International Prostate Symptom Score (IPSS) and International Index of Erectile Function erectile function domain (IIEF-EF) score at week 12 to prove superiority and non-inferiority of FDCs compared with tadalafil 5 mg. The safety assessments were adverse reactions, laboratory test results, and vital signs at week 24. Results The mean changes in total IPSS and IIEF-EF scores were −9.46 and 9.17 for FDC 0.4/5 mg and −8.14 and 9.49 for tadalafil 5 mg, respectively, which indicated superiority in LUTS improvement (P = .0320) and non-inferiority in ED treatment with FDC 0.4/5 mg compared with tadalafil 5 mg. However, the results from FDC 0.2/5 mg failed to demonstrate superiority in LUTS improvement. No clinically significant adverse events regarding the investigational products were observed during the 24-week period. Clinical Implications The FDC 0.4/5 mg is the first combined formulation of an α-blocker and a phosphodiesterase type 5 inhibitor that offers benefits in patient compliance and as add-on therapy in patients with comorbid BPH-associated LUTS and ED. Strengths and Limitations The study clearly demonstrated the advantage of FDC 0.4/5 mg. The main advantage of FDC 0.4/5 mg was the enhanced efficacy on BPH-associated LUTS comorbidity with ED, the lower incidence of side effects, and the simplification and convenience of therapy, which led to better overall patient compliance. However, the lack of a tamsulosin monotherapy control group was a limitation of this study. Conclusion The FDC 0.4/5 mg therapy was safe, well tolerated, and efficacious, indicating that combination therapy could provide clinical benefits for patients with BPH-associated LUTS complaints and ameliorate the comorbidity of ED.

INTRODUCTION AND OBJECTIVES:Ejaculation frequency, including sexual intercourse, nocturnal emissions, and masturbation, affect the development of prostate disease, such as benign prostatic hyperpla...

Purpose We investigated the long-term survival and patient satisfaction with an inflatable penile prosthesis as a treatment for refractory erectile dysfunction (ED). Materials and Methods Between July 1997 and September 2014, a total of 74 patients underwent implantation of an inflatable penile prosthesis. The present mechanical status of the prosthesis was ascertained by telephone interview and review of medical records, and related clinical factors were analyzed by using Cox proportional hazard regression model. To investigate current status and satisfaction with the devices, novel questionnaires consisting of eight items were administered. Results The mean (±standard deviation) age and follow-up period were 57.0±12.2 years and 105.5±64.0 months, respectively. Sixteen patients (21.6%) experienced a mechanical failure and 4 patients (5.4%) experienced a nonmechanical failure at a median follow-up of 98.0 months. Mechanical and overall survival rates of the inflatable penile prosthesis at 5, 10, and 15 years were 93.3%, 76.5%, and 64.8% and 89.1%, 71.4%, and 60.5%, respectively, without a statistically significant correlation with host factors including age, cause of ED, and presence of obesity, hypertension, and diabetes mellitus. Overall, 53 patients (71.6%) completed the questionnaires. The overall patient satisfaction rate was 86.8%, and 83.0% of the patients replied that they intended to repeat the same procedure. Among the 8 items asked, satisfaction with the rigidity of the device received the highest score (90.6%). In contrast, only 60.4% of subjects experienced orgasm. Conclusions The results of our study suggest that excellent long-term reliability and high patient satisfaction rates make the implantation of an inflatable penile prosthesis a recommendable surgical treatment for refractory ED.

Introduction The method of administration of oral phosphodiesterase-5 inhibitors has been expanded to once-daily repeated administration with lower initial dosage than on-demand administration. Aim The aim of this study was to evaluate the efficacy and safety of once-daily udenafil as a treatment for erectile dysfunction (ED) for intermediate-term period. Methods This multicenter, randomized, double-blind clinical trial included 346 ED patients (placebo, udenafil 50 mg, udenafil 75 mg). Subjects were treated with each medication once daily for 24 weeks. Main Outcome Measures Subjects were asked to complete the International Index of Erectile Function (IIEF)-erectile function (EF) domain at baseline, 12 weeks, and 24 weeks and the development of adverse drug reactions (ADRs) was inspected. Results Both dosages of udenafil induced a significant increase in IIEF-EF compared with placebo at both 12 and 24 weeks. When patients were divided according to the severity of baseline EF score, significant improvement was observed only with udenafil 75 mg regardless of the degree of ED. At 24 weeks, the proportions of patients who reported a return to normal EF (IIEF-EF over 26) were 39.1% for udenafil 50 mg and 47.0% for udenafil 75 mg. In terms of safety, ADRs were observed in 6.1%, 12.9%, and 17.9% for placebo, udenafil 50 mg, and 75 mg, respectively. Although a statistically higher rate of ADRs was observed in the udenafil 75 mg group (P = 0.024), the majority were mild and recovered without treatment. Conclusions Once-daily administration of udenafil 50 mg and 75 mg for 24 weeks resulted in improvement of EF. In particular, udenafil 75 mg improves EF regardless of the baseline degree of ED.

INTRODUCTION AND OBJECTIVE:To evaluate the long-term outcomes of the tension-free vaginal tape (TVT) procedure, we investigated the data from female patients with stress urinary incontinence (SUI) ...

INTRODUCTION AND OBJECTIVE:The midurethral sling (transobturator tape [TOT]) procedure has been widely performed for treatment of urinary incontinence; however, little has been reported regarding s...

Purpose: Though prompt diagnosis to minimize symptom duration (SD) is highly associated with organ salvage in cases of testicular torsion (TT), SD is subjective and hard to determine. We thus investigated the clinical implications of systemic in-flammatory responses (SIRs) as potential surrogates of SD to improve testis survival. Materials and Methods: Sixty men with TT that underwent immediate operation among orchiectomy and orchiopexy follow-ing a visit to a single emergency department were retrospectively enrolled. Mandatory laboratory tests conducted included neutrophil, lymphocyte, and platelet counts. Results: Mean age and SD was 15.7±3.7 years and 8.27±4.98 hours, respectively. Thirty-eight (63.3%) underwent orchiec-tomy and the remaining 22 underwent orchiopexy. Leukocytosis (p=0.001) and neutrophil-lymphocyte ratio (NLR, p

Priapism is a persistent penile erection that continues for hours beyond, or is unrelated to, sexual stimulation. Priapism requires a prompt evaluation and usually requires an emergency management. There are two types of priapism: 1) ischemic (veno-occlusive or low-flow), which is found in 95% of cases, and 2) nonischemic (arterial or high-flow). Stuttering (intermittent or recurrent) priapism is a recurrent form of ischemic priapism. To initiate appropriate management, the physician must decide whether the priapism is ischemic or nonischemic. In the management of an ischemic priapism, resolution should be achieved as promptly as possible. Initial treatment is therapeutic aspiration with or without irrigation of the corpora. If this fails, intracavernous injection of sympathomimetic agents is the next step. Surgical shunts should be performed in cases involving failure of nonsurgical treatment. The first management of a nonischemic priapism should be observation. Selective arterial embolization is recommended for the management of nonischemic priapism in cases that request treatment. The goal of management for stuttering priapism is prevention of future episodes. This article provides a review of recent clinical developments in the medical and surgical management of priapism and an investigation of scientific research activity in this rapidly developing field of study.

Visual internal urethrotomy (VIU) is an option for the management of urethral stricture. However, little is known regarding sexual function after surgery.Seventy-six patients who underwent VIU were evaluated by using the Korean version of the Male Sexual Health Questionnaire. Three sexual functional domains of erection (EFD), satisfaction (SAD), and ejaculation (EjFD) were assessed at baseline, 3 months, 6 months, and 12 months after surgery. We assessed clinical factors (age, etiology, and maximum flow rate) and radiologic factors (stricture site, stricture length, frequency of recurrence, and duration until first recurrence). We compared with each sexual functional domain score by age group (range: 40-49, 50-59, 60-69, and 70-79 years).A total of 76 men with mean age of 57.1±13.07 years completed this study. In univariate analysis, there were significant losses of EFD scores at postoperative 3 months for all age groups (P0.05). And these scores were regained after postoperative 6 months. There was no statistically significant difference in SAD. Age, length of stricture, frequency of recurrence, and duration until first recurrence were significant differences in EjFD (P0.001, P=0.006, P=0.005, and P=0.013, respectively). In 40 to 49 and 50 to 59 age groups, VIU improves EjFD (P0.001, respectively). Multiple linear regression analysis revealed that age and stricture length were independent factors of VIU on EjFD (P0.001 and P=0.013, respectively).VIU can improve ejaculatory function in younger age group (40-59 years). Age and stricture length are independent predictive factors of VIU on ejaculatory function.

Purpose: This study discusses the treatment of premature ejaculation (PE) using various approaches with the goal of evaluating the methods of diagnosis and treatment of PE in clinical practice in 2014 in South Korea. Materials and Methods: We surveyed 200 urologists and andrologists who treated patients with PE from July 1, 2014 to July 29, 2014 using an online questionnaire. The questionnaire was composed of 4 parts: disease, comorbidities, diagnosis, and treatment. Using the answers to this survey, current trends in the diagnosis and treatment of PE were investigated using weighted averages. Results: The median number per month of patients who were diagnosed with PE was 14 patients (interquartile range, 7∼24). The time to ejaculation necessary for a diagnosis of PE was considered to be ＜1 minute by 12% of respondents, ＜2 minutes by 27%, ＜3 minutes by 28%, ＜5 minutes by 13%, and 20% stated that diagnosis was based on a patient’s subjective complaint. The treatment methods preferred by PE patients were reported to be pharmacological treatment (87%), surgical treatment (9.5%), and behavioral management (3.5%). The treatment methods used by respondents were pharmacological treatment (77%), surgical treatment (15%), and behavioral management (14%). The most commonly used pharmacological treatment was the oral administration of dapoxetine (97%). Conclusions: In 2014 in South Korea, various methods were used to diagnose and treat PE. The most commonly used treatment for PE was the oral administration of dapoxetine. It was also found that surgical treatment was applied in some cases.

Once-daily administration of phosphodiesterase type 5 inhibitors has been shown to correct erectile dysfunction (ED).To evaluate the long-term efficacy and safety after once-daily oral administration of udenafil 75 mg in men with ED.This clinical trial was an open-label, fixed-dose, 24-week extension study (DA8159_EDDL_III) of a 24-week double-blinded efficacy and safety study of once-daily udenafil (parent study: DA8159_EDD_III). Subjects received udenafil 75 mg once daily for 24 weeks during this extension study, and the follow-up visit occurred during the 4-week ED treatment-free period.Subjects were asked to complete the International Index of Erectile Function questionnaire and the Global Assessment Questionnaire at the 24-week extension and after the 4-week ED treatment-free period, and the development of adverse drug reactions was investigated.In total, 302 subjects were enrolled in this extension study. Improvement was shown with an increased erectile function (EF) domain score compared with baseline (14.60 ± 4.57) at extension week 48 (23.98 ± 5.44) and a slight increase in EF domain score compared with the last time point (week 24) of the parent study (P .001). The Global Assessment Questionnaire showed a high improvement rate of 95.4% at the extension 48-week time point. For shift to normal, almost half the subjects (45.1%) recovered "normal" EF, and 14.2% of subjects reported normal erections after the 4-week ED treatment-free period. The occurrence rate of adverse drug reactions was 8%, which consisted mainly of flushing and headache.Once-daily dosing of udenafil 75 mg showed excellent efficacy and safety with long-term administration and allowed a more spontaneous sexual life.

Penile lengthening techniques are composed of release of the suspensory ligament and penopubic skin advancement. Penopubic skin flap has been used in an attempt to elongate penopubic skin. These procedures are performed to advance full skin covering of the extended penis. Inverted V-Y advancement flap and z-plasty have been mainly used to elongate penopubic skin.

This study was undertaken to determine the impact on ejaculatory function of tamsulosin (0.2 mg) given once daily (OD) for 12 weeks and to identify risk factors for ejaculatory dysfunction in patients undergoing this treatment. Males with an International Prostatic Symptom Score (IPSS) ≥8 were enrolled in this study. All participants completed questionnaires, including the IPSS and the Male Sexual Health Questionnaire (MSHQ), and serum prostate-specific antigen, transrectal ultrasound and uroflowmetry with post-void residual were measured. After initiating 0.2 mg OD tamsulosin, patients were re-evaluated on the fourth and twelfth weeks of medication. The chi-squared test, the independent t-test and one-way ANOVA were used to compare means. Binary logistic regression analysis was used to calculate the odds ratio for all risk factors. A total of 177 men constituted the study cohort. No significant difference was observed between baseline and follow-up for the erectile function, ejaculatory function, satisfaction, sexual activity and desire domains (EFD, EjFD, SDA and ADD) or for erectile or ejaculatory bother mean scores. After 12 weeks, the overall incidence of ejaculatory dysfunction (EjD) was 13.4%. Incidences of the seven different types of EjD (decreased frequency, delay, dryness, decreased strength/force, decreased volume, decreased pleasure and pain at ejaculation) were 2.4%, 3.1%, 3.9%, 3.9%, 6.3%, 7.1% and 3.1%, respectively. Baseline EjFD scores were higher for IPSS responders than for non-responders (26.09 vs. 24.06, P=0.03). An EjFD score reduction was more frequent in IPSS responders. The incidence of EjD was small, but not negligible and was more frequent in patients with less lower urinary tract symptoms, a smaller prostate, higher baseline MSHQ totals and higher EjFD scores.

Mirodenafil is a recently developed oral phosphodiesterase type 5 inhibitor, which was observed to significantly improve erectile function and was well tolerated in men with broad-spectrum erectile dysfunction (ED).To investigate the efficacy and safety of mirodenafil treatment compared with placebo in men taking at least one antihypertensive medication.A multicenter, double-blind, placebo-controlled, parallel group, fixed-dose study was conducted with 109 subjects who were randomized to placebo or mirodenafil 100 mg for 12 weeks on an "as needed" basis.The primary efficacy measures were the changes from baseline in sum of scores on International Index of Erectile Function-erectile function domain (IIEF-EF) questions 1 to 5 and 15 with treatment. The secondary efficacy measures included scores on IIEF question 3 and 4 (Q3 and Q4), all domain scores of IIEF, and Sexual Encounter Profile Question 2 and 3 (SEP2 and SEP3) along with responses to Global Assessment Question (GAQ) and Life Satisfaction Checklist (LSC). The safety assessments included laboratory tests, vital signs, 12-lead electrocardiogram recordings, and patients' reporting of adverse events.The mirodenafil group showed significantly greater increase in IIEF-EF scores at 12 weeks compared with the placebo group (9.35 ± 6.86 vs. 2.66 ± 6.44, P0.001). The mirodenafil group also demonstrated significantly greater improvement in scores of IIEF Q3 and Q4, other four domains of IIEF, SEP2, SEP3, and LSC along with percentages of patients responding positively to GAQ compared with the placebo group. During the study, no clinically significant changes were observed regarding blood pressure, heart rate, electrocardiographic findings, or laboratory values. Facial flushing and headache were the most common treatment-associated adverse events, which were mild or moderate in severity, resolving spontaneously.Mirodenafil was effective and safe in men with ED concomitantly taking antihypertensive medications.