Diagnosis and Treatment of Premature Ejaculation by Urologists in South Korea

서덕하,제성욱,최시민,감성철,김새웅,양대열,문두건,양상국,문기학,현재석 대한남성과학회 2016 The World Journal of Men's Health Vol.34 No.3

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.

Impact of Lower Urinary Tract Symptoms/Benign Prostatic Hyperplasia Treatment with Tamsulosin and Solifenacin Combination Therapy on Erectile Function

서덕하,감성철,현재석 대한비뇨의학회 2011 Investigative and Clinical Urology Vol.52 No.1

Purpose: To examine the effects on erectile function of concomitant treatment with an alpha-blocker (tamsulosin) and an antimuscarinic agent (solifenacin) in patients with lower urinary tract symptoms (LUTS)/benign prostatic hyperplasia (BPH). Materials and Methods: Fifty-seven male patients with LUTS/BPH were assessed for the degree of LUTS and erectile function. In group 1 (tamsulosin) and group 2 (tamsulosin and solifenacin), changes in the International Prostate Symptom Score [IPSS: total scores, storage symptoms (ST), voiding symptoms (VD), and quality of life (QoL)], prostate-specific antigen, trans-rectal ultrasonography, urine flowmetry, residual urine, and a 5-item version of the International Index of Erectile Function (IIEF-5) were assessed after a 3-month treatment period. In both groups, it was determined whether treatment was associated with changes in LUTS and erectile function and whether improvement in the IPSS was correlated with the IIEF-5. Comparative analysis was also done to examine the linear relationship between improved IPSS scores and IIEF-5 scores. Results: A comparison of the degree of improvement in all the parameters indicated that both groups showed significant improvement in total IPSS, IPSS-ST, IPSS-VD, and IPSS-QoL (p<0.05). A comparison of the degree of improved sexual function associated with improved LUTS in each patient showed significant improvement in the IIEF-5 score associated with the degree of improvement in the IPSS-ST domain in group 1, but no significant associations were found in group 2. In cases in which tamsulosin was administered, the IIEF-5 score significantly improved as the IPSS-ST domain score improved. In the group in which tamsulosin and solifenacin were concomitantly administered, improvement of the IPSS-ST domain score had no significant effect on the IIEF-5 score. Conclusions: In patients with LUTS/BPH, tamsulosin and solifenacin combination therapy was effective for LUTS, but erectile function was not significantly improved. Therefore, although effective for improving LUTS, combination therapy with an alpha- blocker and an antimuscarinic agent was not effective for improving erectile function. Purpose: To examine the effects on erectile function of concomitant treatment with an alpha-blocker (tamsulosin) and an antimuscarinic agent (solifenacin) in patients with lower urinary tract symptoms (LUTS)/benign prostatic hyperplasia (BPH). Materials and Methods: Fifty-seven male patients with LUTS/BPH were assessed for the degree of LUTS and erectile function. In group 1 (tamsulosin) and group 2 (tamsulosin and solifenacin), changes in the International Prostate Symptom Score [IPSS: total scores, storage symptoms (ST), voiding symptoms (VD), and quality of life (QoL)], prostate-specific antigen, trans-rectal ultrasonography, urine flowmetry, residual urine, and a 5-item version of the International Index of Erectile Function (IIEF-5) were assessed after a 3-month treatment period. In both groups, it was determined whether treatment was associated with changes in LUTS and erectile function and whether improvement in the IPSS was correlated with the IIEF-5. Comparative analysis was also done to examine the linear relationship between improved IPSS scores and IIEF-5 scores. Results: A comparison of the degree of improvement in all the parameters indicated that both groups showed significant improvement in total IPSS, IPSS-ST, IPSS-VD, and IPSS-QoL (p<0.05). A comparison of the degree of improved sexual function associated with improved LUTS in each patient showed significant improvement in the IIEF-5 score associated with the degree of improvement in the IPSS-ST domain in group 1, but no significant associations were found in group 2. In cases in which tamsulosin was administered, the IIEF-5 score significantly improved as the IPSS-ST domain score improved. In the group in which tamsulosin and solifenacin were concomitantly administered, improvement of the IPSS-ST domain score had no significant effect on the IIEF-5 score. Conclusions: In patients with LUTS/BPH, tamsulosin and solifenacin combination therapy was effective for LUTS, but erectile function was not significantly improved. Therefore, although effective for improving LUTS, combination therapy with an alpha- blocker and an antimuscarinic agent was not effective for improving erectile function.

The Correlation between Body Mass Index and Routine Parameters in Men Over Fifty

서덕하,윤솔,최재휘,도정모,이신우,이천우,제성욱,최세민,감성철,화정석,정기현,권성원,김세철,박동수,송재만,이경섭,현재석 대한남성과학회 2017 The World Journal of Men's Health Vol.35 No.3

Purpose: This study aimed to investigate the relationships between body mass index (BMI) and prostate-specific antigen (PSA) levels, international prostate symptom score (IPSS), quality of life (QoL), and prostate volume (PV).Materials and Methods: Height, weight, PSA levels, PV, and IPSS were analyzed in 15,435 patients who underwent a prostate examination between 2001 and 2014. Patients aged <50 years or with a PSA level ≥10 ng/mL were excluded. The relationships between BMI and PSA, IPSS, QoL, and PV were analyzed by a scatter plot, one-way analysis of variance, and the Pearson correlation coefficient.Results: The mean age was 71.95±7.63 years, the mean BMI was 23.59±3.08 kg/m2, the mean PSA level was 1.45±1.45 ng/mL, the mean IPSS was 15.53±8.31, the mean QoL score was 3.48±1.25, and the mean PV was 29.72±14.02 mL. PSA, IPSS, and QoL showed a tendency to decrease with increasing BMI, and there were statistically significant differences for each parameter (p≤0.001). PV showed a significant tendency to increase with BMI (p<0.001). In the correlation analysis, BMI showed a statistically significant correlation (p<0.001) with PSA, IPSS, and QoL, although the correlations were very weak. In contrast, BMI showed a significant correlation with PV (p<0.001), with a meaningful Pearson correlation coefficient of 0.124.Conclusions: Higher BMI was associated with lower PSA levels and higher IPSS and QoL scores. Meanwhile, PV increased with BMI. Although obese individuals had a greater PV, obesity did not aggravate lower urinary tract symptoms.

전립선 레이저치료의 최신지견

서덕하,감성철 대한의사협회 2017 대한의사협회지 Vol.60 No.5

Benign prostatic hyperplasia (BPH) is one of the most common urological diseases in men after middle age. The most common surgical treatment of BPH is transurethral prostatectomy. Recently, because of the rapid development of lasers, they have been used for the treatment of BPH. The treatment of BPH using lasers has been shown to lead to significant improvements in symptoms and to have excellent therapeutic effects. It is widely used as a minimally invasive treatment of BPH because of the risk and complications associated with transurethral prostate resection. Currently, 3 kinds of lasers are generally used in the treatment of BPH in Korea: potassium-titanyl-phosphate, holmium, and thulium lasers. With developments in laser technology, surgical procedures have improved continuously. The most common surgical procedures are holmium laser enucleation of the prostate (HoLEP), photoselective vaporization of the prostate (PVP), and thulium laser enucleation of the prostate. HoLEP is an effective surgical procedure for large prostates. PVP is safe for patients who are elderly, are in poor general health, or are taking anticoagulants. Thulium laser enucleation of prostate has advantages over PVP and HoLEP surgery due to specific characteristics of the laser and the surgical method. Compared with transurethral prostate resection, laser-based surgical procedures require shorter hospitalization and Foley catheter insertion periods. HoLEP and PVP are safe and effective methods for the surgical treatment of BPH. Therefore, if more data are accumulated from research into these methods, they will become the standard surgical treatments for prostate hyperplasia.

The Effect of Alcohol Administration on the Corpus Cavernosum

최세민,서덕하,이신우,이천우,제성욱,감성철,화정석,정기현,현재석 대한남성과학회 2017 The World Journal of Men's Health Vol.35 No.1

Purpose: We studied the effects of alcohol administration on the corpus cavernosum (CC) using an animal model.Materials and Methods: CC sections and the aortic ring of rabbits were used in an organ bath study. After acute alcohol admin-istration, changes in blood alcohol concentration and electrical stimulation induced intracavernosal pressure/mean arterial pres-sure (ICP/MAP) percentage were compared in rats. Cyclic adenosine monophosphate (cAMP) and cyclic guanosine mono-phosphate (cGMP) levels in the CC were measured using immunoassays. After chronic alcohol administration, ICP/MAP percent-age, cAMP and cGMP were compared in rats. Histological changes were examined using the Masson trichrome stain and the Sircol collagen assay. Endothelial nitric oxide synthase (eNOS) expression was examined using immunohistochemistry and Western blotting.Results: Alcohol relaxed the CC in a dose-dependent manner, and the relaxation response was suppressed when pretreated with propranolol, indomethacin, glibenclamide, and 4-aminopyridine. In rats with acute alcohol exposure, the cAMP level in the CC was significantly greater than was observed in the control group (p<0.05). In rats with chronic alcohol exposure, however, changes in cAMP and cGMP levels were insignificant, and the CC showed markedly smaller areas of smooth muscle, greater amounts of dense collagen (p<0.05). Immunohistochemical analysis of eNOS showed a less intense response, and western blot-ting showed that eNOS expression was significantly lower in this group (p<0.05).Conclusions: Acute alcohol administration activated the cAMP pathway with positive effects on erectile function. In contrast, chronic alcohol administration changed the ultrastructures of the CC and suppressed eNOS expression, thereby leading to erec-tile dysfunction.

코코아 추출물의 흰쥐 음경 해면체 이완에 미치는 영향

최세민,서덕하,이승현,제성욱,감성철,정재훈,화정석,정기현,현재석 대한남성과학회 2008 The World Journal of Men's Health Vol.26 No.3

Purpose: Cocoa has antihypertensive activity, improves cerebral blood flow, and is an antioxidant. We evaluated the effect of cocoa extract on penile erection using the relaxation of the corpus cavernosal tissue in rat. Materials and methods: We used male 8-week-old Sprague-Dawley rats weighting 250-350 g divided into three groups: corpus cavernosal tissue with the endothelium (group 1), tissue without the endothelium (group 2), and endothelium pretreated with L-NAME (group 3). Changes in isometric tension were examined in an organ bath. Aortic tissues were divided into three groups and treated in similar experiments simultaneously. Results: Cocoa extract dose-dependently relaxed corpus cavernosal tissue pre-contracted by phenylephrine (10-6). In group 1, cocoa extract (10-3g/ml) induced relaxation by 97±5% (mean±SD). The extract was still effective but less potent tissue without endothelium or pretreated with L-NAME (10-4M). Similar effects were seen in aortic rings. Conclusion: Cocoa extract relaxes corpus cavernosal tissue in a dose-dependent manner via NOS and the endothelium. Cocoa extract may therefore be effective for improving erectile function.

Relationship between Hypogonadal Symptoms, Sexual Dysfunction and Chronic Prostatitis in Middle-Aged Men by Self-Reported Questionnaires, even without Biochemical Testosterone Deficiency

이민호,서덕하,이춘우,최재휘,제성욱,이신우,최시민,화정석,현재성,정기현,감성철 대한남성과학회 2020 The World Journal of Men's Health Vol.38 No.2

Purpose: To investigate the association of erectile dysfunction (ED), premature ejaculation (PE), and chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) in men with late-onset hypogonadism (LOH). Materials and Methods: We reviewed the data of 408 enrolled men between January 2014 and January 2019. All participants completed the Androgen Deficiency in the Aging Male (ADAM), international index of erectile function-5 (IIEF-5), National Institutes of Health chronic prostatitis symptom index (NIH-CPSI), and premature ejaculation diagnostic tool (PEDT) questionnaires. Participants were divided by ADAM positive (ADAM+: Group 1) and ADAM negative (ADAM–: Group 2). Results: Total of 289 subjects were in Group 1 and 119 were in Group 2. The mean age was 53.8±7.8 years. The mean total testosterone was 4.8±1.2 ng/dL and showed no differences between the groups (p=0.839). In Groups 1 and 2, ED (IIEF≤21) was identified in 233 (80.6%) versus 37 (31.1%), respectively (p<0.001). The prevalence of PE (PEDT≥9) was 112 (38.7%) versus 13 (10.9%) in Groups 1 and 2, respectively (p<0.001). However, PE (intravaginal ejaculation latency time<5 minutes) showed no differences between the groups (p=0.863). The incidence of chronic prostatitis (NIH-CPSI pain score≥4) showed significant differences with 49 (17.0%) versus 8 (6.7%) in Groups 1 and 2, respectively (p=0.007). IIEF-5 total score showed the significantly highest negative correlation (r=-0.313, p<0.001). Conclusions: Those who complained of LOH symptoms and positive results in the ADAM questionnaire need to be assessed concurrently with the above questionnaires. This could aid useful to detect of ED, PE, and chronic prostatitis co-occurrence.

Angiomyofibroblastoma-Like Tumor of the Scrotum

이승현,양정욱,도정모,서덕하,정재훈,정기현,이종실,현재석 대한비뇨의학회 2010 Investigative and Clinical Urology Vol.51 No.5

Various tumors can occur in the scrotum. Of them, angiomyofibroblastoma-like tumors are very rare mesenchymal tumors. Angiomyofibroblastoma-like tumors cannot be easily differentially diagnosed from other malignant tumors invading the male genital tract on the basis of clinical characteristics and imaging study. Therefore, surgical removal and a histopathologic diagnosis must also be performed.

The Risk Factors of Recurrent Febrile Urinary Tract Infection within 1 Year in Urinary Stone Patients with Acute Obstructive Pyelonephritis

이신우,윤솔,도정모,서덕하,이춘우,제성욱,최시민,감성철,화정석,정규현,현재석 대한요로생식기감염학회 2017 Urogenital Tract Infection Vol.12 No.2

Purpose: To identify and evaluate the risk factors for the development of recurrent febrile urinary tract infection (fUTI) among patients with previous urinary stone and acute obstructive pyelonephritis (OPN). Materials and Methods: We retrospectively reviewed the medical records of 52 patients, who had urinary tract stones presented with OPN, between 2010 and 2015. Following their initial treatment, patients who were subsequently admitted with fUTI were included.Results: The mean age of patients was 62.2±14.6 years, and the mean follow-up duration was 26.0±20.39 months. Escherichia coli was found to be the dominating organism (68.2%, 15/22) in the initial urine culture. Patients were divided into two groups: The recurrent fUTI group (n=23) and the non-recurrent fUTI group (n=29). Between these two groups, significant differences were found with respect to diabetes history (recurrent group: 47.8% vs. non-recurrent group; 17.2%, p=0.018), stone location (kidney, 60.9% vs. ureter, 31.0%, p=0.031), and initially positive urine culture (60.9% vs. 27.6%, p=0.016). In a multivariate analysis, having an initially positive urine culture (95% confidence interval, 1.130-224.117; p=0.040) was identified as being an independent risk factor for developing recurrent fUTI. In a multivariate analysis, the initial laboratory test finding of acute renal insufficiency (ARI, p=0.019) and presence of a kidney stone (p=0.022) were significant factors associated with a newly-diagnosed-positive urine culture diagnosis. Conclusions: Having an initially positive urine culture was a significant risk factor for the development of recurrent fUTI in urinary stone patients with acute OPN. In addition, repeated urine tests were also needed in patients with ARI or renal stones during the follow-up period.

전립선 농양에서 영상검사의 중요성과 경직장초음파를 이용한 세침흡입술의 유용성

이승현,제성욱,정재훈,정기현,현재석,서덕하 대한남성과학회 2009 The World Journal of Men's Health Vol.27 No.2

Purpose: Prostatic abscess is a very rare disease whose incidence has been reported to be approximately 0.2% in patients with urologic symptoms. Besides, it cannot be diagnosed by interview and physical examination, for which imaging studies must also be performed. In the current study, we examined the clinical usefulness of imaging studies in making a diagnosis of prostatic abscess and the effect of a fine needle aspiration based on trans-rectal ultrasonography on the treatment outcomes. Materials and Methods: In ten patients who were diagnosed with prostatic abscess and then treated during a period ranging from January of 1995 to June of 2008 (mean age: 61.8 years, range: 40-89 years), a past history, clinical symptoms, physical examination findings, laboratory findings, trans-rectal ultrasonography findings, computed tomography findings, treatment modalities and complications were retrospectively analyzed. Results: All patients complained fever and voiding dysfunction as chief complaint. On trans-rectal ultrasonography and computed tomography scans, all the ten patients had abnormal findings. In five patients, there were nonhomogenous hypo-echoic lesions on trans-rectal ultrasonography. All the patients had cystic abscess lesions detected on computed tomography scans. In four patients, in whom the diameter of lesions was greater than 1cm on computed tomography scans, a fine needle aspiration was performed on trans-rectal ultrasonography and antibiotic treatment was performed. In six patients, in whom the diameter of lesions was smaller than 1 cm on computed tomography scans, antibiotic treatment was performed. There were statistically significant differences in the length of hospital stay and the size of prostate gland between the group where a fine needle aspiration was performed using trans-rectal ultrasonography and the group where antibiotic treatment was performed (P<0.05). However, there was no significant difference in the period of antibiotic treatment (P>0.05). Length of antibiotic therapy was shorter in antibiotic therapy only group, but there was no statistically significant difference (P>0.05). Conclusions: A computed tomography is a useful diagnostic modality for prostatic abscess. Besides, a fine needle aspiration based on trans-rectal ultrasonography is one of the minimally invasive treatment regimens for prostatic abscess, whose good treatment outcomes have been well documented. Furthermore, there were no severe complications in our series.