실데나필 (비아그라Ⓡ) 장기 복용자 배우자의 성태도와 성관계 및 발기부전치료에 대한 인식

김세철 대한남성과학회 2008 The World Journal of Men's Health Vol.26 No.4

Purpose: This study aimed to investigate the sexual attitudes and perception of sexual relationships and erectile dysfunction treatment among the wives of the long-term users of sildenafil (ViagraⓇ). Materials and Methods: The study was conducted as a market survey with using random face-to-face interviews and a structured questionnaire on a population of 31 wives (mean age; 49.8 years) of long-term sildenafil users who had first taken sildenafil 5 years or more previously and they continued its use in the previous 6 months. Results: All the wives said 'It is desirable to have sex even though I am getting old, if I am healthy' and 84% had sex not for their satisfaction but for husband's satisfaction. Forty five percent perceived that having sex 1∼2 times a week was ideal and 35% said having sex once per two weeks was ideal, and this was not different from happened in their real lives. Ninety four percent and 90% perceived that erectile dysfunction and women's sexual dysfunction should be treated, respectively, and 35% took a form of hormonal replacement therapy. The most influencing factors of sildenafil use on the overall satisfaction of wives' sexual and marital life were the increased frequency and intensity of orgasm and they became more intimate with their husbands, followed by the disappearance of depressed or annoying moods (p<0.01). They also felt the improved rigidity of their husband’s erection after initial sildenafil use was maintained after more than 5-year use. Conclusions: Wives of long-term sildenafil users had positive, but husband-oriented sexual attitudes. They had an intercourse-focused perception on their sexual relationship, and they ranked the increased frequency and intensity of their orgasms and becoming more intimate with husbands as the most influential factors for their sexual and marital life, and they also felt that their husbands’ erection rigidity was maintained after more than 5-year use of sildenafil.

젊은 한국 남성에서 혈중 테스토스테론, 성호르몬결합글로불린, 에스트라디올 및 황체형성호르몬의 일중변동

유대선,김은탁,김경연,우승효 대한남성과학회 2007 The World Journal of Men's Health Vol.25 No.2

발기부전의 유전자치료

서준규,류지간 대한남성과학회 2006 The World Journal of Men's Health Vol.24 No.2

현재까지의 연구결과로 미루어 볼 때, 유전자치료는 향후 발기부전 치료법에 있어 중요한 위치를 차지할 것이다. 유전자치료는 기존의 경구용 PDE5 억제제 또는 주사용 혈관확장제와 비교해서 여러 장점이 있다. 첫째, 장기, 즉 음경해면체를 구조적, 기능적으로 회복할 수 있다. 둘째, 단 1회 투여로 장기간의 치료효과를 기대할 수 있다. 셋째, 성관계 시 계획이 필요 없어 성행위의 자발성을 회복할 수 있다. 넷째, 발기력이 완전히 정상수준으로 회복되지 못한 경우에도, 부분적으로 개선된 음경해면체 기능으로 인해서 기존의 경구용 PDE5 억제제와 병용하면 효과를 얻을 수 있다. 이와 같은 많은 장점에도 불구하고 임상적으로 사용될 수 있는 유전자치료제의 개발이 부진했던 것은 치료효과가 완전하고 장기적인 치료유전자의 개발이 미흡했기 때문이다. 최근, 임상시험 중인 포타슘통로 유전자, 전임상연구 중인 혈관생성 유전자, Rho-kinase 억제 유전자 등에서 이러한 문제를 해결할 수 있을 것으로 기대한다. 악성종양과 같은 치명적인 질환과 달리 발기부전에서 유전자치료가 실제 환자에게 적용되기 위해서는, 좀 더 높은 수준의 안전성이 필요하다. 실제로 기존의 아데노바이러스 벡터 또는 AAV 벡터를 발기부전 환자에게 사용하기는 어려울 것이다. 오랜 기간 높은 효율로 유전자를 발현할 수 있고, 면역반응을 최소화하는 새로운 바이러스 벡터의 개발, 생분해성 중합체 (biodegradable polymer)를 이용한 좀 더 효율적인 비바이러스 벡터의 개발, 그리고 음경해면체에서 특정 유전자의 발현을 증가시킬 수 있는 촉진자의 개발이 필요하다. 발기부전 분야에서 유전자치료의 임상적 성공은, 다른 여러 종류의 심혈관질환 및 평활근 질환에서도 새로운 치료의 길을 열어줄 것이다.

Expression and Distribution of Free Zinc in Penile Erectile Tissue

Kang Beom Seok,Suh Sang Won,Yang Dae Yul,Choi Bo Young,Lee Won Ki 대한남성과학회 2023 The World Journal of Men's Health Vol.41 No.1

Purpose: Several studies have shown that zinc has a significant influence on erectile function. However, no studies evaluating the cellular distribution of free zinc in penile erectile tissue have been performed. Therefore, this study aimed to test whether free zinc is present in penile tissue and whether it may be involved in the electrical stimulation (ES)-induced penile erection. Materials and Methods: The subjects for this study were 26 young (8-week-old) male C57BL/6J mice. After the cavernous nerve was exposed through a midline stomach incision, 14 mice received ES of the cavernous nerve (ES group), whereas 12 mice did not (control group). Intracavernous pressure (ICP) (consisting of 10 V at a duration of 1 min, frequency of 12 Hz and a pulse width of 1 m/s) was recorded during ES. Immediately after ICP was recorded, penile tissues were harvested for histo-logical and biochemical analysis, including analysis of zinc transporter 3 (ZnT3) and intracellular free zinc levels. Results: The expression of neuronal nitric oxide synthase (nNOS) and endothelial NOS (eNOS) in penile tissue was significantly greater in the ES group than in the control group (p=0.036 and 0.016, respectively). And then, ZnT3 and intracellular free zinc were present in the penile tissue of both groups. However, ZnT3 immunofluorescence in the ES group was more intense in the dorsal nerve bundle (22% increase, p=0.032). The ES group also showed higher intensity N-(6-methoxy-8-quinolyl)-para-tolu-enesulfonamide (TSQ) fluorescence signals indicative of intracellular free zinc level in the penile tissue compared to the control group (49% increase in dorsal nerve bundle, p=0.001; 50% increase in corpus cavernosum, p=0.001). Conclusions: The results of the study supported the expression and distribution of free zinc in penile tissue and increased levels after penile erection. Therefore, this study provides anatomical evidence for the potential role of free zinc in penile erection.

Testosterone Recovery after Androgen Deprivation Therapy in Prostate Cancer: Building a Predictive Model

Borque-Fernando Ángel,Estrada-Domínguez Fernando,Esteban Luis Mariano,Gil-Sanz María Jesús,Sanz Gerardo 대한남성과학회 2023 The World Journal of Men's Health Vol.41 No.1

Purpose: To analyze the variability, associated actors, and the design of nomograms for individualized testosterone recovery after cessation of androgen deprivation therapy (ADT). Materials and Methods: A longitudinal study was carried out with 208 patients in the period 2003 to 2019. Castrated and normogonadic testosterone levels were defined as 0.5 and 3.5 ng/mL, respectively. The cumulative incidence curve described the recovery of testosterone. Univariate and multivariate analyzes were performed to predict testosterone recovery with can-didate prognostic factors prostate-specific antigen at diagnosis, clinical stage, Gleason score from biopsy, age at cessation of ADT, duration of ADT, primary therapy and use of LHRH (luteinizing hormone-releasing hormone) agonists. Results: The median follow-up duration in the study was 80 months (interquartile range, 49–99 mo). Twenty-five percent and 81% of patients did not recover the castrate and normogonadic levels, respectively. Duration of ADT and age at ADT ces-sation were significant predictors of testosterone recovery. We built two nomograms for testosterone recovery at 12, 24, 36, and 60 months. The castration recovery model had good calibration. The C-index was 0.677, with area under the receiver operating characteristic curve (AUC-ROC) of 0.736, 0.783, 0.782, and 0.780 at 12, 24, 36, and 60 months, respectively. The normogonadic recovery model overestimated the higher values of probability of recovery. The C index was 0.683, with AUC values of 0.812, 0.711, 0.708 and 0.693 at 12, 24, 36, and 60 months, respectively. Conclusions: Depending on the age of the patient and the length of treatment, clinicians may stop ADT and the castrated tes-tosterone level will be maintained or, if the course of treatment has been short, we can estimate if it will return to normogo-nadic levels.

Temporal Changes of Clomiphene on Testosterone Levels and Semen Parameters in Subfertile Men

Jiang Tommy,Sigalos John T.,Osadchiy Vadim,Santamaria Alvaro,Zheng Michael H.,Modiri Neilufar,Regets Keith V.,Mills Jesse N.,Eleswarapu Sriram V. 대한남성과학회 2023 The World Journal of Men's Health Vol.41 No.1

Purpose: Clomiphene citrate (CC) is prescribed off-label in men to improve testosterone and sperm parameters, but the dura-tion of treatment needed to reach maximal benefit remains unclear. Our objective was to examine temporal effects of CC on total testosterone (TT) and semen analysis (SA) using longitudinal follow-up data in treated men. Materials and Methods: We analyzed an IRB-approved database of men treated with CC (25 mg q.d. or 50 mg q.o.d.) from January 2016 through May 2021. We identified patients with 3, 6, 9, and 12 month follow-up data for TT and 3, 6, and 9 month follow-up SA. Mean absolute changes in TT and sperm concentration compared to baseline were calculated, along with 95% confidence intervals. Men with prior genitourinary procedures or hormone therapy were excluded. Paired t-tests were used to compare TT and sperm concentration at each time point to baseline (alpha=0.05). Results: One hundered thirty-four men received CC, mean age 37.7 years (SD 6.7, range 24–52). TT at all follow-ups (3, 6, 9, and 12 months) were available for 25 men, and SA at 3, 6, and 9 months for 26 men. Baseline TT was 358±145 ng/dL and sperm concentration was 13±17.2 M/mL. Significant improvement in TT was identified at 3 months (62.7 ng/dL, 95% CI: 0.49–125.0, p=0.048), additional benefit at 6 months (181.8 ng/dL, 95% CI: 114.1–249.5, p<0.01), and plateau at 9 and 12 months. Improvement in sperm concentration was first observed at 9 months (20.7 M/mL, 95% CI: 10.2–31.2, p<0.01). Se-men volume and sperm motility did not change. Conclusions: Duration of treatment with clomiphene may impact testosterone and sperm concentration, and the historical 3 month milestone may be insufficient for clinical and research evaluation. Men taking CC may experience plateau in TT at 6 months and first benefit in sperm concentration at 9 months.

Establishment of Prospective Registry of Active Surveillance for Prostate Cancer: The Korean Urological Oncology Society Database

Jung Gyoohwan,Kim Jung Kwon,Jeon Seong Soo,Chung Jae Hoon,Kwak Cheol,Jeong Chang Wook,Ahn Hanjong,Joung Jae Young,Kwon Tae Gyun,Park Sung Woo,Byun Seok-Soo 대한남성과학회 2023 The World Journal of Men's Health Vol.41 No.1

Purpose: To establish a prospective registry for the active surveillance (AS) of prostate cancer (PC) using the Korean Urologi-cal Oncology Society (KUOS) database and to present interim analysis. Materials and Methods: The KUOS registry of AS for PC (KUOS-AS-PC) was organized in May 2019 and comprises multiple institutions nationwide. The eligibility criteria were as follows: patients with (1) pathologically proven PC; (2) pre-biopsy prostate-specific antigen (PSA) ≤20 ng/mL; (3) International Society of Urological Pathology (ISUP) grade 1 or 2 (no cribriform pattern 4); (4) clinical T stage ≤T2c; (5) positive core ratio ≤50%; and (6) maximal cancer involvement in the core ≤50%. Detailed longitudinal clinical information, including multi-parametric magnetic resonance imaging and disease-specific out-comes, was recorded. Results: From May 2019 to June 2021, 296 patients were enrolled, and 284 were analyzed. The mean±standard deviation (SD) age at enrollment was 68.7±8.2 years. The median follow-up period was 11.2 months (5.9–16.8 mo). Majority of pa-tients had pre-biopsy PSA ≤10 ng/mL (91.2%), PSA density <0.2 ng/mL2 (79.7%), ISUP grade group 1 (94.4%), single positive core (65.7%), maximal cancer involvement in the core ≤20% (78.1%), and clinical T stage of T1c or lower (72.9%). Fifty-two (18.3%) discontinued AS for various reasons. Interventions included radical prostatectomy (80.8%), transurethral prostatec-tomy (5.8%), primary androgen deprivation therapy (5.8%), radiation (5.8%), and focal therapy (1.9%). The mean±SD time to intervention was 8.9±5.2 months. The reasons for discontinuation included pathologic reclassification (59.6%), patient pref-erence (25.0%), and radiologic reclassification (9.6%). Two (4.8%) patients with pathologic Gleason score upgraded to ISUP grade group 4, no biochemical recurrence. Conclusions: The KUOS established a successful prospective database of PC patients undergoing AS in Korea, named the KUOS-AS-PC registry.

The Impact of the Percent of Residual Prostate-Specific Antigen on Metastasis-Free Survival in Patients with Persistent Prostate-Specific Antigen after Radical Prostatectomy

Lee Dan Bee,Kim Jae Yeon,Song Won Hoon,Nam Jong Kil,Lee Hyun Jung,Kim Tae Un,Park Sung-Woo 대한남성과학회 2023 The World Journal of Men's Health Vol.41 No.1

Purpose: Persistent levels of prostate-specific antigen (PSA) is a poor prognostic factor for recurrence after radical prostatectomy (RP). We investigated the impact of the percentage of residual PSA (%rPSA) [(post-/preoperative PSA)×100], representing a biochemical residual tumor, and the first postoperative PSA (fPSA) level on metastasis-free survival (MFS) in men with persistent levels of PSA after RP. Materials and Methods: We retrospectively identified male patients within a single tertiary referral hospital database who harbored persistent (≥0.1 ng/mL) vs. undetectable (<0.1 ng/mL) PSA levels 4 to 8 weeks after RP. Kaplan–Meier analyses and Cox regression models were used to test the effect of persistent PSA levels, the fPSA level, and %rPSA on MFS. Results: Of 1,205 patients, 178 patients with persistent PSA levels were enrolled. Seven-year MFS rates were 60.5% vs . 84.3% (p<0.001) for patients with a %rPSA ≥6% and <6%, respectively. Multivariable Cox regression models of the overall cohort revealed that persistent PSA levels (hazard ratio [HR], 3.94; p=0.010), extracapsular extension (HR, 4.17; 95% confidence interval [CI], 1.06–16.41; p=0.041), and pathological Gleason grade group (pGGG) (HR, 3.69; 95% CI, 1.32–10.27; p=0.013) were independent predictors of metastasis. Multivariable Cox regression models in men with persistent PSA levels revealed that the %rPSA (HR, 8.92; 95% CI, 1.74–45.71; p=0.009) and pGGG 4–5 (HR, 4.13; 95% CI, 1.22–13.96; p=0.022) were independent predictors of distant metastasis, but not the fPSA level after surgery. Conclusions: Persistent levels of PSA were associated with worse MFS after RP. In men with persistent PSA levels after RP, the %rPSA is a valuable predictor of MFS unlike the fPSA level.

Male Attitudes towards Infertility: Results from a Global Questionnaire

De Jonge Christopher J.,Gellatly Steven A.,Vazquez-Levin Mónica H.,Barratt Christopher L.R.,Rautakallio-Hokkanen Satu 대한남성과학회 2023 The World Journal of Men's Health Vol.41 No.1

Purpose: In general, men are less likely to seek health care than women. Infertility is a global disease that afflicts approxi-mately 15% of reproductive age couples and the male contributes to 40% of the diagnosable cause. Remarkably, no large or multi-national population data exist regarding men’s perceptions about their infertility. The purpose of this study was to advance our knowledge about the infertile male’s social experience regarding: (1) how they feel about their infertility, (2) what motivated them to seek health care, (3) how likely are they to talk with others about their infertility, (4) their awareness of male infertility support groups, and (5) what their primary source for information is regarding male infertility? Based on the results from this study, these simple questions now have clearer definition. Materials and Methods: An Institutional Review Board-approved, male-directed, anonymous questionnaire translated into 20 languages was made globally available through the Fertility Europe website (https://fertilityeurope.eu). Males (n=1,171) age 20–49 years were invited to complete the online survey after informed consent. Results: Most respondents were European (86%). Of European men, <15.8% were self-motivated to seek medical help. Fur-ther, their physician was not the primary source of information regarding their infertility. While most men (59%) viewed their infertility positively, a large majority were not very likely (73%) to talk about it. Most respondents indicated a lack of aware-ness or absence of male infertility support groups. Conclusions: These are the first multi-national population data revealing men’s feelings about their infertility, what motivates them to seek help and their awareness of resources for peer support and information. These findings also serve to highlight significant gaps that exist in the provision of male reproductive health care and in supportive resources for men suffering from infertility. We offer recommendations on how to address the problem(s).

Impact of Antioxidant Therapy on Natural Pregnancy Outcomes and Semen Parameters in Infertile Men: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Agarwal Ashok,Cannarella Rossella,Saleh Ramadan,Harraz Ahmed M.,Kandil Hussein,Salvio Gianmaria,Boitrelle Florence,Kuroda Shinnosuke,Farkouh Ala’a,Rambhatla Amarnath,Zini Armand,Colpi Giovanni,Gül Mur 대한남성과학회 2023 The World Journal of Men's Health Vol.41 No.1

Purpose: Seminal oxidative stress (OS) is a recognized factor potentially associated with male infertility, but the efficacy of antioxidant (AOX) therapy is controversial and there is no consensus on its utility. Primary outcomes of this study were to in-vestigate the effect of AOX on spontaneous clinical pregnancy, live birth and miscarriage rates in male infertile patients. Sec-ondary outcomes were conventional semen parameters, sperm DNA fragmentation (SDF) and seminal OS. Materials and Methods: Literature search was performed using Scopus, PubMed, Ovid, Embase, and Cochrane databases. Only randomized controlled trials (RCTs) were included and the meta-analysis was conducted according to PRISMA guide-lines. Results: We assessed for eligibility 1,307 abstracts, and 45 RCTs were finally included, for a total of 4,332 infertile patients. We found a significantly higher pregnancy rate in patients treated with AOX compared to placebo-treated or untreated con-trols, without significant inter-study heterogeneity. No effects on live-birth or miscarriage rates were observed in four studies. A significantly higher sperm concentration, sperm progressive motility, sperm total motility, and normal sperm morphology was found in patients compared to controls. We found no effect on SDF in analysis of three eligible studies. Seminal levels of total antioxidant capacity were significantly higher, while seminal malondialdehyde acid was significantly lower in patients than controls. These results did not change after exclusion of studies performed following varicocele repair. Conclusions: The present analysis upgrades the level of evidence favoring a recommendation for using AOX in male infertility to improve the spontaneous pregnancy rate and the conventional sperm parameters. The failure to demonstrate an increase in live-birth rate, despite an increase in pregnancy rates, is due to the very few RCTs specifically assessing the impact of AOX on live-birth rate. Therefore, further RCTs assessing the impact of AOX on live-birth rate and miscarriage rate, and SDF will be helpful.