PURPOSE: It is reported that 65% of diabetic male patients over 60 of their age are impotent. However, there is no report concerning the effect of serum glucose control on erectile dysfunction in diabetic patient. This study was performed to evaluate the effects of serum glucose control on erectile dysfunction. MATERIALS AMD METHODS: The development of Diabetes mellitus was defined that the serum glucose level was above 200mg/dL in random test at 25 weeks. We designed the experimental specimen into 3 groups; group I: diabetic OLETF (Otsuka Long Evans Tokushima Fatty) rats without blood sugar control (n=10), group II: diabetic OLETF rats with blood sugar control with 4U insulin subcutaneous injection daily from 26 to 46 weeks (n=10), group III: diabetic OLETF rats with blood sugar control with 10U insulin subcutaneous injection daily from 26 to 46 weeks (n=10). We estimated the collagen content of penile tunica albuginea with the scanning electron microscopy and observed the endothelial layers of corpus cavernosum with the transmission electron microscopy in each group. RESULTS: The serum glucose level was 249 +/- 4.1mg/dL, 234 +/- 2.7mg/dL, 215 +/- 3.0mg/dL respectively in group I, II, III, and decreased in order of group II, III. The differences among groups were statistically significant (p<0.05). The thickness of collagen bundles of penile tunica albuginea was 0.98 +/- 0.1 micrometer, 0.94 +/- 0.3 micrometer, 0.92 +/- 0.1 micrometer respectively in group I, II, III, and decreased in order of group II, III. The differences among groups were statistically significant (p<0.05). The endothelial layers of corpus cavernosum were decreased in II, III. CONCLUSIONS: The serum glucose control in diabetic rats decreases the collagen con tents in penile tunica albuginea and the endothelial layers of corpus cavernosum.
Animals ; Blood Glucose* ; Collagen* ; Diabetes Mellitus ; Endothelium ; Erectile Dysfunction ; Humans ; Injections, Subcutaneous ; Insulin ; Male ; Microscopy, Electron, Scanning ; Microscopy, Electron, Transmission ; Rats* ; Rats, Inbred OLETF

No abstract available.
Follow-Up Studies* ; Intermittent Urethral Catheterization*

There is no safe and effective standard method for glans penis augmentation. Furthermore, there has been scant research on glans penis augmentation due to a poor understanding of glans anatomy, technical difficulty, and a lack of suitable substances for augmentation. Cross-linked dextran gel is a newly developed filler for soft-tissue augmentation. We evaluated the efficacy and safety of using a novel technique to inject cross-linked dextran gel for glans penis augmentation during a 24-week follow-up study. This prospective, single-arm, multicenter study enrolled twenty healthy adult men who underwent glans penis augmentation between June and August 2013. Cross-linked dextran gel was injected into the glans penis using a simple and easy technique. The sizes of the glans penis and individual satisfaction were assessed. Any adverse event was also reported. A total of 18 individuals were analyzed; two of them were lost to follow-up. The mean procedure time and injected volume were about 30 min and 6.6 ± 0.9 ml, respectively. The mean surface areas of the glans at baseline and 24 weeks were 20.0 ± 3.5 cm2 and 33.6 ± 5.4 cm2, respectively, representing a mean increase of 68.7% ± 14.0% (P < 0.001). Sixteen individuals (88.9%) were satisfied with the outcomes, and none were dissatisfied. There were no serious adverse events during the study. Cross-linked dextran gel injection for glans penis augmentation was easy and showed a significant augmentative effect on the glans penis, good durability, and was well tolerated without serious adverse events. Therefore, cross-linked dextran gel injection may be an effective, new technique for glans penis augmentation.

p27kip1, a cyclin dependent kinase inhibitor, has been recognized as a negative regulator of cell cycle. To investigate the role of p27kip1 on progression of cancer and apoptotic pathway, we analyzed p27kip1 expression using immunohistochemical stain in 40 cases of prostatic adenocarcinoma and apoptotic index by TUNEL method in 30 cases of prostatic adenocarinoma. Both were correlated with Gleason grade and Gleason score. Loss of p27kip1 expression was more frequent in prostatic adenocarcinomas of higher score (Gleason score 7 to 10) (60.7%) than in those of lower score (Gleason score 4 to 6) (33.3%) (p<0.05). The value of mean apoptotic index of carcinoma was 1.13+/-0.26, 1.80+/-0.91, 2.06+/-0.79, and 2.12+/-0.82 in grade 2, 3, 4, and 5, respectively, and was positively correlated with grade of carcinoma (p<0.05). Mean apoptotic index of higher Gleason score (score 7 to 10; 2.05+/-0.63) was also significantly increased than in lower Gleason score (score 4 to 6; 1.34+/-0.39) (p<0.05). Mean apoptotic index in cases with and without p27kip1 expression was 1.92+/-0.86 and 1.89+/-0.81, respectively (p>0.05). These results suggest that loss of p27kip1 expression and increased apoptotic index may be the morphologic markers to predict the behavior of prostatic adenocaricnoma. The role of p27kip1 on apoptotic pathway seems to be meager in this study and needs further study.
Adenocarcinoma* ; Cell Cycle ; Cyclins ; In Situ Nick-End Labeling ; Neoplasm Grading ; Phosphotransferases

Ureteroscopic management of ureteral calculi is now an established highly successful technique with low morbidity. Manipulation of calculi can be done under direct vision using flexible forceps or stone baskets. We also have used a laser lithotriptor to disintegrate stones that were too large to be removed by manipulation. Between April 1988 and July 1989, 136 ureteroscopic procedures were performed for removal of stone. The stones were removed successfully in 119( 87.5% ) procedures. Laser lithotripsy was used successfully to remove the stone in 70(51.5%) procedures. There were no immediate complications except one case of urine extravasation because of ureteral injury. We conclude that ureteroscopic management of ureteral calculi can be done safely if certain guide lines such as proper selection of patient, adequate equipment, and proper execution of the basic technique are adhered to strictly.
Calculi ; Humans ; Lithotripsy, Laser ; Surgical Instruments ; Ureter* ; Ureteral Calculi ; Ureteroscopy*

PURPOSE: Peak urinary flow rate is a widely used parameter in the diagnosis and evaluation of treatment erect of BPH because of its objectiveness and non-in vasiveness. The peak urinary flow rate, however is different with each voided volume in the same patient and tends to decrease even in an asymptomatic man with increasing ages. Therefore we need an adjusted peak urinary flow rate corresponding with the age and voided volume. This adjusted peak urinary flow rate can be used to evaluate the voiding function more easily in the same patient periodically or In the different patient of various voided volume and ages. MATERIALS AND METHODS: Data on age, volume voided and peak urinary flow rate were accumulated from 216 male aged from 10 to 80 who were free of voiding symptoms. All combinations of peak urinary flow rate, age and volume voided were tested for equation of bet fit by the least squares method with search for the equation providing least residual standard deviation with SAS package. RESULTS: When the peak urinary flow rate is defined as a function of age and voided volume, the equation is Q=35.01+0.086A-0.0031A2-1612/V(Q: peak urinary flow rate, A: age, V: voided volume). At the point of population means for volume voided(247.5ml) arid age(35.2) the reference peak urinary flow rate was 27.7m1/sec. Adjusted peak flow rate can be obtained by subtracting the difference between the measured and expected peak flow rate(expected minus measured) from the reference peak flow rate. To make the adjusted peak flow rate obtained easily with measured peak flow rate, age and voided volume nomogram that incorporates the equation has been designed. In our nomogram an adjusted peak flow rate < 19.9 ml/sec or > 1.3 standard deviation below mean should be considered suspicious for obstruction. CONCLUSIONS: Nomogram for adjusted peak flow rate that incorporates the age, voided volume and measured peak flow rate would be satisfactory for clinical use.
Diagnosis ; Humans ; Least-Squares Analysis ; Male* ; Nomograms

Squamous cell carcinoma of the renal pelvis is an uncommon tumor, comprising about 0.5-2% of all primary malignant tumor of the kidney. The patients of this disease usually presented late with extensive local infiltration. In addition, poor response to surgery, radiotherapy and chemotherapy result in a poor prognosis and short survival. We report a patient of squamous cell carcinoma of renal pelvis with staghorn calculi in a 66-year-old woman who had a history of right sided renal colic and palpable abdominal mass.
Aged ; Calculi* ; Carcinoma, Squamous Cell* ; Drug Therapy ; Female ; Humans ; Kidney ; Kidney Pelvis* ; Prognosis ; Radiotherapy ; Renal Colic

Erectile dysfunction following radical prostatectomy is significant quality of life issue even with increased understanding of the anatomy and advancement of surgical skills such as nerve sparing prostatectomy, laproscopic, and robotic surgery. The changes of neuropraxia, ischemic and hypoxic injury vascular damage, fibrotic remodeling, and venous leak are all believed to contribute to erectile dysfunction. Penile rehabilitation is the use of any drug or device at or after radical prostatectomy to preserving penile function and earlier return of potency. There are no generally accepted guidelines for penile rehabilitation regiments. There exist several popular options such as PDE5I (phosphodiesterase type 5 inhibitor), intracorporeal injection of vasoactive agent, vacuum device, intraurethral alprostadil, and combination of these modalities. Current animal and human data support the primary use of PDE5I (phosphodiesterase type 5 inhibitor) for nerve sparing and injection of vasoactive agent for supposed nerve injury patients. Some experimental modalities including hyperbaric oxygen therapy, neuromodulator, and stem cell strategies are under preclinical study. This paper will review the literatures involving both basic and clincial evidences for rehabilitation approaches following radical prostatectomy.
Alprostadil ; Animals ; Erectile Dysfunction ; Humans ; Hyperbaric Oxygenation ; Male ; Neurotransmitter Agents ; Prostatectomy ; Quality of Life ; Stem Cells ; Vacuum

No abstract available.

Male sexual disorders, which are the target of clinical treatment, can be largely divided into erectile dysfunction (ED), ejaculation disorder, infertility, sexual desire disorder, hypogonadism, and other diseases related to penile structure changes, such as Peyronieʼs disease. Current approaches to ED treatment for most men are based on pharmacotherapy. Pharmacotherapy has evolved since the introduction of papaverine and phenoxybenzamine in the early 1980s. Sildenafil, a phosphodiesterase type 5 inhibitor (PDE5I), was the first approved drug for ED. Currently, PDE5Is are the most widely prescribed drugs and have an overall efficacy of 60% to 80% in all categories of ED. Most drugs used in ED are peripheral agents that act on the penis. If a combined treatment with a central nervous system agent and peripheral agents is possible, it may be an effective treatment strategy with higher efficacy. Premature ejaculation (PE) is the most frequent ejaculatory disorder. The absence of a consensus on the definition of PE has served as an obstacle in the investigation of its prevalence and the effectiveness of treatment strategies. Although the etiology of PE is unknown, some biological and psychological hypotheses, including anxiety, penile hypersensitivity, and 5-hydroxytryptamine receptor dysfunction have been suggested. Dapoxetine hydrochloride, a short-acting selective serotonin reuptake inhibitor, was approved for on-demand treatment of PE. Off-label use of antidepressants, topical anesthetic agents, tramadol, and PDE5Is is now available as a pharmacological option. The aim of this review is to describe recent advancements in the pharmacological treatment of male sexual disorders, especially focused on ED and PE.