A recent study investigated the role of vitamin D in urinary incontinence (UI). However, very few data are available on this topic. Therefore, we evaluated these relationships using nationally representative data from Korea. We included 6,451 women over the age of 20 years who had participated in the Korea National Health and Nutrition Examination Survey IV. We conducted a propensity-matched study by identifying women with UI. Women without UI, matched for menopause, number of pregnancies, hypertension, diabetes, body mass index, age, stroke, asthma, and chronic obstructive pulmonary disease, were selected as a control group at a 2:1 ratio. The χ² test, t-test and logistic regression analyses were used. Following propensity score matching, 558 UI cases and 1,116 normal controls were included, and confounders (menopause, hypertension, diabetes mellitus, asthma, age, obesity, and number of pregnancies) were evenly dispersed and did not differ significantly between the groups. There was no significant difference between the mean vitamin D levels of the UI and normal groups (vitamin D: 18.4 ± 6.6 vs. 18.5 ± 7.0 ng/mL; P = 0.752). Additionally, there was no significant difference in the distribution of vitamin D levels (< 20 ng/mL, 20–30 ng/mL, > 30 ng/mL: 63.8%, 30.5%, and 5.7% in normal controls, 64.0%, 27.8%, and 8.2% in UI cases; P = 0.107). In conclusion, low serum vitamin D is not significantly and independently related to female UI after propensity score matching in representative Korean data.

A male factor is the only cause of infertility in 30% to 40% of couples. Most causes of male infertility are treatable, and the goal of many treatments is to restore the ability to conceive naturally. Varicoceles are present in 15% of the normal male population and in approximately 40% of men with infertility. Varicocele is the most common cause of male infertility that can be corrected surgically. In males with azoospermia, the most common cause is post-vasectomy status. Approximately 6% of males who undergo vasectomy eventually seek reversal surgery. Success of vasectomy reversal decreases with the number of years between vasectomy and vasovasostomy. Other causes of obstructive azoospermia include epididymal, vasal or ejaculatory duct abnormalities. Epididymal obstruction is the most common cause of obstructive azoospermia. Patients with epididymal obstruction without other anatomical abnormalities can be considered as candidates for vasoepididymostomy. With microsurgical techniques, success of patency restoration can reach 70~90%. In case of surgically uncorrectable obstructive azoospermia, sperm extraction or aspiration for in vitro fertilization is needed. Nonobstructive azoospermia is the most challenging type of male infertility. However, microsurgical testicular sperm extraction may be an effective method for nonobstructive azoospermia patients.
Azoospermia ; Ejaculatory Ducts ; Family Characteristics ; Fertilization in Vitro ; Fibrinogen ; Humans ; Infertility ; Infertility, Male ; Male ; Spermatozoa ; Varicocele ; Vasectomy ; Vasovasostomy

Klinefelter's syndrome (KS) is a genetic syndrome that presents with hypogonadism and is associated with metabolic syndrome. Patients demonstrating hypogonadism show a greater prevalence of metabolic syndrome due to changes in body composition. We aimed to determine the association between KS and dyslipidemia. The KS group comprised 55 patients who visited the infertility clinic for an infertility evaluation and were confirmed as having a diagnosis of KS. The control group comprised 120 patients who visited the clinic for health screening. Patient characteristics were compared between the two groups with respect to height, weight, body mass index (BMI), testosterone, total cholesterol, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, and triglyceride (TG) levels. Height and weight were significantly greater in patients belonging to the KS group, but no statistically significant difference was found with respect to the BMI. Testosterone levels in patients belonging to the KS group were significantly lower compared to the control group (2.4 ± 2.6 vs. 5.2 ± 1.8 ng/mL, P < 0.001). Compared to the control group, TG levels in patients belonging to the KS group were increased (134.9 ± 127.8 vs. 187.9 ± 192.1 mg/dL, P = 0.004) and HDL cholesterol was significantly decreased (51.2 ± 22.0 vs. 44.0 ± 9.5 mg/dL, P = 0.009). LDL cholesterol and total cholesterol were not significantly different between the two groups (P = 0.076 and P = 0.256, respectively). Significant differences were noted between patients belonging to the KS group and normal control group with respect to elevated TG and decreased HDL cholesterol levels.
Body Composition ; Body Weight ; Cholesterol ; Cholesterol, HDL ; Cholesterol, LDL ; Diagnosis ; Dyslipidemias* ; Humans ; Hypogonadism* ; Infertility ; Klinefelter Syndrome* ; Lipoproteins ; Mass Screening ; Prevalence ; Testosterone ; Triglycerides

PURPOSE: Urologic injuries occur frequently during surgery in the pelvic cavity. Inadequate diagnosis and treatment may lead to severe complications and side effects. This investigation examined the clinical features of urologic complications following obstetric and gynecologic surgery. MATERIALS AND METHODS: We accumulated 47,318 obstetric and gynecologic surgery cases from 2007 to 2011. Ninety-seven patients with urological complications were enrolled. This study assessed the causative disease and surgical approach, type, and treatment method of the urologic injury. RESULTS: Of these 97 patients, 69 had bladder injury, 23 had ureteral injury, 2 had vesicovaginal fistula, 2 had ureterovaginal fistula, and 1 had renal injury. With respect to injury rate by specific surgery, laparoscopic-assisted radical vaginal hysterectomy was the highest with 3 of 98 cases, followed by radical abdominal hysterectomy with 15 of 539 cases. All 69 cases of bladder injury underwent primary suturing during surgery without complications. Of 14 cases with an early diagnosis of ureteral injury, 7 had a ureteral catheter inserted, 5 underwent ureteroureterostomy, and 2 underwent ureteroneocystostomy. Of nine cases with a delayed diagnosis of ureteral injury, ureteral catheter insertion was carried out in three cases, four cases underwent ureteroureterostomy, and two cases underwent ureteroneocystostomy. CONCLUSIONS: Bladder injury was the most common urological injury during obstetric and gynecologic surgery, followed by ureteral injury. The variety of injured states, difficulty of diagnosis, and time to complete cure were much greater among patients with ureteral injuries. Early diagnosis and urologic intervention is important for better outcomes.
Delayed Diagnosis ; Early Diagnosis ; Female ; Fistula ; Gynecologic Surgical Procedures ; Humans ; Hysterectomy ; Hysterectomy, Vaginal ; Iatrogenic Disease ; Ureter ; Urinary Bladder ; Urinary Catheters ; Urinary Tract ; Vesicovaginal Fistula

PURPOSE: To compare the efficacy and safety of Sulosin D (PACIFICPHARMA, Korea) and Harnal D (ASTELLAS PHARMA KOREA, Korea) in treating patients with lower urinary tract symptoms associated with benign prostatic hyperplasia (BPH). MATERIALS AND METHODS: This randomized, controlled, open-label, multicenter non-inferiority study was conducted at four sites in Korea. We randomly assigned 123 patients with an International Prostate Symptom Score (IPSS) > or =12 to receive either Sulosin D or Harnal D treatment for 8 weeks. The primary outcome was the mean change in IPSS from baseline to endpoint. Secondary outcomes were the mean change from baseline to endpoint in IPSS quality of life subscores, maximum uroflowmetry (Qmax), and post-voiding residuals (PVR). RESULTS: In all, 123 patients were randomly assigned (60 Sulosin D and 63 Harnal D). The changes in the total IPSS from baseline in the Sulosin D- and Harnal D-treated groups were -4.97 and -4.03, respectively. There were significant decreases compared with baseline in both groups. The mean difference (Sulosin D - Harnal D) was -0.91 (with a two-sided 90% confidence interval), inferring that Sulosin D was not inferior to Harnal D. The mean changes in the IPSS subscore, Qmax, and PVR from baseline were comparable between the groups (both p>0.05). During the treatment periods, the incidence of adverse events was 23.33% and 34.92% in the Sulosin D and Harnal D groups, respectively (p=0.1580). CONCLUSIONS: We demonstrate the non-inferiority of Sulosin D to Harnal D in patients with lower urinary tract symptoms associated with BPH.
Drugs, Generic ; Humans ; Incidence ; Korea ; Lower Urinary Tract Symptoms ; Prostate ; Prostatic Hyperplasia ; Quality of Life ; Sulfonamides

OBJECTIVE: Growth hormone and its mediator, insulin-like growth factor-1 (IGF-1), have been suggested to exert gonadotropic actions in both humans and animals. The present study was conducted to assess the relationship between serum IGF-1 concentration, seminal plasma concentration, and sperm parameter abnormalities. METHODS: A total of 79 men were enrolled in this study from December 2011 to July 2012 and were prospectively analyzed. Patient parameters analyzed included age, body mass index, smoking status, urological history, and fertility history. Patients were divided into four groups based on their semen parameters: normal (A, n=31), abnormal sperm motility (B, n=12), abnormal sperm morphology (C, n=20), and two or more abnormal parameters (D, n=16). Patient seminal plasma and serum IGF-1 concentrations were determined. RESULTS: Patient baseline characteristics were not significantly different between any of the groups. The serum IGF-1 levels in groups B, C, and D were significantly lower than the levels in group A; however, the seminal plasma IGF-1 levels were not significantly different between any of the groups. CONCLUSION: Men with abnormal sperm parameters had significantly lower levels of serum IGF-1 compared with men with normal sperm parameters. Seminal plasma IGF-1 levels, however, did not differ significantly between the groups investigated here. Further investigations will be required to determine the exact mechanisms by which growth hormone and IGF-1 affect sperm quality.
Animals ; Body Mass Index ; Fertility ; Growth Hormone ; Humans ; Infertility ; Infertility, Male* ; Insulin-Like Growth Factor I ; Male ; Male* ; Prospective Studies ; Semen* ; Smoke ; Smoking ; Sperm Motility ; Spermatozoa

PURPOSE: Urinary incontinence (UI) is associated with nursing home admission, functional decline, and risk of death among community-dwelling older adults. Little information, however, is available on sex differences in lower urinary tract symptoms (LUTS) in older Korean adults exclusively living in rural areas. This study examined sex-related differences in LUTS, factors associated with UI in older adults living in rural areas, and health-related quality of life (HRQoL) in incontinent older adults. METHODS: This was a cross-sectional study in which face-to-face interviews were conducted at 15 rural community-health centres. A total of 323 older adults aged ≥65 years from rural areas of Korea participated. LUTS prevalence was evaluated and HRQoL was measured using the King’s Health Questionnaire. The chi-square test and t -test were used to examine sex differences in characteristics, LUTS, and HRQoL. Multivariable logistic regression was used to identify risk factors associated with UI. RESULTS: Nocturia was the most prevalent symptom, affecting 87% of men and 86% of women. Women (53%) had significantly more UI of any kind than did men (35%) (P=0.007). Urgency UI was the most frequent type of UI in men, whereas stress UI was the most frequent in women. Regarding HRQoL, men had significantly higher scores in the domains of sleep/energy disturbances (P=0.032) than did women, and women reported greater effects from the severity of incontinence (P=0.001) than did men. Arthritis was the only factor associated with UI in men (odds ratio [OR], 6.88; 95% confidence interval [CI], 1.46–32.36). However, women with diabetes mellitus were less likely to have UI than those without (OR, 0.43; 95% CI, 0.23–0.82). CONCLUSIONS: LUTS were found to be highly prevalent in community-dwelling older Korean adults in rural areas. Interventions to improve sleep and to reduce UI severity are needed for incontinent men and women, respectively.
Adult* ; Arthritis ; Cross-Sectional Studies ; Diabetes Mellitus ; Female ; Humans ; Korea ; Logistic Models ; Lower Urinary Tract Symptoms* ; Male ; Nocturia ; Nursing Homes ; Prevalence* ; Quality of Life* ; Risk Factors ; Sex Characteristics* ; Urinary Incontinence

The overactive bladder (OAB) and incontinence may occur at any age but are more common in the elderly. These lower urinary tract symptoms are associated with reduced quality of life and morbidity. Urinary incontinence is a significant symptom that affects social life and incurs economic costs. Most patients do not seek treatment because of embarrassment and misperception of the normal consequences of the aging process. Most elderly patients have several comorbidities, and polypharmacy is common. Modifying lifestyle and behavior may prevent urinary incontinence. Muscarinic receptor antagonists are the most commonly used drug, and are well-tolerated, safe, and effective in elderly patients with OAB. However, the selection of an optimal agent must be considered carefully in elderly patients. Surgical treatment may also be indicated in some patients. Anti-incontinence procedures like the mid-urethral sling operation or the Burch procedure are appropriate in stress urinary incontinence. Botulinum toxin A injection in the bladder may have a useful effect in refractory OAB patients. The management of OAB/incontinence in the elderly often poses significant management challenges. With a variety of drugs and procedures, however, physicians can optimize OAB/incontinence treatment for elderly patients.
Aged ; Aging ; Botulinum Toxins ; Comorbidity ; Humans ; Life Style ; Lower Urinary Tract Symptoms ; Polypharmacy ; Quality of Life ; Receptors, Muscarinic ; Suburethral Slings ; Urinary Bladder ; Urinary Bladder, Overactive* ; Urinary Incontinence*

PURPOSE: Klinefelter syndrome (KS) is related to testicular insufficiency, which causes low testosterone levels in serum. Generally, sex hormone levels and bone mineral density (BMD) are lower in patients with KS than normal. We investigated the effects of testosterone replacement on serum testosterone levels and BMD in KS patients. MATERIALS AND METHODS: From December 2005 to March 2008, 18 KS patients with a 47, XXY karyotype were treated with initial intramuscular injections of long-acting testosterone undecanoate (Nebido(R), 1000 mg/4 mL) at baseline and second injections after six weeks. An additional four injections were administered at intervals of 12 weeks after the second injection. BMD was measured at the lumbar spine (L2-4), the left femoral neck and Ward's triangle, using dual energy X-ray absorptiometry. Medical histories, physical examinations and prostate specific antigen, hematology and serum chemistry were conducted for each patient. In addition, total testosterone and sex hormone-binding globulin levels were measured. RESULTS: Following testosterone replacement, mean serum total testosterone increased significantly from baseline (0.90 vs. 4.51 ng/mL, p<0.001), and total testosterone rose to normal levels after replacement in all patients. The mean BMD of the lumbar spine increased significantly (0.91 vs. 0.97 g/cm2, p<0.001). Similar increases of BMD were also observed at the femoral neck, but this increase was not significant. CONCLUSION: These findings suggest that testosterone replacement therapy may be effective in treating BMD deficiency in men with testosterone deficiency, especially those with Klinefelter syndrome.
Adult ; Bone Density/*drug effects ; Female ; Hormone Replacement Therapy/*methods ; Humans ; Klinefelter Syndrome/*drug therapy ; Male ; Testosterone/*therapeutic use

PURPOSE: Benign prostatic hyperplasia (BPH) with prostatitis is a common clinical problem. There have been no previous reports of the effect of pathologic prostatitis on the improvement of lower urinary tract symptoms (LUTS) preceded by transurethral resection of prostate (TURP). Therefore, the purpose of this study was to determine the effect of pathologic prostatitis on improvement of LUTS after TURP. MATERIALS AND METHODS: From March 1996 to December 2006, 237 patients who received TURP were divided into two groups of with mild or severe pathologic prostatitis according to the pathological results of prostate tissue evaluation, International Prostate Symptom Score (IPSS), quality of life (QoL), maximum flow rate (Qmax) and the development of complications were recorded before and at 3 months follow up after surgery. RESULTS: No statistically significant differences were identified in the two groups with regard to Qmax, resection rate and complications (p>0.05). However, the IPSS and QoL were significantly different in comparisons between the two groups (p<0.05). CONCLUSIONS: Therefore, the results of this study show that BPH accompanied by pathologic prostatitis affects the improvement of LUTS, after TURP, and treatment of prostatitis may increase patients' satisfaction after surgery.
Follow-Up Studies ; Humans ; Lower Urinary Tract Symptoms ; Prostate ; Prostatic Hyperplasia* ; Prostatitis* ; Quality of Life ; Transurethral Resection of Prostate