In recent years, the metabolic syndrome has garnished much attention in Korean population. This condition is multi-faceted and potentially leading to significant disturbance of numerous physiological processes including male reproductive function. The risk factors of the metabolic syndrome have been thought to have a detrimental effect on semen quality, and several studies have addressed the impact of these factors on male fertility. This review article evaluates the medical literature on the metabolic syndrome and its association with male reproductive health. The implications of obesity, diabetes, dyslipidemia, and hypertension are each examined with regard to their associated detrimental effects on male fertility.
Diabetes Mellitus ; Dyslipidemias ; Fertility ; Humans ; Hypertension ; Infertility ; Infertility, Male ; Male ; Obesity ; Physiological Processes ; Reproductive Health ; Risk Factors ; Semen Analysis

PURPOSE: We examined the predictable determinants affecting satisfactory rigidity induced by PGE1 in patients with dysfunction. MATERIALS AND METHODS: Two hundred and sixty eight consecutive impotent patients entered the study. The pharmacologic erectile response to intracavernosal injection of PGE1 10 micro gram were analysed according to several factors which were patient's age, duration of impotent symptom, quality of residual erectile function, smoking and alcohol consumption history, and vascular risk factors of diabetes, hypertension, heart diseases and hypercholesterolemia. RESULTS: There was a significant decrease of erectile response to PGE1 in patients having vascular risk factors (p<0.01). Patient's age and quality of residual erectile function had an significant effect on pharmacologic erectile response (p<0.05). Other factors such as impotent duration and smoking/alcohol consumption did not reach significant difference. CONCLUSIONS: These data demonstrates that patient's age and their vascular risk factors have negative effect and residual erectile function has positive effect on the pharmacologic penile erection in patients with erectile dysfunction.
Alcohol Drinking ; Alprostadil ; Erectile Dysfunction* ; Heart Diseases ; Humans ; Hypercholesterolemia ; Hypertension ; Male ; Penile Erection ; Risk Factors ; Smoke ; Smoking

PURPOSE: The incidences of four main vascular risk factors (VRFs) - diabetes mellitus (DM), smoking, hyperlipidemia (HLP), and obesity were investigated in men aged over 40 years with or without erectile dysfunction. PATIENTS AND METHODS: There were 943 patients with erectile dysfunction (mean age 55.0 years; range 40-73 years) and 242 normal men (mean age 50.6; range 40-71 years). Blood levels of various lipid fractions (triglycerides, total cholesterol, low-density lipoprotein, high-density lipoprotein), body weight, and height were measured in all subjects. Abnormal VRFs were defined as follows: hypertension = >160 mmHg (systolic pressure) or 95 mmHg (diastoic pressure), hyperlipidemia = at least one abnormal fraction (triglycerides > 160 mg/dl, total cholesterol >250 mg/dl, LDL >150 mg/dl), and obesity = >120% of ideal body weight. The presence or absence of DM, hypertension, smoking, and erectile dysfunction was determined by a self-reported subject questionnaire and history. RESULTS: The incidence of abnormal LDL was significantly (p<0.05) higher in patients than the control men. The incidences of HLP, DM, and hypertension were significantly (all p<0.05) higher in the patients 40 to 59 years of age than in the control men of corresponding ages, but differences in the incidences of smoking and obesity were not statistically significant. Abnormal VRFs were significantly (all p<0.01) more common in patients aged 40 to 59 years than in the control men of the same ages. In men over 60 years of age, there were no differences between the patients and control subjects in number of VRFs or the incidences of HLP, DM, and hypertension. CONCLUSIONS: Especially in men 40 to 59 years of age, DM, HLP, and hypertension were significantly correlated with erectile dysfunction. The aging process, rather than such specific risk factors, might be a main cause of erectile dysfunction in men aged over 60 years.
Aging ; Body Weight ; Cholesterol ; Diabetes Mellitus ; Erectile Dysfunction* ; Humans ; Hyperlipidemias ; Hypertension ; Ideal Body Weight ; Incidence* ; Lipoproteins ; Male ; Obesity ; Surveys and Questionnaires ; Risk Factors* ; Smoke ; Smoking

PURPOSE: Androgen plays an important role during penile development and is essential for libido in the male, but its role in the regulation and maintenance of the erectile response has been controversial. We investigated the effect of castration and androgen replacement on penile erection in the adult rat. MATERIALS AND METHODS: Adult male Spargue-Dawley rats were divided into three groups: control, castration, and androgen replacement after castration. Androgen (testosterone, DHT) was administrated for 7 days at week 1, 2, 3, and 4 after castration. The intracavernosal pressure was recorded after submitting the rats to cavernous nerve stimulation. The percentages of cells in the penis expressing Ki-67 (proliferative index) and of apoptotic cells, assessed by morphologic analysis (apoptotic index), were analyzed. Nitric oxide synthase (NOS) activity was measured by the arginine-citrulline conversion ratio, and expression of nNOS and eNOS was determined by Western blot analysis. RESULT: After castration, a significant increase was noted in the apoptotic index, with a decrease in the expression of nNOS and eNOS. Replacement of androgen increased the proliferative index and the expression of cavernous nerve stimulation; NOS activity and erectile function were restored with androgen replacement. CONCLUSIONS: These results suggested that the penile tissue and NOS activity of the adult rat are affected by the androgen milieu and androgen such as testosterone and DHT play a direct role in the erectile function at the level of the erectile tissue.
Adult* ; Animals ; Apoptosis ; Blotting, Western ; Castration ; Humans ; Libido ; Male ; Nitric Oxide ; Nitric Oxide Synthase ; Penile Erection ; Penis* ; Rats* ; Testosterone

PURPOSE: There has been a scarcity of integrated, long-term (>4 week) studies on structural and functional alterations in the penis according to the period following cavernous nerve (CN) injury. The aim of this study was to investigate time-dependent structural and functional changes in the corpus cavernosum following CN injury in a rat model. MATERIALS AND METHODS: Ninety male Sprague-Dawley rats (10 weeks old) were divided into 4 groups: normal control (C), sham (S), bilateral CN resection (R), and bilateral CN crush injury (I) groups. At 1, 4, and 12 weeks after the procedure, erectile function was assessed by electrostimulation. The terminal deoxynucleotidyl transferase-mediated 2'-deoxyuridine 5'-triphosphate nick end labeling (TUNEL) assay was performed for detection of apoptosis. Masson's trichrome staining and immunohistochemistry were performed for detection of alpha smooth muscle actin (alpha-SMA). Western blot analysis was then performed. RESULTS: The R and I groups showed persistent impairment of erectile function at all three points in time. Apoptosis peaked at 1 week after resection or crush injury and then gradually subsided. The smooth muscle cell/collagen ratio and expression of alpha-SMA gradually decreased over time after CN resection or crush injury. Myosin phosphatase target subunit 1 phosphorylation progressively increased over time after CN resection or crush injury. On the other hand, expression of phospho-protein kinase B, phospho-endothelial nitric oxide synthase, and neuronal nitric oxide synthase transiently decreased at 1 week after resection or crush injury and then recovered to the control values. CONCLUSIONS: Our results suggest that persistent up-regulation of the RhoA/Rho-kinase pathway and structural change such as decreased smooth muscle cell and increased cavernosal fibrosis might play an important role in persistent erectile dysfunction following CN injury.
Actins ; Animals ; Apoptosis ; Blotting, Western ; Caves ; Deoxyuracil Nucleotides ; Erectile Dysfunction ; Fibrosis ; Hand ; Humans ; Immunohistochemistry ; Male ; Muscle, Smooth ; Myocytes, Smooth Muscle ; Myosin-Light-Chain Phosphatase ; Nitric Oxide Synthase ; Nitric Oxide Synthase Type I ; Penis ; Phosphorylation ; Phosphotransferases ; Prostatectomy ; Rats ; Rats, Sprague-Dawley ; Salicylamides ; Up-Regulation

PURPOSE: To examine the effectiveness of small-molecule inhibitor of transforming growth factor-beta (TGF-beta) type I receptor, an activin receptor-like kinase 5 (ALK5), on erectile dysfunction (ED) in a rat model of cavernous fibrosis, in which fibrosis was induced by intracavernous injection of adenovirus expressing TGF-beta1 (Ad-TGF-beta1). MATERIALS AND METHODS: Four-month-old Sprague-Dawley rats were divided into four groups (n=10 per group): age-matched controls without treatment, age-matched controls receiving intracavernous injection of LacZ adenovirus, and cavernous fibrosis rats receiving an intracavernous injection of saline or ALK5 inhibitor (5 mg/kg). ALK5 inhibitor or saline was administered on day 5 after injection of Ad-TGF-beta1. On day 30, erectile function was assessed by electrical stimulation of the cavernous nerve and the penis was then harvested for histologic studies (n=6 per group) and for the measurement of the hydroxyproline level (n=4 per group). RESULTS: Ad-TGF-beta1-induced cavernous fibrosis rats treated with saline showed a significant decrease in cavernous smooth muscle and endothelial content, and an increase in collagen deposition, which resulted in profound deterioration of all erectile function parameters, such as the ratios of maximal intracavernous pressure (ICP), total ICP, and slope to mean arterial pressure. ALK5 inhibitor significantly restored erectile function in a rat model of cavernous fibrosis by increasing cavernous smooth muscle and endothelial content, and by blocking cavernous fibrosis. CONCLUSIONS: The results suggest that inhibition of the TGF-beta pathway is a promising therapeutic strategy for the treatment of ED related to cavernous fibrosis from various causes.
Activin Receptors ; Adenoviridae ; Animals ; Arterial Pressure ; Caves ; Collagen ; Electric Stimulation ; Erectile Dysfunction ; Fibrosis ; Hydroxyproline ; Male ; Muscle, Smooth ; Penis ; Protein-Serine-Threonine Kinases ; Rats ; Rats, Sprague-Dawley ; Receptors, Transforming Growth Factor beta ; Transforming Growth Factor beta ; Transforming Growth Factor beta1

Female sexual function is highly complex and deeply influenced by hormonal and non-hormonal factors. As sexual dysfunction becomes a common and important problem for women of all ages with related quality of life issues, we need to understand more about the effect of sex steroid hormones in female sexual function. However, there are limited data about the correlation between the value of sex steroid hormones- testosterone, in particular-and female sexual function. In a certain type of female sexual dysfunction (FSD), hypoactive sexual desire disorder, for example, there is evidence that treatment with androgens or with estrogens is effective. To widen the therapeutic options of hormone replacement therapy in FSD, further research is needed as to the benefits and risks of hormonal treatments in both pre- and post-menopausal women. Although important unanswered questions still exist in hormonal treatment of FSD, new therapeutic strategies are being studied and many ongoing clinical trials are expecting favorable results leading to more successful treatment of FSD.
Androgens ; Estrogens ; Female ; Gonadal Steroid Hormones ; Hormone Replacement Therapy ; Humans ; Quality of Life ; Risk Assessment ; Sexual Dysfunctions, Psychological ; Testosterone

Androgen acts via the androgen receptor and can play a critical role in the development and growth of the prostate and the pathophysiology of prostatic diseases. Testosterone is the most abundant circulating androgen and is converted to dihydrotestosterone (DHT), a more potent androgen, by steroid 5alpha-reductase. There are two 5alpha-reductase isoenzymes, type 1 and type 2, in humans and animals. Type 2 5alpha-reductase predominates in the prostate. While deficiency of type 2 5alpha-reductase causes male pseudohermaphroditism, increased DHT has been implicated in benign prostatic hyperplasia and prostate cancer. The aim of this article is to highlight the significance of 5alpha-reductase in the development and growth of the prostate and pathogenesis of prostatic diseases.
46, XY Disorders of Sex Development ; Animals ; Dihydrotestosterone ; Growth and Development ; Humans ; Isoenzymes ; Prostate ; Prostatic Diseases ; Prostatic Hyperplasia ; Prostatic Neoplasms ; Receptors, Androgen ; Sexual Development ; Testosterone

PURPOSE: Prostate biopsies have typically been performed on all patients with prostate specific antigen (PSA) levels above 4 ng/ml, however, the cancer detection rate is low. We would like to predict cancerous conditions of the prostate by developing a new PSA formula. MATERIALS AND METHODS: Between July 2004 and July 2006, 93 patients with serum PSA levels above 4 ng/ml received extended prostate biopsies. The medical records of all patients - age, total/free PSA after/before prostate massage, final diagnoses of prostate biopsies - were reviewed retrospectively. We developed a new formula to calculate the delta PSA: (total/free PSA after prostate massage - total/free PSA before prostate massage) / total/free PSA before prostate massage. RESULTS: The patients were divided into two groups, the prostate cancer group (39 patients) and the benign disease group (54 patients). Mean total/free PSA for the benign disease group were 9.35/1.49 ng/ml (before) and 16.66/5.06 ng/ml (after), while values for the data of prostate cancer group were 21.02/2.43 ng/ml (before) and 24.61/4.40 ng/ml (after). The positive predictive value of the patients with PSA levels between 4 and 10 ng/ml was 32%; the positive predictive value of the patients with PSA levels above 10 ng/ml was 75%. The mean delta total/free PSA values for the benign disease and prostate cancer groups were 0.92/2.42 and 0.28/1.14, respectively. The cut off value of delta total/free PSA was below 0.5/2.0. Sensitivity, specificity, and positive predictive values for delta total PSA were 90% (95% confidence interval (CI), 80.2~99.3), 54% (95% CI, 41.4~67.7) and 58% (95% CI, 45.9~70.8), respectively. Sensitivity, specificity, and positive predictive values based on delta free PSA were 87% (95% CI, 76.7~97.7), 48% (95% CI, 36.7~63.3), and 56% (95% CI, 43.3~68.2), respectively. CONCLUSIONS: We suggest that the use of delta total/free PSA in patients with serum PSA levels above 4 ng/ml may be helpful, not only to better detect prostate cancer, but also to reduce unnecessary prostate biopsies.
Biopsy ; Diagnosis ; Humans ; Male ; Massage ; Medical Records ; Prostate* ; Prostate-Specific Antigen* ; Prostatic Neoplasms* ; Retrospective Studies ; Sensitivity and Specificity

PURPOSE: We analyzed the long-term efficacy and safety of bipolar transurethral resection of the prostate (TURP) using the Gyrus(TM) PlasmaKinetic System compared with conventional monopolar TURP. MATERIALS AND METHODS: This study included 54 patients with benign prostatic hyperplasia (BPH) who underwent TURP between May 2003 and April 2004. In all, 28 consecutive patients had bipolar and 26 had monopolar TURP. All patients were assessed by preoperative and postoperative International Prostate Symptom Score (IPSS), uroflowmetry, transrectal ultrasonography, operative time, weight of resected tissue, length of hospital stay, duration of catheter use, change in hemoglobin and serum sodium, and complication rates. RESULTS: Significant improvement was seen postoperatively in both groups, and no difference was observed in the resection time, weight of resected tissue, change in hemoglobin and serum sodium, improvement of IPSS and maximum flow rate (Qmax) or complication rates over the 36-month follow up. However, there was a significant difference in duration of catheter use and hospital stay. Duration of catheter use (2.1 days vs. 3.5 days p=0.012) and hospital stay (2.9 days vs. 4.1 days p=0.024) were shorter in the bipolar group. CONCLUSIONS: Bipolar TURP using the Gyrus(TM) PlasmaKinetic System is as effective as conventional monopolar TURP with the advantages of reduced length of catheter use and shorter hospital stay. Both methods have low complication rates. In the long-term comparison, improvements in IPSS and Qmax after bipolar and monopolar TURP are similar. Thus bipolar TURP may be a good alternative to conventional TURP.
Catheters ; Follow-Up Studies* ; Humans ; Length of Stay ; Operative Time ; Prostate* ; Prostatic Hyperplasia* ; Sodium ; Transurethral Resection of Prostate ; Ultrasonography