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Primary Cavernous Hemangioma of Penile Shaft with Painful Erection and Penile Curvature.

Dong Wan SOHN ; Jo Un JUNG ; Sung Dae KIM ; Doo Bae KIM ; Hyun Woo KIM ; Yong Hyun CHO ; Sae Woong KIM

Korean Journal of Andrology.2008;26(1):45-47.

Hemangiomas result from proliferation of immature capillary vessels. This disorder in the genitourinary tract is a rare lesion. We experienced one case of a 31 years old man suffered from cavernous hemangioma of the penis shaft with painful erection. He was treated successfully with surgical excision. Herein, we report our experience and a critical review of the literature.
Capillaries ; Caves ; Hemangioma ; Hemangioma, Cavernous ; Male ; Penis

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Laser Doppler Flowmetry: Usefulness in Female Sexual Dysfunction.

Ha Na LEE ; Woo Sik CHUNG ; Bong Suk SHIM ; Hana YOON

Korean Journal of Andrology.2008;26(1):39-44.

Purpose: Various diagnostic tools have been developed to diagnose and differentiate the causes of female sexual dysfunction. In this study, we used laser Doppler flowmetry to measure the genital blood flow and analyzed its usefulness as a diagnostic tool in patients with sexual dysfunctions. Materials and Methods: We enrolled 50 female patients with sexual difficulties(45.8+/-9.8 years old). Ten sexually healthy women were enrolled as a control group. We measured the superficial blood flow of the clitoral glans, vestibule, and anterior wall of the vagina using laser Doppler flowmetry(Periflux 5000, Permed AB, Sweden), and compared these measurements with blood flow measured in response to sexual stimulation induced by an erotic film. Medical and personal histories, physical examinations, and self-reporting questionnaires were taken from the patients for classifying their sexual problems. Results: The patients complained of problems with desire(46 patients, 92%), arousal(41, 82%), orgasm(49, 98%), pain(10, 20%), and satisfaction(32, 64%). Most patients had more than one problem. In patients with sexual dysfunction, baseline blood flows at all measuring sites were significantly lower than in the control group(p<0.05). After the sexual stimulation, the blood flows of the glans, vestibule, and anterior vaginal wall were significantly increased(p<0.0001). In the groups with desire and arousal problems, blood flow changes were significantly less than in the control group. Conclusions: Laser Doppler flowmetry can provide very useful information on whether patients have hemodynamic-based sexual problems. We can approach the causes of sexual difficulties, particularly sexual desire or arousal problems, using this novel technological instrument.
Arousal ; Female ; Humans ; Laser-Doppler Flowmetry ; Physical Examination ; Surveys and Questionnaires ; Vagina

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Clinical Features of Prostate Cancer Detected on Initial and Repeated Biopsy.

Dong Wan SOHN ; Yun Seok JUNG ; Sung Dae KIM ; Doo Bae KIM ; Hyun Woo KIM ; Sae Woong KIM ; Yong Hyun CHO

Korean Journal of Andrology.2008;26(1):35-38.

Purpose: To determine the clinical differences between prostate cancer detected on initial biopsy and repeated biopsy Materials and Methods: Between January 2003 and December 2006, 67 patients were evaluated in this study who were diagnosed prostate cancer by transrectal ultrasound-guided biopsies and their prostate specific antigen (PSA) were below 20 ng/ml and clinical stages were less than T2. Among 67 patients, 43 patients were diagnosed at the first biopsies (group A) and others were diagnosed at the repeate biopsies (group B). We retrospectively characterized differences in clinical features such as age, digital rectal examination (DRE), prostate volume, the number of biopsy core, rate of positive core, PSA, % free PSA, Gleason score and rate of insignificant cancer. Results: There were no significant differences in age, PSA, % free PSA, rate of insignificant cancer between groups A and B. However, positive rate of DRE, prostate volume and rate of patients whose PSA were 7 ng/ml or higher in group A were significantly higher than those in group B. Despite the number of biopsy core was higher in group A, there were no differences in the number of positive biopsy core. Conclusions: Compared to the patients who were diagnosed as prostate cancer in the initial biopsies, prostate volume, positive rate of DRE and rate of Gleason score 7 or more were significantly lower in repeated biopsy group. From now on we are planning to include more patients and compare these characteristics of biopsies with the final pathological features after radical prostatectomy.
Biopsy ; Digital Rectal Examination ; Humans ; Neoplasm Grading ; Prostate ; Prostate-Specific Antigen ; Prostatic Neoplasms ; Retrospective Studies

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Effects of Medication with Dutasteride on Detection of Prostate Cancer in Patients with Serum Prostate-specific Antigen Level of 4~10 ng/ml.

Jun Shik SHIN ; Sung Ryong CHO

Korean Journal of Andrology.2008;26(1):29-34.

Purpose: We assessed the effects of medication with dutasteride on serum prostate-specific antigen (PSA), PSA density (PSAD) and prostate volume to avoid unnecessary biopsies. Materials and Methods: Between 2005 and 2007 patients with serum PSA level of 4~10 ng/ml were recruited in this prospective study. Patients were treated with 0.5 mg of dutasteride once daily for 3 months. PSA, PSAD and prostate volume were measured at baseline and at the end of treatment. The patients with a high PSA level (> or =4 ng/ml) after medication with dutasteride had a prostate biopsy. The patients were divided as group I (prostate cancer; n=29) and group II (benign disease; n=55). We compared the changes of serum PSA, PSAD, and prostate volume change between two groups. Results: In group I, PSA, PSAD and prostate volume decreased from baseline means of 8.16 ng/ml, 0.23 ng/ml/cm3 and 46.81 cc to 5.69 ng/ml, 0.18 ng/ml/cm3 and 40.41 cc. The difference in PSA, PSAD and prostate volume was -0.2%, -2.1% and -3.6% for group I. On the contrary, in group II, PSA, PSAD and prostate volume decreased from baseline means of 7.65 ng/ml, 0.16 ng/ml/cm3 and 56.48 cc to 4.48 ng/ml, 0.11 ng/ml/cm3 and 51.35 cc. The difference in PSA, PSAD and prostate volume was -41.4%, -33.3% and -9.1% for group II. When 4.83 ng/ml and 0.15 ng/ml/cm3 were chosen as the PSA and PSAD cutoff levels after treatment with dutasteride, unnecessary biopsies could be avoided effectively. Conclusions: These data suggest that the magnitude of changes in serum PSA and PSAD after 3 months of dutasteride challenge could be useful to avoid unnecessary prostate biopsies in patients with elevated PSA level.
Azasteroids ; Biopsy ; Humans ; Prospective Studies ; Prostate ; Prostate-Specific Antigen ; Prostatic Neoplasms ; Dutasteride

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Prostate Safety of Androgen Replacement Therapy Focusing on Prostate Specific Antigen.

Kyeong Hoon LEE ; Yong Hyuk CHOI ; Sung Yong CHO ; Keon Cheol LEE ; In Rae CHO

Korean Journal of Andrology.2008;26(1):24-28.

Purpose: The greatest concern in the androgen replacement therapy (ART) is the possible side effects to the prostate. We evaluated the effects of ART focusing on the prostate specific antigen (PSA). Materials and Methods: From 2003 to 2006, 47 patients 44 to 75 years old (mean age 60.1) received ART. At baseline and after ART, digital rectal examination, serum testosterone and PSA measurement and transrectal ultrasonography were evaluated. Mean follow-up was 7.9 months (range 1 to 41). Patients were classified into two groups based on the initial PSA level, as PSA levels of 2.5 ng/ml or greater (group 1) (n=29) and PSA levels of less than 2.5 ng/ml (group 2) (n=18). Results: ART significantly increased serum testosterone, PSA and free PSA levels. However, prostate volume did not change significantly. When serum PSA was compared, the increase of PSA levels was greater than in high PSA group (group 1) than in group 2, although the ratio between the two groups in PSA increase was 38.3% for group 2 and 18.2% for group 1, respectively. A total of 4 patients (16.7% of group 1 and 3.4% of group 2) with a serum PSA level greater than 4 ng/ml after ART underwent a prostate biopsy but no patients were found to have prostate carcinoma. Conclusions: Rates of PSA elevation (>4 ng/ml) and prostate biopsies were higher in patients with high baseline PSA level (> or =2.5 ng/ml) than in those with PSA level less than 2.5 ng/ml who received ART. However, our findings suggest that an increased risk of prostate cancer was not associated with ART.
Biopsy ; Digital Rectal Examination ; Follow-Up Studies ; Humans ; Prostate ; Prostate-Specific Antigen ; Prostatic Neoplasms ; Testosterone

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Combination Therapy of Sildenafil with Trazodone in Erectile Dysfunction Patients with Decreased Libido and Normal Serum Testosterone.

Min Gu PARK ; Myeong Heon JIN ; Jae Hyun BAE ; Je Jong KIM ; Du Geon MOON

Korean Journal of Andrology.2008;26(1):18-23.

Purpose: This study was done to assess the therapeutic effect of trazodone, an antidepressant agent in combination with sildenafil in patients with erectile dysfunction (ED) and decreased libido with normal serum testosterone level. Materials and Methods: From March 2005 to February 2006, 90 patients with ED complaining of decreased libido but whose serum testosterone level was within normal range were screened and enrolled in this study. The subjects were randomly treated by sildenafil only (group 1) and combination of sildenafil with trazodone (group 2). Patients received trazodone for at least 3 consecutive months, with daily doses starting at 50 mg. By intention-to-treat basis, the period of study was extended by 9 month. The intention-to-treat population included 39 sildenafil recipients and 35 sildenafil with trazodone recipients. The patients were asked to make up two questions, Q1: 'Did you experience improvement of erection after treatment?' and Q2: 'Did you experience improvement of libido after treatment?' and the change of International index of erectile function (IIEF) scores before and after the treatment were analyzed to assess the efficacy of treatment. Results: After 3 month treatment period, 70% of group 1 and group 2 answered 'yes' to Q1. Twenty seven percents of group 1 and 51% of group 2 answered 'yes' to Q2 and 20% of group 1 and 24% of group 2 answered 'yes' to both Q1 and Q2. In the intention-to-treat population, seventy-two percents of group 1 and 71% of group 2 answered 'yes' to Q1 and 28% of group 1 and 52% of group 2 answered 'yes' to Q2, 21% of group 1 and 26% of group 2 answered 'yes' to both Q1 and Q2. The change of IIEF scores before and after the treatment at 3 month and 9 month showed similar results. Both group 1 and group 2 showed significant improvement on scores of IIEF-5 and question 15 of IIEF after treatment (p<0.01). Meanwhile, only group 2 showed significant improvement on question 11 and 13 of IIEF after the treatment compared to group 1 (p<0.05). Two patients with high dose of trazodone complained of headache and drowsiness, but the symptoms disappeared by dose reduction. Conclusions: The combination therapy of trazodone with sildenafil increased libido and sexual satisfaction on patients with ED. Therefore, combination of trazodone with sildenafil might be considered in ED patients of decreased libido with normal serum testosterone level rather than sildenafil monotherapy.
Erectile Dysfunction ; Headache ; Humans ; Libido ; Male ; Piperazines ; Purines ; Reference Values ; Sleep Stages ; Sulfones ; Testosterone ; Trazodone ; Sildenafil Citrate

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Influence of Metabolic Syndrome on Late-onset Male Hypogonadism Symptoms and Serum Total Testosterone Level.

Hyun Jun PARK ; Jung Woo YE ; Chang Soo PARK ; Nam Cheol PARK

Korean Journal of Andrology.2008;26(1):11-17.

Purpose: Although concern about the health disorders in aging men have been growing, the association has not been elucidated in relation to the late onset male hypogonadism(LOH) and metabolic syndrome(MS). In this background, we evaluated the clinical impact of MS on LOH symptoms and serum total testosterone level. Materials and Methods: 100 patients with LOH symptoms who visited to the urology clinic between May, 2004 and October, 2006 were analyzed. Of all object, 48 patients were associated with MS(Group I) and 52 patients were not(Group II), based on the NCEP-ATP III(2001) guidelines. We compared the LOH status with Saint Louis University Androgen Deficiency in Aging Males(ADAM) questionnaire, serum total testosterone level, as well as prevalence of MS components between the two groups. Results: The overall prevalence of MS was 48% among LOH patients. The average age of group I and II were 57.7+/-10.5 and 58.6+/-11.2 years, respectively. Positivity for ADAM questionnaire was 83.3% in group I and 76.9% in group II, respectively(p<0.05). Serum total testosterone level decreased according to number of components of MS(p<0.05). The obesity group had significantly decreased serum total testosterone level(3.41+/-1.34 ng/ml) comparing to control group(4.41+/-2.23 ng/ml)(p<0.05). Conclusions: MS and its risk factors were significantly associated with LOH symptoms and positively correlated with the severity of disease. The evaluation of MS are required for the diagnosis and treatment of the patients with LOH.
Aging ; Erectile Dysfunction ; Humans ; Hypogonadism ; Male ; Obesity ; Prevalence ; Surveys and Questionnaires ; Risk Factors ; Saints ; Testosterone ; Urology

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2006 KOSAR Recommendations for Investigation, Treatment and Monitoring of LOH in Males.

Moon Jong KIM ; Yumie RHEE ; Ju Tae SEO ; Dae Yeol YANG ; Du Geon MOON ; Nam Cheol PARK ; Je Jong KIM

Korean Journal of Andrology.2008;26(1):8-10.

Androgen deficiency in the aging male has become a topic of increasing interest and debate throughout the world. The evidence from results showing that testosterone decrease progressively with age and that a significant percentage of men over the age 60 years have serum testosterone levels that are below the lower limits of young adults(age 20~30) men suggest that older hypogonadal men will benefit from testosterone replacement therapy. Long term data on the effects of testosterone replacement therapy in the older population, however, are limited and specific risk data on the prostate and cardiovascular systems are needed. Key questions of functional benefits that may retard frailty of the elderly are not yet available. The recommendations described below were based on document suggested by the International Society of Andrology(ISA), the International Society for the Study of the Aging Male(ISSAM) and the European Association of Urology(EAU) in 2005. The academic committee of the Korean Society for the Aging Male Research(KOSAR) suggested these recommendations to provide the appropriate information about investigation, treatment and monitoring for late-onset hypogonadism in aging Korean men following an annual meeting in October 2006.
Aged ; Aging ; Cardiovascular System ; Humans ; Hypogonadism ; Male ; Prostate ; Testosterone

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A Case of Testicular Tunica Albuginea Cyst with Psammoma Body.

Koon Ho RHA ; Byung Soo CHUNG ; Cheon Jin PARK ; Hyeun Jae NA ; Jong Yup BAE ; Kwan Joong CHOO

Korean Journal of Andrology.1999;17(1):57-59.

We report a case of testicular tunica albuginea cyst with psammoma body which was treated with excision and testicular preservation. The presumptive diagnosis of a simple intratesticular cyst was made by ultrasound. The intraoperative pathological diagnosis was benign serous cyst and then simple excision of the lesion with testicular masses, and it may permit identification of lesions that can be excised locally with testicular preservation. To our knowledge tunica albuginea cyst with psammoma body, a characteristic histological finding, has not been reported. Its histogenesis was also discussed.
Diagnosis ; Testis ; Ultrasonography

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Extensive Penis Paraffinoma: Treatment by Penoplasty Using Various Scrotal Flaps and Radial Forearm Free Flap.

Jae Sik YOON ; Choal Hee PARK ; Dong Won CHOI

Korean Journal of Andrology.1999;17(1):51-56.

PURPOSE: There is no single method of choice for penoplasty in extensive penile paraffinoma, and surgeons must choose a suitable method according to the condition of each individual patient. Herein, we present 19 cases of extensive penile paraffinoma treated with various scrotal flaps or a new method involving a radial forearm free flap. PATIENTS AND METHODS: We reviewed the 19 cases of penile paraffinoma, which affected the whole penile skin with or without involvement of the scrotal flap 5 cases, an "apron" scrotal flap in 4 cases, and a bipedicle scrotal flap in 3 cases. Because of his underdeveloped scrotum, a new technique, radial forearm free-flap penoplasty, was done in one patient with Klinefelter's syndrome. The postoperative results were satisfactory in all except six cases. One of these was managed by a secondary full-thickness skin graft for partial scrotal flap necrosis, and the others were managed by secondary simple repair for wound disruption and infection. All patients were satisfied with the cosmetic and functional results of the scrotal flap. CONCLUSIONS: Because of their great elasticity, scrotal flaps are extremely advantageous for the repair of an extensively denuded penis. A radial forearm free flap, perhaps including the subcutaneous tissue, a long vascular pedicle, and less hair, is an alternative method when a scrotal flap is not available. Its biggest drawback is the unpleasant appearance of the donor site, which is closed with a split-thickness skin graft.
Elasticity ; Forearm* ; Free Tissue Flaps* ; Hair ; Humans ; Klinefelter Syndrome ; Male ; Necrosis ; Penis* ; Scrotum ; Skin ; Subcutaneous Tissue ; Tissue Donors ; Transplants ; Wounds and Injuries

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