Thomas I.S. Hwang

A survey of erectile dysfunction in Taiwan: use of the erection hardness score and quality of erection questionnaire.

INTRODUCTIONnThere are currently no studies in the Asia-Pacific region using the erection hardness score (EHS) and Quality of Erection Questionnaire (QEQ) to assess erectile dysfunction (ED).nnnAIMSnTo provide up-to-date data on the prevalence of ED in Taiwanese men and to validate the EHS and QEQ in this population.nnnMETHODSnA representative sample of 1,060 men aged ≥ 30 years completed a telephone interview. ED status was confirmed via direct questioning and using the abridged five-item version of the 15-item International Index of Erectile Function (IIEF-5). Responses regarding EHS, QEQ, marital and sexual satisfaction, and attitude to treatment were also recorded.nnnMAIN OUTCOME MEASURESnIIEF, EHS, and QEQ.nnnRESULTSnThe prevalence of ED, as defined by IIEF-5, was 27% among all respondents and 29% among those aged ≥ 40 years. Although, the prevalence of ED increased with age, men of all ages tended to underestimate their erectile problems. Among men who indicated that they did not have ED, 25% were found to have mild to moderate ED according to the IIEF-5 assessment. An EHS ≤ 3, indicating the presence of ED, was reported in 26% of men. The EHS was consistent with the QEQ: When the EHS was 4, the satisfaction of each domain of QEQ ranged from 85% to 90%. The QEQ score correlated well with the IIEF-5 score and significantly affected both sexual and marital satisfaction (P < 0.005).nnnCONCLUSIONSnThese data indicate that EHS is a simple, practical tool for clinical use. QEQ scores appear to be independently associated with sexual and marital satisfaction, and may be of value in the assessment and monitoring of ED patients. While ED is a common health problem in Taiwan and the prevalence of ED increases with age, affected men lack awareness regarding the presence of erectile problems and the importance of initiating timely and effective treatment.

A Survey of Obesity and Erectile Dysfunction of Men Conscripted into the Military in Taiwan

INTRODUCTIONnObesity is receiving growing research attention. However, investigations concerning the potential impact of obesity and testosterone on erectile dysfunction (ED) in young men have not been completely clarified.nnnAIMnTo identify the relationship between ED, serum testosterone level, and obesity in draftees in Taiwan.nnnMETHODSnData were obtained from a baseline survey of 364 young adult military conscripts (19-24 years old). Their demographic data, body mass index (BMI), serum testosterone, and ED status were assessed. Sixty-four subjects had ED, and 300 comprised the normal control group.nnnMAIN OUTCOME MEASURESnThe International Index of Erectile Function-5 (IIEF-5), Sexual Desire Inventory, and Sexual Behavior Scale were used to assess ED, sexual desire, and sexual function.nnnRESULTSnThree hundred sixty-four men were available for analysis. The mean age of the sample was 21.66 ± 0.92 years (19-24 years). The IIEF total score had a mean of 21.99 ± 2.34 and median of 23; 64 (17.6%) subjects had ED, although mild. The results showed an increased risk of ED among obese men and subjects with lower serum testosterone. Among the predictors of ED, obesity (odds ratio =83.97, 95% CI = 16.17-436.03, degrees of freedom [d.f.] = 1, P < 0.001) and lower serum testosterone (odds ratio = 679.84, 95% CI = 108.48-4,260.58, d.f. = 1, P < 0.001) were significantly independent factors. Testosterone levels were lower in subjects with obesity (P < 0.001).nnnCONCLUSIONnThis study supports the idea that BMI and serum testosterone may provide warning signs of ED and, at the same time, an opportunity for early intervention in young men.

Low-dose testosterone treatment decreases oxidative damage in TM3 Leydig cells

Testosterone replacement therapy has benefits for aging men and those with hypogonadism. However, the effects of exogenous testosterone on Leydig cells are still unclear and need to be clarified. In this report, we demonstrate that testosterone supplementation can reduce oxidative damage in Leydig cells. The TM3 Leydig cell line was used as an in vitro cell model in this study. Cytoprotective effects were identified with 100-nmol l⁻¹ testosterone treatment, but cytotoxic effects were found with ≥ 500-nmol l⁻¹ testosterone supplementation. Significantly reduced reactive oxygen species (ROS) generation, lipid peroxide contents and hypoxia induction factor (HIF)-1α stabilization and activation were found with 100-nmol l⁻¹ testosterone treatment. There was a 1.72-fold increase in ROS generation in the 500-nmol l⁻¹ compared to the 100-nmol l⁻¹ testosterone treatment. A 1.58-fold increase in steroidogenic acute regulatory protein (StAR) expression was found in 50-nmol l⁻¹ testosterone-treated cells (P < 0.01). Chemically induced hypoxia was attenuated by testosterone supplementation. Leydig cells treated with low-dose testosterone supplementation showed cytoprotection by decreasing ROS and lipid peroxides, increasing StAR expression and relieving hypoxia stress as demonstrated by HIF-1α stabilization. Increased oxidative damage was found with ≥ 500-nmol l⁻¹ testosterone manipulation. The mechanism governing the differential dose effects of testosterone on Leydig cells needs further investigation in order to shed light on testosterone replacement therapy.

Technical modification of retroperitoneal laparoscopic adrenalectomy for primary hyperaldosteronism and clinical outcomes

BACKGROUND/OBJECTIVEnStandard laparoscopic adrenalectomy requires early control of the main adrenal vein; however, the small retroperitoneal working space is challenging for beginners to perform this maneuver. We report a technical modification of retroperitoneal laparoscopic adrenalectomy (RLA) for primary hyperaldosteronism (PHA) and the clinical outcomes.nnnMETHODSnA total of 38 RLAs were performed for the patients with PHA. The patients were placed in true lateral position with mild bending to expand the surgical field. Instead of attempting to control the main adrenal vein initially, we adopted a technical modification that manipulating and freeing the gland first before controlling the main adrenal vein.nnnRESULTSnThe RLAs were successfully performed in all but one case, which was converted to open surgery due to pancreatic injury. Mean operative time was 124 minutes and estimated blood loss was 74xa0ml. Mean maximal fluctuation of systolic blood pressure was 29xa0mmHg. For the right-side RLA, less operative time (113.5 vs. 137.9 minutes) and estimated blood loss (59.5 vs. 91.2xa0ml) were noted compared with the left-side procedure. Postoperative complications included cerebrovascular accident in one patient, one surgical site hematoma, and two patients had postoperative fever. Potassium level returned to normal in all patients and 70% of the patients reduced their antihypertensives.nnnCONCLUSIONnTechnical modification RLA for PHA without initial control of the main adrenal vein is a safe and feasible procedure. No vigorous blood pressure fluctuation was intraoperatively noted. No vascular injury occurred. Moreover, the right-side procedure became easier.

Female Sexual Dysfunction: Physiology, Epidemiology, Classification, Evaluation and Treatment

Sexual health is defined by the World Health Organization as the integration of somatic, emotional, intellectual, and social aspects in ways that are positively enriching and that will enhance personality, communication, and love. The female sexual response is multifaceted and involves neurovascular, endocrine, and psychosocial factors. Optimal female sexual health comprises physical, mental, and emotional aspects, and these are the context in which a woman experiences desire, arousal, and orgasm. Sexual dysfunction in females is a complex and highly prevalent disease, and is commonly associated with the quality of life. Several factors influence female sexual function, including physiological and psychosocial factors. This article discusses models of female sexual response, defines and categorizes female sexual dysfunction, and identifies therapeutic modalities for female patients with sexual dysfunction.

Impact of alfuzosin on sexual function in Taiwanese men with benign prostatic hyperplasia

To assess the effect of alfuzosin (XATRAL) 10u2009mg once daily on sexual function in men with moderate to severe lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH), patients with suggestive symptomatic BPH, an International Prostate Symptom Score (IPSS) >8 (range of scores, 0–35), and sexual attempts at least once per month were enrolled. All patients received alfuzosin 10u2009mg once daily for 24 weeks and were asked to complete the IPSS test and Male Sexual Health Questionnaire at weeks 0 (baseline), 1, 4, 12, and 24. Other assessments included the International Index of Erectile Function—five‐item version (range of scores: 5–25), as well as onset of action and peak urinary flow rate (Qmax). From September 2006 to May 2008, 279 patients were enrolled from nine centers in Taiwan. At 24 weeks, alfuzosin effectively improved LUTS and quality of life, as demonstrated by a reduction in the IPSS total score (17.3 vs. 9.9, pu2009<u20090.001) and the IPSS bother score (3.8 vs. 2.5, pu2009<u20090.001). The majority (85%) of patients perceived an improvement of urinary symptoms within 1 month of administration. In patients with an International Index of Erectile Function—five‐item version score of ≤16, alfuzosin significantly improved erectile disorder and satisfaction subscores at each time point (pu2009≤u20090.02). Prolonged‐release alfuzosin effectively improved LUTS, quality of life, erectile function, and sexual satisfaction in men with BPH and mild to severe erectile dysfunction. Alfuzosin is an effective treatment option for the management of patients with BPH/LUTS and concomitant sexual dysfunction.

Acridine orange exhibits photodamage in human bladder cancer cells under blue light exposure

Human bladder cancer (BC) cells exhibit a high basal level of autophagic activity with accumulation of acridine-orange(AO)-stained acidic vesicular organelles. The rapid AO relocalization was observed in treated BC cells under blue-light emission. To investigate the cytotoxic effects of AO on human BC cell lines under blue-light exposure, human immortalized uroepithelial (SV-Huc-1) and BC cell lines (5637 and T24) were treated with indicated concentrations of AO or blue-light exposure alone and in combination. The cell viability was then determined using WST-1, time-lapse imaging with a Cytosmart System and continuous quantification with a multi-mode image-based reader. Treatment of AO or blue-light exposure alone did not cause a significant loss of viability in BC cells. However, AO exhibited a dose-dependent increment of cytotoxicity toward BC cells under blue-light exposure. Furthermore, the tumor formation of BC cells with treatment was significantly reduced when evaluated in a mouse xenograft model. The photodamage caused by AO was nearly neglected in SV-Huc-1 cells, suggesting a differential effect of this treatment between cancer and normal cells. In summary, AO, as a photosensitizer, disrupts acidic organelles and induces cancer cell death in BC cells under blue-light irradiation. Our findings may serve as a novel therapeutic strategy against human BC.

Will Medical Management of Benign Prostatic Hyperplasia Result in Better or Worse Sexual Function in Men

Urinary symptoms of benign prostatic hyperplasia (BPH) may affect sexual function, considered by patients themselves to be one of the most important aspects of the disease. Though lack of consensus on the underlying mechanism involved, some hypothesis are accounted for this association, such as autonomic hyperactivity, decreased nitric oxide (NO) production in the prostate and penile cavernous muscle, as well as pelvic atherosclerosis and endothelial dysfunction. Although medical treatment with α-blockers and/or 5α-reductase inhibitors are the mainstays of benign prostatic hyperplasia/lower urinary tract symptoms (BPH/LUTS), there are some contradictory bias on the effect of sexual function either erectile or ejaculatory function. α-blocker is currently recommended as a first line treatment of BPH. Since it will reduce the sympathetic overstimulation of prostate, it may also affect the similar pathway in penis. It has been suggested that α-blockers may improve sexual function in patients with BPH. However, among α-blockers, tamsulosin is associated with an increased risk of ejaculation disorders. Long-term use of 5α-reductase inhibitors alone or combined with α-blockers will cause reduction of prostate volume and improved the clinical symptoms; however, it may associate with sexual problems, especially ejaculation disorders. Based on the already published data, the effect of α-blockers and 5α-reductase inhibitors on the sexual function will be reviewed. Moreover, this may reinforce physicians to manage appropriately these two highly prevalent and bothersome conditions.

A Giant Pseudoaneurysm Following Robot-Assisted Laparoscopic PartialNephrectomy

Renal artery pseudoaneurysm (RAP) is a rare complication after partial nephrectomy. Here we present a 63-yearold male who had an incidental finding of a right renal cancer, with stage T1bN0M0. The patient underwent a robotassisted laparoscopic partial nephrectomy and presented with a giant RAP since one month after the operation. He was successfully treated by an angiography with selective embolization.

Genetic polymorphism of sulfotransferase 1A1, cigarette smoking, hazardous chemical exposure and urothelial cancer risk in a Taiwanese population: SULT1A1 polymorphism and UC

Objectives:u2003 To investigate the association between genetic polymorphism of sulfotransferase1A1 (SULT1A1), cigarette smoking, hazardous chemical exposure and urothelial cancer risk in a Taiwanese population.