Young Yo Park

Is Obesity an Underlying Factor in Erectile Dysfunction

Objectives: We conducted a study to evaluate the impact of obesity on erectile function in men with erectile dysfunction. Methods: Three hundred and twenty-five consecutive patients with erectile dysfunction were evaluated. We classified the men into 2 groups according to body weight: <120% of the ideal body weight, and ≥120%. We compared several erectile capacities and the findings of penile duplex ultrasonography. Results: There was a statistically significant decrease in the quality of residual erectile function in patients with obesity (penile rigidity grade 1.32 versus 1.62 in the nonobese patients). Obese patients also have an increased prevalence of vascular risk factors based on a review of the medical records and vascular impairment by duplex ultrasound study (43 and 62% in the obese patients versus 30 and 42% in the nonobese patients, respectively, p < 0.05). However, when we focused only on the patients without any vascular risk factors, no significant difference between the 2 groups was noted in the quality of residual erectile function and also the prevalence of penile vascular impairments (p > 0.05). Conclusions: These data demonstrate that obesity in itself does not seem to be an underlying factor, but does impose a risk to vasculogenic impotence by developing chronic vascular disease.

The Impact of Aging on Penile Hemodynamics in Normal Responders to Pharmacological Injection: A Doppler Sonographic Study

PURPOSE The change in arterial flow velocity with age in patients with a normal response to pharmacological injection was evaluated. MATERIALS AND METHODS We studied 64 patients with erectile dysfunction who responded well to intracavernous injection of 10 micrograms. prostaglandin E1 with well sustained penile rigidity for longer than 1 hour and normal cavernous arterial flow velocities on color Doppler ultrasonography. The men were classified into 4 groups according to age younger than 30 years, and 30 to 39, 40 to 49 and 50 years old or older. Flow parameters were compared. RESULTS The statistically significant decreasing tendency of peak systolic velocity with age was revealed by a simple regression test (p = 0.003). The greatest decrease was observed between patients in the third and fourth decades. When comparing the peak systolic velocity according to timing of measurement, the greatest velocities occurred at later measurements after the fifth decade, while in younger patients these values were reached earlier. CONCLUSIONS These data demonstrate that cavernous arterial flow during pharmacological erection decreases and the response time of the cavernous artery or tissue to a vasoactive drug becomes longer with age.

Hemodynamic insult by vascular risk factors and pharmacologic erection in men with erectile dysfunction: Doppler sonography study

Abstract To evaluate the penodynamic impact of known vascular risk factors in men with erectile dysfunction, we obtained thorough medical histories covering diabetes, hypertension, heart disease and hypercholesterolemia, alcohol ingestion, and smoking in 265 consecutive patients. We also measured their penile hemodynamic parameters by color duplex ultrasonography after intracavernous prostaglandin E1 injection. In patients with vascular risk factors there was a statistically significant decrease in the peak systolic velocity and increase in the end-diastolic velocity of the cavernosal artery (P < 0.01). Those men who had diabetes had higher average end-diastolic velocities and lower resistance indices (P < 0.01). Smoking and alcohol use also affected penile hemodynamics (P < 0.05). These data confirm that vascular risk factors do increase the likelihood of vasculogenic impotence and that diabetes plays a major role in veno-occlusive dysfunction in the penis.

A comparative study of clinical symptoms and treatment outcomes of acute bacterial prostatitis according to urine culture.

Purpose Because acute bacterial prostatitis (ABP) is an urgent condition of the prostate but prostatic massage is contraindicated at the onset of ABP, clinical symptoms and urine tests are used for diagnosis. In this study, we compared the clinical symptoms and treatment outcomes of patients with negative urine culture results, to whom only empirical antibiotics were administered, with those of patients with positive urine culture results. Materials and Methods Patients were divided into two groups according to the results of urine culture. Then, the clinical symptoms and course of each group were analyzed. In addition, age, symptoms, antibiotics, mean inpatient and outpatient length of treatment, and the treatment outcome of each group were also analyzed. Results Of the total 144 patients, the positive urine culture group consisted of 51 patients (35.4%) and the most frequent bacterial strain causing ABP was reported to be Escherichia coli. Fever and storage symptoms were significantly more common in the positive urine culture group than in the negative urine culture group (p=0.031 and 0.047, respectively). Only inpatient treatment was significant longer in the positive urine culture group than in the negative urine culture group (p<0.05). The mean length of treatment of inpatients was 4.8±2.6 days and 6.2±2.9 days in the two groups, respectively. No sequelae such as prostatic abscess or chronic prostatitis were found in either group. Conclusions In the treatment of ABP, the use of empirical antibiotics can be expected to have sufficient effects regardless of bacterial culture. However, it is hard to determine the causative bacteria of ABP by urine culture results only.

Prospective factor analysis of alpha blocker monotherapy failure in benign prostatic hyperplasia.

Purpose We aimed to determine the treatment of choice criteria for benign prostatic hyperplasia (BPH) by analyzing the factors causing alpha-adrenergic receptor blocker (α-blocker) monotherapy failure. Materials and Methods This retrospective study enrolled 129 patients with BPH who were prescribed an α-blocker. Patients were allocated to a transurethral resection of prostate (TURP) group (after having at least a 6-month duration of medication) and an α-blocker group. We compared the differences between the two groups for their initial prostate volume, serum prostate-specific antigen (PSA), maximum urinary flow rate (Qmax), International Prostate Symptom Score (IPSS), and postvoid residual urine volume (PVR). Results Of the 129 patients, 54 were in the TURP group and 75 were in the α-blocker group. Statistically significant differences (p<0.05) between the two groups were found in the prostate volume (50.8 ml vs. 34.4 ml), PSA (6.8 ng/ml vs. 3.6 ng/ml), Qmax (6.84 ml/sec vs. 9.99 ml/sec), and IPSS (27.3 vs. 16.8). According to the multiple regression analysis, the significant factors in α-blocker monotherapy failure were the IPSS (p<0.001) and prostate volume (p=0.015). According to the receiver operating characteristic (ROC) curve-based prediction regarding surgical treatment, the best cutoff value for the prostate volume and IPSS were 35.65 ml (sensitivity 0.722, specificity 0.667) and 23.5 (sensitivity 0.852, specificity 0.840), respectively. Conclusions At the initial diagnosis of BPH, patients with a larger prostate volume and severe IPSS have a higher risk of α-blocker monotherapy failure. In this case, combined therapy with 5-alpha-reductase inhibitor (5-ARI) or surgical treatment may be useful.

Body Image Following Radical Cystectomy and Ileal Neobladder or Conduit in Korean Patients

Purpose The aim of this study was to compare the body images of patients who underwent radical cystectomy with an orthotopic ileal neobladder or an ileal conduit. Materials and Methods A total of 114 adult patients who underwent radical cystectomy between March 2006 and December 2012 at a single institution, Ewha Womans University Mokdong Hospital in Korea, were evaluated in this retrospective chart-review study. Forty-two patients (29 orthotopic ileal neobladder and 13 ileal conduit) who completed questionnaires were included in the final analysis; the remaining patients were excluded. The patients were assessed with two questionnaires: the Korean version of the Body Image Scale (K-BIS) and the self-designed questionnaire. Results The results did not differ significantly by age at surgery, time from surgery to survey, pathologic stage, grade, histologic subtype, education, residency, or Eastern Cooperative Oncology Group performance status, but did differ significantly by age at survey and sex. The mean summary score for K-BIS showed significant differences between the two groups (p=0.001). We found that patients who underwent an orthotopic ileal neobladder had a significantly better body image. The self-designed questionnaire score was not significantly different between the two groups (p=0.572). Conclusions In our retrospective analysis, patients who underwent orthotopic ileal neobladder had a superior body image compared with those who underwent an ileal conduit.