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ABSTRACT: INTRODUCTION: The roles of testosterone and orchiectomy on male bladder subjected to ischemic/reperfusion (I/R) injuries received little attention. To fill this gap, the present study intended to examine testosterone and orchiectomy effects on male rabbits subjected to I/R damages. AIM: To elucidate the effects of testosterone and orchiectomy on contractile response, bladder morphology, interstitial fibrosis, and oxidative stress in male rabbit bladder subjected to I/R surgery. METHODS: Male New Zealand rabbits were distributed into five groups as follows: Group 1 received sham surgical procedure. In group 2, I/R surgery was performed. In group 3, testosterone (100 μg/kg/day) was intramuscularly injected prior to I/R surgery. In group 4, orchiectomy was performed prior to I/R surgery. In group 5, orchiectomy was performed with subsequent testosterone administration, followed by I/R surgery. All the rabbits were euthanized 7 days after I/R. Comparative studies were analyzed to elucidate the effects of testosterone and orchiectomy on bladder dysfunction subjected to I/R injuries. MAIN OUTCOME MEASURES: Bladder contractile function was evaluated. Masson's trichrome staining and immunohistochemical studies were performed to evaluate bladder morphology and intramural nerve terminals. Western blotting was examined to investigate the expressions of fibrosis and oxidative stress markers. RESULTS: I/R surgery significantly decreased bladder contractility in response to various stimulations with and without testosterone treatment. I/R damages decreased bladder nerve density with and without testosterone. The expressions of fibrosis and oxidative stress-related proteins were increased by I/R injuries with or without testosterone treatment. Testosterone depletion significantly decreased the expressions of transforming growth factor-β and fibronectin expressions after I/R injury. Supraphysiological testosterone treatment after orchiectomy greatly increased the expressions of these fibrosis proteins; however, orchiectomy alone ameliorated I/R injuries. CONCLUSIONS: Testosterone treatment or orchiectomy affected I/R-induced bladder damages in male rabbits. Orchiectomy decreased the level of fibrosis and oxidative stress markers and increased neurofilament densities. Supraphysiological exogenous testosterone administration after orchiectomy further exacerbated such detrimental effects of I/R.
Journal of Sexual Medicine 02/2013; · 3.55 Impact Factor
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Chia-Cheng Yu,
Shu-Pin Huang, Yung-Chin Lee,
Chao-Yuan Huang,
Chia-Chu Liu,
Tzyh-Chyuan Hour,
Chun-Nung Huang,
Bang-Jau You,
Ta-Yuan Chang,
Chun-Hsiung Huang,
Bo-Ying Bao
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ABSTRACT: Although most advanced prostate cancer patients respond to androgen-deprivation therapy (ADT), the efficacy is widely variable. We investigated whether the host genetic variations in sex hormone pathway genes are associated with the efficacy of ADT. A cohort of 645 patients with advanced prostate cancer treated with ADT was genotyped for 18 polymorphisms across 12 key genes involved in androgen and estrogen metabolism. We found that after adjusting for known risk factors in multivariate Cox regression models, AKR1C3 rs12529 and AR-CAG repeat length remained significantly associated with prostate cancer-specific mortality (PCSM) after ADT (P≤0.041). Furthermore, individuals carrying two unfavorable genotypes at these loci presented a 13.7-fold increased risk of PCSM compared with individuals carrying zero (P<0.001). Our results identify two candidate molecular markers in key genes of androgen and estrogen pathways associated with PCSM after ADT, establishing the role of pharmacogenomics in this therapy.
PLoS ONE 01/2013; 8(1):e54627. · 4.09 Impact Factor
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ABSTRACT: In addition to adipocytokines, estradiol (E2) and vitamin D have been reported to affect insulin sensitivity, glucose homeostasis and body weight. However, studies about the impact of E2 and vitamin D on metabolic syndrome (MetS) are still limited. The aim of this study is to clarify the roles of circulating E2 and vitamin D on the risk of MetS in middle-aged Taiwanese males. A total of 655 male volunteers, including 243 subjects with MetS (mean age: 56.7±5.8 years) and 412 normal controls (mean age: 55.1±3.6 years), were evaluated. Subjects with MetS had significantly lower circulating E2, 1,25(OH)2D3, and adiponectin, and higher leptin than those without MetS (P<0.001 for all comparisons). E2 and 1,25(OH)2D3 were significantly associated with 4 individual components of MetS; more than adiponectin and leptin that were only associated with 3 individual components. In multivariate regression analysis, E2 (beta = -0.216, P<0.001) and 1,25(OH)2D3 (beta = 0.067, P = 0.045) were still significant predictors of MetS independent of adiponectin and leptin. Further large studies are needed to confirm our preliminary results and elucidate the possible mechanism.
PLoS ONE 01/2013; 8(3):e60295. · 4.09 Impact Factor
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ABSTRACT: This study aimed to evaluate the influence of the lifestyle, prostate volume (PV), and metabolic syndrome (MS) on lower urinary tract symptoms (LUTS) in the elderly males. A total of 764 men aged greater than 40 years were enrolled. Their severities of LUTS were assessed by the International Prostate Symptom Score questionnaire, while their MS was diagnosed according to the criteria developed by the National Cholesterol Education Program Adult Treatment Panel III. Lifestyle factors, PV, and components of MS were compared between no/mild and moderate/severe LUTS groups. In univariate analysis, age, cigarette smoking, alcohol consumption, physical activity, and PV significantly correlated with the severity of LUTS, but the presence or any components of MS did not. Results of multivariate analysis showed that aging, cigarette smoking, lack of regular exercise, and larger PV were independent predictors for moderate/severe LUTS. Notably, the risk factors for LUTS was influenced by the presence of MS. PV may play a role in determining the severity of LUTS for men without MS, while physical activity was the critical factor for men with MS. It was suggested that healthy lifestyle would be beneficial to lessen the severity of LUTS in the elderly males.
The Aging Male 03/2012; 15(3):166-72. · 1.52 Impact Factor
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ABSTRACT: Introduction. In addition to a depletion of androgen, attenuated action of androgen receptor (AR) might also contribute to andropausal symptoms. Aim. To evaluate the interaction of AR cytosine adenine guanine (CAG) repeat polymorphism and serum testosterone levels and their effect on andropausal symptoms in aging Taiwanese men. Methods. From August 2007 to April 2008, a free health screening for men older than 40 years was conducted by a medical center in Kaohsiung City, Taiwan. All participants received physical examination, answered questionnaires to collect their demographic information and medical histories, completed the Androgen Deficiency in the Aging Male (ADAM) questionnaire, and provided 20-cm(3) whole blood samples for biochemical and genetic evaluation. Main Outcome Measures. The ADAM questionnaire was used to evaluate andropausal symptoms. Serum albumin, total testosterone (TT), and sex hormone-binding globulin levels were measured. Free testosterone level was calculated. AR gene CAG repeat polymorphism was determined by direct sequencing. Results. Seven hundred two men with the mean age of 57.2 ± 6.5 years were included. There was no significant association between TT levels and the distribution of AR CAG repeat polymorphism. When TT levels were above 340 ng/dL, subjects with AR CAG repeat lengths ≧25 showed significantly higher risk of developing andropausal symptoms, as compared with those with AR CAG repeat lengths ≦22 (P = 0.006), but this was not observed when TT levels were 340 ng/dL or below. Age and number of comorbidities were also independent risk factors for andropausal symptoms. Conclusion. In subjects with normal TT concentration, those with longer AR CAG repeat lengths have a higher risk of developing andropausal symptoms. Age and number of comorbidities can also influence the appearance of andropausal symptoms. In clinical practice, a multifactorial approach to evaluate andropausal symptoms and the interactions between those risk factors is suggested. Liu C-C, Lee Y-C, Wang C-J, Yeh H-C, Li W-M, Wu W-J, Huang C-N, Bao B-Y, Huang C-H, and Huang S-P. The impact of androgen receptor CAG repeat polymorphism on andropausal symptoms in different serum testosterone levels. J Sex Med 2012;9:2429-2437.
Journal of Sexual Medicine 03/2012; 9(9):2429-2437. · 3.55 Impact Factor
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Yung-Chin Lee,
Shu-Pin Huang,
Chia-Chu Liu,
Yi-Hsin Yang,
Hsin-Chih Yeh,
Wei-Ming Li,
Wen-Jeng Wu,
Chii-Jye Wang,
Yung-Shun Juan,
Chun-Nung Huang,
Tzyh-Chyuan Hour,
Chu-Fen Chang,
Chun-Hsiung Huang
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ABSTRACT: Accumulated evidences have outlined the potential relation between insulin resistance and endothelial dysfunction. The impaired ability of endothelium to synthesize or release nitric oxide may provide a common pathophysiological mechanism in the development of metabolic syndrome (MtS) and erectile dysfunction (ED).
The aim of this article was to investigate the genetic susceptibility of endothelial nitric oxide synthase (eNOS) G894T polymorphism underlying the development of both disorders.
A total of 590 subjects with a mean (standard deviation) age of 55.3 years (4.1) were enrolled during a free health screening. Complete clinical data and questionnaires were taken for all subjects. Multivariate logistic regression analysis was used to determine the independent predictors of MtS and ED. The eNOS G894T polymorphism was determined using a polymerase chain reaction-restriction fragment length polymorphism method.
The definition of MtS was according to the modified criteria developed by the Bureau of Health Promotion in Taiwan. Patients with ED were defined as those having a five-item International Index of Erectile Function (IIEF-5) <21.
Our results showed that the eNOS 894T allele carriers had significantly higher prevalence of MtS and ED (odds ratio [OR]=1.64, 95% confidence interval [CI]=1.05∼2.56, P=0.02 and OR=1.76, 95% CI=1.11∼2.80, P=0.01, respectively) after adjustment for each other and age. Also the T allele carriers had significantly lower IIEF-5 score and more MtS components than G allele carriers (P<0.01 and P<0.01, respectively), which were significantly associated with an increment of the T allele number (P<0.05).
The eNOS 894T allele carriers are at greater risk for both MtS and ED, suggesting that eNOS G894T gene polymorphism might play an implication as a common genetic susceptibility factor to develop both disorders.
Journal of Sexual Medicine 03/2012; 9(3):837-43. · 3.55 Impact Factor
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Kuang-Shun Chueh,
Shu-Pin Huang, Yung-Chin Lee,
Chii-Jye Wang,
Hsin-Chih Yeh,
Wei-Ming Li,
Wen-Jeng Wu,
Yueh-Fong Tsai,
Chia-Chun Tsai,
Hsu-Cheng Juan,
Chun-Hsiung Huang,
Chia-Chu Liu
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ABSTRACT: The prevalence of androgen deficiency in men increases with aging. Two common instruments, the Aging Male Symptoms (AMS) scale and the Androgen Deficiency in the Aging Male (ADAM) questionnaire, are often used to screen for androgen deficiency in clinical practice. The aim of this study is to compare the capability of the AMS scale and the ADAM questionnaire to detect androgen deficiency in middle-aged Taiwanese men. In April 2008, a free health screening was conducted by Kaohsiung Medical University Hospital. All participants completed a health questionnaire and had blood samples drawn between 8:00 am and noon. Serum total testosterone (TT), albumin, and sex hormone-binding globulin levels were measured. The level of free testosterone (FT) was calculated. Clinical symptoms associated with androgen deficiency were screened by using the AMS scale and ADAM questionnaire. Androgen deficiency was defined as TT < 300 ng/dL or both TT < 300 ng/dL and FT< 5 ng/dL. In total, 339 men were included in the final analysis, with the mean age of 54.6 ± 4.9 years (range, 47-65 years). Androgen deficiency was found in 75 men (22.1%) based on the criteria of TT < 300 ng/dL, and in 54 men (15.9%) based on the criteria of TT < 300 ng/dL and FT < 5 ng/dL. When detecting participants with both TT < 300 ng/dL and FT < 5 ng/dL, the sensitivity and specificity of the AMS scale were 57.4% and 48.1%, compared with 66.7% and 25.6% for the ADAM questionnaire. In a sample of middle-aged Taiwanese men, neither the AMS scale nor the ADAM questionnaire had sufficient sensitivity and specificity to detect androgen deficiency. In addition to using those 2 screening instruments, a thorough physical and biochemical workup should still be conducted in patients at risk or suspected of androgen deficiency.
Journal of Andrology 01/2012; 33(5):817-23. · 2.97 Impact Factor
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ABSTRACT: Several genome-wide association studies (GWAS) have been conducted to identify the common single nucleotide polymorphisms (SNPs) that influence the risk of prostate cancer. It was hypothesized that some prostate cancer-associated SNPs might relate to the clinical outcomes in patients treated for prostate cancer using androgen-deprivation therapy (ADT). A cohort of 601 patients who have received ADT for prostate cancer was genotyped for 29 SNPs that have been associated with prostate cancer in Cancer Genetic Markers of Susceptibility GWAS, and within the genes that have been implicated in cancer. Prognostic significance of these SNPs on the disease progression, prostate cancer-specific mortality (PCSM) and all-cause mortality (ACM) after ADT were assessed by Kaplan-Meier analysis and Cox regression model. Three SNPs, namely CASP3 rs4862396, BMP5 rs3734444 and IRS2 rs7986346, were found to be closely associated with the ACM (P≤0.042), and BMP5 rs3734444 and IRS2 rs7986346 were also noted to be significantly related to the PCSM (P≤0.032) after adjusting for the known clinicopathologic predictors. Moreover, patients carrying a greater number of unfavorable genotypes at the loci of interest had a shorter time to ACM and PCSM during ADT (P for trend <0.001). Our results suggest that CASP3 rs4862396, BMP5 rs3734444 and IRS2 rs7986346 may affect the survival in patients after ADT for prostate cancer, and the analysis of these SNPs can help identify patients at higher risk of poor outcome.
PLoS ONE 01/2012; 7(7):e41219. · 4.09 Impact Factor
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ABSTRACT: Recently, metabolic syndrome (MtS) has received increasing attention. However, investigations regarding the potential impact of MtS and its components on erectile dysfunction (ED) have not been completely clarified.
To determine the potential impact of MtS on ED in aging Taiwanese males.
The definition of MtS was according to the modified criteria developed by the Bureau of Health Promotion in Taiwan. The presence and severity of ED were evaluated by International Index of Erectile Function 5 (IIEF-5) scores.
A total of 639 subjects with a mean age of 60.2 years (range 40-83) were enrolled during a free health screening. All the men had complete clinical data and questionnaires taken. Clinical variables were compared according to MtS and ED prevalence. Multiple logistic regression analysis was used to determine the independent predictors of ED and MtS.
Using age-adjusted multivariate logistic regression analysis, our results showed that subjects with ED had significantly higher prevalence of MtS (P<0.01, OR=2.30, 95% CI: 1.44-3.69). The presence of MtS had significant correlation with lower IIEF-5 scores (P<0.01), which were associated with the increment of MtS components number (P<0.01). Among the MtS components, abnormal fasting blood glucose (FBG) was the most significantly independent factor of MtS for ED (P=0.01, OR=1.60, 95% CI: 1.09-2.35). Testosterone levels were significantly lower in subjects with MtS (P=0.05), while inversely correlated with number of MtS components (P<0.01).
In aging Taiwanese males, the presence of MtS is strongly associated with ED and abnormal FBG is the most independent predictor for ED. Low testosterone level might be viewed as another possible common denominator for various pathologies linking MtS to ED.
Journal of Sexual Medicine 09/2010; 7(9):3127-34. · 3.55 Impact Factor
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Chia-Chu Liu,
Hsu-Cheng Juan, Yung-Chin Lee,
Wen-Jeng Wu,
Chii-Jye Wang,
Hung-Lung Ke,
Wei-Ming Li,
Hsin-Chih Yeh,
Ching-Chia Li,
Yii-Her Chou,
Chun-Hsiung Huang,
Shu-Pin Huang
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ABSTRACT: Sexual activity in older people has become a topic of growing interest. The aim of this study is to investigate the effect of physical health and socioeconomic factors on the sexual activity of middle-aged and elderly Taiwanese men. From August 2007 to April 2008, 744 men older than 40 years were enrolled from a free health screening in Kaohsiung, Taiwan. All participants received detailed physical examination and answered questionnaires that collected demographic and lifestyle information, and medical history as well as answered items from the International Prostate Symptoms Score and five-item version of the International Index of Erectile Function (IIEF-5). Overall, 100 (13.4%) participants reported to be sexually inactive in previous 6 months. Older age, lower education levels, loss of a partner, erectile dysfunction, and increased number of comorbidities were found to be independent predictors for sexual inactivity. In conclusion, most middle-aged and elderly Taiwanese men remain sexually active. In addition to erectile dysfunction and loss of a partner, lower education levels and increased number of comorbidities were found to be predictors for sexual inactivity. Further research would need to elucidate whether improvement of those factors could help to preserve sexual activity.
The Aging Male 03/2010; 13(2):148-53. · 1.52 Impact Factor
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ABSTRACT: This study assessed the possible associations between lower urinary tract symptoms (LUTS) and erectile dysfunction (ED) in aging Taiwanese males and investigated the impact of various aspects of LUTS on ED.
A free health screening for aging males (> or =40 years old) was conducted in Kaohsiung Medical University Hospital. All the subjects had completed clinical data and answered questionnaires. ED and LUTS were assessed by validated symptom scales: the International Index of Erectile Function-5 (IIEF-5) and the International Prostate Symptom Score (IPSS).
A total of 339 eligible patients enrolled in this study with a mean age of 60.1 years old. In multiple logistic regression analysis, age and IPSS (p < 0.001 and p = 0.013, respectively) were significantly associated with ED after controlling other comorbidities. In a further age-adjusted multiple regression analysis, our results showed that irritative symptoms (p = 0.042) have a more significant association with ED than the obstructive symptoms (p = 0.101).
Our results indicate that age and LUTS are the two most independent risk factors for ED. Aging Taiwanese males with LUTS are at increasing risk for ED, especially for those with significant irritative symptoms.
The Aging Male 02/2010; 13(3):179-83. · 1.52 Impact Factor
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ABSTRACT: A number of literature has now identified the role of impaired nitric oxide synthase/nitric oxide pathway in the endothelium as the central to the development of erectile dysfunction (ED) and benign prostate hyperplasia-related lower urinary tract symptoms (BPH/LUTS). Recently a few studies have reported the associations between endothelial nitric oxide synthase (eNOS) G894T gene polymorphisms and ED. However, there has been no report investigating the eNOS G894T genetic susceptibility factor for both ED and BPH/LUTS.
To investigate the possible associations among eNOS G894T polymorphism, ED, and BPH/LUTS in a Taiwanese population.
Patients with ED were defined as those having a 5-item International Index of Erectile Function-5 <21.
In all, 372 Taiwanese men underwent a free health screening were enrolled. All the men had complete clinical data and questionnaires taken. The eNOS G894T polymorphisms were determined using the polymerase chain reaction-restriction fragment length polymorphism method.
Three hundred seventy-two men had a mean (standard deviation) age of 60.2 (8.8) years. With multivariate analysis, our data identified that aging, diabetes mellitus (DM), and eNOS G894T gene polymorphism were three independent common risk factors for both ED and BPH/LUTS (P < 0.001, P = 0.036, and P = 0.039 for ED; P = 0.034, P = 0.004, and P = 0.016 for BPH/LUTS, respectively). The eNOS 894T allele carriers had significantly higher prevalence of ED (77.9% vs. 60.4%, P = 0.012) and higher International Prostate Symptom score (IPSS) (13.3 +/- 10.7 vs. 9.3 +/- 7.8, P = 0.001) than G allele carriers.
Our results showed that aging, DM, and eNOS 894T allele carrier gene polymorphism were the three independently common risk factors for both ED and BPH/LUTS in the Taiwanese population. The eNOS 894T allele carriers had significantly higher frequencies of ED and higher IPSS, suggesting that eNOS G894T gene polymorphisms may play an implication as a genetic susceptibility factor for both ED and BPH/LUTS.
Journal of Sexual Medicine 06/2009; 6(11):3158-65. · 3.55 Impact Factor
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Chia-Chu Liu,
Wen-Jeng Wu, Yung-Chin Lee,
Chii-Jye Wang,
Hung-Lung Ke,
Wei-Ming Li,
Hsi-Lin Hsiao,
Hsin-Chih Yeh,
Ching-Chia Li,
Yii-Her Chou,
Chun-Hsiung Huang,
Shu-Pin Huang
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ABSTRACT: Androgen deficiency in aging men has attracted much medical interest. Most studies on androgen deficiency have been conducted in Caucasian populations, and data from other ethnicities are lacking.
To evaluate the prevalence of and risk factors for androgen deficiency and symptomatic androgen deficiency in Taiwanese men over 40 years old.
From August 2007 to April 2008, a free health screening was conducted by a medical center in Kaohsiung, Taiwan, and 819 men participated in this health screening. All participants completed a health questionnaire, received a detailed physical examination, and blood samples were drawn between 8:00 and 12:00 am.
Serum total testosterone (TT), albumin, and sex hormone-binding globulin levels were measured. The level of free testosterone (FT) was calculated. Clinical symptoms of androgen deficiency were assessed using the Androgen Deficiency in the Aging Male (ADAM) questionnaire.
Seven hundred thirty-four men who met the inclusion criteria (mean age 57.4 +/- 6.7 years; range: 43-87 years) were included in this study. The prevalence of androgen deficiency was 24.1% based on the criterion of TT level < 300 ng/dL, and 16.6% based on the criterion of both TT < 300 ng/dL and FT < 5 ng/dL. The prevalence of symptomatic androgen deficiency was 12.0%. Both prevalence of androgen deficiency and symptomatic androgen deficiency increased with age. Older age, obesity, and diabetes mellitus were independent risk factors for androgen deficiency and symptomatic androgen deficiency.
In a sample of aging Taiwanese men, a substantial proportion had androgen deficiency and symptomatic androgen deficiency, and the prevalence increased with age. Older age, obesity, and diabetes mellitus were independent risk factors for androgen deficiency and symptomatic androgen deficiency. Those potentially modifiable risk factors like obesity and diabetes mellitus should be prevented to maintain normal testosterone levels during aging in men.
Journal of Sexual Medicine 02/2009; 6(4):936-46. · 3.55 Impact Factor
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ABSTRACT: Vascular etiologies are the most common risk factors for erectile dysfunction (ED). Published studies have reported the associations of GNB3 C825T polymorphism with many vascular diseases. However, there are few reports about the association between this gene polymorphism and ED.
To investigate the associations among GNB3 C825T polymorphism, ED, and related risk factors in Taiwanese subjects.
A total of 155 patients with ED and 81 healthy controls were enrolled. All men had complete clinical histories taken. The 5-item International Index of Erectile Function (IIEF-5) was used to assess erectile conditions. The GNB3 C825T polymorphisms were determined using the polymerase chain reaction-restriction fragment length polymorphism method.
Patients with ED were defined as those having an IIEF-5 of <21.
Two hundred thirty-six men were enrolled with a mean (standard deviation) age of 59.0 (10.2) years. Diabetes mellitus (DM), hypertension, and age were the three most significant independent risk factors for ED in a multiple logistic regression analysis (P = 0.008, 0.003, and 0.007, respectively). The prevalence of DM, hypertension, and body mass index (BMI) was significantly higher in GNB3 825T allele (CT/TT) carriers (P = 0.023, 0.049, and 0.035, respectively). There was no significant difference of ED prevalence between T and C allele carriers (69.1% vs. 56.2%, P = 0.07). However, the T allele carriers had significantly lower IIEF-5 scores (P = 0.02) associated with an increment of the T allele number (16.4[CC] vs. 14.4[CT] vs. 13.2[TT], P = 0.04).
In the present study, DM, hypertension, and BMI had significant associations with GNB3 825T allele carriers. Our results failed to show a significant association of the GNB3 C825T polymorphisms with ED prevalence. However, we cannot exclude that the presence of the T allele might influence the risk for ED severity indirectly through an increased risk for some vascular diseases.
Journal of Sexual Medicine 10/2008; 5(9):2061-8. · 3.55 Impact Factor
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ABSTRACT: The purpose of this study was to investigate the impact of hydronephrosis on the treatment outcome of patients with a solitary proximal ureteral stone after extracorporeal shock wave lithotripsy (ESWL). A total of 182 consecutive patients who underwent ESWL for a solitary proximal ureteral stone of between 5 and 20 mm in size in our institution were included in this study. The degree of hydronephrosis was defined by renal ultrasonography. Patient data, stone size, shock wave numbers and shock wave energy were also recorded. Treatment outcome was evaluated 3 months after the first session of ESWL. In multivariate analysis, only the maximal stone length (odds ratio [OR], 0.15; 95% confidence interval [CI], 0.03-0.91; p = 0.04) and the degree of hydronephrosis (OR, 0.40; 95% CI, 0.16-0.98; p = 0.045) were significant predicting factors for stone-free status 3 months after ESWL. For stones < or = 10 mm, the stone-free rate decreased from 80% in patients with mild hydronephrosis to 56.4% in those with moderate to severe hydronephrosis. For stones > 10 mm, the stone-free rate decreased further, from 65.2% in patients with mild hydronephrosis to 33.3% in those with moderate to severe hydronephrosis. In summary, patients with a solitary proximal ureteral stone and a stone > 10 mm, the treatment outcome after ESWL was not good if moderate to severe hydronephrosis was noted on ultrasonography. Alternative treatments, such as ureteroscopic lithotripsy, may be appropriate as initial treatment or after failure of one session of ESWL.
The Kaohsiung journal of medical sciences 10/2008; 24(10):507-13. · 0.61 Impact Factor
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ABSTRACT: The purpose of this study was to determine the influence of metabolic syndrome (MS) and serum testosterone in patients with erectile dysfunction (ED) and their possible association. A total of 103 men with ED were enrolled. The International Index of Erectile Function (IIEF) questionnaire was used to assess erectile condition. MS was defined according to the criteria formulated by the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) and the International Diabetes Federation (IDF). The mean age of the study population was 57.5 +/- 10.7 years, with an average IIEF of 14.7 +/- 6.7. The age and prevalence of MS using the NCEP ATP III criteria, but not the IDF criteria, were significantly different between mild and moderate/severe ED patients (p = 0.031 and 0.009, respectively). The percentage of hypertension (78.6% vs. 36.2%; p < 0.001) and raised fasting glucose levels (46.4% vs. 19.1%; p = 0.004) were significantly higher in the moderate/severe ED group, and both differences remained significant in multivariate analysis (p = 0.001 and 0.042, respectively). In addition, serum testosterone levels were significantly lower in ED patients with MS (p = 0.002). In summary, the presence of MS is associated with more severe ED. Among the components of MS, elevated blood pressure and fasting blood glucose were independent risk factors. NCEP ATP III criteria seem to correlate better with the degree of ED than the IDF definition. Our results also indicate that MS is associated with a lower testosterone level in patients with ED.
The Kaohsiung journal of medical sciences 05/2008; 24(5):240-7. · 0.61 Impact Factor
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ABSTRACT: The simultaneous occurrence of renal collecting duct (Bellini duct) carcinoma and bladder urothelial carcinoma is very rare. A 68-year-old female patient with bladder urothelial carcinoma first received transurethral resection of the tumor. Left side nephrouretectomy and transurethral resection of the intramural ureter were performed 8 months later under the diagnosis of concomitant renal pelvic urothelial carcinoma. However, the final pathologic examination revealed collecting duct carcinoma. The patient received systemic chemotherapy after surgery, but distant metastasis was noted 6 months later. Here, we report a rare case of combined renal collecting duct carcinoma and bladder urothelial carcinoma confirmed by pathologic examination and immunohistochemical staining.
The Kaohsiung journal of medical sciences 04/2008; 24(3):157-62. · 0.61 Impact Factor
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ABSTRACT: To investigate the possible correlations among eNOS G894T polymorphism, erectile dysfunction (ED) and related risk factors in a Taiwanese population.
In all, 151 patients with ED and 77 healthy controls were enrolled. All the men had a complete clinical history taken and laboratory data was collected. To assess erectile conditions the five-item version of the International Index of Erectile Function (IIEF-5) was used. The eNOS G894T polymorphisms were determined using the polymerase chain reaction-restriction fragment length polymorphism method.
In all, 228 men were enrolled with a mean (sd) age of 58.6 (9.7) years. In a univariate analysis, age, serum testosterone level, and the prevalence of diabetes mellitus (DM) and hypertension were significantly different between patients with ED and the healthy controls (P < 0.01). In the multiple logistic regression analysis, DM, age and hypogonadism were three independent risk factors for ED (P = 0.018, P = 0.046 and P = 0.016, respectively). The prevalence of ED in T allele carriers (GT/TT) was significantly greater than in G allele carriers (GG; 80.0% vs 63.3%, P = 0.04). Also the eNOS 894T allele carriers had significantly lower IIEF-5 scores than the eNOS 894G allele carriers, at 13.2 (5.3) vs 15.7 (6.1) (P = 0.01) and it was associated with increment of T allele number (11.0 (5.6) vs 13.6 (5.2) vs 15.7 (6.1); P = 0.03).
Our results indicate that DM, age and hypoganadism are three significant independent risk factors for ED. Also, in the Taiwanese population, the eNOS 894T allele carriers are at greater risk of ED, both in prevalence and severity, and this might be a factor of genetic susceptibility.
BJU International 12/2007; 100(5):1116-20. · 2.84 Impact Factor
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ABSTRACT: Urolithiasis is a common urologic disease. Stones may occur in the kidney, ureter, or urinary bladder. We collected 1,000 stone samples in the subtropical area of southern Taiwan. Stone components were analyzed by Fourier transform infrared spectroscopy. Mixed components of calcium oxalate and calcium phosphate were the most common form of stones (52.3%), followed by calcium oxalate (27.8%) and calcium phosphate (9.3%). Uric acid stones accounted for 7.6%. Magnesium ammonium phosphate stones accounted for 3.0%. Only one cystine stone was found. In the study of urinary stone formation mechanism and prevention of recurrent urolithiasis, knowing the stone composition is important.
The Kaohsiung journal of medical sciences 03/2007; 23(2):63-6. · 0.61 Impact Factor
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ABSTRACT: To determine efficacy and clinical predictors of stone fragmentation when using slow-rate shock wave lithotripsy (SWL).
In total, 116 patients with radiopaque urinary tract stones were randomized into two groups: 57 patients were treated with SWL at 90 shocks/min, and 59 patients were treated with SWL at 120 shocks/min. The efficacy of SWL was evaluated within 1 month after treatment. Patient characteristics, features of stones, and SWL conditions were reviewed. Success rates relating to individual parameters were assessed by using chi-square and Student t tests. All factors were further entered into multivariate logistic regression analysis.
There were no statistically significant differences between the two groups with regard to age, sex, site and size of the stones, renal function, and total number of shock waves. In univariate analysis, the success rate was significantly related to shock wave frequency (p = 0.023), length and width of the stones (p < 0.001), total number of shock waves (p = 0.047), and age (p = 0.049). In multivariate analysis, however, only shock wave rate and stone length remained statistically significant (p = 0.021 and p = 0.046, respectively). The overall success rate was significantly higher in the group treated with 90 shocks/min (p = 0.02). However, this higher success rate was statistically significant only in patients with a stone length > or = 10 mm (50.0 vs. 18.5%, p = 0.019).
SWL at 90 shocks/min yielded better outcomes than SWL at 120 shocks/min, particularly in patients with stone lengths > or = 10 mm.
Urologia Internationalis 01/2007; 79(2):124-8. · 0.99 Impact Factor
