[show abstract][hide abstract] ABSTRACT: In February 2011, the Korean Society for Sexual Medicine and Andrology (KSSMA) realized the necessity of developing a guideline on erectile dysfunction (ED) appropriate for the local context, and established a committee for the development of a guideline on ED. As many international guidelines based on objective evidence are available, the committee decided to adapt these guidelines for local needs instead of developing a new guideline. Considering the extensive research activities on ED in Korea, data with a high level of evidence among those reported by Korean researchers have been collected and included in the guideline development process. The latest KSSMA guideline on ED has been developed for urologists. The KSSMA hopes that this guideline will help urologists in clinical practice.
The world journal of men's health. 08/2013; 31(2):83-102.
[show abstract][hide abstract] ABSTRACT: A recording of the intracavernosal pressure (ICP) in conscious rats using telemetry has the advantage of being able to evaluate erection under physiological conditions. The aim of this study was to determine whether the radiotelemetric assessment of ICP in apomorphine-induced erection is appropriate for assessing erectile function in an animal model of disease. Seven rats were assigned to the normal group, and another nine rats were assigned to the hypercholesterolemia group. A telemetric pressure sensor was implanted in the corpus cavernosum. Pressure was recorded in freely moving animals after apomorphine injection. Sexual events were visually identified and recorded. Only the pressure increase occurring during sexual behavior was analyzed. The main outcome measures were as follows: latency for first peak after injection (latency), duration, maximum ICP (Max ICP) and area under the curve (AUC). The mean latency, mean duration of each episode, mean Max ICP, mean AUC and mean summed AUC were 389.9±59.4 s, 61.6±7.8 s, 140.0±22.5 mm Hg, 1834.4±358.2 mm Hg s and 3259.1±795.9 mm Hg s, respectively, for the normal group vs 652.8±102.2 s, 32.4±5.2 s, 92.7±6.4 mm Hg, 572.9±73.6 mm Hg s and 739.9±87.2 mm Hg s, respectively, for the hypercholesterolemia group. There was a significant difference in mean latency, mean AUC and mean summed AUC. Additionally, we cannot find any obvious immediate adverse events after surgical implantation in both normal control and hypercholesterolemic rats. And, no catheter displacement and no adverse local reaction, including fibrosis to the implant, were observed. In conclusion, radiotelemetric assessment of ICP in apomorphine-induced erection provided consistent and accurate data during erectile events, and was appropriate for assessing erectile function in an animal model of disease.International Journal of Impotence Research advance online publication, 25 July 2013; doi:10.1038/ijir.2013.32.
International journal of impotence research 07/2013; · 2.73 Impact Factor
[show abstract][hide abstract] ABSTRACT: This study compared the prevalence of premature ejaculation (PE) diagnosed by the PE diagnostic tool (PEDT) score, self-reporting and stopwatch-recorded intravaginal ejaculation latency time (IELT). It examined the characteristics of males diagnosed with PE by each criterion. A questionnaire survey enrolled 2081 subjects from March to October, 2010. Stopwatch-recorded IELT was measured in 1035 of the 2081 subjects. We aimed to determine whether PE has an influence on the frequency and satisfaction of sexual intercourse, the degree of libido/erectile function and the satisfaction. These factors were evaluated according to different definitions of PE to assess whether the definition used yielded differences in the data. The prevalence of PE, based on a PEDT score of 11, self-reporting and stopwatch-recorded IELT of 1 min was 11.3%, 19.5% and 3%, respectively. The prevalence of PE diagnoses based on PEDT score and self-reporting increased with age, but stopwatch-recorded IELT-based diagnoses did not. Males experiencing PE showed lower levels of libido, erectile function and frequency and satisfaction of sexual intercourse compared with non-PE males. PE males felt that they did not satisfy their partners in terms of the partners' sexual satisfaction and frequency of orgasm, in comparison with non-PE males. PE is a highly prevalent sexual dysfunction in males. Regardless of whether the PE diagnosis was made on the basis of self-reporting, PEDT score or stopwatch-recorded IELT, subjective symptoms were similar among PE males.International Journal of Impotence Research advance online publication, 30 August 2012; doi:10.1038/ijir.2012.27.
International journal of impotence research 08/2012; · 2.73 Impact Factor
[show abstract][hide abstract] ABSTRACT: Introduction. Herbal preparations have long been used as folk remedies for erectile dysfunction (ED). Aim. This study examined the effects of Tribulus terrestris and Cornus officinalis extracts on relaxation of the smooth muscle of the corpus cavernosum (CC), their mechanisms of action, and the effects of oral administration of a mixture of the herbal extracts on penile erection. Methods. The relaxation effects and the mechanisms of action of T. terrestris extract, C. officinalis extract, and the mixture of both extracts on the rabbit CC were investigated in an organ bath. To evaluate whether the relaxation response of the CC shown in an organ bath occurs in vivo, intracavernous pressure (ICP) was calculated in rats after oral administration for a month. Additionally, adenosine 3',5'-cyclic monophosphate (cAMP) and guanosine 3', 5'-cyclic monophosphate (cGMP) in the CC were measured using immunoassay. Main Outcome Measures. Smooth muscle relaxation was expressed as the percent decrease in precontraction induced by phenylephrine. ICP was assessed in rats after the oral administration of a mixture of both extracts for 1 month and changes in cGMP and cAMP concentrations were measured based on the concentration of the mixture of both extracts. Results. T. terrestris extract, C. officinalis extract, and the mixture of both extracts showed concentration-dependent relaxation effects of the CC. In both the endothelium-removed group and N(G)-nitro-L-arginine methyl ester pretreatment group, T. terrestris extract inhibited relaxation. ICP measured after oral administration of the extract mixture for a month was higher than that measured in the control group, and a significant increase in cAMP was observed in the mixture group. Conclusions. T. terrestris extract and C. officinalis extract exhibited concentration-dependent relaxation in an organ bath. In the in vivo study of the extract mixture, ICP and cAMP was significantly potentiated. Accordingly, the mixture of T. terrestris extract and C. officinalis extract may improve erectile function. Kam SC, Do JM, Choi JH, Jeon BT, Roh GS, and Hyun JS. In vivo and in vitro animal investigation of the effect of a mixture of herbal extracts from Tribulus terrestris and Cornus officinalis on penile erection. J Sex Med **;**:**-**.
Journal of Sexual Medicine 08/2012; 9(10):2544-51. · 3.51 Impact Factor
[show abstract][hide abstract] ABSTRACT: We investigated the molecular identity and functional activity of STIM1 and ORAI in human cavernous smooth muscle. We also determined whether transferring dominant negative mutants of the STIM1 or ORAI gene would correct diabetes related erectile dysfunction in a rat model.
Reverse transcriptase-polymerase chain reaction was done to identify ORAI and STIM in human cavernous smooth muscle. For the in vivo study intracavernous pressure, blood pressure and their ratio were assessed after cavernous nerve stimulation to diabetic rats transfected with pcDNA encoding the ORAI1(DN) or the STIM1(DN) gene.
ORAI (1, 2 and 3) and STIM (1 and 2) were identified in human cavernous smooth muscle cells. After [Ca(2+)] depletion by thapsigargin and cyclopiazonic acid we recorded store operated Ca(2+) entry in human cavernous smooth muscle cells. Entry was decreased by the store operated Ca(2+) channel blockers La(3+) and SKF96365. Mean ± SE intracavernous pressure/blood pressure in rats with ORAI1(DN) or STIM1(DN) gene transfer was 78.8% ± 2.2% and 77.1% ± 1.2% in 11 and 10, respectively. This result was significantly higher than that in 10 diabetic controls (51.0% ± 3.7%) and similar to that in 9 normal controls (85.8% ± 2.6%). Using reverse transcriptase-polymerase chain reaction we confirmed transgene expression in rat cavernous tissue.
Transfer of ORAI(DN) or STIM1(DN) genes restored erectile function in diabetic rats. It might be applicable to develop new therapy for erectile dysfunction.
The Journal of urology 03/2012; 187(5):1903-10. · 4.02 Impact Factor
[show abstract][hide abstract] ABSTRACT: Lower urinary tract symptoms (LUTSs) and ED are clearly correlated, but to date no correlation with ejaculatory dysfunction (EjD) has been identified. Therefore, this study evaluated the impact of erectile function in men with LUTS on EjD and premature ejaculation (PE). Erectile function, PE and EjD of 239 men (mean age, 53.0 ± 10.65 years), International Prostate Symptom Score (IPSS), International Index of Erection Function (IIEF), intravaginal ejaculatory latency time (IELT) and the seven-item Male Sexual Health questionnaire (MSHQ)-EjD were used to compare with the degree of LUTS. Ages were divided into five groups (<40, 40-49, 50-59, 60-69 and >70 years). The IPSS categorized patients into three symptom groups: mild, 1-7; moderate, 8-19; and severe, >19. ED was classified into five categories based on IIEF-EF scores: severe (0-6), moderate (7-12), mild-to-moderate (13-18), mild (19-24) and normal (25-30). The correlations among age, IIEF-EF, IELT and the MSHQ-EjD domain were studied through regression and cross-tabulation analyses. The results revealed that aging significantly affected each item of the MSHQ-EjD (P<0.05). The IIEF-EF domain was also correlated with each question on the MSHQ-EjD (P<0.05). PE (IELT <1 min) increased in incidence as patients got older but was not linked to IIEF-EF (P>0.05). These results indicate that EjD is closely related to age and erectile function, and that PE is closely related to age, although PE is not related to erectile function.
International journal of impotence research 02/2012; 24(3):101-5. · 2.73 Impact Factor
[show abstract][hide abstract] ABSTRACT: Higenamine mediates cardiotonic, vascular relaxation and bronchodilator effects. The relaxation effects and the mechanism of action of higenamine on the rat corpus cavernosum (CC) were assessed to investigate the effect of higenamine on penile erection. Strips of CC and aorta were used in organ baths for isometric tension studies. Tension was measured with isometric force transducers, and muscle relaxation was expressed as the percent decrease in precontraction induced by phenylephrine (PE). The relaxation reactions were investigated in an endothelial-denuded group and groups pretreated with N(G)-nitro-L-arginine methyl ester (NO synthesis inhibitor), propranolol (β-receptor blocker), indomethacin (COX inhibitor), glibenclamide (K(+)(ATP) channel inhibitor), 4-aminopyridine (membrane potential-dependent potassium channel inhibitor) and methylene blue (guanylyl cyclase inhibitor) for 30 min. Intracavernous pressure (ICP) was assessed in rats after the intravenous administration of higenamine, and changes in guanosine 3',5'-cyclic monophosphate and adenosine 3',5'-cyclic monophosphate (cAMP) concentrations were measured on the basis of the higenamine concentration. Also, the combined reaction of higenamine and the phosphodiesterase type-5 (PDE-5) inhibitors was assessed. Higenamine induced relaxation of the CC and the aortic strips precontracted with PE in a dose-dependent manner. The CC was significantly more relaxed than the aortic rings in response to the same higenamine concentration (P<0.05). The CC relaxation reaction was suppressed by the β-receptor blocker propranolol. The cAMP concentration increased gradually with increased higenamine concentration (P<0.05). The ICP also increased with increased higenamine concentration in vivo (P<0.05). In the group pretreated with 10(-7) M higenamine, the relaxation reaction of CC induced by the PDE-5 inhibitor increased significantly, compared with CC exposed to the PDE-5 inhibitor but not pretreated with higenamine (P<0.05). In conclusion, higenamine induced relaxation of the rat CC in a dose-dependent manner. The effect may be mediated through β-adrenoceptors. The results suggest that higenamine may be valuable as a new lead compound for treating erectile dysfunction.
International journal of impotence research 09/2011; 24(2):77-83. · 2.73 Impact Factor
[show abstract][hide abstract] ABSTRACT: To identify the effects of sertraline, a selective serotonin reuptake inhibitor, for the treatment of premature ejaculation (PE), changes in brain current-source density (CSD) of the high beta frequency band (22-30 Hz) induced by sertraline administration were investigated during audiovisual erotic stimulation. Eleven patients with PE (36.9±7.8 yrs) and 11 male volunteers (24.2±1.9 years) were enrolled. Scalp electroencephalography (EEG) was conducted twice: once before sertraline administration and then again 4 h after the administration of 50 mg sertraline. Statistical non-parametric maps were obtained using the EEG segments to detect the current-density differences in the high beta frequency bands (beta-3, 22-30 Hz) between the EEGs before and after sertraline administration in the patient group and between the patient group and controls after the administration of sertraline during the erotic video sessions. Comparing between before and after sertraline administration in the patients with PE, the CSD of the high beta frequency band at 4 h after sertraline administration increased significantly in both superior frontal gyri and the right medial frontal gyrus (P<0.01). The CSD of the beta-3 band of the patients with PE were less activated significantly in the middle and superior temporal gyrus, lingual and fusiform gyrus, inferior occipital gyrus and cuneus of the right cerebral hemisphere compared with the normal volunteers 4 h after sertraline administration (P<0.01). In conclusion, sertraline administration increased the CSD in both the superior frontal and right middle temporal gyrus in patients with PE. The results suggest that the increased neural activity in these particular cerebral regions after sertraline administration may be associated with inhibitory effects on ejaculation in patients with PE.
International journal of impotence research 06/2011; 23(5):213-9. · 2.73 Impact Factor
[show abstract][hide abstract] ABSTRACT: In this study, we investigated the effects of a combination of Ginkgo biloba extracts (GBE) and phosphodiesterase type 5 (PDE-5) inhibitors on the muscular tone of the corpus cavernosum and potassium channel activity of corporal smooth muscle cells. Strips of corpus cavernosum from male New Zealand white rabbits were mounted in organ baths for isometric tension studies. After contraction with 1×10⁻⁵ mol l⁻¹ norepinephrine, GBE (0.01-1 mg ml⁻¹) and mirodenafil (0.01-100 nmol l⁻¹) were added together into the organ bath. In electrophysiological studies, whole-cell currents were recorded by the conventional patch-clamp technique in cultured smooth muscle cells of the human corpus cavernosum. The corpus cavernosum was relaxed in response to GBE in a dose-dependent manner (from 0.64%±8.35% at 0.01 mg ml⁻¹ to 52.28% ± 11.42% at 1 mg ml⁻¹). After pre-treatment with 0.03 mg ml⁻¹ of GBE, the relaxant effects of mirodenafil were increased at all concentrations. After tetraethylammonium (TEA) (1 mmol l⁻¹) administration, the increased effects were inhibited (P<0.01). Extracellular administration of GBE increased the whole-cell K(+) outward currents in a dose-dependent fashion. The increase of the outward current was inhibited by 1 mmol l⁻¹ TEA. These results suggest that GBE could increase the relaxant potency of mirodenafil even at a minimally effective dose. The K(+) flow through potassium channels might be one of the mechanisms involved in this synergistic relaxation.
Asian Journal of Andrology 04/2011; 13(5):742-6. · 2.14 Impact Factor
[show abstract][hide abstract] ABSTRACT: To examine the effects on erectile function of concomitant treatment with an alpha-blocker (tamsulosin) and an antimuscarinic agent (solifenacin) in patients with lower urinary tract symptoms (LUTS)/benign prostatic hyperplasia (BPH).
Fifty-seven male patients with LUTS/BPH were assessed for the degree of LUTS and erectile function. In group 1 (tamsulosin) and group 2 (tamsulosin and solifenacin), changes in the International Prostate Symptom Score [IPSS: total scores, storage symptoms (ST), voiding symptoms (VD), and quality of life (QoL)], prostate-specific antigen, trans-rectal ultrasonography, urine flowmetry, residual urine, and a 5-item version of the International Index of Erectile Function (IIEF-5) were assessed after a 3-month treatment period. In both groups, it was determined whether treatment was associated with changes in LUTS and erectile function and whether improvement in the IPSS was correlated with the IIEF-5. Comparative analysis was also done to examine the linear relationship between improved IPSS scores and IIEF-5 scores.
A comparison of the degree of improvement in all the parameters indicated that both groups showed significant improvement in total IPSS, IPSS-ST, IPSS-VD, and IPSS-QoL (p<0.05). A comparison of the degree of improved sexual function associated with improved LUTS in each patient showed significant improvement in the IIEF-5 score associated with the degree of improvement in the IPSS-ST domain in group 1, but no significant associations were found in group 2. In cases in which tamsulosin was administered, the IIEF-5 score significantly improved as the IPSS-ST domain score improved. In the group in which tamsulosin and solifenacin were concomitantly administered, improvement of the IPSS-ST domain score had no significant effect on the IIEF-5 score.
In patients with LUTS/BPH, tamsulosin and solifenacin combination therapy was effective for LUTS, but erectile function was not significantly improved. Therefore, although effective for improving LUTS, combination therapy with an alpha-blocker and an antimuscarinic agent was not effective for improving erectile function.
[show abstract][hide abstract] ABSTRACT: Premature ejaculation (PE) is the most prevalent male ejaculation disorder. The premature ejaculation diagnostic tool (PEDT) was developed to systematically apply the DSM-IV-TR criteria in diagnostic PE.
To evaluate the diagnostic value of the PEDT and its association with intravaginal ejaculatory latency time (IELT).
(i) Korean validation of PEDT: data was collected from men interviewed by one of the two clinical experts, who made a diagnostic of present or absence of PE, using DSM-IV-TR criteria. A total of 103 patients with PE and 100 men without PE were enrolled into the study and requested to complete the PEDT; and (ii) The correlation between IELT and PEDT: 200 participants were enrolled and each participant was asked to make out PEDT. All participants were requested to measure IELT.
Validity and reliability of the PEDT and its association with IELT.
The geometric mean IELT of the PE group was 115.37 ± 78.14 seconds. The number of men reporting IELTs of <1, 1 to ≤ 2, and >2 minutes were 28 (28.6%), 29 (29.6%), and 41 (41.8%), respectively. The Cronbach's alpha score was calculated as 0.93, showing adequate internal consistency. The test-retest correlation coefficients of each item were higher than 0.72 and the correlation coefficients of the total score was 0.88. (P < 0.001) Sensitivity and specificity analyses suggested a score of ≤ 8 indicated no PE, 9 and 10 probable PE, and ≥ 11 PE. The PEDT total score and IELT showed an adequate negative correlation. (ρ = -0.77, P < 0.0001) also, the PEDT total score of the PE subgroup (IELT ≤ 2 minutes) and IELT showed a negative correlation. (ρ = -0.6, P < 0.0001)
The PEDT was highly effective in detecting the presence of PE. The result of our study supports its validity as a diagnostic tool in the clinical setting.
Journal of Sexual Medicine 12/2010; 8(3):865-71. · 3.51 Impact Factor
[show abstract][hide abstract] ABSTRACT: Heavy alcohol consumption is associated with an increased risk of erectile dysfunction (ED); however, the acute effects of ethanol (EtOH) on penile tissue are not fully understood. We sought to investigate the effects of EtOH on corporal tissue tonicity, as well as the intracellular Ca(2+) concentration ([Ca(2+)](i)) and potassium channel activity of corporal smooth muscle. Strips of corpus cavernosum (CC) from rabbits were mounted in organ baths for isometric tension studies. Electrical field stimulation (EFS) was applied to strips precontracted with 10 μmol L(-1) phenylephrine as a control. EtOH was then added to the organ bath and incubated before EFS. The [Ca(2+)](i) levels were monitored by the ratio of fura-2 fluorescence intensities using the fura-2 loading method. Single-channel and whole-cell currents were recorded by the conventional patch-clamp technique in short-term cultured smooth muscle cells from human CC tissue. The corpus cavernosal relaxant response of EFS was decreased in proportion to the concentration of EtOH. EtOH induced a sustained increase in [Ca(2+)](i) in a dose-dependent manner, Extracellular application of EtOH significantly increased whole-cell K(+) currents in a concentration-dependent manner (P < 0.05). EtOH also increased the open probability in cell-attached patches; however, in inside-out patches, the application of EtOH to the intracellular aspect of the patches induced slight inhibition of Ca(2+)-activated potassium channel (KCa) activity. EtOH caused a dose-dependent increase in cavernosal tension by alterations to [Ca(2+)](i). Although EtOH did not affect KCa channels directly, it increased the channel activity by increasing [Ca(2+)](i). The increased corpus cavernosal tone caused by EtOH might be one of the mechanisms of ED after heavy drinking.
Asian Journal of Andrology 11/2010; 12(6):890-8. · 2.14 Impact Factor
[show abstract][hide abstract] ABSTRACT: Transient receptor potential (TRP) channels play an important role in modulating intracellular Ca(2+) ([Ca(2+)](i)) levels.
We examined the hypothesis that overexpression of TRPC6(DN) (dominant negative) may contribute to decreased [Ca(2+)](i) levels in corporal smooth muscle (CSM). We also investigated whether gene transfer of TRPC6(DN) could restore erectile function in diabetic rats.
For the in vitro study, the K(Ca), K(ATP), and TRPC6(DN) channel genes were transferred using cDNA, into cultured human CSM cells and human embryonic kidney cells. For the in vivo study, young adult rats were divided into three groups: normal controls; diabetic controls transfected with vector only; and a diabetic group transfected with pcDNA of the TRPC6(DN) gene.
After gene transfer, the effects of reducing [Ca(2+)](i) levels were assessed by Fura-2-based imaging analysis. The intracavernosal pressure (ICP) response to cavernosal nerve stimulation was assessed after intracorporal injection of TRPC6(DN) pcDNA. The transgene expression of the TRPC6(DN) was examined by reverse transcription polymerase chain reaction (RT-PCR) in rats transfected with TRPC6(DN) pcDNA.
Gene transfer of ion channels effectively reduced [Ca(2+)](i). Among these channels, transfer of the TRPC6(DN) gene resulted in the greatest reduction of [Ca(2+)](i) in human CSM. The mean (+/-standard error of the mean) ratio of ICP to mean arterial pressure (BP) in the gene-transfer rats was 79.4 +/- 2.4% (N = 8). This was significantly higher than that in control rats (55.6 +/- 3.7% [N = 8]), and similar to that in the young control rats (83 +/- 2.2% [N = 12]). The RT-PCR showed expression of TRPC6(DN) genes in the transfected rats.
Gene transfer of TRPC6(DN) not only reduced [Ca(2+)](i) in human CSM but also restored erectile function in diabetic rats. These results suggest that pcDNA transfer of TRPC6(DN) may represent a promising new form of therapy for the treatment of male erectile dysfunction in the future.
Journal of Sexual Medicine 03/2010; 7(3):1126-38. · 3.51 Impact Factor
[show abstract][hide abstract] ABSTRACT: Although many reports have shown a relationship between lower urinary tract symptoms (LUTS) and sexual function (SF), it is not known which symptom(s) among LUTS should be treated to improve SF.
Thus, the aim of this study was to investigate correlations between LUTS and SF and to determine which symptom(s) should be improved to increase SF.
The correlation between the severity of LUTS and erectile dysfunction (ED) was investigated, and changes in LUTS were compared and analyzed to determine which symptom(s) should be eliminated to improve SF.
The correlation between LUTS and SF was investigated in 365 men (62.04 +/- 8.26) with benign prostatic hyperplasia. To measure the severity of the LUTS and ED, the International Prostate Symptom Score (IPSS), frequency of nocturia, uroflowmetry, residual urine, transrectal ultrasonography, and the International Index of Erectile Function (IIEF)-5 were performed at the first visit. After 3 months of treatment with alpha-blockers (n = 304), they were assessed again to evaluate the effectiveness of the treatment.
All parameters of LUTS (IPSS, age, residual urine, uroflow rate, and nocturia) except prostate volume correlated significantly with the total and each domain of IIEF-5 (P < 0.01). After 3 months, the changed scores in the IPSS-VD domain and IPSS-quality of life (QoL) correlated significantly with the improvement in total IIEF-5 and the domains of IIEF-5 (P < 0.05). The changed rates of the mean uroflow correlated significantly with the improvement in total IIEF-5 and the EF domain (P < 0.05).
Among the LUTS parameters, improvement in the IPSS-VD domain, IPSS-QoL, and mean uroflow significantly correlated with an increased score in the IIEF-5 EF domain. Thus, it is expected that the improvement of voiding symptoms and uroflow will be associated with the improvement in erectile function.
Journal of Sexual Medicine 06/2009; 6(8):2299-304. · 3.51 Impact Factor