The World Journal of Men s Health

Published by Korean Society for Sexual Medicine and Andrology
Print ISSN: 2287-4208
Histopathologic findings of the prostate lateral lobe in each of the 4 groups (H&E, ×100). (A) The control group showed extensive infiltration of inflammatory cells, including neutrophils, lymphocytes, macrophages, and degeneration of glandular epithelial cells. All of the rats showed grade 3 inflammation. (B) The ciprofloxacin group showed a nearly normal appearance of the glandular epithelium with less leukocyte infiltration. All of the rats showed grade 1 inflammation. In the (C) WSY-1075 (100 mg/kg) and (D) WSY-1075 (400 mg/kg) groups, the inflammatory cells in the lumina and the epithelial cells of the gland and stroma showed more improvement than those of the control group but less improvement than those of the ciprofloxacin group. All of the rats showed grade 1~2 inflammation.
Effect of WSY-1075 (100 mg/kg) and WSY-1075 (400 mg/kg) on serum tumor necrosis factor-α levels. Each value represents mean±standard deviation. *p<0.05, compared with the control group, †p<0.05, compared with the ciprofloxacin group.
Effect of WSY-1075 (100 mg/kg) and WSY-1075 (400 mg/kg) on serum interleukin-6 levels. Each value represents mean±standard deviation. *p<0.05, compared with the control group, †p<0.05, compared with the ciprofloxacin group.
Effect of WSY-1075 (100 mg/kg) and WSY-1075 (400 mg/kg) on serum interleukin-8 levels. Each value represents mean±standard deviation. *p<0.05, compared with the control group, †p<0.05, compared with the ciprofloxacin group.
The aim of this study was to investigate the anti-inflammatory effects of a new herbal formula (WSY-1075) in a nonbacterial prostatitis rat model. Prostatitis was induced in male Wistar rats (n=32) by treatment with 17 beta-estradiol and dihydrotestosterone for 4 weeks. After the induction of prostatitis, the rats were randomly divided into one of four treatment groups: control (n=8), ciprofloxacin (n=8), WSY-1075 (100 mg/kg) (n=8), and WSY-1075 (400 mg/kg) (n=8). After 4 weeks of treatment, the prostatic proinflammatory cytokine (tumor necrosis factor-α, interleukin [IL]-6, and IL-8) levels and histological findings were noted. The ciprofloxacin and WSY-1075 treatment groups showed significantly decreased proinflammatory cytokine levels compared with the control group. Histologically, treatment with ciprofloxacin and WSY-1075 significantly suppressed the severity of prostatitis lesions compared with those in the control group. No differences in the proinflammatory cytokine levels or histologic findings were observed with the dose dependent treatment of WSY-1075. The new herbal formula, WSY-1075, showed effective anti-inflammatory activities in the prostate and may be useful for the clinical treatment of nonbacterial prostatitis. Our findings suggest that WSY-1075 has a beneficial effect on the prevention and treatment of nonbacterial prostatitis.
Study flow diagram. KNHANES IV: the Korean National Health and Nutrition Examination Survey IV, MetS: metabolic syndrome.
Socio-demographic characteristics
Age-adjusted mean of components of metabolic syndrome, fasting insulin, HOMA-IR, and G/I ratio according to type of work
Odds ratio for type of work in relation to metabolic syndrome
Type of work might be related to insulin resistance and the metabolic syndrome (MetS). However, scant data are available. We performed this study to investigate whether the prevalence of MetS and insulin resistance differed according to occupation in middle-aged men. In all, 2,348 men in their 40s~50s who had participated in the Korean National Health and Nutrition Examination Survey IV were included and were classified into two groups according to the type of work (manual worker vs. non-manual worker). Diagnosis of MetS required satisfying three or more of the National Cholesterol Education Program-Adult Treatment Panel III criteria. Fasting insulin, the glucose/insulin ratio (G/I ratio), and the homeostasis model assessment of insulin resistance (HOMA-IR) were used to estimate the insulin resistance. We used the Mann-Whitney test, χ(2) tests, multiple linear regression test, and logistic regression analyses to examine the relationships. Age was significantly higher in the manual worker group. Body mass index was significantly lower in the manual worker group. Rates of current smoking and frequent drinking were higher in the manual worker group. In terms of surrogate markers of insulin resistance, the age-adjusted mean of fasting insulin, G/I ratio, and HOMA-IR indicated that lower insulin resistance was significantly related to manual work. After adjusting for age and other confounding factors, non-manual workers had a higher risk of the MetS than manual workers. The odds ratio in relation to MetS was significantly lower in the manual workers. MetS and impaired insulin resistance are significantly related to non-manual work in middle-aged Korean men.
The deformities caused by Peyronie disease are many and varied. All patients appearing in this figure were intracavernosally injected with alprostadil to induce erection prior to photography. The pictures illustrate a dorsal bend with skin buckling (A), a pure lateral bend (B), a more gradual dorsal curvature (C), a dorsal curve with rotational deformity (as evidenced by the laterally displaced frenulum) (D), a circumferential plaque creating a 'waist' effect (E), and a ventral curve caused by a ventral plaque (F).
Summary of recent studies investigating non-surgical treatment modalities for Peyronie disease
Peyronie disease is a common cause of penile deformity and sexual dysfunction. Although surgery is regarded as the definitive management for this condition, there are many medical and minimally invasive therapies available, with widely varying efficacy reported in the literature. The purpose of this review is to describe the current state-of-the-art for each of the most commonly used as well as several developing non-surgical treatments. Further, we hope to offer perspectives that will aid practitioners in deciding among these treatments that are either already in use or have the potential to be used as alternatives to surgery in the management of this frustrating disease.
HSP27 reverse transcription polymerase chain reaction results according to the cell type (RWPE-1, LNCaP, PC-3, and TSU-Pr1). The density of HSP27 mRNA expression was shown to be higher than the low grade malignant cell line. Values are mean±standard error of mean. HSP27: heat shock protein 27, GAPDH: glyceraldehyde-3-phosphate dehydrogenase. ap<0.05 vs. control.
Heat shock protein 27 immunofluorescence staining according to the cell type (RWPE-1, LNCaP, PC-3, and TSU-Pr1). The staining for TSU-Pr1 was more intense than that of the other cell lines. The intensity of staining was RWPE-1<LNCaP<PC-3<TSU-Pr1. ×200; Fluoview confocal laser scanning microscope (Olympus Optical Co., Ltd., Tokyo, Japan).
HSP27 gene expression patterns according to the doxazosin treatment concentration. The HSP27 gene expression with 25 µM of doxazosin treatment was higher than that with 10 µM (Control, CV, 10 µM, 25 µM). Values are mean±standard error of mean. HSP27: heat shock protein 27, GAPDH: glyceraldehyde-3-phosphate dehydrogenase. ap<0.05 vs. control.
HSP27 immunofluorescence staining of PC-3 with doxazosin treatment (Control, CV, 10 µM, 25 µM). ×200; Fluoview confocal laser scanning microscope (Olympus Optical Co., Ltd., Tokyo, Japan). CV: control vehicle, HSP27: heat shock protein 27, TUNEL: terminal transferase-mediated biotinylated 16-desoxy-uridine triphosphate nick-end labeling.
Heat shock protein 27 (HSP27) is known as the material that plays a role in apoptosis control in tumor and cell protection including the immune response, drug tolerance, and so on. In this study, HSP27 expression according to the prostate cancer malignancy level was evaluated, and HSP27 expression was also analyzed after inducing apoptosis by doxazosin treatment of the prostate cancer cell lines. Reverse transcription polymerase chain reaction (RT-PCR) and immunofluorescence staining of the HSP27 was implemented by the culture of RWPE-1, LNCaP, androgen-independent human prostate cancer cells (PC-3), and TSU-Pr1 cell lines. Analysis was separately conducted in the control group, control vector group treated by dimethyl sulfoxide, and groups treated with 10 µM or 25 µM doxazosin. The expression of HSP27 in RT-PCR and immunofluorescence staining was observed and evaluated after conversion to numerical values. In the RT-PCR results, depending on the cell type, LNCaP, TSU-Pr1 showed the highest HSP27 expression followed by PC-3, LNCaP and RWPE-1 in sequence. After doxazosin treatment, the expression detected by RT-PCR was stronger at a 25-µM doxazosin concentration compared to that at a 10-µM concentration, and the result was similar by immunofluorescence staining. HSP27 expression increased depending on the prostate cancer cell line. This meant that HSP27 expression was related to the prostate cancer malignancy level. Additionally, the higher the treatment concentration in PC-3 was, the higher the HSP27 expression was. This result showed that doxazosin induced apoptosis of prostate cancer.
Changes in prostate volume, PdetQmax, and BOOI in PVP and TURP group from baseline to 6 months follow up. White bars represent baseline and black bars 6 months follow up. PVP: photoselective laser vaporization prostatectomy, TURP: transurethral resection of the prostate, PdetQmax: detrusor pressure at maximum flow rate, BOOI: bladder outlet obstruction Index. *p<0.05.
Change in obstructive parameters - PdetQmax, BOOI prevs. post-treatment. The values were adjusted using baseline values as covariates. The white bars represent the PVP group and black bars, the TURP group. PVP: photoselective laser vaporization prostatectomy, TURP: transurethral resection of the prostate, BOOI: bladder outlet obstruction index, PdetQmax: detrusor pressure at maximum flow rate, p: group comparisons of improvement rates after treatment.
Preoperative patient characteristics in the PVP and TURP groups
Changes in IPSS, bother score, maximum flow rate, and postvoid residual volume from baseline to 6 months postoperatively in the PVP and TURP groups
Surgical complications
There is little data evaluating the changes of severity of bladder outlet obstruction after 80 W-potassium-titanyl-phosphate (KTP) photoselective laser vaporization prostatectomy (PVP) by pressure-flow study. We evaluated the efficacy of PVP to relieve the obstruction in benign prostate hyperplasia (BPH) compared with transurethral resection of the prostate (TURP). This is a prospective, non-randomized single center study. The inclusion criteria were as follows: Men suffering from lower urinary tract symptoms (LUTS) secondary to BPH, age ≥50 years, International Prostatic Symptom Score (IPSS) ≥13, maximum flow rate (Qmax) ≤15 ml/s, and ability to give fully informed consent. Patients with neurogenic cause or detrusor underactivity were excluded. The IPSS, bother score, Qmax, postvoid residual volume (PVR), detrusor pressure at maximum flow rate (PdetQmax), bladder outlet obstruction index (BOOI), and prostate volume were measured before and 6 months after surgery and compared between PVP and TURP. Sixty-seven patients (53 in PVP, 14 in TURP) were evaluable. In both groups, the IPSS, bother score, Qmax, and PVR had significantly improved (p<0.05), and there were no differences between the changes in those parameters. PVP could effectively reduce the PdetQmax, prostate volume, and BOOI from baseline (from 68.7±23.3 to 40.6±11.2 cmH2O, 49.5±16.3 to 31.3±12.1 ml, 49.8±25.6 to 9.8±20.7), similar to TURP. There were no differences in postoperative PdetQmax, prostate volume, or BOOI between the two groups. The percentage of patients with BOOI ≥40 was decreased from 64% to 4% in the PVP group and from 86% to 14% in the TURP group. PVP could reduce the prostate volume effectively and relieve bladder outlet obstruction similar to TURP by the 6-month follow up in men with BPH.
Left lateral view of the penis showing enlargement on the left side (arrow). 
Transverse ultrasound image of the abscess with heterogeneous appearance seen in the left corpus cavernosum. 
Abscess formation of the corpus cavernosum is very rare. Here, we report a case of long-term anabolic androgenic steroid (AAS) abuse that is suspected to have facilitated the development of a corpus cavernosum abscess in a healthy bodybuilder. Cultures obtained from the abscess contained Staphylococcus epidermidis, a microorganism that almost exclusively affects immunocompromised patients. Therefore, prompt drainage of pus from cavernosal bodies should be the primary aim of the treatment. This case illustrates the potential danger of AAS suppressing the immune system and causing a serious infection.
Monitoring granulomatous prostatic tubercular abscess after bacillus Calmette-Guérintreatment during anti-tuberculous medication using computed tomography (CT). (A) A CT scan showed a round low density lesion in the right lobe of the prostate (arrow). (B) A CT scan showed the disappearance of the previously noted low density lesion in the right lobe of the prostate (arrow). 
Histopathology showed granulomatous inflammation with caseating necrosis in the right lobe of the prostate. (A) A low power microphotograph showing the destruction of glandular architecture by inflammatory lesions with caseating necrosis (H&E stain,×200). (B) A high power microphotograph consisting of epithelioid cells and multinucleated giant cells displaying chronic granulomatous inflammation (H&E stain, ×400). (C) A Ziehl-Neelsen stain, known as the acid-fast stain, discloses the mycobacterium species (×1,000). Acid-fast bacilli are indicated by arrow. 
We present a case of acute prostatitis with abscess. The patient had undergone intravesical bacillus Calmette-Guérin (BCG) immunotherapy for bladder cancer. A prostate biopsy demonstrated tuberculous prostatitis with abscess. This case illustrates that when bladder cancer is treated with BCG, a tuberculous prostate abscess can develop.
(A) Swollen mass on the ventral aspect of the right proximal penile shaft, (B) penile abscess, (C) rupture of the tunica albuginea was noted inside of the abscess.  
Penile ultrasonography revealed a 3.5 cm, mixed echogenic cystic mass along the right side of the penile shaft. (A) Longitudinal view, (B) transverse view.  
Penile abscesses are rare, but can develop after trauma, injection therapy, or surgery of the penis, or as an unusual presentation of sexually transmitted diseases. We report a case of penile abscess in a 51-year-old diabetic man, presented 9 days after neglected penile fracture following intracavernosal injection therapy and sexual intercourse. Penile ultrasonography and surgical exploration confirmed the physical examination findings of involvement of the corpus cavernosum. The pus culture from the abscess revealed Enterococcous faecalis. The patient was successfully treated by surgical drainage of the abscess and primary closure of the ruptured tunica albuginea.
Study flowchart. DRE: digital rectal examination, TRUS: transrectal ultrasound.
Sensitivity and specificity plot against DRE cut-offs. DRE: digital rectal examination.
Patient characteristics
Diagnostic test results above the PV cut-off
PSA values by diagnostic tool and prostate volume
To assess the diagnostic reliability of a dichotomous digital rectal examination (DRE) tool in assessing prostate volume (PV) compared to gold-standard transrectal ultrasound (TRUS) volume measurement. Male patients presenting to a single tertiary referral centre urology practice requiring TRUS were prospectively recruited between January 2010 and August 2011. Size was estimated by DRE immediately prior to TRUS measurement. DRE measurements were classed into four groups: <30 mL , 30 to 49 mL, 50 to 99 mL and >100 mL. The primary outcomes were sensitivity, specificity, and the positive and negative likelihood ratios for a 30 mL cut-off. Three hundred and three patients were recruited to the study. The median age of the study group was 64.9 years. On TRUS analysis, 244 patients had a PV larger than 30 mL and 139 of them, larger than 50 mL. The median PV was 47 mL with a median International Prostate Symptom Score of 10 and prostatic specific antigen (PSA) of 5.7. When analysed for the ability to identify a gland larger than 30 mL, DRE had a high sensitivity and low negative likelihood ratio. The median PSA level (ng/L) for prostates measured by DRE with a 30 mL cut-off was significantly different with higher median PSA values for volumes larger than 30 mL. DRE is a reliable tool for dichotomous assessment of prostatic volumes above 30 mL and 50 mL. These results illustrate the value of re-examining the role of categorical DRE estimations in benign prostatic hyperplasia patients.
Giant condyloma acuminatum covering the penis, scrotum, and inguinal area. 
Genital appearance after treatment. 
Giant condyloma acuminatum (also known as Buschke-Löwenstein tumor) is a rare disease, for which the treatment of choice is still controversial. In the case described in this report, we used a combination of electrocautery and a surgical scalpel to resect a huge genital wart, followed by long-term local treatment with podophyllin. This procedure was relatively fast, easy to perform, involved minimal bleeding, and did not result in any complications. Moreover, combination therapy enabled us to avoid deep resection of the lesion and consequently, sexual function was preserved completely.
Bacterial species detected in men with acute epididymitis
Comparison of negative and positive urine culture groups' patient characteristics
Comparison ofcharacteristics of positive urine culture patients between STO culture group and non-STO culture group (N=20)
We evaluated adult patients with acute epididymitis to identify the frequency of actual sexual contacts and the causative organism, and compared clinical examinations, degrees of manifested symptoms, and radiological test results. We reviewed the medical records of 65 patients older than 18 years presenting with acute epididymitis who had been treated between 2002 and 2011. Scrotal ultrasonography, urinalysis, and urine culture were performed to diagnose the acute epididymitis. Patients were divided into negative (n=45) and positive (n=20) urine culture groups. Then the latter groups were subdivided into a sexually transmitted organism (STO) culture group (n=13) and a non-STO (n=7) culture group. Data on any history of sexual contact, scrotal pain and tenderness, symptoms of urethritis (discharge, dysuria, urethral burning, or irritation), and lower urinary tract symptoms (dysuria, frequency, and urgency of urination) were obtained from all of the subjects. Patients in the positive urine culture group were significantly younger than those in the other group (p=0.224) and were more likely to have a history of sexual contact at least two weeks prior to onset of epididymitis (p=0.012). They had also a significantly enlarged epididymal head and significantly more severe complaints of pain or tenderness than those of latter group (p=0.348, p=0.288). However, the difference in these measures between the STO and non-STO group was not significant, except in the case of age (p=0.044). Patients of the positive urine culture group with acute epididymitis were significantly younger and more sexually active than the others. They also had severe pain or tenderness and an enlarged epididymal head. There was a close association between clinical symptoms, a positive urine culture, and ultrasonographic findings.
Ultrasonography revealed a normal right testis with septated paratesticular cystic mass. 
The hernia sac filled with hemorrhagic fluid (white arrow) was separated from right testis. A hernia sac communicated directly with the peritoneum (black arrow) and was twisted an angle of about 360 o and contained no internal contents. 
Torsion of a hernia sac is an extremely rare condition that presents as acute scrotum in children. We report a case of a 6-year-old boy who presented with an acute scrotum and was found during surgical exploration to have torsion of an indirect hernia sac associated with hydrocele. Upon scrotal exploration, deterioration of the scrotum due to inflammatory changes was found. A necrotic cyst was recognized within a communicating hydrocele of the scrotum and was twisted at an angle of about 360°. All urologists should be aware of this special condition in the differential diagnosis of acute scrotum.
Interplay between adipocyte and androgen. AR: adrenoreceptor, LPL: lipo-protein lipase, TG: triglyceride, ARO: aromatase, DHT: dihydrotestosterone, AKR1C: Aldo-keto-reductase 1C.
Adipose tissue, where various metabolic hormones are secreted, plays a role in metabolizing different substances including androgen. Within fat tissue, enzymes such as aromatase and aldo-keto reductase 1C are responsible for metabolizing testosterone into estrogen and 5-dihydrotestosterone into inactive metabolites. Adipose tissue can also affect the secretion of gonadotropin, which influences the formation of androgen in the testes. At the same time, androgen has an impact on the distribution and proliferation of adipose tissue. The adrenoreceptors for catecholamines, which have been proven to play an essential role in controlling lipolysis, function by being up-regulated by androgens. Furthermore, androgens regulate the activity of lipoprotein lipase, a key enzyme involved in intracellular esterification of adipose tissue.
Protective effect of rolipram from apoptotic cell death in seminiferous tubules following pelvic irrdiation (IR) (2Gy). (A) Representative images (×400) showing apoptotic cells stained with transferase dUTP-biotin nick end labeling (TUNEL) in irradiation testis with or without rolipram treatment at 12 hours post-irradiation. Apotosis was easily recognized by the presence of entire apoptotic bodiesstained by peroxidase. Irradiation increased the expression of the apoptotic nuclei in the germ cells of the mice. Most of the apoptotic cells were in the spermatogonia and primary spermatocytes. Rolipram treatment before irradiation decreased the TUNEL-positive cells compared with the vehicle-treated mice. (B) The graph depicts the number of apoptotic cells per seminiferous tubule in the testis section, as observed using the TUNEL method. Values are reported as the mean±standard deviation of five mice in each group (*p<0.05 as compared to the irradiation control group). 
Protective effect of rolipram on the body and testis weight 35 days following pelvic irrdiation (IR) (2Gy). Graphs showing body weight (A), testis weight (B), and testis per body weight (C). Values are reported as the mean±standard deviation of five mice in each group (*p<0.05 as compared with the irradiation control group). 
Protective effect of rolipram on sperm characteristics in the testis 35 days following pelvic irrdiation (IR) (2Gy). Graphs showing the number of sperm per cauda epididymis (A), and sperm mobility (B). Values are reported as the mean±standard deviation of five mice in each group (*p<0.05 as compared with the irradiation control group). 
Effect of rolipram on phosphorylated CREB (pCREB) and total (tCREB) expression in the testis after pelvic irradiation (IR) (2 Gy). (A) Western blot analysis of pCREB and tCREB expression after 12 hours and 35 days following pelvic irrdiation (2 Gy). Values are reported as the mean±standard deviation of five mice in each group (*p<0.05 as compared with the irradiation control group). (B) Representative images (×100) showing pCREB-stained testis sections from the sham control, rolipram+sham control, irradiation control, and rolipram+irradiation groups 35 days after irradiation. OR: odds ratio. 
Pelvic irradiation for the treatment of cancer can affect normal cells, such as the rapidly proliferating spermatogenic cells of the testis, leading to infertility, a common post-irradiation problem. The present study investigated the radioprotective effect of rolipram, a specific phosphodiesterase type-IV inhibitor known to increase the expression and phosphorylation of the cyclic adenosine monophosphate response element-binding protein (CREB), a key factor for spermatogenesis, with the testicular system against pelvic irradiation. Male C57BL/6 mice were treated with pelvic irradiation (2 Gy) and rolipram, alone or in combination, and were sacrificed at 12 hours and 35 days after irradiation. Rolipram protected germ cells from radiation-induced apoptosis at 12 hours after irradiation and significantly increased testis weight compared with irradiation controls at 35 days. Rolipram also ameliorated radiation-induced testicular morphological changes, such as changes in seminiferous tubular diameter and epithelial height. Additionally, seminiferous tubule repopulation and stem cell survival indices were higher in the rolipram-treated group than in the radiation group. Moreover, rolipram treatment counteracted the radiation-mediated decrease in the sperm count and mobility in the epididymis. These protective effects of rolipram treatment prior to irradiation may be mediated by the increase in pCREB levels at 12 hours post-irradiation and the attenuated decrease in pCREB levels in the testis at 35 days post-irradiation in the rolipram-treated group. These findings suggest that activation of CREB signaling by rolipram treatment ameliorates the detrimental effects of acute irradiation on testicular dysfunction and the related male reproductive functions in mice.
Comparison of seminal parameters between the surgical group and drug group before and after treatment
Summary of articles of varicocele repair performed in men with NOA
A male factor is the only cause of infertility in 30% to 40% of couples. Most causes of male infertility are treatable, and the goal of many treatments is to restore the ability to conceive naturally. Varicoceles are present in 15% of the normal male population and in approximately 40% of men with infertility. Varicocele is the most common cause of male infertility that can be corrected surgically. In males with azoospermia, the most common cause is post-vasectomy status. Approximately 6% of males who undergo vasectomy eventually seek reversal surgery. Success of vasectomy reversal decreases with the number of years between vasectomy and vasovasostomy. Other causes of obstructive azoospermia include epididymal, vasal or ejaculatory duct abnormalities. Epididymal obstruction is the most common cause of obstructive azoospermia. Patients with epididymal obstruction without other anatomical abnormalities can be considered as candidates for vasoepididymostomy. With microsurgical techniques, success of patency restoration can reach 70~90%. In case of surgically uncorrectable obstructive azoospermia, sperm extraction or aspiration for in vitro fertilization is needed. Nonobstructive azoospermia is the most challenging type of male infertility. However, microsurgical testicular sperm extraction may be an effective method for nonobstructive azoospermia patients.
Descriptive statistics showing differences between the early and late recovery groups
Patient distribution of the neurovascular bundle sparing technique and the type of surgical procedure between the early and late recovery group
Age-adjusted partial correlation coefficients (r) between parameters and continence recovery duration
Multivariate analysis of the relationship between parameters and continence recovery duration
We analyzed factors associated with early recovery of continence after laparoscopic radical prostatectomy. Among 467 patients treated with laparoscopic radical prostatectomy for localized prostate cancer between 2007 and 2012, 249 patients who underwent a preoperative urodynamic study were enrolled. The patients' age, prostate volume, preoperative serum prostate-specific antigen (PSA), Gleason score, pathologic stage, and preoperative urodynamic parameters were recorded. The preoperative membranous and prostatic urethral length on magnetic resonance image, nerve sparing technique, and type of surgical procedure (extrafascial and intrafascial) were analyzed. Patients were considered to have early recovery of continence when they needed no pad in 3 months or less after surgery. Ninety-two patients were in the early recovery group and 157 were in the late recovery group. The membranous urethral lengths were 12.06±2.56 and 11.81±2.87 mm, and prostatic urethral lengths were 36.39±6.15 and 37.45±7.55 mm in each group, respectively. The membranous-posterior urethral length ratios were 0.25±0.06 and 0.24±0.06, and prostatic-posterior urethral length ratios were 0.75±0.06 and 0.76±0.06, respectively. In and of themselves, the membranous and prostatic urethral lengths were not associated with recovery duration however, the membranous-total and prostatic-total urethral length ratios were related (p=0.024 and 0.024, respectively). None of the urodynamic parameters correlated with continence recovery time. In the multivariate analysis, the type of surgical procedure (odds ratio [OR], 7.032; 95% confidence interval [CI], 2.660 to 18.590; p<0.001) and membranous urethral length (OR, 0.845; 95% CI, 0.766 to 0.931; p=0.001) were significantly related to early recovery of continence. The current intrafascial surgical procedure is the most important factor affecting early recovery of continence after laparoscopic radical prostatectomy.
Baseline characteristics 
The aim of this study was to investigate the efficacy of mirodenafil in middle-aged male patients with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). Eighty-eight males with CP/CPPS were randomized to receive either levofloxacin (500 mg/d) (group L, 40 patients) or levofloxacin (500 mg/d) and mirodenafil (50 mg/d) (group ML, 48 patients) for six weeks. The International Prostate Symptom Score (IPSS), National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI), and erectile function (EF) domain scores of the International Index of Erectile Function (IIEF) questionnaire were used to grade symptoms at baseline and 6 weeks after treatment. The mean change in total IPSS from baseline was higher in group ML than that in group L (group L, -1.1 vs. group ML, -4.3; p<0.05). Significant improvements were also seen in the IPSS voiding subscore (group L, -0.7 vs. group ML, -3.0; p<0.05). Changes observed in the NIH-CPSI of group ML at six weeks were greater than those at baseline (group L, -3.2 vs. group ML, -7.2; p<0.05). Significant improvements were seen in the NIH-CPSI voiding (group L, -0.5 vs. group ML, -1.7; p<0.05) and quality of life domains (group L, -1.0 vs. group ML, -1.8; p<0.05). Group ML showed a significantly greater increase in the IIEF-EF score than did group ML (group L, +0.2 vs. group ML, +7.8; p<0.05). Mirodenafil (50 mg once daily) was well tolerated and resulted in significant symptomatic improvement in middle-aged males with CP/CPPS.
Effect of exendin-4 on testis morphology of normal and aging mouse models (n=12) Groups Testis weight (mg) Testis length (mm) Testis width (mm) Testis volume (mm 3 ) 
Effect of exendin-4 on the sperm count of normal and aging mouse models. Values are presented as mean±standard error; n=12. *p<0.05 compared with the D-galactose group, # p <0.05 compared with the control group. 
The purpose of this study was to evaluate the role of exendin-4 on reproductive alteration in a D-galactose-induced aging mouse model. In this experimental study, 72 male Naval Medical Research Institute mice (20~25 g) were randomly divided into six groups: control, exendin-4 (1 nmol/kg), exendin-4 (10 nmol/kg), D-galactose (500 mg/kg), D-galactose+exendin-4 (1 nmol/kg), and D-galactose+exendin-4 (10 nmol/kg). The aging model animals were gavaged with D-galactose for six weeks, and exendin-4 was injected intraperitoneally in the last 10 days. At the end of treatment serum luteinizing hormone (LH), follicle-stimulating hormone (FSH) and testosterone levels were evaluated and the cauda epididymis and testis were removed to analyze the sperm count and testis morphology. The testis weight and volume decreased in the D-galactose group (p<0.01 and p<0.05) respectively. Exendin-4 (1, 10 nmol/kg) increased these parameters in the normal and aging mouse models. Serum LH and FSH levels increased and the sperm count decreased in the D-galactose group (p<0.05). Further, exendin-4 (1 nmol/kg) decreased LH and FSH levels and increased the serum testosterone level and sperm count in both normal and aging animals. D-galactose can induce aging alternations in the male reproductive system such as decreased sperm count and increased serum LH and FSH levels through reactive oxygen species over production and reduced antioxidant enzyme activity. Further, co-administration of exendin-4 reduced reproductive complications of D-galactose in an aging mouse model.
Effect of hydro-alcoholic extract of Rhus coriaria (S) seeds on sperm count in normal and nicotinamide-streptozotocininduced diabetic mice. Values are presented as mean±standard error; n=8. GLI: glibenclamide, S: Sumac. a p<0.05 compared with the diabetic group, b p<0.05 compared with the control group. 
Effect of hydro-alcoholic extract of Rhus coriaria (S) seeds on sperm viability in normal and nicotinamide-streptozotocininduced diabetic mice. Values are presented as mean±standard error; n=8. GLI: glibenclamide, S: Sumac. a p<0.05 compared with the diabetic group, b p<0.05 compared with the control group. 
Effect of hydro-alcoholic extract of Rhus coriaria (S) seeds on serum luteinizing hormone (LH) levels in normal and nicotinamide-streptozotocin-induced diabetic mice. Values are presented as mean±standard error; n=8. GLI: glibenclamide, S: Sumac. a p<0.05 compared with the diabetic group, b p<0.05 compared with the control group. 
Effect of hydro-alcoholic extract of Rhus coriaria (S) seeds on serum follicle-stimulating hormone (FSH) levels in normal and nicotinamide-streptozotocin-induced diabetic mice. Values are presented as mean±standard error; n=8. GLI: glibenclamide, S: Sumac. a p<0.05 compared with the diabetic group, 
Effect of hydro-alcoholic extract of Rhus coriaria (S) seeds on serum testosterone level in normal and nicotinamidestreptozotocin-induced diabetic mice. Values are presented as mean±standard error; n=8. GLI: glibenclamide, S: Sumac. a p <0.05 compared with the diabetic group, b p<0.05 compared with the control group. 
The purpose of this study was to investigate the effects of the hydro-alcoholic extract of Rhus coriaria seeds on the reproductive system of nicotinamide-streptozotocin-induced type-2 diabetic mice. In this experimental study, 56 male Naval Medical Research Institute mice were randomly divided into seven groups (n=8): control; diabetic mice; diabetic mice administered glibenclamide (0.25 mg/kg); diabetic mice who received the hydro-alcoholic extract of R. coriaria seeds (200 and 400 mg/kg groups); and normal mice who received this extract (200 and 400 mg/kg groups). Diabetes was induced by intraperitoneal administration of streptozotocin (65 mg/kg) 15 minutes after an injection of nicotinamide (120 mg/kg). Then, glibenclamide and the above mentioned extract were administered orally for 28 consecutive days. Twenty-four hours after the last treatment, serum samples, the testes, and the cauda epididymis were removed immediately for hormonal, testis morphology, and sperm parameter assessments. Body and testicular weight, sperm count and viability, and serum luteinizing hormone, follicle-stimulating hormone and testosterone levels were significantly lower in the diabetic mice (p<0.05). The diabetic mice treated with 400 mg/kg of the hydro-alcoholic extract of R. coriaria seeds recovered from these reductions (p<0.05). Further, glibenclamide alleviated hormonal and sperm count depletion in diabetes-induced mice (p<0.05). The present results indicated that the hydro-alcoholic extract of R. coriaria seeds has anti-infertility effects in diabetic males.
Baseline characteristics of the patients 
Changes in the International Index of Erectile Function (IIEF) after treatment with 10 mg alfuzosin. p value: compared with the first visit. 
Changes in the Male Sexual Health Questionnaire Ejaculation Function Domain (MSHQ-EjFD) after treatment with 10 mg alfuzosin. p value: compared with the first visit. 
To identify sexual function improvement associated with alfuzosin (10 mg daily for 2 years). We enrolled 30 men with lower urinary tract symptom (LUTS) who visited Gyeongsang National University Hospital between 2010 and 2012. At first visit, urinalysis, prostate specific antigen, transrectal ultrasound, and uroflowmetry were performed. The nternational Prostate Symptom Score (IPSS), quality of life (QoL), International Index of Erectile Function (IIEF), and Male Sexual Health Questionnaire Ejaculation Function Domain (MSHQ-EjFD) questionnaires were administered, and the subjects answered the same questionnaires at 1 month, 6 months, 1 year, and 2 years of follow-up. Twelve men completed of the entire study. After administration of alfuzosin, the median IPSS at first visit, 1 month, 6 months, 1 year, and 2 years was 18.00 (interquatile range [IQR]: 14.00~29.75), 20.00 (IQR: 11.50~30.00), 15.50 (IQR: 8.50~25.25), 14.50 (IQR: 9.25~19.50), and 11.50 (IQR: 5.00~17.75), respectively, which showed an improvement. The median QoL at the same times was 4.50 (IQR: 4.00~5.00), 4.50 (IQR: 4.00~5.00), 3.00 (IQR: 2.00~4.00), 3.50 (IQR: 2.25~4.00), and 3.00 (IQR: 1.00~3.00), respectively, and also showed improvement. Likewise, the median IIEF was 36.50 (IQR: 24.50~46.75), 37.50 (IQR: 26.75~47.25), 45.50 (IQR: 35.00~59.75), 48.50 (IQR: 34.75~62.75), and 47.50 (IQR: 43.25~61.00), while the median MSHQ-EjFD was 19.00 (IQR: 12.0~24.75), 19.50 (IQR: 13.50~27.75), 23.00 (IQR: 19.25~32.25), 26.50 (IQR: 18.25~34.50), 27.00 (IQR: 21.50~32.50), respectively, with both showing improvement. After administration of alfuzosin (10 mg daily for 2 years), the IPSS, QoL, IIEF, and MSHQ-EjFD all improved significantly. This means long-term administration of 10 mg of alfuzosin daily would be effective not only for LUTS but also erectile function and ejaculation.
Comparison of parameters at baseline and after TRT in 246 patients
Comparison of parameters at baseline and after TRT in 246 patients
Comparison of parameters at baseline and after TRT in 17 selected patients with moderate LUTS without BPH medication
Comparison of baseline characteristics in patients with or without BPH-related medication
To evaluate the actual impact of testosterone replacement therapy (TRT) on patients with lower urinary tract symptom (LUTS), without benign prostate hyperplasia (BPH) medication. Two hundreds forty-six patients underwent TRT using intramuscular injection of 3 months bases injection of testosterone 100 mg undecanoate over a year. Among them, 17 patients had moderate LUTS with a maximal flow rate of at least 10 ml/s but did not take any BPH-specific medication during TRT. The changes in prostate specific antigen (PSA), International Prostate Symptom Score (IPSS), and uroflowmetery were measured before and after TRT. After TRT, PSA remained unchanged after a year of treatment (p=0.078). Compared with their counterparts (n=229), the patients without BPH medication had similar baseline prostate characteristics in all variables, including prostate volume, IPSS, maximal flow rate, voiding volume, and PSA, except the median amount of residual urine, which was higher in the patients without BPH medication (21 ml vs. 10 ml). In the no-BPH medication group, the total IPSS score was decreased significantly (p=0.028), both in storage symptoms (questionnaire 2, 4, 7) and voiding symptoms (questionnaire 1, 3, 5, 6), while the maximal flow rate and residual urine amount remained unchanged after a year of TRT. During the median follow up of 15.1 months, no patients experienced urinary retention, BPH-related surgery, or admission for urinary tract infection. Over a year of TRT for the no-BPH medication patients with moderate LUTS and maintained a relatively high maximal flow rate and improved both storage and voiding symptoms, without the clinical progression of BPH or rising PSA.
To investigate the relationships among the Wnt/β-catenin pathway, androgen receptor (AR), and clinicopathological factors in hormone-naïve prostate cancer. This study was conducted with132 cases of hormone-naïve prostate cancer treated by prostatectomy and prostate needle biopsy. An immunohistochemical study using antibodies against β-catenin, matrix metalloproteinase-7 (MMP-7), and the AR was performed. For the in vitro study, PC-3, LNCaP, 22Rv1, and DU145 cell lines were used. The clinical or pathological stage ware a localized cancer in 36 patients (27.3%), locally advanced cancer in 31 (23.5%), and metastatic cancer in 65 (49.2%). We detected increased β-catenin, AR, and MMP-7 expression with a high Gleason grade, disease progression, and increasing serum prostate-specific antigen (PSA) levels (p<0.01). In Spearman's rank correlations, the expression of cytoplasmic β-catenin, MMP-7, and the AR were found to be significantly positively correlated. In addition, the expression of β-catenin, MMP-7, and the AR were significantly correlated with clinicopathological variables indicative of a poor prognosis. Forty-nine patients with primary androgen deprivation had short response durations from hormone therapy to PSA progression with elevated MMP-7 expression on the Kaplan-Meier curve (p=0.0036). These data show that an activated Wnt/β-catenin pathway and AR expression in prostate cancer are correlated with metastasis and aggressiveness. In addition, the expression of MMP-7 protein, a target of the Wnt/β-catenin pathway, is associated with PSA progression in prostate cancer patients undergoing primary hormone therapy.
Characteristics of the patients treated with primary androgen-deprivation therapy 
(A) Prostate-specific antigen (PSA) progression according to the PSA nadir. PSA progression-free survival in patients with localized (B), locally advanced (C), and metastatic prostate cancer given primary androgen-deprivation therapy according to the PSA nadir (D). 
Comparison of the patients treated with primary androgen-deprivation therapy according to prostate cancer stage 
Clinical factors predictive of PSA progression based on a Cox regression analysis 
Prostate-specific antigen (PSA) progression-free survival in patients with localized (A), locally advanced (B), and metastatic prostate cancer on primary androgen-deprivation therapy according to the Gleason score (C). 
To evaluate the characteristics of patients who received primary androgen deprivation therapy (PADT) for prostate cancer and the clinical efficacy of this treatment. Two hundred forty patients treated by PADT were reviewed. These patients could not receive definitive therapy owing to old age, patient need, and medical comorbidity. The patients were divided into three groups according to the extent of prostate cancer: localized, locally advanced, and metastatic. Then, prostate-specific antigen (PSA) progression in these groups was analyzed. The median age of the patients was 73.0 years, and the median pretreatment PSA level was 47.0 ng/mL. Of the patients, 91.7% were treated with combined androgen blockade, and 8.3% were treated with monotherapy. Clinical factors for PSA progression were a PSA nadir and a high clinical stage. Estimated PSA recurrence-free median survival time in each group was 57, 24, and 12 months, respectively. A PSA nadir of >0.2 ng/mL and metastatic stage were independent factors for expecting a poor response to PADT (hazard ratio 4.26, p<0.001; and 2.60, p<0.001). Patients with localized or locally advanced prostate cancer who did not receive definitive therapy had lower PSA progression rates than those at metastatic stage during PADT. Further, a PSA nadir of ≤0.2 ng/mL showed better progression-free survival. Therefore, PADT can be another therapeutic option in well-selected patients with localized or locally advanced prostate cancer and PSA change should be checked carefully.
Cardiac risk stratification
Cardiac risk stratification
Pharmacokinetic data for the five PDE5 inhibitors used to treat erectile dysfunction in Korea
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.
Prostate weights in each experimental groups. Group I: control group, Group II: andropause, Group III: andropause treated with anthocyanin. aSignificant difference (p<0.05) compared with the Group I.
H&E stain of the prostate in each experimental groups. (A) It shows normal prostate gland (Group I). (B) All acini of the prostate gland were diffusely atrophic. Each atrophic acini formed a relatively certain round shape and were separated by thick fibrohyaline collar and stromal fibrosis (Group II). (C) All acini of the prostate gland were diffusely atrophic. The variable sized and shaped acini closely packed together and lined by atrophic epithelium. Also fibrohyaline collar and stromal fibrosis, separated each acini, were decreased (Group III).
Comparisons of the activity of superoxide dismutase (SOD) and apoptotic index in each experimental groups. Group I: control group, Group II: andropause, Group III: andropause treated with anthocyanin. aSignificant difference (p<0.05) compared with the Group I. bSignificant difference (p<0.05) compared with the Group II.
Terminal deoxyribonucleotidyl transferase-mediated dUTP-digoxigenin nick end-labelling (TUNEL) stain in each experimental groups (×200). (A) A fewer cells were stained positively (Group I). (B) Nearly almost cells were stained positively (Group II). (C) Positively stained cells were decreased in Group III compared with Group II.
Changes in prostate weight, activity of SOD and the apoptotic index in the experimental groups
To evaluate the anti-apoptotic effect of the antioxidant reaction of anthocyanin on the prostate in an andropause animal model. Sprague-Dawley rats were divided into three groups (n=12 in each): control (Group I), andropause (Group II), andropause treated with anthocyanin (Group III). For induction of andropause, Group II and III underwent bilateral orchiectomy. Group III was treated with daily oral anthocyanin (160 mg/kg) for 8 weeks. After 8 weeks, the rats were sacrificed and their blood and prostates were examined pathohistologically and evaluated for oxidative stress and apoptosis. Oxidative stress was assessed by the activity of superoxide dismutase (SOD) and apoptosis in the prostate was identified by terminal deoxyribonucleotidyl transferase-mediated dUTP-digoxigenin nick end-labelling assay. Group II showed markedly increased activity of SOD in serum over that observed in Group I, whereas the rats in Group III showed reduced oxidative stress compared to Group II. Despite no significant differences in prostate weight between Group II and III (p=0.078), the apoptotic index was significantly greater in Group II than Group I, and was significantly lesser in Group III than Group II. We suggest that the oxidative stress caused by low testosterone may be another inducer of apoptosis, and this apoptosis may partly contribute to the overall apoptosis of the prostate in the andropause animal model. Therefore, anthocyanin supplementation may contribute to preventing excessively rapid cell death by apoptosis in the prostate in an animal model of andropause.
Preclinical in vivo angiogenic growth factor therapies for erectile dysfunction
Preclinical in vivo cell/stem cell therapies for erectile dysfunction targeting endothelial cell regeneration
The cavernous endothelium plays a crucial role in regulating the tone of the underlying smooth muscle and physiologic penile erection. Recently, the link between erectile dysfunction (ED) and cardiovascular disease was unveiled, and the main etiology of ED was found to be vasculogenic. Although oral phosphodiesterase-5 inhibitors are generally effective for men with ED, such therapies do not cure underlying vasculopathy in the corpus cavernosum tissue. This review addresses current preclinical protein, gene, and cell or stem cell therapies for enhancing cavernous endothelial regeneration and restoring erectile function.
Randomized clinical trials and large-scale long-term observational studies concerning antipsychotic-induced sexual dysfunction
Sexual dysfunction is a common condition in patients taking antipsychotics, and is the most bothersome symptom and adverse drug effect, resulting in a negative effect on treatment compliance. It is known that hyperprolactinemia is a major cause of sexual dysfunction. Based on the blockade of dopamine D2 receptors, haloperidol, risperidone, and amisulpride are classed as prolactin-elevating antipsychotics, while olanzapine, clozapine, quetiapine, ziprasidone, and aripiprazole are classed as prolactin-sparing drugs. Risperidone and the other typical antipsychotics are associated with a high rate of sexual dysfunction as compared to olanzapine, clozapine, quetiapine, and aripiprazole. With regard to treatment in patients suffering from sexual dysfunction, sildenafil was associated with significantly more erections sufficient for penetration as compared to a placebo. Subsequent studies are needed in order to provide physicians with a better understanding of this problem, thereby leading toward efficacious and safe solutions.
Cystoscopy showed bullous erythematous changes of the dome of the urinary bladder. However, there was no definite fistulous tract opening or stool debridement in the bladder. 
Computed tomography scan demonstrates enhanced mass-like mucosal thickening at the right side of the bladder (white arrow). 
Intraoperative laparoscopic findings show a long appendix, which is firmly attached to the right side of the urinary bladder dome (white arrow). B: bladder, C: cecum. 
A 26-year-old man complained of a vague low abdominal discomfort for the previous 2 months. Radiologic evaluations demonstrated that there was tubular structure connected with the right side wall of the bladder, suggesting Meckel's diverticulum with fistula formation to the bladder as well as a mass-like bladder wall thickening. With an impression of Meckel's diverticulum with fistula with the bladder, laparoscopic surgery was performed to confirm a diagnosis and to manage the Meckel's diverticulum with fistula with the bladder. The distal tip of the appendix was firmly attached to the right side of the bladder. The final diagnosis was corrected by laparoscopy followed by laparoscopic appendectomy and fistula repair. Vesico-appendiceal fistula is an uncommon type of vesico-enteral fistula and a rare complication of unrecognized appendicitis. Additionally, this report showed the significant value of laparoscopy as a diagnostic and therapeutic tool to this entity.
Urethroscopy of the prostatic urethra shows a smooth, well marginated polypoid mass, white grayish in color, and stalks from the prostatic urethra above the verumontanum.  
Transrectal ultrasonography shows a 1.4 cm echogenic mass that originated from the prostatic urethra.  
The prostatic mass was removed after transurethral resection.  
The microscopic findings show that the fibrovascular core of tumor cells is oriented toward the lamina propria and there is an inverted pattern of growth with a papillary projection (H&E stain, ×100).  
Inverted papilloma of the urinary tract is a rare benign lesion. We report, to our knowledge, the first case of inverted papilloma of the prostatic urethra arising in a juvenile. Our patient was referred for evaluation of painless, gross hematuria and voiding difficulty. Transrectal sonography demonstrated a 1.4 cm papillary lesion on the medial aspect of the prostatic urethra. Cystoscopy showed a solitary, papillary tumor on the prostatic urethra. Transurethral resection was performed and histological examination showed an inverted papilloma.
Artificial urinary sphincter components. Picture provided by AMS company.
American Medical System artificial urinary sphincters. A: AS721 (1972~1979), B: AS742 (1974~1979), C: AS761 (1976~1977), D: AS791/792 (1977~1979), E: AMS800 Single Cuff (1983~now), F: AMS800 Double Cuff (1986~now). Pictures provided by AMS company.
Comparison of males and females
The evolution of the artificial urinary sphincter has affected the current surgical options for urinary incontinence. With its unique features, the artificial urinary sphincter (AUS) has been an attractive option for the treatment of urinary incontinence regardless of gender. The current paper discusses the indications, contraindications, types of devices, surgical approaches, outcomes, and complications of the AUS in the treatment of both male and female urinary incontinence. A PubMed review of the available literature was performed and articles reporting implantation of artificial urinary sphincters for urinary incontinence in both male and female patients were evaluated. There was a comparable satisfactory continence rate after the implantation of an AUS (59~97% in males vs. 60~92% in females). In comparison, there were some differences in the indications, contraindications, surgical approaches, outcomes, and complications of the AUS implanted for urinary incontinence in male and female patients. AUS implantation is a safe and effective surgical option for the treatment of urinary incontinence of various etiologies. Continuous evolution of the device has made it an attractive option for the treatment of both male and female urinary incontinence.
Efficacy of tadalafil in men with lower urinary tract symptoms
This review assesses lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) with or without erectile dysfunction (ED) and related therapies focusing on tadalafil. A literature search was obtained and reviewed for the epidemiology, treatment therapies, pathophysiology, and efficacy and safety of phosphodiesterase type 5 inhibitor (PDE5i) tadalafil in patients with LUTS/BPH. Approximately 42% of men aged 51 to 60 years have BPH. Approximately 90% of men aged 45 to 80 years have LUTS. Occurrence of LUTS increases with age for almost all racial/ethnic groups (range, 32% to 56%) with prevalence of LUTS highest among Hispanic men, then Blacks, Caucasians, and Asians. There is an independent relationship with LUTS/BPH and ED, with approximately 70% of men with LUTS/BPH having ED with severity of one disease often correlating with the other. The European Urological Association guidelines include the use of the PDE5i tadalafil. Tadalafil is the only therapy recommended for treatment of co-existing BPH and ED, while other therapies have unwanted ED side effects. The mode of action of tadalafil may involve different areas of the lower urinary tract such as smooth muscle cell relaxation in the bladder neck, prostate, and urethra, but there may also be resulting modulation of the afferent nerve activity. Tadalafil (5 mg) in Asian men with LUTS/BPH, similar to global studies, is efficacious and safe. Tadalafil (5 mg) improves co-existing LUTS/BPH and ED, independently. Men with LUTS/BPH likely also have ED. Asian men with LUTS/BPH have similar incidence rates, co-existing ED, comorbid diseases, and risks as non-Asian men. Tadalafil can improve co-existing LUTS/BPH and ED.
Patients' characteristics 
Intraoperative and postoperative outcomes 
Despite the large number of analytical reports regarding the learning curve in the transition from open to robot-assisted radical prostatectomy (RARP), few comparative results with laparoscopic radical prostatectomy (LRP) have been reported. Thus, we evaluated operative and postoperative outcomes in RARP versus 100 simultaneously performed LRPs. A single surgeon had performed more than 1,000 laparoscopic operations, including 415 cases of radical nephrectomy, 85 radical cystectomies, 369 radical prostatectomies, and treatment of 212 other urological tumors, since 2009. We evaluated operative (operation time, intraoperative transfusion, complications, hospital stay, margin status, pathological stage, Gleason score) and postoperative (continence and erectile function) parameters in initial cases of RARP without tutoring compared with 100 recently performed LRPs. Mean operation time and length of hospital stay for RARP and LRP were 145.5±43.6 minutes and 118.1±39.1 minutes, and 6.4±0.9 days and 6.6±1.1 days, respectively (p=0.003 and p=0.721). After 17 cases, the mean operation time for RARP was similar to LRP (less than 2 hours). Positive surgical margins in localized cancer were seen in 11.1% and 8.9% of cases in RARP and LRP, respectively (p=0.733). At postoperative 3 months, sexual intercourse was reported in 14.0% and 12.0%, and pad-free continence in 96.0% and 81.0% in patients with RARP and LRP, respectively (p=0.796 and p=0.012). Previous large-volume experience of LRPs may shorten the learning curve for RARP in terms of oncological outcome. Additionally, previous experience with laparoscopy may improve the functional outcomes of RARP.
We evaluated the self-reported prevalence of and attitudes toward premature ejaculation (PE) in a community-based study of married couples. A community-based cross-sectional study of PE was conducted among married couples in Gwangju, Korea. Self-reported data were collected through the use of questionnaires, which included demographic questions, the Premature Ejaculation Diagnostic Tool (PEDT), the intravaginal ejaculation latency time (IELT), patient-reported outcome (PRO), and the Female Sexual Function Index (FSFI). Of the 290 couples who completed the survey, the prevalence of PEDT-diagnosed PE including probable PE was 23.7% of men. By IELT measure, the prevalence of PE was 21.7% as reported by the men and 23.9% as reported by their partners, respectively. PRO responses indicated that control over ejaculation and severity of PE were not reported significantly differently by the men and their partners. Satisfaction with sexual intercourse was poorer for the men's partners than for the men. Personal distress and interpersonal difficulty were higher for the men than for their partners. The partners of men in the PE group had significantly lower FSFI scores than did the partners of men in the non-PE group. The reporting of the prevalence of PE did not differ significantly between the men in this study and their partners. However, PE in men tended to impact their partners' sexual function.
Late-onset hypogonadism (LOH) is a syndromic condition that has a well-recognized association with sexual and reproductive failure. LOH is frequently associated with chronic conditions including cardiovascular diseases (CVD), obesity, osteoporosis, HIV infection, renal failure, and obstructive pulmonary diseases. Despite this evidence, in patients with these conditions, LOH is still only rarely investigated and testosterone replacement therapy (TRT) rarely considered. In this paper, we critically reviewed the available evidence on LOH treatment focusing on possible risks and benefits. Medical therapy of LOH should be individualized depending on the etiology of the disease and the patient's expectations. The fear of prostate cancer and the risk of erythrocytosis probably represent the main limitations of TRT in aging men. However, TRT in healthy older men in near physiological doses does not appear to incur serious adverse events, although regular monitoring of prostate-specific antigen and hematocrit levels is required. Available evidence also suggests that TRT might ameliorate central obesity and glycometabolic control in patients with metabolic syndrome and type 2 diabetes. In addition, TRT has been associated with an increase in bone mineral density in men with osteoporosis, with an improvement in lean body mass in subjects with human immunodeficiency virus infection or chronic obstructive pulmonary disease, as well as with peripheral oxygenation in patients with chronic kidney diseases. Despite this evidence, however, it should be recognized that the results of these trials were heterogeneous and limited by small sample sizes. Hence, further research is required regarding the long-term benefits and adverse effects of TRT in LOH.
Baseline clinical characteristics of each group
Comparison of IPSS, VS, SS, QoL, and Qmax of each group, before and after TURP
Comparison of IPSS, VS, SS, and QoL of each group, after three months of TURP
Many patients with benign prostatic hyperplasia (BPH) have not only voiding symptoms but also storage symptoms. Despite the many types of treatment that have been developed for BPH, storage symptoms persist. We conducted an assessment of the efficacy of transurethral resection of the prostate (TURP) and the change in the International Prostate Symptoms Score (IPSS) storage sub-score after the procedure according to prostate size in patients with BPH. Men aged 50 years or older who had BPH were enrolled in this study. 186 patients were divided into two groups according to prostate size measuring using transrectal ultrasonography: In group 1, prostate size was less than 30 ml (51 patients), and in group 2, prostate size was greater than 30 ml (135 patients). All of the patients underwent TURP. We examined whether the degree of change in the IPSS, voiding symptoms, storage symptoms, and quality of life (QoL) differed before and after TURP and according to prostate size. After three months of TURP, the subjects in both groups showed significant improvement in the IPSS, voiding symptoms, storage symptoms, QoL, and maximum flow rate (p<0.05). The scores for the IPSS, voiding symptoms, storage symptoms, and QoL of group 1 and 2 after three months of TURP were 16.36, 14.25 (p=0.233), 8.21, 8.24 (p=0.980), 8.11, 5.16 (p=0.014), 2.89, and 2.10 (p=0.030), respectively. TURP is an effective treatment for patients with BPH, regardless of prostate size. However, while the improvement in the storage symptoms of patients with a prostate size of less than 30 ml was not significant, it was in patients with a prostate size greater than 30 ml.
Population demographics and the prevalence of BPH
Prevalence and severity of lower urinary tract symptoms (LUTS) in different age groups studied. The prevalence of moderate to severe LUTS increased significantly with age.
Severity of subunits of lower urinary tract symptom (LUTS) categories in International Prostate Symptom Score (IPSS) questionnaire. The score for nocturia was highest followed by frequency.
Pearson correlation coefficients of the IPSS with each parameter. Age* and Qmax* were weak correlation factors but the rest were strong correlation factors (p<0.001). IPSS: International Prostate Symptom Score, Qmax: peak urinary flow rate, QoL: quality of life.
Population demographics and the prevalence of BPH
We report on the prevalence of benign prostatic hyperplasia (BPH) and lower urinary tract symptoms (LUTS) among men of Jeju Island, representing a coastal and insular area, using a cross-sectional community-based survey. A total of 553 participants in a prostate health screening campaign on Jeju Island were subjected to measurements of the International Prostate Symptom Score (IPSS), prostate volume, uroflowmetry, postvoiding residual urine volume, and prostate-specific antigen levels. Eliminating 58 participants who were suspected of having prostate cancer, we analyzed the data from 495 participants. The definition of BPH was a combination of moderate IPSS (8~19) to severe IPSS (>19) and prostate enlargement (>30 g on transrectal ultrasonography). The prevalence of BPH was 21.0% overall: 11.6% among subjects aged 50~59 years, 18.1% for those aged 60~69, 30.8% for those aged 70~79 and 50.8% among those aged 80 years or more. Compared with previous studies in urban or rural areas, the prevalence was slightly lower. The prevalence of BPH and of moderate to severe LUTS increased with age and showed significant differences between age groups (p=0.028 and 0.033, respectively). A positive correlation was found between the IPSS and quality of life score. Among subunits of IPSS, the nocturia score contributed most to the severity of LUTS and had the highest correlation with a quality of life score. The overall prevalence of BPH in this study was 21.0%, which is slightly lower than in previous studies in urban or rural areas.
Patient characteristics
Comparison of lower urinary tract symptoms/benign prostate hyperplasia between metabolic syndrome and non-metabolic syndrome groups
Correlation of BPH with metabolic syndrome and components of metabolic syndrome
Correlation between prostate gland volume, IPSS, maximal flow rate, or postvoid residual urine volume and components of metabolic syndrome, or metabolic syndrome
To investigate any associations between lower urinary tract symptoms (LUTS)/benign prostate hyperplasia (BPH) and metabolic syndrome (MetS). In all, 1,224 male police officers in their 50s who had participated in health examinations were included. LUTS/BPH was assessed by serum prostate-specific antigen, International Prostate Symptom Score (IPSS), transrectal ultrasonography, maximum urinary flow rate (Q max), and postvoid residual urine volume (PVR). In addition, testosterone was also examined. The MetS was defined using NCEP-ATP III guidelines. We used the multiple linear regression test and logistic regression analyses to examine the relationships. MetS was diagnosed in 29.0% of participants. There was no significant difference in the percentage of cases of BPH (IPSS >7, Q max <15 ml/sec, and prostate gland volume ≥ 20 ml) (14.2% in the non-MetS group vs. 17.2 in the MetS group; p value=0.178). The total IPSS score and the Q max were not significantly different. The prostate volume and PVR were significantly greater in the subjects with MetS. After adjusting for age and testosterone, the presence of MetS was not associated with BPH (multivariate odds ratio, 1.122; 95% confidence interval, 0.593~2.120). Additionally, MetS was not related to IPSS (Beta, -0.189; p value=0.819), prostate volume (Beta, 0.815; p value=0.285), Q max (Beta, -0.827; p value=0.393), or PVR (Beta, 0.506; p value=0.837). According to our results, the MetS was not clearly correlated with LUTS/BPH in Korean men in their 50s.
Abdominal computed tomography features of the bladder tumor. (A) A large bladder mass (black arrow) found in the base and (B) right lateral wall (white arrow) of the bladder with perivesical infiltration (asterix) and enlarged regional lymph nodes (black arrow) around the bladder. 
Cystoscopic findings of a papillary mass in the trigone (A) and left lateral wall of the bladder (B). 
Histologic features of a resection specimen of the bladder obtained from transurethral resection of the bladder tumor. The specimen showed low grade, non-invasive papillary urothelial carcinoma in the epithelium (arrow), while infiltration of atypical medium-sized to large lymphocytes showing vesicular nuclei, prominent multiple nucleoli, and an appreciable amount of basophilic cytoplasm were seen in the subepithelial connective tissue (asterisk). The atypical lymphoid cells showed more aggressive and dedifferentiated features than those of the inguinal lymph nodes (A: H&E, ×100, B: H&E, ×400). 
Histologic features of the right inguinal lymph node specimen. (A) The specimen showed a vague follicular growth pattern with relatively monotonous small lymphocytes, plasma cells, and plasmacytoid lymphocytes (H&E, ×400). (B) They were positive for immunohistochemical stains for CD20, CD79a, Bcl-2, CD43, and immunoglobulin M (IgM), but negative for CD3, CD5, Cyclin D1, CD23, and Bcl-6. The VS38 immunohistochemical stain was positive but was negative for CD138 and CD10 (Immunohistochemical examination stain or IgM, ×400). 
Malignant lymphoma of the bladder is a rare lesion, representing approximately 0.2% of the primary lesions and approximately 1.8% of the secondary lesions. A disseminated lymphoma presenting as a bladder mass is an infrequent phenomenon. The authors report the case of a 71-year-old patient with concurrent bladder lymphoma and bladder cancer presenting as metastatic bladder cancer. To the best of our knowledge, this is the first report of concurrent bladder lymphoma and bladder cancer.
Cystoscopy results revealed a smooth sessile mass at the bladder dome. 
(A) Prostate glands in the subepithelial layer of the urinary bladder. The bladder mucosa seems to be intact (arrows) (H&E, ×40). (B) The prostate glands are composed of a distinct luminal epithelial cell layer and a basal cell layer (H&E, ×200). 
(A) Prostate glands showing irregular dilated lumens with flattened epithelial cells (H&E, ×200). (B) Immunopositive staining of most prostate glands for prostate-specific antigen (H&E, ×200). 
The presence of ectopic prostate tissue in the bladder is common, but the involvement of the bladder dome has rarely been reported. This case report describes a 72-year-old man who presented with gross painless hematuria. Cystoscopy revealed a smooth sessile mass at the dome region of the bladder. A complete transurethral resection of the mass was performed. Histopathological examination of the mass revealed the presence of benign ectopic prostatic tissue.
Characteristics of the two study groups 
Results of the two study groups 
Dutasteride affects the prostate by reducing intraprostatic dihydrotestosterone and prostate tissue vascularity. We evaluated the effect of pretreatment with dutasteride for two weeks on perioperative and postoperative bleeding during transurethral resection of the prostate (TURP). Eighty-three patients who had benign prostatic hyperplasia together with the criteria for eligibility for TURP were included. The dutasteride group consisted of 40 patients who were treated with dutasteride (0.5 mg/d) for two weeks before surgery, and the control group consisted of 43 patients who did not receive dutasteride. Blood loss was evaluated in terms of reduction in serum hemoglobin (Hb) and hematocrit (Hct) levels, which were measured before, immediately after, and 24 hours after surgery. We also measured the durations of indwelling urethral catheter use, continuous saline bladder irrigation, and hospitalization. Lower mean blood loss was observed in the dutasteride group than the control group immediately after and 24 hours after surgery (ΔHb=0.65±1.27 g/dL vs. 1.16±0.73 g/dL, 1.30±1.00 g/dL vs. 1.86±1.05 g/dL respectively, p=0.019, p=0.011; ΔHct=1.89%±3.83% vs. 3.47%±2.09%, 3.69%±2.95% vs. 5.39%±3.23% respectively, p=0.016, p=0.011). In addition, there were fewer days of indwelling urethral catheter use (2.95±1.02 d vs. 3.92±1.14 d, p=0.000), continuous saline bladder irrigation (1.81±1.08 d vs. 2.36±1.06 d, p=0.016), and hospitalization after TURP (3.95±1.09 d vs. 4.76±1.19 d, p=0.001) in the dutasteride group. Preoperative treatment with dutasteride for two weeks before TURP reduces surgical bleeding and length of hospitalization after TURP. This pretreatment can be used to decrease surgical bleeding associated with TURP.
Studies included in the current meta-analysis 
Study selection flow chart. The full texts of articles were reviewed, and 11 articles were selected as potential candidates for the meta-analysis. Subsequently, six articles that did not fit the eligibility criteria of this metaanalysis were removed. Finally, five articles were included in the analysis of the relationship between CXCR4 and the clinicopathological features of prostate cancer. 
Forest plot of high versus low expression of CXCR4. (A) There is no relationship between CXCR4 expression and Gleason scores (GS; <7 vs. ≥7) according to the meta-analysis. (B) CXCR4 expression is not associated with T stage (<T3 vs. ≥T3), and the relevant meta-analysis showed an odds ratio (OR) of 1.803 (95% confidence interval (CI): 0.756∼4.297; p=0.183). (C) Higher CXCR4 expression was strongly associated with the presence of metastatic disease, with a fixed-effects pooled OR of 7.459 (95% CI: 2.665∼ 20.878; p<0.001). W: weight. 
Radial plots indicated no heterogeneity after selection of effects models for all studies. CXCR4 expression and Gleason score (A), CXCR4 expression and T stage (B), and CXCR4 expression and metastasis (C). 
Funnel plots demonstrated no publication bias in this meta-analysis for all studies. CXCR4 expression and Gleason score (A), CXCR4 expression and T stage (B), and CXCR4 expression and metastasis (C). 
Experimental studies have suggested that the stromal-derived factor-1 (SDF-1)/CXCR4 axis is associated with tumor aggressiveness and metastasis in several malignancies. We performed a meta-analysis to elucidate the relationship between CXCR4 expression and the clinicopathological features of prostate cancer. Data were collected from studies comparing Gleason score, T stage, and the presence of metastasis with CXCR4 levels in human prostate cancer samples. The studies were pooled, and the odds ratio (OR) of CXCR4 expression for clinical and pathological variables was calculated. Five articles were eligible for the current meta-analysis. We found no relationship between CXCR4 expression and Gleason score (<7 vs. ≥7). The forest plot using the fixed-effects model indicated an OR of 1.585 (95% confidence interval [CI]: 0.793~3.171; p=0.193). Further, CXCR4 expression was not associated with the T stage (<T3 vs. ≥T3), and the relevant meta-analysis showed OR=1.803 (95% CI: 0.756~4.297, p=0.183). However, increased CXCR4 expression was strongly associated with metastatic disease with a fixed-effects pooled OR of 7.459 (95% CI: 2.665~20.878, p<0.001). Our meta-analysis showed that the higher CXCR4 protein expression in prostate cancer specimens is significantly associated with the presence of metastatic disease. This supports previous experimental data supporting the role played by the SDF-1/CXCR4 axis in metastasis.
Pathophysiology of erectile dysfunction following radical prostatectomy. ROS: reactive oxygen species, TGF-β: transforming growth factor-beta, ET-1: endothelin-1, PGE1: prostaglandin E1, iNOS: inductible nitric oxide synthase.
Radical prostatectomy and consequences for erectile function after the operation
Testosterone replacement therapy following radical prostatectomy and radiation treatment
Prostate cancer is now ranked fifth in incidence among cancers in Korean adult males. This is attributable to the more Westernized dietary style which increases the morbidity of prostate cancer and the development of cancer diagnostic technologies, such as prostate-specific antigen and advanced medical systems, increasing the rate of prostate cancer diagnosis. Prostate cancer effects include not only erectile dysfunction caused by the disease itself, but also by psychiatric disorders caused by prostate cancer or its treatments. Prostate cancer by itself reduces sexual desire and the frequency of sexual intercourse. Additionally, surgery or hormonal therapy to block testosterone further increases the frequency of erectile dysfunction. Erectile dysfunction following radical prostatectomy is primarily attributable to nerve injury caused by intraoperative nerve traction, thermal injury, ischemic injury, and local inflammatory reactions. Additionally, the absence of nocturnal penile tumescence causes persistent hypoxia of the corpus cavernosum, which, secondarily, causes anatomical and functional changes in the corpus cavernosum. Preservation of erectile function is one of the most significant issues for patients with local prostate cancer. Erectile dysfunction following radical prostatectomy is known to have various prognoses, depending on preservation of the neurovascular bundle, patient age, and preoperative erectile status. Intracavernosal injections, PDE5 inhibitors, and penile rehabilitation therapy using a vacuum constriction device after radical prostatectomy are known to improve the recovery of erectile function. Recently, testosterone replacement therapy has also drawn attention as a treatment method.
Semen parameters according to type of cancer 
This study evaluated the demographics and semen parameters of males with cancer who banked their sperm prior to chemotherapy. This is a retrospective study of 66 cases referred for sperm banking prior to initiation of chemotherapy over a 15-year period (1999~2014). Patients who had previously received cancer treatment including chemotherapy or radiotherapy were not included in this study. We studied a total of 66 cancer patients referred for cryopreservation of sperm prior to chemotherapy. The mean age of the patients at the time of banking was 32.0±7.9 years (range, 19~58 years). The types of cancer were testicular cancer (31 cases, 47.0%), non-Hodgkin's disease (10 cases, 15.1%), Hodgkin's disease (5 cases, 7.6%), leukemia (8 cases, 12.1%), gastrointestinal malignancy (5 cases, 7.6%), and musculoskeletal malignancy (5 cases, 7.6%). There were significant differences in sperm concentration and viability among the various types of cancer, but no significant difference in semen volume or sperm motility and morphology. In this study we found that sperm quality could decrease even before chemotherapy. Because chemotherapy can also negatively affect spermatogenesis, sperm cryopreservation prior to treatment should be strongly recommended for cancer patients of reproductive age.
Left cystic renal mass with irregular wall thickening, heterogeneous attenuation, and soft tissue infiltration.  
Tumor is located in the renal pelvis, and extending to and infiltrating the renal parenchyma.  
Moderate-differentiated squamous cell carcinoma. Nests of infiltrating squamous cells with hyperchromatic nuclei and prominent keratin production should be noted (H&E, ×400).  
We present a rare case of a metastatic renal tumor originating from adenosquamous carcinoma of the intrahepatic bile duct. A 64-year-old man treated with bisegmentectomy and extended cholecystectomy for cholangiocarcinoma had a left cystic renal mass, which had irregular wall thickening, heterogeneously low attenuation, and soft tissue infiltration as determined by a computed tomography scan. The first impression was renal abscess. Left nephrectomy was performed and the nonencapsulated mass was gray in color macroscopically. Histological examination of the specimen revealed alveolar proliferation of small cancer cells, which was consistent with the original tumor of the intrahepatic bile duct. The left renal tumor was misdiagnosed as a renal abscess but finally diagnosed as squamous cell carcinoma metastasized from the intrahepatic bile duct. The patient expired because of lung metastasis after 14 months following left nephrectomy. In our opinion, this case would be the first report of a renal metastasis from a cholangiocarcinoma clinically and was treated with nephrectomy.
Demographics and other baseline characteristics of male patients with sexual dysfunction Variable Total 
Results of multiple linear regression analysis of the Framingham risk score 
The aim of the present study aimed to evaluate the effect of testosterone on cardiovascular disease by using the Framingham Risk Score (FRS) in patients with sexual dysfunction. A total of 308 men with sexual dysfunction were enrolled in this study. Clinical assessments included the 15-item International Index of Erectile Function (IIEF), blood pressure measurement, and clinical laboratory indexes. The FRS, which predicts the incidence rate of cardiovascular diseases in the next 10 years, was calculated on the basis of age, gender, total cholesterol, smoking status, high density lipoprotein cholesterol, and systolic blood pressure. The mean age of the 308 enrolled patients was 49.42±10.73 years, and the patients' mean body mass index (kg/m(2)) was 25.07±3.14. The mean total IIEF score was 28.44±18.06. The median total testosterone concentration was 3.2 ng/mL (interquartile range [IQR]: 2.3~3.2 ng/mL). The median calculated free and bioavailable testosterone concentrations were 0.052 ng/mL (IQR 0.039~0.070 ng/mL) and 1.30 ng/mL (IQR: 1.00~1.76 ng/mL), respectively. The mean FRS was 10.47±6.45. The FRS tended to show a negative correlation with the total and calculated free testosterone levels, but this was not significant (p=0.064 and p=0.074, respectively). In the multiple linear regression analysis, a significant negative correlation was observed between the total testosterone level and the FRS (p=0.048). The results suggest that the testosterone level is related to the FRS and that a high testosterone level may decrease the risk of cardiovascular disease.
Patient characteristics
The questionnaire
Retinopathy, neuropathy, and nephropathy are well-known complications of diabetes; they are often expected to occur and, therefore, are usually tested for. However, urogenital complications, such as sexual and voiding dysfunctions, are less well known, and consequently, many patients are not treated appropriately despite their symptoms. Thus, we surveyed diabetic patients with regard to their perception of urogenital complications. We designed a survey for patients in our hospital who were being treated for diabetes mellitus (DM). The questionnaire included items on age, sex, treatment duration, treatment options for and the level of perception of urogenital symptoms, the presence of urogenital symptoms, and whether treatment was intended or had been initiated. In total, 275 patients participated in the survey. The perception questions on DM-associated urogenital complications showed that 89 patients (32.4%) had no knowledge, 84 patients (30.5%) had some knowledge, and 102 patients (37.1%) had detailed knowledge about these complications. A total of 124 patients (45.1%) reported urogenital symptoms: 93 patients (75.0%) reported voiding dysfunction and 61 patients (49.2%) reported sexual dysfunction. Common symptoms of voiding dysfunction were urinary frequency, nocturia, sense of residual urine, weak stream, and urinary incontinence. Common symptoms of sexual dysfunction were reduced libido, and erectile and ejaculatory dysfunction. The survey showed that the subjective prevalence rate of urogenital symptoms in diabetic patients was 45.1%. However, only a small percentage (37.1%) of the patients cognized that these symptoms were associated with DM. Therefore, it is necessary to properly inform and educate diabetic patients on possible urogenital complications that may occur.
Medical institution of corresponding author. 
Quality assessment of RCTs according to publication year 
A low quality clinical trial could produce errors, and these errors could, in turn, distort the results of the clinical trial. To avoid applying distorted results of trials clinically, a quality analysis of clinical trials is needed. We selected randomized controlled trials (RCTs) about erectile dysfunction (ED) conducted in Korea using Medline and KoreaMed. Quality assessment of selected RCTs was performed using three assessment tools (Jadad scales, van Tulder scale, Cochrane Collaboration Risk of Bias Tool [CCRBT]). The first RCT about ED conducted in Korea was published in 2002. Since 2002, a total of 20 RCTs have been published in medical journals. Among the 20 articles, only 1 article was found to have a low risk of bias according to the CCRBT. On the Jadad scale, there were 17 high quality articles, while 19 articles were assessed as high quality by the VTS. Only 2 RCTs described the randomization method adequately. Only 1 RCT presented allocation concealment. A low quality clinical trial could produce errors, and these errors could, in turn, distort the results of the clinical trial. To avoid applying distorted results of trials clinically, a quality analysis of clinical trials is needed. The quality of RCTs was found to be high because almost all of the selected RCTs were double blinded studies. However, the quality of RCTs was inadequate with regard to the lack of randomization and absence of allocation concealment. Therefore, performing adequate randomization and adding a description of the appropriate concealment of allocation may improve the quality of RCTs.
Retrograde urethrogram showed stricture on bulbous urethra (arrow). 
Cystoscopic appearance of hair in penile urethra with stricture on bulbous urethra. 
Cystoscopic appearance of penile urethra after hair removal. 
We experienced the growth of urethral hair along the urethral stricture six years after simultaneous urethral repair and reimplantation of penile prosthesis (RPP) in a patient with a urethral stricture. We detected hair in the urethra with a stricture on the bulbous urethra. Further, we performed hair removal by using a pair of cystoscopic forceps and internal urethrotomy. Then, we performed RPP, and the patient voided well; the prosthesis worked very well and without any complications. One-stage urethroplasty with a pedicle island of the penile skin and RPP in a simultaneous stage may be an option for treating the long-segment urethral stricture in the penile prosthesis patient. However, we should pay attention to the urethral hair growth that can occur after urethral repair performed using a skin graft.
(A) Scrotal sonography reveals the dilated bowel loop and mesenteric fat (M) in the left hemiscrotum. (B) Two testes in the left hemiscrotum. (C) Both testes are attached to one gubernaculum (**). A ligated suture (*) for the inguinal hernial sac and normally developed penis (***) are visible. T: testis, LT: left testis, RT: tight testis. 
Summary of the cases of crossed testicular ectopia as an incarcerated inguinal hernia 
Crossed testicular ectopia (CTE) is generally defined as both testes located in the same hemiscrotum and contralateral hydrocele with the absence of a testis. However, the initial presentation of CTE in an infant as an incarcerated inguinal hernia is extremely rare. We report on a 10-month-old infant with CTE, who visited the emergency room presenting with a left incarcerated inguinal hernia. After manual reduction for an incarcerated hernia and left inguinal herniorraphy, the left testis was fixed into the left hemiscrotum and right transseptal orchiopexy was performed.
Multiple simple cyst in the right testis: a well circumscribed, anechoic area with a smooth wall and posterior acoustic enhancement.
The specimen was a product of right intratesticular cyst excision, measuring 0.2 g in weight with dimensions of 1.0×0.8×0.6 cm.
Multiple simple cysts were seen. The cyst wall was fibrous tissue completely lined by simple flattened epithelial cells. There were no sperm in the cyst (H&E stain, ×40).
Intratesticular cysts, once thought to be a rarity, are now being reported with an increasing prevalence as a result of the wider use of scrotal ultrasound scanning. Despite greater understanding of intratesticular cysts, their management remains unclear. Treatment has included enucleation and even radical orchiectomy over fear of the possibility of an associated malignancy. A more conservative approach with serial ultrasound scanning has been advocated if a clear distinction can be made between neoplastic and non-neoplastic testicular cysts. However, in view of the benign nature of such cysts, even repeated ultrasound scanning may not be necessary and may be considered over-treatment. In this study we present clinical and morphological characteristics of multiple cysts in the right testicle in a 62-year-old patient, where a slightly nodular lesion in the right testicle was detected.
Top-cited authors
Ashok Agarwal
  • Cleveland Clinic
Stefan S Du Plessis
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Gurpriya Virk
Chloe Ong
  • National University Hospital - NUH
Ralf Henkel
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