Presentations
S22 No. 49 No. 50 Diabetes-induced impotence in rat model: possible Putative role for antioxidant in erectile dysfunction mechanisms secondary to hypercholesterolemia Koichi Nakajima'·2, Ahmed El-Sakka', Nobuhisa Ishii2 , Kazukiyo B Srilatha PG Adaikan SC Ng Miura2, and Raj vir Dahiya'. Department of Urology', VA Medical Department of Obstetrics & Gynaecology, National University Hospital, Center and UCSF San Francisco 2 1St. Department of Urology, National University of Singapore, Lower Kent Ridge Road, Singapore 119074 Toho University School of Medicine, Tokyo, Japan.
Objective: The purpose of this study was to investigate the cellular and molecular mechanisms of diabetes-induced erectile In this study, we sought to identify the effect of the hypolipidaemic dysfunction in rats. antioxidant probucol on cavernosal changes secondary to hyper cholesterolaemia. male Fisher 344 rats (aged 60 to 80 days) were Two experimental groups of New Zealand White rabbits (n=6, each) were divided into 2 groups. The experimental group (N=30) received administered fresh egg yolk (lOg/kg), apart from the standard diet, daily intraperitoneal injection of Streptozotocin (STZ), 25 mglkg twice for 8 weeks to precipitate abnormal lipid profiles as compared to normal in two weeks interval, to induce diabetes. Age-matched control controls (n=6). In one treatment group, the possible metabolic alteration to (n=lO) received injection of citrate buffer vehicle only. After 8 high cholesterol intake was countered with concurrent oral probucol weeks, erectile function was assessed by electrostimulation of the supplementation at a daily dose of 1OOmglkg body weight for 8 weeks. NADPH diaphorase staining was used to Biochemical analysis of blood samples collected every 2 weeks gave an Identify expressiOn NOS. RT-PCR was used to identify gene indication of the advancing derangement. In the drug-excluded group, expression of nNOS, eNOS, iNOS, NGF, IGF-1, TGFbl. Protein serum cholesterol was twice as much as that in the probucol treated group; expression of these growth factors was measured by western with both the test groups demonstrating marked increase in lipid blotting. parameters from the baseline values. Daily egg yolk intake in the absence of probucol produced gross structural and functional changes in the rabbit Summary of the results: Electrostimulation of the cavernous cavernosum. Oxidative conversion of low-density lipoprotein cholesterol in the diabetic group revealed significantly lower is central to the pathological changes of hypercholesterolaemia and mtracavernous pressure and longer latency period than the control atherosclerosis. In the drug-treated group, probucol by virtue of its group. In the diabetic group, there was a significant decrease in antioxidant property prevented the formation of macrophage-derived foam NOS containing nerve fibers in the dorsal and intracavernous nerves as compared to control. RT-PCR showed down-regulation cells in the cavernosum with a well-preserved morphology comparable to of nNOS and iNOS mRNA expression in the diabetic group. the untreated control. In addition, the contractile, endothelium-mediated showed down-regulation of nNOS protein expression and nitrergic relaxation responses to neurotransmitters and electrical m group. Growth factors were differentially expressed in stimulation in this group closely mimicked those obtained from control diabetic rat as compared to control. cavemosal strips. Thus, taken together, results from this investigation clearly indicate the Conclusion: Alterations in gene and protein expression of NOS ameliorating effect of probucol and the prophylactic need for and growth factors may provide the mechanisms of diabetes antioxidant(s) in management of erectile dysfunction related to induced erectile dysfunction. hypercholesterolaemia.
No. 51 No. 52 Erection modulates the endothelin-1 effect on the Comparison of the synergistic effects of tamsulosin rat penis Mills. T., Lewis, R., Dai, Y., Pollock, D., Stopper, versus phentolamine on penile erection: in vitro V., Wingard, C. Department of Physiology and Endocrinology, and in vivo studies Department of Surgery, Urology Section, Vascular Biology Center. Kyung Keun Seo, Sae Chul Kim, Sun Kyu Lee, Eun Suk Song, Medical College of Georgia, Augusta, Georgia, USA. and Moo Yeo! Lee' Dept. of Urology & Physiology*, Chung-Ang Univ. Yongsan Hospital, 65-207, Hangang-Ro 3-Ka, Yongsan-Ku, Seoull40-757, Korea Endothelin-1 (ET -1) causes vaso-constriction and would be expected to reduce the magnitude of the erectile response by limiting blood Purposes: In vitro and in vivo studies were performed to flow into the erectile tissue. Studies from this laboratory used rats to determine the potential use of tamsulosin (TAM) versus show that blockade of the endothelin A receptor (ETA) or the B phentolamine (PRE) for intracavernosal injection (ICI) therapy when mixed with papaverine (PAP) and/or prostagladin E, (PGE,) receptor (ET8 ) did not reduce the magnitude of the erectile response or with vasoactive intestinal polypeptide (VIP) for the treatment induced by electrical stimulation of the autonomic innervation of the of erectile dysfunction. penis. However, when ET-1 (50 pmole/rat) was injected into the Materials and Methods: We performed isometric tension studies cavernous sinuses, the magnitude ofthe subsequent erectile responses on rabbit (n=l5), dog (n=S), and human (n=!O) cavernous smooth was reduced: prior blockage with the ETA antagonist prevented this muscle strips with TAM, PAP, PRE, VIP, PGE" and the combinations of PAP and PRE; PAP and TAM; VIP and PRE; reduction. These studies demonstrate that the cavemosal circulation VIP and TAM; PAP, PGE, and PRE; and PAP, PGE1 and TAM. is responsive to the vaso-constrictor action of exogenous ET-1. TAM-containing trimix (PAP 18.75 mg, PGE, 6.25 and TAM However, the failure of the ETA and ET8 antagonists to alter the 0.875 mg per ml) or PRE-containing trimix (PAP, PGE" and PRE erectile response led us to hypothesize that there may be a mechanism 0.625 mg per ml) were also injected into the cavernous bodies of I 0 mongrel dogs. that is activated during erection which prevents ET -1 from causing Results: Among the single agents, TAM and PGE1 (only in vaso-constriction. To test this hypothesis, ET-1 (50 pmole/rat) was human) had the strongest effect on the relaxation of cavernous injected into the cavernous sinuses of80- 120 day old Holtzman rats muscles in rabbit, dog, and human strips (p International Journal of Impotence Research Presentations ffi S23 No. 53 No. 54 Mechanical reliability of the AMS 700CXM Fracture at the input tube-cylinder junction of inflatable penile prosthesis for the treatment of AMS 700 inflatable penile prosthesis as a impotence complication of a modified implantation technique in a series of 99 patients Young Deuk Choi, Woong Hee Lee, Yeong Jin Choi, Zhong Cheng Xin and Hyung Kj Cboi Seuog Hwao Yoon, Sae Chul Kim, and Kyung Keun Seo Dept. of Urology and Institute of Andrology, Yonsei Univ. College of Medici Dept. of Urology, Chung-Ang University Yongsan Hospital, 65- ne, Seoul, Korea 207, Hangang-Ro 3-Ka, Yongsan-Ku, Seoul140-757, Korea INTRODUCTION AND OBJECTIVES: The American Medical Systems Mode Purposes: To compare the incidence of a specific failure mode of I 700 Inflatable Penile Prosthesis with CXM Cylinders was introduced in 199 the penile implant, fracture at the input tube - cylinder junction, 0 to provide ·a device that provided controlled expansion in girth with the fit with respect to two methods of managing the input tube. ness for an Orientals. We review the experience of AMS 700CXM prosthesis Materials and Methods: AMS 700 series three-piece inflatable with particular regard to the complication and reliability of prosthesis. penile prostheses were implanted in the first 26 patients using an METHODS: From January 1991 to April 1999, 273 males with erectile impot ordinary technique in which the input tubing runs alongside the ence received the AMS 700CXM. Follow-up ranged from 3 months to 100 m cylinder within the corpus and exits through the corporotomy onths with a mean of 47 months. We reviewed a medical chart and interview ('Method A'). In the subsequent 73 men, the input tube exited ed by telephone. through a separate stab wound in the proximal corpus using a RESULTS: Patient's ages ranged from 24 to 78 years( mean 50.9± 11.3). Thei modification of the basic surgical technique ('Method C'). The r causes of erectile dysfunction were diabetic in 22.1 %, spinal cord injury 15. mean follow-up period was 136.4 months for 'Method A' and 2%, vasculogenic 28.7%, idiopathic 11.8%, pelvic trauma 9.1 %. The length of 69.0 months for 'Method C'. The incidence of fracture at the used device ranged from 12 to 20 cm(mean 16.5 ± 1.3). There were 20(7. junction of the input tube and cylinder was compared according to 3%) cases of mechanical complications (mean duration: 37± 19.9 months). Th the variables of input tube management, prostheses types, and e mechanical reliability of the device was 98.2% after 2 years, 95.7% after 3 width of the proximal corpora. years, and 92.7% after 6 years. Among the mechanical complications, the cy Results: The overall incidence of mechanical failure was 12.1%. Iinder tear occurred in 11 (4.0%)men (mean duration: 40±21.7 months) and Fractures at the input tube - cylinder junction with leaking pump failure occurred in 4 (1.5%) man(mean duration: 24.5±23.4 months). T occurred in 7 patients. The cylinders in these patients were all he cause of mechanical complication could not be determined in 5 men who implanted using 'Method C'. The incidence of fracture at the were not operated. There were 8 men (2.9%) showed nonmechanical com plica junction was significantly higher (p<0.05) in men with narrow tions, that were 1 selection error (tube kinking), 2 infection, 3 erosion, and 2 corpora (17.1%) than in the others (0%), regardless of the type of surgical complication. prostheses implanted. The average functional duration of the CONCLUSION: AMS 700CXM is suitable for Koreans that is most natural fl accidity and erection. The mechanical reliability of AMS 700CXM is excellen failed prostheses was 66.1 months. t, however, more modifications of the devices are needed to guarantee good r Conclusions: The modified surgical procedure ('Method C') eliability for long-term follow up. should be avoided in patients with a narrow width penis due to an increased likelihood of damage to the input tube - cylinder junction. No. 55 No. 56 Experience of Limis Erection Supporter in surgical Short-term and long-term complications of management of erectile dysfunction augmentation penoplasty using autologous dermo Seung-Hyun Lim, Dr. Lim's Andrology Clinic, 340-6, 2"" Floor fat graft Daehanilbo Building, Taepyung-ro 2"" st, Jung-ku, Seoul 100-102, Korea Lee Youn Soo, MD. Lee YoiUI Soo Anclrology Clinic Augmentation penoplasty using autologous Derma-fat graft is Purposes: I have obtained a patent on "Erection Supporter" from being widely performed because of absence of complications nine countries. This silicone device may induce adequate rigidity for associated with foreign body implantation. However no review on satisfactory intercourse and be removed easily without adverse effect possible complications resulting from the operation itself on erectile tissues. Herein, I report the clinical experience of this exists. We studied short-term and long-term complications of device for the surgical management of erectile dysfunction. augmentation penoplasty using Derm-fat graft. From Nov. 1989 to Materials and Methods: Between August 1996 and October 1998, Aug. 1998, augmentation penoplasty using Ilermo-fat graft was 94 patients who were reluctant to receive intracavemosal injection performed on 850 patients complaining of "small penises• Lower therapy and penile prosthesis, were implanted the Limis Erection abdomen and buttock were chosen as donor sites for the Derma-fat Supporter. Of 94 men, 75 (mean; 53 years, range; 45-67) have been graft. Complications appearing shortly after the operation were followed more than 6 months (mean; 15.5). The device is consisted of classified as short-term complication and complications ring, rod, and supporter. The ring (1.5cm width) is placed into appearing 6 months after wound healing were classified as subcoronal area and is attached to tube. The rod (7 rom width) is placed in the dorsum of the penile shaft between Buck's and Colles' long-term complication. The incidence of short term complication fascia. The distal rod is inserted into lumen of the tube, and the ring was residual urine sense in 57.""'(488 patients), Pain on with tube can move proximally and distally during flaccid and erection in 30. 9•(263 patients). Both resolved within 2 months erection state. The rectangle-shaped supporter is implanted into the after operation. Delayed wOIUid healing appeared in 13. 2!11( 113 infrapubic area and is connected to proximal rod. Bending axes patients) and wound revision was performed in 0. 7!11(6 patients). between supporter and rod maintains the erection angle. The device Graft tissue necrosis appeared in 6.2!11(53 patients). Among them, was inserted through U-shaped infrapubic skin incision under local 62. 3%(33 patients) improved after continuous antibiotics anesthesia in all patients. After compressive dressing for 1 week, the therapy, 28.3!11(15 patients) required excision of necrotic tissue ring with tube was frequently pulled for more than 6 months to with woiUid revision due to wo\Uid infection and 9. 4!11(5 patients) prevent erectile restriction due to formation of pseudocapsule around required complete excision of necrotic graft tissue. 101 the device. Postoperative satisfaction data were obtained by a self patients were followed up for more than 6 months and 69. 3!11(70 reported patient questionnaire. patients) c011plained of poor cosmetic appearance. Reoperation Results: Average operation time was 88 minutes. Of the 74 men, 56 was necessary in 8. 9!11(9 patients) (74. 7%) were satisfied to do sexual intercourse. No significant Short-term and Iong-teno complications may result after complications were developed in all patients. augmentation penoplasty using autologous Derma-fat graft which Conclusions: The implantation of the Limis Erection Supporter can be distressing to both the patient and the physician. might be a simple, safe, and effective treatment modality in the select Therefore care should be taken in selecting the patient and patients for whom oral drug therapy failed and who were reluctant to deciding on the operative technique with possible complications receive intracavemosal injection therapy and penile prosthesis. in mind. International Journal of Impotence Research Presentations S24 No. 57 No. 58 The effectiveness of potassium channel opener in Introduction and expression of a foreign gene into the relaxation of rabbit vaginal smooth muscle human corpus cavernosal smooth muscle cells using lipofection Du Geon Moon, Hong Seok Park, Je Jong Kim Ki Dong Kim, Soo Woong Kim and Jae-Seung Paick Department of Urology, Korea University Hospital, Seoul, Korea Department of Urology, Seoul National University College of Medicine, Seoul, Korea PURPOSE: The aims of this study was to assess the effectiveness of Purpose: We examined the feasibility of gene therapy for erectile potassium channel opener in relaxing vaginal smooth muscle of the rabbit. dysfunction using cultured human corpus cavemosal smooth muscle cells. METHODS: New Zealand white female rabbits (n=il) were The gene for green fluorescent protein (gfj:>) was exploited as a viable euthanized. The . entire vagina and clitoris were removed and strips of marker for transfected cells. Methods: In vitro culture of human corpus cavemosal smooth muscle vaginal wall were prepared for isometric tension measurement in the organ cells was performed according to the established methods. The vector bath. Electrical field stimulation (EFS) was induced via two platinum construct was designed to contain a fusion gene of lacZ and gfj:> which electrodes. Contraction was studied at baseline tension while relaxation was was under the control of CMV promoter. Cells within the second passage studied in tissues pre-contracted with 5 Jl M of phenylnephrine. were transfected with the vector DNA using the lipofection method when 60 to 70% confluent. G418 (neomycin) was added at 24 hr after RESULTS: EFS induced biphasic contraction/relaxation response. transfection to select transfectants. Expression of transfered gene was Atropine did not abolished the EFS-induced contraction but bretylium investigated at 24-hr interval after transfection using the X-gal abolished. Acetylcholine, minoxidil and pinacidil induced dose-dependent cytochemical staining and fluorescent microscopy. RT-PCR was also relaxtion and the potency was in order of pinacidil>minoxidil carried out to confirm expression of foreign gene at the same time >acetylcholine. Even with a high concentration (1-IOOmM) of L-arginine interval. or PGE I induced only a 10-15% of relaxation. Acetylcholine, minoxidil or Results: Expression of lacZ was shown to be 30"/o and 50% before (at 24 hr post-transfection) and after (at 48 and 72 hr post-transfection) pinacidil-induced relaxations were partially blocked by tetraethylammonium, G418-selection, respectively. Similar temporal pattern was observed in gfj:> tolbutamide or 4-aminopyridine, respectively. Acetylcholine-induced expression. Expression of both genes was found to be colocalized. It was relaxations were completely blocked by apamin or kalliotoxin, respectively. also demonstrated that expression was not restricted to specific subcellular While pinacidil or minoxidil-induced relaxations were not influenced by region. Results from RT-PCR analysis confnmed the gene expression at apamin or kalliotoxin, respectively. the transcriptional level. It was also shown that culture period did not affect level of transcription upto 72 hrs after transfection. CONCLUSIONS: These results suggest that relaxation of vaginal Conclusions: Our results demonstrate that the liposome-mediated gene smooth muscle is mediated largely by cholinergic and partly by the NO transfer was shown to be effective in corpus cavemosal cells. However, it pathway. Also, vaginal smooth muscle relaxes via KATP and maxi-K has to be further verified if expression of a foreign gene can be channel, seperately. Additionally, KATP channel opener seems promising in maintained following successive passages. Results showing expression of gfj:>, a viable selection marker, could simplifY selection of transfectants and relaxing vaginal smooth muscle. facilitate tracing cells transplanted. No. 59 No. 60 Inhibitory effect of serotonergic drugs on MUSE (medicated urethral system for erection) in intraluminal pressure response to electrical nerve the clinic setting-Western Australian experience stimulation of the rat vas deferens: in vivo study Earle Carolyn M. Chew Kim K, Stuckey Bronwyn GA and Lee John. Kyung Keno Seo, Sae Chul Kim, Jun Hyun Han, and Moo Yeo! Lee* Keogh Institute for Medical Research, QEII Medical Centre, Penh, Dept. of Urology & Physiology*, Chung-Ang Univ. Yongsan Hospital, Western Australia, Australia, 6009. 65-207, Hangang-Ro 3-Ka, Yongsan-Ku, Seoull40-757, Korea Purpose: To evaluate, in vivo, the activity of certain serotonergic Introduction - Intracavernosal injection (ICI) therapy has been the mainstay of the treatment for erectile dysfunction (ED) for almost 20 drugs in delaying ejaculation by inhibiting the intraluminal years. However, many men find this method distasteful, and are pressure response to electrical nerve stimulation of rat vas willing to try alternative therapy. MUSE offers one such alternative. deferens. We report on the first 46 patients treated with MUSE in our clinic. Materials and Methods: Twenty-five Sprague Dawley rats (250- starting dose of 250,500 or IOOOJ.Lg MUSE was used 300 g. each) were equally divided into 5 groups based on according to the patients' previous response to therapy - no previous experimental agent; normal saline, clomipramine, sertraline, therapy or responding to< IOJ.Lg PGEI, responding toreuptake blockers suggests a possible peripheral action blood pressure was noted but in most cases this was asymptomatic. of clomipramine in addition to its central serotonergic action. Response to therapy was not predictable by aetiology. International Journal of Impotence Research Presentations ffi S25 No. 61 No. 62 Clinical evaluation of 27 patients with erectile Multicenter study of the treatment of erectile dysfunction treated with MUSE (medicated dysfunction with transurethral alprostad.il (MUSE) urethral system for erection) at home in Korea Ahn Choi HK', Choi NG', Chung TG', Chung WS', Hwang Han-Sun Cbi•na Ta-Cbi Wen and Jen-Feng Liang TY', TK', Hyun JS', Jung GW', Kim CI", Kim JJ10, Kim SW11 , Lee CH 12, Lee KS 13, Lee we•, Lee WH', Min KS 14, Moon KH15, Paick JS 11 , Park KS 16, Park NC', Deportment of Urology, Taipei Medical College Hospital, Taipei, Taiwan. Park YK18, Seo JK19, Seo KK1, Shin JS20, Yoon YR21 Dept. Urology, Chung-Ang1, Ulsan2, Yonsei3, Hallym4, Ehwa', Catholic', We cooducted the clinical trial oftransure1hral prostaglandin E1 (MUSE, Vivos Gyeongsang7, Dong-A', Keimyung', Korea10, Seoul 11 , Kyung-Hee 12, SungKyunKwan13, Inje14, Yeungnam 15, Chonnam16, Pusan17, Kyungpook 18, Company) in Taiwan. Totally 64 Patients were enrolled in the titratioo study. Among Inha19, Pocheon Cha", Chungnam University Hospital21 , Korea them, 42 patients completed the titratioo with sw:cessful en:ctioo using ditl'en:nt dosage A unique Korean multicenter study was conducted to assess the effectiveness of MUSE: 125Jlg, 250Jlg, 500Jlg and 1000118· After a double blind, plaCebo cootrolled of transurethral alprostadil with MUSE in 334 subjects with chronic erectile dosage cballenge test, all of these 42 patients eokled the home-trealment trial. dysfunction (ED) who were enrolled in 21 clinical centers. Patients with In a 3 month follow up, 27 patients (64.3%) completed the whole course of home psychogenic impotence comprised about 30 % of subjects. Intraurethral alprostadil was titrated in a stepwise fashion in clinic from 250 to 500 or 1000 treatment. The 250118 dose was selected for home use by 7 patients (25.9%), the SOOJ!g meg based on erectile response and tolerability. The erectile responses were dose by 13 patients (48.1%) and lOOOJ!g dose by 7 patients(25.9%). During the three evaluated with an Erection Assessment Scale (score of 1-5). The dose that produced a maximal penile response of score 5 (full rigid erection) or 4 (full month period of home treatment, avemge time of administratioos of medicatioos in these tumescence, partial rigidity) was selected for home treatment. Patients who 27 patients is 14 times ( 4.67 times per month), 97% of the MUSE administratioo did showed partial erection (score of 3) with 1000 meg were also included in the improve the quality of erection, and 79% could achieve successful sexual intercow'se. home-treatment group. In-clinic phase; A total of 198 men (59.3 %) had maximal penile responses The average duratioo ofen:ctioo was 28 minute. There were 7 patients (25. 9"A>), of score 4 or 5. The rate of maximal responses was not related to patient age, occaaionally felt uretlual discomfort in MUSE administralioo. No other serious adverse etiology or duration of the ED. A total of 228 (68.3 %) men progressed to home treatment. The overall level of comfort of the transurethral alprostadil was rated effects were n:ported in this home-treatment trial. A specially designed elastic bandage as Wlcomfortable or vety uncomfortable in 12%. Home phase; During the two could enhance the penile en:ctioo in the MUSE administration. month period of' home treatment, 178 (78.1 %) men had successful sexual In our study, we concluded that MUSE is effective for the patients of en:ctile intercourse at least once, and 78.2 % of administrations (1,976) resulted in successful intercourse. The main causes of were insufficient erectile dysfuru:tioo by self-administratioo in the home-treatment Even though more response in 27 men (ll.8 %), adverse reactions (mostly penile or urethral pain) coovenient oral medicatioos had been appeared in the market, we believe that the in 7 (3.1 %), or both in 7 (3.1 %). In conclusion, transure1hral alprostadil could he a suitable treatment optioo minimal invasive, minor adven;e effect and safety of the MUSE still have a place of ED for patients with ED regardless of age and etiology of ED. Efficacy in an Asian treatment in the future. population (Korea) is comparable to that reported previously in Caucasians. No. 63 No. 64 The effect of intraurethral alprostad.il application Enhancing tumescence of the glans penis: an with visual sexual stimulation in 33 patients with indication for transurethral alprostadil (MUSE) erectile dysfunction ' Chew Kim K and Stuckey Bronwyn GA. Yuh-Chen Kno, Shih-Ping Liu, Jyh-Homg Chen, Tsong-Chang Tsai, Ming-Kuen Keogh Institute for Medical Research, QEII Medical Centre, Lai and Ju-Ton Hsieh Perth, Western Australia, Australia, 6009. Department of Urology, National Taiwan University Hospital, Taipei, Taiwan, R.O.C. INTRODUCTION AND OBJUCTIVES: We investigated the effect of Lack of tumescence of the glans penis and inadequate penile intraurethral alprostadil application with visual sexual stimulation in 33 organic girth are often among the shortcomings of penile implant impotent patients who responded well to intracavernous injection of alprostadil. surgery. Even the tumescence achieved in intracavernosal MEHTODS: An erection assessment scale (1-5) was used to evaluate erectile injection therapy involves primarily and mainly the response to vasoactive pharmacologic stimulation. A good responder will have a cavernosal tissues. score of 4 or 5. Subjects responded well to intracavemous injection of 20 Jlg. alprostadil was tested with intraurethral administration of 500 flg. alprostadil. Transurethral absorption of alprostadil into the corpus Visual sexual stimulation was then initiated and the erectile response was spongiosum and thence the corpora cavernosa results in reevaluated. Peak systolic velocity of the cavernous arteries following tumescence of the spongiosa! as well as the cavernosal intracavemous injection and intraurethral administration of alprostadil was compartments. Although this is a known phannacodynamic measured for comparison. characteristic of transurethral alprostadil (MUSE), it has not RESULTS: I) It took significantly longer time for the patients to respond (4.70 been specifically used for enhancing the tumescence of the ± 1.67 vs. 2.74 ± 0.91 minutes) and to reach the maximal erectile response glans. (11.60 ± 4.07 vs. 7.86 ± 2.70 minutes) with intraurethral administration of alprostadil. 2) 6/33 (18%) patients, all with the score 4, had good response to A 74 year old man, who had 12 years previously received a intraurethral alprostadil application and 15 other patients reached score 4 Dynaflex penile prosthesis for erectile dysfunction after response after visual sexual stimulation. 3) There was no statistical difference between intracavemous injection and intraurethral administration of alprostadil failed intracavernosal injection therapy, presented for regarding the mean peak systolic velocity of the cavemosal arteries (37.27 ± treatment because of lack of glans tumescence. A trial of 12.55 vs. 35.52 ± 11.02 em/second). 4) 20/33 (61%) patients experienced MUSE was undertaken and satisfactory glans tumescence urethral pain with intraurethral administration of alprostadil. Among them, four was achieved with a dose of 500Jlg without any side effects. stated it as intolerable. CONCLUSIONS: Intraurethral administration of alprostadil alone is not as MUSE should be considered in patients with penile effective as intracavemous injection of alprostadil. When combined with the use prostheses and indeed in any situation where enhanced glans of visual sexual stimulation, 21/33 (64%) patients responded well. tumescence is desired. International Journal of Impotence Research Presentations S26 No. 65 No. 66 Effects of transurethral alprostadil on motility Comparative clinical study with sertraline as parameters and acrosomal reaction of human needed versus SS-cream in premature ejaculation sperm (PE) patients Jae-Seung Paick, Kwanjin Park and Soo Woong Kim Lee. Xin, Department of Urology, Seoul National University College of Medicine, Woong-Hee Zhong-Cheng Hyung-,Ki Choi Seoul, Korea Department of Urology, Yonsei University College of Medicine, Seoul, Korea . PURPOSE: We performed comparative clinical study wtth selective serotonin reuptake inhibitor, sertraline treatment 'as-needed' Purpose: Transurethral alprostadil, newly developed treatment modality for base and SS-cream made from 9 herbal medicine to evaluate both patients with erectile dysfunction, may have untoward effects on human the efficacy and adverse effects of the treatments. . . sperm. Although previous studies indicated that remained alprostadil had METHODS: 44 PE patients were treated 5 times With sertraline no significant effects on the motility, viability and membrane integrity of 50rng as-needed base 5 hours before intercourse in the first month human sperm, the possibility that alprostadil might have roles in sperm and in the second month, with 5 times SS-cream 0.2gm on the hyperactivation and acrosomal reaction still exists. So we have evaluated glans penis 1 hour before and washed out before intercourse. the effects of alprostadil on motility parameters and acrosomal reaction of RESULTS: 31 patients were primary and 13 were developed human sperm in vitro. secondarily associated with male erectile dysfunction (ME D) 7, Methods: Eight healthy volunteers provided semen samples that were prostatitis 3, idiopathic 3. When the efficacy of treatment incubated with 0.1 mglml and 0.4 mglml alprostadil which represented defined as elongation of ejaculatory latency time longer than 2 mm, similar and exaggerated concentration after transurethral administration. in primary PE, sertraline was effective in with Control incubations included polyethylene glycol 1450, the formulation elongation and SS-cream was in 27(f57%) wtth 11.3±15.2mm. 1n vehicle and Ham's F-10 buffer. Serial evaluations of percent sperm secondary PE, sertraline was effective in 3(39.0%) with 2.1 motility and several computer generated measurements of sperm motion elongation and SS-cream was in 10(76.9%) witJ:l 8.4±15.?nun. 1n were performed after 30, 60 and 120 minutes of incubation. After 120 primary PE, there were 3 selective responders With who minutes, we performed simultaneous fluorescein isothiocyanate labelled were characterized by low vibration threshold of glans perus. Tho::re Pisum sativum lectin/Hoechst 33258 staining to evaluate acrosomal status. were 3 secondary PE patients with selective responsiveness With Results: None of the group had significant difference in manually sertraline who were associated with mild MED. Adverse effects of calculated percent sperm motility. The alprostadil group showed decreases sertraline' were reported in 24(54.5%)(nausea 7, yawning, sleepiness in linearity, increases in amplitude of lateral head displacement and 6 MED 2 and headache dizziness 3). 1n the case of SS-cream 3 increased fraction of hyperactivated sperm with statistical significance of adverse 'effects were reported (hypersensitivity 2, (ANOV A, p<0.05). The fraction of spontaneous acrosomal reaction decreased erectile function 1). increased significantly in the low and high dose alprostadil group (28 ±4.1 CONCLUSION: SS-cream has better efficacy in PE treatment and 31 ±4.8%, I test, p<0.05) compared with that of control group (11 ± with less adverse effects than sertraline treatment 'as-needed' base. 3.9%) without dose response relationship. The least responsive patients with SS-cream were patients with Conclusions: Alprostadil administration in vitro changed several computer hypersensitive vibration threshold of glans penis in primary PE and assisted sperm motion analysis parameters and increased spontaneous patients associated with MED in secondary PE. acrosomal reaction. For further evaluation of the effects of remained alprostadil on sperm and pregnancy, well controled in vivo study will be needed. No. 67 No. 68 Is intracavernosal self-injection therapy effective in The efficacy and safety of self-intracavernosal the treatment of premature ejaculation complicatfd injection with alprostadil in diabetic or hypertensive with erectile dysfunction? patients with erectile dysfunction Taejoon Ha-, Kyuseon Cho', Soo Woong Kim and Jae-Seung Paick Jiann-Hui Ou, Johnny SN Lin, YM Lin, YS Tsai, YC Huang Sunrung Top Andrology Clinic', Department of Urology, Seoul National Department of Urology, National Cheng Kung University HospitaL University College of Medicine, Seoul, Korea Tainan, Taiwan Purpose: To investigate the efficacy of intracavemosal self-injection Erectile dysfunction is a common problem in men with diabetes therapy in the treatment of premature ejaculation complicated with erectile dysfunction. or hypertension. This study was conducted to evaluate the long-term Methods: A total of 102 patients (53.2 years of mean age) with efficacy and safety of intracavernosal alprostadil in diabetic or premature ejaculation complicated with erectile dysfunction underwent hypertensive patients with erectile dysfunction (ED). We enrolled intracavemosal injection therapy with the Trimix (mixture of papaverine 19 totally 42 patients with diabetes (n=22), hypertensiion (n=I2) and mglml, phentolamine 0.59 mglml and PGE I 6 mcglml). Dose was adjusted both diabetes and hypertension (n=8) who have history of erectile to achieve sufficient rigid erection more than 30 minutes. All patients dysfunction for at least 4 months. The titration phase, the initial were suffered from various degree of premature ejaculation which was home-use dose was determined, followed by a 3 to 6 -month, self newly developed or aggravated after their erectile capacity had diminished. Ejaculation latency was assessed before treatment and every month during injection home phase (diabetes for 6 months, hypertension for 3 treatment. Follow-up period ranged from 3 to 15 months (average 8.2). months). The efficacy and adverse events were documented. During Results: During treatment phases, all subjects performed self-injection of the 6-month maintenance phase, 78% and 73% of injections assessed Trimix from 0.2 to 0.8 cc as needed. Mean latency to ejaculation was 1.2 by the diabetic or hypertensive patients resulted in satisfactory sexual ± 0. 9 minutes before treatment. During treatment periods, latency to activity, respectively and 76 % and 67.2% of injections assessed the ejaculation was increased significantly in 77 patients (75%). Mean their partners, respectively. Penile pain was the commonest complaint ejaculation latency in these patients was 9.3±3.5 minutes. Among the 77, 42 patients reported prolonged ejaculation latency after the first episode of (diabetes vs. hypertension, 61% and 30%, respectively). Prolonged self-injection therapy and others as the number of injection went up. erection occurred in two patients (4.7%). One patient with both Twenty eight out of 38 patients who showed improvement of natural hypertension and diabetes had penile fibrotic lesion after maximal erections while using Trimix reported that they could maintain same dose of 60 for 6 months. One patient suffered from right putamina! ejaculation latency when they perform intercourse without injection. Four hemorrhage in the last month and it was not considered to be patients could not ejaculate at initial trial, but it disappeared as the clinically relevant. lntracavernosal alprostadil injection is an effective injection was repeated. and safe therapy for diabetic or hypertensive patietns, provided that Conclusions: This study showed that intracavemosal self-injection therapy can be successful in the treatment of premature ejaculation complicated the individual dose is established by titration, patients are trained in with erectile dysfunction. the self-injection technique with periodical supervision. International Journal of Impotence Research Presentations S27 No.69 No. 70 New cocktails of intracavernosal injection using Risk factors for dose increase of intracavernous KATP channel opener, pinacidil vasoactive agents in the early stage of pharma Du Geon Moon, Hi Cheal Park, Je Jong Kim cotherapy for erectile dysfunction Department of Urology, Korea University Hospital, Seoul, Korea Sung Woon Lee, Sae Chul Kim, and Kyung Keun Seo Dept. of Urology, Chung-Ang University Yongsan Hospital, 65- 207, Hangang-Ro 3-Ka, Yongsan-Ku, Seoull40-757, Korea PURPOSE: Since intracavemous erectogenic agents is associated with adverse effects e.g. corporal fibrosis, pain and insufficient erection, there Purposes: To identify factors that influence dose increases of has been an increasing interest in finding effective and safe alternatives. intracavernous vasoactive agents to maintain erection for Recent studies demonstrated that pinacidil effectively relax the smooth intercourse in the early stage of pharmacotherapy. muscle. We performed this study to assess the efficacy of pinacidil (Pi) as !'faterials and Methods: Seventy-nine patients using an alternate or supplemental component of intracavemous injection such as. mtracavernous _pharmacotherapy with tri-mix (PGEI> papaverine, PGE, (PG) or mixture with papaverine (Pa) or phentolamine (Ph). and a 3 - 4 year period were enrolled. At 3 METHODS: In twenty-eight adult male cats in vivo, maximal month tn!ervals, w_ere questioned about erection response, intracavemous pressure (ICPmax), time to ICPmax(Tl/2) and duration of changes m dose t_o erection for satisfactory intercourse, increased ICP (Time) to the intracavemous PG or Pa alone, and mixture and frequency ofmJectwn, and also underwent examination of the of Pa+Ph and Pa+PG+Ph were compared with those of new cocktails penis. patients were divi_ded into two groups according to containing pinacidil (e.g. Pi+Pa, Pi+PG, Pi+Pa+Ph, Pi+PG+Pa), to find the changes m dose: Group A; an mcrease 20% of the initial dose more effective and less harmful mixture. The cocktails were composed of and Group B; no change, or an increase in dose < 20% of the same concentration of each drugs within I o·"- w·'M. initial dose. RESULTS: Despite lower concentration than alone, all mixtures of Results: A significant increase (p No. 71 No. 72 Use of a vacuum erection device can enhanee Penile vein ligation plus cavernoplasty for intracavernosal injection therapy venogenic impotence Earle Carolyn M. Chew Kim K and Stuckey Bronwyn GA. Shen Mjng, Li jin-kun ,Qin Yun-lin, Yu Jian-hong,Zhao yong-ping Keogh Institute for Medical Research, QEII Medical Centre, Penh, Western Australia, Australia, 6009. The First Affiliated Hospital,Kunming Medical College, Dept. of Andrology, Kunming Yunan,P.R.China. Introduction - The use of intracavernosal injection therapy (ICI) has been well documented in the treatment of erectile dysfunction (ED). 36 men aged 24-67years(mean 38 ± 6.2) complaining Vacuum erection devices (VED) have also been used to treatED non impotence were diagnosed as venogenic impotence, using invasively for many years with varying results. Aim - Our aim was to assess if there was a benefit in utilising a methods such as audio-visual sexual stimulation test(AVSS), combination of both methods of treatment in men who did not rigiscan plus, dual-radioisotope penography (penogram index of respond to ICI alone. anery system were 118.2±45.6%, penogram index of venous - 61 patients whose response to ICI alone was not system were -72.8 ± 7.8%), cavernosography and satisfactory entered the study. 57 were suitable for analysis. Records were analysed to assess if there was any relationship between bulbocavernosus reflex latency time(BCR-L). The research treatment efficacy and medical, social and psychological history. was from 1995.3 to 1999.4. 22 of them underwent the deep Previous ICI treatment ranged between PGEl (5Jlg-60Jlg) n=39, dorsal vein ligation surgery plus cavernoplasty. 14 of them Papaverine (20mg-120mg) n=9 and combination therapy n=9. Successful treatment was judged as an erection suitable for underwent the cavernoplasty only. All patients were followed intercourse. up at shon and long-term periods. In shan-term follow-up 45.6% of these patients found that the combination of ICI + group (21 cases within 6months) 18 patients showed VED did not improve their erection whilst 54.4% stated it did. spontaneous erection, 3 patients needed intracavernous Factors such as length of time of ED, type of ED, medical history, smoking, age, height, weight and biochemistry did not differ between injection or vacuum constriction device(VCD). In long-term the two groups. follow-up group (15 cases over one year) 9 patients showed Patients who did not benefit from the combination therapy all reponed spontaneous erection, 6 patients needed intracavernous gradual onset of (100%) ED in comparison to sudden onset (0%). Yet, patients who did improve reported both gradual (76%) and injection or VCD. 27 cases of sample (75%) were able to sudden onset (24%) in their ED. Patients who gained improvement in have acceptable sexual intercourse again. We concluded that this area were smokers (28% vs 14%) and non drinkers (28% vs penile vein ligation plus cavernoplasty could be an useful 0%). alternative for such patients , but it should be performed for Conclusion - Using a combination of VED and ICI did salvage some patients who had inadequate response to ICI alone. However, it was the well selected patients, specially those showing difficult to predict which patients would respond to the combined abnormality in dual-radioisotope penography or dynamic therapy given the lack of significance in parameters assessed. infusion cavernosometry and cavernosography. International Journal of Impotence Research Presentations S28 No. 73 No. 74 A small pararectal incision for dissection of the A modified penile augmentation and elongation inferior epigastric artery required for microsurgi surgery cal revascularization of the penis Gen11-Lon11 Hsu Shin-Hon Chen*, Chin Kwo Tsai* Department of Urology, Tomoteru Kishimoto, Kazunori Kimura, Kunihisa Yamaguchi, Po-Jen General Hospital Hiroyoshi Nakatsuji, Keiji Kojima, Akira Yamamoto, Yasuo *Taiwan Adventist Hospital Kawanishi, Akira Numata Taipei, Taiwan, ROC Department of Urology, Takamatsu Red Cross Hospital Purpose: Penile augmentation is necessary for micropenia patients. However, the proper size is very subjective. We report a modified preputial augmentation. Patients & Methods Purpose : We designed a new procedure involving a small 31 patients underwent penile lengthening and augmentation pararectal incision (4cm) for dissection of the inferior epigastric procedures with proximal dorsal nerve block and peripenile infiltration. artery required for microsurgical revas cularization of the penis. All the operations were carreid out in outpatient basis. Patients' ages Methods : We dissected the epigastric vessels through a small range from 21 to 71 years. The follow-up period varied from 1.5 to 32 pararectal incision utilizing an ultrasonic tissue coagulator and months. 30 patients received preputial flap. One received peno-scrotal island flap at the beginning of this procedure because he had had laparoscopic clips. circumcision previously. Result : A wide pararectal incision has traditionally been required to harvest the inferior epigastric artery. Recently a laparoscopic Results approach has been proposed to avoid the long abdominal incision 30 patients noted increase both in length and girdle of the penis postoperatively .One patient sustained a shorter penis because of with the risk of postoperative bleeding, pain, and hernia wound contracture. Unfortunately two patients reported uneven formation. However, a laparoscopic procedure is both time prepuce most likely due to increased tension. One patient found his consuming and costly. Our new procedure avoids the demerits of glans of the penis was relatively too small to his augmented penile shaft. both the open and laparoscopic procedure. Two patients reported prolonged penile edema as long as 4 months. The Conclusion : The new procedure involving a small pararectal overall improved rate is 93 .5%,however the satisfactory rate reduces to incision achieves time cost and prognosis benefits when 78.1% harvesting the inferior epigastric artery for microsurgical Conclusion rev as cularization of the penis. Our modified penile augmentation method is promising for those who feel their penis shaft do not measure up to the "standard". No. 75 No. 76 Summarization of oral medication during 19 years Clinical effects of Gosha-jinki-gan on erectile for the psychogenic ED before Viagra use dysfunction resulting from Shen Xu Hitoshi HIRAKATA, Yukie TAKIMOTO, Nozomu KAWATA, Shuji Haruaki Sasaki, Ryuta Goto, Hiroyasu Yoshikawa, Yasutada SUGIMOTO, Hiraki YAGASAKI, Yuji NAKANOYA Onodera, Takao lkeuchi, Yoshio Kai Department of Urology, Nihon University School of Medicine, Department of Urology, Showa University Fujigaoka Hospital, Surugadai Nihon University Hospital, Tokyo, JAPAN Syowa University School of Medicine. International Journal of Impotence Research Presentations S29 No.77 No.78 Treatment of intracorporal injection non-responders Participation of patients' partners in the treatment with sildenafil alone or in combination with polyagent of impotence intracorporal injections Zbigniew Lew-Starowicz Institut of Sexology and Faculty of Rehabilitation-Warsaw McMahon, C.G., Samali, R, Johnson, H. Australian Centre.for Sexual Health, Sydney Australia The studied involved 2789 patients with diagnosed of erec tile dysfunction (ED), treated in the Institute of Sexo Objective: To assess the efficacy of sildenafil as salvage therapy for intracorporal logy. Conclusions: injection therapy (ICI) non-responders. l) 12% of partners of patients treated with training tech niques resigned of participation. The reason of training Methods: 93 fully evaluated patients w"h chronic erectile dysfunction (ED) and a techniques rejection included first of all their time-con mean age of 53.6years (range 24-77) who had previously failed a home trial of ICI suming and unforeseem changes in the partners' relationship. high dose alprostadil and polyagent ICI were treated with sildenafil c"rate alone 2) 85% of patients treated with ICI technique, did not want or in combination with ICI. their partners to participate in therapy and hid it because Results: 29/93 had arteriogenic ED, 36/93 had cavernosalvenous leakage (CVL), of shame and fears. 24/93 had mixed vasculogenic ED (MVED), 3/93 had psychogenic EP and 1/93 3) 94% of patients treated with ICI technique, whose partners participated in therapy, suffered from its nega had post-priapism intra-cavernous fibrosis. 32193 (34%) responded to sildenafil, tive consequences. 30/32 requiring 100mg and 2/32 requiring 50mg. 29/93 (31%) responded to 4) People identifying themselves with traditional sex sildenafiVICI, all requiring 1OOmg. 32/93 (34%) failed to respond to sildenafil or roles reject the participation of their partners in ED sildenafiVICI. Mean liEF question 3 and 4 scores were 1.7 and 1.5 at baseline, 2.3 therapy. and 1.9 with ICI, 4.6 and 4.2 with sildenafil responders and 4.1 and 4.0 with 5) A participation of partners of ED patients in case of the traditional roles of sexes in the partnership leads sildenafiVICI responders respectively. 29/93 (31%) reported adverse effects with to negative consequences affecting a harmony and conti ICI comprising penile pain (27), dizziness (5) and headache (2). 34/93 (37%) nuation of relationship. reported adverse effects w"h sildenafil comprising headache (30), facial flushing 6) The treatment of ED with Viagra, not revealing this (25), dyspepsia (12), nasal congestion (9), dizziness (5) and visual disturbances fact to the partner, is quite popular in the relation (1 ). 20/41 (49%) reported adverse effects with sildenafiVICI comprising penile pain ships in which partners identity themselves with tradi tional sex roles. (15) headache (15), facial flushing (12), dyspepsia (7), nasal congestion (3), 7) Sex roles of both partners have a significant effect dizziness (12) and syncope (1). on ED therapy. Conclusion: Sildenafil alone or sildenafiVICI is effective salvage therapy for ICI non-responders. Sildenafil in combination with SIT is associated with a 33% incidence of adverse effects including a 20% incidence of dizziness. No.79 No. 80 TRAPS (transpenile barrier systems) in Clinical profile of patients with diabetes mellitus treatment of erectile dysfunctions: a new method treated for erectile dysfunction (ED) in penile rehabilitation Chew K Kim. Stuckey Bronwyn GA and Earle Carolyn M. IJOSCilh TRITTO, E. AZZOLLINI, P. TEILLAC, A. LEDUC Keogh Institute for Medical Research, QEII Medical Centre, Service of Urology, Unit of Surgical Andrology, Saint- Louis Hos1Jital, Perth, Western Australia, Australia, 6009. Paris - France Trans1Jcnile barrier Systems ( TRAPS ) are defined as new emerging methods delivery vasoactive drugs for erectile dysfunction and erectile tissue ,rehabilitation. Transdermal Barrier ( TDB ) systems are compared to We studied the clinical profile of diabetic patients treated by Transe1Jidermal Barrier ( TEB ) methods to evaluate passive versus active intracavernosal injection therapy for ED at our Institute during penetration through the intact cutaneous barrier. 1995 to 1997. The introduction of new vasoactive drugs with microvasculokinetic activity in a phosphatidylcholine complexed structure in clinical trials on vasculogenic The mean age of 42 patients with insulin-dependent diabetes impotence indicntes the possibility to improve the microvasculokinetic activity of the corpora ca\'ei"nosa and to restore progressively the metabolic impaired (IDDM) was 48.4 years (range 23-70). 78.0% had DM for balance of the erectile tissue. more than 5 years. 42.9% were overweight and 31.0% were A llrcliminary llhase Ill study is realized using the obese. 34.5% were hypercholesterolaemic. Hypertension, phosphatidylcholine/troxerutine complex ( 3% ) daily applied for 3 months on ischaemic heart disease and peripheral vascular disease were the penile skin in a selected gruup of 24 !leer-patients (aged between 20 and 55 present in 14.3%, 11.9% and 2.4% of patients respectively. ), affected by a severe vascular disease ( hypertensive, arterio-arteriolo sclerotic, diabetic ) with along standing erectile dysfunction. Clinical and functional data (number of spontaneous daily erections, duration The mean age of 171 patients with non-insulin-dependent and rigidity, OPVC [Optic Video Capillaroscopy of the penile skin ), LDF diabetes (NIDDM) was 58.4 years (range 30-77). 50.6% had [Laser Dop1Jier Flowmetry of penile and corpora vessels )) are collected at TO DM for more than 5 years. 43.9% were overweight and Tl-T2-T3. 40.9% were obese. Hypercholesterolaemia was present in The global llrimary outcome shows at Day 90 an effective positive response of 65.0%. There were concomitant hypertension, ischaemic iTroxerutine (Tr) group versus Placebo (P) group: Tr 19/24 (79.2%) versus P heart disease and peripheral vascular disease in 31.0%, 23.4% 11/24 (4.2%). No difference is found in 4/24 (16.3%). More interesting, in the and 4.7% of patients respectively. isecondary outcome evaluation the mean duration of spontaneous daily erections improves gradually from 5.4 to 8.0 in Tr group versus an inverse decrease from 6.0 to 1.6 in P group. ED was present for 1-5 years in 69.0% of IDDM and 63.5% The LDF comJJarative evaluation shows a clear difference in the A score of NIDDM patients. NIDDM appeared to be associated with a 'between P and Tr groups: PT0=6.99, PT30=7. 77, PT60=5.81, PT90=8.41 I greater prevalence of cardiovascular risk factors placing the TrT0=48. 76, TrT30=63.12, TrT60=74. 72, TrT90=81. 77 ( p < 0.001 at patients at higher risk for ED. TO,TJO,T60,T90 ). This first positive clinical trial with a TRAPS system designed to improve the Intracavernosal prostaglandin E 1 injection therapy was microvasculokinetic activity of the erectile tissue demonstrates a new method to increase the mean duration of natural erections through the amplification of successful in 76.2% ofiDDM and 79.5% of NIDDM patients. the microvasculokinetic response of the erectile tissue in a specific A dose of 20mcg or less was adequate in 81.3% and 73.5% of background sustaining the organic erectile dysfunction. these patients respectively. International Journal of Impotence Research Presentations S30 No. 81 No. 82 A trial treatment for preserving potency with Recovery of erectile function after bilateral nerve adjuvant ftutamide monotherapy in locally sparing radical prostatectomy advanced prostate cancer patients identified after nerve-sparing radical prostatectomy Ryuichi Kato, Kenichi Sunaoshi, Masahiro Y anase, Noriomi Miyao and T. Araki", K. Kunitomi, S. ltoh, Y. Shiotsuka, N. Ishito, H. Taiji Tsukamoto Araki Urological Clinic1> and Department of Urology, C!ent.er for Adult Diseases2l, Kurashiki, Japan. Department of Urology, Sapporo Medical University School of Medicine. AIM: Preserving potency is an important QOL problem with prostate cancer (PC) patients after a radical prostatectomy. The nerve-sparing radical (Purpose) We investigated the recovery of erectile function after prostatectomy (NSRP) is indicated for Tl and T2 prostate cancer. However, bilateral nerve-sparing radical prostatectomy. the incidence is not small with PC patients who required postoperative adjuvant therapies, since the postoperative histological evaluation revealed a locally advanced one. For that kind of patient who hoped for both cancer (Patients and Methods) A total of 23 patients who received bilateral control and the preservation of potency, we have tried adjuvant flutamide nerve-sparing radical prostatectomy were evaluated. All patients had (oral nonsteroidal antiandrogen) monotherapy. increases in nocturnal penile tumescence (NPT) of more than 20mm or PATIENTS: 1) 60 y.o. (T2aNoMo). NSRP was performed in April1998, after a had sufficient penile rigidity for vaginal penetration before receiving neoadjuvant therapy with LH-RH agonist for 3 months. Postoperative evaluation showed pT3aNoMo (Gleason score 6). He was administered radical prostatectomy. We used a sexual function questionnaire and 250mg of flutamide daily for one year after the surgery. He recovered measured NPT to evaluate the erectile function over time after radical satisfactory intercourse at 8 months after the surgery and no cancer prostatectomy. The mean follow-up period was 17.9 months. recurrence has been evaluated at 15 months postoperatively. 2) 58 y.o. ('!'2aNoMo). NSRP was perfonned in January 1997, after LH-RH agonist (Results) At 12 months after radical prostatectomy, 10 of 23 (47%) neoadjuvant therapy for 3 months. Postoperative evaluation showed pT3aNoMo (Gleason score 5). He was administered LH-RH agonist for 9 patients had increases in NPT of more than 20mm or had sufficient penile months postoperatively. He restored erection at 6 months after the last rigidity for vaginal penetration. At 54 months after radical injectiOn of LH-RH agonist. At 24 months after the surgery, biochemical prostatectomy, 80% of patients recovered their erectile function. Patients recurTence has occurred, and 250mg of flutamide daily administration has begun. PSA decreased to 0.13 and his erection is preserved after 4 months of who had better pre-operative NPT were likely to recover the erectile starting the therapy. function earlier. DISCUSSION and CONCLUSION: It is well known that nonsteroidal antiandrogens including flutamide has a merit for preserving sexual function (Conclusion) The period for recovery of erectile function after radical during the treatment on preoperative PC patients. However, the merit is not prostatectomy varied according to the patient. Our results suggested that utilized well on post-prostatectomy patients, since it is usually administered as a combination with LH-RH agonist. It may be advantageous to use the patient's pre-operative erectile function and residual function of nonsteroidal antiandrogen monotherapy for patients who request both cancer neurovascular systems were involved in determining the period for the control and preserving potency though unfortunately requiring an adjuvant recovery of erectile function. therapy after nerve-sparing radical prostatectomy. Our 2 patients showed its useful possibility though a long-term follow-up is needed on cancer control. No. 83 No. 84 Sexual activity in BPH patients Chronic prostatitis and sexual dysfunction Yasusuke Kimoto, Mineo Takei, Akito Yamaguchi, Sanshin Hara, CaiJian, MD Narihito Seki, Seiji Naito Department of Urology, Wenzhou Medical College 1st Affiliated Departments of Urology, Kyushu University & Harasanshin Hospital, Hospital, PR China Fukuoka, Japan Chronic prostatitis is not a rare disease in male adults. Its causes are still uncertain, so no satisfactory therapies can be adopted. The clinical symptoms of the disease are versatile and not specific, but its effect on INTRODUCTION AND OBJECTIVES: Since the introwction of Viagra, the sexual function including erection dysfunction and premature ejaculation public interest in sexual dysfunction has been sparlced The prevalence of botli are being emphasized by clinical andrologists. sexual dysfunction and voiding dysfunction are known to increa<;e with aging. We reviewed 120 cases of chronic prostatitis including bacterial Furthermore the therapeutic modalities to BPH are known to impair sexual prostatitis and non-bacterial prostatitis. The average age of them was functions frequently. To get baseline wta of sexual functions in BPH populalion, 32.5 years. Eighty-five percentage of patients had complaint of various we mnducted this study. erection dysfunction and premature ejaculation, one quarter among them PATIENTS AND METHODS: 2817 males who visited our outpatient clinic went to see a doctor with the main complain of sexual dysfunction. Otherwise all cases were given routine exmination to eliminate other with the complaint of voiding dysfunction from October 1994 to July 1998 were causes for sexual dysfunction, such as vascular, endocrine, drug origins incluthl. They all answered self-administered IPSS and sexual activity and soon. questionnaires. With routine therapy, the clinical symptom and laboratory examina RESULTS: The populations who answered "once or more sexual intercourse in tion of all patients were improved, but still 28 percentage had no a month" are as follows: 52% in 65-69 years old men, 35% in 70-74 , 19% in improvement on sexual function. So we should not only provide routine 75-79, 9% in 80-84 and 6% in 85-89. therapy for chronic prostatitis, but also give comprehensive therapies CONCLUSIONS: Old men are very sexually-active beyond our expectations. including psychological, sexual action and necessary physical or drug Therefore, we should choose the therapeutic modality for BPH population with the therapy for sexual dysfunction caused by chronic prostatitis. consideration of the impact to sexual health. International Journal of Impotence Research Presentations S31 No. 85 No. 86 Clinical investigation of erectile dysfunction during Effect of oral beraprost in the treatment of the past 12 years at Department of Urology, Chiba impotence University Hospital Jun-Kyu Suh, Yun-Seog Kang, Hee-Seon Yu, ln-chul Sohn Department of Urology, Inha University, Inchon, Korea Akira Komjya, Jouji Yuasa, Hiroyoshi Suzuki, Akiyuki Shimizu, Youko Kawana, Y oshio Shiseki, Kouichi Suzuki, Makoto Masui, Purpose: Beraprost Sodium (BPS) is an orally stable prostacyclin analogue which leads to platelet aggregation inhibition and vasodilatation. Hirokatsu Tsuji, Noriyuki Suzuki, and Haruo Itou. To predict the value of BPS in the treatment of impotence, a total of 55 successive patients were subjected to receive oral BPS. Materials and Methods: Evaluation was consisted of history, physical Department of Urology, Chiba University Hospital, Chiba examination, laboratory studies, pharmacological erection test, penile University School of Medicine, Chiba, Japan. duplex ultrasonogram, and cavernous NO synthase staining. Treatment method of Beraprost was two; one was to take 40pg, 40 to 60 minutes prior to intercourse to obtain immediate erection and the other was to Between 1987 and 1998 before Sildenafil is available to erectile continuously receive 40pg, two to three times a day (a total 80-120pg /day) for long term control of ED. Sexual function was compared before dysfunction (ED), 150 patients (mean age, 41.1 years old) visited and after treatment for 2 months by analysis of International Index for ED clinic at Department of Urology, Chiba University Hospital. In Erectile Function (liEF) and the degree of patient's satisfaction. Side effect of the drug was also evaluated. the patients aged < 30 years old, the percentage of functional ED Results: Of the total 55 patients, 45 completed the treatment program. Every index of liEF was significantly changed after treatment for those was high (48%). In the patients aged 50-69 years old, the incidence (mean total score: from 30.3 to 47.8, p No. 87 Diagnostic accuracy of cavernous nitric oxide synthase staining in the evaluation of neurogenic impotence Yun-Seog Kang, Dong-Soo Ryu*, Ki-Hak Moon', Joa-Jun Kim, Jee-Young Han, Jun-Kyu Suh Department of Urology and Pathology, Inha University, Inchon and Sungkyunkwan University*, Masan and Yeungnam University#, Taegu, Korea Introduction: Nitric oxide synthase (NOS) histochemistry has been found to provide important insight into the cavernous nerve integrity. We also reported that it might be clinically useful to directly diagnose neurogenic impotence. The present study was performed to investigate the diagnostic accuracy of NOS histochemistry for cavernous neuropathy, in comparison with other diagnostic tools. Methods: Ninety patients with erectile dysfunction (ED) were subjected to this study. The etiology of ED was classified into psychogenic vasculogenic neurogenic and undetermined group based on multidisciplinary impotence work-ups. Cavernous tissue was obtained by percutaneous gun biopsy and assessed using NADPH diaphorase (dNADPH) staining. We also analyzed diagnostic values of penile biothesiometry and autonomic nerve function Results: On cavernous NOS stain, dNADPH positive nerve fibers were significantly decreased in neurogenic group (22±20) (p International Journal of Impotence Research