Earticle

In this study, the pattern of depressive mood in patients following radical prostatectomy (RP) for localized prostate cancer (PCa) was determined. A total of 30 patients (aged 68.03± 6.1 years) who were diagnosed with localized PCa and underwent RP within 1 month entered the study. Evaluations included body mass index, prostate-specific antigen, testosterone, underlying disease, international prostate symptom score and quality of life (QoL), international index of erectile function as well as Beck depression inventory (BDI), both at the initial stage and 3 months later. Basic demographic data, laboratory results, and questionnaires were analyzed statistically. The BDI score significantly decreased 3 months after the surgery. In correlation analysis, BDI was related with the international prostate symptom score but not with the underlying disease, QoL or international index of erectile function. Body mass index was identified as one of the risk factors to decrease the probability of BDI score (≥ 3) significantly. Underlying disease increased the probability of BDI score. In the assessment of the correlation between BDI and each subscale, sadness, self-dislike, self-criticalness, and worthlessness showed high correlation. In the early period, depressive mood was improved at the short-term follow-up in localized PCa patients after RP. Voiding symptoms were only related with the depressive mood, but not with other parameters, including sexual function. The depressive mood had no effect on the QoL in the early stage.

As a urologist, we usually encounter with two representative functional behaviors, namely, voiding and sexual function. These are not only im-portant but also complex and synchronized so if these functions are im-paired, patients need active functional rehabilitation to recover. These functional impairments should be recognized and corrected early be-cause they could not only cause direct damage to the affected func-tions but also have harmful consecutive consequences such as kidney damage due to voiding abnormality and self-esteem damage due to de-creased sexual function. Numerous rehabilitative methods are current-ly available, which help minimize the negative effects of these function-al impairments. In terms of voiding function, pelvic floor muscle exer-cise, biofeedback, functional magnetic stimulation, neuromodulation, and clean intermittent self-catheterization are representative rehabilita-tion modalities. In case of children, extra-attention should be paid be-cause this might affect their entire life. In impairment of sexual function, early intervention to maintain male erection is the main target of reha-bilitation to prevent corporal fibrosis and penile deformity and increase recovery chance in patients who underwent radical prostatectomy or major surgery. In this review, we will elucidate various rehabilitation methods in urology to further increase our understanding of the rehabil-itative characteristics of urology and widen our view of rehabilitation medicine.

복분자, 산수유 및 토사자를 일정한 비율로 배합하여 열수추출로 얻어진 KH-305를 일반쥐에 투여해서 해면체 평활근 이완에 관련된 세포 내 신호전달체계 NO-cGMP pathway에 관여하는 NOS, 혈액내의 testosterone, BVSMCs cell에서 cGMP농도를 측정하여 음경발기 지속 및 촉진에 미치는 영향을 보았으며 음경조직의 활성산소제거와 관련하여 SOD/Mn, SOD/Cu의 단백질 발현정도를 측정하였다. KH-305는 NO-pathway에 관여하는 NOS의 발현증가, 낮은 농도에서의 cGMP농도 증가, testosterone의 수치를 증가시킴으로써 발기유지 및 촉진시키고, 동시에 음경조직내의 활성산소 및 NO 합성에서 나타나는 독성을 조절하여 주는 SOD발현이 증가됨으로써 활성산소에 의한 음경피로도를 경감시켜 음경해면체 평활근의 이완장애를 일으키는 발기부전 증상을 개선시킬 것으로 생각된다.

This study was designed to investigate the effects of KH-305 on erectile dysfunction in young rats, via nitric oxide (NO)-cGMP pathways. After oral administration of the KH-305 mixture (50, 100, 200, 300 mg/kg) to young rats for 10 days, NOS and SOD protein expressions in penile tissue and testosterone in plasma were measured. cGMP degradation was also investigated using bovine vascular smooth muscle cells pretreated with an NO donor, S-nitroso-N-Acetylpenicillamine (SNAP). The penile expression levels of nNOS and eNOS-dependent NOS activities as well as SOD preventing oxidative stress by overproduction of NO were increased significantly. Also, the concentration of testosterone in the plasma was increased. In vitro, cGMP concen-trations were decreased dose dependently in the KH-305. These results suggest that KH-305 may be useful in erectile dysfunction.

As the radical prostatectomy (RP) for the patient diagnosed as localized prostate cancer has been increasing, erectile dysfunction (ED) associat-ed with RP is increased and ED after RP is a significant risk factor to re-duce the quality of life for the patient after RP. Therefore, the treatment concept called penile rehabilitation was introduced and phosphodies-terase type 5 inhibitor (PDE5I) is used widely for the prostate cancer pa-tient after RP. Generally PDE5I is considered as safe and effective drug for the prostate cancer patient after RP. Recently, a report against the general opinion that PDE5I use is safe in the patient with prostate cancer was reported and the analysis of 5-yr biochemical recurrence-free sur-vival after RP between the PDE5I users and non-PDE5I users after bilat-eral nerve sparing RP showed decreased 5-yr biochemical recur-rence-free survival in the PDE5I users. In addition, a longitudinal cohort study reported that sildenafil, a kind of PDE5I, use might be associated with the development of melanoma and this result suggested the possi-bility of adverse effect of PDE5I on some kinds of cancers as well as prostate cancer. Moreover, the studies to evaluate the influence of nitric oxide (NO) and guanosine monophosphate (cGMP) signaling pathway associated with PDE5 showed both cancer reduction and cancer devel-opment. Therefore, the role of NO and cGMP signaling pathway in can-cer was reviewed based on the previous studies and suggested the ne-cessity of further clinical studies concerning about the safety of PDE5I in prostate cancer.

Purpose: The purpose of this study was to examine late-onset hypogonadism, erectile dysfunction, depression,and quality of life among middle-aged male workers. Methods: The subjects included 343 men aged between 40and 64, responded to self-report questionnaires on general characteristics, late-onset hypogonadism, erectile dysfunction, depression, and quality of life. Data were collected from May 16, 2012 to October 9, 2012 and analyzed using t-test, ANOVA, x2-test, hierarchical multiple regression. Result: The prevalence rate of late-onset hypogonadism was 63.8% with high points in reduction of libido, energy, physical strength and endurance, and erectile function. There were significant differences in late-onset hypogonadism according to age(x2=8.98, p=.048)and in erectile dysfunction according to age(F=11.03, p<.001), monthly income(F=2.84, p=.024) and smoking(t=2.96, p=.018). Significant differences were also found in depression according to educational level(F=8.12,p<.001) and in quality of life according to monthly income(F=7.21, p<.001). The factors which influenced quality of life were late-onset hypogonadism, erectile dysfunction, depression, marital status and religion. Conclusion:Symptoms of erectile dysfunction can be improved by smoking cessation education program. In order to improve the life quality of middle-aged men, nursing intervention programs that would both provide proper knowledge on climacteric syndrome and alleviate symptoms should be designed while, at the same time, other programs to evaluate,prevent and control depression are developed.

The purpose of this study was to examine the effects of Maca water and/or ethanol extract on the nitric oxide (NO) production in human umbilical vein endothelial cells HUVAC and on erectile dysfunction in rats. Maca was extracted due to both solutions, which are water and ethanol. Each Maca extract was applied to HUVAC, and NO production was checked. Additionally, three different dosages (250, 500 and 1,000 mg/kg) of Maca ethanol extract was administered to Sprague-Dawley rats for 4 weeks. All rats were sacrificed and each sample was collected for analysis. The control rats received only the saline vehicle. The NO production of HUVAC was significantly increased by domestic and homemade Maca water extracted at $60^{\circ}C$ group. Both NO generation and testosterone release were not influenced due to the oral administration of Maca. In the EtOH group rats, the number of sperm was reduced compared to that of the control group. All Maca groups had a high number of sperm and each sperm count had increased as a result of the Maca extract dose. The results of this research suggest that Maca has a positive effect on male erectile dysfunction, which need to be examined further in future studies.

연구는 남성 발기부전(ED)의 치료에 있어 새로운 접근 방법으로 Mucuna pruriens의 도파민 작용을 활용하는 가 능성을 탐구하고자 하였다. 기존의 치료법(PDE5 억제제 등)은 주로 성기에 혈류를 증가시키는 데 초점을 맞추고 있으나, 본 연구는 뇌의 역할, 특히 도파민의 역할에 주목하였다. 연구 방법으로 Mucuna pruriens의 도파민 증가 효과와 관련된 기존 문헌을 검토하였다. 결과적으로 Mucuna pruriens가 도파민 수치를 증가시켜 성적 흥분과 발기 유지에 긍정적인 영 향을 미칠 가능성이 있음을 확인하였다. 이는 ED 치료에 있어 보다 포괄적인 접근 방법이 될 수 있으며, 향후 임상 연구 를 통해 그 효과와 안전성을 평가할 필요가 있다.

This study explores the potential of Mucuna pruriens as a novel approach in the treatment of erectile dysfunction (ED) by leveraging its dopaminergic effects. Traditional treatments such as PDE5 inhibitors primarily focus on increasing blood flow to the penis. However, this study emphasizes the role of the brain, particularly dopamine, in ED treatment. Through a review of existing literature on Mucuna pruriens' dopamine-enhancing effects, this study found that Mucuna pruriens can positively impact sexual arousal and erectile maintenance by increasing dopamine levels. This suggests a more comprehensive approach to ED treatment, necessitating future clinical research to evaluate its efficacy and safety.

전문의약품은 소비자의 직접 구매가 제한적이고, 민감한 문제를 다루는 특성상 마케팅 전략 수립에 제약이 따른다. 특 히 발기부전제와 같은 제품은 정보 중심의 전달보다 정서적 접근이 효과적일 수 있으며, 이에 따라 감성적 소통을 중심으 로 한 ‘펀마케팅’이 새로운 대안으로 부상하고 있다. 본 연구 는 발기부전제를 중심으로 펀마케팅 전략이 브랜드 개발 및 소비자 인식에 미치는 영향을 분석하였다. 국내 발기부전제 36종의 브랜드 네이밍 유형을 분석하고, 이를 바탕으로 5개 유형의 29개 네이밍을 개발하여 소비자 선호도 조사를 실시 하였다. 이후 상위 득표 네이밍을 바탕으로 브랜드 디자인을 개발하고, 적합성, 차별성, 유희성, 기억성, 정보전달성 등의 항목에 대한 평가를 통해 마케팅 효과를 분석하였다. 연구 결 과, 직접적이고 유머러스한 네이밍이 소비자의 기억성과 호 감도를 높이며, 제품에 대한 심리적 저항을 낮추는 데 효과적 임을 확인하였다. 특히 ‘원모어(One More)’는 직설성과 재미 를 결합한 네이밍 전략으로 높은 평가를 받았다. 본 연구는 펀마케팅이 민감한 의약품군에서도 효과적으로 적용될 수 있 으며, 브랜드 차별화와 소비자 접근성 강화에 기여할 수 있음 을 시사한다. 발기부전제와 같이 소비자에게 특정 문제 해결 을 명확히 전달해야 하는 의약품에서는 직설적으로 표현하는 전략이 주효할 수 있음이 결과로 도출되었다.

Prescription drugs are subject to restrictions in direct consumer purchasing and often address sensitive health is sues, which imposes limitations on the formulation of marketing strategies. In particular, for products such aserectile dysfunction (ED) medications, emotionally driven app roaches may prove more effective than information-centered communication. As a result, fun marketing—an emotional and engaging form of communication—has emerged as a viable alternative strategy. This study examines the impact of fun marketing strategies on brand development and consumer perception, focusing on the case of ED medications. The study analyzed the brand naming types of 36 ED drugs available in the domestic market and developed 29 brand name candidates across five naming categories. A consumer preference survey was conducted to evaluate these names. Based on the top-ranked names, brand designs were developed and assessed in terms of rele vance, differentiation, playfulness, memorability, and informativeness. Findings indicate that direct and humorous naming strategies significantly enhance consumer recall and favorability, while also reducing psychological resista nce to the product. In particular, the name “One More,” which combines directness with humor, received high ev aluations across multiple dimensions. The results suggest that fun marketing can be effectively applied even in se nsitive pharmaceutical categories, contributing to brand differentiation and increased consumer accessibility. Furth ermore, in pharmaceutical segments like ED treatment, where it is crucial to clearly communicate a solution to a specific problem, direct expression proves to be an especially effective strategy.

The fallowing are the result of the experimental studies of KH-304 on the penile nitric oxide synthase (NOS) activity, SOD and the level of blood testosterone in old rat. KH-304 was tested for the expression and activity of eNOS, nNOS, SOD/Mn, caveol in-1, 3 in penis of old-rat. The penile expression level of the five enzyme were increased significantly after oral administration of the KH-304 100mg/kg for 100ays and the concentration of testosterone in the blood were increased. In vitro, the effect of SOD and free radical scavenging were increased significantly. Conclusively, KH-304 is capable of improving of sexual ability in old-rat.

The fallowing are the result of the experimental studies of KH-304 on the penile nitric oxide synthase (NOS) activity, SOD and the level of blood testosterone in old rat. KH-304 was tested for the expression and activity of eNOS, nNOS, SOD/Mn, caveol in-1, 3 in penis of old-rat. The penile expression level of the five enzyme were increased significantly after oral administration of the KH-304 100mg/kg for 10days and the concentration of testosterone in the blood were increased. In vitro, the effect of SOD and free radical scavenging were increased significantly. Conclusively, KH-304 is capable of improving of sexual ability in old-rat.

This study was designed to investigate effects of KH-304 in improving erectile dysfunction (ED), particularly in terms of nitric oxide (NO)-cGMP pathways. After oral administration of the KH-304 water extract, 1OOmg, 300mg, 500mg or 700mg per 1 kg of Dody weigh for 10days, We examined the expression and activity of two enzyme: neuronal NO synthase (nNOS), endothelial NO synthase (eNOS) and that act upon the major NO-cGMP signaling pathway in penile tissue. Effect of KH-304 on COMP degradation was also examined using bovine vascular smooth muscle cells pretreated with an NO donor, S-nitroso-N-Acetylpenicillamine (SNAP), Also, it examined the endothelial NO synthase (eNOS) for seaching effecting period (100mg, 300mg/kg for 10 and 30days) and peak intracavernous pressures (ICPS) in penile tissues rabbit copus cavernosum contracted by 10-6 M phenylephrine. The severely reduced peak intracavernous pressures (ICPS) in penile tissues were restored completely after KH-304 treatment, and KH-304 treatment significantly made the latency period earlier. Furthermore, the penile expression levels of nNOS, eNOS dependent NOS activities and COMP concentrations were increased significantly in the KH-304 100, 300mg treated rats. These results suggest that KH-304 with high expression of NOS may be useful in erectile dysfunction.

This study was designed to investigate effects of KH-304 in improving erectile dysfunction (ED), particularly in terms of nitric oxide (NO)-cGMP pathways. After oral administration of the KH-304 water extract, 100mg, 300mg, 500mg or 700mg per 1kg of body weigh for 10days, We examined the expression and activity of two enzyme: neuronal NO synthase (nNOS), endothelial NO synthase (eNOS) and that act upon the major NO-cGMP signaling pathway in penile tissue. Effect of KH-304 on cGMP degradation was also examined using bovine vascular smooth muscle cells pretreated with an NO donor, S-nitroso-N-Acetylpenicillamine (SNAP). Also, it examined the endothelial NO synthase (eNOS) for seaching effecting period (100mg, 300mg/kg for 10 and 30days) and peak intracavernous pressures (ICPs) in penile tissues rabbit copus cavernosum contracted by 10-6 M phenylephrine. The severely reduced peak intracavernous pressures (ICPs) in penile tissues were restored completely after KH-304 treatment, and KH-304 treatment significantly made the latency period earlier. Furthermore, the penile expression levels of nNOS, eNOS dependent NOS activities and cGMP concentrations were increased significantly in the KH-304 100, 300mg treated rats. These results suggest that KH-304 with high expression of NOS may be useful in erectile dysfunction.

Background/Aims: Despite sexual function making an important contribution to the quality of life, data on erectile function are relatively scant in patients with chronic liver disease. We evaluated the prevalence of and risk factors for erectile dysfunction (ED) in patients with liver disease related to hepatitis B, especially among those with chronic hepatitis B (CHB) or early-stage cirrhosis. Methods: In total, 69 patients (35 with CHB and 34 with hepatitis-B-related liver cirrhosis [HBV-LC]) aged 40?59 years were analyzed. Child-Pugh classes of A and B were present in 30 (88.2%) and 4 (11.8%) of the patients with HBV-LC, respectively. The erectile function of the patients was evaluated using the Korean version of IIEF-5. Results: The prevalence of any ED was 24.6% for all patients, and 8.6% and 41.2% for those with CHB and HBV-LC, respectively (P=0.002). While there was only one (2.9%) CHB patient for each stage of ED, mild, moderate, and severe ED stages were seen in three (8.8%), one (2.9%), and ten (29.4%) of the HBV-LC patients, respectively. Multiple regression analysis identified the type of liver disease (P=0.010), hypertension (P=0.022), score on the Beck Depression Inventory (P =0.044), and the serum albumin level (P=0.014) as significant independent factors for the presence of ED. Conclusions: The prevalence of ED was significantly higher in patients with early-stage HBV-LC than in those with CHB. Therefore, screening male patients with early viral cirrhosis for ED and providing appropriate support are needed, especially when the cirrhosis is accompanied by hypertension, depression, or a depressed level of serum albumin.

Distribution of various illegal or counterfeit drugs of seven approved erectile dysfunction drugs and their analogues has been increased, causing health problems such as cardiovascular disorder, tachycardia, headache, or vision disturbance. We used liquid chromatography-electrospray ionization-tandem mass spectrometry (LC-ESI-MS/MS) to determine the erectile dysfunction drugs and their analogues in various counterfeit drugs. Eleven erectile dysfunction drugs and their analogues were detected, with sildenafil and its analogues being the most counterfeited compounds (73.8 %), followed by tadalafil and its analogues (25.4 %). The limits of detection (LOD) and the limits of quantitation (LOQ) of liquid-type and solid-type negative samples ranged from 0.1 to 3.3 ng/mL or ng/g and from 0.3 to 10.0 ng/mL or ng/g, respectively. The recoveries ranged from 84.3 to 112.3 % and 83.2 to 110.2 %, respectively. The contents of sildenafil and tadalafil in the various counterfeit drugs ranged from 21.0 to 947.5 mg/g and from 0.2 to 170.2 mg/g, respectively.

Background and Purpose To determine the risk of Parkinson’s disease (PD) in relation to erectile dysfunction (ED) based on the National Health Insurance Research Database in Taiwan. Methods We identified 3,153 patients who were newly diagnosed with ED between January 1, 2004 and December 31, 2010. A total of 12,612 randomly selected people without ED served as healthy controls. All of the study subjects were followed-up from the index date to the date of PD diagnosis, withdrawal from the National Health Insurance program, or the end of 2012 whichever occurred first. Results The incidence density rate of PD was 1.52-fold higher in the ED cohort than the non-ED cohort (3.44 vs. 1.64 per 1,000 person-years), with an adjusted hazard ratio (HR) of 1.52 [95% confidence interval (CI)=1.09?2.12]. The combined effects on patients with ED and diabetes as well as hypertension showed a significant combined association with the PD risk compared with patients without ED, counterpart comorbidities, or medication use. The adjusted HR of PD for ED was higher for diabetes (2.82, 95% CI=1.42?5.63) and hypertension (2.19, 95% CI = 1.35?3.55). Conclusions ED leads to an increased risk of PD. ED patients with diabetes or hypertension have an elevated risk of PD.

Background: To investigate the prevalence of premature ejaculation (PE) and erectile dysfunction (ED) in a sample of patients with prostate cancer and to determine the utility of the previously suggested cutoffs of the Premature Ejaculation Diagnostic Tool (PEDT) for the diagnosis of PE and that of International Index of Erectile Function (IIEF-5) for ED. Materials and Methods: A total of 1,202 men with prostate cancer were invited from urology clinics at the universities of Iran, Tehran, Qazvin, Ahvaz, Guilan and Tabriz. Clinical characteristics were collected through medical records. PE and ED diagnoses were made by trained urologists. In addition to the clinical diagnoses, PE and ED were measured through self-report using the PEDT and the IIEF-5. Questionnaire cutoff scores were determined using receiver operating characteristic (ROC) curves and confirmed by predictive ability using logistic regression. Results: The prevalence of PE was 63.7% and that of ED was 66.2%. Prevalences of PE decreased and that of ED increased with advanced TNM stages. According to ROC, the suggested cutoff for the PEDT to diagnose a PE was ${\geq}11$ (sensitivity=0.988, 1-specificity=0.084, and predictive ability=0.914) and ${\leq}17$ for the IIEF-5 (sensitivity=0.966, 1-specificity=0.031, and predictive ability=0.967). Conclusions: Prevalence of sexual problems was high in prostate cancer patients in Iran, therefore oncologists should take into account these potential problems when deciding on treatment modalities.

Background/Aims: Sarcopenia and erectile dysfunction (ED) are associated with poor health and quality of life in older men. We investigate the association between sarcopenia and severe ED in community-dwelling older men. Methods: We prospectively assessed sarcopenia and ED in 519, community-dwelling, older men (mean age, 74.0) in Pyeongchang, Korea, in 2016 to 2017. Sarcopenia was based on muscle mass, grip strength, and gait speed according to the Asian Working Group consensus algorithm. Severe ED was defined as 5-item International Index of Erectile Function questionnaire score under 8. Logistic regressions were used to study associations between incident severe ED and sarcopenia, after adjusting age, cardiovascular risk factors, depression, and polypharmacy. Results: The prevalence of severe ED was 52.4% and that of sarcopenia was 31.6%. At baseline, the prevalence of severe ED was higher in men with sarcopenia than in those without (73.2% vs. 42.8%; adjusted odds ratio [aOR], 1.89; 95% confidence interval [CI], 1.18 to 3.03; p = 0.008). Slow gait speed (aOR, 2.80; 95% CI, 1.18 to 6.62; p = 0.019) and decreased muscle mass (aOR, 2.54; 95% CI, 1.11 to 5.81; p = 0.027) were associated with the incidence of severe ED, while decreased grip strength (aOR, 0.76; 95% CI, 0.30 to 1.91; p = 0.564) was not. Conclusions: Sarcopenia was associated with severe ED. Slow gait speed, and decreased muscle mass was independently associated with incident severe ED at 1 year. Further research is warranted to examine whether an intervention targeting these components can prevent severe ED.