Chronic prostatitis in Korea:a nationwide postal survey of practicing urologists in 2004

Aim： To examine the diagnosis and treatment of chronic prostatitis by means of a nationwide postal survey of practicing urologists in 2004. Methods： A random sample of 850 Korean urologists from the Korean Urological Association Registry of Physicians were asked to complete a questionnaire that explored practicing characteristics, attitudes and diagnostic and treatment strategies in the management of chronic prostatitis. Results： Of the 850 questionnaires sent, 302 were returned （response rate 35.5 %） and 275 were induced in the final analysis. More than 50 % believed in a multifactorial etiology for chronic prostatitis and 52 % considered chronic abacterial prostatitis to be bacterial in nature. For routine diagnostic assessment, the most commonly used tests were reported to be urinalysis （95.3 %）, analysis of expressed prostatic secretions （89.5 %） and digital rectal examination （81.1%）. Only a few urologists use specific lower urinary tract cultures. Symptom assessment according to the National Institute of Health-Chronic Prostatitis Symptom Index was less frequently used （12.7 %）. First choices for therapy included antibiotics （96.4 %）, alpha-blockers （71.6 %） and sitz baths （70.5 %）. If unsuccessful, urologists frequently continued to prescribe a second course of either alpha-blockers （69.5 %） or antibiotics （57.8 %）. Conclusion： These data provide a picture of current practice regarding the management of chronic prostatitis in Korea. The diagnostic and treatment practices for prostatitis do not follow standard textbook algorithms. Further studies are needed to elucidate the etiology and pathogenesis of chronic prostatitis and to establish guidelines for its diagnosis and treatment.

Are age, anthropometry and components of metabolic syndrome-risk factors interrelated with lower urinary tract symptoms in patients with erectile dysfunction？ A prospective study

Aim： To evaluate the effects of metabolic profiles on lower urinary tract symptoms （LUTS） in men with erectile dysfunction （ED）. Methods： A total of 75 impotent men aged 25-75 years old （mean 58.1 years） were included in the study on a prospective basis. Patients were evaluated with a complete history, physical examination, anthropometry and metabolic profiles. LUTS were assessed using the International Prostate Symptom Score （IPSS）. Results： Overall, there was no correlation between the IPSS and continuous parameters. However, when continuous variables were categorized, some parameters were significantly associated with LUTS. Patients with triglyceride level of 150 mg/dL or higher had more severe symptoms than those with tiglyceride levels less than 150 mg/dL （19.4±2.4 vs. 14.3±1.1, P = 0.033）. When 40 mg/dL was chosen as the high-density lipoprotein （HDL）-cholesterol cut-off level, the IPSS was significantly different between the two groups divided by 40 mg/dL （19.4±2.6 for HDL-cholesterol 〈 40 mg/dL vs. 14.4±1.0 for HDL-cholesterol 2 40 mg/dL, P = 0.042）. The area under the receiver operating characteristic curve （AUROCC） of triglyceride was 65.7% （95% confidence interval [CI], 52.6%-82.3%; P = 0.034） for severe LUTS. However, the AUROCC for ＇HDL-cholesterol＇ was not significant （area, 65.4%; 95% CI, 48.2%-82.7%; P = 0.062）. No other factors were determined to be significant in this regard. Conclusion： The results of the present study indicate that some metabolic profiles might influence LUTS in men with ED.

Reasons for discontinuation of sildenafil citrate after successful restoration of erectile function

Aim: To investigate the reasons for discontinuations of sildenafil after the successful restoration of erectile function. Methods: One hundred fifty six patients, whose scores of erectile function domain of the 15-item International Index of Erectile Function (IIEF) increased to 26 or more after sildenafil medication, were included in this study. Six-months after the first sildenafil prescription, compliance to medication and the reason for discontinuity were reviewed by chart or surveyed by telephone. Results: Fifty-four (34.6%) of the 156 successfully treated patients discontinued sildenafil medication. The r easons for discontinuance were shortcomings in the partners' or patients' emotional readiness for the restoration of sexual life after long-term abstinence (37.0%), fear of possible side effects (18.5 %), recovery of spontaneous erection (14.8 %), postponement of ED treatment because of co morbid disease treatment (11.1%), unwillingness to accept drug-dependent erection (7.4%), high drug cost (3.7%), unacceptability of planned sexual activity (3.7%) and lack of sexual interesi (3.7%). Conclusion: The reasons for discontinuing sildenafil medication were primarily emotional or relationship-oriented, which indicates that simple recovery of a rigid erection is insufficient to restore sexual activity. More education about the effects of drug and the counseling of both partners is recommended to promote the successful recovery of sexual activity.