[Appllication of human acellular dermal matrix in surgical treatment of genitourinary disease]

Humanacellular dermal matrix (HADM) is widely used in the field of burn wound repair and tissue engineering plastic surgery. HADM is manufactored by physical and chemical decellular process to remove the antigenic components that might cause immune rejection in dermis.The extracellular matrix of three-dimensional cell scaffold structure with collagen fibers had been used for wound repair and tissue regeneration, while HADM characterized with low absorption rate after implantation and strong ability to induce angiogenesis in host tissue. Studies reported that after the HADM was implanted into the patient, the host cells, such as fibroblasts and myofibroblasts, as well as lymphocytes, macrophages, granulocytes and mast cells, rapidly infiltrated the graft. The connective tissue and neovascularization were then formed within the HADM three-dimensional cell scaffold, the lymphatic system also appears after vascular reconstruction. Traditional urethral reconstruction using autologous skin flaps has some defects, such as complexity of the technology, risk of necrosis of the skin flaps after transplantation, and failure to achieve functional repair of the urethral epithelium. It has been reported that using HADM to reconstruct the urethra in patients with urethral stricture, hypospadias and bladder-vaginal fistula, showed promising results. Others have reported the experience of using HADM to repair and reconstruct congenital classic bladder exstrophy. HADM has also been used for tissue repair in patients with penile skin defect caused by Fonier's gangrene and hidradenitis suppurativa, and implanted under Bucks' fascia to enlarge the penis. The report of HADM implantation for treating premature ejaculation also deserves attention. Researchers found that HADM implantation can form a tissue barrier between the skin and corpus cavernosum, which can effectively reduce penile sensitivity and treat premature ejaculation. The safety and effectiveness of HADM implantation in the treatment of premature ejaculation need to be further standardized by data from multi-center, large-sample clinical studies. In summary, HADM is the extracellular matrix and three-dimensional cell scaffold of human dermis. As a new type of tissue repair material, new blood vessels are formed actively after implantation, which shows good histocompatibility. HADM has shown increasingly broad application prospects in treatment of genitourinary diseases including penis, urethra and bladder diseases. HADM has also been used in the treatment of premature ejaculation in recent clinical studies, and its long-term safety and efficacy need to be further investigated.

[Feasibility study of transplantation of penile corpus cavernosum and major pelvic ganglion in renal subserous region]

OBJECTIVE

To study the feasibility of transplantation of normal rat penile corpus cavernosum and major pelvic ganglion (MPG) into the renal subserous region of a Nu/Nu mouse based on allograft technology.

METHODS

Penile corpus cavernosum and MPG, harvested from Sprague-Dawley (SD) rats under sterile condition, were transplanted underneath the kidney capsule of Nu/Nu mice through the microsurgery instruments and surgery microscope. The histopathologic changes and cellular proliferation in the transplanted penile corpus cavernosum and MPG were then analyzed at the end of 1week and 4 weeks after transplantation. Histological staining and immunohistochemical staining were used to evaluate the main outcome measures.

RESULTS

After 1 week, the tissue morphology of the transplanted corpus cavernosum underneath the kidney capsule of Nu/Nu mice was consistent with normal penile corpus cavernosum, and blood could be observed in the penis cavernous sinus of the graft; after 4 weeks, the mophorlogy of the tranplanted corpus cavernosum near the kidney was consistent with normal penile corpus cavernosum, while fibrosis was noteworthy in the graft away from the kidney, but blood could still be seen in the penis cavernous sinus. After 1 week, the tissue morphology of the transplanted MPG was consistent with normal MPG, multiple islet-like cell clusters could be seen in the transplanted MPG in the renal subserous region, and angiogenesis could be observed near the kidney; after 4 weeks, a network of blood vessels was clearly visible away from the kidney, and islet-like cell clusters were still clearly observed in the transplanted MPG. In addition, ki67 positive cells were observed in the transplanted penile corpus cavernosum and MPG after 4 weeks of transplantation, which indicated that there was still cell proliferation activity in the grafts.

CONCLUSION

The transplanted corpus cavernosum and MPG underneath the kidney capsule of Nu/Nu mice could survive at least 4 weeks. Moreover, the inner structure of the transplanted corpus cavernosum and MPG was close to the normal tissue. The underlining mechanism may be related to the local microenvironment underneath the kidney capsule of Nu/Nu mice and the neovascularization in the transplanted grafts.

[Feasibility study of transplantation of penile corpus cavernosum and major pelvic ganglion in renal subserous region]

OBJECTIVE

To study the feasibility of transplantation of normal rat penile corpus cavernosum and major pelvic ganglion (MPG) into the renal subserous region of a Nu/Nu mouse based on allograft technology.

METHODS

Penile corpus cavernosum and MPG, harvested from Sprague-Dawley (SD) rats under sterile condition, were transplanted underneath the kidney capsule of Nu/Nu mice through the microsurgery instruments and surgery microscope. The histopathologic changes and cellular proliferation in the transplanted penile corpus cavernosum and MPG were then analyzed at the end of 1week and 4 weeks after transplantation. Histological staining and immunohistochemical staining were used to evaluate the main outcome measures.

RESULTS

After 1 week, the tissue morphology of the transplanted corpus cavernosum underneath the kidney capsule of Nu/Nu mice was consistent with normal penile corpus cavernosum, and blood could be observed in the penis cavernous sinus of the graft; after 4 weeks, the mophorlogy of the tranplanted corpus cavernosum near the kidney was consistent with normal penile corpus cavernosum, while fibrosis was noteworthy in the graft away from the kidney, but blood could still be seen in the penis cavernous sinus. After 1 week, the tissue morphology of the transplanted MPG was consistent with normal MPG, multiple islet-like cell clusters could be seen in the transplanted MPG in the renal subserous region, and angiogenesis could be observed near the kidney; after 4 weeks, a network of blood vessels was clearly visible away from the kidney, and islet-like cell clusters were still clearly observed in the transplanted MPG. In addition, ki67 positive cells were observed in the transplanted penile corpus cavernosum and MPG after 4 weeks of transplantation, which indicated that there was still cell proliferation activity in the grafts.

CONCLUSION

The transplanted corpus cavernosum and MPG underneath the kidney capsule of Nu/Nu mice could survive at least 4 weeks. Moreover, the inner structure of the transplanted corpus cavernosum and MPG was close to the normal tissue. The underlining mechanism may be related to the local microenvironment underneath the kidney capsule of Nu/Nu mice and the neovascularization in the transplanted grafts.

[Changes in morphology and steroidogenic function of aged human Leydig cells]

OBJECTIVE

To investigate the changes of morphology and steroidogenic function in aged human Leydig cells and to understand the mechanism of late onset hypogonadism (LOH).

METHODS

Ten young and ten aged male subjects were enrolled in this study. AMS (Aging Male's Symptoms) scale was used for symptom evaluation. Testes species with LOH were utilized as the research model. Then the histological changes in testis and ultrastructure of Leydig cells were observed by HE staining and electron microscopy (EM), respectively. The serum total testosterone concentrations were measured by an ELISA kit. The expressions of steroidogenic acute regulatory (StAR) protein and cholesterol-side-chain cleavage enzyme (P450scc) were detected by western blot.

RESULTS

The scores of AMS in the aged group were higher than those in the young group with decreased serum testosterone levels (61.25 ± 7.08 vs. 20.75 ± 3.73,P<0.001). And the serum testosterone level of the aged human was lower than that of the young human [(3.12 ± 0.58) μg/L vs. (6.29 ± 1.17) μg/L,P<0.05]. HE staining showed that degenerative changes occurred in the aged human testes. And many swollen mitochondria with mitochondrial cristae that disappeared were found in Leydig cells of the aged human by EM. The serum total testosterone level of the aged human was significantly lower than that of the young group. And the expressions of StAR and P450scc protein in the aged group were significantly lower than those of the young group.

CONCLUSION

Mitochondrial swelling and decreased expressions of StAR and P450scc were closely related to the reduced ability of testosterone synthesis in aged males. And the exact mechanism needs further investigation.

Effects of icariin on cGMP-specific PDE5 and cAMP-specific PDE4 activities

AIM

To clarify the mechanism of the therapeutic action of icariin on erectile dysfunction (ED).

METHODS

PDE5 was isolated from the human platelet and PDE4 from the rat liver tissue using the FPLC system (Pharmacia, Milton Keynes, UK) and the Mono Q column. The inhibitory effects of icariin on PDE5 and PDE4 activities were investigated by the two-step radioisotope procedure with [(3)H]-cGMP/[(3)H]-cAMP. Papaverine served as the control drug.

RESULTS

Icariin and papaverine showed dose-dependent inhibitory effects on PDE5 and PDE4 activities. The IC(50) of Icariin and papaverine on PDE5 were 0.432 micromol/L and 0.680 micromol/L, respectively and those on PDE4, 73.50 micromol/L and 3.07 micromol/L, respectively. The potencies of selectivity of icariin and papaverine on PDE5 (PDE4/PDE5 of IC(50)) were 167.67 times and 4.54 times, respectively.

CONCLUSION

Icariin is a cGMP-specific PDE5 inhibitor that may be developed into an oral effective agent for the treatment of ED.

[Advances in the research of penile erection and erection dysfunction]

Recent advances in the research on erectile dysfunction (ED) has more clearly explained the mechanism of penile erection, which is a hemodynamic process involving relaxation of corpus cavernosum smooth muscle and related arterials, and NO-cGMP signaling pathway proven to play an important role on modulating the relaxation of corpus cavernosum smooth muscle. Studies on NOS and PDEs not only provide strong evidence for the clinical treatment of ED, but also provide the chance to develop Sildenafil. Although the gene therapy for ED is still in the laboratory stage by now, it may be one of the effective clinical therapies for ED in future.

Masturbation and its relationship to sexual activities of young males in Korean military service

This study examined the masturbatory experiences and other sexual activities of young Korean males in military service. The actual status of masturbation and its relationship to sexual activity questionnaire. A total of 1,212 young males among military personnel in Korea were interviewed with sexuality questionnaires on masturbation, sexual intercourse and personal characteristics. We divided these subjects into four groups according to the age of initiation of masturbation and analyzed the relationship between masturbation and other sexual activities. The mean age of subjects was 22.03 +/- 1.22 (19-27) years. The percentage of men who reported ever having masturbated was 98.1% (1189/1212) and the average age of initiation of masturbation was 14.26 +/- 1.66 years. So we divided 1,212 males into four groups on the basis of the average age below and above one standard deviation. Overall, 67.7% (821/1212) had experienced sexual intercourse, and significantly, the earlier the initiation age of masturbation, the higher the coitus rate in each group (p < 0.05). About 21.5% of the men who were not virgins had experienced their first sexual intercourse with prostitutes. The mean age of first coitus, the incidence of sexually transmitted disease (STD) and the frequency of masturbation were closely linked to the initiation age of masturbation, respectively (p < 0.05). A masturbatory guilt feeling was seen in about 10.9% (132/1212) and there was no significant difference according to the types of religious worship (p = 0.227). On the basis of this study, sexual activities generally increased accordingly as the beginning of masturbation was earlier. Coital incidence in this study was 67.7% for young males in Korean military service, and 21.5% of them had their first sexual intercourse with prostitutes. Prostitution still plays an important role in the sexual lives of males in Korea. The incidence of STD was over 10% and homosexual manifestation was seen in 1.07% of subjects. Thus a proper and sound sex education at school during childhood is needed in Korea. A large scale survey of sexual behavior in various populations is essential for the improvement of correct sexual concepts.

Clinical study of SS-cream in patients with lifelong premature ejaculation

OBJECTIVES

To investigate the clinical efficacy of SS-cream, the topical agent made from the extracts of nine natural products for the treatment of premature ejaculation, we performed a double-blind, randomized, placebo-controlled Phase III clinical study of patients with lifelong premature ejaculation in three medical centers.

METHODS

One hundred six patients (mean age 38.7 +/- 0.61 years) completed this study. The ejaculatory latency measured by stopwatch and sexual satisfaction ratio of both partner and patient were investigated twice in the screening period and once after each treatment (1 placebo 0.20 g and 5 SS-cream 0.20 g for a total of six treatments). Patients were instructed to apply the cream on the glans penis 1 hour before sexual intercourse in a double-blind randomized fashion. Clinical efficacy was compared with the prolongation of ejaculatory latency and improvement of the sexual satisfaction ratio before and after each treatment.

RESULTS

In the screening period, the mean ejaculatory latency was assessed at 1.37 +/- 0.12 minutes, and neither the patients nor their partners were satisfied with their sexual lives. After treatment, the mean ejaculatory latency was prolonged to 2.45 +/- 0.29 minutes in the placebo group and 10.92 +/- 0.95 minutes in the SS-cream group. The clinical efficacy of placebo and SS-cream as judged by an ejaculatory latency time prolonged more than 2 minutes was 15.09% and 79.81%, respectively. The improvement of sexual satisfaction to a grade higher than effective was 19.81% and 82.19%, respectively, for placebo and SS-cream. Of 530 trials of SS-cream, 98 (18.49%) resulted in a sense of mild local burning and mild pain. No adverse effect on sexual function or partner and no systemic side effects were observed.

CONCLUSIONS

According to these results, SS-cream is effective and safe in the treatment of premature ejaculation, with mild local side effects.

Penile vibratory threshold changes with various doses of SS-cream in patients with primary premature ejaculation

SS-cream made with extracts from natural products is a topical agent for treating premature ejaculation (PE). In order to elucidate the penile vibratory threshold changes and clinical effects of various doses of SS-cream, 53 patients with primary PE were investigated in a double-blind randomized placebo-controlled study. The mean age was 37.3 +/- 6.4 years and mean ejaculatory latency was 1.37 +/- 0.52 minutes. Neither the patients nor their sexual partners were satisfied with their sexual lives. Vibratory threshold at the glans penis, penile shaft, scrotum and index finger were measured using a biothesiometer twice during the screening period and three times one hour after the application of respective creams (SS-cream 0.05, 0.10. 0.15, 0.20 gm and placebo 0.10 gm) on the glans penis according to the order of the allocation table in a randomized fashion. The efficacy of SS-cream was defined as when the vibration threshold increased by more than 4 microns compared to the value tested during the screening period. The vibratory thresholds at the glans penis increased significantly in a dose-dependent manner after the application of various doses (0.05, 0.10, 0.15, 0.20 gm) of SS-cream (p < 0.001), and the efficacy of SS-cream on the penile vibration threshold increased according to the increased dosage (penile shaft: 48.4, 51.6, 54.8, 64.5%, glans penis: 58.1, 67.7, 77.4, 83.9%, respectively). With these results, we concluded that SS-cream increased the penile sensory threshold dose dependently, and therefore it is clinically effective for treating the heightened penile sensory response in patients with PE.

Safety and efficacy study with various doses of SS-cream in patients with premature ejaculation in a double-blind, randomized, placebo controlled clinical study

OBJECTIVES

SS-cream is a topical agent made from the extracts of natural products for treating premature ejaculation (PE). To determine the optimal clinical dosage of SS-cream on PE, we investigated the safety and efficacy of SS-cream with various doses. A double blind, randomized placebo controlled clinical study was performed.

METHODS

Fifty patients completed the study. Mean age of the patients was 37.1+/-1.O y and mean ejaculatory latency was 1.35+/-0.07 min. Sexual satisfaction rate of both the partner and patient was 16.2%. Each patient was instructed to apply the different cream (placebo, SS-cream 0.05, 0.10, 0.15, 0.20 g) on glans penis 1 h before sexual intercourse in random fashion. The ejaculatory latency was measured by stop watch and the satisfaction rate of both partner and patient was also recorded two times in the screening period and after the application of each test drugs. Clinical efficacy was considered if ejaculatory latency was prolonged more than 2 min and sexual satisfaction rate increased more than 20% than that of pretest values.

RESULTS

The mean ejaculatory latencies were significantly prolonged after using various test drugs (placebo 2.27+/-0.32, SS-cream 0.05 g 4.47+/-0.81, 0.10 g 5.34+/-0.79, 0.15 g 6.22+/-0.87, 0.20 g 11.06+/-1.17 min, respectively). Clinical efficacies evaluated by ejaculatory latency were placebo 18%, SS-cream 0.05 g 30%, 0.10 g 60%, 0.15 g 54%, 0.20 g 84%, respectively. The satisfaction rate was also significantly increased dose-dependently (placebo 26%, SS-cream 0.05 g 60%, 0.10 g 70%, 0.15 g 78%, 0.20 g 90%, respectively). A side effect such as local mild burning sensation was noted in 35/250 times (14%) and no adverse effect on sexual function and no systemic side effects were observed. From the result of logistic regression analysis on clinical efficacy, the ED50 of SS-cream was obtained as 0.10 g. SS-cream 0.20 g was effective in 84% without any serious systemic side effects.

CONCLUSION

From the above results, our conclusions are that SS-cream is effective on the treatment of PE with a few local side effects and that clinical optimal dose of SS-cream is 0.20 g.

Spontaneous breakage of malleable penile prosthesis

The reported complications of malleable penile prosthesis include infection, erosion and chronic pain. We report the first two cases of bilateral breakage of malleable penile prosthesis.

Effect of Korean red ginseng on the rabbit corpus cavernosal smooth muscle

The extracts of Korean red ginseng (EKG) is a complex mixture containing ginsenosides, polysaccharides, and several other products. Animal experiments have shown that the intravenous administration of extract of ginseng reduces blood pressure. Recently, it has been reported that ginseng has a relaxing effect on vascular smooth muscle and that the relaxation is associated with nitric oxide (NO) released from the vascular endothelium. The present study was undertaken to investigate the effects of EKG on isolated rabbit corpus cavernosal smooth muscle for evaluation of the possibility of developing EKG as an pharmacoerecting agent. Strips of rabbit corpus cavernosum were mounted in organ chambers to measure isometric tension. On the precontracted muscle strip with phenylephrine (PHE; 5 x 10(-6) M), EKG began to exert a relaxing effect at the concentration of 1 mg/ml and the maximal relaxation effect was reached at 40 mg/ml in a dose-dependent manner. EKG was inhibited significantly by endothelial disruption and by pretreatment with methylene blue, pyrogallol, L-NNA or atropine. EKG partially inhibited the PHE (5 x 10(-6) M) induced contraction up to 45.67% of the control in a dose-dependent fashion. EKG decreased basal tension as well as inhibited the contraction induced by addition of CaCl2 (10(-3) M) dose-dependently in muscle strips at basal equilibrated state in Ca2+ free, high K+ depolarizing solution. EKG also inhibited the contraction induced by depolarization with 20, 40 and 60 mM of KCl. However, this inhibitory effect did not occur with high concentrations of KCl (80 and 120 mM). EKG has a relaxing effect on the rabbit corpus cavernosal tissue in a dose dependent manner. The relaxation action of EKG is mediated by multiple action mechanisms that include increasing the release of NO from the corporal sinusoids, increasing intracellular calcium sequestration, and a hyperpolarizing action.

Somatosensory evoked potentials in patients with primary premature ejaculation

PURPOSE

Premature ejaculation has been believed to be psychological in the majority of patients. With few exceptions organic conditions are rarely implicated. We investigated the possible role of sensory function in patients with primary premature ejaculation to determine whether there is an etiological basis for this condition.

MATERIALS AND METHODS

We performed somatosensory evoked potentials from the penis in 34 patients with primary premature ejaculation and in 30 normally potent men. The latencies and amplitudes of the evoked potentials were measured at the penile shaft (dorsal nerve) and at the glans penis.

RESULTS

Mean latency of dorsal nerve and glans penis somatosensory evoked potentials was 1.51 and 6.80 (significant) msec. shorter, respectively, in the patients than in the normal subjects. In the normal subjects the mean latency of glans penis somatosensory evoked potentials was 0.99 msec. longer than that of the dorsal nerve (not significantly different) but in patients the mean latency in the glans penis was 4.30 msec. shorter (p < 0.001). Mean amplitude of glans penis somatosensory evoked potentials was less than that of the dorsal nerve in both groups. However, mean amplitudes of dorsal nerve and glans penis somatosensory evoked potentials were significantly greater in patients than in normal men.

CONCLUSIONS

Patients with premature ejaculation have hypersensitivity and hyperexcitability of the glans penis, which may give rise to uncontrolled ejaculation and are believed to be organic implications for premature ejaculation.

The distribution of nitric oxide synthase in human corpus cavernosum on various impotent patients

Recent evidence implicates NO (Nitric oxide) as the principal mediator in an erection. To investigate the role of NO in the human erectile function, we studied the distribution pattern of nitroxergic fibers in the corpus cavernosum specimens obtained from 38 men using nicotinamide adenine dinucleotide phosphate diaphorase (NADPH-d) histochemistry. Diffusely scattered delicate nerve fibers showing blue color reaction after NADPH-d histochemical staining were observed in normal control specimens from potent men. The neurogenic impotence group showed a statistically-significant decrease in the number of positive fibers compared to the normal control group. The number of positive fibers in the non-neurogenic impotence group was decreased compared to the normal control group but was statistically insignificant. With nitric oxide synthase (NOS) immunohistochemical stain, immunoreactive nerve bundles were easily seen in normal control specimens from potent men. NOS immunoreactive nerve bundles were contained within the corpus cavernosa which stained with NADPH-d reaction. Our results suggest that nitric oxide, a potent smooth muscle relaxing neurotransmitter in the autonomic nervous system, plays a physiologic role in erectile function and NADPH-d enzyme histochemical staining on the biopsied corpus cavernosum may be used as an important diagnostic method in the evaluation of neurogenic impotence.

Efficacy of a topical agent SS-cream in the treatment of premature ejaculation: preliminary clinical studies

SS-cream is a topical agent for treating premature ejaculation (PE) which is made with extracts from 9 natural products. We evaluated the efficacy of SS-cream in the treatment of PE. An open pilot study was performed in 186 patients with PE. The mean ejaculatory latency from intromission to ejaculation was 1.5 minutes. Sixty-four of the 186 patients (34.4%) were combined with mild erectile dysfunction in whom penile rigidity was not sufficient to be satisfied in sexual activity. Patients were instructed to apply 0.1 gm. of SS-cream on the glans penis 1 hour before sexual contact and to wash out the cream before sexual intromission. Patients were asked to complete a report form including ejaculatory latency, the degree of satisfaction in the sexual lives of both themselves and their partners, and any adverse effects after each application. One hundred and sixty-six out of 186 patients (89.2%) reported they were satisfied with the application of the SS-cream and the mean ejaculatory latency was significantly prolonged to 10.89 +/- 5.60 minutes. The mean ejaculatory latency was 9.85 +/- 3.58 minutes in 52 out of 64 patients (81.2%) with mild erectile dysfunction. There was no significant difference in the changes of ejaculatory latencies between patients with pure PE and patients with mild erectile dysfunction. Twenty patients (10.8%) claimed to have no changes of ejaculatory latencies after the application of SS-cream. Adverse effects were noted in 11 patients (5.9%), which were mild local irritation symptoms in 7 patients, and delayed ejaculation of more than 30 minutes in 4 patients, the symptoms subsided spontaneously within 4 hours. These results indicate SS-cream is effective in the treatment of PE and also PE combined with mild erectile dysfunction with a few side effects. Further studies on the action mechanisms of SS-cream and a double blind placebo-controlled trial are needed.

The effects of SS-cream and its individual components on rabbit corpus cavernosal muscles

SS-cream (Severance Secret cream) is made up of extracts from 9 natural products for treating premature ejaculation (PE). SS-cream has been proved to be effective in the treatment of PE in pilot clinical studies. It has also been found to have a potentiating effect of their erectile capacity in some patients. Therefore, we investigated the pharmacological actions of SS-cream and the extracts of its individual components in rabbit corpus cavernosal smooth muscle to realize the effect of SS-cream on penile erection. Extracts of Bufonis Venenum induced a dose-related contraction of rabbit corpus cavernosal muscle, which was significantly inhibited by phentolamine. Extracts of Caryophylli Flos induced a dose-related relaxation in the muscle strips precontracted with phenylephrine (5 x 10(-6)M; PHE). Caryophylli Flos caused a dose-dependent inhibition of the PHE induced contraction and also inhibited the contractility of Bufonis Venenum. Other extracts, when used individually or in a mixture, induced a dose-related relaxation in the precontracted muscle strips with PHE. SS-cream began to exert a relaxing effect at the concentration of 0.05 mg/ml in the muscle strips precontracted muscle strips with PHE (5 x 10(-6)M); causing dose-dependent relaxation with a maximal effect at 0.2 mg/ml. The relaxation effect of SS-cream was partially inhibited by endothelial disruption and by pretreatment with methylene blue, pyrogallol, atropine, and indomethacin, although they were not statistically significant. The results show that SS-cream has a relaxing effect on cavernosal smooth muscle. And it is partly related with enhancing the NO/cyclic GMP pathway although the relaxation mechanism in detail remains to be elucidated. Therefore, SS-cream may be effective for future treatment of mild erectile dysfunction, in addition to its role for premature ejaculation.

Penile sensitivity in patients with primary premature ejaculation

PURPOSE

We investigated penile sensory levels in patients with primary premature ejaculation to determine whether there is an etiological basis for this condition.

MATERIALS AND METHODS

Penile biothesiometry was performed in 120 patients with primary premature ejaculation without erectile dysfunction and neurological deficit, and in 66 normal potent male volunteers. Vibratory thresholds were recorded at the glans penis, penile shaft, scrotum and index finger using a biothesiometer.

RESULTS

On the glans penis and penile shaft the values in patients with premature ejaculation were significantly less than those in normal potent men (p < 0.001). In normal potent men an age dependency of biothesiometric parameters was noted, with a significant increase in vibratory threshold at the glans penis and penile shaft in older patients. However, in patients with premature ejaculation there were consistently decreased values without age dependency at the glans penis and penile shaft (p > 0.05).

CONCLUSIONS

Patients with primary premature ejaculation have penile hypersensitivity, which provides further implications for an organic basis of premature ejaculation.

Sensory evoked potential and effect of SS-cream in premature ejaculation

The cause of premature ejaculation (PE) has been thought to be psychological in the majority of patients but we investigated penile hypersensitivity for an organic basis of PE. For another organic basis of PE, we have suggested hyperexcitability of the ejaculation center. SS-cream is a topical agent containing 9 oriental herbs for treating PE. Clinically SS-cream has been effective in the treatment of PE. Therefore, in order to implicate the organic basis of PE and realize the effect of SS-cream on PE, we investigated the somatosensory evoked potential (SEP) in patients with PE(16 cases) and the effects of SS-cream on SEP for treating PE. The latencies and amplitudes of the evoked responses were measured by two different places in stimuli, one was on the penile shaft with ring electrode and the other on the glans penis with a surface electrode. The latency of SEP stimulated at the glans penis was significantly longer than that stimulated at the penile shaft (p < 0.05). The latency stimulated at the glans penis after applying SS-cream was significantly longer than before applying SS-cream (p < 0.05), which was near the level of a normal potent man. But the latency stimulated at the penile shaft has no significant difference between before and after the application of SS-cream (P > 0.05). The amplitudes of the evoked responses stimulated at the glans penis were significantly higher than those stimulated at penile shaft (p < 0.05). And both these amplitudes were significantly reduced with the application of SS-cream (p < 0.05). With these result, we can suggest that the patients with PE have glans penile hyperexcitability and it provides further implications for an organic basis of PE, SEP stimulated at the glans penis can be a very useful method to evaluate PE, along with SEP stimulated a penile shaft and SS-cream prolongs the sensory conduction and reduces the penile hyperexcitability of the patient with PE.

Ten years of experience with various penile prosthesis in Korean

Currently there are more than 10 types of penile prosthesis available, ranging from the very simple to the very sophisticated. We review our experiences with various penile prosthesis, with particular regard to the complication rate. From Dec. 1983 to Jul. 1993, we implanted 295 penile prosthesis of eight different types. The average age of patients was 44 years. Every patient was evaluated with various multidisplinary diagnostic approaches. The etiologies of impotence were vasculogenic 29%, diabetogenic 22%, spinal cord injury 16%, pelvic bone injury 11%, etc. The types of implanted prosthesis were AMS malleable 143, Jonas 42, Dynaflex 36, Hydroflex 8, Uni-Flate 1000 2, AMS 700 CXM 58, Ultrex 3, Mentor alpha-1 3 and the mean follow-up period was 34 months. The diameters of implanted prosthesis were from 9.5 mm to 13 mm, mostly 9.5 mm (52.9%). The length of implanted prosthesis were from 10 cm to 20 cm, mostly 16 approximately 18 cm (68.8%). Cases with uneven diameters or lengths were 20 (6.8%). The int aoperative complications were 1 corporeal rupture and 1 bladder rupture, and the postoperative complications were 2 prosthesis infections, 2 mechanical failures, and 1 prosthesis infection with mechanical failure. In those 4 patients reimplantations were successful. More than 99% (290/291) patients still have functioning prosthesis. Every prosthesis has their advantages and disadvantages. Factors to be analysed in the selection of proper prosthesis should include patients economic status, education, personality, social activity, hand dexterity, and penile size.(ABSTRACT TRUNCATED AT 250 WORDS)