International Journal of Impotence Research (2014) 26, 141–145; doi:10.1038/ijir.2013.53
Data on the Utilization of Treatment Modalities for ED in Taiwan in the Era of PDE5 Inhibitors
W-K Tsai1,2 and B-P Jiann3,4 1Department of Urology, Mackay Memorial Hospital, Taipei, Taiwan; 2Mackay Medical College, Mackay Junior College of Medicine,
Nursing, and Management, Taipei, Taiwan; 3Division of Basic Medical Research, Department of Medical Education and Research,
Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan and 4School of Medicine, National Yang-Ming University, Taipei, Taiwan.
Oral PDE5 inhibitors, intracavernosal injection and penile implants are mainstay
treatments for ED. Data on their utilization reflect economic aspects of ED, but are
underreported. We report utilization data and user characteristics for these modalities in
Taiwan between 1999 and 2011. Sales data on PDE5 inhibitors—sildenafil citrate,
tadalafil and vardenafil and on alprostadil were retrieved from International Market
Services Health, and on penile implants from the local importing company for them.
Users’ clinical characteristics were derived from one institution. Between 1999 and
2011, sales of PDE5 inhibitors increased 5.9-fold, whereas those of alprostadil and
penile implants remained stable. Over 90% of PDE5 inhibitors were purchased in
pharmacies without a prescription. Between 1999 and 2011, the number of patients
who received PDE5 inhibitors (n=4715) exceeded those who underwent penile
injection (n=333) and penile implantation (n=108). The mean age of patients with ED
who first received PDE5 inhibitors tended to decrease over consecutive years.
Discontinuation of treatment with PDE5 inhibitors or intracavernosal injection reached
90% within 3 years of treatment initiation. Our data on the increasing market for PDE5
inhibitors and the trend for first use of PDE5 inhibitors at younger ages highlight the
growing burden of ED and the acceptance of PDE5 inhibitors as the primary treatment
for ED.
男性學論文獎 一般醫師臨床組 第一名
J Sex Med 2014;11:230–239.
Factors Associated with Sex Hormones and Erectile Dysfunction in Male Taiwanese Participants with Obesity
Ming-Der Shi, MS,*
Jian-Kang Chao, MD, PhD,†‡ Mi-Chia Ma, PhD,§
Lyh-Jyh Hao, MD,¶
and I-Chen Chao, MD** *Department of Pathology and Laboratory Medicine,
Kaohsiung Veterans General Hospital Tainan Branch, Tainan, Taiwan; †Department of Psychiatry, Yuli Veterans Hospital, Hualien, Taiwan; ‡
Department of Health Administration, Tuz Chi College of Technology, Hualien, Taiwan; §
Department of Statistics, National Cheng Kung University, Tainan, Taiwan; ¶
Department of Internal Section, Endocrinology and Metabolism,
Kaohsiung Veterans General Hospital Tainan Branch, Tainan, Taiwan; **Graduate Institute of Clinical Medicine, Southeast University, Nanjing, China
Introduction. Obesity has been receiving an increasing amount of attention recently, but investigations regarding the potential impact of obesity, sexual behaviors, and sex hormones on erectile dysfunction (ED) in men have not completely clarified the association.
Aim. To identify the relationship between ED, sexual behavior, sexual satisfaction, sex hormones, and obesity in older adult males in Taiwan.
Methods. Data were obtained from a baseline survey of 476 older adult males (≧40 years old). Their demographic data, body mass index (BMI), sex hormones, sexual desire, sexual satisfaction, and ED status were assessed.
Main Outcome Measures. The International Index of Erectile Function-5 (IIEF-5), Sexual Desire Inventory (SDI), and Sexual Satisfaction Scale (SSS) were used to assess ED, sexual desire, and sexual satisfaction.
Results. In all, 476 men were available for analysis. The mean age of the sample was 51.34 ± 7.84 years (range 40 to 70 years). The IIEF total score had a mean of 19.44 ± 4.98; 264 (55.5%) subjects had ED, 250 (52.9%) were currently obese (BMI ≧27), and 297 (62.4%) had metabolic syndrome. The results showed an increased risk of ED among obese men and subjects with lower levels of sex hormones and lower sexual desire. Testosterone levels were lower in subjects with obesity (P < 0.001). Among the predictors of ED, obesity (odds ratio [OR] = 1.62, 95% CI = 1.07–2.44, P = 0.021), abnormal high sensitivity C-reactive protein (hs-CRP) (OR = 10.59, 95% CI = 4.70–23.87, P < 0.001), and lower serum full testosterone (OR = 3.27, 95% CI = 2.16–4.93, P < 0.001) were significantly independent factors.
Conclusions. This study supports the idea of a close relationship between low levels of sex hormones, sexual desire, sexual satisfaction, obesity, and ED, and also shows that low free testosterone and hs-CRP may predict ED, even in obese populations.
男性學論文獎 一般醫師臨床組 第二名
PLOS ONE / www.plosone.org August 2014 / Volume 9 / Issue 8 / e105091
Predictive Clinical Indicators of Biochemical Progression in Advanced Prostate Cancer Patients Receiving Leuplin Depot as Androgen Deprivation Therapy
Chien-Hua Chen1, Ju-Ton Hsieh2, Kuo-How Huang2, Yeong-Shiau Pu2, Hong-Chiang Chang2* 1 Department of Urology, En Chu Kong Hospital, Taipei, Taiwan, 2
Department of Urology,
National Taiwan University Hospital and College of Medicine,
National Taiwan University, Taipei, Taiwan
Therapeutic planning and counseling for advanced prostate cancer patients receiving
androgen deprivation therapy (ADT) is complicated because the prognoses are highly
variable. The purpose of this study is to identify predictive clinical indicators of
biochemical progression (BCP). In this retrospective analysis, data from 107 newly
diagnosed patients (from November 1995 to April 2008) with advanced prostate
adenocarcinoma receiving Leuprorelin acetate depot were analyzed. Data was collected
from the computerized registry of two collaborating medical centers in Taiwan. Cox
regression and Kaplan-Meier analyses were used to evaluate the relationship between
potential predictive parameters and BCP. Univariate analysis revealed that predictors of
BCP included (1) initial serum prostate-specific antigen (PSA) (hazard ratio [HR], 1.00;
95% confidence interval [CI] 1.00–1.00); (2) log of initial PSA (HR, 1.35; 95% CI
1.17–1.56); (3) PSA density at diagnosis (HR, 1.00; 95% CI 1.00–1.01), and (4)
pathological bone fracture (HR, 2.22; 95% CI 1.20–4.11). Age (HR, 0.94; 95% CI
0.91–0.98) and hemoglobin levels (HR, 0.86; 95% CI 0.76–0.97) were also associated
with greater risk of BCP. After adjusting for age, pathologic fracture, and hemoglobin
level, the initial PSA and PSA density were no longer significantly associated with BCP.
However, age and hemoglobin levels continued to be associated with greater risk of BCP
(P ≤ 0.007). Using Kaplan-Meier analysis, patients with higher initial PSA concentration,
pathological bone fracture, and low hemoglobin had a greater probability of BCP. Thus,
low hemoglobin and age are predictive indicators of BCP and therefore early indicators
of BCP despite ADT therapy.
The Role of Sympathetic and Parasympathetic Nerve Systems on the Smooth Muscle of Rat Seminal Vesicles - Experimental Results and Speculation for Physiological Implication on Ejaculation
1J-T Hsieh, 2Y-C Kuo, 3H-C Chang, 3SP Liu, 4J-H Chen and 3-5 V.F.S. Tsai 1 Urology, National Taiwan University, 2 Urology, Taipei City Hospital, 3 Urology, National Taiwan University Hospital, Taipei, 4Jyh-Horng Chen’s Urologic Clinic, Hsih Chu, and 5Urology, Ten-Chan General Hospital, Taoyuan, Taiwan.
Ejaculation is a process involving sympathetic and parasympathetic effects during
different stages - emission and ejection. Some conditions of ejaculation dysfunction are
associated with autonomic nerves. However, the exact effects of autonomic nerves on
ejaculation are not well defined. Autonomic agonists induce different recorded trace
patterns of seminal vesicular contraction. The different traces contain different
components of phasic and tonic contraction, which may have physiological implications.
In this study, we examined isolated rat seminal vesicle (SV) contraction by phenylephrine
(PE), acetylcholine, and their respective antagonists and then speculated upon
physiological roles of sympathetic and parasympathetic nerves on SV during ejaculation.
We found that PE and Ach both achieved good contraction of rat SV. Compared to α
1b
for sympathetic and M1, M2 for parasympathetic receptors, α 1a and M3 are the
relatively dominant subtypes on rat SV. Adrenergic and cholinergic agonists cause
different trace patterns of SV contraction. We speculated that the sympathetic effect is
dominant during emission to squeeze seminal fluid out and that the parasympathetic
effect is dominant during ejection to provide an anti-reflux effect on the ejaculatory
duct.
男性學論文獎 一般醫師基礎組 第二名
Int. J. Mol. Sci. 2013, 14, 22102-22116; doi:10.3390/ijms141122102
SEPT12-Microtubule Complexes are Required for Sperm Head and Tail Formation
Pao-Lin Kuo 1,†, Han-Sun Chiang 2,†, Ya-Yun Wang 1, Yung-Che Kuo 3, Mei-Feng Chen 4,
I-Shing Yu 5, Yen-Ni Teng 6, Shu-Wha Lin 7 and Ying-Hung Lin 2,* 1 Department of Obstetrics & Gynaecology, National Cheng Kung University, 2 Graduate Institute of Basic Medicine, Fu Jen Catholic University, 3 Graduate Institute of Basic Medical Sciences, National Cheng Kung University, 4 Research Center for Emerging Viral Infections, Chang Gung University, 5 Laboratory Animal Center, National Taiwan University College of Medicine, 6 Department of Biological Sciences and Technology, National University of Tainan, 7 Clinical Laboratory Sciences and Medical Biotechnology, National Taiwan University, National Taiwan University Hospital
The septin gene belongs to a highly conserved family of polymerizing GTP-binding
cytoskeletal proteins. SEPTs perform cytoskeletal remodeling, cell polarity, mitosis, and
vesicle trafficking by interacting with various cytoskeletons. Our previous studies have
indicated that SEPTIN12+/+/+/− chimeras with a SEPTIN12 mutant allele were infertile.
Spermatozoa from the vas deferens of chimeric mice indicated an abnormal sperm
morphology, decreased sperm count, and immotile sperm. Mutations and genetic
variants of SEPTIN12 in infertility cases also caused oligozoospermia and
teratozoospermia. We suggest that a loss of SEPT12 affects the biological function of
microtublin functions and causes spermiogenesis defects. In the cell model, SEPT12
interacts with α- and β-tubulins by co-immunoprecipitation (co-IP). To determine the
precise localization and interactions between SEPT12 and α- and β-tubulins in vivo, we
created SEPTIN12-transgene mice.
We demonstrate how SEPT12 interacts and co-localizes with α- and β-tubulins during
spermiogenesis in these mice. By using shRNA, the loss of SEPT12 transcripts disrupts
α and β-tubulin organization. In addition, losing or decreasing SEPT12 disturbs the
morphogenesis of sperm heads and the elongation of sperm tails, the steps of which are
coordinated and constructed by α- and β-tubulins, in SEPTIN12+/+/+/− chimeras. In this
study, we discovered that the SEPTIN12-microtubule complexes are critical for sperm
formation during spermiogenesis.
男性學論文獎 住院醫師臨床組 第一名
Journal of the Chinese Medical Association 76 (2013) 624-628
The Role of Hormones on Semen Parameters in Patients with Idiopathic or Varicocele-related Oligoasthenoteratozoospermia (OAT) Syndrome
Tzu-Chun Wei a,c
, William J. Huang a,b,c,*
, Alex T.L. Lin a,c
, Kuang-Kuo Chen a,ca
Division of Urology, Department of Surgery,
Taipei Veterans General Hospital, Taipei, Taiwan, ROC
b
Division of Clinical Education, Department of Medical Education and Research,
Taipei Veterans General Hospital, Taipei, Taiwan, ROC c
Department of Urology and Physiology, Shu-Tien Urological Institute,
National Yang-Ming University, Taipei, Taiwan, ROC
Background: Oligoasthenoteratozoospermia (OAT) syndrome is the most frequently
seen phenotype in male infertility. Spermatogenesis relies closely on hormone regulation.
The aim of this study was to assess the correlation between hormone profile and semen
parameters in infertile men with idiopathic or varicocele-related OAT syndrome. We
tried to illustrate the correlative factors for better semen parameters in these patients.
Methods: A total of 96 patients with idiopathic or varicocele-related OAT were included
for assessment. Serum levels of follicle-stimulating hormone (FSH), luteinizing hormone
(LH), testosterone (T), estradiol (E2), prolactin (PRL), and the combinative ratios of these
hormones, such as T/E2, T/FSH, T/LH, T/(FSH × LH), PRL × T/FSH, PRL × T/LH,
PRL × T/(FSH × LH), were compared individually with sperm parameters. The
parameters included sperm concentration, total sperm count (TC), percent motile sperm
count, percent normal sperm count, total motile sperm count (TMC), total normal sperm
count (TNC), and total motile normal sperm count (TMNC).
Results: T correlated well with percent normal sperm count ( p = 0.031). PRL
positively correlated with sperm concentration ( p = 0.019), TMC ( p < 0.001), TNC
( p = 0.003), and TMNC ( p < 0.001). In hormonal combinative ratios, T/FSH, T/LH,
T/(FSH × LH), PRL × T/FSH, PRL × T/LH, and PRL × T/(FSH × LH) all showed significant
correlations to concentration and count-related parameters including TC, TMC, TNC,
and TMNC.
Conclusion: For patients with OAT syndrome, T, PRL, T/FSH, T/LH, T/(FSH × LH),
PRL × T/FSH, PRL × T/LH, and PRL × T/(FSH × LH) may be used as predictive markers
for better semen quality. This investigation could be a catalyst for future studies on the
extent to which manipulating the hormonal combinative ratios can affect the quality of
spermatogenesis in infertile males with OAT syndrome.