Cont ent s 2 Organizing Committee and Faculty 4 essage from the President, M Asia Pacific Society for Sexual Medicine 5 essage from the Congress M Chairman, Asia Pacific Society for Sexual Medicine 2011 6 Program at a Glance 7 Acknowledgement 8 Floor Plan & Exhibition 10 General Information 12 Presentation Guideline 14 Social Program 17 Scientific Program 35 Poster Presentation List Abstract 45 102 Oral Presentation Speakers’ Abstract Organizing Committee and Faculty APSSM Executive Committee Founding President Masafumi Shirai (Japan) Honorary President Ganesan P. Adaikan (Singapore) President Doddy M. Soebadi (Indonesia) President-Elect Tai Young Ahn (Korea) Immediate Past President Han-Sun Chiang (Taiwan) Secretary General Carolyn Earle (Australia) Deputy Secretary General Nam Cheol Park (Korea) Treasurer Hui-Meng Tan (Malaysia) Deputy Treasurer Kavirach Tantiwongse (Thailand) APSSM Committee The Honorary Committee Dr. Ross Cartmill (Australia) Prof. Johnny Shinn-Nan Lin (Taiwan) Dr. Rudi Yuwana (Indonesia) Prof. Sae Chul Kim (Korea) Prof. Hyung Ki Choi (Korea) Prof. Akihiko Okuyama (Japan) Prof. Eng Choon Tan (Singapore) Prof. Kew Kim Chew (Australia) The ByLaws Committee Chair Apichat Kongkanand (Thailand ) Members Kavirach Tantiworngse (Thailand) Ken Marumo (Japan) Sae-Woong Kim (Korea) Peter HC Lim (Singapore) The Nominating Committee Chair Mikio Namiki (Japan) Members Tai Young Ahn (Korea) Po Chor Tam (Hongkong) Thomas I.S. Hwang (Taiwan) The Audit Committee Chair Zhong Cheng Xin (China) Lau Lang Chu (Singapore) The Scientific Program and Research Committee Chair Kwangsung Park (Korea) Members Akira Tsujimura (Japan) Hyun Jun Park (Korea) Zhong Cheng Xin (China) T.R. Murali (India) Koichi Nakajima (Japan) Kavirach Tantiwongse (Thailand) Srilatha Balasubramanian (Singapore) Bang-Ping Jiann (Taiwan) Wah Yun Low (Malaysia) The 13th Biennial Mee t ing of the Asia -Pacific So ciet y for Sexual M edicine The Development Committee Chair Ju-Ton Hsieh (Taiwan) Members Zhong Cheng Xin (China) Serozsha Goonewardena (Sri Lanka) Sudhakar Krishnamurti (India) Anupan Tantiwong (Thailand) Jong-Kwan Park (Korea) Ken Marumo (Japan) The Publications Committee Chair Srilatha Balasubramanian (Singapore) Members Yasusuke Kimoto (Japan) Khurram Mutahir Siddiqui (Pakistan) Dae Yul Yang (Korea) The Communication Committee Chair Sung Won Lee (Korea) Members Hyun-Jun Park (Korea) Man Kay Lee (Singapore) Ju-Ton Hsieh (Taiwan) Ji-hong Liu (China) The Standard Committee Chair Ganesan P. Adaikan (Singapore) Members Sudhakar Krishnamurti (India) Woo Sik Chung (Korea) Akmal Taher (Indonesia) Bannakit Lojanapiwat (Thailand) Koichi Nagao (Japan) The Local Arrangements Committee Chair Ganesan P. Adaikan (Singapore) Bang-Ping Jiann (Taiwan) 13th APSSM2011 Organizing Committee Honorary Chairman Han-Sun Chiang Chairman Bang-Ping Jiann Co-chairman Johnny Shinn-Nan Lin Kuang-Kuo Chen Thomas I.S. Hwang Ju-Ton Hsieh Chii-Jye Wang Yen-Ching Lin Secretary General Shih-Tsung Huang Scientific Committee Thomas I.S. Hwang Han-Sun Chiang Bang-Ping Jiann Chii-Jye Wang Kuang-Kuo Chen Shih-Tsung Huang Yen-Ching Lin Johnny Shinn-Nan Lin Ju-Ton Hsieh Financial Committee Ju-Ton Hsieh Shih-Ping Liu Publication Committee Han-Sun Chiang Bang-Ping Jiann Ju-Ton Hsieh Yen-Ching Lin Ming-Tsun Chen Chia-Chu Liu Exhibition Committee Guang-Huan Sun Social Program Committee Charles C.J. Wu Planning Committee Chih-Cheng Lu Chin-Pao Chang Hospitality Committee Shang-Sen Lee Message from the President, Asia Pacific Society for Sexual Medicine Dear members of APSSM and all participants of The 13th Biennial Meeting of Asia Pacific Society for Sexual Medicine, With the current aging and socioeconomic changes of the world population, the APSSM faces new challenges and opportunities to meet the problems of sexual health. As the field of Sexual Medicine has advanced and grown, please join us to share ideas and newest developments at The 13th APSSM 2011 in Kaohsiung, Taiwan. The organizing committee is working hard to welcome you to this congress with an interesting line-up of topics and world-renowned speakers in sexual medicine. I am looking forward to meeting you in Kaohsiung at what promises to be a most interesting and enjoyable event! Doddy M. Soebadi Prof. Doddy M. Soebadi, MD, PhD President, Asia Pacific Society for Sexual Medicine The 13th Biennial Mee t ing of the Asia -Pacific So ciet y for Sexual M edicine Message from the Congress Chairman, Asia Pacific Society for Sexual Medicine 2011 Dear Member, Colleagues, and Friends, As the Congress Organizer, it gives us great pleasure to welcome you to The 13th Biennial Meeting of Asia Pacific Society for Sexual Medicine, which will be held on November 16-20, 2011. in Kaohsiung, Taiwan. Kaohsiung City, which has the largest city in southern Taiwan, and is unlike any other city in Taiwan, whereby people can enjoy the beauty of a River named Love along the riverbank. With the wealth of interesting and fun activities available in Kaohsiung, You can enjoy the beauty of the Port City in any number of ways. The theme of our Congress is “Sexual Health in Asia-Pacific”. The full scientific program will include State-of-the-Art Lecture, Expert talk Symposium, Oral and Poster Presentation. Many distinguished figures and active researchers have been invited as speakers who will provide participants with the latest updates and a glimpse into the state-of-the-art practices and developments in the future. Besides the academic activities, you will have the opportunity to meet friends both old and new through the wellplanned social program. We welcome you and look forward to meeting you all in Kaohsiung Bang-Ping Jiann, M.D. Congress Chairman, The 13th Biennial Meeting of APSSM The 2nd CrossStrait Session (13:30-18:10) Welcome Reception 38F, Opal Ballroom (18:30-21:30) Registration (13:30-18:00) Golf Tournament (10:00-17:00) 11/16 (Wednesday) 14:45-15:45 13:30-14:45 Free Night Podium 2 42F, Crystal/ Coral 41F, Diamond Room II Podium 1 Symposium2 Women Sexual Dysfunction Symposium1 Alternative Medicine for ED 42F, Crystal/ Coral Faculty Dinner By Invitation Only (18:00-21:00) APSSM Executive Committee 42F, Agate (16:00-17:00) Podium 4 42F, Crystal/ Coral 41F, Diamond Room II Podium 3 Symposium4 Tx of Peyronie's dis. Round Table Discussion 42F, Crystal/ Coral Symposium3 Basic research in Sexual Medicine 41F, Diamond Room II Lunch Symposium 2 Lunch Symposium 1 1200-1300 41F, Diamond Room II Expert Talk-2 Round Table Expert Talk-1 Panel Discussion-Testosterone and Medicine State-of-the-Art Lecture 1 10:30-12:00 Gala Dinner 41F, Diamond Room II (18:30-21:30) Podium 6 42F, Crystal/ Coral Symposium6 Stem Cell Study in Urology Basic Research 42F, Crystal/ Coral APSSM General Assembly 42F, Agate (16:00-17:00) Podium 5 41F, Diamond Room II Symposium5 ED LUTS and OAB Round Table 41F, Diamond Room II Lunch Symposium 3 Coffee Break Coffee Break Coffee Break 10:15-10:30 State-of-the-Art Lecture 3 41F, Diamond Room II 11/19 (Saturday) Sexual Health in Asia-Pacific State-of-the-Art Lecture 2 41F, Diamond Room II 41F, Diamond Room II Opening Addresses 11/18 (Friday) 11/17 (Thursday) Program at a Glance 08:30-10:15 08:00-08:30 Time Moderated Poster Presentation- Display Time 0830-1400 ; Discussion Time-1400-1530 Registration (11/ 17-19 07:30-16:00, 11/20 07:30-12:00); Exhibition (11/ 17- 19 08:00-16:00) Closing Ceremony (11:50-12:00) Expert Talk-3 Future Sexual Medicine Coffee Break State-of-the-Art Lecture 4 42F, Crystal/ Coral 11/20 (Sunday) The 13th Biennial Mee t ing of the Asia -Pacific So ciet y for Sexual M edicine Acknowledgement The 13th Biennial Meeting of Asia Pacific Society for Sexual Medicine would like to extend our sincere appreciation to the following supporters, sponsors and exhibitors. (By Company Alphabetical order) Sponsors APSSM American Medical Systems Eli Lilly and Company Itamar Medical Ltd. Medispec Ltd. Pfizer Ltd. Takeda Pharmaceuticals Taiwan, Ltd. Government Supporters Fu Jen Catholic University Ministry of Economic Affairs, Republic of China Ministry of Education, Republic of China Ministry of Foreign Affairs, Republic of China National Science Council Floor Plan & Exhibition 41F The 13th Biennial Mee t ing of the Asia -Pacific So ciet y for Sexual M edicine 42F General Information Secretariat c/o K&A International Co., Ltd. 3F., No. 183, Kangchien Rd., Taipei, Taiwan 11494 Tel: +886-2-8751-3588 Fax:+886-2-8751-2799 Email: [email protected] Official Language English is the official language. No simultaneous interpretation will be offered. Mandarin will be spoken during the Cross-Strait Forum. Participant Badge Participant badge can be collected at on-site registration counter during operation hours. It is required to wear the conference badge to access all event grounds and coffee break at all times. Certificate of Attendance Your certificate of attendance can be collected while checking in at on-site registration counter during operation hours. Best Paper Award Two winners will be determined from all categories. The winner of the award will be announced at Gala Dinner on November 19, 2011, and also will received an award plaque, plus monetary award of NTD 10,000. **Abstracts accepted by the APSSM2011 Congress will be published in “The Journal of Sexual Medicine (JSM)” and also can be downloaded from www.apssm2011.com or www.apssm.org 10 The 13th Biennial Mee t ing of the Asia -Pacific So ciet y for Sexual M edicine Event Grounds Venue: The Splendor Kaohsiung Address: No.1, Ziqiang 3rd. Rd., Lingya Dist., Kaohsiung City 802, Taiwan. TEL: +866-7-566-8000 FAX: +866-7-566-8080-10 Operation Hours and Location Secretariat /Preview Room Registration Counter Exhibition Area Poster Presentation 42F, Amber Wednesday, November 16, 13:00-18:00 Thursday, November 17, 07:00-16:30 Friday, November 18, 07:00-16:30 Saturday, November 19, 07:00-16:30 Sunday, November 20, 07:00-12:00 39F, Foyer Wednesday, November 16, 13:30-18:00 41F, Foyer Thursday, November 17, 07:30-16:00 Friday, November 18, 07:30-16:00 Saturday, November 19, 07:30-16:00 42F, Foyer Sunday, November 20, 07:30-12:00 41F, Diamond I Thursday, 08:00-16:00 Friday, 08:00-16:00 Saturday, 08:00-16:00 41F, Diamond III Thursday, 08:30-16:00 Friday, 08:30-16:00 Saturday, 08:30-16:00 11 Presentation Guideline Instructions for Oral Presentations Symposium: presentation time will be 15 minutes. ● Oral Presentation: presentation time will be 10 minutes. ● 1. A ll speakers are requested to strictly observe the allotted presentation time. Since the conference schedule is tight, session chairpersons will strictly enforce the timing. The staff will ring the bell for time-reminding. 2. It is required to use the laptop prepared by the conference for stable computer system connection. For any reason that you MUST use your own laptop, please inform the secretariat in advance. 3. T he conference will have a laptop set up at the podium for all presenters. A remote control for changing the slides will be prepared; the presenter can control the slides on his/her own. 4. A ll presentation slides should be prepared by “Microsoft Office PowerPoint 2002” or above. Every speaker is requested to go to the on-site Preview Room to upload the slide two hours before the respective presentation at the latest. It is suggested you to save your final slides both in a CD-R and a USB flash memory and bring to the Preview Room. If your slides are prepared by Mac system, the data may deform after its transfer to the Windows system. Please check and correct this possible deformation at the Preview Room. 5. Video tape presentation is NOT available. If you need to use video records, please transfer them to the computer in a digital form. The projector does not support Full HD video mode, please avoid this kind of file format. 6. If you prepare to use a Mac laptop, please bring the Apple DVI to VGA display adapter. The connector of the projector is D-SUB, be sure the correct adapter is brought with you. 7. S tandard microphone is prepared for all presenters, if you wish to use a pin-microphone or a wireless one, or any other special equipment or need, please advice in advance for proper arrangement. 12 The 13th Biennial Mee t ing of the Asia -Pacific So ciet y for Sexual M edicine Instructions for Moderated Poster Presentation In order to allow free discussion on your poster, please ensure that the presenting author is present at your poster during the display day. It is mandatory to ensure fruitful discussions during the poster session, and that the presenting author or one co-author stays in front of the poster during the session from 14:00 to 15:30. A. F or moderated Poster Presenters, you will need both to prepare poster for display as well oral Discussion for 2-3 minutes. B. N ecessary office supplies for poster mounting will be provided on-site. Staple guns are prohibited for mounting. Congress will provide free masking tape for all poster presenters. C. A ll poster board has a surface of 90 cm wide and 180 cm high. Top corner space will be used to place the poster number, pre-fixed by the Secretariat. Poster display date and times are as follows, Hanging: 0830-1400; Discussion Time: 1400-1530 41F, Diamond III November 17 PP01-PP20 November 18 PP21-PP54 November 19 PP55-PP91 13 Social Program Welcome Reception Date November 16, 2011 (Wednesday) Time 18:30-21:30 Venue 38F, Opal Ballroom, The Splendor Kaohsiung Conference Welcome Reception is one of the Conference’s most important social event; the welcome reception is a not-to-be-missed opportunity to consolidate contacts and re-new friendship. Gala Dinner Date November 19, 2011 (Saturday) Time 18:30-21:30 Venue 41F, Diamond Ballroom, The Splendor Kaohsiung Conference Gala Dinner is the highlight of the event with five star cuisine and refreshments sourced locally, distinctly Taiwanese entertainment and theme which gives a sense of why Kaohsiung is a city that once experienced, charmed forever. 14 The 13th Biennial Mee t ing of the Asia -Pacific So ciet y for Sexual M edicine You Successfully Treated His ED But What About His Cardiovascular Risk? The link between ED and CV disease is well established ● ● ● ● ● Erectile Dysfunction (ED) is an early indicator as well as an independent risk factor for future Cardiovascular (CV) events1 The Princeton Consensus Panel recommends assessment of CV risk in the ED patient2 Endothelial Dysfunction contributes to the pathophisiology of ED and is often undiagnosed3 Endothelial Dysfunction assessment using Endo-PAT assesses CV risk and predicts future CV events4 9 out of 10 urologists surveyed would modify management of the ED patient when Endothelial Dysfunction is also present5 Thompson et al. JAMA 2005 Kostis et al. Am J Cardiol 2005 3 Montorsi et al. European Urology 2006 4 Rubinshtein et al. JACC 2009; Suppl. 5 Internal Itamar Medical survey of urologists at AUA, 2008 (n=80) 1 2 www.itamar-medical.com Itamar Medical [email protected] +972-4-6177000 Scientific Program Opening Address 08:00-08:30 November 17 (Thursday) 41F [Diamond Room II] Sexual Health in Asia-Pacific 08:30-10:15 November 17 (Thursday) 41F [Diamond Room II] Chairpersons: Dr. Chris McMahon, Dr. Bang-Ping Jiann 08:30-08:45 SH-01 MALE SEXUAL DYSFUNCTIONS IN AUSTRALIA Kew-Kim Chew, Keogh Institute for Medical Research, Australia 08:45-09:00 SH-02 PHYTOTHERAPY ON SEXUAL DYSFUNCTION IN ASIA: PAST, PRESENT AND FUTURE Zhong-Cheng Xin, Andrology Center, Peking University First Hospital, Peking University, China 09:00-09:15 SH-03 SEXUAL DYSFUNCTION AND QUALITY OF LIFE IN INDONESIA Doddy M. Soebadi, Department of Urology, Airlangga University Hospital, Indonesia 09:15-09:30 SH-04 SEXUAL MEDICINE IN MONGOLIA Nansalmaa Naidan, Health Science University of Mongolia ADAM Urology and Andrology Clinic, Mongolia 09:30-09:45 SH-05 IS INDIA THE IMPOTENCE (ED) CAPITAL OF THE WORLD? Sudhakar Krishnamurti, Andromeda Andrology Center, India 09:45-10:00 SH-06 SEXUAL MEDICINE: KOREA’S ASPECT IN ERECTILE DYSFUNCTION Nam Cheol Park, Department of Urology, Pusan National University School of Medicine, Republic of Korea 10:00-10:15 SH-07 SEXUAL MEDICINE: TAIWAN'S ASPECT Han-Sun Chiang, Department of Urology, Taipei Medical University Hospital, Taiwan 10:15-10:30 Coffee Break 17 State-of-the-Art Lecture 1 10:30-12:00 November 17 (Thursday) 41F [Diamond Room II] Chairpersons: Dr. Apichat Kongkanand, Dr. Luke S. Chang 10:30-10:55 SL-01 PRIAPISM: NEW CONCEPT AND IMPROVED STRATEGY Tom F. Lue, Department of Urology, University of California, United States 10:55-11:20 SL-02 UPDATE ON THE MANAGEMENT OF EJACULATORY DYSFUNCTION Chris McMahon, Australian Centre for Sexual Health, Australia Chairpersons: Dr. B. Srilatha, Dr. Kew-Kim Chew Debate: Pro 11:20-11:40 HYPOACTIVE SEXUAL DESIRE DISORDER IS TREATABLE SL-03 Tai Young Ahn, Asan Medical Center and College of Medicine, University of Ulsan, Republic of Korea Debate: Con 11:40-12:00 TREATMENT OF HYPOACTIVE SEX AND THE ED OBSTACLE SL-04 George Lee, Clinical Associate Professor Consultant Urological Surgeon Gleneagles Intan Medical Centre Kuala Lumpur, Malaysia Lunch Symposium 1 Pfizer Ltd 12:00 - 13:00 November 17 (Thursday) 41F [Diamond Room II] Chairperson: Dr. Thomas I.S. Hwang 12:00-12:20 LS-01 ENDOTHELIAL DYSFUNCTION, END-ORGAN DISEASE AND ERECTILE DYSFUNCTION Tom F. Lue, Department of Urology, University of California, United States 12:20-12:40 LS-02 ERECTION HARDNESS SCALE Thomas I.S. Hwang, Shin Kong WHS Memorial Hospital, Taiwan 12:40-13:00 LS-03 MILESTONES OF VIAGRA George Lee, Clinical Associate Professor Consultant Urological Surgeon Gleneagles Intan Medical Centre Kuala Lumpur, Malaysia 18 Symposium1- Alternative Medicine for ED 13:30 - 14:45 November 17 (Thursday) 41F [Diamond Room II] Chairpersons: Dr. Nam Cheol Park, Dr. Ju-Ton Hsieh 13:30-13:45 S1-01 THE CLINICAL FEATURES OF SEVERE PRIMARY ERECTILE DYSFUNCTION IN CHINESE Zhong-Cheng Xin, Andrology Center, Peking University First Hospital, Peking University, China 13:45 -14:00 S1-02 FEMALE SEXUAL DYSFUNCTIONS – AN OVERVIEW Sudhakar Krishnamurti, Andromeda Andrology Center, India 14:00-14:15 S1-03 ROLE OF COMPLEMENTARY AND ALTERNATIVE MEDICINE FOR ERECTILE DYSFUNCTION IN INDONESIA Doddy M. Soebadi, Dept. of Urology, Soetomo General Hospital, Airlangga University School of Medicine, Indonesia 14:15-14:30 S1-04 ALTERNATIVE MEDICINE FOR ED IN MONGOLIA Nansalmaa Naidan, Health Science University of Mongolia, Mongolia 14:30-14:45 S1-05 WHY MEN WANT TO HAVE A BIGGER PENIS Kavirach Tantiwongse, Chulalongkorn University, in Bangkok, Thailand Podium1 14:45-15:45 November 17 (Thursday) 41F [Diamond Room II] Chairpersons: Dr. Arif Adimoelia, Dr. Chin-Pao Chang 14:45-14:55 OP01 VALIDITY OF PREMATURE EJACULATION DIAGNOSTIC TOOL (PEDT) IN FOUR SUBGROUPS OF PREMATURE EJACULATION SYNDROME: DATA FROM THE KOREAN INTERNET SEXUALITY SURVEY – PART I Hwan Cheol Son, Department of Urology, Seoul National University Boramae Hospital, Korea 14:45-15:05 OP02 A STUDY OF ATTITUDES AND BEHAVIORS OF KOREAN MEN TO COMPLEMENTARY AND ALTERNATIVE MEDICINE FOR THE IMPROVEMENT OF SEXUAL FUNCTION: THE KOREAN INTERNET SEXUALITY SURVEY (KISS) – PART II Woo Suk Choi, Department of Urology, Yanggu Health Center, Yanggu-Gun, Korea 19 15:05-15:15 OP03 SERTRALINE COMBINED WITH DESENSITIZATION TRAINING FOR TREATMENT OF PREMATURE EJACULATION: A SINGLE-CENTER EXPERIENCE IN SOUTH CHINA Heng-Jun Xiao, Department of Urology, The Third Affiliated Hospital of Sun Yat-Sen University, China 15:15-15:25 OP04 THE PREVALENCE OF PREMATURE EJACULATION IN TAIWAN: EVALUATION FROM THE FEMALE PARTNERS’ PERSPECTIVE Thomas I-Sheng Hwang, Division of Urology, Department of Surgery, Shin Kong WHS Memorial Hospital, Taiwan 15:25-15:35 OP05 BIOIDENTICAL DHEA (PHYTO-DHEA) ANDTHE CONVERSION OF ALBUMINBOUND-TESTOSTERONE TO FREE- AND TOTAL TESTOSTERONE IN HYPOGONADIC MEN WITH SEXUAL DYSFUNCTION Arif Adimoelja, Naval Teaching Hospital Dr. Ramelan/Men’s Health, Reproduction, Sexual Health, School of Medicine, Hang Tuah University, Indonesia 15:35-15:45 OP06 PREVALENCE AND MOLECULAR ANALYSIS OF EJACULATORY DYSFUNCTION IN TAIWAN Pei-Yu Lin, Division of Urology, Department of Surgery, E-Da Hospital, Kaohsiung; Department of Urology, College of Medicine and Hospital, National Cheng Kung University, Taiwan 15:45~21:00 Free Night Symposium2- Women Sexual Dysfunction 13:30-14:45 November 17 (Thursday) 42F [Crystal/Coral] Chairpersons: Dr. B. Srilatha, Dr. Te-Fu Tsai 13:30-13:45 S2-01 FEMALE SEXUAL DYSFUNCTION: THE DEFINITION, CLASSIFICATION AND DEBATES Ching-Hui Chen, Department of Obstetrics and Gynecology, Taipei Medical University Hospital and Taipei Medical University, Taiwan 13:45-14:00 S2-02 ALGORITHM FOR THE OFFICE MANAGEMENT OF FSD B. Srilatha, Department of Obstetrics & Gynaecology, National University Hospital, Singapore; Yong Loo Lin School of Medicine, National University Hospital, National University of Singapore, Singapore 20 14:00-14:15 S2-03 PSYCHOGENIC ERECTILE DYSFUNCTION: DIAGNOSIS AND TREATMENT MODALITY IN UROLOGIC CLINICS Ken Marumo, Department of Urology, Tokyo Dental College, Ichikawa General Hospital, Japan 14:15-14:30 S2-05 THE IMPACT OF LOWER URINARY TRACT SYMPTOMS ON FEMALE SEXUAL FUNCTION--A HOSPITAL EMPLOYEE-BASED STUDY. Yuh-Chen Kuo, Taipei City Hospital, Taiwan 14:30-14:45 Discussion Podium 2 14:45-15:45 November 17 (Thursday) 42F [Crystal/Coral] Chairpersons: Dr. Farid Saad, Dr. William J. Huang 14:45-14:55 OP07 THE IMPACT OF ANDROGEN RECEPTOR CAG REPEAT POLYMORPHISM ON ANDROPAUSAL SYMPTOMS IN AGING TAIWANESE MEN Chia-Chu Liu, Kaohsiung Medical University Hospital; Kaohsiung Medical University; Pingtung Hospital, Department of Health, Executive Yuan, Taiwan 14:55-15:05 OP08 CONTINUOUS IMPROVEMENTS OF FEATURES OF THE METABOLIC SYNDROME OVER 48 MONTHS UPON NORMALIZATION OF SERUM TESTOSTERONE IN THREE COHORTS, IN TOTAL 410 MEN Farid Saad, Scientific Affairs Men’s Healthcare, Bayer Pharma AG, Germany; Gulf Medical University School of Medicine, United Arab Emirates 15:05-15:15 OP09 EFFECTS OF 4 YEAR TESTOSTERONE TREATMENT ON COMPONENTS OF THE METABOLIC SYNDROME Ahmad Haider, Private Urology Practice, Germany 15:15-15:25 OP10 BIOAVAILABE AND FREE TESTOSTERONE RATIOS ARE SIGNIFICANTLY ASSOCIATED WITH THE AGING MALE’S SYMPTOM SCORE OF TAIWANESE MALE I-Ching Lee, The Department of Urology, West Garden Hospital, Taiwan 21 15:25-15:35 OP11 POOR GLYCEMIC CONTROL IS A RISK FOR LOW TESTOSTERONE IN TYPE 2 DIABETIC MEN WITH ERECTILE DYSFUNCTION Bang-Ping Jiann, Department of Medical Education and Research Kaohsiung Veterans General Hospital, Taiwan 15:35-15:45 OP12 SERUM TOTAL TESTOSTERONE LEVELS IN MEN WITH ERECTILE DYSFUNCTION Bang-Ping Jiann, Department of Medical Education and Research Kaohsiung Veterans General Hospital, Taiwan 15:45~21:00 Free Night State-of-the-Art Lecture 2 08:00 - 10:10 November 18 (Friday) 41F [Diamond Room II] Chairpersons: Dr. Tai Young Ahn, Dr. Han-Sun Chiang 08:00-08:25 SL-05 SEXUAL MEDICINE: GLOBAL'S ASPECT Chris McMahon, Australian Centre for Sexual Health, Australia 08:25-08:50 SL-06 PENILE PROSTHESIS IMPLANTATION: AN UPDATE IN 2011 Run Wang, Department of Urology, University of Texas Medical School at Houston and MD Anderson Cancer Center, United States 08:50-09:15 SL-07 STUTTERING PRIAPISM HOW TO TREAT Doddy M. Soebadi, Dept. of Urology, Soetomo General Hospital, Airlangga University School of Medicine Surabaya, Indonesia Chairpersons: Dr. Kew-Kim Chew, Dr. Allen D. Seftel 09:15-09:40 SL-08 THE ROLE OF MAJOR PELVIC GANGLION IN THE NEURAL PATHWAY OF ELECTRICAL STIMULATION-INDUCED SEMINAL VESICAL PRESSURE INCREASE IN THE RAT Kuang-Kuo Chen, Department of Surgery, Taipei Veterans General Hospital, and Shu-Tien Urological Research Center, National Yang-Ming University, Taiwan 22 09:40-09:55 SL-09 ADT VS ART IN PROSTATE CANCER Thomas I.S. Hwang, Shin Kong WHS Memorial Hospital, Taiwan; School of Medicine, Fu-Jen Catholic University, Taiwan; School of Medicine, Taipei Medical University, Taiwan 09:55-10:10 SL-10 CHINA ANDROLOGIC DEVELOPMENT- PAST, PRESNET AND FUTURE Hui Jiang, Department of Urology, Reproductive Medicine Center, Peking University Third Hospital, China 1010:10:30 Coffee Break Expert Talk 1- Panel Discussion Testosterone and Medicine 10:30-12:00 November 18 (Friday) 41F [Diamond Room II] Chairpersons: Dr. Chii-Jye Wang, Dr. Jae-Seung Paick 10:30-10:50 ET-01 SCIENCE OF TESTOSTERONE FROM BASIC TO CLINIC Tai-Young Ahn, Asan Medical Center and College of Medicine, University of Ulsan, Republic of Korea 10:50-11:10 ET-02 TESTOSTERONE AND SEXUAL DESIRE Kew-Kim Chew, Keogh Institute for Medical Research, Australia 11:10-11:30 ET-03 TESTOSTERONE DEFICIENCY SYNDROME Mikio Namiki, Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Japan 11:30-11:50 ET-04 TESTOSTERONE AND PROSTATE Allen D. Seftel, Division of Urology, Cooper University Hospital, United States 11:50-12:00 Panel Discussion 23 Lunch Symposium 2 Orient Europharma 12:00-13:00 November 18 (Friday) 41F [Diamond Room II] Chairperson: Dr. Kuang-Kuo Chen 12:00-12:20 LS-04 HYPOGONADISM: NEW EVIDENCE Allen D. Seftel, Division of Urology Cooper University Hospital, United States 12:20-12:40 LS-05 EFFICACY AND SAFETY OF TESTOSTERONE REPLACEMENT THERAPY Han-Sun Chiang, Department of Urology, Taipei Medical University Hospital, Taiwan 12:40-13:00 LS-06 IS IT JUSTIFIED TO ROUTINELY SCREEN FOR LOW TESTOSTERONE IN ED PATIENTS? Kuang-Kuo Chen, Department of Surgery, Taipei Veterans General Hospital, and Shu-Tien Urological Research Center, National Yang-Ming University, Taiwan Symposium3- Basic Research in Sexual Medicine 13:30-14:45 November 18 (Friday) 41F [Diamond Room II] Chairpersons: Dr. Doddy M. Soebadi, Dr. Chia-Chu Liu 13:30-13:45 S3-01 AUTOPHAGY IN UROLOGY AND SEXUAL MEDICINE Yi-Chia Lin, Division of Urology, Department of Surgery, Shin Kong WHS Memorial Hospital, Taiwan 13:45-14:00 S3-02 AUTOPHAGIC DEFICIENCY IS RELATED TO STEROIDOGENIC DECLINE IN AGED RAT LEYDIG CELLS Wei-Ren Li, Andrology Center, Peking University First Hospital, Peking University, China 14:00-14:15 S3-03 EFFECTS OF ICARISIDEⅡON TGF-Β1/SMAD/CTGF AND NO-CGMP PATHWAYS AND CORPUS CAVERNOSUM FIBROUS-MUSCULAR ALTERATIONS IN RATS WITH STREPTOZOTOCIN-INDUCED DIABETES Zhong Cheng Xin, Andrology Center, Peking University First Hospital, Peking University, China 24 14:15-14:30 S3-05 STEM CELL RESEARCH FOR THE TMANAGEMENT OF ERRECTILE AND VOIDING DYSFUNCTION Shing-Hwa Lu, Department of Urology, Zhongxiao Branch, Taipei City Hospital, Taiwan 14:30-14:45 Discussion Podium 3 14:45-15:35 November 18 (Friday) 41F [Diamond Room II] Chairpersons: Dr. Chih-Shou Chen, Dr. Nansalmaa Naidan 14:45-14:55 OP13 KARYOTYPING OF AZOOSPERMIC MALES Wei-Min Cheng, Division of Urology, Department of Surgery, Taipei Veterans General Hospital, Taiwan 14:55-15:05 OP14 THE CORRELATION OF GR/GR Y CHROMOSOME MICRODELETION AND AZOOSPERMIC INFERTILITY To Chang, Division of Urology, Department of Surgery, Taipei Veterans General Hospital, and Department of Urology, School of Medicine, National Yang-Ming University, Taiwan 15:05-15:15 OP15 TRANSURETHRAL SEMINAL VESICULOSCOPY FOR EVALUATION AND MANAGEMENT OF PERSISTENT AND RECURRENT HEMOSPERMIA: A PRELIMINARY STUDY Heng-Jun Xiao, Department of Urology, the Third Affiliated Hospital of Sun Yat-Sen University, China 15:15-15:25 OP16 LAPAROENDOSCOPICSINGLE-SITE ASSISTED MALE-TO-FEMALE SURGERY Abai Xu, Department of Urology, Zhujiang Hospital, Southern Medical University, China 15:25-15:35 OP17 OUTCOMES OF MUTLI-OPERATION FOR INTERSEX PATIENTS: A REPORT OF 18 CASES Hui Zhu, Department of Plastic Surgery, Peking University Shenzhen Hospital, China 25 Symposium4- Tx of Peyronie's dis. Round Table Discussion 13:30-14:45 November 18 (Friday) 42F [Crystal/Coral] Chairpersons: Dr.Chin-Pao Chang, Dr. Kok Bin Lim 13:30-13:45 S4-01 PEYRONIE'S DISEASE AFTER PROSTATE CANCER TREATMENT IS MORE COMMON THAN PREVIOUSLY KNOWN Run Wang, University of Texas Medical School at Houston and MD Anderson Cancer Center, United States 13:45-14:00 S4-02 PEYRONIE’S DISEASE: CURRENT STATUS OF PENILE PLICATION PROCEDURE Te-Fu Tsai, Department of Urology, Shin Kong Wu Ho-Su Memorial Hospital, Department of Surgery, Shin Kong Wu Ho-Su Memorial Hospital,Taiwan 14:00-14:15 S4-03 THE KRISHNAMURTII OPERATION IN CAUCASIANS AND LIGHT-SKINNED PATIENTS WITH PEYRONIE’S DISEASE Sudhakar Krishnamurti, Andromeda Andrology Center, India 14:15-14:30 S4-04 A NOVEL PEYRONIE'S DISEASE ANIMAL MODEL COMPARATIVE STUDY OF INTRALESIONAL VERAPAMIL VERSUS NORMAL SALINE INJECTION: ASSESSMENT OF IMMUNOHISTOCHEMICAL OUTCOMES Eric Chung, Princess Alexandra Hospital, Australia 14:30-14:45 S4-05 THERAPEUTICAL EFFECTIVENESS OF A PENILE DEVELOPMENT CORRECTION DEVICE: PRELIMINARY REPORT ON PUBERTY PATIENTS Geng-Long Hsu, Microsurgical Potency Reconstruction and Research Center, Hsu’s Andrology, Department of Urology, Buddhist Tzu Chi General Hospital, Taipei Branch Taiwan 26 Podium 4 14:45-15:35 November 18 (Friday) 42F [Crystal/Coral] Chairpersons: Dr. Chii-Jye Wang, Dr. Mikio Namiki 14:45-14:55 OP18 COMPARISON OF TRANSRECTAL ULTRASONOGRAPHY BETWEEN POTENT BENIGN PROSTATIC HYPERPLASIA PATIENTS WITH AND WITHOUT ERECTILE DYSFUNCTION AFTER TRANSURETHRAL RESECTION OF PROSTATE Shiou-Sheng Chen, Division of Urology, Taipei City Hospital Renai Branch, Taiwan; School of Medicine, National Yang-Ming University, Taiwan 14:55-15:05 OP19 THE COMPARISON OF THE AGING MALE SYMPTOMS (AMS) SCALE AND ANDROGEN DEFICIENCY IN THE AGING MALE (ADAM) QUESTIONNAIRE TO DETECT ANDROGEN DEFICIENCY IN AGING TAIWANESE MEN Kuang-Shun Chueh, Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Taiwan 15:05-15:15 OP20 RISK OF ERECTILE DYSFUNCTION IN TYPE 2 DIABETIC MEN WITH ALBUMINURIA Yao-Chi Chuang, Division of Urology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taiwan 15:15-15:25 OP21 CLINICAL EVALUATION FOR ERECTILE DYSFUNCTION IN MEN UNDER 40 YEARS OLD Bang-Ping Jiann, Department of Medical Education and Research Kaohsiung Veterans General Hospital, Taiwan 15:25-15:35 OP22 THE EFFECT OF CIRCUMCISION ON YOUNG ADULT SEXUAL FUNCTION Chih-Wei Tsao, Division of Urology, Department of Surgery, Tri-Service General Hospital, Taiwan 27 State-of-the-Art Lecture 3 08:00-10:10 November 19 (Saturday) 41F [Diamond Room II] Chairpersons: Dr. Verna Lee, Dr. Thomas I.S. Hwang 08:00-08:25 SL-11 TESTOSTERONE REPLACEMENT THERAPY IN PATIENTS WITH A DIAGNOSIS OF PROSTATE CANCER: FACT OR FICTION? Ajay Nehra, Mayo Clinic College of Medicine Rochester, Minnesota, United State 08:25-08:50 SL-12 STUDIES ON POSSIBLE MOLECULAR BIOLOGICAL MECHANISM OF LOH Zhong Cheng Xin, Andrology Center, Peking University First Hospital, Peking University, China 08:50-09:15 SL-13 CRITICAL ROLE OF MIND OVER BODY IN THE MANAGEMENT OF EJD AND ED Ganesan Adaikan, Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University Hospital, National University of Singapore, Singapore Chairpersons: Dr. Donald Bodner, Dr. Hsi-Chin Wu 09:15-09:40 SL-14 A NEW PHYSIOLOGIC STUDY TOOL IN ERECTILE FUNCTION Jong Kwan Park, Department of Urology, Medical School, and Institute for Medical Sciences, Republic of Korea; National University, and Research Institute and CTC for Medical Device of Chonbuk, Republic of Korea 09:40-09:55 SL-15 ED TREATMENT IN THE ELDERLY IN JAPAN Haruaki Sasaki, Showa University Fujigaoka Hospital, Yokohama, Japan 09:55-10:10 SL-16 ACCEPTING ED: THE CHALLENGES AND OBSTACLES AHEAD George Lee, Clinical Associate Professor Consultant Urological Surgeon Gleneagles Intan Medical Centre Kuala Lumpur, Malaysia 10:10-10:30 Coffee Break 28 Expert Talk 2- Round Table 10:30 - 12:00 November 19 (Saturday) 41F [Diamond Room II] Chairpersons: Dr. Kuang-Kuo Chen, Dr. Ganesan P. Adaikan 10:30-10:50 ET-05 METABOLIC MEMORY AND DIABETIC NEUROVASCULAR COMPLICATIONS Tom F. Lue, Department of Urology, University of California, United States 10:50-11:10 ET-06 ED, VASCULAR DISEASE AND METABOLIC SYNDROME Jae-Seung Paick, Division of Urology, Seoul National University Hospital, Republic of Korea 11:10-11:30 ET-07 SCREENING FOR METABOLIC SYNDROME IN MEN WITH ERECTILE DYSFUNCTION Bang-Ping Jiann, Department of Medical Education and Research Kaohsiung Veterans General Hospital, Taiwan 11:30-11:50 ET-08 THE QEQ SURVEY OF CHINESE ED PATIENTS Kai Hong, Department of Urology, The Third Hospital of Peking University, China 11:50-12:00 Panel Discussion Lunch Symposium 3 Eli Lilly and Company 12:00 - 13:00 November 19 (Saturday) 41F [Diamond Room II] Chairperson: Dr. Shih-Tsung Huang 12:00-12:20 LS-07 ED and LUTS Allen D. Seftel, Division of Urology Cooper University Hospital 12:20-12:40 LS-08 WHO NEEDS DAILY USE OF PDE-5 INHIBITORS Verna Lee, Consultant physician in Primary Care, University of Malaya, Malaya 12:40-13:00 LS-09 LUNCH SYMPOSIUM: THE SAFETY AND EFFICACY OF TADALAFIL: AN UPDATE Shih-Tsung Huang, Department of Urology and Surgery, Chang Gung Memorial Hospital, Linkou Branch; College of medicine, Chang Gung University, Taiwan 29 Symposium5- ED LUTS and OAB Round Table 13:30 - 14:45 November 19 (Saturday) 41F [Diamond Room II] Chairpersons: Dr. Farid Saad, Dr. Chih-Shou Chen 13:30-13:45 S5-01 ANDROGEN DEFICIENCY SYNDROME AND LUTS Shih-Ping Liu, Department of Urology, National Taiwan University Hospital, Taiwan 13:45-14:00 S5-02 THE SPOUSE STUDY--ERECTILE DYSFUNCTION TREATMENT OUTCOMES IN PATIENTS AND PARTNERS Ajay Nehra, Mayo Clinic College of Medicine Rochester, Minnesota, United State 14:00-14:15 S5-03 EJACUALATORY FUNCTION AND DYSFUNCTION ASSOCIATED WITH LUTS/BPH Jae-Seung Paick, Seoul National University College of Medicine, Republic of Korea 14:15-14:30 S5-04 ASSOCIATIONS OF THE LOWER URINARY TRACT SYMPTOMS WITH THE LIFESTYLE, PROSTATE VOLUME, AND METABOLIC SYNDROME IN THE ELDERLY MALES Hsin-Chih Yeh, Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Taiwan 14:30-14:45 S5-05 CONTEMPORARY MANAGEMENT OF SEXUAL DYSFUNCTION IN SCI MALE Donald R. Bodner, CWRU School of Medicine University Hospitals of Cleveland DVAMC, United States Podium 5 14:45-15:45 November 19 (Saturday) 41F [Diamond Room II] Chairpersons: Dr. Kew-Kim Chew, Dr. Shei-Dei Yang 14:45-14:55 OP23 MEDICAL COMORBIDITY ASSOCIATED WITH ERECTILE DYSFUNCTION: A POPULATION-BASED STUDY Wei-Che Wu, Division of Urology, Department of Surgery, Far Eastern Memorial Hospital, Taiwan 14:55-15:05 OP24 ERECTILE DYSFUNCTION SHOCK WAVE THERAPY- A NEW TREATMENT MODALITY IN THE MANAGEMENT OF ERECTILE DYSFUNCTION: PATIENT SELECTION AND OPTIMIZING STRATEGIES. Vasan Satya Srini, DNB- Urology, Director and Head of Department Andrology, Ankur Health Care Private Limited, India 30 15:05-15:15 OP25 CURRENT STATUS AND STRATEGY FOR COUNTERFEIT ERECTILE DYSFUNCTION MEDICATION (PHOSPHODIESTERASE TYPE 5 INHIBITORS) IN JAPAN: A FOUR-COMPANY SPONSORED SURVEY ON DRUGS OBTAINED VIA THE INTERNET Ken Marumo, Department of Urology, Tokyo Dental College, Ichikawa General Hospital, Japan 15:15-15:25 OP26 MORE PSYCHOGENIC OR MORE ORGANIC? A MULTICENTRAL INVESTIGATION OF ERECTILE DYSFUNCTON ETIOLOGY IN CLINIC OUTPATIENTS IN CHINA Yuxin Tang, Department of Urology, Third Xiangya Hospital, Central South University, China 15:25-15:35 OP27 CLINICAL CHARACTERISTICS OF YOUNG MEN WITH ERECTILE DYSFUNCTION Yung-Ming Lin, Department of Urology, College of Medicine, National Cheng Kung University, Taiwan 15:35-15:45 OP28 A NATION-WIDE POPULATION STUDY OF TRAZODONE USE IN UROLOGICAL PATIENTS Wei-Ming Cheng, Divisions of Urology, Department of Surgery, Taipei Veterans General Hospital, Taiwan 18:30-21:30 Gala Dinner Symposium6- Stem Cell Study in Urology Basic Research 13:30-14:45 November 19 (Saturday) 42F [Crystal/Coral] Chairpersons: Dr. Zhong Cheng Xin, Dr. Shing-Hwa Lu 13:30-13:45 S6-01 STEM CELL RESEARCH FOR UROLOGICAL REGENERATION Shing-Hwa Lu, Department of Urology, Zhongxiao Branch, Taipei City Hospital, Taiwan 13:45-14:00 S6-02 STEM CELLS FOR ERECTILE DYSFUNCTION Tom F. Lue, Department of Urology, University of California, San Francisco, United States 14:00-14:15 S6-03 GENE POLYMORPHISMS AND ERECTILE DYSFUNCTION Yung-Chin Lee, Kaohsiung Medical University Chung-Ho Memorial Hospital, Taiwan 31 14:15-14:30 S6-04 STEM CELLS USED FOR REGENERATION OF CORPUS CAVERNOSUM Kuo-Liang Chen, Department of Urology, China Medical University Hospital, China Medical University, Taiwan 14:30-14:45 Discussion Podium 6 14:45 - 15:35 November19 (Saturday) 42F [Crystal/Coral] Chairpersons: Dr. Kok Bin Lim, Dr. Shih-Ping Liu 14:45-14:55 OP29 MICROSURGICAL EXCISION OF URETHRAL HAIR ROOTS IN PATIENTS WITH A HISTORY OF SURGICAL TREATMENT OF HYPOSPADIAS DURING CHILDFOOD Koichi Nagao, Department of Urology, Toho University School of Medicine, Japan 14:55-15:05 OP30 CLINICAL EXPERIENCE OF A SATISFIED BLOCK FOR OUTPATIENT PENILE PROSTHESIS IMPLANTATION Cheng-Hsing Hsieh, Department of Urology, Buddhist Tzu Chi General Hospital, Taipei Branch, Taiwan 15:05-15:15 OP31 VENO-OCCLUSIVE DYSFUNCTION IN YOUNG PATIENTS RESULTING FROM JELQING MANEUVER: LONG-TERM RESULTS OF PENILE VENOUS STRIPPING SURGERY Geng-Long Hsu, Microsurgical Potency Reconstruction and Research Center, Hsu’s Andrology, Taiwan 15:15-15:25 OP32 CORPOROPLASTY PLICATION SURGERY FOR THE TREATMENT OF PENILE CURVATURE Te-Fu Tsai, Division of Urology, Department of SurgeryShin Kong Wu Ho-Su Memorial Hospital; School of Medicine, Fu-Jen Catholic University, Taiwan 15:25-15:35 OP33 TRUE PENILE AUGMENTATION - PRELIMINARY REPORT Li-Jen Liu, Yi-He Hospital, Taiwan 18:30-21:30 Gala Dinner 32 State-of-the-Art Lecture 4 08:00-10:10 November 20 (Sunday) 42F [Crystal/Coral] Chairperson: Dr. Shih-Tsung Huang 08:00-08:25 SL-17 UPDATE ON FEMALE SEXUAL FUNCTION AND DYSFUNCTION Kwang Sung Park, Chonnam National University Medical School, Gwangju, Republic of Korea 08:25-08:50 SL-18 REAL-WORLD IMPERATIVE OF OUTCOMES RESEARCH Allen D. Seftel, Division of Urology Cooper University Hospital, United States 08:50-09:15 SL-19 ANDROGEN DEFICIENCY SYNDROME IN TAIWANESE MEN Shih-Ping Liu, Department of Urology, National Taiwan University Hospital, Taiwan Chairpersons: Dr. Wei-Kung Tsai, Dr. Arif Adimoelia 09:15-09:40 SL-20 MODIFIED PLICATION OF THE TUNICA ALBUGINEA IN TREATING CONGENITAL PENILE CURVATURE Ju-Ton Hsieh, National Taiwan University Hospital, Taiwan 09:40-09:55 SL-21 MORNING ERECTION /SLEEP-RELATED ERECTION IS TRUE SIGN OF ERECTILE FUNCTION AND EXACTLY OF THE SYMBOL OF MALENESS Yoshiaki Kumamoto, Japanese Institute of Clinical Andrology, Japan 09:55-10:10 Discussion 10:10-10:30 Coffee Break Expert talk 3 10:00-11:50 November 20 (Sunday) 42F [Crystal/Coral] Chairperson: Dr. Cheng-Hsing Hsieh, Dr. Bang-Ping Jiann 10:30-10:50 ET-09 TESTOSTERONE AND OBESITY - LONG-TERM DATA PROVIDE MORE SURPRISES Farid Saad, Scientific Affairs Men’s Healthcare, Bayer Pharma AG, Germany; 33 10:50-11:10 ET-10 THE PERSPECTIVE OF SEXUAL MEDICINE IN PSYCHIATRY Jian-Kang Chao, Department of Psychiatry, Yuli Veterans Hospital, Department of Nursing, Chung Hwa University of Medical and Technology, Taiwan 11:10-11:30 ET-11 THE FUTURE OF PENILE VEIN LIGATION Geng-Long Hsu, Microsurgical Potency Reconstruction and Research Center, Hsu’s Andrology, Department of Urology, Buddhist Tzu Chi General Hospital, Taipei Branch Taiwan 11:30-11:50 ET-12 THE PERSPECTIVE OF SEXUAL MEDICINE IN JAPAN Yoshiaki Kumamoto, Japanese Institute of Clinical Andrology, Japan Closing Ceremony 11:50-12:00 November 20 (Sunday) 42F [Crystal/Coral] 34 Poster Presentations List November 17, Moderated Poster Chairperson: Dr. Chris McMahon, Dr. Wei-Kung Tsai PP01 LOPERAMIDE INDUCING PROSTATIC RELAXATION BY ACTIVATION OF OPIOID MU2-RECEPTORS IN A RAT MODEL Chih-Cheng Lu, Hsien-Hui Chung, Juei-Tang Cheng (Taiwan) PP02 CHARACTERIZATION OF LECTIN-BINDING SITES IN EPITHELIAL CELLS OF THE MOUSE EPIDIDYMIS Syouta Tajiri, Tatsuya Fukui, Kazuya Yoshinaga (Japan) PP03 SEPARATION, CULTURE AND IDENTIFICATION OF RAT CORPUS CAVERNOSAL ENDOTHELIAL CELLS Jun Chen, Bin Zhang, Hengjun Xiao, Tao Qi (China) PP04 PENILE TRACTION AND PEYRONIE'S DISEASE: IN-VITRO ANALYSIS OF THE EFFICACY OF TRACTION ON CELLULAR CHANGES IN PEYRONIE'S PLAQUE IN A STRAIN CULTURE SYSTEM. Eric Chung, Ling De Young, Gerald Brocke (Canada) PP05 PENILE VENOUS OCCLUSION MECHANISM: EVIDENCES FROM AN ELECTROCAUTERY EFFECT TO THE SINUSOIDS ON DEFROSTED HUMAN CADAVERS Cheng-Hsing Hsieh, Geng-Long Hsu (Taiwan) PP06 MESENCHYMAL STROMAL CELLS TRANSFECTED BY RECOMBINANT ADENOVIRUS VECTOR WITH SHORT HAIRPIN RNA OF SILENCING PDE5 Heng-Jun Xiao, Yan Zhang, Min Xia, Xin Gao, Jun Chen, Ning Na, Hao Zhang, Xiao-Peng Liu (China) PP07 EFFECTS OF PHOSPHODIESTERASE 5 EXPRESSION ON EX VIVO DIFFERENTIATED MESENCHYMAL STROMAL CELLS USING ADENOVIRAL GENE TRANSFER OF SHORT HAIRPIN RNA Heng-Jun Xiao, Jun Chen, Xiao-Yong Pu, Liao-Yuan Li, Yan Zhang, Xiao-Peng Liu, Hao Zhang, Xin Gao (China) PP08 INDUCTION OF APOPTOSIS BY BENZYL ISOTHIOCYANATE (BITC) IN HUMAN PROSTATE CANCER CELLS Te-Fu Tsai, Ji-Fan Lin, Hung-En Chen Yi-Chia Lin, Kuang-Yu Chou, Thomas I-Sheng Hwang (Taiwan) 35 PP09 INDUCTION OF AUTOPHAGIC CELL DEATH BY ALLYL ISOTHIOCYANATE Hung-En Chen , Ji-Fan Lin, Te-Fu Tsai, Yi-Chia Lin, Kuang-Yu Chou, Thomas I-Sheng Hwang (Taiwan) PP10 THE EFFECTS OF AMPHETAMINE AND KETAMINE ON SPERM QUALITY AND APOPTOSIS-RELATED GENES EXPRESSION IN TESTIS AND EPIDIDYMIS OF MALE RAT Hung-En Chen, Ji-Fan Lin, Te-Fu Tsai, Yi-Chia Lin, Kuang-Yu Chou, Thomas I-Sheng Hwang (Taiwan) PP11 HIGH-DOSE TESTOSTERONE TREATMENT CAUSE APOPTOTIC CELL DEATH IN HUMAN ANDROGEN-SENSITIVE AND –INDEPENDENT PROSTATE CANCER CELLS Chao-Wei Tseng, Thomas I-Sheng Hwang, Yi-Chia Lin, Te-Fu Tsai, Hung-En Chen, Kuang-Yu Chou, Ji-Fan Lin (Taiwan) PP12 RESTORATION OF MIR-204 EXPRESSION INDUCES CELL APOPTOSIS BY TARGETING BCL2 IN HUMAN BLADDER AND PROSTATE CANCER CELLS Chao-Wei Tseng, Thomas I-Sheng Hwang, Yi-Chia Lin, Te-Fu Tsai, Hung-En Chen, Kuang-Yu Chou, Ji-Fan Lin (Taiwan) PP13 THE ASSOCIATION OF HEMOCHROMATOSIS GENE (H63D, S65C, C282Y) MUTATIONS WITH IDIOPATHIC MALE INFERTILITY IN CHINESE HAN POPULATION Yu XY, Wang BB, Xin ZC, Liu T, Ma K, Jiang J, Fang X, Yu LH, Peng YF, Ma X (China) PP15 A FLEXIBLE PROGRAM OF PENILE REHABILITATION FOR THE PATIENTS OF PROSTATIC CANCER AFTER SURGERY OR IRRADIATION TREATMENT Han-Sun Chiang, (Taiwan) PP17 COMPARISON OF THE EFFECT ON CAVERNOUS NERVE STIMULATION-INDUCED INTRACAVERNOUS PRESSURE INCREASE BETWEEN DAILY AND WEEKLY ADMINISTRATION OF SILDENAFIL IN THE RAT Kuang-Kuo Chen, Luke S. Chang (Taiwan) PP18 THE EFFECT OF TESTOSTERONE ON EPIMEDIUM BREVICORNUM MAXIM EXTRACT-INDUCED PENILE ERECTION IN THE RAT Kuang-Kuo Chen, Luke S. Chang (Taiwan) 36 PP19 HYPERPROLACTINEMIA-INDUCED HYPOGONADISM IN MALE RATS IS RELATED WITH AUTOPHAGY OF LEYDIG CELLS William J Huang, Hsiao-Fung Pu, Alex TL Lin, Kuang-Kuo Chen, Yi-Ting Tsai, Yi-Te Chiang, Yi-Te Chiang (Taiwan) PP20 THE EFFECTS OF ANTI-TNF-ANTIBODY ON NEURAL NO SYNTHASE EXPRESSION AND SMOOTH MUSCLE CONTENT IN CARVERNOSAL TISSUE IN RATS WITH HYPERPROLACTINEMIA-RELATED ERECTILE DYSFUNCTION William J Huang, Yi-Ting Tsai, Yi-Te Chiang, Hsiao-Fung Pu, Alex TL Lin, Kuang-Kuo Chen, Zhong-Lin Wang (Taiwan) November 18, Moderated Poster Chairperson: Dr. Allen D. Seftel, Dr. Donald Bodner PP21 STORAGE LOWER URINARY TRACT SYMPTOMS ARE PRONOUNCED IN MIDDLE-AGED MEN WITH ERECTILE DYSFUNCTION Wei-Kung Tsai (Taiwan) PP22 THE TIMING OF FIRST SEXUAL INTERCOURSE AMONG CHINESE ADOLESCENTS: A NATIONAL STUDY Wei Guo, Zheng Wu, Yue Qiu, Gong Chen, Xiaoying Zheng (China, Canada) PP23 THE ATTTITUDE ABOUT PHOSPHODIESTERASE TYPE 5 INHIBITORS AMONG PHARMACISTS—A LOCAL OBSERVATIONAL STUDY Chih-Cheng Lu, Wen-Chou Fan (Taiwan) PP24 METABOLIC SYNDROME IN HONG KONG PATIENTS WITH ERECTILE DYSFUNCTION Ho-Yin Ngai, Steve Wai-Hee Chan (Hong Kong) PP26 ASSESSMENT OF ERECTILE FUNCTION IN OVERWEIGHT AND OBESE PATIENTS Heng-Jun Xiao, Jun Chen, Xiao-Yong Pu, Hao Zhang, Xiao-Peng Liu, Yan Zhang, Bin Zhang, Xin Gao (China) PP27 PERCEPTION OF ERECTILE DYSFUNCTION (ED) AS A MEDICAL CONDITION BY POPULATION WITH VARIED EDUCATIONAL BACKGROUND Mun Yee Siaw, George EngGiap Lee (Malaysia) PP28 PERCEPTION OF ERECTILE DYSFUNCTION (ED) AS A MEDICAL CONDITION BY POPULATION WITH DIFFERENT SEXUAL ACTIVITY STATUS Mun Yee Siaw, George EngGiap Lee (Malaysia) 37 PP29 PERCEPTION OF ERECTILE DYSFUNCTION (ED) AS A MEDICAL CONDITION BY POPULATION OF DIFFERENT AGE GROUPS Mun Yee Siaw, George EngGiap Lee (Malaysia) PP30 ANALYSIS OF THE FACTORS WHICH HAVE EFFECTS ON ERECTILE FUNCTION; THE RELATIONSHIP BETWEEN ERECTILE FUNCTION AND LOWER URINARY TRACT SYMPTOMS Eitetsu Koh, Kazuhiro Sugimoto, Masashi Iijima, Yuji Maeda, Hiroyuki Konaka, Teruaki Iwamoto, Mikio Namiki, Kazuyoshi Shigehara (Japan) PP31 THE DEVELOPMENT OF SELF-RATING LIBIDO SCALE FOR MALE Bin Zhang, Tao Qi, Jun Chen, Hengjun Xiao, Bao Wang, Xiaoming Li (China) PP32 CLINICAL INVESTIGATION OF PATIENTS WITH EJACULATORY DYSFUNCTION AND MALE INFERTILITY Yasushi Miyagawa, Tetsuya Takao, Hidenobu Okuda, Keisuke Yamamoto, Shinichiro Fukuhara, Iwao Yoshioka, Yasuhiro Matsuoka, Akira Tsujimura (Japan) PP35 PENILE DUPLEX VENO-OCCLUSIVE ULTRASONOGRAPHY DYSFUNCTION OR IN POOR MEN WITH PEYRONIE'S DISEASE: CAVERNOSAL ARTERIAL INFLOW; CLINICAL INSIGHTS TO DIFFERENTIATE THEIR CONTRIBUTIONS TO ED Eric Chung, Ling De Young, Gerald Brock (Australia, Canada) PP36 THE CLINICAL EFFICACY OF HIGH DOSE VARDENAFIL FOR ERECTILE DYSFUNCTION IN ELDER OR PATIENTS WITH METABOLIC SYNDROME Toshiyasu Amano, Masaya Seki, Tetsuya Imao, Katsurou Takemae (Japan) PP37 TWO DIFFERENT TYPE OF PRIAPISM AND JAPANESE EXPERIENCE OF PRIAPISM Kenro Yamamoto, Yasutada Onodera, Yoshio Ogawa, Haruaki Sasaki, Keiichiro Aoki, Michiya Ota (Japan) PP38 EFFICACY AND SAFETY OF CLOMIPRAMINE HYDRO??HLORIDE CONTAINING NASAL SPRAY FOR THE TREATMENT OF PREMATURE EJACULATION Sh. Shavakhabov, A. Fozilov (Uzbekistan) PP39 THE DARK SIDE OF SSRI Yasusuke Kimoto (Japan) PP41 2 CASES OF PREMATURE EJACULATION INDUCED BY LUMBOSACRAL NERVE INJURY 38 Bin Zhang, Jun Chen, Tao Qi, Bo Wang, Xiaoming Li, Shiqin Chen (China) PP42 INVESTIGATION OF INTRAVAGINAL EJACULATORY LATENCY TIME IN COUPLES Bin Zhang, Jun Chen, Tao Qi, Bo Wang, Xiaoming Li, Shiqin Chen (China) PP44 THE EFFECTS OF ORAL ADMINISTRATION OF DA-8031, A NOVEL COMPOUND FOR PREMATURE EJACULATION, ON MALE RAT SEXUAL BEHAVIOR JH Sung, GJ Ahn, KK Kang, SH Kim (Republic of Korea) PP45 MINIMALLY INVASIVE SURGERY FOR PENILE AUGMENTATION USING TYPE I COLLAGEN Tae Kyoung Yun, Hoon Seog Jeon, Dong Wan Sohn (Republic of Korea) PP46 PENILE LENGTHENING FOR ADULT CONTRACTILE PENIS PRESERVING SUSPENSORY LIGAMENT Tae Kyoun Yun, Hoon Seog Jeon, Dong Wan Sohn (Republic of Korea) PP47 TREATMENT OF ABNORMALITY OF STABILITY OF PENILE ERECTION BY SUSPENSION OF PENIS (A SINGLE CENTER EXPERIENCE WITH 3 PATIENTS) Jun Chen, Bin Zhang, Hengjun Xiao, Tao Qi (China) PP48 DOES CIRCUMCISION DECREASE PENIS SENSITIVITY ? Joon Yong Kim, Byung Moo Kim (Republic of Korea) PP49 PENILE AUGMENTATION SURGERY USING ACELLULAR HUMAN DERMAL TISSUR WITH INJECTION METHOD. Joon Yong Kim, Byung Moo Kim (Republic of Korea) PP50 VULVODYNIA AND SEXUAL QUALITY OF LIFE Ching-Hui Chen, Yen-chin Lin, Wei-Min Liu, Li-Hsuan Chiu, Peng-Hui Wang (Taiwan) PP51 OBESITY, INSULIN RESISTANCE AND THEIR CORRELATION WITH TESTOSTERONE LEVELS IN AGING MALE PATIENTS Sh Janjgava, L. Uchava, T. Doliashvil, M. Tsagareli, E. Giorgadze, K. Asatiani, N. Jiqurauli, T. Zerekidze (Georgia) 39 PP53 THE COMPARISON OF GREENLIGHT LASER AND DIODE LASER PROSTATECTOMY: ANALYSIS OF SEXUAL FUNCTION CHANGES Fu-Shun Hsu (Taiwan) November 19, Moderated Poster Chairperson: Dr. Ajay Nehra, Dr. T. Kamaraj PP55 DEDIFFERENTIATED LIPOSARCOMA OF THE SCROTUM AND PARATESTICULAR REGION—CASES REPORT Chih-Cheng Lu (Taiwan) PP56 UPDATING COMPARISON OF PROSTATE CANCER PRACTICE GUIDELINES AND CONSENSUS AMONG CHINA, SINGAPORE AND TAIWAN Chih-Cheng Lu, Wen-Chou Fan, Tse-Chou Cheng (Taiwan) PP57 THE CORRELATION OF TESTICULAR MICROLITHIASIS AND MALE INFERTILITY To Chang, William J.S. Huang, Yi-Te Chiang, Alex T.L. Lin, Kuang-Kuo Chen (Taiwan) PP58 DYNAMIC EVIDENCE OF THE PENILE VENOUS ERECTILE APPARATUS Geng-Long Hsu, Cheng-Hsing Hsieh (Taiwan) PP59 THE ASSOCIATION BETWEEN ERECTILE DYSFUNCTION AND THE RISK FACTORS FOR CARDIOVASCULAR DISEASE: A BRIEF REVIEW OF THE LITERATURE Heng-Jun Xiao, Cheng Hu, Teng-Cheng Li, Yan Zhang, Jun Chen, Bin Zhang, Xiang-Fu Zhou, Xin Gao (China) PP61 MULTIPLE ARTERIAL OCCLUSION WITH CLINICAL MANIFESTATIONS OF ERECTILE DYSFUNCTION Bin Zhang, Jun Chen, Tao Qi, Bo Wang, Xiaoming Li, Shiqin Chen (China) PP62 VENTRICULAR TACHYCARDIA INDUCED BY SEXUAL ACTIVITY （TWO CASES REPORTED） Bin Zhang, Jun Chen, Tao Qi, Bo Wang, Xiaoming Li, Shiqin Chen (China) PP63 Α-BLOCKERS COMBINED WITH ELECTRONIC BIOFEEDBACK TREATMENT PROSTATITIS EFFECTS OF TYPE III le xu, minqie qiu, jiehong jiang (China) PP64 MICROSURGICAL DENERVATION OF THE SPERMATIC CORD FOR TREATMENT OF IDIOPATHIC CHRONIC ORCHIALGIA (FIRST CASE OF REPORT IN CHINA) 40 Xiangan Tu, Shaopeng Qiu, Chunhua Deng, Liangyun Zhao, Xiangzhou Sun (China) PP65 EFFECT OF TRANSURETHRAL RESECTION OF EJACULATORY DUCT FOR TREATMENT OF EJACULATORY DUCT OBSTRUCTION (REPORT OF 60 CASES) Chuanhua Deng, Xiangan Tu, Liangyun Zhao, Liang Zhao, Wenwei Wang, Liwen Deng, Yu Chen (China) PP69 HOW HARD IT WOULD BE FOR PENIS TO BREAK INTO VAGINA? Liuhong Cai, Bin Zhang, Jun Chen, Hui Lin (China) PP70 THE MANAGEMENT AND TRAINING FOR THE GUIDE NURSES IN OUT-PATIENT DEPARTMENT OF SEXUAL MEDICINE Xinjian Feng, Hui Lin, Bin Zhang, Jun Chen (China) PP71 IMPLEMENTATION OF CONSULTATION INTRODUCTION SERVICES IN OUTPATIENT DEPARTMENT OF SEXUAL MEDICINE Xinjian Feng, Hui Lin, Bin Zhang, Jun Chen (China) PP72 INVESTIGATION ON THE SATISFACTION OF OUT-PATIENTS IN OUT-PATIENT DEPARTMENT OF SEXUAL MEDICINE WITH HOSPITAL NURSING Xinjian Feng, Hui Lin, Bin Zhang, Jun Chen (China) PP73 “PARTIN TABLE” FOR TAIWANESE PATIENTS WITH PROSTATE CANCER Ching-Hsin Chang, William J.S. Huang, Yen-Hwa Chang, Chin-Chen Pan, Hsiao-Jen Chung, Junne-Yih Kuo, Shing-Hwa Lu, Alex T.L. Lin, Kuang-Kuo Chen (Taiwan) PP74 TRAUMATIC EXPERIENCE AND SUBJECTIVE SYMPTOM SCORES IN WOMEN WITH INTERSTITIAL CYSTITIS/PAINFUL BLADDER SYNDROME (IC/PBS) IN TAIWAN Wei-Chih Chen, Ming-Huei Lee, Chiu-De Chiu, Huei-Ching Wu, Yi-Chang Chen (Taiwan) PP75 DIFFERENCES IN THE SUBJECTIVE SYMPTOMS, URODYNAMIC EXAMINATION AND CYSTOSCOPIC MAXIMAL BLADDER CAPACITY OF INTERSTITIAL CYSTITIS/ PAINFUL BLADDER SYNDROME (IC/PBS) IN WOMEN WITH OR WITHOUT SEXUAL PAIN Huei-Ching Wu, Wei-Chih Chen, Ming-Huei Lee, Chui-De Chiu, Yi-Chang Chen (Taiwan) PP76 PATHOLOGY OF URETHRAL FIBROUS-MUSCULAR SYSTEM RELATED TO PARTURITION-INDUCED STRESS URINARY INCONTINENCE AND TGF-Β1/SMAD PATHWAY 41 Guang-Yong Li, Wan-Shou Cui, Feng Zhou, Zhe-Zhu Gao, Hua Xin, Tao Liu, Wei-Ren Li, Yan-Qing Gong,Guang-Yi Bai, Zhong-cheng Xin (China) PP77 EFFECTS OF ICARIIN AND ICARISIDEⅡON ENOS EXPRESSION AND NOS ACTIVITY IN PORCINE AORTA ENDOTHELIAL CELL PREVENTIVE Tao Liu, Xincheng Qing, Weiren Li, Feng Zhou, Guangyong Li, Hua Xin, Yanqing Gong, Zhongcheng Xin (China) PP78 EFFECTS OF ICARIIN ON IMPROVING ERECTILE FUNCTION IN STREPTOZOTOCIN-INDUCED DIABETIC RATS Tao Liu, Hua Xin, Weiren Li, Jian Zhang, Feng Zhou, Wanshou Cui, Guangyong Li, Yanqing Gong, Zhang Nan, Xin Zhongcheng (China) PP79 EFFECTS OF ICARISIDEⅡ ON TGF-Β1/SMAD/CTGF AND NO-CGMP PATHWAYS AND CORPUS CAVERNOSUM FIBROUS-MUSCULAR ALTERATIONS IN RATS WITH STREPTOZOTOCIN-INDUCED DIABETES Feng Zhou, Hua Xin, Tao Liu, Guang-Yong Li, Zhe-Zhu Gao, Jing Liu, Wei-Ren Li, Wan-Shou Cui, Guang-Yi Bai, Nam Cheol Park, Zhong-Cheng Xin (China, Republic of Korea ) PP80 PLGA BIODEGRADABLE SCAFFOLD COGRAFTING WITH AUTOLOGOUS ADSC ON PENIS GIRTH ENHANCEMENT Wanshou Cui, zhe Jin, Yanqing Gong, Tao Liu, Weiren Li, Guangyong Li, Feng Zhou, Guangyi Bai (China) PP81 EFFICACY AND SAFETY OF RETROPERITONEAL LAPAROSCOPIC VERICOCELECTOMY(RPLV) SUPER-HIGH LIGATION FOR TREATING VARICOCELE WITH MALE INFERTILITY. A PILOT CLINICAL STUDY Jin-xing Lv, Liang-liang Wang, Guang-yong Li, Jin-xian Fu, Zhong-cheng Xin (China) PP82 THE SELF-ESTIMATION INDEX OF ERECTILE FUNCTION-NO SEXUAL LIFE (SIEF-NS):A MULTIDIMENSIONAL SCALE FOR ERECTILE DYSFUNCTION-NO SEXUAL LIFE Yiming Yuan, Zhichao Zhang, Bing Gao, Jing Peng, Zhongcheng Xin, Weidong Song, Jie Jin, Yinglu Guo (China) PP83 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 Vincent FS Tsai, Hong-Chiang Chang, Yuh-Chen Kuo, Shih-Ping Liu, Ju-Ton Hsieh (Taiwan) 42 PP84 THE PERIPHERAL EFFECT OF DOPAMINE ON CONTRACTION OF RAT SEMINAL VESICLES--- IN VIVO REGULATION AND ORGAN BATH STUDY Vincent FS Tsai, Fu-Shan Jaw, Hong-Chiang Chang, Yuh-Chen Kuo, Shih-Ping Liu, Ju-Ton Hsieh (Taiwan) PP85 WHAT DO MEN KNOW ABOUT THEIR SEXUAL HEALTH – A QUALITATIVE STUDY IN “GEN X AND Y” VKM Lee1, CJ Ng2, EM Khoo2, LP Wong2, WY Low2, HM Tan (Malaysia) PP86 THE EFFECT OF PLATELET RICH FIBRIN ON CAVERNOUS NERVE REGENERATION IN A NERVE INJURY RAT MODEL Chien-Chih Wu, Hsiu-O Ho, Yi-No Wu, Han-Sun Chiang (Taiwan) PP87 ASSOCIATION BETWEEN ENDOGENOUS SEX HORMONES, SEX HORMONE-BINDING GLOBULIN, AND SERUM C-REACTIVE PROTEIN LEVELS IN BOTH SEXES Chun-Hou Liao, Han-Sun Chiang, Hung-Yuan Li, Wen-Ya Ma (Taiwan) PP88 SERUM TESTOSTERONE LEVELS SIGNIFICANTLY CORRELATE Yu-Wei Chou, Chun-Hou Liao, Han-Sun Chiang, Hong-Jeng Yu (Taiwan) PP89 TESTOSTERONE AND SEX HORMONE-BINDING GLOBULIN HAVE SIGNIFICANT ASSOCIATION WITH METABOLIC SYNDROME IN TAIWANESE ME Chia-Hao Kuei, hun-Hou Liao, Hong-Jeng Yu, Han-Sun Chiang (Taiwan) PP90 DEVELOPMENT OF SEXUAL SELF-CONCEPT SCALE FOR ADOLESCENTS Jiunn-Horng Lou, Sheng-Hwang Chen, Cheng-Joo Eng, Yen-Chin Lin, Fang-Chen Lin (Taiwan) PP91 THE MEDICAL-CARE SEEKING BEHAVIORS AND LIFE EXPERIENCES AMONG VAGINISMUS PATIENTS AND THEIR PARTNERS IN TAIWAN Hsing-Yuan Liu, Cherng-Jye Jeng (Taiwan) 43 Abstracts Speakers’ Abstract P. 45- P. 101 Oral Presentation Poster Presentation P. 102- P. 134 Please visit the website at www.apssm2011.com 44 SH-01 MALE SEXUAL DYSFUNCTIONS IN AUSTRALIA Kew-Kim Chew Keogh Institute for Medical Research (Australia) Purpose: To present an overview of male sexual dysfunctions in Australia. Materials and methods: Australian epidemiological data from research publications relevant to male sexual dysfunctions were reviewed and their implications examined. Management options were investigated as well as their availability, accessibility and affordability. Results: About 70% of adult Australian men were sexually active, and the level of sexual activity decreased with age. Of men aged 40-80 years, 38% had sexual intercourse more than once a week. Decreased sexual desire was reported by 18-37% of men aged 40 years and older. The prevalence rate of premature ejaculation was 23% in this age group. The prevalence and severity of erectile dysfunction (ED) increased with age. ED regardless of severity was reported by 25.1% of men aged 20-80+ years, and 8.5% reported severe ED. Of men with ED, 30% had sought treatment in a study conducted in 2003, compared to 12% and 14%, respectively, in studies conducted in 1996/97 and in 2001/02. Cigarette smoking was shown to incur, independently, increased risk of ED and that, to be beneficial, smoking cessation must occur early and before mid-life. Findings from various studies confirmed a close relationship between ED and cardiovascular (CV) disease, the common denominator in both these conditions being atherosclerosis from endothelial dysfunction. ED was associated with increased risk of subsequent CV events, particularly in the younger age groups. It was also associated with increased CV mortality. There is a wide range of treatment options for ED in Australia. This is available within the national Medicare system and from alternative sources. Accessibility is reasonable but treatment is not always affordable. Conclusion: Male sexual dysfunctions are prevalent in Australia, and are age-related and undertreated. These have significant implications in a population with rapidly increasing proportion of elderly men. Men with ED, particularly cigarette smokers, should be rigorously investigated for CV risk factors and disease. 45 SH-02 PHYTOTHERAPY ON SEXUAL DYSFUNCTION IN ASIA: PAST, PRESENT AND FUTURE Zhong-cheng Xin Andrology Center, Peking University First Hospital,Peking University (China) Herbal medicine has been used as phytotherapy in Asia more than thousands of years, especially in the eastern and southern Asian countries. In history, the phytotherapy in Korea（Dong-eui-bo-gam）and Japan (Kampo medicine) were introduced with Traditional Chinese Medicine (TCM) before the introduction of Western medicine. In TCM, many of cocktailed natural herbs are widely used as integrity therapy for caring the patients in different forms such as powder, capsules, tinctures, or syrups et al. Among of the herbs in the cocktail, one or two herbs work as the remedies cardinal in the therapy, and the others work as the remedy adjutants, which help the remedies cardinal to work more effectively. Different from Western medicine, all the interactive ingredients are looked as integrity for therapy, and the individualized treatment of disease is looked as the essence of TCM. Although the safety and efficacy of phytotherapy on sexual dysfunction still need to be further investigated, recently, there are more interesting studies were carried out to investigate the efficacy of monomer chemical ingredients isolated from herb medicine on sexual dysfunction. In this manuscript, we evaluated past, present and future phytotherapy on sexual dysfunction. 46 SH-03 SEXUAL DYSFUNCTION AND QUALITY OF LIFE IN INDONESIA Doddy M. Soebadi Department of Urology, Airlangga University Hospital (Indonesia) The mostly reported sexual problems among Indonesian men were lack of sexual interest, erection difficulties and early ejaculation. Sexual problem among Indonesian women were dominated by lack of sexual interest, lubrication difficulties and inability to reach orgasm. About 96% of Indonesian men and women who had sexual problem did not seek help for their problems. The main reason mentioned was that talking to other people about their sexual problems was embarrassing (24). Sexual dysfunction among older people is a sensitive issue, and talking and discussing about sexuality is uncommon in many settings. It can be embarrassing and usually uncomfortable to do in some socio-cultural settings in the community. Even though over 1/3 of the world population at sexual active age-group reported at least one problem of sexual dysfunction, only less than 1/5 of them seek medical help for their sexual problem (25). Only few of the older people (less than 10%) discussed their sexual dysfunction with their physicians and they reported that physician seldom asked about patient’s sexual life (22). There is a lack of common understanding of sexual problem, sexual satisfaction and general sexual life among elderly people. Many were lack of awareness on the problem, and believed that sexual problem does not need to take into account, or not being troubled by the problem. Men and women who had no more sexual contact in the last 12 months had higher odds to report poor quality of life than those older people who had sexual frequency at least once a week. The qualitative study found out that respondent view an older. iii␣people with good quality life as a healthy older people (physical and mental health), if the older people gets supports from family and community, if they are still productive economically and can participate in the community activity, if they are knowledgeable, and if they believe in God. The older people agreed it is natural that sexual activity decreased with aging, that it can be worsen by diseases which make sexual activity become difficult, and that sexual activity is viewed as a responsibility to their spouse For men in Indonesia, the ‘idea’ frequency of sexual intercourse is significantly higher than what it is for women (13/month vs. 8.9/month). Over half of men and women felt they were having about the right amount of sex. For both men and women in Indonesia, an ‘ideal’ sexual experience is strongly associated with erection-related factors. More than eight in ten men and three-quarters of women rank erection hardness or the ability to maintain an erection as either the ‘most’ or ‘second most’ important elements necessary for achieving an ‘ideal’ sexual experience. For both men and women in Indonesia having an emotional connection with their partner is the most important aspect to improve in order to achieve ‘ideal’ sexual relations. Physical foreplay and good communication round out the top three improvement priorities for both genders. Seven in ten men (71%) and nearly two-thirds of women (64%) agree that the ability to maintain an erection during intercourse is one of the most important erection-related aspects to improve in order to achieve an ‘ideal’ sexual experience. 47 SH-04 SEXUAL MEDICINE IN MONGOLIA Nansalmaa Naidan Health Science University of Mongolia ADAM Urology and Andrology Clinic (Mongolia) Mongolia is one of Asian developing countries has about 2.7 population in big land 1mln 566 4600 Sq. km. Gender ratio is 49,6 : 50,4 male to female. Immigration from rural area to urbanization increased in last ten years and therefore, now in 218 people in 1 sq km and in contrast 0.4 people in some places.Fast grown urbanization brings many health issues including cardiovascular disease, obesity and metabolic syndromes causing from life style changes as well as many sexual disorders such as erectile dysfunction, sexual transmitted diseases and also counterfeit drugs. Since established Mongolian Society for Sexual Medicine in 2009, the first international meeting held about sexual medicine and ED with sponsorship APSSM. The Second meeting will be in November conjunction with Mongolian Urological association. We had following progress in sexual medicine. 1. The first initial androgenic study was completed in aging males in 2010-2011. Two following research studies are ongoing: 1).The effect of the human androgen receptor genes CAG and GGN repeat polymorphisms on hypogonadism and androgen level of Mongolians. 2). Determine the relation between the androgen receptor level and androgens level on hypogonadism rate among aging man. 2. Erectile dysfunction is available to diagnose and treat by PDF-5 blockers by Bayer Shering and Pfizer ED medicines are now available to use in Mongolia, on the request of MSSM. But still we have many fake medicines are selling on black market. 3. Testosterone replacement therapy the first introduced in 2011 Jan in testosterone undeconate (Nebido by Bayer Shering). 4. European and traditional medicine doctors collaborating in clinical research in male and female sexual dysfunction in some medicine. We have goals to increase the number of specialist and need to bring more attention to professionals and makers and sexual health problems related to both genders sexual health and life quality. - According to wrong information many young men have injected foreign body in their penis at home and come to hospital when have inflammation or laceration. -Sexual problems among women are still not solved well. It is related to cultural issues and do not have enough specialists for female sexual disorders except gynecologist. 48 SH-05 IS INDIA THE IMPOTENCE (ED) CAPITAL OF THE WORLD ? Sudhakar Krishnamurt Andromeda Andrology Center (India) Large scale demographic studies of sexual dysfunctions have not been conducted in India yet. However, we have deductive logical inferences that strongly suggest that India is the ED capital of the world in terms of sheer numbers. Here’s how: - Today, India already nearly has the world’s largest population. - Thanks to female feticide, infanticide, and homicide, India has more males than females. - This means that India nearly has the world’s largest population of men. - With the world's third most populous nation being far behind, this leaves only China and India to compete for the impotence crown. - India has more young men than China, which has more old men. - Therefore, India probably has the largest number of men in the sexually active age group. Even with prevalence rates pegged merely at the global average (10 % of below 40s, and 52 % of over 40s), India will have the largest absolute numbers of impotent men in the world. But there is evidence that India has a higher prevalence rate of ED than most other countries, e.g.: - India has a very high incidence of coronary heart disease (CHD) in young, sexually active men in their 30s, 40s and 50s. In one study conducted in Chandigarh, it was found that 65.4 % of men over 30 suffered some form of CHD ! - India has very high prevalence rates of hypertension, hypercholesterolemia and other hyperlipidemias. - Lastly, and importantly, it is already well known that India is the diabetes (most important cause of ED) capital of the world. And, with increasing urbanization (demographic experts predict that in another few decades, 80 to 90 % of India will live in and around its cities), co-morbid factors like sedentary lifestyles, bad diets, obesity, stress, poor quality of sexual relationships, cigarette smoking, excessive alcohol consumption, and drug abuse increase significantly, making matters even worse. 49 SH-06 SEXUAL MEDICINE: KOREA’S ASPECT IN ERECTILE DYSFUNCTION Nam Cheol Park Department of Urology, Pusan National University School of Medicine (Republic of Korea) Erectile dysfunction (ED) has become one of the major public-health challenges in Korea over the last decade. ED is a common male disability associated with increasing age, and has significant impacts on the quality of life and interpersonal well-being under the progressive circumstance to aging or aged society. Current ideas related with ED in Korean society also has been deeply influenced by rapid changes to western lifestyle, especially high fat diet as well as the peeling of the traditional conception. In addition, increase of specific medical illnesses such as cardiovascular disease, components of metabolic syndrome like diabetes mellitus, visceral obesity, hypertension and dyslipidemia, lower urinary tract symptoms and depression are inevitable causes to increase ED patients. In Korea, sildenafil was approved by KFDA on 1999, and has excellent effectiveness, simplicity, lack of serious safety concerns, and preferences of patients and physicians over previous therapeutic options, which followed by increasing the public awareness about ED and the number of patients seeking physicians for the treatment of ED. After these revolutions, oral pharmacotherapy with phosphodiesterase-5 (PDE-5) inhibitors are mostly preferred in the vast majority of ED patients. Other PDE-5 inhibitors were helpful to accommodate better for patient's needs and preferences with more advanced ® effective solution to provide wider range of choices. There are 6 PDE-5 inhibitors including udenafil (Zydena ), mirodenafil ® ® ® ® (Mvix ) and avanafil (Zepeed ) from Korean pharmaceutical companies as well as sildenafil (Viagra ), vardenafil (Levitra ) ® and tadalafil (Cialis ) from global pharmaceutical companies. Unfortunately, up to now, it is not fully studied about comparative results among 6 PDE-5 inhibitors and which agent is better or more adequate for any patient because of lack of data by head-to-head or cross-over clinical trials. Now we are just facing to phase II study of avanafil from global pharmaceutical company. Oral pharmacotherapy generally followed by self-injection pharmacotherapy, vacuum constriction device and penile prosthesis as second-line options for ED treatment according to the clinical setting and preference by patient and his partner. Among the original products from global manufacturers for these standard therapeutic options, Korean pharmaceutical companies have developed new drugs independently to enhance the male ® sexual function, such as topical anesthetics for premature ejaculation (SS cream ) in 1998, dry frozen powder for trimix ® ® ® (Standro ) in 2002 and three kinds of new oral PDE-5 inhibitors, udenafil (Zydena ), mirodenafil (Mvix ) and avanafil ® (Zepid ) in 2005, 2007 and 2011, respectively, under KFDA approval. Under situation of terminating the right of patent for sildenafil on 2012, Korean pharmaceutical companies are currently developing new preparations including new oro-dispersible agent with biofilm or mixed agents with selective serotonin reuptake agent. Other non-prescribed herbal medicines are still attractive to some ED patients and sex partners under the influence of oriental tradition. Results of recent researches also support scientific evidences for clinical availability of oriental herbal medicines for the treatment of ED, for examples Korean ginseng extract and KH-204 etc. In the past 3 decades, a lot of basic and clinical researches for the understanding of the physiology of erectile function brought a tremendous advance in the management of ED patients. Successful academic activities by basic researchers and clinicians working at major university research institutes and general hospitals as well as pharmaceutical companies have made the current Korean situation to be possible. Furthermore, ED is almostly conquered disease in modern medicine. Thus from now on, our efforts should be focused on the prevention of ED and the development of new therapeutic options for ED patient. In spite of delightful clinical setting and outcome, the choices by most Korean men for ED treatment still have limited by the traditional options, like as herbal medicine and various healthy foods, which results in extremely low chance to discuss his problems with physician, comparing with high attention about his sexual activity on a recent inquiry survey. Therefore, continuing education is mandatory to enhance the detection of partner issues as well as the patient understandings and communications related with ED. 50 SH-07 SEXUAL HEALTH IN TAIWAN Han-Sun Chiang Immediate Past President of APSSM The concept of sex as a part of health, sexual dysfunction is a part of disease in Taiwan could be gradually evoluted in the year of 1980. Before that, sex is taboo and could not be talked in public; sexual dysfunction was belong to some kind of general weakness and only treated by traditional medicine. A group of health education professor, psychiatrist, urologist, gynecologist and psychology counselor devoted to sex education and formed the society of sex education in the year of 1995. They promoted the sex education in the school and community, including sexuality and sexual development, fertility and contraception, prevention of sexual transmitted diseases etc. After that, the material of sex education enter into the curriculum and medium in Taiwanese society. Clinically, sexual dysfunction was only treated by some psychiatrist with sex therapy in the year before 1990. Penile prosthesis implantation was started then. The Taiwanese association of Andrology was founded in 1993, most of the members are urologist and subspeciaized in male sexual function or male infertility. Prof Lin and I had joined the APSIR (Asian-Pacific Society for Impotence Research) which was founded on Nov. 5-6, 1987. We organized the 3rd APSIR congress in Taipei on 1991. The management of male sexual dysfunction became very active after the era of PDE5 inhibitors. We also founded EDAC (Erectile Dysfunction Association Committee) in the Taiwanese Association of Andrology. The committee conducted collaboration research project, established the clinical guideline for the diagnosis and treatment of ED as well as promoted social education for the public awareness. In the mean time, there is also a male infertility study group founded in the Taiwanese Association of Andrology to conduct the male infertility investigations in Taiwan. The current status of sexual health in Taiwan is well developed and promoted. In Kaohsiung, a graduate institute of sexuality was established with master and Ph D courses. The major interests of sexual medicine are not only limited to the field of male erectile dysfunction. They covered the field of aging problems, female sexual dysfunction, sexual rehabilitation, premature ejaculation etc. The program of sexual transmitted diseases prevention also became a regular forum for the medical doctors. SL-01 PRIAPISM: NEW CONCEPT AND IMPROVED STRATEGY Tom F. Lue Department of Urology, University of California (United States) Better understanding of the mechanism of various types of priapisms has resulted in better understanding of priapism and improved management strategy. Ischemic priapism may be conceptualized as a compartment syndrome of the penis which leads to tissue ischemia and damage. The final common pathway seems to be paralysis of the intracavernous smooth muscle resulting in venous occulsion. While management of underlying co-morbid conditions (drugs, sickle cell disease, etc) may be of value in preventing recurrences there should be no delay in prompt therapy to relieve the priapism itself. As with any other ischemic condition, best results are obtained when ischemic priapism is managed quickly and effectively. Non-ischemic priapism is mostly due to traumatic rupture of the cavernous artery or its branches. In the majority of cases the venous channels remain open and the penis is partially erect. Non-ischemic priapism is not typically painful and need not be managed in an emergent fashion as tissue ischemia and damage do not typically occur. A variant of non-ischemic priapism is the hyperemic state after shunting procedure for ischemic priapism. Directed therapy for ischemic priapism should not be delayed. For priapism of less than 24-hour duration, evacuation of old blood and intracavernous injection of diluted alpha-adrenergic agent (e.g. phenylephrine) is the treatment of choice. In priapism of more than 24-hour duration, most cases require a shunting procedure to re-establish circulation of the corpora cavernosa. There are three types of shunting: cavernosum to glans, cavernosum to spongiosum and cavernosum to dorsal or saphenous vein. The easiest and most effective is T-shunt with or without tunneling. Non-ischemic priapism is not an emergency. Spontaneous resolution of non-ischemic priapism has been reported. By color Doppler, two types of ruptured artery can be identified: main cavernous artery or its branches. If management is desired, androgen ablation therapy is effective in managing the ruptured branches. In cases with ruptured main cavernous artery, angiographic embolization followed by androgen ablation may be needed. In long standing cases, surgical ligation can be considered in cases where angiography fails. The ruptured artery must form a rind-like pseudocapsule before surgery is contemplated. Stuttering priapism is a complication of a treated ischemic priapism. By virtually eliminating nocturnal erections, androgen ablation therapy can be used to prevent the recurring episodes. Low dose of type 5 phosphodiesterase inhibitors and 5 alpha reductase inhibitor have also been reported to be effective in some cases. 51 SL-03 HYPOACTIVE SEXUAL DESIRE DISORDER IS TREATABLE Tai Young Ahn Asan Medical Center and College of Medicine, University of Ulsan (Republic of Korea) Hypoactive sexual desire disorder (HSDD) is relatively common among women and causes considerable distress as well as interpersonal difficulties. Up to 10% of women in the USA suffer from female sexual dysfunction of which HSDD is the major subindication. Nevertheless, many women with HSDD remain untreated because they are reluctant to discuss sexual issues with their physicians and have low expectations concerning the prospects for help. HSDD may result from pathophysiological changes in excitatory and inhibitory neurotransmission. Thus, a hypofunctional excitation and/or a hyperfunctional inhibition are likely to be involved in HSDD by means of significant alteration in neurochemical and neuroanatomical brain systems. Flibanserin is in late stage clinical development for the treatment of HSDD in women. These data were first presented on November 16, 2009 at the congress of the European Society for Sexual Medicine in Lyon, France. The women receiving flibanserin reported that the average number of times they had “satisfying sexual events” rose from 2.8 to 4.5 times a month. Evaluation of the overall improvement of their condition and whether the benefit was meaningful to the women, showed a significantly higher rate of a meaningful benefit in the flibanserin-treated patient group versus the placebo group. The overall incidence of adverse events among women taking flibanserin was low, the majority of adverse events being mild to moderate and resolved during the treatment. The most commonly reported adverse events included dizziness, nausea, fatigue, somnolence and insomnia. This agent is known to work on the central nervous system, acting as both a 5-HT1A serotonin receptor agonist and a 5-HT2A serotonin receptor antagonist. Chronic treatment of flibanserin reduces 5-HT activity and enhances dopamine and norepinephrine activity in prefrontal cortex, which may act to increase the efficiency of informantion processing in critical pyramidal neurons linked to the symptoms of HSDD. 52 SL-04 CON- TREATMENT OF HYPOACTIVE SEX AND THE ED OBSTACLE George Lee Consultant Urological Surgeon Associate Professor of Surgery University of Malaya (Malaysia) Male hypoactive sexual desire disorder (HSDD) is believed to be a common sexual dysfunction that affects a significant male population. The majority of the researches done are on female HSDD while male oriented studies remain underreported and poorly understood and there is a paucity of standardized clinical data on male HSDD. McCarthy & Metz, 2007 has stated that contrary to the public perception of male sexuality as being natural and simple, male sexuality is multi-causal, multi-dimensional, and complex, with large individual, couple, cultural and value differences. The core issue is sexual secret, where the alpha male commonly stonewalls from his sexual partner. In descending order, they are a variant arousal pattern (deviant arousal is much less common), a preference for masturbatory sex rather than intimate couple sex, a history of poorly processed sex trauma; or a conflict about sexual orientation. At present, there is no generally accepted treatment for both female and male HSDD. Although bupropion, a drug with possible efficacy to treat HSDD are used, there are no standardized clinical data. Attempts to treat by using PDE-5 inhibitors and other medications have failed to address the most important underlying issue, which is sexual desire. Studies of efficacy of dehydroepiandroterone have been inconsistent. Long-term supraphysiological doses of testosterone have unclear implication. Male HSDD remains a stigmatized and underreported sexual dysfunction. Usually, the man denies the problem and avoids dealing with sexual secrets or fears. The need for a more conceptual, research, and clinical attention to this multi-causal and multi-dimensional problem is pivotal in addressing the issue. Clinically oriented approach to male HSSD should focus on assessment of both individual and couple factors. Male HSDD is the prime factor in non-sexual marriages and needs to be addressed in a comprehensive, couple psychosocial model of assessment, treatment and prevention of relapse. 53 SL-07 STUTTERING PRIAPISM, HOW TO MANAGE Doddy M. Soebadi Department of Urology, Airlangga University Hospital (Indonesia) Introduction: Priapism is defined as a persistent, uncontrollable penile erection continuing beyond or unrelated to sexual stimulation. When an erection lasts longer than 4 hours, it is considered priapism and warrants evaluation and possible treatment. Although the initial evaluation of both types of priapism is similar, the pathophysiology and intervention differ for each, thus necessitating proper diagnosis.New concepts in the field of priapism research suggest that priapism often results from altered vascular homeostatic actions in the penis and is associated with deficient erection control mechanisms on a molecular level. Material and Methods: Review of the literature that relates the pathways and clinical treatment that contribute to the development and treatment of priapism including stuttering priapism. Results: Ischemic priapism (“low flow”) is primarily a disorder of the venous outflow and/or stasis. Nonischemic (“high flow”) is a disorder of arterial inflow. An important consideration when distinguishing between the 2 types of priapism is the sequelae of fibrosis and erectile dysfunction more often associated with ischemic priapism. For diagnosis of ischemic priapism, emergent intervention is required with the predominant course to achieve smooth muscle constriction via corpora cavernosal aspiration / irrigation with concomitant use of a sympathomimetic agent. In the event that aspiration fails, surgical intervention may be required utilizing distal or proximal shunts. Nonischemic priapism is not a surgical emergency. Observation will result in spontaneous resolution in 60% of patients; for patients who require intervention, selective arterial embolization is the primary treatment modality. Conclusion: The goal of the management of a patient with recurrent (stuttering) priapism is prevention of future episodes while management of each episode should follow the specific treatment recommendations for ischemic priapism. Hormonal therapy for stuttering priapism has a contraceptive effect and interferes with normal sexual maturation. Therefore, these agents are contraindicated in persons (children) who have not completed their growth and sexual maturation and those trying to conceive. 54 SL-08 THE ROLE OF MAJOR PELVIC GANGLION IN THE NEURAL PATHWAY OF ELECTRICAL STIMULATION-INDUCED SEMINAL VESICAL PRESSURE INCREASE IN THE RAT Kuang-Kuo Chen, Luke S. Chang Department of Surgery, Taipei Veterans General Hospital, and Shu-Tien Urological Research Center, National Yang-Ming University (Taiwan) Purpose: Seminal vesicle contraction and the following increase of seminal vesical pressure (SVP) under sympathetic innervation occur during the emission phase of ejaculatory process. The lesser splanchnic nerve (LSN) is a presynaptic sympathetic nerve. Our previous studies have found that electrical stimulation (ES) of the major pelvic ganglion (MPG) or LSN may induce a significant increase of SVP in the rat. Cavernous nerve (CN) is a branch of MPG. Therefore, the aim of this study was to investigate the role of MPG in the neural pathway of ES-induced SVP increase in the rat Materials and methods: Male adult Sprague-Dawley rats were used. A PE50 tube was inserted into left and right seminal vesicle, respectively to simultaneously monitor the SVP on each side. The MPG and LSN were electrically stimulated, respectively. Then the right MPG was resected and LSN was stimulated. The left MPG was then also resected, and LSN was electrically stimulated again. In the other experiments, CN was also electrically stimulated. Then transection of CN, and stimulated the distal CN again. The amount of SVP increase was defined as the difference between peak SVP and resting SVP. Results: There was an equivalent amount of SVP increase at left and right side (60.3 ± 8.2 mmHg and 61.1 ± 6.3 mmHg, respectively, p=0.818) after ES of right MPG. A comparable amount of SVP increase at left and right side (56.4 ± 9.8 mmHg and 44.7 ± 8.5 mmHg, respectively, p=0.310) after ES of LSN was also noted. After transection of right MPG followed by ES of LSN, again there was a comparable amount of SVP increase at left and right side (55.5 ± 7.1 mmHg and 34.7 ± 3.3 mmHg, respectively, p=0.065). However, there was no change of SVP at each side after resection of bilateral MPG followed by ES of LSN. A significant increase of SVP was noted (9.7 ± 1.2 mmHg vs. 49.7 ± 6.3 mmHg, p=0.028) after ES of CN. After transection of CN, ES of distal CN was ineffective to induce a significant change of SVP. However, there was a significant increase of SVP from 2.2 ± 0.7 mmHg to 41.7 ± 7.5 mmHg after MPG stimulation. Conclusion: Electrical stimulation of the MPG and LSN may elicit a simultaneous significant equivalent amount of SVP increase on left and right seminal vesicle, respectively in the rat. Electrical stimulation of LSN may induce bilateral SVP increase even one side MPG is resected. However, this ES of LSN-induced bilateral SVP increase is eliminated after resection of bilateral MPG. Electrical stimulation of CN may also elicit a significant increase of SVP. Transection of CN may eliminate the ES-induced SVP increase. This implies that there may be a retrograde stimulatory transmission to MPG to induce a significant increase of SVP after ES of CN. All these results suggest that the MPG plays a major role in the neural pathway of ES of LSN and CN-induced SVP increase in the rat. 55 SL-09 ADT VS ART IN PROSTATE CANCER 1,2,3 Thomas I.S. Hwang 1 Shin Kong WHS Memorial Hospital (Taiwan) 2 School of Medicine, Fu-Jen Catholic University (Taiwan) 3 School of Medicine, Taipei Medical University (Taiwan) ADT for patients with prostate cancer In advanced prostate cancer the main systemic treatment is androgen suppression (AS), either by surgical castration (orchiectomy) or by long-term use of a luteinising-hormone releasing hormone agonist. Bilateral orchiectomy orchiectomy or luteinizing hormone-releasing hormone agonists are recommended initial androgen-deprivation treatments (ADTs). Nonsteroidal antiandrogen monotherapy merits discussion as an alternative; steroidal antiandrogen monotherapy should not be offered. Combined androgen blockade should be considered. In metastatic or progressive Pca, immediate versus symptom-onset institution of ADT results in a moderate decrease (17%) in relative risk (RR) for Pca-specific mortality, a moderate increase (15%) in RR for non-PCa-specific mortality, and no overall survival advantage. Therfore, early ADT initiation may not be recommended. This treatment is associated with a loss of bone-mineral density, but the risk of fracture after androgen-deprivation therapy has not been well studied. Of men surviving at least five years after diagnosis, 19.4 percent of those who received androgen-deprivation therapy had a fracture, as compared with 12.6 percent of those not receiving androgen-deprivation therapy (p < 0.001). There was a statistically significant relation between the number of doses of gonadotropin-releasing hormone received during the 12 months after diagnosis and the subsequent risk of fracture. Newly diagnosed prostate cancer patients who received ADT for at least 1 year were found to have a 20% higher risk of serious cardiovascular morbidity compared with similar men who did not receive ADT. ADT is associated with significantly increased cardiovascular morbidity in men with prostate cancer and may lower overall survival in men with low-risk disease. ART for patients with prostate cancer Testosterone therapy (TT) in alleviating symptoms of hypogonadism has been established. Despite these potential benefits of TT, physicians may be reluctant due to the long-standing fear of either inducing or stimulating prostate cancer. Lowering the serum testosterone level would lead to PCa regression, whereas increasing the serum testosterone level would stimulate PCa growth. Recent articles, however, suggest that “higher serum testosterone leads to increased PCa risk and invariably stimulates PCa growth” is without much scientific support. For example, some reports demonstrated that TT may safely be considered in patients with a history of successfully treated PCa. These data raise the attention that "may we treat the hypogonadism in men with prostate cancer ? " This idea was activated by Morgentaler et al, with a theory of saturation model-beyond a certain serum testosterone concentration, androgens have a limited ability to stimulate PCa growth, further increases in serum testosterone levels do not lead to further prostate stimulation because the binding capacity of the intraprostatic androgen receptors is saturated. Recently physicians and patients consider enthusiastically to use TT in patients with prostate cancer. However, few studies address this issue. Five series with a small combined sample size (n=74) have reported on the effect of TT after radical prostatectomy. Of the 74 patients reported overall, only 1 (1.4%) experienced biochemical recurrence after TT. Only one study reported on TT after low-dose brachytherapy with or without EBRT. Overall, 36 men received TT in this study. At the last follow-up, 74% of the patients had a PSA value < 0.1 ng/ml. In summary, the available literature indicated that TT is feasible after curative PCa therapy without jeopardizing cancer control in selected patients. However, according to all guidelines, TT is contraindicated in men with diagnosed clinical PCa. The recent European Association of Urology (EAU) guidelines(2009) state that TT may be considered in symptomatic hypogonadal men who were successfully treated for PCa, after a prudent interval. However, a prudent interval was not defined. The issue of TT after definitive PCa therapy is also addressed in the 2006 guidelines from the Endocrine Society. Due to the paucity of data and the lack of randomized trials, a general recommendation on this topic was not made. In the absence of large-scale studies with long-term follow-up, specific recommendations have not been made regarding the use of TT in men who appear to have been cured of PCa. Especially until more data from well-designed studies become available, clinicians must individually discuss the potential risks and benefits of TT before starting therapy. The patient needs to be unambiguously informed about the limited experience in this field, informed consents should be well documented, and a thorough follow-up also be guaranteed. According to the saturation model, TT may not exert a negative effect on the natural history of PCa in these men, yet traditionally TT has been contraindicated for these men. In conclusion, the long-term effect of exogenous testosterone administration on prostate carcinogenesis and the safety of TT in men with prostate cancer remain unknown. So, TT should not be used, or only highly selective to hypogonadal men with prostate cancer. 56 SL-11 TESTOSTERONE REPLACEMENT THERAPY IN PATIENTS WITH A DIAGNOSIS OF PROSTATE CANCER: FACT OR FICTION? Ajay Nehra Mayo Clinic College of Medicine Rochester, Minnesota (United States) Purpose: The hotly debated topic regarding TRT replacement in men with a diagnosis of prostate cancer is currently brewing. At the clinical level, most clinicians are reluctant that a surge of androgens may indeed enhance tumor progression while men who are hypogonadal or complaining of low libido insist and at times persist the clinician potentially render them to a eugonadal status should this be a patient complaint. While this remains a dilemma, several small studies have indeed shown that the addition of testosterone in patients with prostate cancer while enhancing and improving androgen levels do not appreciably change PSA levels. Methods: The objective of this presentation is to critically assess the changes in PSA and testosterone levels in patients with a known diagnosis of prostate cancer on testosterone replacement therapy. The pathophysiology of androgens within the prostate and their overall role in patients with prostate cancer will be discussed and presented. Outcome measures as demonstrated by changes in PSA, and tumor progression if any will be discussed as well. Results: While the studies are truly limited, a number of retrospective and prospective studies being performed will be presented. These studies certainly have looked at changes in PSA values over 36 months following a radical prostatectomy, and the entire dilemma of TRT replacement would certainly require long-term studies. Summary: TRT replacement in patients with a known diagnosis of prostate cancer remains a challenge, both for the clinician and for the patient. Nonetheless there are numerous studies that have shown an improvement in the hypogonadal state without significant changes in PSA levels. Nonetheless as per clinical guidelines the patient needs to be urged caution and should sign a consent form, prior to initiating therapy. 57 SL-12 STUDIES ON POSSIBLE MOLECULAR BIOLOGICAL MECHANISM OF LOH Zhong Cheng Xin Andrology Center, Peking University First Hospital, Peking University (China) Androgen deficiency is believed to contribute to late-onset hypogonadism (LOH) in aged males; however, the mechanism remains unclear. Androgen is mainly produced by Leydig cells in males. Many enzymes such as StAR protein, cytochromeP450scc and 3β-hydroxysteroid dehydrogenase (3β-HSD) are involved in the process of testosterone production. Among these, the functional form of StAR and P450scc are localized in the mitochondrial membrane, their function is closely related to mitochondria. Furthermore, the StAR protein is the most important and rate-limiting enzyme of steroid biosynthesis in the testis. In order to study the possible molecular mechanism of late-onset hypogonadism (LOH), the morphological changes and the differential of gene expression in testes of and young and aged humans or rats were investigated using HE staining, immunohistochemistry, electron microscopy and molecular biology techniques. We found that serum testosterone level was decreased and autophagic activity was reduced in Leydig cells in aged human and rats testis. In primary cultured Leydig cells from young and aged rats, treatment with wortmannin, an inhibitor for autophagy, led to inhibition of luteinizing hormone (LH)-stimulated steroidogenic acute regulatory (StAR) protein expression and decreased testosterone production In contrast, treatment with Rapamycin, an autophagy activator, resulted in enhancement of LH-stimulated testosterone production in Leydig cells from aged rats, but not in cells from young rats. The intracellular reactive oxygen species (ROS) levels were increased in both young and aged Leydig cells treated with wortmannin, and decreased only in aged Leydig cells treated with Rapamycin. Furthermore, we found that the increased level of ROS induced by H2O2 could inhibition LH-stimulated testosterone production in aged Leydig cells. These results suggested that autophagic deficiency might play an important role in Leydig cell dysfunction in aged rat Leydig cells which may influenced by intracellular ROS accumulation. Further study is recommended. 58 SL-13 CRITICAL ROLE OF MIND OVER BODY IN THE MANAGEMENT OF EJD AND ED Ganesan Adaikan Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University Hospital, National University of Singapore (Singapore) Excluding the mixed etiology, the number of erectile dysfunction (ED) patients suffering from pure psychogenic causes appears to be around 10-20%. Generally, psychogenic ED tends to be more of an acute onset as compared to the insidious and chronic nature of organic ED. Indeed the reasons for such an abrupt, intermittent or situational nature of psychogenic ED can easily be identified during questionnaire evaluation and in-depth discussion with the patient. The triggers for psychogenic causes can be anything from ridicule by the partner of his inability to achieve an erection, interpersonal relationship issues dampening his libido and erection or a major life event. Ejaculatory dysfunctions (EJD) may be clinically classified according to the presence or absence of the sensation of orgasm. Orgasmic ejaculatory disorders include premature, retrograde and retarded ejaculations. Anorgasmic ejaculatory disorders are less common and comprise primary and secondary anejaculations. Premature ejaculation is by far the commonest; Kinsey had stated that it affected as many as 75% of all men. While the organic factors include impairment of sympathetic nervous system, local sensory disturbances, diabetes, arteriosclerosis, polyneuritis etc. there appears to be a major role still for the psychogenic component in dictating the pathophysiology of EJD. Some of the causes for delayed, retarded or absent ejaculation include marital disharmony and relationship issues, alcoholism and drug abuse, neurological and endocrine illnesses, diabetes, cancer, prostatic problems and surgical trauma High noradrenaline levels and sympathetic nervous system activation can block the arousal needed for orgasm. Management includes psychosexual counseling and behavioral therapy, drug treatment, use of vibrator or electroejaculation. Mechanical obstructions to the ejaculatory pathway may need surgical intervention. However, a good percentage of men suffering from anejaculation seem to have the psychogenic element as the main contributing factor which needs addressing. Why some men are more prone to psychogenic causes of ED or EJD than others? Is this an in-born phenomenon? Is there a genetic code for this or is this a Freudian childhood developmental issue? Also the degree of psychogenic factor seems to vary among different individuals. Some patients are more severely affected and are resistant or poor responders to currently existing pharmacotherapy. Others with milder form of psychogenic problems appear to recover with a simple counseling. The brain is the initiator of desire, arousal, erectile and ejaculatory pathways. Therefore, focused interest in exploring and delineating precisely the central pathway for psychogenic upheaval may well be the basis for future pharmacotherapy for these conditions. Such efforts would also lead to our understanding of the “placebo effect” and potential treatments for similar psychosomatic illnesses. 59 SL-14 A NEW PHYSIOLOGIC STUDY TOOL IN ERECTILE FUNCTION 1,2 Chen Zhao , Jong Kwan Park 1,2 1 Department of Urology, Medical School, and Institute for Medical Sciences (Republic of Korea) 2 National University, and Research Institute and CTC for Medical Device of Chonbuk (Republic of Korea) Purpose: To date, hemodynamics and metabolic changes in the penis in vitro have been evaluated using the traditional penile strip chamber model, which allows measurement of only mechanical responses. To solve the problems, we have devised a new in vitro penile perfusion model, which allows the measurement of changes in intracavernosum pressure (ICP), tension, and cyclic nucleotides in penile tissue in a one-step procedure. Materials and methods: Experiments were performed on penile corpus cavernosum smooth muscle from male New Zealand White rabbits which were pre-contracted with L-phenylephrine (PhE, 10 μM). We investigated the role of NO-cGMP pathway in both systems activated by Ach or EFS. We measured cGMP in the penile corpus cavernosum smooth muscle in both systems and perfusates in the penile perfusion model. Results: In both systems, Ach relaxed the PhE-precontracted penile corpus cavernosum smooth muscle in a concentration-dependent manner. Pretreatment with atropine, Nw nitro-L-arginine-methyl ester (L-NAME), and 1H-[1,2,4]oxadiazolo[4,3-a]quinoxalin-1-one (ODQ) blocked the Ach-induced decrease in the tension in both models and ICP in penile perfusion model. Ach increased cGMP levels in the perfusate of penile perfusion model and the changes were attenuated by tetrodotoxin (TTX), atropine, L-NAME and ODQ. In the penile strip chamber model, EFS decreased the tension in a frequency-dependent manner and the changes were attenuated by TTX, atropine, L-NAME, and ODQ. In the penile perfusion model, we discovered an extraordinary phenomenon; specifically, the tracing elicited by EFS presented 3 distinct phases. Phase I was abolished by L-NAME. Phase II was decreased by eserine and Guan, but increased by L-NAME. Phase III was abolished by atropine, but enhanced by eserine and Guan. TTX diminished all three phases Conclusion: The results indicated that the responses of penile strip and perfused penile tissue to Ach and EFS were very similar in both models in terms of tension and cGMP levels. Furthermore, the new model has more advantages over the classical penile strip chamber model in measuring intracavernosum metabolic changes and ICP without interruption of the procedure. EFS stimulated adrenergic, cholinergic, and NANC neuroeffector systems simultaneously. 60 SL-15 FRACTURE OF THE PENIS Apichat Kongkanand Bumrungrad International Hospital, Chulalongkorn Hospital Department of Surgery (Thailand) Presentation of the men with history of penile fracture who came in with pain and eggplant deformity, dark ecchymosis and 2 cases of 3 days duration and 6 weeks duration. The repair was complete and success without problem including the one who came in late because he was in remote area and unable to find the suitable treatment. The review of treatment were noted in conclusion including those with immediate repair and those who came in late. Late repair or those who failed to receive the treatment will face the severe bending, thickening of the penile shaft and erectile dysfunction. The diagnosis was made by the patient and mostly had intercourse in reverse missionary position. The review showed that in Arab countries there are many people who had treatments after the manipulation and some has fracture while lying in bed and turning. The investigation was mainly by examination and ultrasound of the penile shaft, MRI was best to show the diagnosis but mostly no necessary test was carried out before surgery. The injection of Methyline Blue during the surgery could help locating the fracture in some cases. For those who has urethral injury which is approximately 5% would need retrograde urethrogram or cystoscopy ,bilateral penile shaft fracture happened in 10% of the cases. 61 SL-16 ACCEPTING ED: THE CHALLENGES AND OBSTACLES AHEAD George Lee Consultant Urological Surgeon Associate Professor of Surgery University of Malaya (Malaysia) Erectile dysfunction (ED) is commonly estimated to affect more 50% of men aged between 40 and 70 years old. Despite the availability of efficacious medical treatment of phosphodiesterase 5 Inhibitors (PDE-I) for more than a decade, clinicians are still faced with obstacles and challenges in the treatment of men with ED. In order to assess the ED patients and their partners treatment seeking behavior, ACCEPT studying (Attitude, Concerns and Constraints towards ED and PDE5-I Treatment) was conducted to have in-depth analysis of attitudes towards ED, concerns and constraints towards PDE5-I and its counterfeits and non mainstream traditional therapy. More than three thousand men and women participants were recruited from non-urological clinics in a tertiary urban Hospital to complete self-administered questionnaires. Participants were asked about they views on ED and its associations with other medical conditions and safety issues associated with the use of PDE5-I. In addition, the participants also expressed their views on the utilization of counterfeit medications and non-mainstream traditional therapy as the treatment options for ED. The differences of such views were subsequently analyzed according to the participants’ educational background, monthly income, gender, age and race in order to further understand the variations of views. Such study may have the potential to verify general perceptions of ED as a medical condition and the associated taboo. The analysis of the attitudes towards treatment choices of PDE5-I, counterfeit or traditional therapies may also play a role to address attitudes, concerns and constraints deriving the decision making process in the treatment of Erectile Dysfunction. 62 SL-17 UPDATE ON FEMALE SEXUAL FUNCTION AND DYSFUNCTION Kwang Sung Park Chonnam National University Hospital, Sexual Medicine Research Center, Chonnam National University (Korean) Female sexual arousal results from a complex series of psycho-neuro-vascular events. Various sexual stimulations lead to central nervous system activation, which results in engorgement of genital structure and vaginal lubrication. Brain function associated with sexual arousal and response can be elucidated by functional brain imaging technique. The fMRI study for the investigation of cerebral correlates of the sexual arousal or orgasm in female is very informative and promising, even though so far a few clinical studies have been reported in premenopausal or postmenopausal women. Female sexuality is an important women’s health issue. It has been reported that 30% to 50% of women have some kind of sexual dysfunction. Female sexual dysfunction (FSD) is characterized by decreased sexual desire, decreased sexual a rousal, difficulty in achieving orgasm, and painful sexual intercourse. The etiology of FSD is often multifactorial including organic causes and psychological factors. FSD is a common complication after pelvic surgery including hysterectomy. FSD in urinary incontinence is also frequent. There have been limited investigations of female sexual dysfunction, however, and few developments of medical therapie s. Although several medications have been tried, such as estrogen, transdermal testosterone, prostaglandins, apomorphi ne, and phosphodiesterase type 5 inhibitors, and melanocortin agonists, however, no medications are currently approved for use in female sexual dysfunction. Alternative medicines such as Korean red ginseng (KRG) and ginkgo biloba have al so been tried to ameliorate menopausal symptoms and to improve sexual function in women. 63 SL-18 REAL-WORLD IMPERATIVE OF OUTCOMES RESEARCH Allen D. Seftel Division of Urology Cooper University Hospital (United States) Domains of Outcomes Research Comparative Effectiveness of Clinical Strategies in Real world Settings Patients, clinicians, and policy makers face immense gaps in knowledge that impede informed decision making. This domain is concerned with filling those gaps by determining which strategies are most effective— whether overall, for selected patients or populations, or when delivered by particular types of hospitals and practitioners. Perspective of the Patient The second domain involves generating knowledge that promotes the alignment of health care decisions with patient preferences, values, and goals. System Performance The third domain focuses on health system performance, with emphasis on optimally implementing strategies to prevent, diagnose, and treat disease; eliminating waste and ensuring equity in access and care;and achieving optimal return on health care investments. Types of Investigation Within Outcomes Research Within the 3 domains, 3 overlapping types of investigation are conducted: discovery, application, and surveillance. Future of Outcomes Research Outcomes research faces 3 critical challenges. The first is to build partnerships with those who will use the knowledge that the investigations yield. The second challenge is to produce studies that are relevant, timely, and methodologically rigorous by advancing methods and study design and expanding the number of capable investigators within the outcomes research community. Third, the information-sharing infrastructure and technological tools must be improved to support the conduct of high-quality research through better use of existing data and more efficient methods of collecting and analyzing new data. Existing data, including electronic health record data that protect patient privacy, should be made widely available to expand research capacity and facilitate independent validation of findings. 64 SL-20 MODIFIED PLICATION OF THE TUNICA ALBUGINEA IN TREATING CONGENITAL PENILE CURVATURE Ju-Ton Hsieh National Taiwan University Hospital (Taiwan) Technique: After degloved the penis, artificial erection was induced by normal saline infusion. Only minimal dissection of the neurovascular bundle was needed where the plication was planned. Allis clamp was used to grasp the underlying tunica albuginea. We used two interrupted U-shaped sutures with 2-zero polyglactin underneath the Allis clamp to create bump. Penile torsion is a three dimensional anomaly. We delineated a parabolic curve as a counter direction to the torsion after artificial erection was induced. The Allis clamp was applied perpendicular to the parabolic curve on the tunica albuginea. When patient has penile torsion with curvature, we need to correct the torsion first to make the three- dimensional anomaly into a two-dimensional deformity, and then correcting the remaining curvature. From January 1999 to July 2005, 114 consecutive patients including 103 penile curvature and 11 complex type of curvature corrected with modified corporeal plication technique were retrospectively reviewed. The long-term outcome and patient satisfaction were assessed by a post hoc questionnaire interview. Among the 114 patients, complete straightness of the penis was achieved in 65 (57%) patients, and 33 (29%) patients reported a 15-degree or less residual or recurrent curvature at 6months postoperatively. Although 32 (28%) patients experienced suture failure (median time: 38.5 d), only half of them had a residual or recurrent curvature greater than 15 degrees. Younger patients ( < 24 yr) had a higher chance of suture failure than elder patients ( p = 0.03). Among the 103 patients completing the questionnaire, no palpable suture knots, suture granuloma, erectile discomfort, or erectile dysfunction was reported (median follow-up time: 41.5 months). Eighty-three (81.5%) patients were either very or moderately satisfied with the surgical outcome. In conclusions, the modified technique using double, interrupted, U-shaped sutures and absorbable suture material is a simple and effective method for treating congenital penile curvature. Suture-related complications rarely happen. 65 SL-21 MORNING ERECTION /SLEEP-RELATED ERECTION IS TRUE SIGN OF ERECTILE FUNCTION AND EXACTLY OF THE SYMBOL OF MALENESS Yoshiaki Kumamoto Japanese Institute of Clinical Andrology (Japan) Recently, so-called ED diagnosed by IIEF-5 Questionnaire is regarding as early sign of cardio-vascular disease. And then, such ED would be caused almost by aging decrease of serum testosterone. Furthermore, the low serum testosterone is inducing the shortening of male longevity. So that, these erectile dysfunction are now becoming of big clinical problem in the field of men’s health medicine.However to do diagnose the erectile function by IIEF-5 Questionnaire depending upon Caucasian standard has several problems in clinical use on Asia country.There are many sexless males among middle and high aged men in Asian countries.Moreover, even in Westerner who are usually thought to have sexual intercourse in routine life, some aged male also become to be sexless in their personal reason. Then, for evaluation of erectile function as sign of endothelial function disorder, we need another checking point, instead of IIEF-5 Questionnaire in sexless male. We have the sleep-related erection/morning erection as physiological back ground of erectile function. That can be claimed to be the fundamental physiological sign of maleness. That is surely recognized from fetal stage, if he is the man. And also Morning erection (ME) is the last sleep-related erection (SRE) at awaking time in morning. Then, SRE&ME are the involuntary erection, depending upon on serum testosterone. I would like to recommend the data of sleep related erection to use as true evaluation of personal erectile function for middle～elderly sexless Asian male and old male Westerner without sexual activity with female partner.Then erectile finding, depending upon serum testosterone, is becoming to be very important as the clinical sign of Men’s Health. Then, we need the exact judgment of male erectile function for men’s health medicine. Recently, low testosterone surely related the short life span in male population. SRE&ME is the fundamental sexual function of maleness, depending serum testosterone. Then correlating to aging decreasing change of serum testosterone by aging, function of SRE/ME will decreasing in linking together with such changing of that serum testosterone level.Total SRE time % in whole sleeping time is declining, with remarkably linked to the aging decrease of serum free testosterone. And maximum enlargement of penile circumstance during SRE in REM-sleeping time and furthermore recognizing rate of morning erection by himself, decreased also connected with such an aging decline of serum free testosterone. 66 ET-01 SCIENCE OF TESTOSTERONE FROM BASIC TO CLINIC Tai-Young Ahn Asan Medical Center and College of Medicine, University of Ulsan (Republic of Korea) Clinicians may be interested in using testosterone to treatment with some degree of androgen deficiency who present with suggestive symptoms, osteoporosis, sexual dysfunction, and poor quality of life. However, more widespread use raises concern about the undesirable cardiovascular consequences of testosterone administration. It has been reported that testosterone injection has a relieving effect on patient with angina pectoris and is beneficial to men with coronary artery disease or congestive heart failure. This suggests that testosterone may have an effect on vascular function. Androgen receptors (AR) have been identified in vascular cells nearly 20 years ago, and later research has shown that these receptors mediate a variety of actions of androgens in endothelial and smooth muscle cells. Endothelial cells are key regulators of cardiovascular function. Deranged production of vasodilating agents and enzymes that control coagulation and fibrinolysis are some of the main consequences of endothelial dysfunction, and play a central role in the phenomena that lead to vascular disease. Although the classical pathway of androgen action involves steroid binding to the AR, there are now considerable evidence for rapid, non-genomic effect of steroids including androgens. Non-genomic effects of androgen usually involve the rapid induction of conventional second-messenger signal transduction pathways, such as increases in cytosolic calcium and activation of protein kinase A (PKA), protein kinase C (PKC), and mitogen activated protein kinase (MAPK), leading to diverse cellular effects which includes smooth muscle relaxation. Also, in addition to the routine upregulation of tissue factor pathway inhibitor (TFPI) level through the AR, testosterone may upregulate TFPI level at least in part by activating the MAPK cascade and thus prevent thrombosis development in men. 67 ET-02 TESTOSTERONE AND SEXUAL DESIRE Kew-Kim Chew Keogh Institute for Medical Research (Australia) Purpose: This presentation examines the role of testosterone in sexual desire and the management of low sexual desire in men and women. Materials and methods: Published literature relevant to sexual desire and the physiological functions of testosterone was reviewed. Based on pertinent research on endogeneous blood testosterone levels, therapeutic testosterone deprivation and testosterone therapy for hypogonadism, the pharmacological actions of testosterone and the role of testosterone in sexual desire were collated. Results: Testosterone influences sexual desire through the androgen receptors at multiple sites and through its active metabolites from 5α-reduction and aromatization. Low blood testosterone levels in men are associated with decreased sexual desire, and the interaction between testosterone and sexual desire is bi-directional with both entities being affected by similar socio-demographic, cultural and clinical factors. The role of oestrogen in male sexual function is yet to be clarified. It is possible that oestradiol, from aromatization of testosterone, or the oestradiol / testosterone ratio contributes to sexual dysfunctions in men. Sexual functions, including sexual desire, are influenced by age and age-related factors. Many of the age-related risk factors also influence sexual functions regardless of age. However, testosterone therapy improves sexual functions in hypogonadal but not in eugonadal men. In women, higher endogeneous blood testosterone levels and testosterone therapy after oophorectomy are associated with increased sexual desire. The increased testosterone level at ovulation probably enhances sexual behavior at mid-cycle. However, there is minimal or no correlation between testosterone levels and sexual desire in women. In the management of low sexual desire in both men and women, all contributory factors require due attention. The impact of hormonal factors is unclear and the benefits of hormone therapy uncertain. When testosterone supplementation is considered, appropriate surveillance for possible adverse side-effects is mandatory Conclusion: Testosterone is one of the many factors influencing sexual desire in men and women. Testosterone therapy should be initiated only for confirmed indications in accordance with current evidence-based good clinical practice guidelines. 68 ET-03 TESTOSTERONE DEFICIENCY SYNDROME Mikio Namiki, Eitetsu Koh, Kazuyoshi Shigehara, Kazuhiro Sugimoto, Yuji Maeda, Hiroyuki Konaka Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science (Japan) Purpose: Testosterone deficiency syndrome (TDS) or late-onset hypogonadism (LOH) is the clinical and biochemical syndrome associated with advancing age and characterized by typical symptoms and a deficiency in serum testosterone. It may result in significant detriment in the quality of life and adversely affect the function of multiple organ systems. The reason why so many symptoms or signs appear in TDS is that there are many target organs of androgens. Therefore, it may be reasonable to treat TDS with androgen replacement therapy (ART). However, there is little evidence of the effectiveness of ART for most symptoms and signs due to TDS. We conducted a clinical trial to examine the effectiveness of ART for the treatment of TDS. Materials and methods: The eligibility criterion for ART is a serum free testosterone level of less than 11.8 pg/ml. Men with serum free testosterone levels of less than 11.8 pg/ml were randomly divided into two groups: the ART group and the observation group. After 1 year, several signs and symptoms related to TDS were compared. Results: 1680 persons were recruited in the first screening and 335 participants who fulfilled the eligibility criterion were enrolled in the randomized clinical trial. The 335 participants were randomly assigned to the ART group or the observation group. Although 51 out of 169 participants in the ART group and 28 of the 166 participants in the observation group did not complete the treatment, the data of all 335 participants was included in ITT analysis. In regard to QOL evaluated using SF-36, the ART group showed statistically significant improvement in the domain of role physical and a tendency toward improvement in role emotional. The BPH patients receiving ART showed significant improvement in voiding function evaluated by uroflowmetry as well as IPSS. Severe ED patients receiving ART showed statistically significant improvement of IIEF5. The ART group demonstrated a statistically significant decrease in waist circumstance and a significant increase of muscle volume, although increase of the grasping power of hand by ART was not demonstrated in this study. ART also induced a tendency to decrease the percentage of body fat. Hemoglobin and RBC were increased by ART. However, only a few participants had to halt ART treatment due to polycythemia. The ART group showed statistically significant decrease in TG, whereas the values of total cholesterol and HD-cholesterol were not different between the two groups. Unfortunately, the ART group showed no improvement in HbA1c and BS. Although ART was stopped due to an increase of PSA levels in some cases, there was no need for a prostate biopsy. Conclusion: Our clinical trial showed that ART for aging male with hypogonadism may be effective for promoting active aging with high QOL in aging male and that the results of our study may give important information for future studies in this field. We hope that ART will promote active aging with high QOL in the second stage of life. 69 ET-04 TESTOSTERONE AND PROSTATE Allen D. Seftel Division of Urology Cooper University Hospital (United States) Recent data suggest a delicate balance between testosterone (T), DHT and prostatic homeostasis. The USA FDA observed that a reduction in prostate- cancer risk with finasteride and dutasteride (5-alpha reductase inhibitors, 5-ARI) was limited to tumors with a modified Gleason score of 6 or lower. However, an absolute increase of 0.5% in the incidence of tumors with modified Gleason scores of 8 to 10 (relative risk, 2.06; 95% confidence interval [CI], 1.13 to 3.75) was observed with dutasteride treatment. This increase is similar to the absolute increase of 0.7% in the incidence of such tumors observed with finasteride treatment (relative risk, 1.70; 95% CI, 1.23 to 2.34). The conclusion drawn by the advisory committee in December 2010 was that finasteride and dutasteride do not have a favorable risk– benefit profile for the proposed use of chemoprevention of prostate cancer in healthy men. The FDA agrees with this assessment. The effects of finasteride or dutasteride on the incidence of metastatic prostate cancer and prostate-cancer– specific morbidity and 1 mortality have not been evaluated. Further, the FDA has now proposed a label change for these medications. Propecia (finasteride) 1 mg tablet Detailed View: Safety Labeling Changes Approved By FDA Center for Drug Evaluation and Research (CDER) March 2010, March 2011 and June 2011 PRECAUTIONS Increased Risk of High-Grade Prostate 2 Cancer with 5-Alpha Reductase Inhibitors In a recent review looking at 5 alpha-reductase inhibotor therapy, the potential persistent side effects, and the possible mechanisms responsible for these undesirable effects. Erectile dysfunction and diminished libido are reported by a subset 3 of men, raising the possibility of a causal relationship. Male aging is accompanied by hypogonadism and worsening LUTS/BPH. The hypogondal state should lead to diminution in LUTS/BPH symptoms. To understand these paradoxical clinical effects, we used a castrate rat model examining contractility and mRNA expression. Total myosin immunostaining was essentially unchanged, though the glandular cells changed morphologically. Castration significantly decreased KCl and phenylephrine (PE)- induced prostate strip contraction in a dose-dependent manner. Alpha receptor subtypes 1a and 1b significantly increased by 2-fold. nNOS decreased 5-fold while eNOS increased 2-fold. ROKβ decreased 2-fold while ROKα showed no change. PDE5 was reduced 3.3-fold. TGFβ1 increased 4-fold. Competitive RT-PCR of the control prostate displayed around 50% SMA and 50% SMB, 85% SM1 and 15% SM2, 70%LC17a and 30%LC17b myosin isoforms. After castration, SMB, SM1 and LC17b increased by 20%, 15% and 5%, respectively. Total myosin, non-muscle myosin and myocardin significantly decreased 2-fold, 5-fold and 3-fold, respectively. Castration increases prostate alpha 1a and 1b mRNA expression, possibly 4 accounting for LUTS symptoms seen in the aging male faced with hypogonadism. 1. Theoret MR, Ning YM, Zhang JJ, Justice R, Keegan P, Pazdur R. The risks and benefits of 5α-reductase inhibitors for prostate-cancer prevention. N Engl J Med. 2011 Jul 14;365(2):97-9. Epub 2011 Jun 15. 2. http://www.fda.gov/Safety/MedWatch/SafetyInformation/ucm208701.htm 3. . Increased Alpha 1a And 1b Expression In The Castrated Rat Prostate 1 1 1 2 Allen D Seftel , Michael DiSanto , Xinhua Zhang , Rani Sellers 1 2 Cooper University Hospital, Camden, NJ; Albert Einstein College of Medicine, Bronx, Mid Atlantic Section AUA meeting, abstract p19, Nov 3 , 2011, Orlando, FL 4. Traish AM, Hassani J, Guay AT, Zitzmann M, Hansen ML. Adverse side effects of 5α-reductase inhibitors therapy: persistent diminished libido and erectile dysfunction and depression in a subset of patients. J Sex Med. 2011 Mar;8(3):872-84. doi: 10.1111/j.1743-6109.2010.02157.x. Epub 2010 Dec 22. 70 ET-05 METABOLIC MEMORY AND DIABETIC NEUROVASCULAR COMPLICATIONS Tom F Lue Department of Urology, University of California (United States) According to the 2011 US National Diabetic Fact Sheet (released Jan 26, 2011), 25.8 million children and adults in the United States—8.3% of the population—have diabetes In Asia, the prevalence of diabetes has increased rapidly in recent decades. In 2007, more than 110 million individuals in Asia were living with diabetes (Chan et al, 2009). In US, diabetes is the leading cause of new cases of blindness among adults aged 20–74 years as well as the leading cause of renal failure. About 60% to 70% of people with diabetes have mild to severe forms of nervous system damage and more than 60% of nontraumatic lower-limb amputations occur in people with diabetes. Despite tremendous advancements in the understanding and management of diabetes, neurovascular complications continue to occur in many patients even years after the diabetes is well controlled. We hypothesize that the missing link is a lack of understanding of the role of vascular stem cells (VSCs) in microvascular diseases. We strongly believe that elucidation of the mechanism of angiopathy involving the endothelium and basement membrane is a prerequisite for the prevention and/or reversal of diabetic neurovascular complications. We have developed tools such as in vitro angiogenesis model and an in vitro neurite growth model to study the mechanisms. We have also established an “EdU-retaining cell” animal model to examine the effect of diabetes on VSCs and the potential of transplantation of VSCs to mitigate the progression of diabetic neurovascular complications. 71 ET-06 ED, VASCULAR DISEASE AND METABOLIC SYNDROME Jae-Seung Paick Division of Urology, Seoul National University Hospital (Republic of Korea) Introduction: Erectile dysfunction (ED) is usually considered to be a condition of vascular origin. The risk factors for cardiovascular (CV) disease and ED are similar. Most patients with ED have at least one significant CV risk factor such as hypertension, smoking, lipid abnormalities, diabetes, alcohol, physical inactivity, and metabolic syndrome (MS). MS is usually characterized by obesity, hyperlipidemia, impaired glucose tolerance, hypertension, and insulin resistance. Recent studies show the increasing evidence of the association between the severity of ED and the inflammatory reaction or endothelial dysfunction. This review shows an overview of basic, clinical research data in the field of ED by a systemic review using the keywords of erectile dysfunction, endothelial dysfunction, and metabolic syndrome in the Pubmed database. ED and endothelial dysfunction: Endothelial dysfunction seems to be a main pathophysiolgic mechanism of ED and CV disease. Vasodilation in penile arteries is largely mediated by nitric oxide. Because of the structural characteristics of the small diameter of cavernosal artery and the relatively high content of endothelium and smooth muscle, artery size hypothesis and endothelial dysfunction including the occurrence of atherosclerosis have been used to explain how ED acts as a silent marker of other CV diseases. Furthermore, inflammatory response and oxidative stress may have an essential role of the development of atherosclerosis. Some studies have been shown some evidence of the association between erectile and endothelial dysfunction by showing change of some biomarkers such as endothelin-1, asymmetric dimethylarginine, circulating endothelial progenitor cells, C-type natriuretic peptide, hsCRP, fibrinogen, vWF, IL-1β, IL-6 and adhesion molecules. Recently, the importance of both the increase of cavernous muscle contraction related to Rho kinase pathway and the decrease of cavernous muscle volume is being emphasized in the analysis of the pathophysiologic mechanism of ED, because the severity and reversibility of ED seem to be related to each other in a time-dependent manner. ED and MS: ED seems to be highly prevalent in the patients with MS. Coexistence of ED and MS is notable and the positive correlation between the increase of the components of MS and the presence of organic ED has been established. MS is also known to be associated with pro-inflammatory markers and endothelial dysfunction. Reversal of ED: Recently, risk evaluation for CV diseases is being emphasized for management of ED. Although phosphodiesterase-5 inhibitors have positive effects for vascular function, a multidisciplinary approach is also important for CV risk reduction therapy including improved glycemic control, body weight loss or daily moderate exercise. Several studies have evaluated the link between testosterone deficiency and the development of CV diseases, however, no one yet knows that testosterone replacement therapy really reduces CV diseases. Conclusion: ED is highly associated with the presence of vascular endothelial dysfunction and MS. Urologists should be aware of the potential benefit of not only medication therapy but also CV risk reduction therapy in the management of patients with ED. 72 ET-07 SCREENING FOR METABOLIC SYNDROME IN MEN WITH ERECTILE DYSFUNCTION 1 Bang-Ping Jiann , Yung-Jui Huang 2 1 Department of Medical Education and ResearchKaohsiung Veterans General Hospital (Taiwan) 2 Graduate School of Human Sexuality, Shu-Te University (Taiwan) Purpose: Erectile dysfunction (ED) is seen as a precursor of vascular disorders and metabolic syndrome (MetS) is associated with cardiovascular diseases. We assess the prevalence of MetS in men with ED. Methods and Materials: Male subjects presenting to urological outpatient clinics with ED were screened for MetS from Dec. 2010 to Jul 2011. Blood sampling for determining fasting glucose (FG), triglycerides (TG), total cholesterol, high-density lipoprotein-cholesterol (HDL-C), low-density lipoprotein-cholesterol (LDL-C) and total testosterone (TT) was drawn between 0800-1100 am on fasting state. Waist circumference and blood pressure was checked consecutively twice by nurses. Criteria for MetS should meet at least three of the following five conditions: waist circumference ≧90 cm, BP ≧ 130/80 mmHg or use of medication for HT, HDL-C < 40 mg/dl, FG ≧100 mg/dl or use of medication for diabetes, and TG ≧150 mg/dl. Erectile function was assessed by the Sexual Health Inventory for Men (SHIM). Participants has to sign the 2 written inform consent to join the study. Student’s t test, Kruskal Wallis test, χ test and linear regression were used for statistical analysis and the significant was set for P <0.05. Results: A total of 273 subjects completed the study with data eligible for analysis. Mean age was 52.1 ± 11.3 yrs (19-80), mean body mass was 25.7 ± 3.7 (16.7-42.2), mean TT was 400 ± 180 ng/dL (30-910). The severity of ED was mild in 15.6%, mild to moderate in 32.5%, moderate in 28.3% and severe in 22.4%. Of all, 27.4% have DM, 32.1% have HT, and 33.7% have dyslipidemia and 44.3% (121/273) have MetS. The TT levels was significantly lower in MetS group than without MetS (4.4 ± 1.8 vs. 3.6 ± 1.6, P < 0.000). There is no significant difference in the mean age and SHIM score between the MetS group and without MetS group. Both TG and central obesity had negative correlation to TT levels (β=-0.283:-0.158, P <0.05) using linear regression. Conclusion: In the ED subjects, 44% was found to have MetS that is significantly associated with low TT levels. TG and central obesity had negative correlations to TT levels in ED subjects. 73 ET-08 THE QEQ SURVEY OF CHINESE ED PATIENTS Jiang Hui, Hong Kai, Liu Defeng, Zhao Lianming, Tang Wenhao, Mao Jiaming Department of Urology, the Third Hospital of Peking University (China) Objectives: While diagnosising and treating ED patients, we used QEQ questionnaire, international erectile function score (IIEF erectile function) and erection hardness grade(EHS). In order to explore the correlation between the different questionnaires, we investigated the basic epidemiologic data about chinese ED patients, understood the therapeutic effect of PDE5-I and how and why various factors impact the progress of ED and the therapeutic effect . Method: From June 2008 to June 2009, 4252 questionnaires were gathered from 46 centers by urology or andrology doctors all around China. Patients with ED (age ≥20y) filled in first half of the questionnaires when they came for the first time, then completed the second half after 4 weeks PDE5-I therapy. Result: Most of the patients’ ED course were less than 5 years (<5 years 74.0%, 5-10 years 20.8%, >10 years 5.2%). As ED course increase, the incidence of the risk factors of ED, such as smoking, drinking, hypertension, diabetes, cardiac disease and hyperlipidemia also increase (P≤0.01). PDE5-I was effective in improving the quality of sexual activities (P≤0.01). Administration of PDE5-I improves satisfaction, enjoyment and frequency of sexual activities. The longer the ED course, the worse the therapeutic effect (<5 years 96.1% , 5-10 years 94.9% , >10 years 89.0%) (P≤0.01). Conclusions: 1.QEQ is a simple, reliable, and effective new method to evaluate the quality of erections, which is the ideal tool for test and evaluate erectile function and quality. We can accurately know the changes in erectile function and quality and understand the staging of ED patients in mild or severe. 2. Chinese ED out-patients mainly concentrated in young and middle-aged. 3. The ED course greatly affected the therapeutic effect of PDE5-i, so the Patients with ED should consult doctor at the early stages of disease. 4.Admistration of PDE5-I effectively improves the penile erection and the quality of sexual life of the patients hence should be considered as first-line medicine in the treatment of ED. Keywords: Erectile dysfunction(ED); phosphodiesterase type 5 inhibitor (PDE5-I); IIEF; ED course; QEQ 74 ET-10 THE PERSPECTIVE OF SEXUAL MEDICINE IN PSYCHIATRY 1,2 Jian-Kang Chao 1 Department of Psychiatry, Yuli Veterans Hospital (Taiwan) 2 Department of Nursing, Chung Hwa University of Medical and Technology (Taiwan) Sexuality is an integral part of the personality for all of us; man, woman and child. It is a basic need and aspect of being human that cannot be separated from other aspects of life. Sexual health is a state of physical, mental and social well-being in relation to sexuality. It requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination and violence. Sexual health is important for one’s well-being, and sexual enjoyment adds to quality of life at any age. Sexual difficulties may begin early in a person's life, or they may develop after an individual has previously experienced enjoyable and satisfying sex. A problem may develop gradually over time, or may occur suddenly as a total or partial inability to participate in one or more stages of the sexual act. The causes of sexual difficulties can be physical, psychological, or both. At one time, the vast majority of cases of sexual problems were considered to be psychogenic, and few were classified as organic. With greater understanding of the pathophysiology of sex organs and development of improved investigatory procedures that occurred in the late 1980s and early 1990s, the etiological classification pendulum swung in favor of underlying organic causes. Healthy sexual function is fundamental to a full life for most people. Sexual dysfunctions are common and distressing, especially among psychiatric patients and persons taking psychotropic medications, and can potentially lead to noncompliance with drug treatment. Psychiatrists should include a thorough sexual history as a routine part of clinical work for every patient. Sexual disorders have mixed biopsychosocial etiologies and frequently occur comorbidly with medical and psychiatric illness. Part of the psychiatrist’s mandate is to help patients restore, maintain, or improve their quality of life, including sexual function. 75 ET-11 THE FUTURE OF PENILE VEIN LIGATION 1 2 3 Geng-Long Hsu , Cheng-Hsing Hsieh , Hsien-Sheng Wen 1 Microsurgical Potency Reconstruction and Research Center (Taiwan) 2 Buddhist Tzu Chi General Hospital, Taipei Branch (Taiwan) 3 Tung’s Taichung Metro-Harbor Hospital (Taiwan) Background: Contemporary penile vein “ligation” might not be considered an appropriate treatment for patient with erectile dysfunction because of disappointing functional outcomes and unacceptable complications, seemly unavoidable, penile deformity and irreversibly permanent numbness. It, however, follows that an exclusive way of refined penile venous stripping based on more accurate anatomical knowledge and appropriate surgical methods with delicate instruments has been promising since 1986. Patients and Methods: A dual cavernosography has been introduced and subsequently scrutinized since 1985. It provide us a surgery blueprint, which shows one deep dorsal vein, a pair of cavernosal veins, and two pairs of para-arterial veins between the Buck’s fascia and the tunica albuginea. All offensive veins are removed at expense of negligible tissue damage. Subsequently 76-125 emissary-vein stump ligations shall be made closest to the outer longitudinal layer of the tunica in order to restore erectile function. An acupuncture-assisted local anesthesia secures the true ambulatory basis. The key instruments are so essential that neither an electrocautery nor a sucker is used in the entire procedure. Results: This type of penile venous stripping has been chronologically performed on more than three-thousand patients over a period of twenty-five years. Our results speak for themselves as individuals whose previous surgical attempts and pharmaceutical treatments had failed to make any real impact. Discussion and conclusion: Since 1986, rigorous anatomical studies, in Taiwan and further decisively instructed by Professors Tom F. Lue and EA Tanagho in 1991, have provided us with a deeper insight into penile anatomy which, in turn, enhances clinical applications. In addition, intensive microsurgical training on small rats followed by microdissection on cadaveric penis must be mastered before any surgery attempt on human patients. Yearning for it this sustainable method can be popularized worldwide in the “future” since a couple of urological surgeons, Drs Cheng-Hsing Hsieh and Hsien-Sheng Wen, reproduce it “presently”. 76 ET-12 THE PERSPECTIVE OF SEXUAL MEDICINE IN JAPAN 1 Yoshiaki Kumamoto 1 Japanese Institute of Clinical Andrology (Japan) Aging change of free testosterone in Japanese male revealed a little bit early decreasing tendency after 50 years old, comparing to American men. This data was the research results of joint study with Professor Michael Lieber in Mayo clinic in USA, measuring together at same laboratory in USA about serum free testosterone of Japanese and American same aged male I think that decreasing process of free testosterone in male have a little bit ethnic difference, in comparing between Japan and USA. That data may have influence to produce difference of sexual activity between in Japan and USA, By International survey of sexual activity in various countries, remarkable difference between Asian group and Caucasian group. Particularly that is remarkably low in Japan. As posed to international average number of sexual intercourse frequency, Japan is 45which is the lowest level among whole surveyed country in the world. And also we have WHO survey data in Japan that is as follows. 37.3% of Japanese men are sexless even in fifties, 20.6% in forties, 14.4% in thirties, 7.2% in twenties The reason why Asian countries group have such remarkably lower sexual activity and ethnic difference, compared to Caucasian countries groups is not yet cleared. However, at least, some ethnic racial reason in androgen level, just like our Japanese data or simultaneously deference in culture, datary life and religion, may have influence in sexual life. The problem is very interesting and also important as ethnic problem of endocrinological study. Then we are planning to have the symposium titled as “Why we Asian group have such low sexual activity compared to Caucasian group?” in the 12th Asian-Oseania Congress of Sexology at Matsue in Japan, in August 2-5 next year. I hope many members of this congress could actively cooperate such an interest discussion. This is very complicate and difficult problem for arranging many thinkable reasons. 77 S1-01 THE CLINICAL FEATURES OF SEVERE PRIMARY ERECTILE DYSFUNCTION IN CHINESE Zhong-Cheng Xin Andrology Center, Peking University First Hospital, Peking University (China) Primary erectile dysfunction (PED) which means the patients could not perform sucsesful sexual intercourse even once.The purpose of this study is to investigating clinical features of patients with severe primary erectile dysfunction (S-PED) and discussing an Ideal treatment option. Patients who have complained erectile dysfunction(ED) since initial sexual intercourse were involved in our study. Sexual history and marriage condition were evaluated and erectile function was evaluated by IIEF5 scores as well. A multidisciplinary diagnostic approach including sexual hormone analysis, color duplex Doppler ultrasound, neuro-electromyogram and cavernosography was carried out for those PDE5 inhibitor non-responders. The efficacy of penile prosthesis implantation for patients with S-PED was followed up. Seventy two cases (32.7%) were suffered from S-PED with PDE5i non-responders mong of 220 cases primary ED. The mean age was 31.5 士 4.5 years, regularly attempting for sexual activity 2.4 士 3.2 years, 68 cases (94.5%) were organically disorder include arteriogenic 13 cases, venogenic 35 cases, endocrine factor 6 cases, neurologic 9 cases, fibrosis of cavernous 5 cases. Sixty-seven cases (93.5%) were co-existed with varicocele. Among of them, 16 cases (22.2%) had been divorced. Twenty five cases (34.7%) had been treated penile prosthesis implantation, and in the results of 5.6 years’ post-operation follow-up, erectile function (IIEF5) and life quality (QOL) were improved significantly compared to preparation (p < 0.001), and the satisfaction ratio of patient and partner was 93.4% and 92.3% respectively, and without sever complication. S-PED seriously impact young couple’s life quality and relationship. The main pathological abnormal of S-PED was venogenic factor, and penile prosthesis implantation safe and effective for S-PSED. 78 S1-02 FEMALE SEXUAL DYSFUNCTIONS – AN OVERVIEW Sudhakar Krishnamurt Andromeda Andrology Center (India) In recent years, our interest and understanding of female sexual health, function and dysfunction have grown tremendously Female sexuality and sexual dysfunctions are more complex than male sexual dysfunctions. The common dysfunctions are: sexual interest / desire disorder, sexual aversion disorder, subjective sexual arousal disorder, genital sexual arousal disorder, combined genital and subjective arousal disorder, persistent sexual arousal disorder, women’s orgasmic disorder, dyspareunia / vaginismus, and even female infertility. It is common for women to have more than one disorder/s at the same time. The prevalence ranges of desire disorders, orgasmic disorders, arousal disorders and pain disorders are 16 % to 75 %, 16 % to 48 %, 12 % to 64 % and 7 % to 58 % respectively. Anxiety, depression and marital difficulties often co-exist with female sexual dysfunctions (FSDs), either as cause or effect. Hormone deficiencies, diabetes mellitus, cardiovascular and neurological disease, depression, medication and drug use, surgery (e.g. hysterectomy, oophorectomy), gynecological and other cancers, radiation, and stress and relationship difficulties, are some common causes of FSDs. Many women are reluctant/ shy about discussing their sexual problems and the sexual physician must take the initiative. Infertility, pregnancy loss, oophorectomy, the menopause, and many prescription medications, especially hormonal and psychotropic, can increase the risk of FSDs. Many validated instruments and laboratory tests are available and will be required to establish the diagnosis, treatment plan, and prognosis. Treatment modalities include topical and systemic medical, psychological, the use of dilators and other devices, and surgical options. Bartholin’s cysts, clitoral phimosis, vulvar tumours, hypertrophic Skene’s glands, urethral prolapse, and vestibulitis are the common indications for surgery. Other surgical procedures include reduction labiaplasty, defibulation of genital cutting, and clitoridectomy reconstruction. 79 S1-03 ROLE OF COMPLEMENTARY AND ALTERNATIVE MEDICINE FOR ERECTILE DYSFUNCTION IN INDONESIA Doddy M. Soebadi Dept. of Urology, Soetomo General Hospital, Airlangga University School of Medicine (Indonesia) Complementary and alternative medicine (CAM) includes various practices, measures and products, which are not presently considered to be a part of conventional (mainstream) medicine. In Indonesia, herbal products, vitamins, minerals and amino acids (known as supplements) are increasingly popular as dietary supplements for the improvement, treatment and prophylaxis of various diseases, and to improve general health and well being, including in male health. In male health several benefits are in general health, male fertility / infertility, aphrodisiac, and erectile function/dysfunctions. As these products are freely available in Indonesia without prescription, conventional healthcare providers are often unaware that their patients are using CAM. It is essential to know that some herbal supplements may act in the same way as chemical drugs, and that they originate ‘from nature’ does not mean that they are safe and with no potential harmful effects and/or toxicity. Eventual Interactions with conventional medications and contamination with prescription drugs have been reported. The active components of many phytotherapeutic preparations and their mechanism(s) of action are still being determined and evaluated. In Indonesia, there are very popular local or national products called “jamu”, consists of a mixed of herbal products, often with honey and other substance(s). “Jamu” is very popular and makes big business and becomes a very popular medication, as a health supplement and/or treatment in Indonesia. There is scientific evidence for the effectiveness of some CAM treatments, but for most there are important key questions yet to be answered through basic research and well-designed studies according to established guidelines. Because of the increasing popularity and use of CAM, conventional healthcare providers, including male health physicians should not ignore it, and be well informed about the benefits and potential risks of dietary supplements, so that they can advise their patients about this developing field. Physicians should be familiar with all medications, whether conventional or herbal, their patients are taking. This information is necessary to prevent, recognize, and treat potentially serious problems associated with herbal medications, taken alone or in conjunction with conventional medications. Keywords: Complementary and alternative medicine, herbal, erectile dysfunction, placebo effect. 80 S1-04 ALTERNATIVE MEDICINE FOR ED IN MONGOLIA Nansalmaa Naidan Health Science University of Mongolia (Mongolia) In traditional Mongolian Medicine herbal medicine, animal products, minerals, manual and acupuncture therapy and moxibustion (burning mugwort over acupuncture points) used to different diseases. We introduce some of most common therapeutic methods. Herbal: Gymnadenia conopsea. (BAHNLAG in native language)These plants are bulbous geophytes, as they bring their buds in underground tubers or bulbs, organs that annually produce new stems, leaves and flowers. Gymnadenia conopsea is main ingredients of many herbal medicines in Mongolian and Tibetan traditional medicine. It is in use of treating erectile dysfunction, lack of sperm and improving potency and general well being also. Amylase, protein, glycoprotein, potassium and other organic minerals, pionazidi, quarcethini-3β, glucosid-7, iso-quarcethini and astratalini are included in chemical consist. Pantocrin: Extract of deer’s horn. It is water and 50% ethanol solution extract of young deer. Deer’s horn has to be taken before calcification. It has smell of phenol with pH 3,5 - 5,0 used for erectile dysfunction. Maral root or Rhaponticum, (Rhaponticum carthamoides) is a herbaceous perennial plant from the family Asteraceae that inhabits in mountains. This plant derives its traditional name Maral root from the female deer who fed on it. It is an adaptogen which has traditionally used for fatigue, impotence, and recovery from long illness. Animal product: Deer’s musk: The musk deer belongs to the family Moschidae. It is dried either in the sun, on a hot stone, or by immersion in hot oil. Upon drying, the reddish brown paste turns into a black granular material called "musk grain", which is used for alcoholic solutions. The aroma of the tincture becomes more intense during storage and gives a pleasant odor only after it is considerably diluted. In addition to its odoriferous principle, it contains ammonia, cholesterol, fatty matter, a bitter resinous substance, and other animal principles. A deer penis said to have important therapeutic properties. The deer penis is typically very large and, proponents claim, for it to retain its properties it must be extracted from the deer whilst still alive. Often it is then sliced into small pieces, typically by women and then roasted and dried in the sun and then preserved while the deer looks on. It joined steroids and amphetamines on the list of banned substances. Moxibustion: The Mongolian tradition of Moxibustion was developed in Mongolia and later incorporated into Tibetan medicineThe reindeer’s (Rangifer tarandus) horn’s powder with clarified melted butter on the nerve ends. Reindeer’s horn has a pheromone chemical factor that triggers a social response in members of the same species. Pheromones are chemicals capable of acting outside the body of the secreting individual to impact the behavior of the receiving individual. It has following chemical ingredients. The oil soluble vitamins, palmitic acid and aromatase substances are main ingredients of this preparation. 81 S2-01 FEMALE SEXUAL DYSFUNCTION: THE DEFINITION, CLASSIFICATION AND DEBATES 1 2 1 3 4 Ching-Hui Chen , Yen-chin Lin , Wei-Min Liu , Li-Hsuan Chiu , Peng-Hui Wang 1 Department of Obstetrics and Gynecology, Taipei Medical University Hospital and Taipei Medical University (Taiwan) 2 Graduate Institute of Human Sexuality, SHU-TE University, Kaohsiung County (Taiwan) 3 Graduate Institute of Medical Sciences, Taipei Medical University (Taiwan) 4 Department of Obstetrics and Gynecology, National Yang-Ming University, National Yang-Ming University Hospital and Taipei Veterans General Hospital (Taiwan) Purpose: Sexual dysfunction refers to the problem happened during the sexual response cycle. It prevents the individual from experiencing satisfaction from the sexual activity. The prevalence of sexual dysfunction is thought to be high among both men and women. However, lacking of a precise definition of female sexual dysfunction (FSD) leads to a bias of the studies. Results: Psychological factors have been considered to be the primary causes in FSD, while in man it is mostly a pathophysiological problem. As to the current understanding of normal sexual responses, It is first suggested by Masters and Johnson that a progressive 3-phase sexual response cycle, consisting of arousal, orgasm, and resolution. Subsequently, sexologists attempting to treat patients who chronically fail to initiate or respond to sexual stimuli added an initial phase of desire to the sexual response cycle. The American Psychiatric Associations’ Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) classifies the sexual response cycle in 4 related but neurophysiologically discrete phases: appetite, desire, or libido; arousal or excitement; orgasm or climax; and refractory or resolution. Currently, researchers are considering whether a fifth phase, namely satisfaction, would help to further define a normal sexual function. According to the newest definition, clinical guidelines were then generated for the treatment of FSD. Conclusion: Although the incidence of sexual dysfunction may have been exaggerated, and the definition and treatment of FSD still need further improvement, the problem is real for millions of women. It’s rarely a simple issue, because sexual pleasure and sexual distress involve a complex web of physical and emotional factors. To encounter the complicated problem, efforts of sexologists and physicians are still needed. 82 S2-02 ALGORITHM FOR THE OFFICE MANAGEMENT OF FSD B. Srilatha 1,2 , Adaik PG 1,2 1 Department of Obstetrics & Gynaecology, National University Hospital (Singapore) 2 Yong Loo Lin School of Medicine, National University Hospital, National University of Singapore (Singapore) Fundamental to diagnosing of female sexual dysfunction (FSD) is empathetic communication of the physician well-versed in sexual health issues to elicit a detailed history with the patient. In the absence of reluctance to initiate an open conversation or time constraint, a completed history will help define the type of dysfunction, identify the underlying medical or gynaecologic conditions and also provide useful information on the psychosocial and interpersonal issues. As such, FSD tends to be multifactorial stemming from a number of complex issues with considerable interdependence. A successful management outcome necessitates meticulous attention to all potential aetiological factors. Along with desire, arousal, orgasmic and pain disorders, the nature of relationship between the woman and her partner has been shown to have a significant role in both the origin and perpetuation of FSD. Therefore, a rational approach needs to target the couple per se together with the strategies that focus on the affected woman. Also in the same individual, there is significant variation of most domains of sexual functioning with age and hormonal status including menopausal transition which is accompanied by both physiological and psychological challenges. Basic strategies in management include evaluation using validated questionnaires, physical examination and specific or multidisciplinary intervention which targets the co-morbid clinical problems prior to treating FSD. Attention needs to be given to iatrogenic surgical, medical and pharmacological causes of FSD with appropriate preventive measures and lifestyle modifications, if indicated. The limited availability of therapeutic options aside from hormonal or off-label agents makes it imperative to develop and provide safer and approved first-line therapeutic options or alternatives to hormone therapy. Despite these constraints, FSD warrants an appropriate pathophysiological understanding, recognition and diagnosis on par with the importance and awareness gained by male sexual conditions. In view of the essential contribution of sexual health to overall quality of life, a more comprehensive management algorithm which incorporates providing patient education, counseling, sex therapy and reassurance and recommending appropriate referrals, when indicated may offer promising long-term results. 83 S2-03 PSYCHOGENIC ERECTILE DYSFUNCTION: DIAGNOSIS AND TREATMENT MODALITY IN UROLOGIC CLINICS Ken Marumo Department of Urology, Tokyo Dental College, Ichikawa General Hospital (Japan) Penile erection is initiated by direct stimulation of the genital area or through stimuli transmitted from the brain. Following stimulation, chemical agents are released in the brain that cause signals to pass down the spinal cord and reaches through non-adrenergic-non-cholinergic pass way into the penis. At the terminal point of nerves release nitric oxide that causes relaxation of the smooth muscle and blood increased flow into the cavernous bodies, causing erection. Anxiety or fear can prevent the brain signals from reaching the level required to induce erection. The release of catecholamine may also prevent relaxation of smooth muscle in the erectile body. Some men are more vulnerable to developing sexual problems because of their personality, for example, restrictive sexual, problematic sexual experience or poor sex education. If we take more broad sense for psychogenic ED, mental illness including neurosis, depression and schizophrenia is related with ED. A half of patients with obsessive-compulsive neurosis have a symptoms of ED, and most of patients with depression experience variety degree of ED. Psychogenic ED is ordinarily characterized by sudden onset, triggered by some emotional events. In addition, if nocturnal penile tumescence are normal, it is psychogenic ED. Sexual counseling and treatment for depression are ideal for psychogenic ED but most of urologists are not familiarized with these kind of treatment, therefore we refer the patients to sexual counselors. It goes well but sometimes it takes long time. From my experience of treatment for psychogenic ED including patients suffering from depression, 82 % of the patient responded to treatment using PDE5 inhibitors. Initiation with treatment utilizing PDE5 inhibitors for psychogenic ED is recommended. 84 S2-05 THE IMPACT OF LOWER URINARY TRACT SYMPTOMS ON FEMALE SEXUAL FUNCTION--A HOSPITAL EMPLOYEE-BASED STUDY Yuh-Chen Kuo, Heng-Li Shen, Ming-Chih Lai Taipei City Hospital (Taiwan) Objective: Lower urinary tract symptoms (LUTS) is a common problem in women and frequently coexists with female sexual dysfunction (FSD). Previous studies have investigated prevalence and predictors of FSD among women who also have urinary incontinence, but few have raised the issue of sexual function in women with LUTS. We define the impact of LUTS on FSD using three validated instruments, Overactive Bladder Symptom Score (OABSS), American Urological Association Symptom Index (AUA-SI) and the female sexual function index (FSFI). Methods: We performed an institutional review board-approved prospective evaluation of apparently healthy female hospital employee who completed an FSFI-validated questionnaire and OABSS and AUA-SI for LUTS. Medical history including age, body height, body weight, number of gestation, parity, co-morbidities, previous surgery, bowel habit and urinary continence status were also recorded. Those subjects with concurrent neurological disorders (such as stroke, Parkinsonism, spinal cord injury, and multiple sclerosis), active urinary tract infections (UTI), and previous major pelvic surgery as well as evidence of pelvic organ prolapse were excluded from the study. The correlations between the OABSS, AUA-SI total score (AUA-SI-T), AUA-SI emptying subscore (AUA-SI-E) and AUA-SI storage subscore (AUA-SI-S) with six domains and total FSFI scores were analyzed. In addition, subjects were categorized into OAB or non-OAB, mild LUTS or moderate to severe LUTS based upon the results of questionnaire for further comparison of their FSFI total scores and scores within the individual domains. Results: A total of 89 subjects with mean age 43.31 (range 30–66) were enrolled in this study. The mean scores in OABSS, AUA-SI and FSFI were 2.34 (range 0-10), 3.34 (range 0–20) and 21.53 (range 2–34.2) respectively. There were 13 women (14.62%) categorized as OAB and 13 (14.62%) subjects having moderate or severe LUTS (AUA-SI score≧8). The OABSS scores were negatively correlated with FSFI total scores and domains in arousal, lubrication, orgasm and pain (p=0.034, 0.027, 0.046, 0.018 and 0.046 respectively). The AUA-SI-T scores were also negatively correlated with FSFI total scores and domains in arousal, lubrication, orgasm and satisfaction (p=0.050, 0.013, 0.037, 0.035 and 0.048 respectively). Additionally, women with moderate or severe LUTS had significantly lower scores in FSFI total scores and domains in arousal, lubrication, orgasm and satisfaction (p=0.013, 0.003, 0.012, 0.009 and 0.023 respectively). There was no significant difference in FSFI scores between OAB and non-OAB women. Conclusion: The sexual function of women is negatively impacted by the presence of LUTS, with emptying symptoms causing the greatest degree of FSD. The sexual domains most affected are arousal, lubrication, orgasm and sexual satisfaction. 85 S2-06 EFFECTIVE OF BEHAVIORAL TREATMENT FOR FEMALE COITAL DISORDER 1 Xin Tao, Bin Zhang, Jun Chen, Tao Qi , Shu-qi GE Department of Infertility and Sexual Medicine, the Third Affiliated Hospital, Sun Yat-Sen University (China) Purpose: To explore the effects of the behavioral treatment on female coital disorder for the popularization of improved methods in China Materials and methods: Thirty-six voluntary female patients with coital disorder were learned sexual knowledge such aspects as breaking away from the traditional thought, teaching healthy sex concepts, and imparting sexual knowledge and techniques at first and then treated after the basic training model of sensate focus by Masters and Johnson. Response evaluation criteria: patients who had success sex life as cured; patients who could endure big mould in as improved; patients who only could small mould in but the symptoms were still existed as failed. Results: Nineteen cases recovered(52.78%)，twelve eases improved(33.33%), and five cases failed(13.89%),the general rate of effectiveness being 86.11%. Conclusion: The behavioral treatment coupled with sexual knowledge explaining and psychological counseling is remarkably effective in treating female coital disorder and its long term follow-up results show that most of patients were satisfied with their sex life. However, the react of behavioral treatment on some patients who had sexual trauma in the progress of their growing up or had long course of disease were not so good which deserves our special attention in the future study. 86 S3-01 AUTOPHAGY IN UROLOGY AND SEXUAL MEDICINE Yi-Chia Lin Division of Urology, Department of Surgery, Shin Kong WHS Memorial Hospital (Taiwan) Autophagy is a self-eating process that was first observed in cells under starvation. Cells may degrade its own organelles while metabolic stress encountered. This phenomenon was previously though to be a protective mechanism for cells to survive through strict environment. However, evidences showed that autophagy participates in several important cellular regulatory pathways. Mammalian target of rapamycin (mTOR) is the central role of this phenomenon and complex modulatory pathways was found to control the whole process. Divergent outcomes of autophagy were observed in different situations. Recently, autophagy was reported to be associated in the pathogenesis of several diseases including cancer. Defective autophagy was involved in tumorigenesis in several cancers including prostate cancer. Autophagic cell death was also proposed to be another pathway for apoptosis in prostate cancer cells. On the other hand, autophagy can rescue cancers cells treated with some anticancer agents resulting in survival of the cells. In sexual medicine, decreased autophagy was found to be associated with decreased Leydig cell function and erectile dysfunction. With the accumulating evidences, autophagy may involve in areas more than we expected. Interesting and exciting findings that may influence future direction of disease treatment and diagnosis can be expected. 87 S3-02 AUTOPHAGIC DEFICIENCY IS RELATED TO STEROIDOGENIC DECLINE IN AGED RAT LEYDIG CELLS 1 2 3 1 1 3 1 1 Wei-Ren Li , Liang Chen , Zhi-Jie Chang , Hua Xin , Tao Liu , Yan-Quan Zhang , Guang-Yong Li , Feng Zhou Yan-Qing 1 1 1 Gong , Zhe-Zhu Gao ,Zhong-Cheng Xin 1 Andrology Center, Peking University First Hospital, Peking University (China) 2 Department of Urology, China Meitan General Hospital (China) 3 Department of Biological Sciences and Biotechnology, School of Medicine, Tsinghua University (China) Objective: Androgen deficiency occurs in males with aging, but the mechanism remains unclear. In this study, We found reduced testosterone production in aged rat Leydig cells associated with decreased autophagic activity. Materials & Methods: In order to study the effect of autophagic deficiency on the testosterone production of Leydig cells, primary rat Leydig cells and TM3 mouse Leydig cell line were used as models. In Leydig cells from young and aged rats, treatment with wortmannin, an inhibitor for autophagy, led to inhibition of luteinizing hormone (LH)-stimulated steroidogenic acute regulatory (StAR) protein expression and decreased testosterone production. Results: In contrast, treatment with Rapamycin, an autophagy activator, resulted in enhancement of LH-stimulated steroidogenesis in Leydig cells from aged rats, but not in cells from young rats. The intracellular reactive oxygen species (ROS) levels were increased in both young and aged Leydig cells treated with wortmannin, but decreased only in aged Leydig cells treated with Rapamycin. Furthermore, we demonstrated that the increased level of ROS induced by H2O2 resulted in LH-stimulated steroidogenic inhibition. Furthermore, knockdown of Beclin 1 led to decrease of LH-stimulated StAR expression and testosterone production associate with increase of cellular ROS level in TM3 mouse Leydig cells. Conclusion: Autophagic deficiency may play an important role in decreased testosterone production of aged rat Leydig cells possibly via regulation of cellular ROS level. 88 S3-03 EFFECTS OF ICARISIDEⅡON TGF-Β1/SMAD/CTGF AND NO-CGMP PATHWAYS AND CORPUS CAVERNOSUM FIBROUS-MUSCULAR ALTERATIONS IN RATS WITH STREPTOZOTOCIN-INDUCED DIABETES Zhong Cheng Xin Andrology Center, Peking University First Hospital, Peking University (China) Icariin and icarisideⅡ (ICAⅡ), two active components isolated from herba epimedii, have a closely structural relationship. There is evidence that icariin may be useful in the treatment of erectile dysfunction(ED). Data on the efficacy of ICAⅡ in ED is currently scant. We investigated the effects of ICAⅡ on hemodynamic parameters in the penis of rats with streptozocin induced diabetes. We also examined the mechanisms underlying diabetes related penile hemodynamics changes with particular focus on the NO-cGMP and TGFβ1/Smad2/CTGF signaling pathways. Fifty 8 week-old Sprague–Dawley rats were randomly divided into normal control and diabetic groups. Diabetes was induced by a one-time intraperitoneal injection of streptozocin (60mg/kg). Three days later, the diabetic rats were randomly divided into 4 groups including a saline treated placebo arm and 3 ICAⅡ-treated models (1, 5, 10mg/kg/d). After three-months, penile hemodynamics was measured by cavernous nerve electrostimulation (CNE) with real time intracorporal pressure assessment. Penises were harvested with subsequent histological examination (picrosirius red stain, Hart’s elastin stain and immunohistochemical stain) and Western blot to explore activity of the NO-cGMP and TGFβ1/Smad2 signaling pathways. Diabetes significantly attenuated erectile responses to CNE. Diabetic rats had a decreased corpus cavernous smooth muscle/collagen ratio and endothelial cell content relative to control animals. The ratio of collagen Ⅰto Ⅲ was significantly lower in the corpora of diabetic rats compared to normal controls; furthermore cavernous elastic fibers were fragmented in the diabetic animals. ICAⅡ treated diabetic rats had higher expression of nNOS, eNOS, and VEGF in the penis relative to placebo treated diabetic animals. Both the TGFβ1/Smad2/CTGF signaling pathway and apoptosis were down-regulated in the penis from ICAⅡ-treated rats. ICAⅡ treatment attenuates diabetes-related impairment of penile hemodynamics, likely by increasing smooth muscle, endothelial function, and nNOS expression. ICAⅡ may have modulatory effects on the TGFβ1/Smad2/CTGF signaling pathway. 89 S4-01 PEYRONIE'S DISEASE AFTER PROSTATE CANCER TREATMENT IS MORE COMMON THAN PREVIOUSLY KNOWN Haocheng Lin, Rohit Dhir, Andrea Chan, Claudio Romero, Frances Alba, Run Wang University of Texas Medical School at Houston and MD Anderson Cancer Center (United States) Purpose: Peyronie’s disease is a common male sexual disorder with increased incidence in patients after prostate cancer treatment. Erectile dysfunction (ED) associated with Peyronie’s disease can affect the patient’s satisfaction after inflatable penile prosthesis (IPP) implantation. This study was designed to look at the incidence of penile deformity at IPP implantation for treatment of ED in patients with a history of prostate cancer treatment. Materials and methods: The IPP data base in the last 35 months at MD Anderson Cancer Center was reviewed. ED and associated history of cancer treatment were recorded. Peyronie’s disease was diagnosed by history, physical examination and penile Doppler ultrasound before IPP surgery. All patients had penile Doppler ultrasound study before receiving IPP implantation. Results: From January, 2007 to November, 2010 a total of 261 IPP surgeries were included in this study. Of these 261 patients, 75% had prostate cancer treatment, 9.6% had radical cystectomy and 15.4% were diagnosed with ED due to other etiology. Before IPP implantation, 12.8% patients in prostate cancer treatment group were diagnosed with Peyronie’s disease. However, during the IPP implantation surgery, 38.6% of patients without pre-operative diagnosis of Peyronie’s disease were found to have penile curvature that required penile plasty to correct the curvature. The severity of the curvature was from 10 to 45 degrees. The most common deviation was ventral curvature (57.9%) followed by dorsal curvature (31.6%) with only 10.5% pure lateral curvature. Among them, there are 31.6% patients with combined curvature (ventral-lateral or dorsal-lateral). Conclusion: Penile curvature is a very common finding at the IPP implantation surgery for erectile dysfunction after prostate cancer treatment. All patients (even without pre-operative diagnosis of Peyronie’s disease) should be well informed regarding the possible curvature after the surgery and surgeons should prepare to perform penile plasty for every patient receiving IPP. 90 S4-02 PEYRONIE’S DISEASE: CURRENT STATUS OF PENILE PLICATION PROCEDURE 1,2 Te-Fu Tsai 1 Department of Urology, Shin Kong Wu Ho-Su Memorial Hospital, Department of Surgery, Shin Kong Wu Ho-Su Memorial Hospital (Taiwan) 2 Division of Urology, School of Medicine, Fu-Jen Catholic University (Taiwan) Peyronie’s disease is an acquired benign condition with unknown etiology. The presenting symptoms include the presence of a plaque or induration of the penile shaft, penile curvature or deformity during erection, erectile penile pain, and sexual dysfunction. The disease is currently thought to affect between 3 and 9% of adult men. Patients who have immature disease are advised that they are not candidates for surgery to straighten the penile curvature until the disease is mature. Surgical therapy for Peyronie’s disease (plication, graft-based, and prosthetic techniques) should be reserved for the man who has failed conservative therapy. Penile plication procedure is considered the simplest surgical option for Peyronie’s disease, with the fewest side effects. Here we review the current status of penile plication and report our experience in treating Peyronie’s disease. 91 S4-03 THE KRISHNAMURTI OPERATION IN CAUCASIANS AND LIGHT-SKINNED PATIENTS WITH PEYRONIE’S DISEASE Sudhakar Krishnamurt Andromeda Andrology Center (India) The Krishnamurti penile dermal flap operation for Peyronie’s disease was first performed by the author in 1989, presented as a free paper in 1992, and published in 1994 (ISSM Herbert Newman Prize Paper - `Penile dermal flap for defect reconstruction in Peyronie’s disease: Operative technique and four years’ experience in 17 patients.’ – Int. J. Impot. Res.(1995) 7, 195 – 208.) Since then, the technique has been abstracted several times and included in bibliographies as well. Despite penile dermis being excellent graft (flap) material, and good results being consistently reported by the author, however, the technique has not been put to widespread use by other workers in the field of Peyronie’s disease. The reasons for this are as follows: 1) Many surgeons working with circumcised populations do not get much (or any) foreskin to work with, and hence believe they cannot use the technique. 2) Some surgeons have special proclivities for certain industrial graft materials and do not shift their allegiance to any other materials. 3) Some find the operative technique a bit elaborate (though similar principles are routinely used in hypospadias surgery and in skin grafting) and would rather stick with something simpler, tried and trusted. 4) Some who were willing to try the penile dermal flap operation in lighter skinned patients have faced technical difficulty in separating the epidermis from dermis successfully, and have hence reported post-op sebaceous cysts as a consequence: Penile Dermal Flap in Patients With Peyronie’s Disease: Long-Term Results, by Simonato et al. The Journal Of Urology: Vol. 183, 1065-1068, March 2010. A study of the operative photographs in this paper, however, shows that the epidermis has not been properly separated, and hence the cysts. Separation of epidermis from the dermis of Caucasian white and other light-skinned patients’ foreskins is quite easy and is not much different from that in colored skins. In this presentation, the author highlights these technical steps with the use of sharp intra-operative photographs and video clips. 92 S4-04 A NOVEL PEYRONIE'S DISEASE ANIMAL MODEL COMPARATIVE STUDY OF INTRALESIONAL VERAPAMIL VERSUS NORMAL SALINE INJECTION: ASSESSMENT OF IMMUNOHISTOCHEMICAL OUTCOMES 1 2 Eric Chung , Ling De Young , Gerald Brock 1 Princess Alexandra Hospital (Australia) 2 St Joseph Health Care (Canada) 2 Objective: At present no optimal management approach in Peyronie's disease (PD) has been described and medical treatments remain poorly studied. While intralesional injections have been shown to improve penile curvature and decrease plaque volume, the exact mechanism of action on Peyronie's plaque is unknown. The aim of this study is to evaluate the efficacy of intralesional injections of verapamil and normal saline in a Peyronie's disease animal model. Methods: Peyronie's plaque was induced in 2 groups (N=6) of adult male Sprague Dawley rats using established animal model of PD from our earlier experiment (TGF β1 and TrombojectR). After 4 weeks, intralesional injections were carried out. Group 1 consisted of 0.1mg/0.1cc of verapamil injected subtunical into the plaque tissue every second day for 2 weeks while Group 2 received 0.1cc of intralesional normal saline injection. At weeks 6 and 8, 3 rats from each group were sacrificed and serial sections of penile tissue were prepared for immuno-histochemical stains. Results: Intralesional injection of verapamil and normal saline resulted in macro- and microscopic changes to penile curvature and Peyronie's plaque size. There were decrease collagen and elastin fibers as well as smooth muscle α-actin on immuno-histochemical stain. The changes observed were greater in the verapamil group compared to normal saline group. Conclusion: This novel study design offers for the first time, histological evidence of cellular changes observed in Peyronie's plaque following intralesional injections. Volume expansion by hydrodistension appears to plays an important role in the observed plaque remodeling. 93 S4-05 THERAPEUTICAL EFFECTIVENESS OF A PENILE DEVELOPMENT CORRECTION DEVICE: PRELIMINARY REPORT ON PUBERTY PATIENTS 1 2 Geng-Long Hsu , Cheng-Hsing Hsieh 1 Microsurgical Potency Reconstruction and Research Center, Hsu’s Andrology (Taiwan) 2 Department of Urology, Buddhist Tzu Chi General Hospital, Taipei Branch (Taiwan) Purpose: It is commonly believed that the penile deviation is exclusively amenable to surgical intervention. We report a treatment effect in teenage patients with penile deviation who underwent simple non-surgical treatment by using a penis development device during puberty. Materials and Methods: Form August 2003 to November 2010, a total of 15 patients whose genetic counseling was nothing in particular, aged 12 to 13 years, whose penile deviation was greater than 30 degrees, were included and assigned randomly to two groups: managing (n=7) and control (n=8) groups in accordance with treatment with a penile model dressing which was secured to the patient’s waist belt or observation only respectively. The deviation angle was recorded by autography and subsequently hand measured during penile erection. The penile curvature correction device was applied each night for 6 months. They were followed annually. Results: The follow up period varied from 2.0 to 7.0 with an average of 4.7±1.3 years. In the treatment group the original deviation angles were 40.7±8.60 which decreased to 6.30±2.70 after application of the penile curvature correction device for 6 months. An acceptable penile shape was achieved in 6 (85.7%) patients. In the control group, however, the deviation angles were not altered during the 6-month observation period (38.90±8.50 vs 39.90±8.80). The difference between the treatment and control group is statistically significant (P < 0.001). In additional presently a 23 years old male sustained a severe ventro-lateral curvature associated with erectile dysfunction. Conclusion: The congenital penile deviation appears to be preventable at juvenile age when the penile development is in progress. Referring to the disease entity congenital penile deviation, “congenital” may be inappropriately applied at last to some of the patients whose condition may be correctable at puberty during penile development time. 94 S5-03 EJACUALATORY FUNCTION AND DYSFUNCTION ASSOCIATED WITH LUTS/BPH Jae-Seung Paick Seoul National University College of Medicine (Republic of Korea) Purpose: Understanding of the pathophysiology of the different types of ejaculatory dysfunction remains limited. Previous studies provide evidence that ejaculatory function can deteriorate after medical or surgical treatment for LUTS/BPH patients. However, it is poorly elucidated how many patients who visits urology clinic due to LUTS/BPH have ejaculatory dysfunction. Therefore, the authors investigated baseline ejaculatory function and dysfunction of LUTS/BPH patient before the initiation of treatment Materials and methods: We retrospectively reviewed the medical records of 1,574 patients who visited urology clinic of our hospital with complaint of lower urinary tract symptoms. All the patients have completed the ‘5 item questionnaire assessing ejaculatory function (EjQ)’. The EjQ consisted of questions evaluating volume, power, pain, satisfaction, and ejaculatory latency time during the last 4 weeks. Medical history, physical examination, voiding diary, International Prostatic Symptom Score (IPSS), and International Index of Erectile Function (IIEF) were thoroughly reviewed and their relationship with ejaculatory function were analyzed. Results: Among the total study population, 4.0% was in their 40s, 15.5% in 50s, 38.6% in 60s, 35.0% in 70s, and 6.9% in 80s or more. The distribution of mild, moderate, and severe urinary symptom according to IPSS was 19.0%, 51.8%, and 29.2%, respectively. We found 783 patients (49.7%) had sexual relationship during the last 4 weeks (Active group), whereas 791 had not (50.3%) (Inactive group) (Table). Most of the patients in the Inactive group (93.7%) almost never/never felt sexual desire (IIEF Q11). In the Active group, 53.4% reported that their ejaculatory volume was not enough 55.7% reported that their ejaculatory power was not strong enough, and 41.7% were not satisfied with their ejaculatory function. And only 6.1% of patients with low ejaculatory volume and 5.6% with low ejaculatory power were satisfied with their ejaculatory function. The rate of orgasmic dysfunction was 7.4% in the total study population, 12.7% in low ejaculatory volume group, and 12.2% in low ejaculatory power group. There were strong correlation between ejaculatory volume and power (correlation coefficient=0.823, p < 0.001). In the Active group, 3.0% reported to have pain or discomfort when ejaculate. And the ejaculatory latency time was reported to be short in 5.7%, slightly short in 10.5%, long in 14.8%, and very long in 2.3%. Erectile dysfunction was evaluated by IIEF erectile function domain score: mild, moderate, and severe erectile dysfunction was reported in 17.1%, 19.6%, and 14.0%, respectively. IPSS total score was inversely correlated with ejaculatory volume or power and this association remained significant after adjusting for erectile function and age (OR=1.891, 95% CI 1.088-3.287, p=0.024). Conclusion: Before the initiation of medical or surgical treatment, we believe that the evaluation of ejaculatory function is mandatory and that questionnaire assessing ejaculatory volume and satisfaction is an appropriate tool for evaluation. Table: General and symptom related characteristics of LUTS/BPH patients according to different status of sexual relationship during the last 4 weeks (BMI: body mass index, PSA: prostate-specific antigen, TRUS: transrectal ultrasonography, TZ: transitional zone, Qmax: peak flow rate of uroflowmetry, Qol: quality of life, OABSS: overative bladder scoring system, *:p<0.05) scoring system, *:p<0.05) 95 96 S5-04 ASSOCIATIONS OF THE LOWER URINARY TRACT SYMPTOMS WITH THE LIFESTYLE, PROSTATE VOLUME, AND METABOLIC SYNDROME IN THE ELDERLY MALES 1 2 2,3 2,3 2 Hsin-Chih Yeh , Chia-Chu Liu , Yung-Chin Lee , Wen-Jeng Wu , Wei-Ming Li , Shu-Pin Huang 2,3 1 Department of Urology, Kaohsiung Municipal Ta-Tung Hospital (Taiwan) 2 Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung (Taiwan) 3 Department of Urology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung (Taiwan) Purpose: To evaluate the influence of lifestyle, prostate volume (PV), and metabolic syndrome (MS) on LUTS in elderly males. Materials and methods: A total of 764 men aged greater than 40 years were enrolled. Their severities of LUTS were assessed by the International Prostate Symptom Score (IPSS) questionnaire, while their MS was diagnosed according to the National Cholesterol Education Program Adult Treatment Panel III. Lifestyle factors, PV, and components of MS were compared between no/mild and moderate/severe LUTS. Multiple logistic regression analysis was used to determine the independent predictors of moderate/severe LUTS. Results: The mean age of the participants was 56.5 ± 6.3 years, with an average IPSS of 9.6 ± 7.0. In univariate analysis, age (p = 0.001), cigarette smoking (p < 0.001), alcohol consumption (p = 0.02), physical activity (p = 0.03), and PV (p < 0.001) significantly correlated with the severity of LUTS, but the presence or any components of MS did not. Results of multivariate analysis showed that different independent predictors of LUTS were found for males with MS (smoking and physical activity) and without MS (smoking and PV). Conclusion: For Taiwanese males, aging, cigarette smoking, lack of regular exercise, and larger PV were independent predictors for moderate/severe LUTS. PV seemed to be a more important factor in determining the severity of LUTS for men without MS, while physical activity was the critical factor for men with MS. It was suggested that healthy lifestyle would be beneficial to lessen the severity of LUTS in elderly males. 97 S5-05 CONTEMPORARY MANAGEMENT OF SEXUAL DYSFUNCTION IN SCI MALE Donald R. Bodne CWRU School of Medicine University Hospitals of Cleveland Cleveland DVAMC (United States) The annual incidence of spinal cord injury is estimated to be 40 cases per million population in the United States or approximately 12,000 new cases each year with about 265,000 people alive in the US with SCI (1). This compares with a worldwide incidence between 10 and 83 per million per year and around 14.6 per million in Taipei (2,3). Since 2005 in the United States, the average age at injury has increased to 40.7 years with 80.7% of the injuries reported to me among men (75% among men in Taipei) (1,3). Spinal cord injury may disturb the connection between the brain’s main center for sexual function and the genitalia. The level and completeness of injury can affect the ability to obtain and maintain erection and the ability to ejaculate. Erectile dysfunction is a common complaint with 2/3-3/4 reporting the ability to obtain but not necessarily maintain erection. Anejaculation is a common problem with implications for fertility. The clinician’s role in sexual health is summarized in the recent clinical guideline on Sexuality and Reproductive Health in Adults with Spinal Cord Injury (4). This guideline covers sexual history and assessment, practical considerations (bladder/bowel care, positioning, autonomic dysreflexia, spasticity), dysfunction and fertility and relationship issues and emphasizes using the latest revision of the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) (5). A practical consumer companion piece is available for free download at www.pva.org (6). The International Spinal Cord Injury Male Sexual Function Data Set can be downloaded from the ISCoS website (http://www.iscos.org.uk) (7,8). For erectile dysfunction, PDE5 inhibitors are effective and safe treatment options. Intracavernosal injection therapy is effective but close supervision is required as sustained erections are common. Ejaculatory dysfunction can be treated with vibratory stimulation or electroejaculation. Men with SCI are at increased risk for hypogonadism, which may adversely affect metabolism, body composition and sexual function (4,9). Underlying causes (eg, infection, medications, metabolic syndrome, diabetes, brain injury) should be addressed. Testosterone deficiency should be documented before initiating replacement therapy. Preliminary data suggests that testosterone replacement therapy may significantly improve lean tissue mass and energy expenditure when hypogonadism is present (10). References: 1). Spinal Cord Injury Facts and Figures at a Glance. National Spinal Cord Injury Statistical Center, Birmingham, Alabama. J Spinal Cord Med.2011: 34(4). 2). Wyndaele M, Wyndaele JJ. Incidence, prevalence and epidemiology of spinal cord injury: what learns a worldwide literature survey? Spinal Cord. 2006: 44,508-23. 3). Chen HY et al. A nationwide epidemiological study of spinal cord injury in geriatric patients in Taiwan. Neuroepidemiology. 1997:16:241-247. 4). Sexuality and reproductive health in adults with spinal cord injury: a clinical practice guideline for health-care professionals. Consortium for Spinal Cord Medicine. J Spinal Cord Med. 2010:33(3):281-336. 5). Modification of the International Standards for Neurological Classification of Spinal Cord Injury. J Spinal Cord Med. 2011 In Press. 6). Sexuality and reproductive health in adults with spinal cord injury: what you should know. Consortium for Spinal Cord Medicine. Paralyzed Veteran of America 2011. 7.) Alexander MS, Biering-Sorensen F, Elliott S, Kreuter M, Sonksen J. International spinal cord injury male sexual function basic data set. Spinal Cord. 2011: 49(7): 795-8. 8). Alexander MS, Brackett NL, Bodner D, Elliott S, Jackson A, Sonksen J. National Institute on Disability and Rehabilitation Research. Measurement of sexual functioning after spinal cord injury: preferred instruments. J Spinal Cord Med. 2009:32(3):226-36. 9) Wang UH, Huang TS, Lien In. Hormone changes in men with spinal cord injuries. Am J Phy Med Rehabil. 1992: 71(6):328-32. 10) Bauman WA, Cirnigliaro CM, La Fountaine ME, Jensen AM, Wecht JM, Kirshblum SC, Spungen AM. A small-scale clinical trial to determine the safely and efficacy of testosterone replacement therapy in hypogonadal men with spinal cord injury. Hom Metab Res. 2011: 43(8):574-9 98 S6-02 STEM CELLS FOR ERECTILE DYSFUNCTION Ching-Shwun Lin, Tom F. Lue Department of Urology, University of California (United States) Stem cells represent great promise for regenerative medicine. Depending on the source of the cells, two broad categories have generally been recognized: the embryonic stem cells (ESCs) and the adult stem cells (ASCs). ESCs hold the ability to differentiate into any cell type, whereas ASCs have the capacity to give rise only to cells of a given germ layer. Erectile dysfunction (ED) is a common health problem affecting millions of men. Current treatment options are less effective for patients having cavernous nerve (CN) injury or diabetes mellitus (DM)-related ED. These two types of ED are thus the main focus of past and current stem cell (SC) therapy studies. In a total of 16 studies up to 2011, rats were used exclusively as disease models while SC were derived mostly from bone marrow, adipose tissue, or skeletal muscle. For tracking, SC were labeled with LacZ, GFP, DAPI, DiI, BrdU, or EdU, some of which might have led to misinterpretation of data. SC transplantation was done almost exclusively by intracavernous (IC) route. Functional assessment was done exclusively by measuring increases of intracavernous pressure (ICP) during electrostimulation of CN. Histological assessment usually focused on endothelial, smooth muscle, and CN contents/nitric oxide synthase activity in the penis. In general, favorable outcomes have been obtained in all trials so far although whether SC had differentiated into specific cell lineages remains controversial. Recent studies have shown that IC injected SC rapidly escaped the penis and homed in to bone marrow. The differentiation versus paracrine debate requires further investigation. 99 S6-03 GENE POLYMORPHISMS AND ERECTILE DYSFUNCTION Yung-Chin Lee Kaohsiung Medical University Chung-Ho Memorial Hospita (Taiwan) Erectile dysfunction (ED) is a remarkably common disorder. Accumulating data show that ED is linked with coronary artery disease, diabetes, and hyperten sion. These findings suggest that much of ED is vasculogenic in nature. In fact, ED and systemic vascular diseases often coexist and share many common risk factors. ED has now been identified as a marker of silent vascular disease. Recently, evidence has accumulated proving that genotypes of single nucleotide polymorphism (SNPs), including eNOS, ACEI/D and GNB3gene polymorphisms, are associated with an increased risk of developing cardiovascular or metabolic disorders and they affect some of those exact same physiological pathways that are known to play a role in the regulation of penile vasomotor tone. Existing data about the relation between the gene polymorphisms and ED are quite limited. However, considering the close relationship between pathogenetic mechanisms in ED and cardiovascular disorders, the attempt of searching for common genetic factors influencing both disorders appear feasible. Among these candidate genes, eNOS is the most widely studied. The relaxation of the corpora cavernosa is mainly mediated by nitric oxide (NO). NO production from endothelial NO synthase (eNOS), using L-arginine as its substrate, plays an important role in maintaining the tumescence phase of erection after initial stimulation. Three polymorphisms of the gene eNOS, which encoded for eNOS enzyme, have been described. The G894T polymorphism in exon 7 causes an amino acid substitution in the mature protein, resulting in the disturbance of eNOS activity and NO production. The variable number of 27-bp tandem repeats in intron 4 (4 VNTR), also called 4a/4b, has been shown to affect the transcription or functional activity of eNOS. The T786C polymorphism in the promoter region resulted in a significant reduction in the eNOS gene promoter activity by approximately 50% and reduce serum NO concentration markedly. Studies from German and Brazilian populations failed to show a significant association of the G894T polymorphism with ED prevalence. However, our results, enrolling 151 patients with ED and 77 healthy controls in a Taiwanese population, suggest the eNOS 894T allele carriers are more genetically susceptible to ED, both in prevalence and severity. The significant correlations were also supported by studies in Turkish, Iranian and Mexican populations. Up to now, the reported studies did not show the significant associations between intron 4 VNTR polymorphism and ED. Only one study, from Turkey, indicate ‘a’ allele of intron 4 VNTR polymorphism associates with a better sildenafil response for ED. Recently, Wang et al. reported a meta-analysis by retrieving 9 studies that investigated the association between the two eNOS polymorphisms, G894T and 4 VNTR, and the risk of ED. Their results support that G894T, but not 4 VNTR, variant is associated with an increase in the risk of ED. There were only 3 reports about the correlations of T786C polymorphism with ED and the data available are still conflicting. The renin-angiotensin system is a key factor in the systemic vasomotor regulation and recent evidence points out that angiotensin II might play a role in the initiation of detumescence. The angiotesion-converting enzyme insertion/ deletion (ACE I/D) gene polymorphism of a 287 bp sequence in intron 16 of the ACE-gene has been associated with cardiovascular disorders comprising left ventricular dysfunction and myocardial infarction. Several studies reported that DD genotype of ACE I/D is a risk factor for ED in different populations except for ones in a German population. The risk and onset age of ED as well as the erectile response to intracorporal prostaglandin injection were independent of this gene polymorphism. However, they found that patients with the D allele are less likely to respond to sildenafil for ED. A C825T polymorphism has been described in the gene GNB3, which encoded for G-protein subunit Gb3 (GNB3). The GNB3 825T allele is associated with a splice variant of Gb3 referred to as Gb3s, which has functionally increased the activity that could lead to an increased sodium hydrogen exchanger (NHE) activity in the vascular smooth muscle cells, causing the increase of vascular tone that might account for a critical susceptibility of penile erection. There have been many studies reported the associations of the GNB3 825T alleles with a variety of cardiovascular risk factors for ED, including hypertension, diabetes, and dyslipidemia, and are strongly predictive of individual drug responsiveness. However existing data about the associations of the GNB3 C825T gene polymorphisms with ED are very limited. We enrolled 155 patients with ED and 81 healthy controls to test the association of both. Our results along with the other study in a Germen population failed to show a significant association between this gene polymorphism and ED. However, we cannot exclude that the presence of the T allele might influence the risk for ED severity indirectly through an increased risk for some vascular diseases. Although it seems obvious that hereditary factors possibly influence the pathogenesis of ED, there has been no study that proved an independent association between a defined genotype and ED. There is still limited information about this issue and the data available are conflicting. Such variable findings might be because studies were sampled from different populations and relatively small sample size, and this variability can be considered an interesting progress towards the understanding of the role of genetic factors in the pathophysiology of ED. To advance the understanding of the genetic basis of ED, , more large-scale genetic epidemiological and functional studies are clearly needed to investigate the complete range of the signal transduction pathway that confer genetic susceptibility to ED. 100 S6-04 STEM CELLS USED FOR REGENERATION OF CORPUS CAVERNOSUM 1,2 Kuo-Liang Chen 1 Department of Urology, China Medical University Hospital (Taiwan) 2 China Medical University (Taiwan) Penile reconstruction is necessary for patients with congenital anomalies, penile cancer, traumatic penile injury, and some patients with organic erectile dysfunction. Various reconstructive procedures have been attempted to restore a cosmetically acceptable phallus that would allow normal urinary, sexual, and reproductive function. Regeneration of corpus cavernosum is a challenge to be solved. A large number of congenital and acquired abnormalities of the geni¬tourinary system would benefit from the availability of transplantable, autologous corpus cavernosum tissue for use in recon¬structive procedures. Given the major structural and functional impor¬tance of corpora cavernosal tissue, it is clear that the availability of autologous corporal tissue for use in reconstructive pro¬cedures would be of great clinical utility, facilitating enhanced cosmetic result, while providing the possibility of de novo, functional erectile tissue. Tissue-engineered corpus cavernosum is one of the strategies. Three components essential for tissue engineering are cells, scaffolds, and bioactive factors. The cells for tissue engineering might be stem cells, progenitor cells, and differentiated cells. Stem cells exhibit two remarkable properties: self-renew and differentiation into the specialized cell types. They could be fertilized eggs, embryonic stem cells, parthenogenetic stem cells, induced pleuripotent stem cells, stem cells derived from therapeutic cloning, adult stem cells, and so on. Some of them have been differentiated into endothelial cells and/or smooth muscle cells ready for use in creating tissue-engineered corpus cavernosum. In this talk, I am going to introduce the strategies of these stem cells use, such as embryonic stem cells, mesenchymal stem cells, muscle-derived stem cells, adipose-derived stem cells, neural crest stem cells, and endothelial progenitor cells. 101 OP01 VALIDITY OF PREMATURE EJACULATION DIAGNOSTIC TOOL (PEDT) IN FOUR SUBGROUPS OF PREMATURE EJACULATION SYNDROME: DATA FROM THE KOREAN INTERNET SEXUALITY SURVEY – PART I 1 2 Sang Hoon Song , Hwancheol Son , Jae-seung Paick 1 1 Department of Urology, Seoul National University Hospital (Republic of Korea) 2 Department of Urology, Seoul National University Boramae Hospital (Republic of Korea) Purpose: Premature ejaculation diagnostic tool (PEDT) is a brief, multidimensional validated instrument for diagnosis of PE However, evidence of clinical validity of this questionnaire and its capability of differentiating subgroups of PE is insufficient We employed and compared PEDT score in Waldinger’s 4 subgroups of PE (Lifelong, Acquired, Natural variable, and Premature like dysfunction) to identify validity of PEDT score for diagnosis of subgroups of PE. Materials and methods: E-mails were sent to population based sample of males aged 20-59. Participants were asked to complete a questionnaire requesting detailed medical and sexual histories, which included questions from PEDT, and Medical Outcome Study Short-form 36-Item Health Survey (SF-36). Self-reported PE and 4 subgroups were defined and classified by self-assessment. PEDT-PE was defined with cutoff score of 11. Results: E-mails were opened by 1,206 recipient and a total of 443 subjects with mean age of 39.3 ± 10.1 years were included, a response rate of 36.7%. Incidence of PE and their mean PEDT score were; self-reported PE (20.5%, 11.2), Lifelong PE (2.9%, 15.5), Acquired PE (7.0%, 11.2), Natural variable PE (7.4%, 10.4), and Premature like dysfunction (3.2%, 9.0). PEDT scores were significantly higher in Lifelong PE than in other PE subgroups of PE (p < 0.001). Premature like dysfunction group showed the lowest PEDT score and their physical and mental component score of SF-36 were similar to that of non-PE subjects. In the ROC curve analysis, sensitivity and specificity for diagnosis of Lifelong PE by PEDT was 91.3% and 93.8%, respectively. PEDT-PE incidence was 14.6% and its risk factors were erectile dysfunction, nondrinking, and low health related self-perception. Conclusion: This population-based cross-sectional survey shows validity of PEDT as a useful tool for diagnosis of self-reported PE and, especially of Lifelong PE. 102 OP02 A STUDY OF ATTITUDES AND BEHAVIORS OF KOREAN MEN TO COMPLEMENTARY AND ALTERNATIVE MEDICINE FOR THE IMPROVEMENT OF SEXUAL FUNCTION: THE KOREAN INTERNET SEXUALITY SURVEY (KISS) – PART II 1 2 3 Woo Suk Choi , Sang Hoon Song , Hwancheol Son , Jae-seung Paick 2 1 Department of Urology, Yanggu Health Center, Yanggu-Gun (Republic of Korea) 2 Department of Urology, Seoul National University Hospital (Republic of Korea) 3 Department of Urology, Seoul National University Boramae Hospital (Republic of Korea) Purpose: Little research has been performed on complementary and alternative medicine (CAM) usage for improving sexual function. This study is conducted to study CAM usage for sexual problems and to propose a model explaining what leads men to use CAM. Materials and methods: Participants recruited via the Internet were asked to complete questionnaires about CAM usage and sexual function. Actual CAM users were allocated to group A, men who desired but did not actually use CAM were allocated to group B, and others were allocated to group C. It was presumed that men desired CAM when exposed to some risk factors of sexual dysfunction, and these are the men among that actually use CAM. Results: A total of 443 subjects of mean age of 39.2±10.2 years were included. The prevalence of CAM use for sexual function was 11.1% (Group A), and dietary supplements were the most common type of CAM. Overall mean satisfaction for the used CAM by percent was 55.5±24.2%. One hundred and ninety two men (43.3%) were allocated to Group B. By multivariate analysis, the risk factors for desiring CAM included drinking (OR=2.24, 95%CI=1.28-3.91), regarding sex an important part of life (OR=2.16; 95%CI=1.41-4.09), self-reported erectile dysfunction (OR=5.08; 95%CI=1.60-16.1), and self-reported premature ejaculation (OR=3.34; 95%CI=1.65-6.76). Smoking (OR=2.49; 95%CI=1.11-5.61) and having a positive attitude toward sexual activity (OR=3.77; 95%CI=1.42-9.99) were found to be independent risk factors of actual CAM use. On the other hand, RE (role emotion) points on the SF-36 (OR=0.22; 95%CI=0.06-0.73) and self-reported PE (OR=0.22; 95%CI=0.06-0.73) were found to be negatively related to actual use. Conclusion: Smoking, drinking, self-reported ED, self-reported PE, attitude towards sexual activity, and emotional problems play roles in decision making regarding the use of CAM. 103 OP03 SERTRALINE COMBINED WITH DESENSITIZATION TRAINING FOR TREATMENT OF PREMATURE EJACULATION: A SINGLE-CENTER EXPERIENCE IN SOUTH CHINA 1 1 1 1 1 2 2 1 Heng-Jun Xiao , Hao Zhang , Yan Zhang , Jian-Guang Qiu , Xiao-Peng Liu , Jun Chen , Bin Zhang , Xin Gao 1 Department of Urology, the Third Affiliated Hospital of SUN Yat-sen University (China) 2 Department of infertility & sexual medicine, the Third Affiliated Hospital of SUN Yat-sen University (China) Objective:To assess the clinical efficacy of Sertraline and pharmacotherapy combined with desensitization training for treatment of premature ejaculation (PE). Methods:A total of 50 male outpatients from south China who were more than 18 yr of age and in a stable monogamous relationship for 6 months were eligible if they met the ISSM criteria for PE. They were divided randomly into two equal groups. One is the pharmacotherapy group that was given 50mg of Sertraline daily for 4 weeks. The other is a combination therapy group that received oral Sertraline (25mg daily) and desensitization training twice per week for 4 weeks. The desensitization training was a behavioural technique which was used to diminish sense of subjective control of ejaculation by the clinician’s educational interventions. The therapeutic efficiency was assessed by the score of CIPE-5 (Chinese index of sexual function for premature ejaculation) and intravaginal ejaculatory latency time (IELT). Results:After 4 weeks treatment, the overall effective rate in the two groups was 85.0 % and 92.5%. The CIPE-5 score and IELT were significantly higher than those before treatment. The CIPE-5 score and IELT in the pharmacotherapy group were 12.6±3.2, 3.6±2.3 min as compared with 8.2±2.3, 0.8±0.5 min before treatment, and the combination therapy group were 16.3±4.5, 4.9±3.1 min as compared with 7.9±2.3, 0.9±0.4 min, respectively. Pharmacotherapy combined with desensitization training prolong more IELT of the patients, 4.9±3.1 min vs 3.6±2.3 min as compared with simply pharmacotherapy. There were significant differences between them (P < 0.01). The side effects of Sertraline (25mg daily) in the combination therapy group were obviously lower than those of pharmacotherapy group (50mg daily). Combination therapy helps the patients improve ejaculatory control, reduce performance anxiety, and achieve other outcomes including greater sexual satisfaction and less distress. Conclusion:The results showed that Sertraline combined with desensitization training were superior to simply pharmacotherapy on either IELT or CIPE. They suggest combination therapy be a better practice for treatment of PE with lower dosage of Sertraline. 104 OP04 THE PREVALENCE OF PREMATURE EJACULATION IN TAIWAN: EVALUATION FROM THE FEMALE PARTNERS’ PERSPECTIVE 1 2 3 4 Thomas I-Sheng Hwang , Tjin-Shing Jap , Bang-Ping Jiann , Han-Sun Chiang 1 Division of Urology, Department of Surgery, Shin Kong WHS Memroial Hospital (Taiwan) 2 Department of Endocrinology & Metabolism, Taipei Veterans General Hospital (Taiwan) 3 Kaohsiung Veterans General Hospital; * School of Medicine, Fu-Jen Catholic University (Taiwan) 4 School of Medicine, Taipei Medical University Hospital (Taiwan) Background: Premature ejaculation (PE) is a common male sexual dysfunction, which affects men and their partners. Very limited PE research performed in Chinese women, nor validated questionnaire is available for this population. This is the first study in examining the PE prevalence based on self-reported and premature ejaculation diagnostic tool (PEDT) definition for PE by female partners of men. The purpose of this study is to validate the PEDT in Chinese women population as well as to measure its relationship with women self estimated intravaginal ejaculatory latency time (IELT) in this population. Methods: A secured internet survey tool is used in collecting data from Chinese women (ages 18-65). Participants were required to complete a set of questionnaires consisted of questions on general, medical, and sexual history related to ejaculation and self estimated IELT. Results: A total of 775 Chinese women completed those questionnaires with no replicated Internet Protocol (IP) address. The PE prevalence by women self-reported and by women estimated PEDT definition for PE were 126 (16.3%) and 103 (13.3%), respectively. They are similar to those previous studies done in Western communities regardless definition of PE. The estimated IELT from women self-reported men with PE (median, 4.5 minutes) was shorter compared to those self-reported men without PE (median, 7.5 minutes). The whole group has a median of 7.5 minutes (mean 10.5 minutes, range 0.1-25.00). On the other hand, two groups (PE vs. Non-PE groups) in PEDT definition for PE had the same median of IELTs. The PEDT and estimated IELT showed a low correlation (ρ=−0.09486). From the risk analysis, the PE prevalence was positively associated with age, psychological stress and multiple partners of sexual status. For the sexual satisfaction, it had an inverse relationship with PE prevalence and a high prevalence of comorbid PE and erectile dysfunction (ED). Conclusions: PE in Chinese women is as prevalent as it in western countries when PE is defined by women self-reported and PEDT-estimated. But the PEDT is not an adequate questionnaire for women to screen among Chinese patients, especially the low association with estimated IELT. From this study's results, an adequate and validated questionnaire for female reported measures of PE should be reassessed in a further study. 105 OP05 BIOIDENTICAL DHEA (PHYTO-DHEA) ANDTHE CONVERSION OF ALBUMIN- BOUND-TESTOSTERONE TO FREEAND TOTAL TESTOSTERONE IN HYPOGONADIC MEN WITH SEXUAL DYSFUNCTION Arif Adimoelja Naval Teaching Hospital Dr. Ramelan/Men’s Health, Reproduction, Sexual Health,School of Medicine, Hang Tuah University (Indonesia) Purpose: Age-related reduction in testosterone (T) production is well known, but the exact cause is obvious. Laboratory biochemical reports in healthy youthful ages result in total-T ranging 250 - 800 mg/L. 60% are tightly bound to SHBG (sex-hormone-binding-globulin) or 38% to albumin, small fractions (2%) only are unbound or found as “free-T”. Consequently only albumin-bound and free-T constitute the bio-available form of T, which is accessible to target tissues and carry-out the action of essential sex hormones, including the sexual functions. The number of bioavailable-T is influenced by SHBG levels. Aging men experience increase in aromatase activity and elevation in SHBG production. The net result is increased in the ratio of estrogen to T and decrease in total-T and Free-T. Free-T is essential for Di-hydro-testosterone (DHT) production needed to cross the blood-brain-barrier to stimulate TARGET aggressive-centers in the brain which provoke libido. Former studies have shown that Tribulus-terrestris-L extracts contain the active agent PROTODIOSCIN, which can be converted to bioidentical DHEA, that activate the conversion of albumin-bound-T to Free-T and total-T in the presence of 5-alpha-dehydrogenase Materials and methods: 45 hypogonadic men with sexual dysfunctions were recruited. 30 subjects were non-diabetics and 15 were diabetics male patients with ED and decrease libido. They all were treated with 250 mg. Tribulus-terrestris L. extracts 3x daily for a period of 3 months Results: Improvements of libido were noted in 11 (37%) non diabetics and 2 (13%) diabetics ED patients. A total of 13 (29% patients have regained their libido within 10 days only. Increase libido and erections were noted after 3 months in 20 (67 %) non-diabetics and 8 (53 %) 15 diabetic patients. Regaining sexual desires, intercourse frequencies with good erections were noted in 28 (62 %) in all 45 ED patients. At the end of trials their total T levels were arisen significantly (p < 0.005) to normal physiological values Conclusion and comments: Bioidentical DHEA (Phyto-DHEA) exert conversion of bio-available albumin-bound-T to Free-T, total-T and reduce SHBG production in men with hypogonadism. Further trials with greater number of subjects is recommended. 106 OP06 PREVALENCE AND MOLECULAR ANALYSIS OF EJACULATORY DYSFUNCTION IN TAIWAN 1 1 1 Pei-Yu Lin , Victor Chia-Hsiang Lin , Yung-Ming Lin 1 Division of Urology, Department of Surgery, E-Da Hospital, Kaohsiung; Department of Urology, College of Medicine and Hospital, National Cheng Kung University (Taiwan) Purpose: Ejaculatory dysfunction (EjD) is a common problem among men with age more than 50 years old; however, the causes of EjD at the molecular level remain largely unknown. The aims of this study were to investigate the prevalence of EjD in south Taiwan and to explore the molecular networks and genes contributing to the causes of EjD. Materials and Methods: Male Sexual Health Questionnaire-Ejaculatory domain was delivered to 500 men with age ranged between 20 to 80 years old. Patients with bladder or prostatic carcinoma undergoing radical surgery were also enrolled, and the seminal vesicle tissues from three men with normal ejaculatory function and three men with EjD were obtained for cDNA microarray analysis. Genes that are differentially expressed were uploaded into Ingenuity Pathway Analysis software analysis for network analysis. Genes of interest were validated by quantitative real-time RT-PCR. Results: The questionnaire retrieval rate was 75.6%. Five percent of men with age less than 50 had moderate to severe EjD, and 14% of them had mild EjD. In men with age more than 50, 14% of them had moderate to severe EjD and 36% of them had mild EjD. Using age of 50 as a cutoff, older men tend to have varied extent of diminished ejaculatory volume, ejaculatory strength and prolonged time to achieve ejaculation. Of the associated five networks obtained, inflammation response-related network reveals the top one significant network. In accordance with microarray results, the transcript levels of MMP-3, MMP-14, TIMP-4 and KLK3 were significantly up-regulated and MMP-7 was significantly down-regulated in EjD group. Conclusion: Our results reveal that the prevalence of EjD increases with aging, up to 50% of older men in South Taiwan suffer from moderate to severe EjD, and inflammation process contributes to one of the causes of EjD. 107 OP07 THE IMPACT OF ANDROGEN RECEPTOR CAG REPEAT POLYMORPHISM ON ANDROPAUSAL SYMPTOMS IN AGING TAIWANESE MEN 1,2,3 Chia-Chu Liu 1,2,5 Wu 1,2 1,2 1,2 1,3 1,4 , Shu-Pin Huang , Yung-Chin Lee , Chii-Jye Wang , Wei-Ming Li , Hsin-Chih Yeh , Wen-Jeng , Chun-Hsiung Huang 1,2 1 Kaohsiung Medical University Hospital (Taiwan) 2 Kaohsiung Medical University (Taiwan) 3 Pingtung Hospital, Department of Health, Executive Yuan (Taiwan) 4 Kaohsiung Municipal Ta-Tung Hospital (Taiwan) 5 Kaohsiung Municipal Hsiao-Kang Hospital (Taiwan) Objective: Andropause or late-onset hypogonadism has become an area of interest and can cause a broad aspect of physical, psychological and sexual symptoms in aging men. In addition to a depletion of androgen, attenuated action of androgen receptor (AR) can also contribute to andropausal symptoms. The aim of study is to evaluate the impact of AR CAG repeat polymorphism on andropausal symptoms in aging Taiwanese men. Methods: From August 2007 to April 2008, a free health screening for men older than 40 years was conducted by a medical center in Kaohsiung, Taiwan. All participants received physical examination, answered questionnaires to collect their demographic information and medical histories, completed the Androgen Deficiency in the Aging Male (ADAM) questionnaire, and provided 20 cc whole blood samples for biochemical and genetic evaluation. Serum albumin, total testosterone (TT), and sex hormone-binding globulin levels were measured. Free testosterone level was calculated. AR gene CAG repeat polymorphism was determined by direct sequencing. Results: 702 men with the mean age of 57.2±6.5 years (range: 43-87 years) were included. As TT levels increased, the prevalence of andropausal symptoms was found to decrease gradually. When TT levels were above 340 ng/dl, subjects with AR CAG repeat lengths ≧25 showed significantly higher risk of developing andropausal symptoms, as compared to those with AR CAG repeat lengths ≦22 ( p=0.006), but this was not observed when TT levels were 340 ng/dl or below. Decades and number of comorbidities were also independent risk factors for andropausal symptoms. Conclusion: Both serum testosterone levels and AR CAG repeat polymorphism can influence the appearance of andropausal symptoms concomitantly. In subjects with normal TT concentration, those with longer AR CAG repeat lengths have a higher risk of developing andropausal symptoms. Further studies are needed, focusing on a multifactorial approach for andropausal symptoms and the interactions between the risk factors. 108 OP08 CONTINUOUS IMPROVEMENTS OF FEATURES OF THE METABOLIC SYNDROME OVER 48 MONTHS UPON NORMALIZATION OF SERUM TESTOSTERONE IN THREE COHORTS, IN TOTAL 410 MEN 1,2 3 2,4 5 6 5 F Saad , A Haider , A Yassin , M Zitzmann , L Gooren , E Nieschlag 1 Scientific Affairs Men’s Healthcare, Bayer Pharma AG (Germany) 2 Gulf Medical University School of Medicine (United Arab Emirates) 3 Private Urology Practice (Germany) 4 Segeberger Kliniken (Germany) 5 Centre for Reproductive Medicine and Andrology, University of Muenster (Germany) 6 Dpt of Endocrinology, VUMC Amsterdam (Netherlands) Purpose: Men with lower-than-normal serum testosterone often show features of the metabolic syndrome. This study tested the effects of normalization of testosterone over a period of 48 months in three cohorts of men, studied in three different German clinics, following the same treatment protocol. Materials and methods: The study was an observational uncontrolled study. Cohort 1 (Muenster), consisted of 281 men of whom 137 hypogonadal men (aged 40 ± 13 years) were followed up for 48 months. Of the total of 281, 59 men had late onset hypogonadism (LOH). Cohort 2 (Bremerhaven) consisted of 143 men, aged 34-78 years (mean ± SD: 62± 8 yrs)), of whom 119 had LOH. Cohort 3 (Norderstedt) consisted of 130 men aged 46-79 years (mean± SD: 61± 9 yrs) of whom 104 had LOH. The cut-off point for inclusion in the study was serum testosterone < 12 nmol/L. The three cohorts were treated with parenteral testosterone undecanoate for 48 months as the sole intervention. Statistical analysis: (STATA (Stata Corp, College Station, Texas, USA): linear mixed model for longitudinal data. Results: Plasma levels of testosterone rose from a range of 5.6- 9.7 to a range of 15.4- 19.0 nmol/L upon testosterone treatment, reaching their maximum at 9 months and remaining stable over the next 33 months. There was a remarkable progressive decline of body weight and waist circumference over the entire study period, most notably over the first 24 months. Plasma cholesterol, triglyceride, and LDL-cholesterol decreased significantly over the study period. Plasma HDL increased significantly over the first 24 months and then declined in cohort 2 but increased over 48 months in cohorts 1 and 3. Plasma glucose declined over the first 12-18 months and then stabilized. Systolic blood pressure declined over 48 months in cohort 1 and 2 and declined over 24 months to stabilize thereafter in cohort 3. In cohort 1 at baseline 240/281 men fulfilled the harmonized criteria of the metabolic syndrome1, falling to 114/281 after two years. At baseline 88/143 men in cohort 2 and 93/130 men in cohort 3 met the criteria of the metabolic syndrome by the harmonized definition. After 48 months of testosterone treatment this number had declined to 48/143 in cohort 2 and to 62/130 in cohort 3. Conclusion: In men with hypogonadism testosterone treatment over 48 months, normalizing testosterone levels to the mid-normal range led to an improvement of features of the metabolic syndrome. The improvements in the younger men with ‘classical’ primary or secondary hypogonadism (cohort 1) were of a similar magnitude as in men with LOH (cohorts 2 and 3). The most significant improvement of variables of the metabolic syndrome was noted over the first 12-24 months with further improvement over the following 24-36 months. Body weight and waist circumference declined further paralleled by improvements of cholesterol, LDL and triglycerides and systolic/diastolic blood pressure. Reference: Alberti KGMM et al., Harmonizing the Metabolic 109 Syndrome; Circulation 2009; 120: 1640-1645 OP09 EFFECTS OF 4 YEAR TESTOSTERONE TREATMENT ON COMPONENTS OF THE METABOLIC SYNDROME 1 2,3 4 A Haider , F Saad , L Gooren 1 Private Urology Practice (Germany) 2 Scientific Affairs Men’s Healthcare Bayer Pharma (Germany) 3 Gulf Medical University School of Medicine (United Arab Emirates) 4 VUMC Amsterdam (Netherlands) Purpose: Elderly men often show a concurrence of a decline of testosterone with features of the metabolic syndrome. This study tested the effects of normalization of testosterone. Materials and methods: 143 hypogonadal men (34 – 78 years, mean 62 ± 8.0 years), with testosterone levels ≤ 12nmol/L were treated with parenteral testosterone undecanoate for 4 years as the sole intervention. Results: Plasma testosterone rose from 9.7 ± 1.4 nmol/L to 19.0 ± 2.4 nmol/L at 12 months, then stabilized between 17.0 and 18.4 nmol/L during the following three years. There was a remarkable progressive linear decline of body weight, waist circumference, serum total cholesterol, triglycerides, and LDL-cholesterol over the 4 year period. Plasma glucose declined over the first 24 months. There was a significant decrease of systolic and diastolic blood pressure over the first 24 months, then values leveled off. At baseline 88/143 men met the criteria of the metabolic syndrome as defined by the by the harmonized definition; after four years of testosterone treatment this number had declined to 48/143. Conclusion: With testosterone treatment over four years, the most significant improvement of the metabolic syndrome, including blood pressure, was noted over the first 24 months but over the following 24 months improvements were at least maintained or even further improvement was observed. 110 OP10 BIOAVAILABE AND FREE TESTOSTERONE RATIOS ARE SIGNIFICANTLY ASSOCIATED WITH THE AGING MALE’S SYMPTOM SCORE OF TAIWANESE MALE 1 2 2 2 I-Ching Lee , Shih-Ping Liu , Ju-Ton Shieh , Hong-Jen Yu 1 The Department of Urology, West Garden Hospital (Taiwan) 2 The Department of Urology, National Taiwan University Hospital (Taiwan) Purpose: Testosterone decreases with age and thus causes related symptoms. The term late-onset hypogonadism (LOH) has been used to describe hypogonadism in combination with its related symptoms. Aging males’ symptoms scale (AMS) has been used widely to evaluate symptoms related to hypogonadism. Previous studies focusing on the association between AMS and serum testosterone came up with inconsistent conclusions. Our aim was to explore the association between serum testosterone related parameters and AMS. In addition, this study also explored other factors which may interfere with the association. Materials and Methods: This was a cross-sectional study with a total of 774 men aged 40 years or older receiving health checkup service at National Taiwan University Hospital (NTUH) from November 2008 to October 2009. All of them completed the AMS and blood samples were collected to determine serum testosterone levels along with other biomarkers Absolute values of testosterone were tertiled and two testosterone-related parameters were created, i.e. bioavailable and free testosterone ratios (BTR, FTR). AMS was dichotomized according to its severity. Other covariates were also adjusted in the study. Logistic regression and multinomial logistic regression analyses were used for data analysis. Results: Testosterone decreased with age (p for trend < 0.0001). The association between tertiled testosterone and AMS was inconsistent and unstable. In contrast, higher BTR and FTR showed a decreased risk of developing psychological symptoms (AOR for BTR=0.98, AOR for FTR=0.62). Higher BTR and FTR were also associated with decreased risks of developing severe overall symptoms (AOR for BTR=0.94, AOR for FTR=0.25). Similar results were also found by multinomial logistic regression. However, effect modification by some covariates, e.g., hypertension, hyperuricemia, hyperlipidemia, CRP, marital status and age, were not significant. Conclusion: Bioavailable and free testosterone ratios (BTR and FTR) are significantly associated with psychological and total AMS with protective effects. In contrast, the association between absolute value of testosterone and AMS is inconsistent and unstable. 111 OP11 POOR GLYCEMIC CONTROL IS A RISK FOR LOW TESTOSTERONE IN TYPE 2 DIABETIC MEN WITH ERECTILE DYSFUNCTION 1 Bang-Ping Jiann , Yung-Jui Huang 2 1 Department of Medical Education and ResearchKaohsiung Veterans General Hospital (Taiwan) 2 Graduate School of Human Sexuality, Shu-Te University (Taiwan) Purpose: Men with type 2 diabetes mellitus (DM) are associated with a high risk for erectile dysfunction (ED) as well as low testosterone levels. The study investigated the risk factors for hypogonadism in men with DM associated with erectile dysfunction (DMED). Methods and Materials: Men presented with the complaint of ED and a history of DM at urological outpatient clinics were enrolled into the study. Blood sampling for serum total testosterone (T) and HbA1c were determined. Diabetic history included duration of DM (yrs), treatment agents (hypoglycemic agents or insulin injection) and the presence of complications (retinopathy, vasculopathy, nephropathy and neuropathy). Demographic data included age, body mass index (BMI), and smoking habits. Comorbidities included hypertension and dyslipidemia by self-report and chart review. Erectile dysfunction was assessed by the Sexual Health Inventory for Men (SHIM). Low T was defined as total T < 300 ng/dL. Student’s t test, χ2 test, linear regression and logistic regression were used and the significant was for P < 0.05. Results: From June 2006 to June 2011, a total of 286 DMED patients were enrolled into the study and were eligible for analysis. Their mean age was 58.8 ± 11.2 yrs (21-85); mean duration of DM, 7.7 ± 1.2 yrs (0.1-40); and mean total T, 360 ± 150 ng/dL (0.2-9.0). Of them, 43% (123/286) had low T. The low T group had a higher HbA1c level (8.6% vs. 8.2%, P = 0.040) than the eugonadal group whereas there is no significant difference in the prevalence of comorbidities and severity of ED between the two groups. The odds ratio for low T in DMED men increases by 0.17 (95% CI: 0.02-0.34) per 1 increment of HbA1c (%) level (P = 0.030). Conclusion: Poor glycemic control is a risk factor for low T in men with ED associated with type 2 DM. 112 OP12 SERUM TOTAL TESTOSTERONE LEVELS IN MEN WITH ERECTILE DYSFUNCTION 1 Bang-Ping Jiann , Yung-Jui Huang 2 1 Department of Medical Education and Research Kaohsiung Veterans General Hospital (Taiwan) 2 Graduate School of Human Sexuality, Shu-Te University (Taiwan) Purpose: Several studies have evaluated the beneficial effects of testosterone supplement in hypogonadal men who failed to respond to a phosphodiesterase-5 inhibitor. The value of routine screening for testosterone deficiency syndrome (TDS) in men with erectile dysfunction (ED) remains controversial. Methods: Male subjects aged over 40 years presenting to urological outpatient clinics with ED were screened for TDS from 2004 to May 2011. TDS was defined as serum total testosterone (TT) < 300 ng/dL by one sampling, mostly in afternoon without fasting. Demographic data (age, body mass index, and smoking habit) and comorbidities were recorded at the time of screening. Comorbidities included diabetes mellitus (DM), hypertension (HT), dyslipidemia (total cholesterol >240 or triglycerides >200 mg/dL), and cardiovascular events (angiographically documented coronary artery disease, acute myocardial infarction, transient ischemic attack, stroke or peripheral arterial occlusive disease). Subjects with a history of prostate cancer, radical pelvic surgery, endocrinopathy (except DM), liver cirrhosis and chronic renal insufficiency were excluded. Control group comprised of 206 adults without ED from another study. Results: A total of 906 ED patients had TT levels with response rate 46.3% (906/1,958). Compared with the controls, the ED patients was older in age (57.0 vs. 52.6 yrs) and had a higher prevalence of DM (38.3 vs. 6.3%), HT (40.3 vs. 23.8%), hyperlipidemia (36.6 vs. 27.7%), TD (36.8 vs. 5.3%) and a lower TT level (374 vs. 550 ng/dl) (all P < 0.05). Having DM, HT, hyperlipidemia, or a higher BMI (≧24 kg/m2) was associated with a lower TT levels in ED patients. The odds ratio for ED men with a higher BMI, DM and HT to have TDS was 1.88 (95% CI: 1.25-2.83), 1.77 (95% CI: 1.28-2.44) and 1.53 (95% CI 1.11-2.12) (all P < 0.05), respectively using logistic regression. Conclusions: The ED patients have a significantly lower TT levels than the controls. Low testosterone levels in ED patients are attributed to obesity, DM, and HT. 113 OP13 KARYOTYPING OF AZOOSPERMIC MALES 1 1,2 1,2 Wei-Ming Cheng , William JS Huang , Alex TL Lin , Kuang-Kuo Chen 1,2 1 Division of Urology, Department of Surgery, Taipei Veterans General Hospital (Taiwan) 2 Department of Urology, School of Medicine, National Yang-Ming University (Taiwan) Purpose: Chromosomal abnormality is one of the causes of male infertility. It is seen more frequently in azoospermic, and severe oligozoopsermic patients with unknown etiology. These patients were usually candidates of assisted reproduction techniques (ART). In present study, we analyzed the karyotyping patterns of infertile males with azoospermia or severe oligozoospermia, and their associated clinical characteristics. Materials and methods: We retrospective reviewed patients’ log of 370 infertile males with nonobstructive azoospermia (NOA), or severe oligozoospermia from January 2004 to March 2011. Their physical examination findings, hormone profiles were also collected for analysis. Results: Seventy (18.9%) out of the 370 men were identified to have abnormal karyotyping other than 46 XY. Among these 70 patients, 48 (68.6%) were with NOA, 14 (20%) were oligozoospermia, 4 (10.3%) were ductal obstruction, 1 (10%) was normal semen analysis. Among all azoospermic men, those with abnormal karyotyping had significantly higher levels in FSH (P= 0.0007) and LH (P < 0.0001); lower in prolactin (P= 0.047) and testosterone (P < 0.0001), and smaller testes volumes (P < 0.0001). Among all patients with abnormal karyotypes, men with NOA had significantly higher FSH (P < 0.0001), higher LH (P= 0.0004), lower prolactin (P= 0.03) levels, and smaller testes volumes (P= 0.0001), comparing with oligozoospermic and obstructive azoospermic patients. There was no difference among three groups when it comes to serum testosterone (P= 0.085). 47 XXY was the most common abnormal karyotype among azoospermic patients (n= 31, 66.0%), followed by sex chromosome mosaicism (n= 5, 10.4%) and other sex chromosome abnormalities (n= 4, 8.3%). Sex chromosome anomalies were identified in 5 patients (35.7%), and inversion was associated with 4 patients (28.6%), especially inv(9) (21.4%). Der(13, 14)(10p, 10q) was noticed in 2 patients (14.3%). In 25 patients with concomitant varicoceles, 6 have mosaic sex chromosome karyotyping (24%), 20% patients have abnormal karyotyping involving chromosome 9 (inv(9) in 3 patients, t(Y, 9) in 1 patient, and t(5, 9) in 1 patient), and 12% were Klinefelter syndrome. Conclusion: The high incidence of chromosomal anomalies in infertile males with NOA suggests the need for routine genetic testing and counseling in these patients, especially when certain hormonal characteristics were reported. Specific cytogenetic abnormalities or chromosome loci might be worth of further investigation to discover their possible relationship with infertility. 114 OP14 THE CORRELATION OF GR/GR Y CHROMOSOME MICRODELETION AND AZOOSPERMIC INFERTILITY 1 1 1 1 1 1 To Chang , Wiliam J.S. Huang , Shin Lee , Yu-Chi Che , Alex T.L. Lin , Kuang-Kuo Chen 1 Division of Urology, Department of Surgery, Taipei Veterans General Hospital, and Department of Urology, School of Medicine, National Yang-Ming University (Taiwan) Purpose: The phenotypic effects of the gr/gr partial azoospermia factor (AZF) c deletion vary geographically. We evaluated the clinical characteristics of subfertile Taiwanese men with the gr/gr deletion. Materials and Methods: We retrospectively reviewed the clinical data on 371 infertile men tested for the gr/gr deletion. We collected sperm count, hormone profile, and the outcome of microdissection testicular sperm extraction (MD-TESE) regarding gr/gr status and analyzed with Chi-square and Fisher’s exact tests. Normozoospermia, oligozoospermia, and severe oligospermia were defined as ≥ 20 million/ ml, 5 to 20 million/ ml, and < 5 million/ ml respectively. Results: Among the 27 infertile men with gr/gr deletions, 12 had azoospermia (5.5% of 217 azoospermia), 6 had severe oligozoospermia (8.5% of 71), 5 had oligozoospermia (13.2% of 38), and 3 had normozoospermia (7.7% of 39). The percentage of azoospermia/severe oligozoospermia/oligozoospermia/normozoospermia in patients with gr/gr deletion was 11.5%/19.2%/23.1%/46.2%, respectively. A gr/gr deletion correlated well with greater amount of sperm production. The gr/gr deletion rate was lowest in men with azoospermia and was highest in those with oligozoospermia (P= 0.031). MD-TESE was done in 4 azoospermic men with gr/gr deletion but none were found to have sperm. The average sperm retrieval rate of MD-TESE in our institute was 42.9% for the past five years. Conclusions: In our limited data, gr/gr deletion seemed to be a poor prognostic factor for successful sperm retrieval, although we didn’t confirm gr/gr deletion to predict impaired sperm production in general population in Taiwan. Despite the established modulatory impact of the gr/gr deletion on sperm production in some populations at this time, the clinical value of testing infertile Taiwanese men for the gr/gr deletion is not clear yet. 115 OP15 TRANSURETHRAL SEMINAL VESICULOSCOPY FOR EVALUATION AND MANAGEMENT OF PERSISTENT AND RECURRENT HEMOSPERMIA: A PRELIMINARY STUDY 1 1 1 1 2 2 1 1 Heng-Jun Xiao , Xiao-Peng Liu , Hao Zhang , Yan Zhang , Jun Chen , Bin Zhang , Xiang-Fu Zhou , Xin Gao 1 Department of Urology, the Third Affiliated Hospital of SUN Yat-sen Universit (China) 2 Department of infertility & sexual medicine, the Third Affiliated Hospital of SUN Yat-sen University (China) Introduction: Hemospermia is a common and disconcerting condition in young males. Just most patients with hemospermia require only basic investigations and may be managed expectantly as it is slight and self-limited. However, in a few patients, it may be recur or persist and produce a lot of anxiety to the patient and his partner. The dilemma now is how far to treat them. This study was to assess a novel diagnostic and therapeutic technique for persistent and recurrent hemospermia. Objectives: To describe our novel technique of transutricular seminal vesiculoscopy for evaluation and management of persistent and recurrent hemospermia. Methods: The clinical data of eight patients with a course of 6 to 48 months’ (mean 12 months) hemospermia, who were underwent by transurethral seminal vesiculoscopy from 2008 Sep in our department, were analyzed retrospectively and literatures were reviewed. The age ranged from 26 to 55 years (mean 42). The hemospermia were not cured by medical treatment or any other physical therapy. All of eight patients presented persistent or recurrent hemospermia. The definite etiologies of persistent and recurrent haemospermia were excluded by physical examination including blood pressure measurement and digital rectal examination, blood PSA and clotting time, and further imaging investigation such as TRUS, CT or MRI. The ejaculatory duct and seminal vesicle were conducted to observe under direct vision through the distal seminal tracts using a 7F rigid ureteroscope. Results: Transurethral seminal vesiculoscopy was successfully performed in the 8 cases and the mean operative time was 35 min (range 20-75). Eight patients were confirmed by transurethral seminal vesiculoscopy (five seminal vesiculitis, two seminal stone and one vas deferens obstruction). There were no complications including injury of urethra, ejaculatory duct and seminal vesicle. None of them presented postoperative discomforts in the perineal region or reproductive tract infections. The mean follow-up period was 10 months (range 3-24). Hemospermia in 7 cases disappeared and 1 patient recurred in 9 month after receiving transurethral seminal vesiculoscopy. Conclusions: Transurethral seminal vesiculoscopy could be an effective diagnostic and therapeutic approach to persistent and recurrent hemospermia as it is performed easily using slender rigid ureteroscopy with minimal complications. 116 OP16 LAPAROENDOSCOPICSINGLE-SITE ASSISTED MALE-TO-FEMALE SURGERY 1 1 1 Abai Xu , Chunxiao Liu , Shaobo Zheng 1 Department of Urology, Zhujiang Hospital, Southern Medical University (China) Purpose: To report laparoendoscopic single site (LESS) assisted male-to-female (MtF) genital sexual reassignment surgery (SRS) in 4 cases. Materials and methods: Between July and Jun 2011, 4 adolescents were diagnosed of male pseudohermaphroditism with bilateral undescended testes, and perineal hypospadias was found in two cases. Chromosomes analyses confirmed each their genetic gender was male, but their social and psychological gender characteristics were female undoubtedly. After thorough discussion with themselves and their parents, they decided to maintain their current gender identity as girls. After got the approval of local ethical committee, we performed MtF transsexual surgery with laparoendoscopic single site technique. After a 3 cm periumbilical curved incision was made, the homemade single port was inserted, following resection of bilateral cryptorchidism. Sigmoid vaginoplasty and perineoplasty were performed in two perineal hypospadias cases without vagina. Results: LESS assisted transsexual were successfully performed without morbidity. Mean operative time was 127 minutes, and mean estimated blood loss was 52.8 ml. Neither conversion to open or laparoscopic surgery nor blood transfusion was needed. All 4 patients were discharged home on postoperative day 10. The periumbilical incisions were nearly invisible 1 month postoperatively. Hormone therapy was under way according to endocrinologist’s guidance. Conclusion: Laparoendoscopic single-site assisted Male-to-female transsexual surgery for male pseudohermaphroditism was safe and feasible, and gained satisfactory cosmetic results. LESS assisted SRS might be alternative option to selected male pseudohermaphroditism patients. 117 OP17 OUTCOMES OF MUTLI-OPERATION FOR INTERSEX PATIENTS: A REPORT OF 18 CASES 1 1 1 1 Hui Zhu , Yun Long , Yongyan Cui , Lida Zhuang , Junjun He 1 1 Department of Plastic Surgery, Peking University Shenzhen Hospital (China) Purpose: To summarize the application of multi-operation for intersex patients. Materials and methods: Before operation the patients’ diagnoses had all been confirmed by physical examinations, endocrinological lab work, cytogenetic analysis (chromosome karyotype and SRY gene), ultrasound examination and biopsy; MRI scan might be taken when necessary. The main procedures including gonad removal were performed either by cryptorchidectomy or oophorectomy. External genitoplasty had been performed such as phalloplasty, metoidioplasty, clitoroplasty, labioplasty, vaginal reconstruction, and other vulvoplasty as well if needed. Certain additional cosmetic procedures were applied to improve the patient’s secondary male or female characteristics. All patients should have long-term replacement of hormones, and original disease treatment after operation. Results: From April 2004 to March 2008, 18 intersex patients were treated with multi-operation method. Among these cases, 8 were female pseudohermaphrodism, of which 7 underwent feminizing operations and 1 masculine operation, 9 were male pseudohermaphrodism, 6 of which underwent feminizing operations and 3 masculine operations, 1 was true hermaphrodism and underwent feminizing operation. By postoperative follow-up for 4 to 36 months（14 cases）, 2 of the patients had married, 6 had steady sex partners. Results showed that patients were satisfied with their gender appearance including genitalia and secondary sex characteristics, those with sex partners could achieve successful sexual intercourse. Compared with pre-operation, patients found that their gender assignments were more clearly identified, and their quality of life (QoL) significantly improved Conclusion: The main treatment for intersex patients is Gender Assignment or Re-assignment Surgery according to the desire of the patients. Important contributing factors include comprehensive pre-operation examination, proper treatment planning, and precise plastic surgery techniques. 118 OP18 COMPARISON OF TRANSRECTAL ULTRASONOGRAPHY BETWEEN POTENT BENIGN PROSTATIC HYPERPLASIA PATIENTS WITH AND WITHOUT ERECTILE DYSFUNCTION AFTER TRANSURETHRAL RESECTION OF PROSTATE 1,2 Shiou-Sheng Chen 1 Division of Urology, Taipei City Hospital Renai Branch (Taiwan) 2 School of Medicine, National Yang-Ming University (Taiwan) Purpose: To assess in a prospective study the use of variables, presumed circle area ratio (PCAR), resistive index (RI) and maximal horizontal area of seminal vesicle (MHA), for evaluating the differences between potent benign prostatic hyperplasia (BPH) patients with and without erectile dysfunction (ED) after transurethral resection of prostate (TURP). Materials and methods: Between August 2004 and November 2010, 98 potent men (mean age 63.1 years, range 54-75) with symptomatic BPH were included for evaluation. Transrectal power Doppler ultrasonography (TRS) was done before and 12 months after TURP for all the patients. PCAR is the ratio of the area of the maximum horizontal section of the prostate by TRS to the area of a presumed circle of which the circumference is equal to the circumference of the maximum horizontal section (to evaluate how closely the shape of the section approaches a circle). RI is to detect the blood flow in the prostate by TRS. Five-item version of the International Index of Erectile Function (IIEF-5) was used for evaluation of sexual function before and after TURP in all the patients. Results: Of the 98 patients (IIEF-5: 21.2 ± 3.5, before TURP), 17 (17.3 %) had ED (IIEF-5: 10.2 ± 3.2) after TURP. The IIEF-5 was 20.2 ± 3.1 for the other 81 subjects without ED after TURP. No significant difference of age between the patients with and without ED after TURP (61.8 ± 7.5 vs. 63.9 ± 8.3 years). Patients who had ED after TURP had significantly lower PCAR, RI and MHA and than those without ED (0.67 ± 0.04 vs. 0.89 ± 0.06; 0.59 ± 0.04 vs. 0.77 ± 0.08; 4.7 ± 1.5 vs. 7.5 ± 2.3, respectively). Conclusion: Potent BPH patients who had ED after TURP had lower PCAR, RI and MHA than those without ED after TURP In other words, more extended TURP might induce higher incidence of ED in potent BPH patients after TURP. 119 OP19 THE COMPARISON OF THE AGING MALE SYMPTOMS (AMS) SCALE AND ANDROGEN DEFICIENCY IN THE AGING MALE (ADAM) QUESTIONNAIRE TO DETECT ANDROGEN DEFICIENCY IN AGING TAIWANESE MEN 1 1,2 1,3 1,2 1,3 1,2,4 Kuang-Shun Chueh , Shu-Pin Huang , Yung-Chin Lee , Chii-Jye Wang , Hsin-Chih Yeh , Wei-Ming Li 1,2,5 Wu 1 1 1 1,2 , Wen-Jeng 1,4 , Yueh-Fong Tsai Chia-Chun Tsai , Hsu-Cheng Juan , Chun-Hsiung Huang , Chia-Chu Liu 1 Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University (Taiwan) 2 Department of Urology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University (Taiwan) 3 Graduate Institute of Medicine, Kaohsiung Medical University (Taiwan) 4 Pingtung Hospital, Department of Health, Executive Yuan (Taiwan) 5 Department of Urology, Kaohsiung Municipal Hsiao-Kang Hospital (Taiwan) Purpose: To compare the AMS scale and ADAM questionnaire to detect androgen deficiency in aging Taiwanese men. Materials and methods: In April 2008, a free health screening was conducted by Kaohsiung Medical University Hospital. All participants completed a health questionnaire and had blood samples drawn between 8:00 and 12:00 AM. Serum total testosterone (TT), albumin, and sex hormone-binding globulin (SHBG) levels were measured. The level of free testosterone (FT) was calculated. Clinical symptoms suspected of androgen deficiency were screened by using the AMS scale and ADAM questionnaire. Androgen deficiency was defined as TT < 300 ng/dl or both TT < 300 ng/dl and FT < 5 ng/dl. Results: In total, 339 men were included in the final analysis with the mean age of 54.6 ± 4.9 years (range: 47-65 years). Androgen deficiency was found in 75 men (22.1%) based on the criteria of TT < 300 ng/dl, and 54 men (15.9%) based on the criteria of TT < 300 ng/dl and FT < 5 ng/dl. When detecting participants with both TT < 300 ng/dl and FT < 5 ng/dl, the sensitivity and specificity of the AMS scale were 57.4% and 48.1%, compared to 66.7% and 25.6% of the ADAM questionnaire. Conclusion: In a sample of aging Taiwanese men, neither AMS scale nor ADAM questionnaire had sufficient sensitivity and specificity to detect androgen deficiency. In addition to using those two screening instruments, a thorough physical and biochemical work-up should still be conducted in patients at risk or suspected of androgen deficiency. 120 OP20 RISK OF ERECTILE DYSFUNCTION IN TYPE 2 DIABETIC MEN WITH ALBUMINURIA 1 2 2,3 1 3 4 Yao-Chi Chuang , Min-Shen Chung , Pei-Wen Wang , Wei-Chia Lee , Chung-Dar Chen , Hsueh-Wen Chang , Kuender 5 6 2 D. Yang , Michael B. Chancello , Rue-Tsuan Liu 1 Division of Urology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine (Taiwan) 2 Division of Metabolism, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine (Taiwan) 3 Department of Nuclear Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine (Taiwan) 4 5 Department of Biological Sciences, National Sun Yat-Sen University (Taiwan) Department of Medical Research, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine (Taiwan) 6 Department of Urology, Oakland University William Beaumont School of Medicine, Royal Oak, (United States) Purpose: Erectile dysfunction (ED) is a frequent comorbidity in diabetic men, and is frequently overlooked in routine clinical evaluation. Albuminuria is a marker of endothelial dysfunction and may link to ED. The study evaluated the association of albuminuria, and risk factors of ED in men with type 2 diabetes at a diabetic center. Materials and methods: The diagnosis of ED was based on a self –administered questionnaire containing Sexual Health Inventory for Men. Urinary albumin excretion rate was determined by urine albumin-to-creatinine ratio (UACR) in spot urine. The clinical variables, and diabetes associated complications to risk of ED were evaluated. Results: Of 455 consecutive patients, 82.0%, 28.1%, and 35.8% reported having ED, severe ED, and albuminuria, respectively. The UACR level was significantly higher in ED (0.20± 0.83) and severe ED (0.34±1.18) groups compared to non ED group (0.07± 0.33). The presence of albuminuria adjusted for age and duration of diabetes was significantly associated with ED (OR=2.76), and macroalbuminuria has stronger impact (OR= 4.49) than microalbuminuria (OR= 2.48). The other associated risk factors included hypertension, higher level of systolic BP, lower level of serum hemoglobin, and estimated GFR. The presence of retinopathy, neuropathy, and higher level of HbA1c further correlated with severe ED. Total testosterone level, hsCRP level, and the presence of metabolic syndrome were not risk factors. Albuminuria Hypertension (%) Systolic BP (mmHg) 2 eGFR (ml/min/1.73 m ) Hemoglobin (g/dL) Albumin (mg/dL) Normal albuminuria Microalbuminuria Macroalbuminuria OR of ED (95% CI) 2.76 (1.46-5.21) 1.98 (1.98-1.13) 1.02 (1.01-1.04) 0.99 (0.97-1.0) 0.83 (0.69-0.99) 0.31 (0.11-0.85) P value 0.002 0.017 0.007 0.035 0.039 0.022 OR of ED (95% CI) 1.0 P value 2.48 (1.26-4.88) 0.008 OR of severe ED (95% CI) 1.0 2.87 (1.26-6.53) 4.49 (1.01-20.00) 0.049 10.21 (1.94 - 53.58) P value 0.006 0.012 Conclusion: Albuminuria is the most important independent risk factor of ED in diabetic men after adjustment of age and DM duration. Identification and control of albuminuria, and other associated risk factors might play a role in early diagnosis and treatment of ED. 121 OP21 CLINICAL EVALUATION FOR ERECTILE DYSFUNCTION IN MEN UNDER 40 YEARS OLD 1 Bang-Ping Jiann , Yung-Jui Huang 2 1 Department of Medical Education and Research Kaohsiung Veterans General Hospital (Taiwan) 2 Graduate School of Human Sexuality, Shu-Te University (Taiwan) Purpose: Erectile dysfunction (ED) is a common medical condition in men over 40 years old and is attributed mainly to organic factors. ED in men under 40 years old is relatively less common and is believed mainly due to psychological problems. We report the results of clinical evaluation for ED in men under 40 years old. Methods and Materials: ED men ( < 40 y/o) presented at urological outpatients clinics were enrolled into the study. Clinical evaluation involves detailed sexual history (marital status, early morning erection, history of masturbation and onset of disease), physical examination, demographic data (body mass index) and history of substance abuse (illicit drugs, smoking and alcohol consumption). Comorbidities were assessed by self-report of diabetes, hypertension and dyslipidemia. Laboratory studies include blood sampling for SMA-12 and total testosterone (TT) levels and penile Doppler study with injection of prostaglandin E1 20μg. Evaluation for psychological stress was accomplished by 7-item dichotomized questions. Erectile function was assessed by the Sexual Health Inventory for Men (SHIM). Results: A total of 235 eligible patients were enrolled into study from Jun. 2006 to Jul. 2011. Mean age was 31.8 ± 5.1 yrs (18-39) and 70% (164/235) of them were older than 30 yrs. ED severity was mild in 37.3%, mild to moderate in 17.3%, moderate in 4.5% and severe in 2.7%. About one third of men reported to have normal early morning erections or normal erection upon masturbation, 25.6% have premature ejaculation, 33.8% were current smokers and 2.8% had a history of illicit drug abuse. Obesity (BMI ≧27kg/m2) was found in 22.1% of all patients and hypogonadism (TT < 300 ng/dL) in 16.1%. Hypertension and diabetes was reported in 6.4% and 3.4%, respectively. Penile Doppler study reported normal in 60.4% (93/154) and abnormal in 61 (154) and there is no significant difference in the demographic data and the variables between them. Psychological screening revealed that all had at least one positive answer with one positive in 81.0% (189/233) and 2 positives in 17.2% (40/233). Conclusion: Besides having psychological stress, organic factors, such as vascular disorders, smoking, obesity, hypogonadism, and dyslipidemia were commonly found in men with ED younger than 40 years. 122 OP22 THE EFFECT OF CIRCUMCISION ON YOUNG ADULT SEXUAL FUNCTION 1 1 1 1 1 1 1 Ming-Hsin Yang , Chih-Wei Tsao , En Meng , Sheng-Tang Wu , Guang-Huan Sun , Dah-Shyong Yu , Sun-Yran Chang , 1 Tai-Lung Cha 1 Division of Urology, Department of Surgery, Tri-Service General Hospital (Taiwan) Objective: Whether sexual function is affected by circumcision is a subject of considerable debate among advocates and opponents of circumcision. We analyze the sexual function results of young men between the uncircumcised and circumcised states. Methods: From January 2009 to June 2010, 277 patients who received circumcision at the Urology Section in the Tri-Service General Hospital were enrolled. Before circumcision, their sexual performance was evaluated as the international index of erectile function-5 (IIEF-5) and the Brief Male Sexual Function Inventory (BMSFI) scores. The IIEF-5 and BMSFI scores were repeated after a postoperative interval of 90 days. The scores in five main domains of the BMSFI and IIEF before and after circumcision were analyzed. Results: A total of 210 patients were available for follow up. The mean age of subjects was 26.44±6.06 years (range 19-35 years). Indications for circumcision included phimosis in 35.7% of cases, personal hygiene in 14.8%, cosmetics in 15.7%, request by sexual partners in 11.9%, pain when erection in 5.2%, balanitis in 4.3%, ... etc. The differences in the BMSFI scores were statistically significant (p= 0.003), especially in increasing sexual drive after circumcision (p < 0.001). Besides the IIEF-5 score showed no statistically difference before and after circumcision (p= 0.29), however the subjects had more confidence of erection after circumcision (p < 0.001) and slightly increase the difficulty to maintain erection to completion of intercourse (p=0.042). Conclusion: Our findings may help urologists better counsel men who receive circumcision as adults. The sexual performance after circumcision seems improved, especially in the sexual drive and mental confidence of erection. 123 OP23 MEDICAL COMORBIDITY ASSOCIATED WITH ERECTILE DYSFUNCTION: A POPULATION-BASED STUDY 1 Wei-Che Wu , Shiu-Dong Chung 1,2,3 4,5 , Kuan-Ming Chiu , Herng-Ching Lin 3 1 Division of Urology, Department of Surgery, Far Eastern Memorial Hospital (Taiwan) 2 Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University (Taiwan) 3 School of Health Care Administration, Taipei Medical University (Taiwan) 4 Division of Cardiovascular Surgery, Cardiovascular Center, Far Eastern Memorial Hospital (Taiwan) 5 Department of Eldercare, Oriental Institute of Technology (Taiwan) Introduction: Erectile dysfunction (ED) is usually associated with systemic disorders. However, data regarding the prevalence of medical comorbidities among men in Eastern or Western countries with ED remains sparse. Aim: To analyze the prevalence and risk of 37 medical comorbidities in patients with ED compared with the general population. Methods: A total of 2,453 patients with ED and 12,265 matching controls were selected for analysis from the Taiwan National Health Insurance Research Dataset, 2000. We chose 22 comorbidities from the Elixhauser Comorbidity index, 10 highly prevalent medical conditions in an Asian population and 5 male gender-specific comorbidities for analysis. Main outcome measurement: Conditional logistic regression analyses conditioned on age group and monthly income were performed to investigate the risk of various comorbidities for patients with and without ED, after adjusting for geographic region and level of urbanization of the patient’s community. Results: Patients with ED were at increased risk for multiple systemic comorbidities. Conditional regression analyses showed that compared to patients without it, patients with ED had higher odds of alcohol abuse (OR=3.58), drug abuse (OR=2.34), ankylosing spondylitis (OR=2.23), peripheral vascular disorder (OR=2.18), psychoses (OR=2.04), depression (OR=1.97), ischemic heart disease (OR=1.94), uncomplicated diabetes (OR=1.92), complicated diabetes (OR=1.89), comorbid hyperlipidemia (OR=1.68), hepatitis B or C (OR=1.68), hypertension (OR=1.57), chronic pulmonary disease (OR=1.56), cardiac arrhythmias (OR=1.55), renal failure (OR=1.50) and stroke (OR=1.41). Conclusion: The results show that patients with ED have a higher prevalence of multiple non-cardiovascular comorbidities than the general population in Taiwan. The results provide epidemiological data for comorbidities among men in an Asian population with ED. 124 OP24 ERECTILE DYSFUNCTION SHOCK WAVE THERAPY- A NEW TREATMENT MODALITY IN THE MANAGEMENT OF ERECTILE DYSFUNCTION: PATIENT SELECTION AND OPTIMIZING STRATEGIES 1 2 Vasan Satya Srini , Srinivas B.V 1 DNB- UROLOGY, Director and Head of Department Andrology, Ankur Health Care Private Limited (India) 2 MS- General Surgery, Fellow Andrology, Ankur Health Care Private Limited (India) Purpose: Erectile Dysfunction Shockwave Therapy (EDSWT) has brought new hope in the management of Erectile Dysfunction. Its role in treatment of ED has not been established to date, however its application in different medical disciplines to treat various organ dysfunction owing to its property of neovascularisation has proved its worth. Our objective was to evaluate the efficacy of EDSWT on men with erectile dysfunction (ED), to analyze its effect on various subgroups and predict the indications of the usage of EDSWT. Materials and methods: We conducted a double- blind randomized placebo controlled study at a single tertiary andrology hospital setting. A total of 112 patients diagnosed to have arteriogenic erectile dysfunction who had International Index of Erectile Function ED (IIEF-ED) domain scores between 3 and 18 (average: 8.25) and abnormal nocturnal penile tumescence (NPT) parameters were enrolled for the study after obtaining written consent. 29 patients were lost for follow up. 83 patients completed the study with a follow up period of 12 months. The study group were divided into 3 groups, the first group comprised of 26 patients who had responded to oral phosphodiesterase type 5 inhibitors (PDE5-I) prior to the study, the second group comprised 32 patients of non responders to PDE5-I and rest 25 formed patients who had not been on any therapy for ED before. Shockwave therapy comprised two treatment sessions per week for 3 weeks, which were repeated after a 3 week no-treatment interval. Assessment of erectile function was performed objectively by Doppler ultrasound examination. Follow up assessments with IIEF- ED questionnaire and doppler ultrasound examinations were done at 6 and 12 months periods. Results: We evaluated 83 middle-aged men (average age: 39.5 yr) with arteriogenic ED (mean duration: 2.08 years). Among the 83 patients, 51 of them had co-morbidities. 27 had Diabetes mellitus, 26 had hypertension and 12 had hypercholesterolemia. At 6 months of follow-up period, significant increases in IIEF-ED domain scores were recorded in all men (23.30±3.37 vs 7.85±2.68, p < 0.001); these remained unchanged after 12 months. Significant increases in the duration of erection and penile rigidity were also recorded. Doppler ultrasound study objectively recorded the improvement in penile blood flow parameters in terms of peak systolic velocity, end diastolic velocity, vessel wall circumference, vessel wall thickness, pulsatality index, resistivity index. 14 out of 26(53.85%) patients belonging to PDE5-I responders group required no more therapy. 22 out of 32(68.75%) patients belonging to PDE5-I nonresponders group improved among which 9(28.12%) required no more therapy and rest (71.88%) required phosphodiesterase type 5 inhibitors during follow up. No adverse events were noted during procedure and in follow-up. Conclusion: This is the first study in literature that assessed the efficacy of EDSWT for ED based on both subjective and objective evidence. The treatment has shown promising results in its efficacy of improvement of erectile function and the fact that the effects were natural, long lasting and measurable improvement gives a hope in attainment of a possible cure to Erectile dysfunction which no other therapy has been able to provide to date. Similar studies with larger number and longer follow-up needs to be evaluated to establish the definite role of EDSWT in the management of ED. 125 OP25 CURRENT STATUS AND STRATEGY FOR COUNTERFEIT ERECTILE DYSFUNCTION MEDICATION (PHOSPHODIESTERASE TYPE 5 INHIBITORS) IN JAPAN: A FOUR-COMPANY SPONSORED SURVEY ON DRUGS OBTAINED VIA THE INTERNET 1 2 2 3 4 Ken Marumo , Nobuhisa Ishii , Minoru Sugita , Koichi Nagao , Haruaki Sasaki 1 Department of Urology, Tokyo Dental College, Ichikawa General Hospital (Japan) 2 Toho University (Japan) 3 Department of Urology, Toho University School of Medicine (Japan) 4 Department of Urology, Showa University Fujigaoka Hospital (Japan) Purpose: Counterfeit medication is a dangerous and growing problem. This consumer survey assessed awareness and behavior with regard to the counterfeit medicine threat in Japanese men who purchased medications for erectile dysfunction (ED) through hospitals compared with those who purchased via the Internet. Methods: Nationwide online surveys were conducted in Japanese men aged ≥30 years. Men were required to have used medication for the treatment of ED and to have purchased ED medication between July 2010 and the time of the survey (February/March 2011). Proportions were reported; no statistical testing was performed. Results: Of 804 participating men, 288 purchased medication only at hospitals and 276 made purchases using only the Internet. Hospital and Internet purchasers averaged 50.1 and 49.7 years of age, respectively. 97.2% of hospital purchasers and 97.5% of Internet purchasers agreed that there are counterfeit ED medications on the Internet. Internet purchasers believed that the average proportion of counterfeit ED medication on the Internet was 42.0% versus 55.5% for hospital purchasers. More hospital than Internet purchasers believed that the proportion of counterfeit ED medication on the Internet exceeds 50% (73.6% vs 52.5%, respectively). 87.7% of Internet purchasers believed that their most recently purchased ED medication was genuine. More hospital than Internet purchasers believed that they could not distinguish genuine ED medication from counterfeits (95.1% vs 75.4%, respectively); 85.1% and 72.1% believed that ED medications purchased via the Internet could be counterfeit even if they worked. After purchasing ED medications via the Internet, 14.9% of Internet purchasers began receiving direct mail and 17.8% began receiving spam E-mail; credit card information was stolen from 3 individuals and 2 began to receive magazines. Internet purchasers received a greater number of tablets per transaction than hospital purchasers (19.6 vs 7.6 tablets, respectively). Top concerns regarding the risks of counterfeit medications for hospital purchasers were that ingredients are not guaranteed (84% agreement), that manufacturing might occur in a less-than-hygienic manner (69%), and that the product might not work (68%); top concerns for Internet purchasers were lack of guaranteed ingredients (34%), the possibility of personal information being leaked (28%), and unhygienic manufacturing (27%). Among Internet purchasers, 42.8% reported side effects from Internet-purchased ED medications, most commonly headache (41.5%), flushing (40.7%), nasal congestion (18.6%), and palpitations (16.1%); 90.7% did not do anything about these side effects (5.1% used an over-the-counter medication, 2.5% talked to a friend, and 1.7% cited “other” actions). After experiencing these side effects, 69.5% of Internet purchasers continued to purchase from the same website (18.6% switched websites) and 9.3% stopped using ED medication. Conclusion: Awareness of the possibility of counterfeit medications on the Internet was high in both hospital-only and Internet-only ED medication purchasers. However, Internet-only (versus hospital-only) purchasers believed that a smaller proportion of ED medication available on the Internet is counterfeit and 88% believed that their most recent Internet-purchased ED medication was genuine. Internet purchasers were generally less concerned about the risks associated with Internet-purchased ED medication and did not often change their behavior even after experiencing side effects. 126 OP26 MORE PSYCHOGENIC OR MORE ORGANIC? A MULTICENTRAL INVESTIGATION OF ERECTILE DYSFUNCTON ETIOLOGY IN CLINIC OUTPATIENTS IN CHINA 1 1 1 1 Yuxin Tang , Xianzhen Jiang , Leyeo He , Dongjie Li 1 Department of Urology, Third Xiangya Hospital, Central South University (China) Purpose: To assess the primary etiology composition and age structure of erectile dysfunction (ED) in men visiting outpatient clinics in China. Materials and methods: Primary etiologies of 3327 consecutive ED patients (mean age 38.25 years) were identified using various diagnostic tools in the urology/andrology clinics of five hospitals. All of these subjects complained of the inability to achieve and/or maintain erection of sufficient rigidity and duration to permit satisfactory sexual performance. Severity of ED was evaluated with the simplified International Index of Erectile Function (IIEF-5). Patients underwent independent evaluations by an experienced urologist or andrologist. Their diagnostic steps and classification were based on EAU guidelines on erectile dysfunction (update March 2005). They judged the most primary cause on the basis of history taking, physical examination, psychological evaluation, laboratory testing, and even specific tests. Spearman correlations were used to assess the association between IIEF and age; two samples’IIEF scores were evaluated using an Wilcoxon rank sum test; multiple samples were evaluated using an Kruskal-Wallis H test. The association between different ranked datas (severity of ED vs age group) was investigated using Kendall’s tau-b correlation coefficients; P < 0.05 was considered statistically significant. Results: Most patients (95.0%) were younger than 60 years, and none patients was older than 70 years. Psychogenic patients is younger (36.53 years) and more (56.1%) than other patients. Vasculogenic factors were major etiology of organic ED (20.1%). There was significant difference in age structure between psychogenic ED and organic ED (p=0.000). Diabetes, hypertention, coronary artery disease, and hyperlipidaemia were significant in affecting the severity of ED in a statistical model that included age and primary etiology. IIEF scores decreased with age (rs=-0.199, p=0.000). The percentage of severe and moderate cases increased with age (p=0.003, p=0.002, respectively), yet the constituent ratio of patients was sharp decline from to 30.3% to 4.5% with age. Conclusion: Psychological origin is the major pathophysiological cause of ED in the males visiting outpatient clinics in China. The mean age is younger in men visiting outpatient clinics in China. Many older men with ED unwillingly go to hospital for this problem. All above consequences are partly associated with social and cultural factors. This situation might be improved with appropriate public health education and clinical management. 127 OP27 CLINICAL CHARACTERISTICS OF YOUNG MEN WITH ERECTILE DYSFUNCTION 1 1 1 1 Yung-Ming Lin , Johnny Shinn-Nan Lin , Chih Hsien Hung , Wen Horng Yang 1 Department of Urology, College of Medicine, National Cheng Kung University (Taiwan) Purpose: Erectile dysfunction (ED) can occur at any age, but it is more common in men older than 40 years of age. This study was conducted to investigate the clinical characteristics of ED men younger than 40 years. Materials and Methods: From January 2008 to December 2010, a total of 501 men attending National Cheng Kung University Hospital with a chief complaint of ED were enrolled in this study. Each patient underwent history-taking, physical examination, serum biochemistry testing, penile biothesiometry and penile duplex Dopper ultrasonography. The patients younger than 40 years of age were retrospectively reviewed. Results: Of the 501 patients, two were less than 20 years old (0.4%), 17 were between 20 and 29 years old (3.3%) and 70 were between 30 and 39 years old (14%). Thus, young people accounted for 17.7% (89/501) of all ED patients. Dyslipidemia is the most significant common co-morbidity in our patient population. Of the 89 young patients, two (2.2%) had abnormal biothesiometry result. Results from penile duplex Doppler revealed that 44 patients were categorized as having arterial insufficiency (AI) and 28 patients having veno-occlusive dysfunction (VOD). Five (26.3%) or eight (42.1%) out of 19 patients with age less than 30 years had AI or VOD, respectively. Thirty-eight (54.3%) or 20 (28.6%) out of 70 patients with age between 30 and 39 years had AI or VOD, respectively. Conclusion: Vascular disease accounts for 58.4% of the cause of ED in young males, and dyslipidemia correlates significantly with the presence of vascular disease. Most young men with ED possess organic factors, which merits the attention of physicians and further clinical investigation. 128 OP28 A NATION-WIDE POPULATION STUDY OF TRAZODONE USE IN UROLOGICAL PATIENTS 1 1,2 1,2 1,2 3,4 Wei-Ming Cheng , Tzu-Ping Lin , Alex T. L. Lin , Kuang-Kuo Chen , Tzeng-Ji Chen 1 Divisions of Urology, Department of Surgery, Taipei Veterans General Hospital (Taiwan) 2 Department of Urology, School of Medicine, National Yang-Ming University (Taiwan) 3 Department of Family Medicine, Taipei Veterans General Hospital (Taiwan) 4 Division of Family Medicine, Department of Medicine, School of Medicine, National Yang-Ming University (Taiwan) Purpose: Erection dysfunction (ED) has been a prevalent disease worldwide. In a recent report, the prevalence of ED is estimated to be 27% among Taiwanese men older than 40 years old. Trazodone is a 2nd generation antidepressant found in the 1960’s and was approved by Food and Drug Administration (FDA) in 1981, it is an antidepressant of the serotonin antagonist reuptake inhibitor(SARI) class. Some evidence has suggested that trazodone may be helpful in improving the sexual dysfunction, especially arousal problem. Though in controversy, it is sometimes off-label used for erectile dysfunction or arousal problem in urological patients. To have a global view of this off-label use in Taiwan, a nation-wide cross-sectional analysis of urological use of trazodone was done using the National Health Insurance Research Database (NHIRD). Materials and methods: 1/500 randomly-sampled outpatient visits dataset in NHIRD were used to estimate the total and urological prescription visits of Trazodone, stratified by year. Then 1-million randomly-selected dataset issued in 2005 was used to analyze the refill rate and the age at 1st prescription and the diagnoses assigned to the prescription visits. Results: As expected, the prescription visits in urology were almost exclusive of female patients. The prescription increased rapidly since 1998, maintained till 2003, and then declined gradually, corresponding to the marketing of three phosphdiesterase-5 (PDE-5) inhibitors. The diagnoses assigned to the prescription visit were mostly impotence-associated diagnoses, accounting for about 55%, while depression-associated diagnoses accounted for less than 13%. Conclusion: Trazodone use in urological field is an existing fact in Taiwan, mainly used for ED, and there was a trend correlated and influenced by the marketing of three PDE-5 inhibitors between 1997 and 2008. The prescription of trazodone was more prevalent and regular for the elderly, instead of young patients. 129 OP29 MICROSURGICAL EXCISION OF URETHRAL HAIR ROOTS IN PATIENTS WITH A HISTORY OF SURGICAL TREATMENT OF HYPOSPADIAS DURING CHILDFOOD 1 1 1 1 1 1 Koichi Nagao , Jian-lin Hu , Toshihiro Tai , Yumi Ozaki , Hideyuki Kobayashi , Koichi Nakajima 1 Department of Urology, Toho University School of Medicine (Japan) Introduction: Children who undergo hypospadias surgery can later develop pubic hair growth in the urethra. This condition is believed to be due to the need to use scrotal skin during urethroplasty, due to an insufficient quantity of foreskin. The clinical response to such hairs is often to simply pluck them out when they protrude from the external urethral opening; however, later regrowth is virtually certain in such cases. To remove hairs permanently, two surgical techniques are now used: electrolytic cauterizing of the hair roots after surgically opening the urethra, and excision of urethral tissue with the hair roots, followed by replacement of this tissue with a buccal mucosa graft transplant. With electrolytic cauterization, it is difficult to ensure that the hair follicles are completely cauterized, and there remains the possibility of regrowth from incompletely cauterized follicles. With the latter operation, a graft of the buccal mucosa is necessary because of the lack of sufficient tissue in the penis. In addition, this procedure requires repeat surgery. This case report describes a new surgical technique, developed by the authors, that uses a surgical incision of the dorsal urethra followed by microsurgery to completely excise hair follicles. Thus, in a single operation, the patient can be effectively treated, with no chance of recurrence. Case 1: A 42-year-old man presented with pain on erection, urethral bleeding, and hematospermia. He had a history of surgery for hypospadias at age three years. Since then, hair had appeared in his urethra and had been regularly removed by simple plucking. For several years, he had pain during erection, together with hematospermia and urethral bleeding. When he presented for treatment at our department in June 2010, ureteroscopy clearly revealed hair growth in the urethra and urethral stricture. Using a longitudinal incision along the dorsal urethra, it was opened and examined for the presence of hair. Microsurgery confirmed the presence of 14 pubic hair follicles, which were completely excised. The follicles were located from 3.5 to 4 mm below the urethral wall and were producing hairs that grew diagonally outward into the urethra. Eight months later, ureteroscopy confirmed the complete absence of any hair growth, and the patient is without symptoms. Case 2: A 30-year-old man presented with proximal hypospadias, urinary disturbance, ejaculation dysfunction, and penile deformity on erection. He had a history of several hypospadias operations around the age of two years, as well as surgery for cryptorchidism. During urethroplasty, we noted hair protruding from the old external urethral opening. Thus, approximately 3 cm of the urethra was opened along its length and microsurgery was performed to remove five hair follicles. One year after surgery, the patient is able to urinate while standing and has no penile deformity on erection and no hair regrowth. Conclusion: Microsurgical excision of hair follicles in the urethra allowed complete and permanent removal of these hairs in a single surgical procedure. 130 OP30 CLINICAL EXPERIENCE OF A SATISFIED BLOCK FOR OUTPATIENT PENILE PROSTHESIS IMPLANTATION 1 2 Cheng-Hsing Hsieh , Geng-Long Hsu 1 Department of Urology, Buddhist Tzu Chi General Hospital, Taipei Branch (Taiwan) 2 Microsurgical Potency Reconstruction and Research Center, Hsu’s Andrology (Taiwan) Purpose: Careful anesthetic methods of proximal dorsal nerve block, peripenile infiltration, penile crural block, cavernous nerve blockage, and topical injection on an as needed basis seem satisfactory for outpatient penile implantation. We propose a reliable, systematic, and reproducible protocol for these anesthetic methods in an attempt to extend their clinical applications. Materials and Methods: A careful anesthetic block of the paired dorsal nerve in the penile hilum associated with a peripenile infiltration is sufficient to anesthetize the penile structures, except for the sinusoids and penile crura where bilateral crural blockage is required. The cavernous nerve block is mandatory to cover the sinusoidal tissues. A further topical injection of the medial low abdominal region makes it possible for implanting a three-piece model. This availability was derived from chronic clinical practice based on a new knowledge of penile anatomy. Results: Blockade of the proximal dorsal nerve, peripenile infiltration, penile crural block, and cavernous nerve blockade have resulted in the successful implantation of 52 AMS 600, 13 AMS 650, 7 Ambicor, 4 Dynaflex, 18 Duraphase, 36 Acuform, and 32 Malleable penile implants on an outpatient basis, except for one man who required inpatient treatment. Extended topical infiltration of the medial low abdominal region was mandatory to finish three implantations of the AMS 700 model. Common immediate side effects included puncture of the vessels, subcutaneous ecchymosis, transient palpitations and dilatation pain. However, there were no significant late complications. There was no statistical difference in scoring using a visual analog scale among patients who underwent different models of prosthesis implantation except for those who received the AMS 700 model. Conclusions: Recent discoveries and better understanding of the penile anatomy have been meaningful in the development and improvement of local nerve blockade techniques for penile implants, while minimizing anesthetic adverse effects and resulting in a rapid return to daily activity with minimal complications. 131 OP31 VENO-OCCLUSIVE DYSFUNCTION IN YOUNG PATIENTS RESULTING FROM JELQING MANEUVER: LONG-TERM RESULTS OF PENILE VENOUS STRIPPING SURGERY 1 2 Geng-Long Hsu , Cheng-Hsing Hsieh 1 Microsurgical Potency Reconstruction and Research Center, Hsu’s Andrology (Taiwan) 2 Department of Urology, Buddhist Tzu Chi General Hospital, Taipei Branch (Taiwan) Purpose: There is currently believed that the contributor of erectile dysfunction in young adult is psychogenic origin. We report a retrospective study on impotence resulting from jelqing maneuver at the age younger than thirsty. Materials and Methods: From October 2000 to September 2010, 25 patients currently available, aged from 19 to 30 years, were diagnosed with veno-occlusive dysfunction. Subsequently, 18 of them underwent penile venous surgery and were assigned to the venous group. The remaining 7 men were allocated to control group while any strategies but venous surgery were used as necessary. All were followed and evaluated with the abridged five-item version of the international index of erectile function (IIEF-5) and cavernosography if required. Results: In the venous group their pre-operative IIEF-5 score of 12.1±2.3 (n=18) was increased to 21.7±1.7 (p < 0.000) postoperatively. In the control group, however, the mean preoperative IIEF-5 score of 12.3±2.1 (n=7) was changed to score of 13.9±2.9 (p > 0.05). Although there was no significant difference between the two groups’ preoperative IIEF-5 score, there was a statistically significant difference after venous surgery was undergone. The follow-up period ranged from 6 months to 11 years, with an average of 5.0±1.4 years. Eventually 5 (27.8%) and 5 (83.3%) men required additional oral phosphor-di-esterase 5 inhibitors to venous and control group respectively. In the control group a man suffered from depressive status without a sexual partner. Conclusion: In this study, we therefore may conclude that “venous contribution” ought to be also an important factor rather than just the psychogenic origin in those impotence male who suffer from jelqing maneuver. 132 OP32 CORPOROPLASTY PLICATION SURGERY FOR THE TREATMENT OF PENILE CURVATURE 1,2 1,2 1 1,2 1,2 3 1,2 Te-Fu Tsai , Chung-Hsin Yeh , Hung-En Chen , Yi-Chia Lin , Kuang-Yu Chou , Ji-Fan Lin , Thomas I-Sheng Hwang 1 Division of Urology, Department of SurgeryShin Kong Wu Ho-Su Memorial Hospital (Taiwan) 2 School of Medicine, Fu-Jen Catholic University (Taiwan) 3 Central Laboratory, Shin Kong Wu Ho-Su Memorial Hospital (Taiwan) Introduction: Corporoplasty using plication of the albuginea is a simple technique and is still a major concern about the high possibility of recurrence. The aim of this study was to assess long-term functional and cosmetic results of this approach done in our institute. Materials and Methods: From January 2001 to December 2010 a total 48 patients presenting penis curvature accepted corporoplasty with albuginea plication. All patients were assessed preoperatively with history, physical examination and photographic documention of the erectile penis. These patients, all with vaginal penetration problems, were submitted to corporoplication with 2-7 sutures 2/0 (polyglycolic) contralateral to the curvature. Follow-up included functional and cosmetic results, eventual complications and level of patient satisfaction. Results: Median follow-up of our study was 44 months (range 6-118). Complete correction of curvature was achieved in 47 patients (98%) whereas 95.7% reported good erectile function (IIEF-5 > 21). 40 patients (83%) reported penis shortening and 29% complained of palpating the sutures. 1 perioperative complication was wound infection. No altered sensitivity of the glans penis was reported. Conclusions: Simple plication of the corpora cavernosa can be done with optimal functional and cosmetic results. The success of this minimally invasive approach makes it a valid procedure to correct penile curvature. 133 OP33 TRUE PENILE AUGMENTATION - PRELIMINARY REPORT 1 2 3 Li-Jen Liu , Cheng-Hsing Hsieh , Geng-Long Hsu 1 Yi-He Hospital (Taiwan) 2 Buddhist Tzu Chi General Hospital, Taipei Branch (Taiwan) 3 Microsurgical Potency Reconstruction and Research Center, Hsu’s Andrology (Taiwan) Purpose: Penile augmentation surgery might be necessary for some patient with micro-penis or traumatism although there is controversy. Among varied methods a true expansion of the corpora cavernosa is in paucity so far, herein we report a method with a true augmentation. Materials and Methods: From March 2010 to may 2011 3 male, aged at 33, 25 and 29 respectively, with micro penis or ventral curvature associated with erectile dysfunction underwent our varied methods of penile augmentation with autologous tissue. It entailed a careful stripping and preserving of the deep dorsal vein, cavernosal vein and/or internal spermatic veins which were then fashioned to the inner layer of the tunca albuginea (TA) after being de-tubularized with 6-0 nylon suture. Similarly the aponeurosis of the external oblique muscle is fashioned to the outer tunical layer of the corporotomy with its longitudinal fiber parallel to the penile shaft. The wound is closed with 5-0 chromic catgut sutures. The international index of the erectile function (IIEF), cavernosography and penile dimension measurement were used for follow up. Results: The follow-up period ranged from 3 months to one year. The IIEF-5 score was from 9 to 24, 11 to 21 and 10 to 17 respectively. The penile erectile length was 9.1 to 12.0 cm and 8.9 to 11. 7 cm in two men and the penile girth was from 7.8 to 9.2 cm in the third case. Conclusion: These innovative penile augmentation methods may be promising although they are technically challenging and a clinical study of more men and longer time follow are mandatory. 134 PP01 LOPERAMIDE INDUCING PROSTATIC RELAXATION BY ACTIVATION OF OPIOID MU2-RECEPTORS IN A RAT MODEL 1 2 3 Chih-Cheng Lu , Hsien-Hui Chung , Juei-Tang Cheng 1 Chi Mei Medical Center, Liouying (Taiwan) 2 National Cheng Kung University (Taiwan) 3 Chi Mei Medical Center (Taiwan) Objective:The mechanism of opioid μ-receptors activation in improvement of benign prostatic hyperplasia is obscure. We used loperamide to identify the subtype of opioid μ-receptors involved in prostatic relaxation and investigated the possible mechanism of this relaxation. Methods:Prostate strips were isolated from 12-week-old male Wistar rats for identification of isometric tension. Prostate strips were pre-contracted with either 1 μmol/L phenylephrine or 50 mmol/L KCl. Then, characterized 0.1 after cumulative administration of loperamide to 10 decrease of muscle tone was μmol/L into the organ bath for concentration-dependent observation. Specific blockers or antagonists were pretreated to compare the changes of loperamide-induced relaxation. Results:Loperamide produced a marked relaxation in isolated prostates precontracted with phenylephrine or KCl in a dose-dependent manner. This relaxation was abolished by cyprodime, a selective opioid μ-receptor antagonist, but not modified by naloxonazine at the dose sufficient to block opioid μ-1 receptors. Moreover, the relaxation by loperamide was attenuated by glibenclamide at the dose sufficient to block ATP-sensitive K+ channels. Conclusion:Our results suggest that loperamide induces prostatic relaxation open ATP-sensitive K+ channels. through activation of opioid μ-2 receptors to PP02 CHARACTERIZATION OF LECTIN-BINDING SITES IN EPITHELIAL CELLS OF THE MOUSE EPIDIDYMIS 1 1 1 Syouta Tajiri , Tatsuya Fukui , Kazuya Yoshinaga 1 Kumamoto University (Japan) Objective: The epididymis is composed of one single convoluted tubule and can be divided into three regions including the caput, corpus and cauda. The epididymal fluid microenvironment is maintained in each region and contributes to sperm maturation, transport, concentration and storage. Epithelial cells lining the epididymal tubule consist of several types of cells: principal, clear and basal cells and play an important role in active absorption and secretion. The aim of the present study was to examine the characteristics of lectin-binding patterns in the mouse epididymis and to determine the glycan chain expression of the epithelial cells during postnatal development. Methods: Samples from the prepubertal and adult mouse epididymis were fixed by perfusion through the heart with 4% paraformaldehyde. For lectin histochemistry, the avidin-biotin-peroxidase complex technique was used with various biotin-labeled lectins on paraffin sections. In addition to the lectin histochemistry, we also added immunohistochemistry for various specific markers to identify the epithelial cells. Results: In the adult mouse epididymis, Ulex europaeus agglutinin I (UEA-I) lectin stained principal cells as judged by co-localization with anti-aquaporin-9 immunostaining. UEA-I lectin-positive sites in the principal cell were the stereocilia in the proximal caput and the Golgi zone in the distal caput, suggesting a functional association of glycoproteins containing fucose. Maackia amurensis lectin I (MAL-I lectin) selectively labeled the luminal surface membrane of clear cells as judged by co-localization with anti-Foxi1 immunostaining, suggesting a functional association of glycoproteins containing Gal/GlcNAc. Griffonia simplicifolia I B4 (GS-IB lectin) labeled the plasma membrane of basal cells as judged by co-localization with anti-keratin immunostaining, suggesting a functional association of glycoproteins containing D-galactose (the terminal sugar residue with binding affinity to GS-IB). In the prepubertal mouse epididymis, morphological properties of the epithelium are markedly changed from P2 to P3 week. The lectin-binding pattern is also altered in the same period; in the initial segment, for example, ACA lectin stained the principal cell at P1 week, the principal and clear cells at P3 week and clear cells at P9 week. Conclusion: The results indicate that the selectivity in lectin reactivity for distinct cell types and segment-dependent staining in the epididymis seems to be related to cellular and regional differences in function. As some lectins stain particular cells or cellular compartments selectively, these lectins could be useful markers in histopathological evaluation of diseases or diagnosis of male infertility. PP03 SEPARATION, CULTURE AND IDENTIFICATION OF RAT CORPUS CAVERNOSAL ENDOTHELIAL CELLS 1 1 2 1 Jun Chen , Bin Zhang , Hengjun Xiao , Tao Qi 1 Department of Infertility and Sexual Medicine, The Third Affiliated Hospital, Sun Yat-Sen University (China) 2 Department of Urology, The Third Affiliated Hospital, Sun Yat-Sen University (China) Purpose: To develop the methods of separation, culture and identification for rat corpus cavernosal vascular endothelial cells (CCECs). Materials and methods: Cavernosal tissues were isolated from male SD rats. Enzymatic digestion was applied to separate CCECs. Purified cells were obtained using immunomagnetic beads and flow cytometric cell sorting, sub-cultured using EMG-2 medium. The growth curve of CCECs was measured by MTT assay. The cells were identified by von Willebrand factor（vWF） using immunofluorescence, and the positive rate of vWF expression was tested by flow cytometry. Results: The monomorphic cobblestone-like cells were observed by microscopy. High purification was obtained using immunomagnetic beads. After 2 days of incubation, cells entered the logarithmic growth phase, and reached a plateau on the fifth day. The von Willebrand factor expression in cytoplasm was positive. The purity of cells was 95.8%, which was tested by flow cytometry. Conclusion: Rat CCECs can be separated and cultured successfully by the method of enzymatic digestion, immunomagnetic beads and flow cytometric cell sorting. PP04 PENILE TRACTION AND PEYRONIE'S DISEASE: IN-VITRO ANALYSIS OF THE EFFICACY OF TRACTION ON CELLULAR CHANGES IN PEYRONIE'S PLAQUE IN A STRAIN CULTURE SYSTEM. 1 2 Eric Chung , Ling De Young , Gerald Brock 1 Princess Alexandra Hospital (Australia) 2 St Joseph Health Care (Canada) 2 Objective: In recent years, penile traction devices have gained considerable popularity as a non-invasive treatment option in Peyronie's disease (PD) to improve penile curvature and maintain penile length. The exact mechanism of action of penile traction devices is unknown. FlexcellTM is a pressurised chamber system that allows for sustained and dynamic application of hydrostatic pressure with the option of additional tension. We used this cyclic strain culture system to investigate the cellular changes of Peyronie's plaques following single, bi-axial and multi-axial tractional forces. Methods:Primary cell cultures derived from Peyronie's plaque and normal tunical tissue were examined by immuno-histochemistry, Surface-Enhanced Laser Desorption / Ionization Time-of-Flight Mass Spectrometry (SELDI TOF-MS) and Western immunoblotting to provide baseline characteristics. These cell culture media were divided into 3 groups, prepared and exposed to a single (Group 1), bi-axial (Group 2) and multi-axial (Group 3) mechanical strained environment. Following 72 hours of incubation in FlexcellR, these cell culture media were re-evaluated again. Results: Significant increases in collagen to elastin fibers ratio, smooth muscle α-actin, β-catenin, and Hsp47 proteins were identified in cells derived from PD relative to normal tunical tissue. Following exposure to tractional forces, there was a decrease in smooth muscle α-actin on histochemical study and increase in MMP 8 expression on Western blot analysis. Conclusion: This unique study of cell cultured in a mechanical environment will provide strong scientific evidence for the use of penile traction device in Peyronie's plaque remodeling. PP05 PENILE VENOUS OCCLUSION MECHANISM: EVIDENCES FROM AN ELECTROCAUTERY EFFECT TO THE SINUSOIDS ON DEFROSTED HUMAN CADAVERS 1 2 Cheng-Hsing Hsieh , Geng-Long Hsu 1 Department of Urology, Buddhist Tzu Chi General Hospital, Taipei Branch (Taiwan) 2 Microsurgical Potency Reconstruction and Research Center, Hsu’s Andrology (Taiwan) Purpose: The venous occlusion mechanism is paramount for reaching penile rigid erection, the relationship between the penile erection-related veins and the tunica albuginea (TA) is not clearly elucidated. We sought to conduct an electrocautery study in order to explode this issue. Materials and Methods: In late 2010 five adult human male defrosted cadavers whose penis is intact were used for this study. A dorsally median longitudinal incision was made from the retrocoronal sulcus to the pubic region in order to facilitate vascular access. Two #19 scalp needles were inserted and firmly fixed in place with 4-0 silk sutures at the 3 and 9 o’clock positions respectively. One needle was connected to an infusion pump and used to inject 10% colloid into the corpora cavernosa, whereas the other needle was used to monitor the intracavernosal pressure (ICP). The deep dorsal vein (DDV) was freed for 5cm segment via opening the Buck’s fascia, clamped by two hemostats and cut in-between followed by a 2.5×0.5cm2 block of dorsal corpus cavernosum some 0.5cm proximal to retro-coronal sulcus while an emissary vein is included. A watertight milieu was reestablished by 6-0 nylon suture of the corporotomy. A similar tissue block was obtained after an electrocautery, 45 or 60 watts, was applied to the emissary branches of the proximal DDV stump while the ICP was kept at 0, 50, 70, 130 and 150mmHg respectively. Those tissues were rendered for special stains and analysis. Results: The electrocautery effect penetrated categorically into the intracavernosal sinusoids in subject with ICP no more than 70mmHg. This effect was stopped at deeper collagen bundles of the outer longitudinal layer of the TA in subject with ICP 130 and 150mmHg however. Conclusion: An extracorporeal electro-cautery can not penetrate the sinusoidal wall while an ICP is higher than 130mmHg, in contract it deemed penetrates at ICP lesser than 70mmHg. Implying the outer longitudinal layer of the TA can work as a sustainable wall against the sinusoidal pressure in order to provide rigidity building up. PP06 MESENCHYMAL STROMAL CELLS TRANSFECTED BY RECOMBINANT ADENOVIRUS VECTOR WITH SHORT HAIRPIN RNA OF SILENCING PDE5 1 2 1 1 1 1 3 Heng-Jun Xiao , Jun Chen , Ning Na , Hao Zhang , Xiao-Peng Liu , Yan Zhang , Min Xia , Xin Gao 1 1 Department of Urology, the Third Affiliated Hospital of SUN Yat-sen University (China) 2 Department of infertility & sexual medicine, the Third Affiliated Hospital of SUN Yat-sen University (China) 3 chool of public health, SUN Yat-sen University (China) Introduction: Many studies indicate that bone marrow mesenchymal stromal cells (MSCs) not only have multidifferentiation potential and functional regeneration of impaired tissues, but also are relatively easy to isolate and expand ex vivo. In view of these properties, they could be a useful vehicle for gene delivery in adult stem cell-based gene therapy. Specific phosphodiesterases (PDE5) has been shown to regulate penile erection to return to flaccidity by hydrolysis of cyclic guanosine monophosphate (cGMP). Therefore, inhibiting specifically the catalytic activity of the target gene PDE5 has been indicated to promote the accumulation of cGMP and enhance erection. In recent years, the introduction of short hairpin RNA (shRNA) has proved to be a powerful tool for suppressing strongly gene specific expression through a process known as RNA interference. This study was to describe the transfection efficiency of the recombinant adenovirus vector with gene-specific silencing PDE5 of short hairpin RNA transducing into rat MSCs. Purpose: To construct the recombinant adenovirus vectors with short hairpin RNA of silencing PDE5 and investigate the adenoviral transfection efficiency by transducing into rMSCs. Methods and Materials: The recombinant adenovirus vector carrying shRNA with inhibiting the specific expression of PDE5 (pAd-PDE5-shRNA) and enhanced green fluorescent protein (EGFP) gene was constructed. SD rat bone marrow-derived MSCs were separated, cultured and purified in vitro by Percoll density gradient centrifugation combined with adherent culture. The third passage rMSCs were obtained, and were identified by cell surface markers with flow cytometry (FCM). The EGFP gene expression was verified by the intensity of green fluorescence under fluorescence microscope and the transfection efficiency was assessed by FCM in ex vivo expanded rMSCs transfected with pAd-PDE5-shRNA. Results: The recombinant adenovirus vector pAd-PDE5-shRNA was successfully constructed. After pAd-PDE5-shRNA was transfected into rMSCs, the expression of EGFP was detected at 24h and it became the strongest at 72h, which FCM showed the transfection efficiency were 88.6% at this time. The EGFP expression rates of rMSCs transfected with pAd-PDE5-shRNA at 3d, 7d, 14d after transduction were 88.6%, 85.2%, and 78.5%, respectively. There was still visible green fluorescence at 28d after transfection. The Conclusion: Our results show that the recombinant adenovirus vector with gene-specific silencing PDE5 of shRNA could effectively transfect into rMSCs in vitro. Gene-modified rMSCs with pAd-PDE5-shRNA may have a potential cell source of stem-cell-based therapy for ED. PP07 EFFECTS OF PHOSPHODIESTERASE 5 EXPRESSION ON EX VIVO DIFFERENTIATED MESENCHYMAL STROMAL CELLS USING ADENOVIRAL GENE TRANSFER OF SHORT HAIRPIN RNA 1 2 3 1 1 1 1 1 Heng-Jun Xiao , Jun Chen , Xiao-Yong Pu , Liao-Yuan Li , Yan Zhang , Xiao-Peng Liu , Hao Zhang , Xin Gao 1 Department of Urology, the Third Affiliated Hospital of SUN Yat-sen University (China) 2 Department of infertility & sexual medicine, the Third Affiliated Hospital of SUN Yat-sen University (China) 3 Department of Urology, Guangdong Provincial People’s Hospital (China) Introduction: It has been shown that the major causes of organic erectile dysfunction (ED) associated with aging, diabetes and post-radical prostatectomy were via a diffuse and progressive corporal fibrosis to cavernous smooth muscle cells (CSMCs) in the penis. Previous studies have demonstrated that bone marrow mesenchymal stem cells (MSCs) possess the ability for self-renewal, multilineage differentiation and in vivo functional regeneration of damaged tissues. In recent years, several experimental studies have suggested that MSCs could be induced to differentiate into smooth muscle-like cells in vitro and have a potential source for stem-cell-based gene therapy of ED. Phosphodiesterases (PDE5) has been proved to play an important role in regulating penile erection by hydrolysis of cyclic guanosine monophosphate (cGMP) as a specific hydratase. Therefore, inhibiting specifically the catalytic activity of PDE5 has been shown to promote the accumulation of cGMP and improve erectile function. We hypothesis that stem cell-based replacement therapy with rat MSCs by transfected the recombinant adenovirus vector carrying silencing target gene PDE5 of short hairpin RNA (pAd-PDE5-shRNA) could aid in the regeneration of penile smooth musculature and might help to benefit recovery of erectile function. Purpose: To explore the expression of PDE5 in ex vivo differentiation of gene-modified rMSCs into smooth muscle cells using the recombinant adenovirus vector containing silencing target gene PDE5 of shRNA. Methods and Materials: SD rMSCs were separated, cultured and purified in vitro by identification with flow cytometry (FCM). The recombinant adenovirus vector carrying silencing target gene PDE5 of shRNA was constructed and then transfected into the third passage rMSCs. The gene-modified rMSCs were induced to differentiate into smooth muscle-like cells exposed to VEGF and b-FGF media in vitro. The proliferative ability of these cells was tested by cell counting kit 8 (CCK-8). Smooth muscle-like cells differentiation was assessed by immunofluorescence and then subjected to immunocytochemistry for specific markers of α-smooth muscle actin (α-SMA). Real-time quantitative PCR, immunohistochemical staining and Western blot analysis for PDE5 gene expression in differentiated smooth muscle-like cells were carried out. Results: The gene-modified rMSCs were successfully induced to differentiate into smooth muscle-like cells. Transduction of the recombinant adenovirus pAd-PDE5-shRNA into rMSCs led to down-regulation of PDE5. The expression of PDE5 was reduced 53.6% by pAd-PDE5-shRNA compared with the control recombinant adenovirus vector. The proliferative property of rMSCs did not significantly change among those transfected with pAd-PDE5-shRNA (P < 0.01). The differentiated rMSCs were identified to smooth muscle-like cells by immunocytochemistry. The Conclusion: These results suggest that the gene-modified rMSCs could be successfully induced to differentiate into smooth muscle-like cells in vitro. They reveal that pAd-PDE5-shRNA transfected into them could inhibit the expression of PDE5 in differentiated rMSCs. PP08 INDUCTION OF APOPTOSIS BY BENZYL ISOTHIOCYANATE (BITC) IN HUMAN PROSTATE CANCER CELLS 1 2 1 1 1 Te-Fu Tsai , Ji-Fan Lin , Hung-En Chen , Yi-Chia Lin , Kuang-Yu Chou , Thomas I-Sheng Hwang 1 Department of Urology, Shin Kong Wu Ho-Su Memorial Hospital (Taiwan) 2 Central Laboratory, Shin Kong Wu Ho-Su Memorial Hospital (Taiwan) 3 Department of Surgery, Shin Kong Wu Ho-Su Memorial Hospital (Taiwan) 4 Department of Urology, Taipei Medical University, Division of Urology (Taiwan) 5 School of Medicine, Fu-Jen Catholic University (Taiwan) 1,3,4,5 Background: A number of studies support that certain food phytochemicals protect against cancer. An important group of compounds that have this property are organosulfur compounds including isothiocyanates (ITCs). Among them, benzyl isothiocyanate (BITC) has been shown to induce apoptosis in varies cancer cell lines. In this study, we investigate whether BITC induces apoptosis in human prostate cancer cell lines. Methods: We have examined the cell death pattern induces by BITC on PC-3 and CRW22Rv1 (androgen-independent and sensitive human prostate cancer cell lines, respectively) cells survival by MTT assay. Results: Significant dose and time-dependent growth inhibition on both PC-3 and CRW22Rv1 cells was observed in BITC treatment. The cytotoxicity of BITC was greater than AITC in the same concentration. Conclusions: This is the first study showed that BITC markedly inhibit PC-3 and CRW22Rv1 cancer cell growth thought apoptotic cell death. This finding could potentially contribute to the beneficial effect of BITC in prostate cancer treatments. PP09 INDUCTION OF AUTOPHAGIC CELL DEATH BY ALLYL ISOTHIOCYANATE 1 2 1,4 1,4 1,4 1,3,4 Hung-En Chen , Ji-Fan Lin , Te-Fu Tsai , Yi-Chia Lin , Kuang-Yu Chou , Thomas I-Sheng Hwang 1 Department of Urology, Shin Kong Wu Ho-Su Memorial Hospital (Taiwan) 2 Central Laboratory, Shin Kong Wu Ho-Su Memorial Hospital (Taiwan) 3 Department of Urology, Taipei Medical University (Taiwan) 4 Division of Urology, School of Medicine, Fu-Jen Catholic University (Taiwan) Purpose: Previous studies supported that certain food phytochemicals protect against cancer. Isothiocyanates (ITCs) are derivatives of cruciferous vegetable and shown to be effective cancer-prevention agents. Allyl isothiocyanate (AITC), one of the most widely studies members of the ITC family, has recently be demonstrate to inhibit survival of human prostate cancer cells while has minimal effects on a normal prostate epithelial cell line. Our previous studies demonstrate AITC induces autophagic cell death in human prostate cancer cells. In this study, we investigate whether the autophagy induced by AITC treatment is activated by mTOR or other signaling pathway. Materials and methods: We investigated the biological effects of AITC on PC-3 and CRW22Rv1 (androgen-independent and sensitive human prostate cancer cell lines, respectively) on cell viability using MTT assay and induced apoptosis using cell cytometry. We further monitor the induced autophagy in AITC-treated cells by detecting the digestion and formation of LC3-II, a marker protein involved in the formation of autophagosome during autophagic cell death, by Western blot as well as Immunoflorescent (IF) staining. The formation of acidic organelle was detected by acridine orange staining. To identify the signaling pathway involved in AITC-induced autophagy, protein expression of mTOR effector, 4EBP1 and phosphor-S6 and ERK were detected by western blot. Results: AITC exhibited significant dose and time-dependent growth inhibition on both PC-3 and CRW22Rv1 cells. The formation of LC3-II was detectable at 10μM, and increased at 20μM after 24 hours of AITC treatment. IF showed round-up and condensed staining of LC3-II, suggesting the formation of autophagosome in the cytoplasm and acridine orange staining of acidic organelles supporting this finding. Inhibition of autophagy partially rescued cell viability suggesting a protective role of autophagy in AITC-treated cells. Detection of protein levels in AITC-treated cells showed activation of ERK while mTOR signaling was not altered by BITC treatment. Conclusion: We provide evidences that AITC inhibit PC-3 and CRW22Rv1 cancer cell growth thought not only apoptosis cell death but also autoghagic cell death. And the autophagy induced by AITC was via ERK activation but not mTOR inhibition. This activity could potentially contribute to the beneficial effect of AITC in prostate cancer patients. Running title: AITC induces autophagic death via ERK activation in human prostate cancer cell lines. Keywords: Allyl isothiocyanate (AITC); Autophagy; Prostate cancer. PP10 THE EFFECTS OF AMPHETAMINE AND KETAMINE ON SPERM QUALITY AND APOPTOSIS-RELATED GENES EXPRESSION IN TESTIS AND EPIDIDYMIS OF MALE RAT 1,2 1,4 1,4 1,4 1,4 Hung-En Chen , Ji-Fan Lin , Te-Fu Tsai , Yi-Chia Lin , Kuang-Yu Chou , Thomas I-Sheng Hwang 1 Department of Urology, Shin Kong Wu Ho-Su Memorial Hospital (Taiwan) 2 Central Laboratory, Shin Kong Wu Ho-Su Memorial Hospital (Taiwan) 3 Department of Urology, Taipei Medical University (Taiwan) 4 Division of Urology, School of Medicine, Fu-Jen Catholic University (Taiwan) 1,3,4 Purpose: Previous investigations demostrate that chronic administration of cocaine, a kind of CNS stimulant, to peripuberutal male rats has a profound effect on their testicular function. However, the effect of other stimulants, such as amphetamine and ketamine, on male reproductive system is still unclear. We are trying to investigate the effects of amphetamine and ketamine on sperm quality and apoptosis-related genes expression in testis and epididymis of male rat. Materials and methods: Male Sprague-Dawley rats were subcutaneously injected with methamphetamine and ketamine (10 mg/kg body weight) for 90 days. Control animals received equal volume of normal saline. At the end of the daily exposures for 30, 60 and 90 days, the animals were sacrificed by isoflurane asphyxiation. The testis and epididymis were dissected for obtaining the sperm suspension and extracted for determination of apoptosis-related gene expression by real-time PCR. Serum level of testosterone was determined by ELISA Results: Administration of methamphetamine and ketamine significantly decreased sperm count in cauda epididymis for 90 days. Sperm morphologic abnormality was significantly statistic different in study group. Increased expression of Apoptosis-related gene was found in epididymis and testis in amphetamine and ketamine treated rat at 60 days. Serum level of Testosterone decreased significantly at 60 and 90 days of amphetamine and ketamine administration. Conclusions: These results suggested apoptosis and lower serum level of testosterone may play the important roles in the regulation of productive function of psychotropic drugs treated rat. PP11 HIGH-DOSE TESTOSTERONE TREATMENT CAUSE APOPTOTIC CELL DEATH IN HUMAN ANDROGEN-SENSITIVE AND –INDEPENDENT PROSTATE CANCER CELLS 1,2,3 Chao-Wei Tseng, Thomas I-Sheng Hwang 1,3 1,3 1 1,3 , Yi-Chia Lin , Te-Fu Tsai , Hung-En Chen , Kuang-Yu Chou , Ji-Fan Lin 1 Division of Urology, Department of Surgery, Shin Kong Wu Ho-Su Memorial Hospital (Taiwan) 2 Department of Urology, Taipei Medical University, Division of Urology (Taiwan) 3 School of Medicine, Fu-Jen Catholic University (Taiwan) 4 Central Laboratory, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan (Taiwan) 4 Purpose: The use of testosterone was reported as a cancer risk in patients with nascent or occult prostate cancer. Therefore, testosterone replacement therapy (TRT) was prohibited in these patients. However, the biological effects of testosterone on prostate cancer cells were poorly understood. In this study, we study the dose-effects of testosterone on the growth of prostate cancer cells as well as the expression of AR and prostate specific antigen (PSA) and try to identify if there are differential effects on androgen-sensitive and –independent prostate cancer cells. Material and methods: Androgen-sensitive (CWR22Rv1 and LNCaP) and -independent (PC3 and DU145) prostate cancer cell lines were used in this study. Cells were treated with different concentration of testosterone ranging from 1nM to 5μM, and cell proliferation effects of testosterone in serum-deprived medium were accessed by WST assay. To investigate the RNA and protein expression level of AR and PSA after testosterone treatment, qRT-PCR and Western blot were performed respectively. Status of cell cycle in cells treated with 50, 100 and 1,000 nM of testosterone was measured by cell cytometry. And apoptosis induced by high-dose testosterone was detected by Caspase 3 activation. Results: A dose-dependent cell proliferation was occurred from 1 nM to 100 nM of testosterone treatment but significantly decreased when treated with high dose testosterone (> 500 nM), in all cell lines tested. The expression of AR and PSA were increased in androgen-sensitive cells treated with 100 nM testosterone, and the expression of AR is suppressed in high-dose testosterone treatment suggesting a negative feedback regulation. No AR or PSA was detectable in androgen-insensitive cells. Induction of apoptosis was detected in all cells treated with high-dose testosterone (1 μM). Conclusion: Cell proliferation occurred in prostate cancer cell lines treated with low-dose testosterone regardless of their androgen sensitivity. Cell viability was decreased in high-dose testosterone treatment accompany with the induction of apoptosis. PP12 RESTORATION OF MIR-204 EXPRESSION INDUCES CELL APOPTOSIS BY TARGETING BCL2 IN HUMAN BLADDER AND PROSTATE CANCER CELLS 1,2,3 Chao-Wei Tseng, Thomas I-Sheng Hwang 1,3 1,3 1 1,3 , Yi-Chia Lin , Te-Fu Tsai , Hung-En Chen , Kuang-Yu Chou , Ji-Fan Lin 1 Division of Urology, Department of Surgery, Shin Kong Wu Ho-Su Memorial Hospital (Taiwan) 2 Department of Urology, Taipei Medical University, Division of Urology (Taiwan) 3 School of Medicine, Fu-Jen Catholic University (Taiwan) 4 Central Laboratory, Shin Kong Wu Ho-Su Memorial Hospital (Taiwan) 4 Background: Blocking anti-apoptosis genes has been considered as a strategy for cancer therapy in recent years. From our previous studies, we identify 19 down-regulated microRNAs (miRNAs) in human bladder tumor tissues. Among these down-regulated miRNAs, miR-204 is predicted as a potential negative regulator of Bcl2 which is a well studied anti-apoptosis gene. We hypothesized that restoration of miR-204 expression or overexpression of miR-204 will induce apoptosis via repressing Bcl2 expression and cause cancer cell death. Methods: To elevate the expression level of miR-204 in cancer cells, vector-based miRNA expression system was adapted Constructed vector that express functional miR-204 was transfected into human bladder (T24 and J82) and prostate cancer cells (PC3 and DU145). Expression level of matured miR-204 in transfected and mock cells was monitored by Q-PCR. To verified that miR-204 targets Bcl2, 3’-untraslated region (3’UTR) of Bcl2 was constructed into a luciferase reporter vector, the binding and inhibition of target expression was performed by luciferase reporter assay. Bcl2 RNA and protein expression in cells transfected with miR-204 were measured by Q-PCR and Western blot, respectively. Cell viability of miR-204 transfected cells was detected by MTT assays. Induction of apoptosis was determined by increased level of cleavage caspase 3 and its activity. Results: The expression level of miR-204 in transfected cells were elevated, and the function of matured miR-204 was confirmed by luciferase reporter assays. mRNA and protein expression of Bcl2 were decreased in miR-204 trasfected cells that leads to the increased level of cleavaged caspase 3 and reduced cell viability. Co-transfection of reporter vector harboring Bcl2 3’UTR to compete with endogenous transcript partially rescued the apoptosis induced by overexpressed miR-204 provided further evidence that miR-204 targeting Bcl2 induces apoptosis in these cancer cells. Conclusions: miR-204 targets to Bcl2 in human bladder and prostate cancer cells. Restoration of miR-204 in tumor could therefore be considered as a novel strategy for elimination of cancer cells by targeting anti-apoptotic Bcl2. PP13 THE ASSOCIATION OF HEMOCHROMATOSIS GENE (H63D, S65C, C282Y) MUTATIONS WITH IDIOPATHIC MALE INFERTILITY IN CHINESE HAN POPULATION 1 2,3 5 1 1 1 1 XY Yu , BB Wang , ZC Xin , T Liu , K Ma , J Jiang , X Fang , LH Yu 1,4 1 The association of hemochromatosis gene (H63D, S65C, C282Y) mutations with idiopathic male infertili (China) 2 National Research Institute for Family Planning, Beijing, 100081 China (China) 3 Peking Union Medical College, Beijing, China (China) 4 World Health Organization Collaborating Centre for Research in Human Reproduction, Beijing, China (China) 5 Andrology Center, Peking University First Hospital, Beijing 100034, China (China) Purpose: HFE mutations influence the iron status of the general population in Northern Europe, excess iron is related with impairment of spermatogenesis. Several studies have reported that the HFE gene has been associated with idiopathic male infertility. However, this result has not been confirmed in other populations. The aim of this study was to investigate the association between three mutations (H63D, S65C, and C282Y) in the HFE gene with idiopathic male infertility in the Chinese Han population. Methods and materials: Two groups of Chinese men were recruited: 444 infertile men (including 169 with idiopathic azoospermia) and 423 controls of proven fertility. HFE gene was detected by polymerase chain reaction (PCR)-restriction fragment length polymorphism technique. Results: These results demonstrated that no C282Y or S65C mutations were detected. Idiopathic male infertility was not significantly associated with heterozygous H63D mutation (odds ratio = 0.801, 95% confidence interval = 0.452–1.421, χ 2 = 0.577, P=0.448). The H63D mutation frequency did not correlate significantly with the serum LH, FSH or T levels in infertile men(P=0.896, P=0.404, P=0.05, respectively). Conclusion: Our data suggest that the HFE H63D mutation is not associated with idiopathic male reproductive dysfunction. PP-15 A FLEXIBLE PROGRAM OF PENILE REHABILITATION FOR THE PATIENTS OF PROSTATIC CANCER AFTER SURGERY OR IRRADIATION TREATMENT Han-Sun Chiang Department of Urology, Taipei Medical University Hospital, Taiwan Penile rehabilitation can definitely prevent cavernosal hypoxia, fibrosis and penile atrophy. Clinically early rehabilitation can decrease the incidence of permanent erectile dysfunction and penile shortening. For the treatment of localized prostatic cancer, any kind of radical prostatectomy usually may induce more than 60% possibility of erectile dysfunction. Even any other alternative treatment such as irradiation, cryosurgery, HIFU may also cause a 15-30% complication of erectile dysfunction. We start the penile rehabilitation program for the patients of localized prostatic cancer undergoing radical surgery or other alternative treatment with a flexible regimen. We provide different program of intracvernosal injection or/and oral intake of phosphodiesterase type 5 (PDE-5) inhibitor, including daily dosage form of PDE-5 inhibitor. The program is specially combined with a comprehensive counseling for the couples. The penile rehabilitation for the patients after radical prostatectomy usually begins postophecatively when the patients can stand the pain and urinary incontinence. For the patients of irradiation therapy, daily dose Taldanafil (5mg) starts simultaneously with irradiation and sexual behavior or masturbation is encouraged in every 5 days. Based on our preliminary result, almost all of the couples can accept the concept of penile rehabilitation to preserve the penile length and erectile function, even though they may not so active in sexual life. Compare with the group of the prostatic cancer patients without penile rehabilitation the sexual function, sexual intimacy, quality of life of the patients after penile rehabilitation is very much improved. We conclude that sexual rehabilitation should be a gold standard for the patients after radical prostatectomy or during irradiation. PP17 COMPARISON OF THE EFFECT ON CAVERNOUS NERVE STIMULATION-INDUCED INTRACAVERNOUS PRESSURE INCREASE BETWEEN DAILY AND WEEKLY ADMINISTRATION OF SILDENAFIL IN THE RAT 1 1 Kuang-Kuo Chen , Luke S. Chang 1 Department of Surgery, Taipei Veterans General Hospital, and Shu-Tien Urological Research Center, National Yang-Ming University (Taiwan) Purpose: On-demand or once daily use of phosphodiesterase-5 inhibitors has been suggested to improve erectile function. The objective of this study was to compare the effect of weekly (on-demand) or daily administration of sildenafil on intracavernous pressure (ICP) increase after electrical stimulation (ES) of cavernous nerve (CN) in the rat. Materials and methods: Male adult Sprague-Dawley rats were used. Five groups of experiments were arranged: group 1: daily oro-gastric administration (OGA) of sildenafil 0.13 mg for one week; group 2: OGA of sildenafil 0.5 mg at the end of one week; group 3: daily OGA of sildenafil 0.13 mg for 4 weeks; group 4: OGA of sildenafil 0.5 mg every week for 4 weeks, and group 5:without administration of sildenafil. A 26-gauge needle was inserted into the corpus cavernosum to measure the ICP. The CN was electrically stimulated with parameters (5, 7.5, 10 V, 20 Hz, 2 ms, 1 minute) on the 7th day for the group 1 and group 2 rats, and on the 28th day for the group 3 and group 4 rats. The amount of ICP increase was defined as the difference between peak ICP and resting ICP. Results: A significant increase of ICP from resting 7.7 ±1.9 mmHg to a peak 76.2 ±5.9 mmHg after ES of CN with 10V was noted in group 1 rats. There was also a significant increase of ICP from resting 7.0 ±1.6 mmHg to a peak at 72.0 ±5.1 mmHg after ES of CN with 10V in group 2 rats. A significant increase of ICP from resting 8.7 ±3.0 mmHg to a peak at 67.2 ±5.0 mmHg after ES of CN with 10V was also noted in group 3 rats. There was a significant increase of ICP from resting 8.8 ±2.5 mmHg to a peak at 66.3 ±5.3 mmHg after ES of CN in group 4 rats. There was a significant increase of ICP from resting 12.5 ±1.4 mmHg to a peak 52.7 ± 6.8 mmHg after ES of CN with parameter 10V in group 5 rats. The amount of ICP increase was 68.5 ±3.9 mmHg, 65.0 ±4.7 mmHg, 58.5 ±3.7 mmHg, 57.5 ±4.7 mmHg and 40.2 ±5.6 mmHg, in group 1, 2, 3, 4, and 5, respectively. There was a significantly greater amount of ICP increase in groups 1, 2, 3, and 4 rats as compared with group 5 rats. No significant difference of amount of ICP increase was noted among group 1, 2, 3, and 4 rats. Conclusion: The results suggest that there is a significant greater amount of ICP increase after ES of CN in the rats with daily or weekly oral administration of sildenafil than those without sildenafil administration. However, no significant difference of the ES of CN-induced ICP increase is noted among daily and weekly oral administration of sildenafil for up to 4 weeks in the rat. PP18 THE EFFECT OF TESTOSTERONE ON EPIMEDIUM BREVICORNUM MAXIM EXTRACT-INDUCED PENILE ERECTION IN THE RAT 1 1 Kuang-Kuo Chen , Luke S. Chang 1 Department of Surgery, Taipei Veterans General Hospital, and Shu-Tien Urological Research Center, National Yang-Ming University (Taiwan) Purpose: Our previous study has found that intracavernous administration of a Chinese medicine, i.e Epimedium brevicornum Maxim (EbM) extract may induce a penile erection in terms of a significant increase of intracavernous pressure (ICP) in the rat. Androgen has been reported to stimulate the expression of nitric oxide synthase (NOS), production of NO and mediation of penile erection in the rat. Therefore, the aim of this study was to investigate the effect of testosterone on EbM extract-induced penile erection in the rat. Materials and methods: Male adult Sprague-Dawley rats were used. A 26-gauge needle was inserted into corpus cavernosum to monitor the ICP. Five groups of study were designed: 1)intracavernous administration of EbM extract 6500 μg/0.1 ml; 2)bilateral orchiectomy in a young rat (100 g), then intracavernous administration of EbM extract 6500 μg 6 weeks later; 3)bilateral orchiectomy in a young rat (100 g), followed by testosterone replacement with subcutaneous implantation of a silicon tube filled with 85 mg testosterone (4-andronsten-17β-ol-3-one in crystalline form), then intracavernous administration of EbM extract 6500 μg 8 weeks later; 4)sham operation of bilateral orchiectomy, then intracavernous administration of EbM extract 6500 μg 6 weeks later; and 5) intracavernous injection of saline 0.1 ml as a control. The serum levels of testosterone in normal adult rats, and at before and 2 weeks after castration, and 4 weeks after testosterone replacement were examined. Results: There was a significant increase of ICP from resting 4.7 ± 1.2 mmHg to a peak at 99.5 ± 0.5 mmHg after intracavernous administration of EbM extract 6500 μg. However, there was no significant change of ICP after intracavernous administration of EbM extract 6500 μg in the rats 6 weeks after bilateral orchiectomy. After testosterone replacement in the castrated rats, intracavernous administration of EbM extract 6500 μg elicited a significant increase of ICP from resting 13.2 ± 0.7 mmHg to a peak at 100.0 ± 0.0 mmHg. In the rats underwent sham operation, intracavernous administration of EbM extract 6500 μg induced a significant increase of ICP from resting 9.3 ± 1.1 mmHg to a peak at 89.3 ± 7.9 mmHg. Intracavernous application of saline 0.1 ml was ineffective to elicit a significant change of ICP. Serum testosterone was in the castration level 2 weeks after bilateral orchiectomy, and returned to normal level 4 weeks after testosterone replacement. Conclusion: The results suggest that testosterone deprivation by bilateral orchiectomy may eliminate the intracavernous EbM extract-induced penile erection, and this EbM extract-induced penile erection may recover after testosterone replacement in the castrated rats. These observations suggest that testosterone may have a great and pivotal effect on EbM extract-induced penile erection in the rat. PP19 HYPERPROLACTINEMIA-INDUCED HYPOGONADISM IN MALE RATS IS RELATED WITH AUTOPHAGY OF LEYDIG CELLS 1 1 1 1 1 1 1 Yi-Ting Tsai , William J Huang , Yi-Te Chiang , Yi-Te Chiang , Hsiao-Fung Pu , Alex TL Lin , Kuang-Kuo Chen 1 Department of Urology and Physiology, School of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C. Division of Urology, Department of Surgery Taipei Veterans General Hospital (Taiwan) Purpose: Hyperprolactinemia (hyperPRL) is associated with disorder in testosterone (T) release in male rats. The effects contribute to erectile dysfunction and impairment in spermatogenesis. We have confirmed that PRL induces the production of tumor necrosis factor alpha (TNF-α) from the testicular interstitial macrophages. And TNF-α is detrimental to steroidogenesis of LC. Autophagy, a pathway of cell death, could also be induced by TNF-α. Autophagy seems play inhibitory effects on T production in LC. Methods and Materials: This study we examined the density of autophagy signals in testes of hyperPRL male rats. HyperPRL was induced by alografting of 3 anterior pituitary glands (AP) to subrenal capsule. Six weeks after grafting the rats were examined for serum PRL levels. The control groups were prepared by grafting with brain cortex. The testis of the rats were retrieved for Western blotting and immunohistochemistry (IHC) study to define the expression of microtubule-associated protein 1 light chain 3 (LC3). Radioimmunoassay (RIA) was used to assay T concentration of testicular fluid. Results:The data showed that T concentration was much higher in control groups (+CX) than in hyperPRL groups (+AP). LC3 density was significantly higher in +AP hyperPRL groups than in the control groups. Similar resutls were also shown in Western blot. Conclusion:We confirmed the occurance of autophagy is much more popular in LC of rats with hyperPRL. The hyperPRL-induced hypogonadism might in part be contributed by autophagy of the LC. PP20 THE EFFECTS OF ANTI-TNF- ANTIBODY ON NEURAL NO SYNTHASE EXPRESSION AND SMOOTH MUSCLE CONTENT IN CARVERNOSAL TISSUE IN RATS WITH HYPERPROLACTINEMIA-RELATED ERECTILE DYSFUNCTION 1 1 1 1 1 1 1 Zhong-Lin Wang , William J Huang , Yi-Ting Tsai , Yi-Te Chiang , Hsiao-Fung Pu , Alex TL Lin , Kuang-Kuo Chen 1 Department of Urology and Physiology, School of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C. Division of Urology, Department of Surgery, Taipei Veterans General Hospital (Taiwan) Purpose: Hyperprolactinemia (hyperPRL) induces dysfunction of reproductive system in male mammals. Literature has confirmed the appearance of impaired erectile function in these animals. Besides, recent evidence demonstrated that TNF impairing penile tumenscence. The purpose of this study is to discuss the effects of anti-TNF- antibody on the expression of neural nitric oxide synthase (nNOS) and smooth muscle content in carvernosal tissue of rat penis. Methods and Materials: Male Sprague-Dawley rats (8 to 12 week-old) were grafted with either anterior pituitary glands (+AP) or similar amount of cerebral cortex (+CX) to the recipient subrenal capsule 6 weeks before experiments. Rats were injected with anti-TNF- antibody (12.5 g/kg) 1 week before sacrifice, and the penile tissue was retrieved. The paraffin-sectioned slides were prepared for immunofluorescent (IF) and Masson’s trichrome staining. Results: The expression of nNOS was significantly decreased in +AP hyperPRL groups. Smooth muscle content in +AP hyperPRL rats was also significantly decreased. After anti-TNF- antibody treatment, nNOS and smooth muscle content were both compatible with the control groups. Conclusion: In this study we showed anti-TNF- could reverse the detrimental effects of hyperPRL upon erectile function in +AP rats. The recovery of nNOS expression and smooth content might imply that anti-TNF- treatment a potential therapeutic agent to hyperPRL-related erectile dysfunction. PP21 STORAGE LOWER URINARY TRACT SYMPTOMS ARE PRONOUNCED IN MIDDLE-AGED MEN WITH ERECTILE DYSFUNCTION 1 Wei-Kung Tsai 1 Mackay Memorial Hospital (Taiwan) Objective: Lower urinary tract symptoms (LUTS) and Erection (ED) are extremely prevalent in aging men. The results of several large-scale studies have shown a consistent and strong relationship between LUTS and ED but storage and voiding symptoms have different bothersome impacts for aged male. The objective of this study was to assess the correlation of erectile dysfunction and LUTS subtypes in different age groups. Methods: A total of 210 men visited our clinic for erectile dysfunction was investigated and 132 patients were included in the final data. The International Prostate Symptom Scores (IPSS) including storage subscore and voiding subscore, International Index of Erectile Function-5 (IIEF-5), serum testosterone level of patients were reviewed and analyzed by paired t test and Pearson correlation coefficients. Results: The mean age was 57.2 years. The Pearson correlation coefficient was -0.267 (P= < 0.001) in IIEF-5 and IPSS total score, -0.2 in voiding subscore and IIEF-5 score (p=0.01), and -0.312 in storage subscore and IIEF-5 score (p < 0.001). But after stratification by age, significant negative correlation was both found in storage and voiding subscore to IIEF-5 score (r=-0.322, -0.368; p=0.044, 0.024) in age older than 60 years old. Significant negative correlation was found between storage subscore and IIEF-5 score in age 50-59 (r=-0.299; p=0.009) and age younger than 50 (r=-0.301; p=0.026), but no correlation for voiding subscore in age 50-59 (r=-0.059; p=0.326) and age younger than 50 (r=-0.237; p=0.065) (table 1). Serum testosterone did not correlate to IPSS and IIEF-5 scores (p>0.05). Conclusion: Although LUTS and ED have a strong association at previous clinical study and pathophysiologic hypotheses, our results revealed storage urinary tract symptoms are more closely related to erectile dysfunction than voiding symptoms in middle-age men. In the group of age over 60 years. There are significant negative correlations for both subscores with IIEF-5. PP22 THE TIMING OF FIRST SEXUAL INTERCOURSE AMONG CHINESE ADOLESCENTS: A NATIONAL STUDY 1 2 1 1 1 Wei Guo , Zheng Wu , Yue Qiu , Gong Chen , Xiaoying Zheng 1 Institute of Population Research, Peking University (China) 2 Department of Sociology, University of Victoria (Canada) Purpose: The timing of first sexual intercourse among adolescents has far reaching implications for their physical, psychological and social transition into their adult life. However, research on this issue has long been hampered by a heavy lack of adequate data in China. It is therefore important here to address this research gap using the first nationally representative sample data. Materials and methods: Using the newly data set collected in late 2009 and early 2010 from a nation-wide survey First National Youth Reproductive Health Survey (FNYRHS) in China of 22,288 unmarried youth aged 15-24, of whom 22.4% reported having had sexual intercourse, this study estimated the median age at first sex by gender, household registration and region based on life-table techniques, and then determined the gender-specific contextual and individual socioeconomic hazard ratio of sexual activity among adolescents in each group based on Cox regression models. Results: Overall, the adolescents in the sample had a median age at first sex of 23.8years. The males and the urban adolescents reported similar ages (about 23.5 years). Females, rural adolescents, and the adolescents in Eastern China also reported similar ages (about 24.1 years). The adolescents in Western China had the lowest observed median (about 23.1 years). And the adolescents in Central China had a median age at first sex of 23.8years. Distinctive differences in plots of observed survivor functions by gender, household registration and region are also examined. results simultaneously show that gender, household registration, school sex education, The Cox model region, educational attainment, father’s educational attainment, mother’s educational attainment , family structure are all significantly associated with the onset of the sexual transition event. Finally, we find that the significant covariates except of mother’s educational attainment in Cox model affect the timing to first sexual intercourse in the same direction for males and females in subsequent Gender-stratified Cox models. And mother’s education attainment is still significant for males only here. Conclusion: In order to influence sexual behavior and support delays in sexual initiation of Chinese adolescents it may thus be appropriate to employ related health promotion activities focusing upon familial and societal structural factors, as a supplement to traditional methods of sex education. PP23 THE ATTTITUDE ABOUT PHOSPHODIESTERASE TYPE 5 INHIBITORS AMONG PHARMACISTS—A LOCAL OBSERVATIONAL STUDY 1 1 Chih-Cheng Lu , Wen-Chou Fan 1 Chi Mei Medical Center, Liouying (Taiwan) Objective: To understand and evaluate the attitude about use of phosphodiesterase type 5 inhibitors (PDE5I) among the professional pharmacists Methods: A non-validated attitude questionnaire with Lickert-type scale was applied to a local professional pharmacist group in the south of Taiwan. The questionnaire consisted of 3 kinds of questions. The first type of questions was for possible self-use of PDE5I if the pharmacists had ED. The second type of questions was for possible recommending use of PDE5I to the other ED patients who had close relationship to the pharmacists. The third type of questions was for the possible role of taking PDE5I to cure ED. Which kind of PDE5I was thought to be most common used (prescribed by physicians) in their practice was also surveyed. Results: This study was performed in July, 2011. One hundred and ninety five cases were enrolled anonymously. There were 84 male and 111 female. The mean age was 47.0 years (ranged from 24 to 80). If the male pharmacists had ED, more than seventy percent (62/84) of them would possibly take PDE5I for themselves in advance. In some ED patients who had close relationship with the pharmacists, sixty percent (117/195) of the pharmacists would possibly recommend PDE5I use for them. For ED treatment, thirty-nine percent of the pharmacists thought that taking PDE5I to cure the ED was impossible. Among the 3 PDE5I available in Taiwan, The most prescribed PDE5I among the pharmacists in the study was Sildenafil. Fourteen percent of the pharmacists did not have the clinical experience for PDE5I prescription. Conclusion: From this limited study in the attitude about PDE5I among the professional group, over seventy percent of the pharmacists would possibly take PDEI themselves once they had ED. Sildenafil is the most common known prescribed PDE5I among the pharmacists. Further and larger studies are warranted to confirm the findings. PP24 METABOLIC SYNDROME IN HONG KONG PATIENTS WITH ERECTILE DYSFUNCTION 1 Ho-Yin Ngai , Steve Wai-Hee Chan 1 1 Division of Urology, Department of Surgery, Queen Elizabeth Hospital (Hong Kong) Purpose: The association between Erectile Dysfunction (ED), Metabolic syndrome (MetS) and cardiovascular disease has been recognized. Our aim is to evaluate the incidence of MetS in Chinese patients with erectile dysfunction (ED) from Hong Kong. Materials and methods: This is a prospective study enrolling patients with ED, who were referred to our Andrology clinic (as a tertiary referral center in Hong Kong) for assessment from March 2011 to July 2011. Patient characteristics were recorded, physical assessment and biochemical investigations were performed, and data was collected for analysis. Results: Totally 60 Chinese patients with ED are included in the study. The median IIEF-5 score is 10. The mean age was 56 years (range: 32 – 76). Half of the patients were either smoker (18.3%, n=11) and ex-smoker (31.7%, n=19). Hypertension (50%, n=30) and Diabetes (33.3%, n=20) were the major underlying morbidities. Mean duration of ED symptoms were 34 months. Metabolic syndrome (MetS) is defined according to the National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATPIII) criteria in 2005: hypertension, high fasting plasma glucose, low HDL-cholesterol, hypertriglyceridaemia and waist circumference ≥90cm (redefined waist circumference for Chinese men according to World Health Organization Western Pacific Region, International Association for the Study of Obesity and International Obesity Task Force). The incidence of MetS was 38.3%. Hypertension (80%) and impaired glucose tolerance/ diabetes (51.7%) remain the main contributing factors. Conclusion: This is the first study from Hong Kong to evaluate the incidence of MetS regarding the Chinese patients with ED. Such a high incidence (38.3%) of MetS in Hong Kong is similar to figures from American and European populations with ED. The effort in screening and managing the MetS serves as an important part of the holistic care of patients having ED. PP26 ASSESSMENT OF ERECTILE FUNCTION IN OVERWEIGHT AND OBESE PATIENTS 1 2 3 1 1 1 2 1 Heng-Jun Xiao , Jun Chen , Xiao-Yong Pu , Hao Zhang , Xiao-Peng Liu , Yan Zhang , Bin Zhang , Xin Gao 1 Department of Urology, the Third Affiliated Hospital of SUN Yat-sen University (China) 2 Department of infertility & sexual medicine, the Third Affiliated Hospital of SUN Yat-sen University (China) 3 Department of Urology, Guangdong Provincial People’s Hospital (China) Introduction: The prevalence of obesity is growing with the rapid improvement of Chinese living standard in the past thirty years and it is receiving increasing research attention. Obesity has been regarded as one of the most important risk factors for some diseases such as cardiovascular disease (CVD), erectile dysfunction (ED), metabolic syndrome (MS), and type 2 diabetes mellitus (DM2). Body mass index (BMI) is widely used to identify metabolic syndrome as an important parameter of obesity. This study is designed to describe their erectile function and the risk factors for CVD in overweight and obese patients from China mainland. Objective: To assess erectile function and the risk factors for CVD in overweight and obese patients. Methods: A total of 46 overweight and obese male patients more than 20 yr of age who have presented as dyslipidemia were recruited and it was randomly compared with 48 normal weight men as a control group. Based on BMI, patients were grouped into normal (BMI < 24kg/m/m), overweight (24 < or=BMI < 28kg/m/m), and obesity (BMI>or=28kg/m/m). Erectile function was evaluated according to the International Index of Erectile Function (IIEF) scores. The presences of risk factors for CVD were identified in all the men. Results: High BMI (BMI>or=24kg/m/m) showed greater incidence of ED and increased risk factors for CVD compared with normal BMI group. ED was significantly associated with obesity (P < 0.01), whereas the incidence of ED in overweight patients was not higher than those who had normal BMI (P>0.05). IIEF in normal, overweight and obesity patients was 22.5±1.9, 21.3±2.6 and 17.3±4.2, and the prevalences of CVD in three groups were reported by 4.2% (2/48), 12.0% (3/25), and 23.8% (5/21), respectively. Conclusion: Men with high BMI, especially obesity, have more prevalences of ED and CVD. These findings suggest that they have some common risk factors for both pathogenetic conditions which link ED and CVD. PP27 PERCEPTION OF ERECTILE DYSFUNCTION (ED) AS A MEDICAL CONDITION BY POPULATION WITH VARIED EDUCATIONAL BACKGROUND 1 1 Mun Yee Siaw , George EngGiap Lee 1 Monash University Sunway Campus (Malaysia) Purpose: Erectile Dysfunction (ED) is a common sexual dysfunction affecting men and is associated with significant comorbidities such as dyslipidaemia and hypertension. Perception towards ED is one of the main factors in determining patient’s help-seeking behaviour. We conducted a study aimed at exploring males and females’ perception towards ED from various education backgrounds. Materials and methods: Three thousand three hundred and seventy two subjects (2032 males and 1340 females) voluntarily recruited from an urban tertiary hospital, were administered a pre-tested questionnaire on ED. The subjects were grouped into 2 categories according to their gender. Comparison was also made with subject’s education level taken into account. Results: In general, most subjects perceive ED as a medical condition with reported percentage of 74.5% in males and 76.6% in females. Despite that, the vast majority of subjects likewise perceive ED as a lifestyle and psychological condition as well. Overall, 68.3% of males and 67.8% of females reported ED as a lifestyle condition whereas 75.2% and 73.7% of males and females respectively deem ED to be a psychological condition. Comparing subject’s education level, 40.8% of males who reported ED as a medical condition only had high school qualifications while 33.8% graduated from university. Similar results were observed in females where out of the 76.6% of females who believed that ED is a medical condition, 38.2% obtained high school qualifications only while 37.2% were university graduates. Conclusion: ED is commonly perceived as a medical condition regardless of gender and education level. Nevertheless, this medical condition is not taken seriously by both males and females in view of their simultaneous perception that ED is likewise a lifestyle and psychological condition as well. This mixed misconception will directly affect one’s help-seeking behaviour. Essentially, added emphasis should be placed on patient education in order to highlight ED as a medical condition and its correlation with comorbidities such as heart condition. PP28 PERCEPTION OF ERECTILE DYSFUNCTION (ED) AS A MEDICAL CONDITION BY POPULATION WITH DIFFERENT SEXUAL ACTIVITY STATUS 1 1 Mun Yee Siaw , George EngGiap Lee 1 Monash University Sunway Campus (Malaysia) Purpose: Erectile Dysfunction (ED) is a common sexual dysfunction affecting men and is associated with significant comorbidities such as dyslipidaemia and hypertension. Perception towards ED is one of the chief factors governing patient’s help-seeking behaviour. We conducted a study aimed at exploring the general public’s perception towards ED among sexually active and non-sexually active people. Materials and methods: Three thousand three hundred and seventy two subjects (2032 males and 1340 females) voluntarily recruited from an urban tertiary hospital, were administered a pre-tested questionnaire on ED. The subjects were grouped into 2 categories according to their sexual activity status. Results: Of the 3372 respondents, 64.4% were sexually active within the past 6 months while 35.6% had no sexual activity within the past 6 months. Overall, 75.3% of respondents reported ED as a medical condition. The vast majority of them were sexually active with a reported percentage of 48.8%. In contrast, only 26.5% of non-sexually active respondents believed that ED was a medical condition. Conclusion: Individuals who are sexually active commonly perceive Erectile Dysfunction as a medical condition in comparison to non-sexually active individuals. Identification of this significant difference in Erectile Dysfunction perception between sexually active and non-sexually active individuals poses a question as to whether this difference in perception is due to sexual activity affecting public’s perception of Erectile Dysfunction or vice versa; public’s perception of Erectile Dysfunction affecting their sexual activity. Essentially, patient education and awareness, with the added emphasis on non-sexually active individuals, is crucial in order to highlight Erectile Dysfunction as a medical condition and its correlation with comorbidities such as heart condition. PP29 PERCEPTION OF ERECTILE DYSFUNCTION (ED) AS A MEDICAL CONDITION BY POPULATION OF DIFFERENT AGE GROUPS 1 1 Mun Yee Siaw , George EngGiap Lee 1 Monash University Sunway Campus (Malaysia) Purpose: Erectile Dysfunction (ED) is a common sexual dysfunction affecting men and is associated with significant comorbidities such as dyslipidaemia and hypertension. Perception towards ED is one of the chief factors governing patient’s help-seeking behaviour. We conducted a study aimed at exploring the general public’s perception of ED as a medical condition from various age groups. Materials and methods: Three thousand three hundred and seventy two subjects (2032 males and 1340 females) voluntarily recruited from an urban tertiary hospital, were administered a pre-tested questionnaire on ED. The subjects were grouped into 5 categories according to their age groups. Results: In general, majority of subjects perceive ED as a medical condition with reported percentage of 75.3%. Perception of ED as a medical condition was at its lowest with a mere 10.2% among youths aged between 18-25years. An increase was observed among those who were 26-35years where 18% of subjects believed ED to be a medical condition whereas only 14.3% was observed in subjects aged 36-45years. Above all, subjects aged 46-55years recorded the highest percentage with 19.5% of them reporting ED as a medical condition. For subjects aged above 55years, a slight dip in ED perception was noticed with reported percentage of 13.3% only. Conclusion: The anticipated increase in Erectile Dysfunction perception as a medical condition with increasing age was not observed. This poses as a worrying issue considering that incidence of Erectile Dysfunction is increasingly prevalent with age; specifically after 45years of age. More importantly, this low awareness among the general public will directly affect one’s help-seeking behaviour. Essentially, patient education and awareness, with added emphasis on individuals aged 45years and above, is crucial in order to highlight Erectile Dysfunction as a medical condition and its correlation with comorbidities such as heart condition. PP30 ANALYSIS OF THE FACTORS WHICH HAVE EFFECTS ON ERECTILE FUNCTION; THE RELATIONSHIP BETWEEN ERECTILE FUNCTION AND LOWER URINARY TRACT SYMPTOMS 1 2 2 2 2 2 Kazuyoshi Shigehara , Eitetsu Koh , Kazuhiro Sugimoto , Masashi Iijima , Yuji Maeda , Hiroyuki Konaka , Teruaki 3 2 Iwamoto , Mikio Namiki 1 1) Department of Urology, Ishikawa Prefectural Central Hospital (Japan) 2 2) Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science (Japan) 3 3) Center for Infertility and IVF, International University of Health and Welfare (Japan) Purpose: We analyzed some factors which can have effects on erectile function to elucidate the relationship between erectile function and lower urinary tract symptoms (LUTS) or metabolic syndrome. Materials and methods: Two hundred-four male patients were enrolled in this study. The patients with prostate cancer, histories of pelvic surgery, and current administration of testosterone or anti-androgenic agents, were not eligible. Each patient replied the questionnaires such as International index of erectile function (IIEF) 5, Aging Male Score (AMS) and International prostate symptom score (IPSS). In addition, body mass index (BMI), west size, and muscle volume were measured from all patients. In addition, blood biochemical analysis including free testosterone (FT), total cholesterol (Tchol), triglyceride (TG), and HbA1c were also evaluated. We tried to identify any parameters which could have effect on IIEF5 score. Results: Mean patient’s age was 64.9±8.7 (ranged from 42 to 87), and IIEF5, IPSS, west size, BMI, and FT value were 11.4±6.4, 9.7±8.7, 86.6±9.2 cm, 23.8±4.0, and 7.3±2.2pg/mL, respectively. FT value showed a significant inverse correlation with age (r=-0.321) as reported by a previous Japanese large-population study. The parameters which had significant correlations with IIEF5 were age (r=-0.357), IPSS(r=-0.296), and muscle volume (r=0.140). However, since age demonstrated significant associations with many of parameters. Thus, when all parameters were controlled for age, IPSS and AMS were the meaningful factors which had effects on IIEF5 (r=-0.218, and r=-0.195, respectively). In addition, further sub-analysis demonstrated that IIEF5 showed inverse correlations with the voiding domains (IPSS No1, 3, 5, 6, and 7 domains) and all of three AMS domains (psychotic, physical and erectile domains). On the other hand, west size, BMI, FT value, Tchol, TG, and HbA1c did not have a significant correlation with IIEF5 in the present study. Conclusion: Age showed a strongest correlation with erectile function. Furthermore, voiding symptoms of LUTS and AMS were also likely to have some potential effects on erectile function. PP31 THE DEVELOPMENT OF SELF-RATING LIBIDO SCALE FOR MALE 1 1 1 2 1 1 Bin Zhang , Tao Qi , Jun Chen , Hengjun Xiao , Bao Wang , Xiaoming Li 1 Department of Infertility and Sexual Medicine, The Third Affiliated Hospital, Sun Yat-Sen University (China) 2 Department of Urology, The Third Affiliated Hospital, Sun Yat-Sen University (China) Purpose: To develop initially a self-rating libido scale for male (SRLS-M) and apply it to clinical practice. Materials and methods: Firstly we redefinited libido according to CCMD-3, ICD-10 and previous study of parasexuality. Secondly we proposed four aspects as: potential libido, tempting libido, occasional libido, common desire. Structurely designed each item to compose the category according to the definition of libido. In order to abbreviate the items of the scale ,the experts gave a mark to each item and deleted the lower. Thirdly, we pretested the 20 items scale and selected the suit items to compose the formal 13 items scale. Finally we analyzed the reliability and validity of the 13 items scale through 276 effective responsive questionnaires and 50 were retested. Results: ① Reliability: The re-test reliability after two weeks was 0.931. Alpha of homogeneity reliability was 0.8362. ② Validity: Between HS and NORM, the rate of diagnosing the HS was 92.85%. between HS and ED, the rate of diagnosing HS was 100% while ED was 87.87%. between HS and PE, the rate of diagnosing HS was 92.85% while PE was 87.09%. ③Totally 13 items in scale. The results of factor analysis were four factors such as potential libido, tempting libido, occasional libido, common desire. Conclusion: ①This 13 items scale is comprehensive and it rates libido from all aspects of the definition of libido. It can quantitate libido. ②This 13 items scale is good in reliability and validity. It can discriminate HS from other male sexual dysfunctions. PP32 CLINICAL INVESTIGATION OF PATIENTS WITH EJACULATORY DYSFUNCTION AND MALE INFERTILITY 1 1 1 1 1 1 1 1 Yasushi Miyagawa , Tetsuya Takao , Hidenobu Okuda , Keisuke Yamamoto , Shinichiro Fukuhara , Iwao Yoshioka , 2 2 3 1 Yasuhiro Matsuoka , Akira Tsujimura , Hingo Takada , Kiyomi Matsumiya , Yoshio Okamoto , Norio Nonomura 1 Department of Urology, Osaka University Graduate School of Medicine (Japan) 2 Department of Urology, Osaka Police Hospital (Japan) 3 Okamoto Clinic (Japan) Purpose: Ejaculatory dysfunction (EjD) is relatively uncommon, but not rare, cause of male infertility. Ejaculatory infertility is sometimes a challenge for the treating physician. We summarize our recent clinical experience of treatment for patients with EjD and male infertility. Methods and Materials: Medical charts of 60 infertile men with EjD treated at Osaka University Hospital or an affiliated infertility clinic between 2005 and 2010 were reviewed by retrospective analysis. Patients’ characteristics including serum hormone profiles, complications and etiologies, and treatments/ outcomes were analyzed according to the types of EjD. Results: The average age of all patients was 36.9 yrs, while wives’ was 31.4 yrs. Of 60 patients, 4 (7%) were retrograde ejaculation (RE), 10 (17%) were anejaculation (AE) and 46 (77%) were delayed ejaculation (DE) during intercourse. Among 14 patients of RE/AE, four (29%) were orally administrated with amoxapine but none achieved antegrade ejaculation and 11 (79%) utilized assisted reproductive technology (ART) including TESE/ICSI. 41 (89%) of 46 patients of DE were initially treated with PDE5I and 10 (24%) could ejaculate inside vagina and 28 (61%) proceeded to ART such as artificial insemination of husband. Overall, 14 (23%) achieved pregnancy and 11 (18%) got delivery during follow-up. Conclusion: Even ART could not offer satisfactory outcome as for infertility in this series and the development of new integrated therapeutic alternatives for EjD associated with infertility will be necessary to maximize success rates. PP35 PENILE DUPLEX ULTRASONOGRAPHY IN MEN WITH PEYRONIE'S DISEASE: VENO-OCCLUSIVE DYSFUNCTION OR POOR CAVERNOSAL ARTERIAL INFLOW; CLINICAL INSIGHTS TO DIFFERENTIATE THEIR CONTRIBUTIONS TO ED. 1 2 Eric Chung , Ling De Young , Gerald Brock 1 Princess Alexandra Hospital (Australia) 2 St Joseph Health Care (Canada) 2 Objective: At least 20% of men with Peyronie's disease (PD) suffer from erectile dysfunction (ED). The fundamental mechanism is thought to arise from the progression of fibrosis limited to the PD plaque within the tunica albuginea. However recent studies have highlighted the possibility of fibrosis of the cavernosal vessel media wall leading to impairment of arterial inflow. This study evaluates penile duplex ultrasonographic findings in men with PD who have ED and determines whether early features of PD might predict clinical progression. Methods: We performed a retrospective review of all men presenting with penile curvature and length loss who underwent penile colour duplex ultrasonography (CDU) between January 2001 and January 2010. Patient demographic, comorbidities, International Index of Erectile Function-5 (IIEF-5) scores, surgical intervention and physical findings were documented. Penile curvature, plaque size, peak systolic and end-diastolic velocities on CDU were recorded. Results: A total of 1120 men underwent penile CDU during the 10 year period. Complete information was obtained in 810 men with 250 men complained of decreased penile rigidity while 150 men were unable to sustain erection. Comorbidities were similar between PD men with and without ED. Tunical thickening (65%) was the most common CDU feature and mean cumulative calcifications was 24.2mm2 (1 to 360 mm2, SD 76). The peak systolic and end-diastolic velocities on the right cavernosal artery were 14.2 cm/s and 3.5 cm/s, while the left cavernosal artery measurements were 15.1 cm/s and 3.2 cm/s. Multivariate logistic regression model showed strong correlation between plaque size and development of ED. Both veno-occlusive dysfunction and impaired cavernosal arterial inflow were associated with ED. Conclusion: Veno-occlusive dysfunction and impaired cavernosal arterial inflow contributed to the development of ED with larger plaque size being the best predictor of progression to surgical intervention. PP36 THE CLINICAL EFFICACY OF HIGH DOSE VARDENAFIL FOR ERECTILE DYSFUNCTION IN ELDER OR PATIENTS WITH METABOLIC SYNDROME 1 1 1 1 Toshiyasu Amano , Masaya Seki , Tetsuya Imao , Katsurou Takemae 1 Department of Urology, Nagano Red Cross Hospital (Japan) Purpose: The purpose of this study is to make sure the efficacy and safety of high dose vardenafil for erectile dysfunction (ED), especially elder and/or patients with metabolic syndrome or life-related disease. Materials and methods: Total 125 ED patients have been treated with high dose (20mg) vardenafil on demand, and its efficacy and safety were analyzed. The evaluation of efficacy for erection was excellent (enough hardness and maintenance), good (fair hardness and maintenance), fair (possible sexual intercourse, but not so good hardness or maintenance), poor (slight erection, but impossible sexual intercourse) and none (no response at all). Adverse reactions were recorded at the same time. Results: (1) International index of erectile function (IIEF 5) obtained from total 125 ED patients was 7.8 +/- 3.9. The efficacy of high dose vardenafil was excellent in 47 (37.6%), good in 51 (40.8%), fair in 12 (9.6%), poor in 4 (3.2%) and non in 11 (8.8%), respectively. The adverse reactions as headache in 5 and hot flash in 4 (7.2%) were observed, however they were not serious at all. (2) IIEF 5 score was 7.7 +/- 4.1 in 79 patients under 64 years old and 7.8 +/- 3.8 in 46 patients over 65 years old. The results of excellent, good, fair, poor and none were 30 (38.0%), 30 (38.0%), 8 (10.1%), 4 (5.0%) and 7 (8.9%) in under 64 years old group, and 17 (37.0%), 21 (45.6%), 4 (8.7%), 0 (0%) and 4 (8.7%) in over 65 years old group, respectively. There are no statistic differences between two aged groups. (3) Fifty three patients without metabolic syndrome or life related disease and 44 with metabolic syndrome or life related diseases were also analyzed after excluding neurogenic ED or ED after intra pelvic surgery. IIEF 5 score was 8.9 +/- 3.7 in 53 patients without metabolic syndrome or life related disease and 7.3 +/- 3.4 in 44 patients with metabolic syndrome or life related disease, respectively. The distributions of excellent, good, fair, poor and none were 23 (43.4%), 25 47.2%), 3 (5.6%), 0 (0%) and 2 (3.8%) in without complications group, and 18 (40.9%), 18 (40.9%), 6 (13.7%), 0 (0%) and 2 (4.5%) in with metabolic syndrome or life related disease group, respectively. There are no statistic differences between two aged groups. Conclusion: In this study, high dose vardenafil is effective and safety treatment for ED. In addition, the efficacy for the elder ED patients is not inferior to that for the younger group. Furthermore, high dose vardenafil is effective enough for ED patients with metabolic syndrome or life-related disease. PP37 TWO DIFFERENT TYPE OF PRIAPISM AND JAPANESE EXPERIENCE OF PRIAPISM 1 1 1 1 2 3 Kenro Yamamoto , Haruaki Sasaki , Keiichiro Aoki , Michiya Ota , Yasutada Onodera , Yoshio Ogawa 1 Showa University Fujigaoka Hospital (Japan) 2 Onodera Clinic (Japan) 3 Showa University (Japan) 1) A case of non-ischemic priapism 16 years old high school student After bluntly trauma of perineum, he recognized macroscopic hematuria. He was diagnosed urethral injury and received indwelling urethral catheter for 6 days. After removed indwelling catheter, he noticed partial erection without pain. The cavernous blood gas analysis was arterial pattern, pH 7.449, PO2 80.3 mmHg, PCO2 37.2 mmHg. Color Doppler study of cavernosum demonstrated bilateral cavernous arterial injury, left side injury was predominantly than right cavernosum. We had recommended him and his family to observation therapy. However, they hoped immediately therapeutic option because he could not miss his school more over. Bilateral pudendal arteriography revealed bilateral cavernosal arterial injury. We performed embolization using autologous clots and non-absorbable material. After embolization, persistent erection disappeared immediately. Spontaneous erection recovered 11 days after embolization. 2) A case of ischemic priapism 63 years man noticed prolonged erection with pain after masturbation. Penile erection was complete. He went to near hospital four days after onset. Cavernous blood gas analysis in the penis showed a marked acidosis and hypoxia with pH6.573, PCO2 101.7mmHg, PO2 3.5mmHg. We initially tried aspiration using 21 gauge needle without injection of an adrenergic agonist. However we failed to induce detumescence. Emergency operation was performed. We had managed a percutaneous cavernosum-glans surgical shunt procedure. Despite the T-shunt procedure and Burnett method, priapism was continued. Finally we had underwent Al-Ghorab method. Although priapism was disappeared, spontaneous erection has not recovered. 3) We will introduce the Japanese 10 years experience of two different type of priapism. PP38 EFFICACY AND SAFETY OF CLOMIPRAMINE HYDROСHLORIDE CONTAINING NASAL SPRAY FOR THE TREATMENT OF PREMATURE EJACULATION 1 1 Sh. Shavakhabov , A. Fozilov 1 Republic Specialized Center of Urology. Dept. of Andrology (Uzbekistan) Purpose: The aim of the study is to evaluate the efficacy and safety of nasal spray, containing Clomipramine hydrochloride (CL) at the treatment of men with premature ejaculation (PE) Materials and methods: The single blinded, randomized, placebo controlled parallel trial included 58 heterosexual men (mean of age 33+1.8 years), who had stable monogamous sexual relations and self-reported intravaginal ejaculation latency time (IELT) of less than 2 minutes during the period at least 6 last months. The clinical study has been approved by institutional ethical committee. Then underwent assessment in accordance with International Society for Sexual Medicine guidelines. After two weeks washout period patients were randomized to receive either single dose 4mg nasal CL spray (n-36), or nasal placebo spray (n-22), in daily regimen at 1 hour before usual sleeping/intercourse time. Men were prospectively followed up for 8 weeks. Every 4th week of treatment patient condition was assessed by self-reported IELT, Chinese Index of Premature Ejaculation (CIPE) and International Index of Erectile Function (IIEF-5). The primary endpoints were the self-reported IELT and CIPE score, secondary endpoints include IIEF-5 and adverse effects of the drug. Results: The trial was completed by 55(95%) men. The mean IELT increased from pre-treatment values of 31.3 + 20.4 and 32.4 + 24.7seconds to 146.2+ 45.6 and 41.7 + 38.3 seconds post treatment respectively for CL spray and placebo (p < 0.001). Baseline mean CIPE scores 30.5+ 2.3 and 32.1+3.4 reached to 45.2+4.6 and 33.4+ 6 at 8-week treatment for CL spray and placebo, respectively (p < 0.05). The differences between initial and post-post treatment IIEF-5 values in both groups were statistically insignificant. The most common observed side effects was nasal irritation (5 patients in CL spray and 1 in placebo groups), but it was transient and well tolerated. The other adverse effects occurred in 2 patients of CL group were dry mouth and headache. 1 patient with nasal irritation and 2 patients with headaches stopped of therapy. Conclusion: This study showed that CL nasal spray was more efficacious than placebo and well tolerated. The common adverse effects were mild and self-limited. Further studies with different groups of patients are necessary to draw final conclusions on the efficacy of CL nasal spray in PE. PP39 THE DARK SIDE OF SSRI 1 Yasusuke Kimoto 1 Department of Urology, Spinal Injuries Center (Japan) Purpose: The term “Selective Serotonin Reuptake Inhibitor (SSRI)” was manufactured by SmithKlineBeecham (now GlaxoSmithKline) in the early 1990’s. Nowadays, tons of SSRI having been prescribed to treat depression all over the world. At the same time, SSRIs are used to treat Premature Ejaculation (PE). According to the AUA guideline, “Premature ejaculation can be treated effectively with several serotonin reuptake inhibitors (SRIs) or with topical anesthetics”. I focused on the safety of SSRI. Materials and methods: I made a search through PubMed in the last 20 years by the key words of SSRI and suicide/violence. Results: Two key papers were found; Fergusson D et al. Association between suicide attempts and selective serotonin reuptake inhibitors: systematic review of randomized controlled trials. BMJ 2005;330: and Healey D et al. Antidepressants and violence: problems at the interface of madicine and law. PLos Med 2006;3:1478-1487. A systematic review by Fergusson showed that a significant increase in the odds (2.28: 1.14-4.55) of suicidal attempt in patients on SSRI compared with patients on placebo. Conclusion: Premature ejaculation is a benign disease or a QoL disease. When you treat your PE patient with SSRI, you should discuss with him very carefully about the benefits and this very fatal risk of this chemical. PP41 2 CASES OF PREMATURE EJACULATION INDUCED BY LUMBOSACRAL NERVE INJURY 1 1 1 1 1 1 Bin Zhang , Jun Chen , Tao Qi , Bo Wang , Xiaoming Li , Shiqin Chen 1 Department of Infertility and Sexual Medicine, The Third Affiliated Hospital, Sun Yat-Sen University (China) Purpose: To report 2 cases of premature ejaculation induced by lumbosacral nerve injury. Materials and methods: Case1, a 35-year-old married male patient received lumbar discectomy in the hospital because of L5-S1 intervertebral disc protrution. He got sexual dysfunction and didn’t have a sufficient erection to have sexual activity after the operation, but he could ejaculate during each sexual intercourse. Case 2, a 25-year-old unmarried male patient, dropped to the ground when working on a high place, and got vertebral compression fractures of L1 and L2. After the trauma, the patient ejaculated frequently when he was sexually excited. The 2 patients were examined of penis vibratory sensation neurologic examination and nocturnal penile tumescence. Results: The 2 patients’ cremasteric reflexs weren’t obvious and their penis glans vibratory sensations were low. And nocturnal penile tumescence test indicated that their erections were in good condition. The patient in case 1 ejaculated during penis neurologic examination. The patient in case 2 watched the erotic video 2 times in 4 hours and ejaculated in 2 minutes when he began watching the video both times. Conclusion: Lumbosacral nerve injury possibly lowers the threshold of ejaculation centre in the lumbosaeral region. PP42 INVESTIGATION OF INTRAVAGINAL EJACULATORY LATENCY TIME IN COUPLES 1 1 1 1 1 1 Bin Zhang , Jun Chen , Tao Qi , Bo Wang , Xiaoming Li , Shiqin Chen 1 Department of Infertility and Sexual Medicine, The Third Affiliated Hospital, Sun Yat-Sen University (China) Purpose: To assess the effect of premature ejaculation (PE) on the quality of sexual activity. Materials and methods:121 couples carried out a questionnaire survey questionnaire including actual intravaginal ejaculatory latency time (IELT), expected IELT of males and their spouses, the impact of PE on the orgasm and the satisfaction in the sexual intercourse. And there were 80 PE couples and 41 normal control couples. IELTs were measured by female partners using a stopwatch. Results: The actual IELT of PE group was 1.8±1.3min and males’ expected IELT in this group was 15.6±9.4min. The actual IELT of normal control group was 13.8±10.7min and males’ expected IELT in this group was 22.8±18min. The difference between expected IELT and actual IELT of males in PE group was 13.8±9.3min, and the difference between expected IELT and actual IELT of males in normal control was 8.4±16.1min. Both the actual IELT and the expected IELT of males in PE group were shorter than males in normal control group (P < 0.05), and the difference between expected IELT and actual IELT of males in PE group was greater than males in normal control group (P < 0.05). The proportions of males in PE group who had strong orgasm and satisfaction were 22% and 6% respectively, which were obviously lower compared with males in normal control group whose proportions were 73% and 65% (P < 0.05). The proportions of female partners in PE group who had strong orgasm and satisfaction were 4% and 1%, also lower than female partners in normal control group whose proportions were 50% and 50% respectively (P < 0.05). The incidence rates of redundant prepuce in PE males and normal males were 20.9% and 23.3% respectively, but there was no statistical difference in them (P>0.05) Conclusion: PE has bad effect on sexual quality of sexual activity for both males and females. PE males’ demand of IELT is lower than normal males, but the difference between expected IELT and actual IELT of PE males is greater than normal males. And there’s no certain link between redundant prepuce and PE. PP44 THE EFFECTS OF ORAL ADMINISTRATION OF DA-8031, A NOVEL COMPOUND FOR PREMATURE EJACULATION, ON MALE RAT SEXUAL BEHAVIOR 1 1 1 JH Sung , GJ Ahn , KK Kang , SH Kim 1 1 Dong-A Pharmaceutical institute (Republic of Korea) Purpose: DA-8031, which is being actively developed for premature ejaculation (PE), is a novel compound showing high affinity and selectivity to the serotonin transporter. This study was undertaken to prove the effect of DA-8031 on ejaculation and sexual behavior in animal model. Materials and methods: DA-8031 is a PE treatment that repeated-administration showed no accumulation with short half-life in rat. Male Sprague Dawley rats (n=18) were sexually experienced on four different occasions over 2 weeks and sexual behavior was examined in cohorts. The behavioral trial lasted for 30minutes, during which the latency and frequency of mountings, intromissions, ejaculations and post-ejaculatory interval were recorded. The rats were orally given single dose of vehicle, DA-8031 (10mg/kg, 30mg/kg and 100mg/kg) and dapoxetine (100mg/kg) in random order 15minutes before the behavior test, using a crossover design. Results: Single oral DA-8031 administration (100mg/kg) significantly delayed ejaculation latency time (p < 0.05) compared with vehicle group (601.56±52.78 seconds vs. 422.50±41.66 seconds, respectively). The delay of ejaculation was accompanied by an increase in the frequency of mountings and intromissions, which are the index of sexual libido, with no significant. Delayed ejaculation latency in DA-8031 (100mg/kg) caused significant reduction in ejaculation frequency (p < 0.05). Dapoxetine (100mg/kg) significantly increased the mounting frequency with no delay in ejaculation latency. Conclusion: These results demonstrated the efficacy of single oral DA-8031 administration in delaying ejaculation without the sexual libido decrease. Libido was not reduced after dapoxetine administration but efficacy in delaying the ejaculation latency was not proved in this animal model. It was suggested that DA-8031 might be a promising PE treatment drug, but further evaluation in human should be performed. PP45 MINIMALLY INVASIVE SURGERY FOR PENILE AUGMENTATION USING TYPE I COLLAGEN 1 1 Tae Kyoung Yun , Hoon Seog Jeon , Dong Wan Sohn 1 Manomedi Urologic Clinics (Republic of Korea) 2 The Catholic University of Korea (Republic of Korea) 2 Objective: Many penile augmentation has been performed with various materials and methods. Fat injection for penile augmentation has complications like contour irregularities, fat migration and absorption. Recently, Type I collagen implant has been used and the safety has been improved with surgical technique development. The aim of this study is to report clinical safety and surgical techniques in complex phalloplasty using type I collagen. Methods: Type I collagen derived from bovine pericardium (Lyoplant○R) was used for phalloplasty. It has micro porous fibrous structure for rapid and regular ingrowth of autologous connective tissue. We operated penile augmentation in 286 patients with Type I collagen. In the penile dorsal area, 1~2cm from the subglans was incised at a length of 3 to 5 cm and was dissected from glans to the prepubic junction. Then, a fundiform ligament was incised for lengthening. Implant was designed according to the size of the penis and we incised multiple horizontal and vertical slits in collagen tissue using knife for improving of graft survival. Thereafter, enhancement tissue was placed between the dartos fascia and Buck’s fascia. The dartos fascis and skin were closed by 2 layers and whole body of penis except glans was wrapped up by elasctic bandage evenly. To reduce nocturnal erectile pain and discomfort, we prescribed oral ketoconazole which can reduce nocturnal erection. Results: The mean operation time was about 40 minutes and most patients had sexual intercourse successfully after 1 month. The average augmented effect in circumference was 34% and mean penile length gain(flaccid penis) was 2.3cm. Complications like graft failure was occurred in 3 patients(1%) and the graft was removed partially or entirely. Other complications like inflammation or wound dehiscence were treated through conservative treatment. Conclusion: This complex phalloplasty using Type I collagen implant with minimal incision showed positive results in safety and effectiveness. In our experience, these technique may be a good choice in penile augmentation surgery in the future. PP46 PENILE LENGTHENING FOR ADULT CONTRACTILE PENIS PRESERVING SUSPENSORY LIGAMENT 1 1 2 Tae Kyoun Yun , Hoon Seog Jeon , Dong Wan Sohn 1 Manomedi Urologic Clinics (Republic of Korea) 2 The Catholic University of Korea (Republic of Korea) Objective: The resection of suspensory ligament has drawbacks such as the possibility of reattachment of the penis to the pubis, a hump that forms at the base of the penis, in addition to alteration in the angle of erection. The aim of this study is to report a simple and minimally invasive surgical technique for penile lengthening without cutting of suspensory ligament. Methods: Dysgenetic dartos fascial band and hypermobility of penis are the common cause of contractile penis. So it is important to collect these 2 points for correction of contractile penis. We performed penile surgery in 78 patients. All of them were underwent minimally partial circumcision. Through the partial circumcision, dysgenetic dartos fascia was dissected from glans to the prepubic junction. The repair is performed combination of tacking penile base to prepubic fascia and anchoring subcutaneous penile skin to base of penile shaft for correction of hypermobility. The penis was wrapped up by elastic bandage evenly for 2 weeks. The outcome of the operation is evaluated by measurement of penile length before and after operation. Results: The postoperative course was uneventful with no serious complications. The angle of erection (as reported by patient) was similar to that prior to the procedure. The mean penile length gain(flaccid penis) was 2.5cm. There were 74 patients (95.5%) satisfied with the result and retraction occurred in 2 cases after 6 months. Conclusion: The described technique is simple and minimally invasive. In our experience, these technique may be good choice in adult contractile penis and there were no additional procedures required. PP47 TREATMENT OF ABNORMALITY OF STABILITY OF PENILE ERECTION BY SUSPENSION OF PENIS (A SINGLE CENTER EXPERIENCE WITH 3 PATIENTS) 1 1 2 1 Jun Chen , Bin Zhang , Hengjun Xiao , Tao Qi 1 Department of Infertility and Sexual Medicine, The Third Affiliated Hospital, Sun Yat-Sen University (China) 2 Department of Urology, The Third Affiliated Hospital, Sun Yat-Sen University (China) Purpose: To assess the outcomes of treatment of abnormality of stability of penile erection by suspension of penis. Materials and methods: Between December 2005 and November 2010, 3 patients diagnosed with abnormality of stability of penile erection underwent suspension of penis. All cases were available for follow-up. Results: After surgery, 3 patients were able to achieve satisfactory intercourse. Conclusion: The new surgical technique of suspension of penis is a simple operative procedure, which seems to be efficient in the treatment of abnormality of stability of penile erection. PP48 DOES CIRCUMCISION DECREASE PENIS SENSITIVITY ? 1 Joon Yong Kim , Byung Moo Kim 1 1 Philip and Paul Medical Institute, Manomedi clinics (Republic of Korea) Purpose: Circumcision is the longest and the most common penile surgery that has been conducted on the excuse of cultural convention, personal hygiene, and disease prevention including balanitis. There have been discussions from the medical perspective so far on the necessity of circumcision, the merits and demerits, and problems of circumcision, etc. One of the many disputes regarding circumcision is the possibility of a decrease in penile sensitivity caused by circumcision. Circumcision may cause edema in the distal penis including the incision line and histologic changes such as an inflammatory tissue reaction to a certain degree, though it varies by patient; and, there might be a decrease in sensitivity in the distal penis due to obstruction in the peripheral sensory nerves. The authors have measured penis sensitivity after circumcision. This study aims to report the correlation between circumcision and a decrease in sensitivity of the penis, compared to sensitivity in the state of phimosis. Materials and methods: A biothesiometry test was conducted on men who have phimosis and those who were circumcised. For those who have phimosis, it was measured on the back area of the distal penis that is 1.5-2.0 cm from the glans corona and on the front area of the proximal penis that is 1.5-2.0 cm from the penopubic junction. For those who were circumcised, it was measured at the area between the glans corona and the incision line and on the front area of the proximal penis that is 1.5-2.0 cm from the penopubic junction. Results: The average age of men having phimosis is 41 years old (ranging from 21 to 62) and the number of subjects were 22 in total. The threshold from the distal penis and that from the proximal penis was 6.4 and 6.3, respectively. The average age of men who were circumcised is 39 years old (ranging from 23 to 57) and the number of subjects were 81 in total. The threshold from the distal penis and that from the proximal penis was 5.6 and 6.1, respectively. Conclusion: This study showed that the sensitivity that was expected to decrease due to a histological change from surgery turned out to be more sensitive on the distal area than on the proximal area. On the other hand, the men who were circumcised showed less sensitivity on the distal area than on the proximal area. Although the subjects were small in number, it is assumed from the findings that circumcision would not have any influence on a decrease in sensitivity of the penis. PP49 PENILE AUGMENTATION SURGERY USING ACELLULAR HUMAN DERMAL TISSUR WITH INJECTION METHOD. 1 Joon Yong Kim , Byung Moo Kim 1 1 Philip and Paul Medical Institute, Manomedi clinics (Republic of Korea) Purpose: Penile augmentation surgery with tissue grafts through incision so far has been performed with; however, there might be adverse effects such as a wound problem, a scar, pain, prolonged recovery time. Another augmentation method is the injection of fat but there is the disadvantage of migration and a high reabsorption rate. As a result, current penile augmentation surgery has been pursued for rapid recovery using a simple technique and natural appearance. We are to introduce new methods for penile augmentation using acellular human dermal tissue with injection. Materials and methods: Under the local anesthesia, according to the size of the penis and the augmentation size the patient desired, about 3-6cc of dried acellular particulate dermal matrix combined with 1.5-1.8cc of lidocaine and 0.3cc of gentamicin per 1cc of the tissue were injected to the three parts at the shaft of the penis. Results: Retrospective investigation was done for this study with 121 cases from December 2007 to December 2009. 4cc of acellular micronized dermal tissues on average were used for a one-time injection. 2 cases of local skin necrosis were reported but it was treated through the conservatory treatment. There was little migrartion of the injected tissues after the graft. Conclusion: This surgical method does not require an incision and resulting in short operation and rapid recovery time. There are few side effects. Therefore, for the men who experienced difficulty with penile augmentation surgery with the preexisting techniques, for example, those who had physical health problems, or were of an older age, or were on special medications, this surgical method could be recommended . It also may be considered a new technique that can be applied for partial augmentation, correction of deformity, and reconstructive surgery as well PP50 VULVODYNIA AND SEXUAL QUALITY OF LIFE 1 2 1 3 Ching-Hui Chen , Yen-chin Lin , Wei-Min Liu , Li-Hsuan Chiu , Peng-Hui Wang 4 1 Department of Obstetrics and Gynecology, Taipei Medical University Hospital and Taipei Medical University (Taiwan) 2 Graduate Institute of Human Sexuality, SHU-TE University (Taiwan) 3 Graduate Institute of Medical Sciences, Taipei Medical University (Taiwan) 4 Department of Obstetrics and Gynecology, National Yang-Ming University, National Yang-Ming University Hospital and Taipei Veterans General Hospital (Taiwan) Purpose: Vulvodynia is a chronic pain syndrome of unknown etiology which is characterized by discomfort in the vulvar region; the discomfort may range from mild to severe and debilitating. The experiences of women with vulvodynia are poorly understood. Studies tend to determine the diagnosis and management of vulvodynia has been performed in US by assessing large sample of cases of vulvodynia symptoms, but not in Taiwan yet. Results: Women presenting with vulvodynia typically could be in stable, long-term relationships; have had the pain for several years; and have been examined several times by multiple physicians before receiving the diagnosis. The age range is broad, from children to women; most women with this disorder are between 20 and 50 years of age. Symptoms of vulvodynia may have been present since childhood or the time of first intercourse, or they may appear after several years of painless sex. Although women with vulvodynia report that the quality and quantity of their sexual activity has decreased since the onset of symptoms, most of them still have intercourses and orgasms. These women were just as likely as women without pain to participate in other sexual activities. In the past, it was theorized that the pain of vulvodynia was due to psychological issues. However, recent data indicate that women with vulvodynia are psychologically comparable to women without the disorder and are no more likely to have been abused. Marital satisfaction levels also are similar. Conclusion: In conclusion, vulvodynia has broad and substantial effects on sexual QOL. It highlights the psychological distress associated with vulvodynia and under-estimated the need for prospective studies to investigate the relationship between vulvodynia and woman sexual behavior. PP51 OBESITY, INSULIN RESISTANCE AND THEIR CORRELATION WITH TESTOSTERONE LEVELS IN AGING MALE PATIENTS 1 1 1 1 1 1 1 1 Sh Janjgava , E. Giorgadze , K. Asatiani , N. Jiqurauli , T. Zerekidze , L. Uchava , T. Doliashvil , M. Tsagareli 1 Tbilisi State University Department of Endocrinology, LTD “Healthy Life” (Georgia) Purpose: Obesity, insulin resistance refers to a clustering of various medical conditions, with a number of pathological components that contribute to the development of diabetes and cardiovascular disease. Visceral obesity is an important cause of insulin resistance and is strongly linked to the development of impaired glucose tolerance. Some studies have shown that free testosterone levels are low in obese men and inversely correlated with the degree of obesity. In addition, leptin levels increase with obesity and this hormone causes a further reduction in androgen levels in men. The objective of the study is to show correlation with obesity and insulin resistance degree and testosterone levels in aging male patients. The aim is also to study what influence have testosterone replacement therapy in aging male with obesity and insulin resistance. Materials and methods: 98 male patients with the age range 45-65 years and BMI 27,0 – 48,0 kg/m2 were included in the study. The following analyses were done: anthropometric study, oral glucose tolerance test, serum lipid profile, electrolytes, coagulation test, functional tests of liver and kidney, fasting insulin, free testosterone, PSA, leptin, TSH, Prolactin, FSh, LH, HOMA-IR index was calculated, ultrasonography of the abdomen and prostate, ECG. Results: In all investigated patients abnormal lipid profile and increased level of leptin was observed, 54 patients had impaired glucose tolerance test, 62 patients had decreased level of free testosterone and had inversely correlated with the degree of obesity and insulin resistance, 71 patients had increased HOMA-IR index. The appropriate treatment according to the laboratory and clinical condition was prescribed to all patients. The patients were The patients were distributed in the following way 1) First group with obesity, 2) Second group with obesity and insulin resistance, 3) Third group with androgen deficiency, insulin resistance and obesity In the first group with obesity we used diet and physical activity, in the second group with obesity and insulin resistance we used diet, physical activity and metformin, and in the third group we used testosterone undecanoate, metformin, diet and physical activity. After three months of treatment we repeated the diagnostic assessments: In the group which were treated by diet and physical activity the positive result was achieved in ≈ 42 % of patients, in the group which were treated by diet, physical activity and metformin the goal was achieved in ≈ 53% of patients, in patients with the treatment testosterone undecanoate, metformin, diet and physical activity the goal was achieved in ≈ 82%. Conclusion: These observations suggest that an inverse relationship exists between serum androgens, obesity and insulin sensitivity. Low testosterone levels have also been found to be associated with dyslipidaemia and hypertension. Testosterone treatment has also been shown to reduce insulin resistance and obesity in aging male patients and to decrease total cholesterol level. As our study have shown free testosterone levels are low in obese men and inversely correlated with the degree of obesity and insulin resistance. PP53 THE COMPARISON OF GREENLIGHT LASER AND DIODE LASER PROSTATECTOMY: ANALYSIS OF SEXUAL FUNCTION CHANGES 1 Fu-Shun Hsu 1 Department of Urology, TaoYuan General Hospital (Taiwan) Introduction: Laser prostatectomy has been used to treat lower urinary tract symptoms (LUTS) due to BPH for over 15 years. Advances in laser technology, better understanding of tissue-laser interactions, technical improvements (eg. higher power setting, fiber improvements) and growing clinincal experience have achieved more convincing clinical results that challenge transurethral resection of the prostate (TURP).1 However, there is little published results about the comparison of different type laser prostatectomy. We analyze and compare subjective changes, morbidity and sexual function changes following greenlight laser (high-performance system, HPS, 120-W) and diode laser (200-W) in men with LUTS associated with BPH. Materials and Methods: From January 2009 to August 2010, 70 consecutive patients who suffered from BPH-related obstructed voiding symptoms. Amonth these patients, 35 were treated with greenlight laser and 35 were treated with diode laser. Their clininal records including the sexual function preopratively and one-year postoperatively were retrospectively reviewed. Results: There was a significant improvement in IPSS, QoL, Qmax and PVR in each laser group at the 3-, 6- and 12-mo follow-ups compared with baseline.The diode laser demonstrates superior hemostatic properties compared with the GreenLight laser, despite more patients under anticoagulation treatment preoperatively (16.7% vs 6.4%). The improvement in Qmax and PVR of the diode laser group was in favor of the GreenLight laser group. Overall, the complication rate was 19% in the GreenLight laser group and 27% in the diode laser group. Retrograde ejaculation was complained in 36% patients treated by the GreenLight laser and 40% patients treated by the diode laser. There is no statistically defference of changes in sexual function in each laser group. PP55 DEDIFFERENTIATED LIPOSARCOMA OF THE SCROTUM AND PARATESTICULAR REGION—CASES REPORT Chih-Cheng Lu 1,2 1 Chi Mei Medical Center, Liouying (Taiwan) 2 Chiayi Veterans Hospital (Taiwan) Cases Presentation: A 78 year-old male patient suffered from left scrotal painless progressive enlargement for 3 years. The procedure of left orchiectomy was smooth without complications. The pathology showed dedifferentiated liposarcoma of scrotum and cut end free of malignancy. The patient kept 1 year follow-up uneventfully. A 54 year-old male patient suffered from right scrotal mass for about 1 year. The tumor was located at upper margin of right testis. Geminal cell related tumor markers showed unremarkable. The tumor grew gradually. On examination, the palpable mass was firm, movable and about 3x3x4 cm in size. He received radical orchiectomy smoothly. The pathology showed dedifferentiated liposarcoma with margins free of tumor. The patient with follow-up for 1 year showed uneventful. Conclusions: Dedifferentiated liposarcoma is a rare mixed histologic subtype with association of well-differentiated liposarcoma. Liposarcoma accounts for 7.5 to 25% of all soft tissue sarcoma and 1% of all cancer. The usual positions of sarcoma are popliteal fossa, gluteal area and retroperitoneum. Sarcoma comprises 1 to 2% of all malignant genitourinary tumors. Liposarcoma of the scrotum that does not originate from the spermatic cord is extremely rare. The prognosis of liposarcomas with dedifferentiated component of entirely low grade was more similar to traditional liposarcoma. It can be learned from these cases that on encountering a large, painless, cystic or solid mass in the paratesticular scrotal region, primary mesenchymal tumors including sarcomas should be included in the differential diagnosis. PP56 UPDATING COMPARISON OF PROSTATE CANCER PRACTICE GUIDELINES AND CONSENSUS AMONG CHINA, SINGAPORE AND TAIWAN 1 1 Chih-Cheng Lu , Wen-Chou Fan , Tse-Chou Cheng 1 1 Chi Mei Medical Center, Liouying (Taiwan) Objective: To evaluate the clinical practice guidelines(CPG) in prostate cancer(CaP) around the Asian Chinese. It included China, Singapore and Taiwan. Methods: CPGs by Chinese Urological Association(CUA), Singapore Urological Association(SUA) and Taiwan Cooperation Oncology Group(TCOG) were reviewed. A previous comparison was reported at APSSM2009, and this is an updating comparison. Results: The latest CPG for CaP by CUA, SUA, and TCOG were available in 2006, 2004, and 2010 respectively. The TCOG had the first edition of CaP practice guidelines in 1999, the second edition in 2003, and the third edition in 2010. In diagnosis, MRI is suggested before transrectal prostatic biopsy in CUA but not in SUA nor in TCOG. Prostate specific antigen (PSA) measurement is suggested after age of 45 years with a family history in CUA and 40 years in TCOG. Otherwise, 50 years is a suggested starting point. In SUA, screening was not recommended among Asians except for males above 40 year-old with the risk factor of having a first degree relative with prostate cancer at young age. Normal range of PSA was defined from Chinese people data with age specific consideration by CUA, but not in TCOG. In predicting local staging and lymph nodes, MRI was considered more informative in CUA. In SUA, patients with PSA < 10 ng/ml, bone scans were not indicated. Staging by AJCC 2002 was noted in CUA and SUA but AJCC 2010 (the seventh edition) in TCOG. Nomogram was suggested in CUA and TCOG, but not in SUA. In treatment, HIFU and cryo-surgical ablation of the prostate were informed in CUA but not well recommended in TCOG. Bisphosphonates were suggested for bone pain in all CPGs. Hormone refractory CaP was clearly defined (biochemical data) in CUA and TCOG. No role for phytotherapy in all guidelines. In TCOG, lack of evidence-based medicine grading system is noted. Conclusion: There are variations in staging systems, treatment agents among these CPGs. Asian urologists and oncologists are encouraged to be aware of the differences at managing prostate cancer patients. PP57 THE CORRELATION OF TESTICULAR MICROLITHIASIS AND MALE INFERTILITY 1 1 1 1 1 To Chang , William J.S. Huang , Yi-Te Chiang , Alex T.L. Lin , Kuang-Kuo Chen 1 Division of Urology, Department of Surgery, Taipei Veterans General Hospital, and Department of Urology, School of Medicine, National Yang-Ming University (Taiwan) Purpose: Testicular microlithiasis (TM) is a unique finding detected during ultrasonographic (US) examination of the scrotum. The typical US appearance has been described as multiple small (1-3 mm) echogenic foci randomly scattered throughout the testicular parenchyma. TM is associated with various medical conditions, including infertility and germ cell tumor. We herein investigated the correlation between TM and infertility infertility in Taiwanese males. Materials and Methods: From February 2003 to January 2011, totally 339 men visited our institute due to subfertility and received US examination of scrotum. Among them, 78 (22.9%) patients were found to have TM. Classic TM (CTM) was defined as 5 or more echogenic foci in one or both testes. Men with fewer than 5 microliths (but with at least 1) were deemed to have limited TM (LTM). CTM can be further classified to grade I to III according to the number of microliths (grade I: 5-10 microliths/image, grade II: 11-20 microliths/image, grade III: >20 microliths/image). We retrospectively collected information of age, clinical features, hormone profile, semen analysis, and TM grading of these patients. The correlation was analyzed with Chi-square, Kruskal-Wallis or one way ANOVA tests. Results: The mean age of these 78 patients was 35.7 ± 5.1 years old. Forty one patients (52.6%) had LTM and 37 had CTM. Grade I, II, and III CTM accounted for 14 (17.9%), 6 (7.7%), and 13 (16.7%) respectively. The mean sperm count of the patients with LTM, grade I, II, and III CTM were 11.1 (n=35), 17.2 (n=15), 10.2 (n=6), and 3.6 (n=12) million/ml respectively after outliers were deleted (P= 0.1156). If we divided the patients with TM by microliths >10 or ≦10, the mean sperm count were 5.8 (n=18) and 12.9 (n=50) million/ml respectively (P= 0.020). There was no statistical significance on the correlation between TM grading and sperm motility (p=0.784), sperm normal form (P= 0.974), testosterone level (P= 0.973), or presence of varicocele (P= 0.294). Conclusions: Presence of TM was more common in the population with infertility. For subfertile patients with TM, microliths > 10 is associated with lower sperm count. Scrotal US should be conducted in patients with fertility problems and clinician should bear it in mind as an indicator for poorer sperm count. PP58 DYNAMIC EVIDENCE OF THE PENILE VENOUS ERECTILE APPARATUS 1 2 Geng-Long Hsu , Cheng-Hsing Hsieh 1 Microsurgical Potency Reconstruction and Research Center, Hsu’s Andrology (Taiwan) 2 Department of Urology, Buddhist Tzu Chi General Hospital, Taipei Branch (Taiwan) Purpose: Although penile erection-related veins have been recently depicted as a deep dorsal vein (DDV), a pair of cavernosal veins (CVs) and two pairs of para-arterial veins (PAVs) between the Buck’s fascia and the tunica albuginea, which is derived from cadaveric dissection and is not beyond controversy. We sought to conduct an imaging study on clinical patients in order to elucidate whether this information is sustainable. Materials and Methods: From October 2008 to April 2010, 103 patients, aged 21 to 75 years, underwent a dynamic cavernosography. It entailed injecting 60 ml of a 30% Loversol solution intracavernously via a 19-gauge scalp needle firmly affixed to the distal and middle third of penile shaft at lateral aspect respectively. They were categorized into distal (n=81) and middle (n=22) group respectively. It was taken serially from 0.33, 0.67, 1.00, 1.33, 1.67, 2.00, 2.33, 2.67, 3.00, 3.33, 3.67, 4.00, 5.00, 7.00, 10.00, 15.00 seconds while the infusion rate is set at 240 min/min. Analysis of these data was made. Results: In all patients the CVs are consistently first shown before that of the DDV. In the distal group, the presentation of DDV catches on CVs is shown in 46 (45.7%) cases at the middle third, whereas 76 (93.8%) in the proximal third. In the middle group, the presentation of DDV catches on CVs is shown in 14 (63.6%) cases at the proximal third. There are a DDV, a pair of CVs and a group of PAVs between the Buck’s fascia and the tunica albuginea in all patients. Conclusion: We may conclude that penile sinusoidal drainage are initially via corresponding CV and then to DDV and/or to superficial veins. There is PAV which is poor identifiable. PP59 THE ASSOCIATION BETWEEN ERECTILE DYSFUNCTION AND THE RISK FACTORS FOR CARDIOVASCULAR DISEASE: A BRIEF REVIEW OF THE LITERATURE 1 1 1 1 2 2 1 1 Heng-Jun Xiao , Cheng Hu , Teng-Cheng Li , Yan Zhang , Jun Chen , Bin Zhang , Xiang-Fu Zhou , Xin Gao 1 Department of Urology, the Third Affiliated Hospital of SUN Yat-sen University (China) 2 Department of infertility & sexual medicine, the Third Affiliated Hospital of SUN Yat-sen University (China) Introduction: Recent increasing studies have shown that erectile dysfunction (ED) and cardiovascular disease (CVD) are two closely intertwined disease processes. They frequently coexist and postulate an intimate nexus. In this study we have briefly reviewed the main epidemiological evidences on the association between ED and the risk factors for CVD. Objective: To evaluate the association between ED and the risk factors for CVD. Methods: Relevant studies published for the time range 1992-2011 were searched thoroughly in Medline. Abstracts regarding the association between ED and the risk factors for CVD were conducted to review. Results: A growing number of consistent epidemiological evidences suggest CVD and ED share substantially many of the same risk factors (OR: 1.96; 95%CI: 1.53-3.18, P < 0.05), which include age, hypertension, hyperlipidemia, obesity, diabetes mellitus, depression and smoking. The pathogenesis of both CVD and ED has been shown to be common conditions of endothelial dysfunction. They were linked through decreased expression and activation of endothelial nitric oxide synthase (eNOS) occurring with aging. ED may be an early symptom of underlying systemic vascular disease especially coronary artery disease (CAD) rather than itself. Approximately 50-70% of men with CAD have ED. ED can arise before CAD is symptomatic with a time window of 3-5 years. Conclusion: These reviews reveal that ED is beginning to be considered as an early manifestation of underlying CVD which may be a common consequence of endothelial dysfunction. It is a potential risk predictor for the subsequent development of CVD. Recognizing ED may help to identify individuals at risk for having a premature cardiovascular event. PP61 MULTIPLE ARTERIAL OCCLUSION WITH CLINICAL MANIFESTATIONS OF ERECTILE DYSFUNCTION 1 1 1 1 1 1 Bin Zhang , Jun Chen , Tao Qi , Bo Wang , Xiaoming Li , Shiqin Chen 1 Department of Infertility and Sexual Medicine, The Third Affiliated Hospital, Sun Yat-Sen University (China) Purpose: It should be attention that erectile dysfunction might be the precaution of arterial occlusion. Materials and methods: a case of multiple arterial occlusion with clinical manifestations of erectile dysfunction were reported. Results: A 57 years old male patient who worked as a civil servant complained of erectile dysfunction for 10 years. He received oral sidenafil for 100mg discontinuously twice before. And Chinese medicine treatment was of no effect on him. His previous medical history included surgical removal of rectal cancer and there was no past history of cardiac or diabetic involvement. He had been married and procreated and he wasn’t a smoker or a dependent drinker. He was forced to interrupt sexual intercourse because of erectile dysfunction and sought medical treatment in our hospital in 2010.The physical examination of him indicated that his secondary sex characteristics and penis were normal. And the PBI(Penile artery pressure/Brachial artery pressure) was 0.6. The temperature of his left lower limb was lower than the right side by 0.5℃.His primary diagnosis was arterial erectile dysfunction and arterial occlusion of 2 branches of the coronary artery and left lower extremity were shown in the color doppler ultrasonography. Finally, he received the percutaneous coronary intervention treatment after a professional consultation. Conclusion: It should be attention that erectile dysfunction might be the precaution of arterial occlusion. PP62 VENTRICULAR TACHYCARDIA INDUCED BY SEXUAL ACTIVITY （TWO CASES REPORTED） 1 1 1 1 1 1 Bin Zhang , Jun Chen , Tao Qi , Bo Wang , Xiaoming Li , Shiqin Chen 1 Department of Infertility and Sexual Medicine, The Third Affiliated Hospital, Sun Yat-Sen University (China) Purpose: During sexual activity, there are some cardiovascular events should be attention. Materials and methods: two cases of ventricular tachycardia induced by sexual activity were reported. Results: Case 1, a male patient, 32 years old. When he had a girlfriend half a year ago, he began sexual activity with her. The patient got a short dizziness and palpitation after sexual intercourse every time, but he was in good condition at ordinary times. He once visited several outpatient departments of Urology looking for treatment, and his chief complaint was dizziness during sexual activity, but the correct diagnosis on the disease couldn’t be formed. And he was advised by the doctor to reduce premarital sexual activities. Because the period of dizziness lasted to several hours during sexual intercourse, he grew fear for sexual activity. At last the disease was diagnosed as paroxysmal ventricular tachycardia by electrocardiogram. His condition was improving gradually after taking verapamil for treatment, but he still suffered from recurrent attacks. Finally, the disease was rooted out by RFCA of department of Cardiology. Case 2, A male patient, 59 years old, cohabited with his wife. And he was in good condition at ordinary times. He suffered from mild hypertension without chest distress and polypnea, but he didn’t take any antihypertensive drugs for treatment. He got precordium discomfort and dizziness after sexual activities last 2 months, but the symptoms disappeared after a short break. The blood pressure of the patient was 146/92mmHg, and the electrocardiographic examination didn’t indicate any abnormities. The Holter ECG monitoring indicated frequently premature ventricular contraction and ventricular tachycardia. The dizziness during sexual activity of the patient disappeared after he was given Betaloc Zok for treatment. Conclusion: During sexual activity, there are some cardiovascular events should be attention. Such as ventricular tachycardia. PP63 Α-BLOCKERS COMBINED WITH ELECTRONIC BIOFEEDBACK TREATMENT PROSTATITIS EFFECTS OF TYPE III 1 1 1 le xu , minqie qiu , jiehong jiang 1 Nanfan medical university affiliation He-xian memorial hospital (China) Objective: To evaluate the efficacy of α-blockers combined with electronic biofeedback therapy in the treatment of type III prostatitis. Methods: The clinic diagnosed 97 cases of type III patients with prostatitis were randomly divided into control group (48 cases) and experimental group (49 cases). They were both received 4 weeks therapy. The control group received only α-blocker therapy, the experimental group received α-blockers combined electronic biofeedback therapy. The U.S. National Institutes of Health Chronic Prostatitis Symptom Index (NIH - CPSI) score was used to assess two groups before and after treatment, respectively. Prostate massage fluid (EPS) routine examination results are also recorded after treatment as indicators of efficacy evaluation. Results: In control group, 2 cases (4.17%) were cured, 4 cases (8.33%) were effective, 13 cases (27.08%) were improved and 29 cases (60.42%) were ineffective. The total effective rate in control group was 39.58%. In experimental group, 6 cases (12.24%) were cured, 8 cases (16.33%) were effective, 17 cases (34.69%) were improved, and 19 cases (38.78%) were ineffective. The total effective rate in experimental group was 63.27%. There was statistical difference between two groups (P < 0.05). After 4 weeks of treatment, the experimental group CPSI indicators improved significantly than the control group, especially in urinary symptoms and total scores , with the significantly statistical difference (P < 0.05 or P < 0.01). EPS routine examinations after treatment in two groups were normal in 12 cases (25%) of control group, 27 cases (55.10%) of experimental group. There was statistically difference (P < 0.05) between two groups. There were no side effects and anal trauma occurred. Conclusion: The combination of α-blocker treatment and electronic bio-feedback therapy is safe, effective in the treatment of type III prostatitis. PP64 MICROSURGICAL DENERVATION OF THE SPERMATIC CORD FOR TREATMENT OF IDIOPATHIC CHRONIC ORCHIALGIA (FIRST CASE OF REPORT IN CHINA) 1 1 1 1 1 Xiangan Tu , Chunhua Deng , Liangyun Zhao , Xiangzhou Sun , Shaopeng Qiu 1 Department of Urology,The First Affliated Hospital, Sun Yat-Sen University (China) Objective: We first report the effectiveness of microsurgical denervation of the spermatic cord for treatment of idiopathic chronic orchialgia in Chinese hospital. Methods: A patient referred to our hospital diagnosed with left idiopathic chronic orchialgia is evaluated with a thorough medical and psychiatric history, physical examination and scrotal ultrasound. Conservative management failed .The patient had temporary pain relief after undergoing outpatient cord block for three times. Microsurgical denervation of the left spermatic cord was operated in March 24, 2011. Postoperative pain rating scales (0 to 10) were used to determine efficacy. Results: Complete pain relief was noted at one week after operation. Followup was 5 months. Pain rating scales were still zero. No complications including testicular atrophy and hydrocele occurred. Conclusion: Microsurgical denervation of the spermatic cord is a minimally invasive, safe and effective management option for treatment of idiopathic chronic orchialgia. PP65 EFFECT OF TRANSURETHRAL RESECTION OF EJACULATORY DUCT FOR TREATMENT OF EJACULATORY DUCT OBSTRUCTION (REPORT OF 60 CASES) 1 1 1 1 1 1 1 Xiangan Tu , Liangyun Zhao , Liang Zhao , Wenwei Wang , Liwen Deng , Yu Chen , Chuanhua Deng 1 Department of Urology, The First Affliated Hospital, Sun Yat-Sen University (China) Objective: To evaluate the effect of transurethral resection of ejaculatory duct (TURED) for treatment of ejaculatory duct obstruction (EDO). Methods: The clinical information of 60 cases of EDO were analyzed from Oct 2004 to Oct 2010. The diagnostic criteria included semen analyses，fructose in seminal plasma，transrectal ultrasonography(TRUS), and vasography necessarily. All patients were treated by TURED. Postoperative semen assay, postoperative patency rate and postoperative impregnation rate were followed. Results: Semen analyses in the majority of cases showed the typical characteristics of EDO，azoospermia，low semen volume(average 1.10 ml±0.76)，low PH(average 6.5±1.4)，absent or low semen fructose(average 5.86±2.19μmol/ one ejaculation). TRUS showed pure dilation of both ejaculatory duct in 15 cases, prostatic cyst in 6, pure dilated seminal vesicles on both sides in 10，unilateral dilated seminal vesicle in 4，dilation of both ejaculatory duct and seminal vesicles in l0，dilated seminal vesicles with prostatic cyst in 5，unilateral dilated seminal vesicle and contralateral aplasia of seminal vesicle in 2 , dilated seminal vesicles with dilation and calcifications of both ejaculatory duct in 3，the remaining 5 had unilateral dilated ejaculatory duct and seminal vesicle with contralateral aplasia of seminal vesicle . Among all cases followed up more than 6～78 months after TURED, 51 patients(85.0%) had improved semen parameters and 16 patient’s wife(26.7%) pregnancies . Conclusion: TURED may be the simple, minimally invasive and effective method for the treatment of EDO. PP69 HOW HARD IT WOULD BE FOR PENIS TO BREAK INTO VAGINA? 1 1 1 1 Liuhong Cai , Bin Zhang , Jun Chen , Hui Lin 1 Department of Infertility and Sexual Medicine, The Third Affiliated Hospital, Sun Yat-Sen University (China) Purpose: Penile hardness is very important for successful coitus, thus, many studies focused on the penile hardness. Here we measured the pressure that penis had to overcome during sexual intercourse. Vaginal pressure maybe another important factor for evaluating sexual function. Materials and methods: From Jan 1 to May 31, 2011, women came to Department of Infertility and Sexual Medicine, The Third Affiliated Hospital, Sun Yat-sen University, for infertile issue, were included in this study. A total of 95 women were included. Subjects were required to self-assess their current sexual function，vaginal condition were also evaluated with physical examination.They met inclusion/exclusion criteria: 1) 25-35years old; 2) regular sexual intercourse and stable partners; 3) term delivery from vagina (group 1, N=18) or never deliver a baby from vagina (group 2, N=77) .Women with preterm delivery were excluded. Informed consent were obtained from these women. An experienced technician helped them to complete the procedures: Lubricating the artificial penis, recorded the pressure right after the artificial glans penis was totally inserted (pressure 1). Insert-out for 10 times , then recorded the pressure when the artificial glans penis was inserted inward 6cm from the outlet of the vagina (pressure 2) and the pressure right before the artificial glans penis was taken out of the vagina(pressure 3). Results: For group 1, the pressures were 71.7±27.6 mmHg, 51.9±22.1 mmHg and 45.4±21.1 mmHg; For group 2, the pressures were 87.0±27.8 mmHg, 65.3±20.7 mmHg and 56.2±18.1 mmHg. For the two groups respectively, significant difference were found among pressure 1, pressure 2 and pressure 3, with pressure 1 much higer than pressure 2 or pressure 3. Significant difference was also found between the two groups. Conclusion: Vaginal delivery is a sinificant affecting factor for intravaginal pressure during sexual intercourse and partner’s intravaginal pressure should be consider when evaluating males’ sexual dysfunction. PP70 THE MANAGEMENT AND TRAINING FOR THE GUIDE NURSES IN OUT-PATIENT DEPARTMENT OF SEXUAL MEDICINE 1 2 2 Xinjian Feng , Hui Lin , Bin Zhang , Jun Chen 2 1 Outpatient Clinic Service Aera, The Third Affiliated Hospital, Sun Yat-Sen University (China) 2 Department of Infertility and Sexual Medicine, the Third Affiliated Hospital of Sun Yat-Sen University (China) Purpose: To discuss the way of management and training for the guide nurses in out-patient department of sexual medicine. Materials and methods: The management and training methods for the guide nurse in out-patient department of sexual medicine during the time from August 2009 to December 2010 were summarized. Guide-related indicators between one and a half year before and after the management were compared. Results: There were seven complaints of poor service in out-patient department of sexual medicine from February 2008 to July 2009, and there were no complaints from August 2009 to December 2010 except two pieces of advice. Degree of satisfaction of patients in the out-patient department of sexual medicine rose from 80%-85% to 90%-95%. Conclusion:The new management belief and system, plus the improvement of guide nurses’ quality, guaranteed the quality of guide service and improved the image of the hospital. PP71 IMPLEMENTATION OF CONSULTATION INTRODUCTION SERVICES IN OUTPATIENT DEPARTMENT OF SEXUAL MEDICINE 1 2 2 Xinjian Feng , Hui Lin , Bin Zhang , Jun Chen 2 1 Outpatient Clinic Service Aera, The Third Affiliated Hospital, Sun Yat-Sen University (China) 2 Department of Infertility and Sexual Medicine, the Third Affiliated Hospital of Sun Yat-Sen University (China) Purpose: To promote active nursing care in nurses of outpatient department of sexual medicine, strengthen the communication between nurses and patients, and enhance nursing quality. Materials and methods:The details, requirements, and standards of consultation introduction services were established, and nurses were trained and tested, then consultation introduction services were adopted to outpatient department of sexual medicine. Results:The awareness for providing active nursing in nurses was strengthened, the nurse-patient relationship was more harmonious, and the satisfactory rate of out-patients in Outpatient Department of sexual medicine risen from 93.56% in 2009 to 98.83% in 2010. Conclusion: Implementation of consultation introduction services in outpatient department of sexual medicine is beneficial to patients getting information for hospital visits, and improves the quality of outpatient care as well. PP72 INVESTIGATION ON THE SATISFACTION OF OUT-PATIENTS IN OUT-PATIENT DEPARTMENT OF SEXUAL MEDICINE WITH HOSPITAL NURSING 1 2 2 Xinjian Feng , Hui Lin , Bin Zhang , Jun Chen 2 1 Outpatient Clinic Service Aera, The Third Affiliated Hospital, Sun Yat-Sen University (China) 2 Department of Infertility and Sexual Medicine, the Third Affiliated Hospital of Sun Yat-Sen University (China) Purpose: To have an knowledge of the satisfaction of outpatients in out-patient department of sexual medicine with hospital nursing in order to provide the bases for further reforming of the hospital nursing. Materials and methods: Interviewer-administered questionnaires were used among outpatients in out-patient department of sexual medicine. The responsive rate of them was 99•3%• Results: It showed that the overall satisfaction rate of different contents under investigation, among which the satisfaction rates of outpatients in out-patient department of sexual medicine at nursing equipments and the environments were lower than those at the techniques of nurses and nursing services. Conclusion: Hospitals should try their best to perfect the nursing quality, improve the idea of nursing service, and attach great importance to the renewal of nursing equipments and the supplies of nursing staffs of high quality in order to ensure the nursing quality and to increase the satisfaction of outpatients in out-patient department of sexual medicine. PP73 “PARTIN TABLE” FOR TAIWANESE PATIENTS WITH PROSTATE CANCER 1 1 1 1 1 1 Ching-Hsin Chang , William J.S. Huang , Yen-Hwa Chang , Chin-Chen Pan , Hsiao-Jen Chung , Junne-Yih Kuo , 1 1 1 Shing-Hwa Lu , Alex T.L. Lin , Kuang-Kuo Chen 1 Division of Urology, Department of Surgery, Department of PathologyTaipei Veterans General Hospital, and Department of Urology, School of Medicine, National Yang-Ming University (Taiwan) Purpose: Partin Table is a nomogram of prostate cancer to predict the likelihood of status of organ confinement based on pre-operation parameters. Since the data was majorly from a cohort of Caucasian, the predictive value of this Table for the Asian people is questionable. The incidence and mortality rate of prostate cancer are increasing in Taiwan. We tried to determine a Taiwanese version of “Partin Tables”. Materials and Methods: From 2000 to 2011, there were 519 patients with clinically localized prostate cancer underwent radical prostatectomy at our hospital. Of them, 444 patients had complete data to be analyzed. Area under (AUC) receiver operation characteristic (ROC) curve was used to judge the accuracy of our proposed Table. Results: A modified form of “Partin Table” was established according to our own database. There are some major different characteristics in our new Table from the Partin’s, ie, (1) our cohort include Asian only, (2) our patients had higher PSA levels in the corresponding stage. Conclusion: The demographic background of Taiwanese patients with prostate cancer is different from that in the United States. When using the conventional Partin Table to predict the resectioness of prostate cancer for the Taiwanese patients, we might miss some the chance to cure by prostatectomy. Our updated domestic nomogram table for prostate cancer has shown good predictive values. PP74 TRAUMATIC EXPERIENCE AND SUBJECTIVE SYMPTOM SCORES IN WOMEN WITH INTERSTITIAL CYSTITIS/PAINFUL BLADDER SYNDROME (IC/PBS) IN TAIWAN 1 1,2 3 1,2 1 Wei-Chih Chen , Ming-Huei Lee , Chiu-De Chiu , Huei-Ching Wu , Yi-Chang Chen 1 Department of Urology, Taichung Hospital, Department of Health (Taiwan) 2 Central Taiwan University of Science and Technology (Taiwan) 3 Department of Psychology, National Taiwan University (Taiwan) Purpose: IC/PBS is a chronic disease of uncertain etiology that is characterized by urgency, frequency, and suprapubic pain related to bladder filling. Early stressful experience, such as childhood sexual maltreatment, has been considered as an environment risk factor for IC/PBS. However, the definition and the scope of potentially traumatic experience vary in studies. It is unclear to what an extent this experience prevails in patients with IC/PBS and links to its symptom profile. It is therefore the intent of the present study to investigate the traumatic experiences prevalence in IC/PBS patients and correlation between traumatic experience and subjective symptoms. Materials and Methods: This was a prospective case control study. Fifty female patients who were compatible with the NIDDK criteria were included and these patients were assessed by validated questionnaire including O'Leary-Sant Symptom (ICSI) and Problem Index (ICPI) was used to objectify subjective symptoms. Pelvic Pain and Urgency/Frequency (PUF) questionnaire was also completed and standardized self-report instruments, Chinese Brief Betrayal-Trauma Survey (BBTS) questionnaire was used to measure the prevalence of diverse potentially traumatic experiences (natural disasters, traffic accidents, physical and sexual assaults, emotional maltreatment, and witnessing other’s negative events) in childhood and adulthood. Subjects were tested individually in two sessions, in order to avoid fatigue. Of 200 Taiwanese college students who was selected randomly served as controls. These data were analysed using Pearson correlations. Results: Patient demographics show the average age being 40.34 years (± 9.6). The average ICSI, ICPI, and PUF questionnaire were 11.81 (± 3.5), 10.89 (± 2.8), and 19.02 (± 5.3) respectively. The prevalence of physical attack and emotional maltreatment by someone close to the patients showed 14% and 27% compared to control groups, 9% and 12% respectively. Another prevalence of physical attack and sexual maltreatment by someone not so close to the patients showed 8% and 6% compared to controls, 12% and 6% respectively. Our result showed that women with IC/PBS endorsed higher incidences on various traumatic experiences except for sexual maltreatment in both childhood and adulthood. Diverse life events prevail in patients with IC/PBS. Nevertheless, potentially traumatic experiences did not reliably predict the symptom profiles of IC/PBS. Only sexual maltreatment by someone close to patients had negative correlation with subjective symptoms, ICSI. Conclusions: Our study showed that, the prevalence of interpersonal abuse, especially those inflicted by someone close to the patients, was higher in patients with IC/PBS. However, potentially traumatic experiences did not reliably predict the symptom profiles of IC/PBS. PP75 DIFFERENCES IN THE SUBJECTIVE SYMPTOMS, URODYNAMIC EXAMINATION AND CYSTOSCOPIC MAXIMAL BLADDER CAPACITY OF INTERSTITIAL CYSTITIS/ PAINFUL BLADDER SYNDROME (IC/PBS) IN WOMEN WITH OR WITHOUT SEXUAL PAIN 1,2 1 1,2 3 1 Huei-Ching Wu , Wei-Chih Chen , Ming-Huei Lee , Chui-De Chiu , Yi-Chang Chen 1 Department of Urology, Taichung Hospital, Department of Health (Taiwan) 2 Central Taiwan University of Science and Technology (Taiwan) 3 National Taiwan University of clinical psychology (Taiwan) Purpose: Previous study established a strong association between urinary tract symptoms and arousal disorders and sexual pain disorders. Other sources suggested that IC/PBS patients had significantly more dyspareunia and more fear of pain, compared with healthy controls. We investigated the differences in the subjective symptoms, urodynamic findings and anesthetic bladder capacity of IC/PBS in women with or without sexual pain. Materials and Methods: A total of 89 IC/PBS female patients were included in this study. All subjects were asked if they had a history of sexual pain and were assessed by validated questionnaire including O'Leary-Sant Symptom (ICSI) and Problem Index (ICPI). Pelvic Pain and Urgency/Frequency (PUF) questionnaire was also completed. Standardized consecutive filling cystometry and volume at first desire to void (FDV), normal desire to void (NDV), strong desire to void (SDV) and maximum cystometric capacity (MCC) were performed. Cystoscopic anesthetic maximal bladder capacity (MBC was also measured. We compared subjects with and without a history of sexual pain disorder using unpaired 2-tailed t tests. Results: The occurrence of IC/PBS patients with sexual pain disorder was 65/89 (73%). Patient demographics with or without sexual pain disorder showed the average age being 39.98 years (± 11.8) and 41.17 years (± 10.2), respectively. The ICSI and ICPI scores were equivalent between the two groups but patients with sexual pain had a statistically significant higher PUF scores than those without sexual pain (21.52± 5.4 v.s 16.21± 4.6 , p < 0.01). In patients with sexual pain, the values for FDV, NDV, SDV, and MCC were lower than those without sexual pain but were not statistically significant (67.89± 35.9 v.s 86.13 ± 52.5 ml, 93.31± 38.2 v.s 115.13 ± 56.4 ml, 138.78± 65.8 v.s 158.19 ± 110.2 ml, 195.43± 69.9 v.s 225.75 ± 149.8 ml). Similarly, patients with sexual pain had lower anesthetic MBC than those without sexual pain, however no statistically significant difference could be noted (596.15± 210.1 v.s 646.25 ± 156.7 ml, p=0.2). Conclusions: Women with IC/PBS symptoms experience around 73% occurrence rate of sexual pain in our study. MCC and anesthetic MBC showed lower capacity in sexual pain group but without statistically significant difference between two groups. PUF score was higher in patients with sexual pain disorder group but ICSI and ICPI did not show the difference. This suggests that physicians should consider sexual pain disorder in the management of patients with IC/PBS and the evaluation of subjective symptoms including sexual pain in IC/PBS patients, PUF score maybe better than ICSI and ICPI. PP76 PATHOLOGY OF URETHRAL FIBROUS-MUSCULAR SYSTEM RELATED TO PARTURITION-INDUCED STRESS URINARY INCONTINENCE AND TGF-Β1/SMAD PATHWAY 1 1 1 1 1 1 1 1 Guang-Yong Li , Wan-Shou Cui , Feng Zhou , Zhe-Zhu Gao , Hua Xin , Tao Liu , Wei-Ren Li , Yan-Qing Gong ,Guang-Yi 1 Bai , Zhong-cheng Xin 1 1 Andrology Center, Peking University First Hospital, Peking University (China) Purpose: Stress urinary incontinence (SUI) is a prevalent urological problem that is common in women. In order to realize pathological changes, the structural components and the role of TGF-β1/Smad pathway in the urethra of a parturition-induced SUI rat model were investigated. Materials and Methods: Forty 8-week-old Sprague–Dawley female rats at gestational day 16 were used. After delivery, twenty rats were underwent vaginal balloon dilation for 4 hours. One week later, rats were anesthetized and both ovaries were excised. One month after ovariectomy, conscious cystometry and leak point pressure (LPP) were measured. Histological examination (Masson’s trichrome stain, picrosirius red stain, Hart’s elastin stain, Gordon & Sweet's stain and immunohistochemical stain) and western blot were performed. Results: Four weeks after ovariectomy, SUI was developed in 17 out of 20 experimental rats (85%). Extracellular matrix (ECM) was significantly increased, but muscle was significantly decreased in the urethra of SUI rats compare with sham rats. Total collagen fibers and reticular fibers from SUI rats were significantly more increased than sham rats. Meanwhile elastic fibers and reticular fibers showed fragmentation and disorganization that indicated the fibrous-muscular system in SUI rats was impaired. The expression of TGF-β1 and Smad2 protein and activity of Smad2 were significantly higher in SUI rats. Conclusions: The fibrous-muscular system of urethra was important to urethra closuring pressure which was impaired in SUI rats, TGF-β1/Smad pathway might play important role. PP77 EFFECTS OF ICARIIN AND ICARISIDEⅡON ENOS EXPRESSION AND NOS ACTIVITY IN PORCINE AORTA ENDOTHELIAL CELL PREVENTIVE 1 1 1 1 1 1 1 1 Tao Liu , Xincheng Qing , Weiren Li , Feng Zhou , Guangyong Li , Hua Xin , Yanqing Gong , Zhongcheng Xin 1 Andrology Center, Peking University First Hospital, Peking University (China) Objective: Investigated the effects of Icariin and IcarisideⅡon eNOS expression and NOS activity in endothelial cell and possible mechanisms using EGFR over-expressed porcine aorta endothelial (PAE) cell line. Materials & Methods: The EGFR gene was transfected into PAE cell and genetic stable cell line (PAE-EGFR) was selected 12.5uM Icariin and IcarisideⅡwere used to treat the PAE and OAE-EGFR cells respectively for 48h, the eNOS expression in each group was observed. EGF was also used to treat the cells to observe the regulatory effects of Icariin and IcarisideⅡon NOS activity. The regulatory effects of Icariin and IcarisideⅡon NOS activity were also observed, and sildenafil was used as a control. Results: Western blot showed that the basic value of eNOS expression was higher in PAE-EGFR group compared to that in PAE group, both of Icariin and IcarisideⅡincreased the eNOS expression in PAE and PAE-EGFR group (P < 0.01), and the value of eNOS expression was higher in PAE-EGFR group than that in PAE group. In the PAE-EGFR cell line, the NOS activity reached to 15.37±1.49 u/mg when the concentration of IcarisideⅡwas 10-8 M, which was 4.66 u/mg more than that in the PAE cell line. When the concentration reached to 10-7, 10-6 or 10-5 M, the change of NOS activity in PAE-EGFR group was greater than that in PAE group (P < 0.01). Icariin also increased the NOS activity in PAE and PAE-EGFR cells, but the activity was 20% lower compared with IcarisideⅡgroup, however, Sildenafil showed no influence on NOS activity. Conclusion: Icariin and IcarisideⅡmay increase the eNOS expression through activating EGF-EGFR pathway in PAE cell, by which endothelial cell function could be regulated and the better effect was noted in IcarisideⅡ compared to Icariin. PP78 EFFECTS OF ICARIIN ON IMPROVING ERECTILE FUNCTION IN STREPTOZOTOCIN-INDUCED DIABETIC RATS 1 2 1 1 1 1 1 1 1 Tao Liu , Hua Xin , Weiren Li , Jian Zhang , Feng Zhou , Wanshou Cui , Guangyong Li , Yanqing Gong , Zhang Nan , Xin Zhongcheng 1 1 .Andrology Center, Peking University First Hospital, Peking University (China) 2 Department of Urology, Pusan National University School of Medicine (Republic of Korea) Objective: We previously showed that Icariin has the therapeutic effects on erectile function in vasculargenic and castrated rats model. In order to realize the effects of icariin on preventing erectile dysfunction(ED), the pharmacological effects of icariin on DM induced rats ED model were investigated. Materials & Methods: Adult male Wistar rats(n=68) were induced hyperglycemia using streptozotocin (55mg/kg). Rats were randomly divided into 6 groups: Group A for normal controls, Group B, C, D for oral administration of different concentration of Icariin (1mg,5mg,10mg/kg/d) for 8 weeks. Sildenafil(1mg/kg/d) was used as a control (Group E). After 1 week wash out period, intracavernosal pressure (ICP) was measured for evaluating erectile function. Masson staining e groups(1,5,10mg/kg/d) was significantly increased compared to control group(p < 0.01), Smooth muscle content in Icariin treated group showed significantly higher than control group and nNOS and eNOS expression in Icariin treated group were significantly higher than that in control group. Results: Diabetes significantly attenuated the erectile responses with decreased corpus cavermous(CC) smooth muscle/collagen ratio and endothelial cell contents and these were partially prevented by icariin treatment. Icariin improved the expression of nNOS and eNOS in penis tissue from diabetic rats with a significant increase in the expression of endothelial cell marker, PECAM-1 and Factor Ⅷ. TGFβ1/Smad2 signaling pathway was down-regulated in the penis from icariin-treated models compared with that in controls. Conclusion: Icariin showed a preventive effect on DM induced ED, it’s possible mechanism may be related to increasing NOS expression and improving muscle/fibrous proportion in corpus cavernosum, further study is recommended. PP79 EFFECTS OF ICARISIDEⅡ ON TGF-Β1/SMAD/CTGF AND NO-CGMP PATHWAYS AND CORPUS CAVERNOSUM FIBROUS-MUSCULAR ALTERATIONS IN RATS WITH STREPTOZOTOCIN-INDUCED DIABETES 1 2 1 1 1 1 1 1 1 Feng Zhou , Hua Xin , Tao Liu , Guang-Yong Li , Zhe-Zhu Gao , Jing Liu , Wei-Ren Li , Wan-Shou Cui , Guang-Yi Bai , 2 1 Nam Cheol Park , Zhong-Cheng Xin 1 Andrology Center, Peking University First Hospital, Peking University (China) 2 Department of Urology, Pusan National University School of Medicine (Republic of Korea) Objective: To investigate the effects of ICAⅡ on hemodynamic parameters in the penis of rats with streptozocin induced diabetes. We also examined the mechanisms underlying diabetes related penile hemodynamics changes with particular focus on the NO-cGMP and TGFβ1/Smad2/CTGF signaling pathways. Materials & Methods: Fifty 8 week-old Sprague–Dawley rats were randomly distributed into normal control and diabetic groups. Diabetes was induced by a one-time intraperitoneal injection of streptozocin (60mg/kg). Three days later, the diabetic rats were randomly divided into 4 groups including a saline treated placebo arm and 3 ICAⅡ-treated models (1, 5, 10mg/kg/d). After three-months, penile hemodynamics was measured by cavernous nerve electrostimulation (CNE) with real time intracorporal pressure assessment. Penises were harvested with subsequent histological examination (picrosirius red stain, Hart’s elastin stain and immunohistochemical stain) and Western blot to explore activity of the NO-cGMP and TGFβ1/Smad2 signaling pathways. Results: Diabetes significantly attenuated erectile responses to CNE. Diabetic rats had a decreased corpus cavernous smooth muscle/collagen ratio and endothelial cell content relative to control animals. The ratio of collagen Ⅰto Ⅲ was significantly lower in the corpora of diabetic rats compared to normal controls; furthermore cavernous elastic fibers were fragmented in the diabetic animals. ICAⅡ treated diabetic rats had higher expression of nNOS, eNOS, and VEGF in the penis relative to placebo treated diabetic animals. Both the TGFβ1/Smad2/CTGF signaling pathway and apoptosis were down-regulated in the penis from ICAⅡ-treated rats. Conclusion: ICAⅡ treatment attenuates diabetes-related impairment of penile hemodynamics, likely by increasing smooth muscle, endothelial function, and nNOS expression. ICAⅡ could alterate corpus cavernosum fibrous-muscular changes in DM rats which could beregulated by the TGFβ1/Smad2/CTGF and NO-cGMP signaling pathways. PP80 PLGA BIODEGRADABLE SCAFFOLD COGRAFTING WITH AUTOLOGOUS ADSC ON PENIS GIRTH ENHANCEMENT 1 2 1 1 1 1 1 1 Wanshou Cui , zhe Jin , Yanqing Gong , Tao Liu , Weiren Li , Guangyong Li , Feng Zhou , Guangyi Bai 1 Andrology Center, Peking University First Hospital (China) 2 Department of Urology, Beijing Geriatric Hospital (China) Add authers : Liu Jing1, Gao Zhezhu1, Xin Zhongcheng1 Objective: To evaluate the efficacy and safety of tissue engineering surgery with PLGA Biodegradable Scaffold (Maxpol-T) cografting with adipose derived stem cells(ADSC)on penis girth enhancement. Materials & Methods: Forty-five adult New Zealand male rabbits were divided into three groups, including the shame operation group (group A), grafted Maxpol-T only (group B)and Maxpol-T cografted with ADSC (group C), ADSC were isolated from the skin of scrotum of rabbits and seeded into PLGA Scaffold, then transplanted under the deep fascia of penis. The efficacy and safety of girth enhancement were continuously observed for 6 months. Results: The flow cytometry of ADSC showed CD105（+）, CD31（﹣）, CD34（﹣）, CD45（﹣）, CD106（﹣）. 6 months later, no obvious rejection and inflammation were observed. The penis girth of group C was augmented significantly compared with that in group A and group B (p < 0.001). There was no significant difference between the penis girth of group A and group B(p＞ 0.05）.Region histopathological analysis showed that subcutaneous tissue thickening and desmoplasia accompany with new vessels were observed in group B and group C. Conclusion: Icariin showed a preventive effect on DM induced ED, it’s possible mechanism may be related to increasing NOS expression and improving muscle/fibrous proportion in corpus cavernosum, further study is recommended. PP81 EFFICACY AND SAFETY OF RETROPERITONEAL LAPAROSCOPIC VERICOCELECTOMY(RPLV) SUPER-HIGH LIGATION FOR TREATING VARICOCELE WITH MALE INFERTILITY. A PILOT CLINICAL STUDY 1 1 2 1 2 Jin-xing Lv , Liang-liang Wang , Guang-yong Li , Jin-xian Fu , Zhong-cheng Xin 1 Department of Urology, First Affiliated Hospital of Soochow University (China) 2 Andrology Center, Peking University First Hospital, Peking University (China) Purpose: Purpose: Aim of this study to investigate efficacy and safety of a new method of retroperitoneal laparoscopic varicocelectomy (RPLV) super high-ligation for treating varicocele with male infertility. Materials and Methods: The study included 96 infertile patients with left varicocele who were randomized to two groups. Forty-five patients were treated by peritoneal laparoscopy varicocelectomy (PLV) (group I), whereas 51 patients were treated by retroperitoneal laparoscopy varicocelectomy (RPLV) (group II). The 2 techniques were compared regarding intraoperative, and early and late postoperative complications, changes in semen parameters after 12 months. Results: The mean operative time of PLV and RPLV were 35.8±7.39 and 15.44±6.12min. Early postoperative complications were comparable in the 2 groups. At follow up none of the patients in the RPLV group had hydrocele, while it was observed in 3 of 45 (6.7%) in PLV group, representing a significance difference in favor of RPLV. The incidence of recurrent varicocele was significantly lower in RPLV group than in the PLV groups (2 of 51 patients or 3.9% vs 5 of 45 or 11.1%). Vein diameter changes pre and post OP in PLV group were 27.98±2.63 and 22.76±2.73 and RPLV were 27.56±2.56 and 21.33±2.80. 23 patients （45.1%）have seminal parameters improvement in group I, while 24 patients （53.3%）have seminal parameters improvement in group II. Conclusions: Compared with PLV the RPLV has the advantages with no hydrocele and lower incidence of recurrent varicocele, and better improvement in sperm count and motility. Further study is needed. PP82 THE SELF-ESTIMATION INDEX OF ERECTILE FUNCTION-NO SEXUAL LIFE (SIEF-NS):A MULTIDIMENSIONAL SCALE FOR ERECTILE DYSFUNCTION-NO SEXUAL LIFE 1 1 1 1 1 1 1 1 Yiming Yuan , Zhichao Zhang , Bing Gao , Jing Peng , Zhongcheng Xin , Weidong Song , Jie Jin , Yinglu Guo 1 Andrology Center, Peking University First Hospital (China) Objective To create a brief, reliable, self-administered measure of erectile function-No sexual life(ED-NS), which is psychometrically sound, with the sensitivity and specificity for distinguishing ED-NS patients. Methods Relevant domains of sexual function without sexual life were determine, Self-estimation Index of erectile function-No sexual life (SIEF-NS) was established, which includes 12 questions, such as sexual libido, general erectile function, nocturnal penile erection, erectile function during foreplay, erectile function during audio-video sexual stimulation, confidence, depression, etc and each questionnaire has 5 point scale. The SIEF-NS was examined for sensitivity, specificity, reliability (internal consistency and test-retest repeatability), and construct validity. Results 212 ED-NS Patients and 193 normal controls were enrolled into the study and assessed erectile function with SIEF-NS. The mean score of each question and integral score of SIEF-NS in ED-NS patients were significantly different from normal controls (p < 0.05). When the integral score is 35 points according to the ROC curve of integral score, the sensitivity of SIEF-NS is 90.3% and specificity is 93.2%. A principal components analysis identified three factors (that is, hardness of erectile function, duration of erection and psychic factors) with eigenvalues greater than 1.0. Conclusion SIEF-NS, which addresses the relevant domains of Erectile function-NS (that is, hardness of erectile function, duration of erection and psychic factors), is suggested to be a useful method for the evaluation of ED-NS patients. Further study is needed. Key Word 1: Erecile dysfunction-No Sexual life Key Word 2: SIEF-NS PP83 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. 1,2,3 Vincent FS Tsai 1 4 1 1 , Hong-Chiang Chang , Yuh-Chen Kuo , Shih-Ping Liu , Ju-Ton Hsieh 1 Department of Urology, National Taiwan University Hospital (Taiwan) 2 Institute of Biomedical Engineering, National Taiwan University (Taiwan) 3 Department of Urology, Ten-Chen General Hospital (Taiwan) 4 Department of Urology, Taipei City Hospital (Taiwan) Purpose: To exam the isolated rat seminal vesicle smooth muscle (SVSM) contraction reacting to different neurotransmitters, phenylephrine (PE) and acetylcholine (Ach), and the respective antagonists. To speculate the possible physiological role of sympathetic and parasympathetic nerve system on seminal vesicles during ejaculation. Materials and Methods: L-phenylephrine HCl (PE, 10-7 to 3 x 10-4M) and acetylcholine (Ach, 10-7 to 3 x 10-4M) were added with various concentrations into organ bath to induce isometric contraction of the isolated rat seminal vesicles. The dose response curve of the isolated rat seminal vesicles reacting to PE and Ach, the inhibitory dose response curve to the different adrenergic antagonists (prazosin, WB-4101, CEC), muscarinic antagonists (atropine, pirenzepine, methoctramine and 4-DAMP) and cross-over reaction were recorded. Then, the seminal vesicles pretreated with different antagonists at different concentrations. The inhibitory curves of contraction were plotted. The twitch pattern of SVSM contraction was analyzed according to its phasic and tonic components. Results: PE and Ach could both achieve good contraction of rat seminal vesicle, especially with the twitch phenomenon. The IC50 of prazosin and WB-4101 were far greater than that of CEC. The IC50 of 4-DAMP was very close to atropine. PE and Ach could cause different patterns of SVSM twitch. PE induced SVSM contraction had more tonic components, but Ach induced SVSM contraction had more phasic components. Conclusion: The predominant subtypes of adrenergic and cholinergic receptors on rat seminal vesicle are α1a and M3 respectively. The calcium channel blocker, nifedipine could also inhibit the contraction of rat seminal vesicles. Different drugs also cause different pattern of SVSM twitch. In our speculation, sympathetic effect is more dominant during emission stage; however, parasympathetic effect is more dominant during ejection stage and provides an anti-reflux effect on ejaculatory duct. Further studies for realizing physiology of ejaculation are worthy. PP84 THE PERIPHERAL EFFECT OF DOPAMINE ON CONTRACTION OF RAT SEMINAL VESICLES--- IN VIVO REGULATION AND ORGAN BATH STUDY 1,2,3 Vincent FS Tsai 1 1 4 1 1 , Fu-Shan Jaw , Hong-Chiang Chang , Yuh-Chen Kuo , Shih-Ping Liu , Ju-Ton Hsieh 1 Institute of Biomedical Engineering, National Taiwan University (Taiwan) 2 Department of Urology, National Taiwan University Hospital (Taiwan) 3 Department of Urology, Ten-Chen General Hospital (Taiwan) 4 Department of Urology, Taipei City Hospital (Taiwan) Purpose: To investigate the peripheral effect of dopamine on contraction of rat seminal vesicles, including in vivo regulation and organ bath study. Materials and Methods: To exam in vivo regulation, a polyethylene catheter (PE-60) was placed in the lumen of the rat seminal vesicles to record the intra-luminal pressure change. Dopamine and the test drugs were administrated through a catheter running from the femoral artery to the bifurcation of the common iliac artery. Phasic tension (ΔmmHg) of the maximal seminal vesicle contractile response induced by intra-arterial injection of dopamine was used as the control. The seminal vesicle contractile responses to dopamine after pretreatment of blocking agents and antagonists were obtained and compared with the control. For organ bath study, dopamine HCl (DA, 10-5 to 3 x 10-4M) was added with various concentrations into organ bath to induce isometric contraction of the isolated rat seminal vesicles. The dose response curve of the isolated rat seminal vesicles reacting to dopamine and the inhibitory dose response curve to dopaminergic antagonists (R(+)SCH-23390, S(-)-sulpiride) were depicted. Results: Pressure within the seminal vesicles of the Wistar rats increased significantly after intra-arterial injectio dopamine. The maximal mean phasic tension was 61.3 ± 4.1 mmHg when 1 M/kg dopamine was injected. Pretreat with haloperidol, SCH 23390 and domperidone at the doses sufficient to block dopaminergic receptors significantly inhi the dopamine-induced contraction of rat seminal vesicles. These findings suggest the existence of functional dopamin receptors in rat seminal vesicles. Pretreatment with guanethidine also significantly inhibited the dopamine-ind contraction of rat seminal vesicles. Norepinephrine mediation of the dopamine-induced contraction of rat seminal ves was further supported by the findings that prazosin (1 nM/kg) and WB-4101 (1 nM/kg) both significantly impeded the max contractile response. In the organ bath study, dopamine could achieve good contraction of rat seminal vesicle, espe with the phasic phenomenon. The IC50 of R(+)-SCH23390 was similar to that of S(-)-sulpiride. And a calcium cha blocker, nifedipine could also inhibit the contraction of rat seminal vesicles. Conclusion: Contraction of rat seminal vesicle involves dopaminergic receptor regulation. Mediation of norepinephrine in dopamine-induced contraction of rat seminal vesicle is also suggested. The predominant subtypes of dopaminergic receptors on rat seminal vesicle are D2 and D1. PP85 WHAT DO MEN KNOW ABOUT THEIR SEXUAL HEALTH – A QUALITATIVE STUDY IN “GEN X AND Y” 1 2 2 2 2 3 VKM Lee , CJ Ng , EM Khoo , LP Wong , WY Low , HM Tan 1 International Medical University (Malaysia) 2 University of Malaya (Malaysia) 3 Sime Darby Medical Centre (Malaysia) Purpose: Generation X (Gen X) is the group of people aged ranging from 30 to 44 years, who face an uncertain, ill-defined future. Generation Y (Gen Y), on the other hand, are people aged 19 to 29 years, with an increased use and familiarity with communications, media, and digital technologies. With the difference in outlook and skills, it is unclear if their views on sexual health differ. This study aimed to explore the knowledge and attitude about sexual health among Gen X & Y men. Methods: This study used the qualitative methodology. It was conducted at an urban area of Malaysia in 2009/2010. Men were sampled purposively based on the age, ethnicity and educational background. Trained facilitators conducted 10 focus group interviews with men from generation X (n=54) and 12 from generation Y (n=69) using a semi-structured interview guide. The interviews were audio-recorded, transcribed verbatim and checked for accuracy. Two researchers analysed the transcripts independently by extracting and agreeing on the emerging themes before converting them into nodes for coding across the 22 transcripts. NVivo 9 was used to manage the data. Results: Men from both Generation X and Y feel sexual health are very important in maintaining relationships. Gen X men perceive having normal or satisfying sexual relationships boost their confidence, life and work performance. Nevertheless, they are unable to define normal sexual health. Men do not share sexual problem with their sexual partners but may discuss it with their male friends. Most Gen X and few Gen Y men have heard and knew about erectile dysfunction (ED). Most men from both generations know very little about premature ejaculation (PE) and they generally are confused with the symptoms and consequences of ED and PE. Gen Y men are concern about sexually transmitted infections. Conclusion: Men of Gen X and Y agreed sexual health are important but many are still unsure what normal sexual health is They are unsure about premature ejaculation and confused about the difference between erectile dysfunction and premature ejaculation. PP86 THE EFFECT OF PLATELET RICH FIBRIN ON CAVERNOUS NERVE REGENERATION IN A NERVE INJURY RAT MODEL 1,2 3 3 1,4 Chien-Chih Wu , Hsiu-O Ho , Yi-No Wu , Han-Sun Chiang 1 Department of Urology, Taipei Medical University Hospital (Taiwan) 2 School of Medicine, College of Medicine, Taipei Medical University Hospital (Taiwan) 3 College of Pharmacy, Taipei Medical University (Taiwan) 4 Graduate Institute of Basic Medicine, College of Medicine, Fu Jen Catholic University (Taiwan) Objectives: To assess whether platelet rich fibrin (PRF) have theraputic effects on cavernous nerve (CN) regeneration. Materials and Methods：Twenty-four 12-week old male Spraque-Dawley rats were used in this study. These animals were randomly divided into four groups: Group I underwent sham operation, while three groups underwent bilateral CN crush. Three crush-injury groups were treated at the time of injury with an application of PRF, or platelet-derived growth factor (PDGF) or normal saline only on the site of injury, respectively. Erectile function was assessed by CN electrosimulation at 4 weeks. Penile tissue and CN were collected for histology. Results：Four weeks after surgery, in the group that underwent bilateral nerve crush with normal saline , the functional evaluation showed a lower mean maximal intracavernous pressure (ICP) than that in the sham group. Both PRF and PDGF treatments resulted in significant recovery of erectile function of erectile function, as compared with normal saline treatment. Histologically, the groups with the treatment of PRF and PDGF had significantly less fibrosis and a significant preservation of myelinated axons of CNs compared with injured controls. Conclusions: The application of PRF and PDGF to the site of CN crush injury can improve recovery of erectile function and facilitate nerve regeneration in a rat model. PP87 ASSOCIATION BETWEEN ENDOGENOUS SEX HORMONES, SEX HORMONE-BINDING GLOBULIN, AND SERUM C-REACTIVE PROTEIN LEVELS IN BOTH SEXES 1 2 3 1 Chun-Hou Liao , Hung-Yuan Li , Wen-Ya Ma , Han-Sun Chiang 1 Division of Urology, Department of Surgery; College of Medicine, Ph.D. Program in Nutrition and Food Sciences, and Graduate Institute of Basic Medicine, College of Medicine, Fu Jen Catholic University (Taiwan) 2 Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, National Taiwan University (Taiwan) 3 Department of Internal Medicine, Cardinal Tien Hospital, and College of Medicine, Fu Jen Catholic University (Taiwan) Purpose: Endogenous sex hormones and sex hormone-binding globulin (SHBG) have been reported to be associated with cardiovascular disease (CVD) and associated risk factors. Serum C-reactive protein (CRP) level is an important marker of chronic inflammation and CVD risk. We investigate the association between serum sex hormones, SHBG and CRP levels in both sexes. Materials and Methods: This cross-sectional study included 696 subjects (255 men, 235 pre-menopausal women, and 206 postmenopausal women). Body mass index, waist circumference, blood pressure, lipid profiles, plasma glucose, insulin, FSH, LH, total testosterone (TT), estradiol, SHBG, dehydroepiandrosterone sulfate (DHEA-S), and hs-CRP concentrations were measured. MetS was defined according to the updated National Cholesterol Education Progream Adult Treatment Panel III criteria with modification of waist circumference for Asians. Results: Hs-CRP and serum SHBG were negatively correlated in men (r = -0.29, p < 0.001), pre-menopausal women (r = -0.38, p < 0.001), and postmenopausal women (r = -0.27, p < 0.001). In men, TT and hs-CRP showed a negative association (r = -0.25, p < 0.001), but the association was attenuated after adjusting for SHBG (r=-0.14, p=0.039). Multivariate regression models showed that SHBG was independently associated with hs-CRP in men (r = -0.18, p = 0.009), pre-menopausal women (r = -0.15, p = 0.025), and postmenopausal women (r = -0.21, p = 0.005), adjusted for age, MetS components, insulin resistance, low-density lipoprotein-cholesterol, and serum sex hormone levels. Conclusions: Serum SHBG and hs-CRP concentrations were inversely correlated in men, pre-menoposal, and post-menopausal women independently. For serum sex hormones, only TT had significant association with serum CRP level in men after multivariate analysis, but the association was attenuated after adjusting for SHBG. PP88 SERUM TESTOSTERONE LEVELS SIGNIFICANTLY CORRELATE 1,2 1,2,3 Yu-Wei Chou , Chun-Hou Liao 1,2 3 , Han-Sun Chiang , Hong-Jeng Yu 1 Division of Urology, Department of Surgery, Cardinal Tien Hospital; College of Medicine (Taiwan) 2 Ph.D. Program in Nutrition and Food Sciences, and Graduate Institute of Basic Medicine, College of Medicine, Fu Jen Catholic University (Taiwan) 3 Department of Urology, National Taiwan University Hospital and College of Medicine, National Taiwan University (Taiwan) Purpose: Lower urinary tract symptoms (LUTS) include voiding, storage, and postmicturition symptoms. Although male LUTS are attributed to the prostate in elders traditionally, the bladder and systemic diseases are also considered as the causes of LUTS. Despite the well-known association between sex hormones and prostate growth, few data describe the relationship between male LUTS and sex hormones are available. We investigate the association between serum sex hormone levels and LUTS in men aged 40-79 years. Materials and Methods: A cross-sectional study was conducted in 509 Taiwanese men. Serum total testosterone (TT), dihydrotestosterone (DHT), and estradiol (E2) levels were measured. Total prostate volume (TPV) measured by transrectal ultrasonography and International Prostate Symptom Score (IPSS) questionnaire were obtained. Univariate and multivariate regression models were constructed to calculate odds ratio (95% confidence interval). Results: Subjects with moderate to severe LUTS (total IPSS>=8) were elder, with higher incidence of hypertension and diabetes, with larger prostate, and had lower serum TT levels. On univariate analyses, serum total TT levels were negatively associated with total IPSS, IPSS storage subscore, weak stream and nocturia. After adjusting age, hypertension diabetes, and TPV, only serum TT level significantly associated with nocturia (more than 2 times per night) (p=0.042), and men with serum TT levels in the highest quartile had 44% reduced risk of nocturia than in the lowest quartile (p=0.037). Conclusions：In our relative healthy male cohort, most IPSS items showed no significant association with serum sex hormone levels except for nocturia, which showed a negative correlation with serum testosterone level. PP89 TESTOSTERONE AND SEX HORMONE-BINDING GLOBULIN HAVE SIGNIFICANT ASSOCIATION WITH METABOLIC SYNDROME IN TAIWANESE ME 1 1,2 3 1,2 Chia-Hao Kuei , hun-Hou Liao , Hong-Jeng Yu , Han-Sun Chiang 1 Division of Urology, Department of Surgery, Cardinal Tien Hospital (Taiwan) 2 College of Medicine, Fu Jen Catholic University (Taiwan) 3 Department of Urology and Internal Medicine, National Taiwan University Hospital (Taiwan) Purpose: To investigate the relationship between sex hormones and metabolic syndrome (MS) in an Asian population. Materials and Methods: A cross-sectional study was conducted in 237 men (aged 20–88 years, mean age 52 years). These individuals measured their serum concentrations of lipid, glucose, insulin, total testosterone (TT), estradiol (E2), sex hormone-binding globulin (SHBG), dehydroepiandosterone sulfate (DHEA-S) along with their body height, weight, waist circumference, and blood pressure. Free testosterone (FT) and bioavailable testosterone (BT) were calculated. Correlations were determined using univariate and multivariate regression analyses. Results: Men with MS had lower levels of TT, BT, FT, SHBG and DHEA-S than men without MS. In multivariable analysis, both TT and especially SHBG remained associated with MS, with odds ratios of 1.34 (95% confidence interval [CI]: 1.18-1.52) and 1.77 (95% CI: 1.53-2.06) respectively. For the correlation of TT and SHBG with each component of MS, TT was related to waist circumference (P=0.006); SHBG was associated with blood pressure and blood sugar (P=0.009 and P=0.043); and TT and SHBG were risk factor of subjects with abnormal triglycerides level (P=0.001 and P=0.043). A significanttrend was observed between decreasing levels of TT, BT, FT, and SHBG with an increasing number of MS components. Conclusion: Our data suggested that serum levels of TT and SHBG inversely correlated with the risk of MS. In addition, serum TT level was related to waist circumference (obesity) and serum SHBG level was associated with blood pressure and blood sugar. PP90 DEVELOPMENT OF SEXUAL SELF-CONCEPT SCALE FOR ADOLESCENTS 1 2 3 4 Jiunn-Horng Lou , Sheng-Hwang Chen , Cheng-Joo Eng , Yen-Chin Lin , Fang-Chen Lin 5 1 Center for General Education, Hsin Sheng College of Medicine Care and Management (Taiwan) 2 Department of Service Business Management, Hsin Sheng College of Medicine Care and Management (Taiwan) 3 Department of Child Educare, Min-Hwei College of Health Care Management (Taiwan) 4 Graduate School of Human Sexuality, Shu-Te University (Taiwan) 5 Department of Service Business Management, Hsin Sheng College of Medicine Care and Management (Taiwan) Purpose: Self-concept is the cognitive or thinking aspect of self (related to one’s self-image) and generally refers to "the totality of a complex, organized, and dynamic system of learned beliefs, attitudes and opinions that each person holds to be true about his or her personal existence" (Purkey, 1988).The purpose of the study is to develop an adequate sexual self-concept scale suited for adolescents in Taiwan based on theory of self-concept proposed by Michael and Smith. Referring to related scale on sexual self-concept reviewing relevant literature and conducting expert review, the new scale suited for Taiwan was consisted of three constructs (sexual arousability, sexual agency, and negative sexual affect) and 16 items. Methods and Materials: The study used convenience sampling to select 265 valid samples for pilot study from a college. After exploratory factor analysis and reliability analysis, a formal Likert-like scale with 10 items in three dimensions (sexual arousability, sexual agency, and negative sexual affect) was generated. A total of 900 questionnaire were sent to the adolescents of one medical and nursing college in Taiwan with 748 valid copies returned (valid response rate=83.1%). Structural equation modelling and confirmatory factor analysis were used for data analysis. Results: In reliability analysis, the internal consistency coefficients Cronbach’s α of each dimension was between 0.83 and 0.92, and the α of the overall scale was 0.93. In validity analysis, the model fit indices of the confirmatory factor analysis showedχ2 = 53.50, df = 32 (p < 0.01), the root mean square error of approximation (RMSEA) = 0.050, the comparative fit index (CFI) = 0.98 and the standardised root mean square residual (SRMR) = 0.027. Conclusion: The results showed the developed sexual self-concept scale had good reliability. The scales can be used to measure adolescents’ sexual behaviour, perception of contraception, attitude of body image, and sexual motivation. Keywords: Sexual Arousability, Sexual Agency, Negative Sexual Affect, and Sexual Self-Concept Scale. PP91 THE MEDICAL-CARE SEEKING BEHAVIORS AND LIFE EXPERIENCES AMONG VAGINISMUS PATIENTS AND THEIR PARTNERS IN TAIWAN 1 Cherng-Jye Jeng , Hsing-Yuan Liu 2 1 Taipei Medical university (Taiwan) 2 Department of Nursing, Chang Gung Technology University (Taiwan) Review of sexual dysfunction was less than one hundred years of scientific research so far, and most elaborate discussion begins with as the main male sexual dysfunction, for female sexual dysfunction is rarely dwell. Particularly in the health care sector on the importance of female sexual dysfunction, sexual dysfunction than men, behind at least fifteen years. The purpose of this study was to investigate the medical-care seeking behaviors and life experiences among vaginismus patients and their partners. The purpose sampling consisted of 5 couples from a medical university hospital in Northern Taiwan. Data were collected by semi-structured interview on e medical-care seeking behaviors and life, each couple for 2-3 hours. The strategy of data analysis was based on grounded theory. The results showed that the couples limited to medical-care seeking, is not only unable to obtain the related medical resources, but also unfriendly medical environment's and deficient privacy affects the wish which seeks medical help. Four major themes were identified as the medical-care seeking behaviors and life experiences among vaginismus patients and their partners: (a) I’m not good or you are sickness ; (b) Ashamed and helpless for the medical-care seeking behaviors ; (c) the endurance and the fear are pressed from vaginal penetration exercises; (d) to desire attention the local injections of botulinum toxin . Interpretations of these findings and recommendations for future research are presented. Keywords: vaginismus, female sexual dysfunction.
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