Book of Abstracts - Asia Pacific Society For Sexual Medicine

Asia Pacific Society for Sexual
Medicine
Book of Abstracts
108
APSSM 2005 FINAL PROGRAM
Cairns Convention Centre
Day 1: Tuesday 4 October 2005
1200
Registration commences
Venue:
Cairns Convention CentreHall A
1700
The Journal of Sexual Medicine Debate:

Psychologic therapy is preferred over medical therapy in premature ejaculation
Moderator: Ira Sharlip, Associate Editor JSM
For the statement: Kevan Wylie, Doug Lording
Against the statement: Michael Gillman, Chris McMahon
1815
Opening Ceremony
1930
WELCOME RECEPTION
Day 2: Wednesday 5 October 2005

Venue:
0800
The Scientific Program

Kim Chew (Chair, Scientific Committee)
Chairs:
Michael Lowy (Sydney) / Yasusuke Kimoto (Fukuoka)
0815
Plenary A: ED: Prevalence and Clinical Correlates

Global overview and management implications
Ron Lewis (Augusta)
Chairs:
Sudhakar Krishnamurti (Hyderabad) / Hui Jiang (Beijing)
0845
Plenary B: Pharmacotherapy of ED
Rationale of PDE 5 inhibition and other current options
Ira Sharlip (San Francisco)
Chairs:
Kuang-Kuo Chen (Taipei) / Hyung-Ki Choi (Seoul)
0915
Plenary C: Genes and Gene Therapy

The futuristic management of ED
Koichi Nakajima (Tokyo)
0945
MORNING TEA IN THE EXHIBITION AREA
Symposium A: Phosphodiesterase Inhibition
Symposium B: Iatrogenic Sexual Dysfunction
Venue:
CCCHall A
CCCHall B
Chairs:
Ganesh Adaikan (Singapore) / Tai Young Ahn (Seoul)
Sae-Chul Kim (Seoul) / Thomas Hwang (Taipei)
1015
Phosphodiesterase (PDE) inhibition and its implications

Man Kay Li (Singapore)
Iatrogenesis: A cause of sexual dysfunction

Kwangsung Park (Seoul)
1030
Maximising the safe and efficacious use of

phosphodiesterase 5 inhibitors
Chris McMahon (Sydney)
Iatrogenic sexual dysfunction in oncology

Luca Incrocci (Rotterdam)
1045
Phosphodiesterase 5 inhibitors for ED: What are the

choices in Asia Pacific countries?
Edsal Gatchalian (Manila)
Cardiovascular medications and sexual dysfunction

Sudhakar Krishnamurti (Hyderabad)
1100
Phosphodiesterase 5 inhibition: Applications beyond

treatment of male erectile dysfunction
Iatrogenesis and sexual dysfunction: The Urologists

perspective
Ken Marumo (Tokyo)
1115
Non-surgical alternatives to phosphodiesterase 5

inhibitors for ED with special reference to Asia
Pacific countries
Apichat Kongkanand (Bangkok)
Managing the patient with penile fibrosis

Peter Sutherland (Adelaide)
1130
Questions
1145
Podium Presentations (Concurrent)
J Sex Med 2006;3(suppl 2):108170
109
APSSM 2005 Final Program

Podium A: Erectile Dysfunction
Podium B: Basic Science Research 1
Venue:
CCCHall A
CCCHall B
Chairs:
Michael Lowy (Sydney) / Sung Won Lee (Seoul)
Edsal Gatchalian (Manila) / Johnny S Lin (Taipei)
70 Role of intracavernous vasoactive self injections

in erectile dysfunction in the era of the sildenafil
therapy
T R Murali (Madurai)
10 Penile expression of nitric oxide synthase isoforms and

vascular endothelial growth factor in the type II diabetic rat
Nam Cheol Park (Busan)
84 Comparison of satisfaction rates and erectile

function in patients treated with sildenafil,
intracavernous prostaglandin E1 and Penile Implant
Surgery for Erectile dysfunction in Urology Practice
Chirpriya Dhabuwala (Detroit)
30 Effects of metformin on the expression of nitric

oxide synthase in high fat fed obese rats
Ki-hak Moon (Daegu)
23 Prevalence of metabolic syndrome in the Klang

Valley of Malaysia and its association with
testosterone levels and erectile dysfunction
Piang Kian Yap (Kuala Lumpur)
49 The effect of oxytocin antagonist and w-conotoxin on

Nmda-induced penile erection through paraventricular nucleus
of hypothalamus in the rat
Kuang-Kuo Chen (Taipei)
76 Prevalence of comorbidities among men with

erectile dysfunction in the Asian Mens Attitudes to
Life Events and Sexuality Study (Asian M.A.L.E.S.)
Chirk-Jenn Ng (Kuala Lumpur)
45 Effects of chronic type 5 PDE inhibition on the erectile

function of the atherosclerotic rats
Kwanjin Park (Seoul)
36 Coronary heart disease risk of men with erectile

dysfunction
46 The effects of DA-8159, a novel PDE5 Inhibitor

on erectile function in the rat model of hypercholesterolemic
erectile dysfunction
Kyung Koo Kang (Kyunggi)
32 What difference causes chronic arterial insufficiency

to develop into either arteriogenic ED or cavernous ED?
Tomoya Fukawa (Nihama Ehime)
47 Effects of DA-8159, a PDE5 inhibitor, on intraurethral

pressure in steroid induced benign prostatic hyperplasia in rats
Jae Young Yu (Kyunggi)
20 Erectile dysfunction caused by fear of infertility

Toshikazu Otani (Nagoya)
51 The effects of intracavernous administration of L-Arginine

and sildenafil on penile erection in the rat
Venue:
Cairns Convention CentreHall B
1300
Lunch and Pfizer Symposium
Pfizer Symposium:
Innovations in ED Therapy: The Science Behind Better Sex
1310
Welcome and Introduction

Peter Sutherland (Adelaide)
1315
Delivering better erections for better sex

Andrew McCullough (New York)
1345
Mechanisms of sildenafil citrate: The science behind better erections

Ronald Lewis (Augusta)
1415
Question and answer session

Facilitated by Peter Sutherland (Adelaide)
1430
AFTERNOON TEA IN THE EXHIBITION AREA
1500
Podium C: Hormone-Related Research
Podium D: Basic Science Research 2
Venue:
CCCHall A
CCCHall B
Chairs:
John Conaglen (Auckland) /

Wimpie Pangkahila (Denpasar)
Michael Gillman (Brisbane) /

Toshiyasu Amano (Nagano)
6 Mechanisms of action of human growth hormone

on isolated human penile erectile tissue
Stefan Uckert (Hannover)
28 Molecular expression of CLC-3 Chloride channel

on rat corpus cavernous smooth muscle
Yuh-Chen Kuo (Taipei)
J Sex Med 2006;3(suppl 2):108170
110
1630

55 Localization of increased insulin-like growth factor
binding Protein-3 in the diabetic rat penis: Implication
for erectile dysfunction
Jintetsu Soh (Kyoto)
44 Exploring new therapeutic target for ED: Chloride channels

in corpus cavernosum
Lang-Chu Lau (Singapore)
63 Effect of androgen deprivation on the expression of

apoptotic proteins and growth factors in rat penile tissue
Seunghun Song (Seoul)
69 Modulatory role of protein kinase (PKA) in 5-HT3induced

calcium transients in parasympathetic neurons of rat major
pelvic ganglia
Yun Seob Song (Seoul)
19 Optimal prescription of oral testosterone undecanoate

for increasing serum concentration of testosterone
Du Geon Moon (Seoul)
50 The effects of rho-kinase and myosin light chain kinase

inhibitor and angiotensin II Receptor antagonist on penile
cavernous tissuesin vitro study
26 Impact of testosterone depletion on human

ischiocavernosus muscle (ICM) contractility
Manabu Sakaki (Kagawa)
91 Effects and mechanisms of tissue kallikrein in relaxation

of rat corpus cavernosum smooth muscle
Jihong Liu (Wuhan)
54 The effect of testosterone on potassium channels

in human corporal smooth muscle cells
Deok Hyun Han (Seoul)
48 The effects of testosterone on L-Arginine-induced penile

erection through paraventricular nucleus of hypothalamus
in the rat
65 Study of the effects in the testosterone-treated

lyedig cells
Thomas Hwang (Taipei)
29 Changes of brain electrical source distribution by audiovisually stimulated sexual arousal: A cross spectral analysis
using low resolution brain electromagnetic tomography
Jae-Seog Hyun (Chinju)
81 Transdermal testosterone gel import the serum

testosterone level and erectile function in
hypogonadal men
Han-Sun Chiang (Taipei)
118 The study of the HMRS on the hippocamus and anterior

cingulate cortex of the psychogenic erectile dysfunction
Jihong Liu (Wuhan)
Close of Day 2
Day 3: Thursday 6 October 2005

Venue:
0800
Highlights from Day 2

Warrick White (Auckland)
Chairs:
Hui-Meng Tan (Kuala Lumpur) / Je-Jong Kim (Seoul)
0815
Plenary D: Endothelial Dysfunction

The ED/ED Interface
Gerald Watts (Perth)
Chairs:
Benjamin Mendoza (Manila) / Ju-Ton Hsieh (Taipei)
0845
Plenary E: Sex and Cancer

Managing sexual dysfunction in cancer care
Luca Incrocci (Rotterdam)
Chairs:
Clarence Lei (Kuching) / Ken Marumo (Tokyo)
0915
Plenary F: ED and the Prostate

An update on ED in prostate diseases
0945
J Sex Med 2006;3(suppl 2):108170
111

Symposium C:
Male Sexual Dysfunction
Symposium D: Contemporary and

Complementary Medicine in Sexual
Dysfunction
Venue:
CCCHall A
CCCHall B
Chairs:
Kwangsung Park (Seoul) / Yi Xin Wang (Shanghai)
Alan Wright (Perth) / Nam Cheol Park (Busan)
1015
Etiological factors of male erectile dysfunction

Ron Lewis (Augusta)
The metabolic syndrome and erectile dysfunction: Greater than

the sum of parts?
Gerald Watts (Perth)
1030
Male sexual dysfunction and the diabetic patient

Doug Lording (Melbourne)
Lifestyle factors in sexual dysfunction

Tai Young Ahn (Seoul)
1045
Male sexual dysfunction in spinal cord injury

Yasusuke Kimoto (Fukuoka)
The use and misuse of complementary medicine in sexual

dysfunction
Arif Adimoelja (Surabaya)
1100
Psychological factors in male sexual dysfunction

Rudi Yuwana (Semarang)
Managing sexual dysfunction in general practice

Michael Gillman (Brisbane)
1115
Oestrogens and phytoestrogens: Their role in male

sexual dysfunction
Srilatha Balasubramanian (Singapore)
Sexual dysfunction in Asia Pacific countries: Socio-cultural

factors and management strategies
Wah Yun Low (Kuala Lumpur)
1130
Questions
1145
Podium E: Female Sexual Dysfunction
Podium F: Observational Research
Venue:
CCCHall A
CCCHall B
Chairs:
Srilatha Balasubramanian (Singapore) /

Lang Chu Lau (Singapore)
Nam Cheol Park (Busan) / Koichi Nagao (Tokyo)
5 Expression of messenger RNA (mRNA) encoding

for different phosphodiesterase (PDE) isoenzymes
in human clitoral and vaginal tissue
Stefan Uckert (Hannover)
31 Male sexual dysfunction seen in a men only primary

care practice
Clarence SK Yeo (Singapore)
52 The effect of intracavernous administration of

vasoactive agent on rabbit clitoral intracavernous
pressure
8 Reproductive and sexual function in blind Egyptian males

Abdalla M Attia (Cairo)
123 Effects of Korean Red Ginseng on vaginal

blood flow and structure in castrated rat
Kwangsung Park (Seoul)
21 Men with erectile dysfunction and their health seeking

behavior
126 Effect of tadalafil citrate on signal transduction

during treadmill exercise in healthy women
Jong Kwan Park (Jeonju)
35 Help-seeking pattern of men with ED: An Urban

Malaysian model
127 Epidemiologic study for sexual dysfunctionrelated factors in Korean Women

Kweon Sik Min (Busan)
78 Attitudes of men and their partners to erectile dysfunction

and its treatment: The Australian Males Study
Marita McCabe (Melbourne)
18 Magnetic resonance imaging anatomy of female

genitalia in premenopausal and postmenopausal
Korean women
Du Geon Moon (Seoul)
77 Does quality of life differ between men with and without

erectile dysfunction? Preliminary results from the Asian Mens
Attitudes to Life Events and Sexuality Study (Asian M.A.L.E.S.)
Venue:
1300
Lunch and Lilly-Icos Symposium
Lilly-Icos Symposium:
CHOICES
The First Head to Head Oral PDE5 Inhibitor Crossover Efficacy and Preference Study
Geoffrey Hackett
1430
1500
J Sex Med 2006;3(suppl 2):108170
112

Podium G: PDE-5 Inhibition
Podium H: Prostate & Penile Disorders
Venue:
CCCHall A
CCCHall B
Chairs:
Greg Watters (Port Macquarie) /

Sakti Hutama (Surabaya)
Peter Sutherland (Adelaide) / Je-Jong Kim (Seoul)
34 Efficacy of sildenafil citrate for treatment of

erectile dysfunction in men with diabetes
Haruaki Sasaki (Yokohama)
33 What is highly correlated with requiring sexual function

to be preserved when considering treatment options for
prostate cancer
Tomoteru Kishimoto (Tokushima)
128 The comparative effects of PDE5 Inhibitors

(zaprinast, sildenafil, vardenafil) according to the
route of administration in the rabbit model
Seong Choi (Busan)
59 Compliance to penile rehabilitation program following

radical prostatectomy: One year data
Run Wang (Houston)
37 Prediction of efficacy in sildenafil for the diabetic

patients with ED
Yoshiatsu Takahashi (Tokyo)
120 Effects of doxazosin on sexual function in patients with

benign prostatic hyperplasia
Kyung Seop Lee (GyeongJu)
53 A rational combination pharmacotherapy in

men with erectile dysfunction who initially failed
to oral sildenafil citrate alone
Rajesh Taneja (New Delhi)
41 Peyronies Disease and the penile dermal flap operation for

penile deformity correction16 years and 80 cases
66 Vardenafil improves treatment satisfaction and

sexual pleasure in men with erectile dysfunction
and their partners
William Fisher (Ontario)
80 The long term results of modified plication of the tunica

albuginea in the congenital penile curvature
Gyung-Woo Jung (Busan)
67 Vardenafil improves erection quality assessed

by the novel erection quality scale in the broad
population of men with erectile dysfunction
William Fisher (Ontario)
109 The experience of treatment for Peyronies Disease in

Toho University
Koichi Nagao (Tokyo)
7 Uptitration of vardenafil dose from 10-Mg to

20-Mg improved erectile function in men with
spinal cord injury
Yasusuke Kimoto (Fukuoka)
3 Cylinder sizing difference between existing furlow inserter

tool and modified furlow inserter tool for penile prosthesis
implantation
Jung Moon Heo (Busan)
38 Vardenafil improves erectile function in Asian

men with erectile dysfunction
Hui-Meng Tan (Kuala Lumpur)
12 Artificial erectile penis with a windows-shaped corona

glandis opening that acts as a sexual sensor
Takehisa Iwai (Tokyo)
57 Quantitave Rigiscan measurements of

erectile rigidity and sustenance following administration
of Cialis 20 mg
42 Does penile color duplex doppler ultrasound

influence the decision for penile prosthesis implantation?
Run Wang (Houston)
58 Erect penile length induced by intracavernosal injection
versus that obtained with penile prosthesis
Run Wang (Houston)
24 Improvement in procedures for harvesting the inferior
epigastric artery for penile revascularization
Yasuo Kawanishi (Kagawa)
1630
Close of Day 3
1900
CONFERENCE DINNER
at Tjapukai Aboriginal Theme Park
Day 4: Friday 7 October 2005

Venue:
0800

Stephen Adams (Perth)
Chairs:
Chris McMahon (Sydney) / Anupan Tantiwong (Bangkok)
0815
Plenary G: Ejaculatory Dysfunction:

What is new?
Zhong-Cheng Xin (Beijing)
J Sex Med 2006;3(suppl 2):108170
113

Chairs:
Dennis Cherry (Perth) / Apichat Kongkanand (Bangkok)
0845
Plenary H: Sex Therapy

What is its role in sexual dysfunction?
Margaret Redelman (Sydney)
Chairs:
Man Kay Li (Singapore) / Johnny S Lin (Taipei)
0915
Plenary I: Surgery for Male Sexual Dysfunction

Options and indications
Sae-Chul Kim (Seoul)
0945
1015
APSSAM Symposium:
Mens Health and Ageing in Asia Pacific Countries
Venue:
CCCHall A
1015
Opening remarks: Sex and ageing in Asia

Victor Goh (Singapore)
1020
Mens health in the Asia Pacific region

1035
Mens health and ageingTaiwan perspective

1050
Problems in mens health and ageing in India

1105
Relation between PADAM symptom and testosterone in Japan

Akira Tsujimura (Osaka)
1120
Hypogonadism in the aging male in Taiwan

1135
Lifestyle factors in sexual dysfunction

1150
Questions
1155
Closing Remarks
1200
Podium I: Mens Health
Podium J: Ejaculatory Disorders and Herbs
Venue:
CCCHall A
CCCHall B
Chairs:
Arif Adimoelja (Surabaya) /

Stephen Adams (Perth) / Haruaki Sasaki (Yokohama)
73 The impact factors of quality of sexuality among

the elderly
Yi-Chia Lin (Taipei)
27 Clinical efficacy of yohimbine for ejaculatory incompetence

Toshiyasu Amano (Nagano)
64 Prevalence study of adult hypogonadism in Taiwan

56 Vibro-ejaculation and electro-ejaculation can avoid needless

ICSI procedures
11 Comparison of serum testosterone, Adam

questionnaire and IIEF scores in andropause
screening in Korean
Hyun Jun Park (Busan)
71 Our experience with electrojaculation (EEJ) for anejaculation

over a six year period January 1999December 2004
T R Murali (Madurai)
22 Cyber-sexual counsellingold problems and

new ways
Chih-cheng Lu (Chiayi)
130 Clinical efficacy of renewal SS-Cream in patients

with premature ejaculation
Young Deuk Choi (Seoul)
108 Brain activation by visual erotic stimuli in

elderly healthy males
SW Kim & Lee Choong Bum (Seoul)
(Poster)
97 The relaxant effect on the rabbit corpus cavernosum

tissue in vitro, with six extracts from chinese herbal medicines
Jihong Liu (Wuhan)
Venue:
1300
Lunch and Bayer Symposium
J Sex Med 2006;3(suppl 2):108170
114

Bayer Symposium:
Helping Couples Stay ConnectedA Paradigm in ED Management
1310
Welcome and Introduction

1315
Sexual function, ED prevalence and attitudes towards sexuality: Are Asian men different?
1335
ED: Sexual dysfunction of men or couples? The Australian MALES study

Marita McCabe (Melbourne)
1355
Sexual satisfaction for couples

Chris G McMahon (Sydney)
1420
Closing remarks and discussion

Ira Sharlip (San Francisco) and Panel
The presentations may contain information not approved in Australia. They are for educational purposes only.
The opinions expressed by the speakers do not necessarily reflect those of the sponsor.
1430
1500
Podium K: Clinical Research
Podium L: Basic Science Research 3
Venue:
CCCHall A
CCCHall B
Chairs:
Han-Sun Chiang (Taipei) / Rudi Yuwana (Semarang)
HW Yap (Penang) / Koichi Nakajima (Tokyo)
75 Prevalence of erectile dysfunction and treatment:

Preliminary results from four countries in the Asian
Mens Attitudes to Life Events and Sexuality Study
(Asian M.A.L.E.S.)
116 Inhibit the expression of PDE5A3 gene in human

corpus cavernosum smooth muscle Cells by RNA interference
Jinhong Liu (Wuhan)
82 Studies of natural component icariin on erectile

dysfunction
Zhong-Cheng Xin (Beijing)
39 The usefulness of noncontact erections for potency check

in male rats
Yong Soo Lho (Seoul)
40 Androgen and sleep-related erection in vegetative

state patients
Dae Yul Yang (Seoul)
90 Effect of Ginsenoside Rb1 on human sperm mobility of

asthenospermia in vitro
Jihong Liu (Wuhan)
9 Analysis of heart rate variability in patients with

erectile dyfunction
Byung Chul Ahn (Suwon)
117 Effects of tetrandrine on cytosolic free calcium concentration

in corpus cavernosum smooth muscle cells of rabbits
Jihong Liu (Wuhan)
61 LUTs and erectile dysfunction

129 Angiotensin Converting Enzyme (ACE) gene polymorphism

interaction with hypertension in erectile dysfunction
A Wardihan-Sinrang (Makassar)
124 Relationships between hemodynamic

parameters and serum testosterone in impotent
men during dynamic infusion cavernosometry
Seong Choi (Busan)
43 Color doppler ultrasound assesment of penile
vascular system in men with erectile dysfunction
Yu-Hung Lai (Taipei)
1630
Close of Day 4
1930
FACULTY DINNER (Invitation only)

at the Red Ochre Grill Restaurant
J Sex Med 2006;3(suppl 2):108170
115
Day 5: Saturday 8 October 2005

Venue:
0800

Chairs:
Marita McCabe (Melbourne) / Akira Tsujimura (Osaka)
0815
Plenary J: Arousal and Orgasm in the Fairer Sex

What are the issues?
Lorraine Dennerstein (Melbourne)
Chairs:
David de Kretser (Melbourne) / Neil Palmer (Perth)
0845
Plenary K: Sex Steroids in Female Sexual Dysfunction

Pathophysiology and management
John Conaglen (Auckland)
Chairs:
Bronwyn Stuckey (Perth) / Doddy Soebadi (Surabaya)
0915
Plenary L: Research in Sexual Medicine

Current trends and future directions
Ganesh Adaikan (Singapore)
0945
MORNING TEA
1015
Andrology Australia Symposium:

Androgens and the Older Male
Venue:
CCCHall A
Chairs:
Peter Sutherland (Adelaide) / John Conaglen (Auckland)

Androgens and the middle-aged and older Australian male:
Men in Australia Telephone Survey (MATES)
David de Kretser (Melbourne)
Testosterone replacement in the older male
Bronwyn Stuckey (Perth)
Diagnostic issues for androgen deficiency
Ken Sikaris (Melbourne)
1145
Close of APSSM Meeting 2005
1230
SKYRAIL TOUR (Optional)
J Sex Med 2006;3(suppl 2):108170
116
The Scientific Program

KK Chew (Chair, Scientific Program)
Although the success of a scientic meeting is measured

not only by the academic merit and practical value of
the topics discussed but also by the fellowship and
goodwill generated through the social intercourse of
delegates and participants, the Scientic Program is still
very much its main focus and hallmark.
Various forms of sexual dysfunction, affecting both
the male and female genders, have been Old Problems since time immemorial. Fortunately, biotechnological advances in recent years have enabled scientists
and clinicians to provide New Solutions for their
management and prevention. Indeed, Asia-Pacic specialists in sexual medicine have made considerable contributions towards making such solutions possible. It is
therefore appropriate that Old ProblemsNew
Solutions should provide the theme for this Meeting.
The Scientic Program comprises 12 plenary lectures, 4 issue-specic symposia and 13 sessions for
J Sex Med 2006;3(suppl 2):108170
podium presentations of research papers. These are

complemented with a debate, 2 symposia presented by
fellow regional peak organizations the Asia Pacic
Society for the Study of the Aging Male (APSSAM) and
Andrology Australia (AA), and 3 lunch-time symposia
by the Quality Partners of the Meeting Bayer Healthcare, Eli Lilly and Pzer.
Invited speakers, from North America, Europe and
the Asia Pacic region, have accepted their roles graciously and generously. Other well-regarded opinion
leaders have lent their support and participate at this
Meeting in various other capacities. A total of 126
abstracts, from no less than 15 countries, were accepted
for presentation with 5 withdrawals due to unforeseen
circumstances.
It is earnestly hoped that the Scientic Program
would meet the expectations and approval of all who
contribute to and participate in it.
117
Book of Abstracts
Plenary A: ED: Prevalence and Clinical
Correlates
EDPREVALANCE AND CLINICAL
CORRELATES
Ronald W Lewis, MD
For a clear understanding of any disorder, there is a

need for proper epidemiological studies which are basically descriptive or analytical. Descriptive epidemiology
includes prevalence rates and incidence rates. The
former, for erectile dysfunction, are clearly supported
by evidence-based literature. There has been a growing
worldwide appreciation of the prevalence of erectile
dysfunction in various societies. By applying strict criteria to measure external and internal validity, comparative epidemiological studies, particularly in relation to
prevalence of erectile dysfunction, are becoming more
clearly validated. One of the problems in comparing
epidemiological studies is the use of various denitions
to describe erectile dysfunction. On a general basis, all
of the large epidemiological studies (>200 subjects), are
stratied by age and show rising prevalence of ED as
the populations age. Below the age of 40, the prevalence
of ED is very low and always appears to be under 10%.
In various populations for ages 4059, there is a wide
range of prevalence from similar rates for the ages
below 40 to as high as 2030%. However, even greater
ranges are present in the 5059 year age group for ED
reported prevalence rates. These prevalence rates
increase dramatically for the 6069 years of age, except
for some Scandinavian countries where the major rate
change appears to be at age 70 years. Prevalence rates
for erectile dysfunction for those in their 70s and 80s
range from 5075%.
There is clearly a need for more longitudinal studies
so the true incidence rate can be developed. Incidence
rates of erectile dysfunction from the United States
and Europe suggest an incidence for erectile dysfunction of 2530 cases per thousand person years. Again,
as with prevalence rate, incidence rates increase with
age.
Analytical epidemiology deals with, in one sense,
associated risk factors for ED. It has been recently suggested that erectile dysfunction is truly a symptom of
other disease states. Any disease that seems to affect vascular smooth muscle has been associated with erectile
dysfunction. This includes diabetes mellitus, hypertension and generalized arterial sclerosis. For erectile dysfunction smoking and hormonal factors also serve as
well-dened risk factor associated conditions. Cigarette
smoking appears to be an independent risk factor for
ED. Recently also the association between lower
urinary tract symptoms for erectile dysfunction and
other sexual dysfunctions has been highly suggested by
epidemiological studies. Depression and other psychiatric/psychological disorders have a clear-cut association with erectile dysfunction. With the idea that
modication of risk factors in middle-aged males may
affect the incidence of erectile dysfunction, it has

become recently established that increasing physical
activity seems to decrease the incidence of erectile dysfunction. Association between other sexual dysfunctions
and ED in an individual is recently being established by
epidemiological studies. Similarly, correlation to sexual
dysfunctions in ED patients partners is gaining epidemiological support.
Plenary B: Pharmacotherapy of ED
PHARMACOTHERAPY OF ED AND THE
PHARMACOLOGY OF PDE5 INHIBITION:
THE RATIONALE OF CURRENT OPTIONS
I D Sharlip
University of California at San Francisco
2100 Webster St, #222, San Francisco CA 94115 USA
Erections begin with sexual stimulation which causes

endothelial cells and nerve endings within the corpora
cavernosa to produce nitric oxide (NO). Diffusion of
nitric oxide (NO) into the smooth muscle cells of the
corpora cavernosa activates guanylyl cyclase which
converts GTP to cyclic GMP. Cyclic GMP sets off a
cascade of events marked primarily by alterations in
calcium and potassium channels, reducing intracellular
calcium. This produces smooth muscle relaxation, the
essential physiological action needed to ll the corpora
with blood and create an erection. Cyclic GMP is
broken down by PDE Type 5. Type 5 phosphodiesterase
inhibitors work by inhibiting PDE5 within the smooth
muscle cells of the corpora cavernosa, thus potentiating
intracellular cyclic GMP and erection. The cyclic GMP
pathway is the most important pathway with regard to
erectile physiology but a related pathway involving cyclic
AMP contributes to smooth muscle relaxation as well. In
this alternate system, NO activates adenylyl cyclase,
which converts ATP to cyclic AMP which in turn causes
smooth muscle relaxation. Cyclic AMP is broken down
by PDE 2, 3 and 4 but not 5. Therefore this pathway is
not affected by Type 5 PDE inhibitors. There are no
specic Type 2, 3 or 4 PDE inhibitors although these
PDEs can be inhibited by nonspecic PDE inhibitors
such as Prostaglandin E1 and Alprostadil.
The in vitro inhibitory effect of a drug, such as a
phosphodiesterase type 5 inhibitor (PDE5i), on an
enzyme, such as phosphodiesterase (PDE), is a measure
of the drugs biochemical potency. The IC50 of a drug
is dened as the concentration of that drug which is
required to reduce by 50% the activity of the enzyme
being tested. The lower the concentration of a drug
needed to inhibit 50% of the enzymes activity, the more
potent is the drug. For many drugs, high levels cannot
be achieved by oral administration. Therefore a high
IC50 for a drug often means that there will be little
inhibition of that enzyme by oral administration of that
drug. The selectivity of an inhibitor drug is the ratio of
J Sex Med 2006;3(suppl 2):108170
118
its IC50 for two different isoenzymes. The higher the
selectivity ratio, the less likely the PDE inhibitor is to
cross react with the PDE isoenzyme being tested versus
the basic PDE isoenzyme, such as PDE5. The higher
the selectivity, the better is its side-effect prole. PDE
selectivity ratios of >50 have little clinical signicance
because it is impossible to achieve high blood levels by
oral administration. For the three clinically approved
PDE5 inhibitors, the only selectivity ratios for PDE5
which are less than 50 are for PDE6, which is located
primarily in the retina, and PDE 11, which has been
identifed in testes, pituitary, brain, skeletal muscle and
prostate. With regard to PDE5 versus PDE 6 inhibition, the selectivity ratios of sildenal, vardenal and
tadalal are 1011, 425 and 190. Therefore, both
sildenal and vardenal, but not tadalal, may be
associated with visual disturbances in a small percentage of men. With regard to PDE 11 inhibition, the
selectivity ratios of sildenal, vardenal and tadalal are
780, 1160 and 5. Therefore, only tadalal may have a
clinical effect on PDE 11 inhibition. To date, no clinical effect of tadalal on PDE 11 inhibition has been
identied.
PDE5 inhibition may cause other side effects
because of inhibition of PDE5 in tissues outside of
the corpora cavernosa. Headache, facial ushing and
nasal stufness result from vasodilation due to the presence of PDE5 in vascular smooth muscle. Indigestion
results from inhibition of PDE5 in the smooth muscle
of the lower esophagus. The cause of myalgia is not
clear; it is thought to result from vasodilation in large
gravity-dependent muscles of the back, buttocks and
thighs.
Plenary C: Genes and Gene Therapy

THE FUTURISTIC MANAGEMENT OF ED
Koichi Nakajima (Tokyo)
There is no doubt that despite the advent of Sildenal

Citrate, there is room for improvement in the treatment
for erectile dysfunction (ED). Gene therapy has been
traditionally regarded as a treatment for life threatening disease, for which few other treatment options are
available.
Recently, the application of gene therapy for non-life
threatening disease such as ED is being considered.
Furthermore, the penis is an ideal organ for gene
therapy because of its external location and slow circulation. Some human studies have been performed with
specic genetic endpoints coupled with erectile dysfunction. Nitric oxide (NO) is recognized to be the
principal mediator of penile erection. Some reports
have been published regarding to new target for gene
therapy not only NO but also some other cytokines.
Gene therapy is just key strategy of next step to treatment for ED.
J Sex Med 2006;3(suppl 2):108170
Book of Abstracts
PHOSPHODIESTERASE (PDE) INHIBITION AND
ITS IMPLICATIONS
MK Li
Consultant Urologist, Gleneagles Medical Centre and
Mt Elizabeth Hospital, Singapore
The use of PDE5 inhibitors in treatment of erectile

dysfunction (ED) has been one of the best medications
in the last decade and benet millions of men. In fact
the tip of the iceberg as the PDE superfamily has many
different subtypes and isoforms. To date scientists have
discovered 11 types of PDEs and found that they are
widely distributed in nearly all the tissues in the body.
Most of them work via the cyclic GMP (guanosine
monophosphate) or cyclic AMP (adenosine monophosphate) pathways. As such PDEs regulate a wide variety
of cellular functions and therefore of great interest in
the further development of new therapeutic agents.
PDE3 has been used for cardio protection. PDE3 can
also increase insulin secretion and enhance the action
of insulin on adipose tissue and hepatocytes. PDE4 is
used in the treatment of chronic obstructive pulmonary
disease, inammatory bowel disease, autoimmune
disease and cognitive function of the brain including
depression.
PDE5 (sildenal) has shown to increase cardiac
output and maximum workload and the implication of
its use in competitive sports will raise important issues.
Sildenal has been used in the treatment of pulmonary
hypertension. And tadalal has been postulated to be
effective in treating pre-eclampsia.
As scientists and pharmaceutical companies are on
intensive research for this eminent set of targets for
development of new therapeutic agents, there is considerable potential for new drugs to be found, as the
eld of PDEs is a huge ground for the future.

MAXIMISING THE SAFE AND EFFICACIOUS USE
OF PHOSPHODIESTERASE 5 INHIBITORS
Chris McMahon (Sydney)
The availability of highly effective oral medications for

erectile dysfunction (ED) has resulted in an expanding
population of middle aged and elderly men seeking
treatment from medical practitioners. Phosphodiesterase Type-5 (PDE-5) inhibitor drugs are efcacious,
well tolerated and easy to use. Most cases of erectile
dysfunction are no longer treated by an urologist.
Approximately 70% of global prescriptions for this class
of drugs were derived from primary care physicians.
Sildenal (Viagra) was approved for use by the
FDA in 1998, Tadalal (Cialis) in 2002 and Vardenal
(Levitra) in 2003. To date, there have been no published head to head trials of these PDE-5 inhibitors, but
Book of Abstracts
reported success rate are comparable. It remains unclear
whether there is a most effective or best tolerated agent.
In the absence of such data, selection amongst the three
drugs must be based on differences in drug pharmacokinetics including speed of onset and duration of action,
PDE selectivity, adverse effect prole, dosing issues,
impact of food coadministration on drug absorption and
efcacy, and patient preference.
Although approximately 70% of men with ED
report consistently high rates of intercourse completion, a reduced efcacy is reported in men with organic
erectile dysfunction, especially diabetics and men with
ED following treatment of Cancer of the Prostate with
radical prostatectomy, men with a proven androgen
deciency and following incorrect drug usage due to
absent or inadequate patient education. Delayed PDE5 inhibitor treatment failure is usually related to progressive worsening of organic ED related to worsening
of endothelial function and progression of atherosclerosis often related to uncorrected vascular risk factors.
In addition the development of new medical conditions
or the presence of additional psychological or relational
co-factors may be associated with long term treatment
failure. Concerns about the development of tachyphylaxis or drug tolerance due to possible up-regulation of
PDE-5 gene, neurotransmitter exhaustion or either
receptor loss or reduced receptor sensitivity have not
been conrmed in large clinical studies.
Optimal treatment outcomes with PDE-5 inhibitors
will only be achieved in patients receiving adequate
drug use education regarding dose titration, timing of
intercourse after dosing and the effect of food on the
onset drug action. Patients must be informed that an
adequate trial of treatment must include at least 5
administrations at the maximum dose. Education
regarding potential adverse events, reassurance of the
proven overall cardiovascular safety of this class of drug
and review by the prescribing physician after 1 to 2
months of treatment, is implicit in achieving optimal
treatment outcomes.

AVAILABILITY OF PDE-5 INHIBITORS IN SOUTH
EAST ASIA
Edsal Gatchalian (Manila)
Traditional oral medications for the treatment of erectile dysfunction and enhancement of sexual function has
been in the market in Asia for centuries. It was therefore with reluctance that the PDE5 inhibitors were welcomed in this part of the world. But after 1998 where
Asians noted acceptance from the rest of the world,
PDE 5 inhibitors have become available in most countries. All the 3 kinds of PDE5 inhibitors are available in
Asia except Vietnam where only vardenal is available.
Herbal and counterfeit medications have given these 3
medications a run for their money. About 30% of the
119
Asian market is counterfeit. In India and China, majority of the medications are not original. As far as the
pricing, the cost is generally between $8 to $11. In
2004, there was a modest growth of the market at 6.4%
(IMS data). In terms of distribution, PDE5 inhibitors
may be availed of in the retail drugstores in the
Philippines, Indonesia, Taiwan and Korea. However in
Thailand, Singapore and Malaysia, they can only be
acquired through dispensing doctors, hospitals and
clinics. Thai regulations do not allow these medications
to be sold outside of hospitals and clinics. In terms of
market shares, the original is still the leader at 54% followed by tadalal at 32% and vardenal at 14%. It
appears in a local survey among Filipino subjects, the
younger patients prefer tadalal because of its longer
half life and perceived longer effects. In a study in Asia,
preferences were determined comparing tadalal and
sildenal.The results in the study showed that men in
the study preferred tadalal 82% of the time over sildenal. The most common reason was its prolonged half
life allowing men to have more attempts in a period of
24 to 36 hours. Asian men have learned to accept the
presence of reliable medications for ED namely the
PDE5 inhibitors over than of traditional medications.

PHOSPHODIESTERASE TYPE 5 INHIBITION:
APPLICATIONS BEYOND TREATMENT OF MALE
ERECTILE DYSFUNCTION
I D Sharlip
University of California at San Francisco
2100 Webster St, #222, San Francisco CA 94115 USA
Phosphodiesterase Type 5 (PDE5) inhibitors may have

clinical applications in addition to the treatment of ED.
These applications include, in decreasing order of clinical evidence, pulmonary arterial hypertension (PAH),
endothelial dysfunction, post-prostatectomy erectile
dysfunction, female sexual dysfunction (FSD), congestive heart failure (CHF), altitude performance and/or
sickness, lower urinary tract symptoms (LUTS),
ureteral colic and cardiac ischemia-reperfusion injury.
Of these, only the treatment of PAH with sildenal has
been shown clearly to be efcacious. Clinical trials have
shown that, in patients with severe PAH, sildenal
signicantly reduces pulmonary artery pressure and
improves 6 minute walk distance and NY Heart Association functional class. There is a growing body of evidence that PDE5 inhibition, as well as other methods
of improving oxygenation of the corpora cavernosa,
started immediately after radical prostatectomy, is associated with an improved chance of recovering postprostatectomy erectile function. Several well-designed
studies of PDE5 inhibitors document signicant
improvements in Flow-Mediated Dilation (FMD) in
patients with endothelial dysfunction. PDE5 inhibitors
have been shown in limited studies to improve hemoJ Sex Med 2006;3(suppl 2):108170
120
dynamic abnormalities and exercise capacity in CHF.
One study shows efcacy of sildenal for the treatment
of FSD in patients who were carefully diagnosed as
having isolated Female Sexual Arousal Disorder
(FSAD). PDE5 inhibitors are probably not useful for
the treatment of the great majority of women with FSD
because the prevalence of isolated FSAD is low. Early
studies using PDE5 inhibitors for altitude performance
problems, embolic stroke and ureteral colic suggest possible efcacy but clinical use of PDE5 inhibitors for
these conditions awaits outcomes of further studies.
One pilot study has suggested that sildenal is as effective as alpha-blockers for the treatment of lower urinary
tract symptoms (LUTS). Treatment of LUTS with
PDE5 inhibitors is particularly appealing because
LUTS and ED often co-exist. Finally, animal models of
ischemia-reperfusion injury show promising cardioprotective benets from sildenal.

THE TREATMENT OF ED NON SURGICAL
ALTERNATIVE TO PDE-5
The Treatment of ED with PDE-5 inhibitors was primarily prescribed to the patients mostly but still there
are those, who are not responding well or suffers the
side effect of medication namely, headache or ushing
or indigestion and would seek other treatment.
The Vacuum device was one of the primary device
to the advised to be patients, the VCD needs to be
stressed on repetitive use until they are accustomed to
and become expert, not for rst time satisfaction, they
need to be reassured of the result.
The prostaglandin and trimix injection are still available, ever though the regetin is not now available to
many countries but prostaglandin and papaverine are,
still very effective way of treatment.
Apo-morphine is one of the sublingual treatment to
those who are on nitrates the apo-morphine is working
through the central brains, so the result is rather weak
and need to be individually taught for how to use and
serial use of the drug, not the rst time; for some patient
especially, whom are taught to use sublingual Apomorphine, has to remind them for side effect of nausea
vomiting, headache and so on.
The other options of treatment not to for gel the
serum testosterone level of Hypogonadism and those
are short in this level, by adding the male testosterone,
oral or injection will boost a lot of stiffness to the
treatment.
Other treatment in this region include medicated
urethral system for erection (MUSE) which are also
need intensive lesson, some trines for treatment, the
muse at one time is popular among patients, until the
oral medication become available burning sensation
and painful urination are the famous complaint, gene
J Sex Med 2006;3(suppl 2):108170
Book of Abstracts
therapy was not immediate available at the moment, the
watch out oral medicine such as Tonkat Ari or Butea
Superba, are not guaranteed for the result, on the contrary, sometimes the local mixer will add liquid Viagra
by crashing pill and mix it by consumer, not knowing
it, if might result dangerously.

IATROGENESIS: A CAUSE OF SEXUAL
DYSFUNCTION
Kwangsung Park, MD & PhD
Chonnam National University Medical School,
Gwangju, Republic of Korea
Iatrogenic sexual dysfunction can be developed during

drug treatments and surgical procedures or caused by
the wrongdoings of a physician. Drug-induced sexual
disorders such as erectile and/or ejaculatory dysfunctions depend on pharmacological, therapeutic and
patient responses. Sexual morbidity can be developed
from the surgery, radiation or chemotherapy for the
treatment of pelvic malignancies. Although iatrogenic
sexual dysfunction was considered as unfortunate complications of treatments, however, these adverse events
sometimes provide clues to the development of new
drugs to treat sexual disorders, and also lead to create
new surgical methods or instruments.

IATROGENIC SEXUAL DYSFUNCTION
IN ONCOLOGY
Luca Incrocci
Erasmus MC-Daniel den Hoed Cancer Center, PO
Box 5201, 3008 AE Rotterdam,The Netherlands.
Email: L.Incrocci@erasmusmc.nl
Despite the decrease in overall cancer incidence and

mortality rates in developed countries since the early
1990s, cancer remains a major public health problem.
Among men, the most common cancers are cancers of
the prostate, lung, colon and rectum. Sexual dysfunction is one of the more common consequences of cancer
treatment. Men are less likely than women to seek professional help for mental and physical health problems.
Sexual dysfunction in cancer patients may result from
biological, psychological and social factors, just as they
do in healthy men. Biological factors such as anatomic
alterations (rectum amputation, penile amputation),
physiological changes (hormonal status) and secondary
effect of medical intervention may preclude normal
sexual functioning even when sex desire is intact. The
patients physical status is related to both the stage of
the disease and the type of medical intervention. Side
effects of the treatment such as nausea, vomiting,
fatigue, hair loss can result in adverse effects on sexual-
121
Book of Abstracts
ity together with disguring surgery. Negative emotional states such as anxiety, depression, anger may
disrupt sexual activity. Disturbances of body image can
contribute to the development of sexual dysfunction:
orchiectomy is such an example. Other important psychological factors etiologically signicant for sexual
dysfunction are nancial difculties and occupational
changes.
Evaluating sexual functioning in an oncology population is different from evaluating it in a healthy population because of its specic medical, psychological and
social factors. In busy oncology clinics where outpatient
visits must include educating patients about their
disease, prognosis and treatment, physicians and nurses
often do not have the time of assessing quality of life
issues. A large number of instruments already exist to
assess sexuality. It is important to standardize procedures and to use validated questionnaires. Collecting
data on an ongoing basis before and for as long as possible is mandatory, also control groups must be used.

CARDIOVASCULAR MEDICATIONS AND
SEXUAL DYSFUNCTION
Sudhakar Krishnamurti
Andromeda Andrology Center, PO Box 1563,
Hyderabad 500082, India
Email: andrologist@gmail.com;
URL: www.andrology.com; Fax: +91 40 2340 5096
Cardiovascular disease (CVD) is a major cause of sexual

dysfunction (SD). This seems logical, since many sexual
events are vascular and, most vascular disease being
pan-arterial, affects the sexual vasculature as well.
Hypertension and heart disease are the common cardiovascular (CV) conditions causing SD. To these may
be added the secondary co-morbid vascular risk
factorsdiabetes mellitus, hyperlipidemias, and cigarette smoking. SD secondary to CVD can occur in both
sexes. In the male, this usually manifests as erectile dysfunction (ED). Libido impairment and ejaculatory disorders do not normally occur due to CVD, per se. In the
female, decreased vaginal lubrication, decreased clitoral
and genital engorgement and orgasmic dysfunction are
the primary CVD mediated SDs.
To make matters worse for the CVD sufferer, many
medications administered for the treatment of the CVD
can add insult to injury by causing SD as a serious side
effect. Until recently, the list of incriminated CV medications used to be very long, and included virtually all
anti-hypertensives, drugs used for cardiac failure and
coronary artery disease, and lipid lowering drugs. Today,
however, it is known that not all CVD drugs cause SD.
Thiazide diuretics, non-selective b blockers, clonidine,
digoxin and some statins are denitely associated with
sexual dysfunction, while b1-selective blockers, a blockers, ACE inhibitors, and Ca channel antagonists are not.
Alpha antagonists and angiotensin II antagonists may

actually improve sexual function during administration.
Few cardiologists treat SD, and most SD in patients
with CVD is treated by other specialists. It thus
behooves the physician who is treating sexual dysfunction in these patients, to take the trouble to keep abreast
of all related developments in the eld.

IATROGENESIS AND SEXUAL DYSFUNCTION:
THE UROLOGISTS PERSPECTIVE
Ken Marumo, MD
Department of Urology, Tokyo Dental College,
Ichikawa General Hospital, Chiba, Japan
Erectile dysfunction (ED) develops after interference

with the pathways of neural stimuli from the brain or
spinal reexes. ED may be also caused by interfering
with blood supply to the cavernous body. Radical
surgery for colorectal cancer, prostate cancer, and
bladder cancer was associated with a high incidence of
ED. The role of hormonal therapy used in the treatment
of prostate cancer is well-known cause of ED. Estrogens, progestins, and LH-RH agonists in the treatment
of prostate cancer frequently produce ED. Radiation
induced ED mostly occurs during the treatment of
patients with prostate cancer, but the extent of the ED
depends on radiation dose, extent of radiation elds, and
the age of the patients. There is a need for studies which
are large enough to document even a small incidence of
surgery-, radiation- or drug-related ED. These efforts
will lead to reduction in unnecessary ED where substitution of treatment modalities is possible.

MANAGING THE PATIENT WITH
PENILE FIBROSIS
PD Sutherland
326 South Terrace, Adelaide, 5000
08 8223 1472. psutherland@sturology.com.au
Penile Fibrosis at its worst is a devastating condition.

The causes are many and varied. Treatment depends
upon both cause and degree. Penile Fibrosis may be a
primary condition associated with Peyronies Disease. It
may be secondary to priapism. Trauma is also a major
cause. It may be iatrogenic, associated with injection
therapy, surgery or infected penile prosthesis. Many
patients have a small defect that may resolve and they
need only reassurance. Others need reconstructive
surgery, including corporeal plication, incision and graft
and prosthetic techniques. It is important to sort out the
correct indications for treatment and to inform patients
of the risks and benets of these decisions.
J Sex Med 2006;3(suppl 2):108170
122
ROLE OF INTRACAVERNOUS VASOACTIVE SELF
INJECTIONS IN ERECTILE DYSFUNCTION IN
THE ERA OF SILDENAFIL THERAPY
TR Murali, R Ravichandran, K Venugopal,
S Gurubalaji, Hidayathulla
Department of Urology & Andrology, Meenakshi
Mission Hospital, Lake area, Melur Road, Madurai,
India
Indroduction: The management of erectile dysfunction has changed vastly over the last decade. Oral pharmacotherapy is the rst line of management in most
cases. This has resulted in the very limited use of selfinjection therapy. We present our experience.
Materials and Methods: Three hundred and forty
patients were initiated on self-injection of vasoactive
agents, which included papavarine, phentolamine &
PGE 1 in combinations. Excluding 110 patients who
dropped out of therapy for various reasons and fourty
psychogenic cases who regained erections, 190 patients
with organic erecrile dysfunction on self-injection were
followed between 1995 till date. We were able to change
148 cases to oral sildenal and tadalal therapy after
2000 when these drugs were available in India. 42
patients who were given oral pharmacotherapy refused
to give up self-injection therapy. Their preference over
sildenal was due to instant, predictable rigid erections,
ability to perform more than once in a short period and
complete patient and partner satisfaction. The frequency of self-injections ranged from alternate days to
twice a month. Ten of these patients responded better
to self-injection than oral therapy. 5 patients developed
small penile nodules yet insisted on injection therapy.
Conclusions: There is still a role for intracavernous
injection to produce rigid, rapid & prolonged erections
and it should be offered to such men who demand these,
after explaining the risks. It is especially useful in the
sildenal intolerant or contraindicated group.
Book of Abstracts
Materials and Methods: a total of 138 consecutive
patients who received treatment for ED between April
2000 and April 2001 were considered candidates for study.
Mean follow-up was 19.54 months. Of the patients 27
were not available for follow-up and 26 were not on any
form of treatment. Of the patients receiving treatment for
ED, 85 were administered the erectile dysfunction inventory for treatment satisfaction (EDITS) questionnaire and
the erectile function domain (EFD) of the international
index of erectile function questionnaire. Three treatment
groups were identied, including 31 patients on sildenal
citrate, 22 on ICI and 32 who underwent IPP. Mean total
edits, edits index and efd scores in the 3 groups were considered for statistical evaluation.
Results: there was no statistical difference in the total
EDITS (25.59 versus 27.06, P = 0.48), EDITS index
(58.16 versus 61.15, P = 0.49) or EFD (22.91 versus
20.26, P = 0.12) score between the groups on ICI and
sildenal citrate, respectively. Total EDITS, EDITS
index and EFD scores were signicantly higher in
patients who underwent IPP than those on sildenal
citrate (36.09 versus 27.06, P < 0.001, 82.03 versus 61.51,
P < 0.001 and 27.88 versus 20.26, P < 0.001, respectively). Total EDITS, EDITS index and EFD scores
were signicantly higher in patients who underwent IPP
than those on ICI (36.09 versus 25.59, 82.03 versus 58.16
and 27.88 versus 22.91, respectively, all P < 0.001).
Conclusions: at a mean follow-up of 19.54 months
patients who underwent penile implant surgery had
signicantly better erectile function and treatment
satisfaction than those receiving sildenal citrate and
intracavernous prostaglandin E1.

PREVALENCE OF METABOLIC SYNDROME IN
THE KLANG VALLEY OF MALAYSIA AND ITS
ASSOCIATION WITH TESTOSTERONE LEVELS
AND ERECTILE DYSFUNCTION
PK Yap1, EM Khoo2, HM Tan3, WY Low3
Subang Jaya Medical Center, Subang, Selangor,

Department of Primary Care Medicine, University
of Malaya Medical Center, 3Health Research
Development Unit, University of Malaya Medical
Center, 50603 Kuala Lumpur, Malaysia
2
COMPARISON OF SATISFACTION RATES AND

ERECTILE FUNCTION IN PATIENTS TREATED
WITH SILDENAFIL, INTRACAVERNOUS
PROSTAGLANDIN E1 AND PENILE IMPLANT
SURGERY FOR ERECTILE DYSFUNCTION IN
UROLOGY PRACTICE
CB Dhabuwala, Atul Rajpurkar
Wayne State Department of Urology,
cdhabuwa@med.wayne.edu
Purpose: we compared erectile function status and satisfaction rates in patients who received treatment for
erectile dysfunction (ED) with sildenal, intracavernous
prostaglandin e1 (ICI) and penile implant surgery (IPP).
J Sex Med 2006;3(suppl 2):108170
The pattern of diseases in developing countries is changing rapidly. There is increasing interest in the diseases
of afuence, including the metabolic syndrome (MS).
In the highly urbanized Klang Valley of Malaysia, a
random survey of 351 men aged 50 years and above
(response rate of 70%) revealed that the prevalence of
the MS was 21.9% using the NCEP ATP III criteria,
32.2% using the Asian waist criteria and 39.3% using the
new IDF Concensus. The Asian criteria has been validated in studies around the region and this paper will
concentrate on the Asian Metabolic Syndrome.
123
Book of Abstracts
The MS was strongly linked with ethnicity; 51.5%
were Indians, 29.6% Malay and 19.6% Chinese (P <
0.001). A signicantly higher proportion of men with the
MS had low total testosterone levels (<11 nmol/l) 31.9%
vs 13% (p < 0.001) and low SHBG levels (<15 nmol/l)
6.3% vs 1.3% (p < 0.05). Moderate and severe erectile
dysfunction (ED) was also signicantly increased in
patients with the MS 50.4% vs 33.2% (p < 0.002).
Low testosterone levels cause an increase in visceral
obesity and a reduction in muscle mass, one of the
major determinants of the MS. The implications of this
in diagnosis and management will be discussed. The comorbidities associated with the MS may also contribute
to ED.

PREVALENCE OF COMORBIDITIES AMONG
MEN WITH ERECTILE DYSFUNCTION IN THE
ASIAN MENS ATTITUDES TO LIFE EVENTS AND
SEXUALITY STUDY (ASIAN M.A.L.E.S.)
C-J Ng1, H-M Tan 2, W-Y Low1, WA Fisher 3, M Sand 4
1
University of Malaya, Kuala Lumpur, Malaysia;

Subang Jaya Medical Center, Selangor, Malaysia;
3
University Of Western Ontario, London, Canada;
4
Bayer Healthcare, West Haven, CT, USA
2
Objectives: Observational studies of erectile dysfunction (ED) have shown a strong association with other
comorbidities. The Asian MALES study examines, in
part, the prevalence of comorbidities in men with ED
in a population of men aged 2075 years in China,
Korea, Malaysia, and Taiwan.
Methods: 9,057 men recruited via random-digit
dialling participated in the Asian MALES study (Korea
n = 2,002, Malaysia n = 3,000, China n = 2,055, and
Taiwan n = 2,000). A questionnaire, previously utilized
in a similar multinational study, was modied to ensure
appropriate Asian context. It was used to assess selfreports of ED and other diseases.
Results: The overall prevalence of ED varied by
country and increased with age, ranging from 124% in
Korea, 211% in Malaysia, and from 111% in Taiwan.
The self-reported prevalence rates of comorbid illness
among men varied by country and were signicantly
higher among men with ED.
% Prevalence of Comorbidities Among Asian Men With ED
Korea
Feelings of
anxiety/
depression
Diabetes
Enlarged
prostate
Hypertension
Heart
problems
High
cholesterol
*p < 0.0001.
ED
n = 150
Total
n = 2,002
22*
25*
14*
5
2
21*
22*
21*
Malaysia
China
ED
n = 85
ED
n = 121
Total
n = 3,000
Taiwan
Total
n = 2,055
ED
n = 77
Total
n = 2,000
12*
6*
100*
4
<1
7*
8*
2
2
9*
11*
2
1
5
1
5*
9*
3
1
11*
8*
4
2
15*
11*
4
2
6*
8*
Conclusion: Our data in Asia demonstrated that men

with ED had signicantly higher prevalence of comorbidities compared to the overall sample. These data
provide strong evidence for the need to screen men with
ED for other comorbid illness.

CORONARY HEART DISEASE RISK OF MEN
WITH ERECTILE DYSFUNCTION
EM Khoo1, CJ Ng1, HM Tan 2, WY Low 3
1
Department of Primary Care Medicine, University of

Malaya Medical Center, 2Subang Jaya Medical Center,
Subang, Selangor, 3Health Research Development
Unit, University of Malaya Medical Center, 50603
Kuala Lumpur, Malaysia
Erectile dysfunction (ED) has been considered a potential marker for coronary heart disease (CHD). A random
population study of 351 men aged 50 years and above
(response rate of 70%) was conducted in urbanized areas
of the Klang Valley in Malaysia. The objective was to
look at the association between CHD risk and ED. The
10 year CHD risk for men was assessed using the Framingham point scores that included factors such as age,
total cholesterol, smoking, HDL-cholesterol and systolic blood pressure. ED was determined using the
International Index for Erectile Function (IIEF-5).
Mean age of men was 58 7 years old, range 5093
years. 68.9% men have ED; 30.2% in the mild, 16%
moderate, and 22.8% in the severe categories. Using the
Framingham risk stratication of <10%, 1020% and
>20% risk, 9.5%, 41.1% and 49.4% of the men were
found in each group respectively. No signicant association was found between CHD risk and ED. However,
in the men with ED, CHD risk is signicantly associated
with the severity of ED (p < 0.05). Men with severe ED
had signicantly higher CHD risk compared to the mild
& moderate ED groups (p < 0.01).
Men with severe ED are at high risk of having CHD.
They should be screened for CHD risk factors and
appropriate intervention should be instituted early.

WHAT DIFFERENCE CAUSES CHRONIC
ARTERIAL INSUFFICIENCY TO DEVELOP INTO
EITHER ARTERIOGENIC ED OR CAVERNOUS
ED?
T Fukawa1, HT Sujimura1, Y Kawanishi 2,
M Yamanaka 2, K Kojima 2, T Kishimoto3, H Kanayama 3
1
Department of Urology, Ehime Prefectural Nihama

Hospital, 2Department of Urology, Takamatsu Red
Cross Hospital, 3Department of Urology, Tokushima
University
1
Hongo 3-1-1, Nihama, Ehime, Japan 792-0042
J Sex Med 2006;3(suppl 2):108170
124
We do not yet understand the pathophysiology that
causes some chronic arterial insufciency to develop
into arteriogenic ED but others into cavernous ED. We
evaluated the relationship among endothelial function,
extent of arteriosclerosis, and the penile cavernous
artery blood ow.
The subjects of this study were 142 men with erectile dysfunction. We measured the ow-mediated
vasodilation (FMD) of the brachial artery to evaluate
the systemic endothelial function and measured the
pulse wave velocity (PWV) to evaluate the extent of the
arteriosclerosis. With color Doppler ultrasonography
we obtained the peak systolic velocity (PSV) and end
diastolic velocity (EDV) in the cavernous artery as
parameters of the penile hemodynamics.
There was no signicant correlation between PWV
and FMD. PSV showed relevance to FMD. There was
a statistically signicant difference between normal
PSV group (62 cases) and low PSV group (81 cases).
The FMD increase was 10.1% and 7.6% in each group
respectively. EDV showed no relation to FMD. EDV
had relevance to PWV. The median EDV value of the
patients with normal PWV was 4.05 cm/sec, while the
median EDV value of the patients with increased PWV
was 6.25 cm/sec. There was a statistically signicant difference between the two group (p = 0.007). PSV had no
signicant relation to PWV. We further found that
patients who had both impaired FMD and PWV had
both impaired PSV and EDV.
Our results suggest that endothelial dysfunction is
connected to arteriogenic erectile dysfunction, but arteriosclerosis is connected to corporeal veno-occlusive
dysfunction.

ERECTILE DYSFUNCTION CAUSED BY FEAR
OF INFERTILITY
T Otani, Y Itoh, M Senda
Department of Urology, Chubu-Rosai Hospital,
Nagoya-City, Japan
Objectives: We have evaluated cases of ED triggered

by anxiety for infertility.
Material and Methods: 24 men presenting to our
clinic with the chief complaint of ED by reason of
fearing of infertility were analysed.
Results: 24 men were all married, including 1 man who
had remarried. Their ages ranged from 28 to 57 years
(mean: 34.5 years),and the ages of their wives ranged
from 25 to 41 years (mean: 31.5 years). They had been
married for 1 to 134 months (mean: 50 months). Seven
patients (29%) already had a child and 17 (79%) did not
have any children. Some patients only experienced ED
on the day of ovulation. There were also patients with
situational ED, who experienced ED with their wives
but not during extramarital sex. Only 1 patient had an
underlying disease that may have caused ED (depresJ Sex Med 2006;3(suppl 2):108170
Book of Abstracts
sion). Based on assessment of their sexual function, ED
was diagnosed as psychogenic in all cases. Treatment
included counseling at a psychosomatic medicine clinic
(5 cases), use of a vacuum constriction device (2 cases),
yohimbine (1 case), and sildenal (18 cases, all prescribed 50 mg). ED resolved in 1 patient who used the
vacuum constriction device, 1 patient who took yohimbine, and 10 patients who took sildenal. In addition, 4
of the patients using sildenal were able to have children as a result of intercourse after taking the drug (2
cases), intercourse after weaning from the drug (1 case),
and carrying the drug as a lucky charm (1 case). Even
when sildenal was effective, however, some patients
were not able to have children because of failed intravaginal ejaculation. AIH was performed in 4 patients who
wished to have children as soon as possible.
Conclusions: erectile dysfunction caused by fear of
infertility are almost psychogenic ED and treated effectively by Phosphodiesterase type 5 blocker.

PENILE EXPRESSION OF NITRIC OXIDE
SYNTHASE ISOFORMS AND VASCULAR
ENDOTHELIAL GROWTH FACTOR IN THE
TYPE II DIABETIC RAT
HJ Park, TN Kim, BK Park, NC Park
Department of Urology, Pusan National University
Hospital
Introduction and Objective: Erectile dysfunction

commonly occurs in men with diabetes mellitus. Nitric
oxide synthase (NOS) is essential for regulation of
penile erection, and vascular endothelial growth factor
(VEGF) has been recognized for its signicance in different complications of diabetes. However, little is
known about the localization and abundance of NOS
isoforms, and VEGF is changed in diabetes. Therefore,
we characterized the localization and abundance of
NOS isoforms and VEGF, and explored their relationships and how they are altered in diabetes.
Materials and Methods: The Otsuka Long-Evans
Tokushima Fatty (OLETF) rat, the type II diabetes
mellitus, and the Long-Evans Tokushima Otsuka
(LETO) rat, the non-diabetic control group, were used.
We analyzed the distribution of NOS isoforms and
VEGF in the isolated corupus cavernosum of both
LETO and OLETF rats by immunohistochemical
(IHC) stain. The mRNA expressions of NOS isoforms,
and VEGF were also analyzed by reverse transcriptasepolymerase chain reaction (RT-PCR).
Results: The concentration of nitrite/nitrate in cavernosal homogenate was lower in diabetic rats than nondiabetic rats (p > 0.05). There were reductions of
immunoreactivity for nNOS and eNOS as well as
nNOS, eNOS mRNA expression (p < 0.05), whereas
the corpus cavernosum from non-diabetic rats showed
an opposite ndings. In contrast, the IHC stain showed
125
Book of Abstracts
that VEGF decreased on both the endothelium and vascular smooth muscle in the diabetic rats with the downregulated mRNA expession of VEGF gene (p < 0.05).
Conclusion: Biologic activity changes of NOS isoforms and VEGF within the corpus cavernosum seems
to be one of the major pathogenesis of erectile dysfunction accompanied with diabetes mellitus.
These results suggested that NOSs expression were

suppressed by HF diet, which was restored by metformin treatment. The effect of metformin on the NOS
expression resulted from not only leptin sensitizing
effect but also normalizing drive to distorted neuroendocrine factors.

EFFECTS OF METFORMIN ON THE
EXPRESSION OF NITRIC OXIDE SYNTHASE IN
HIGH FAT FED OBESE RATS
KH Moon, ST Kwon, TC Park, YW Kim1, ES Yoo2,
YK Park 2, KS Lee3
Department of Urology, College of Medicine,
Yeungnam,University, Deagu, Department of
Physiology, College of Medicine, Yeungnam University,
Deagu1 and Department of Urology, Kyungpook
National University Daegu2 and Department of
Urology, Dongguk University, Kyungju3, Korea
Obesity is a well-known risk factor for erectile dysfunction, resulting from obesity-related complications and
neuroendocrine abnormalities. However, it is still not
clearly known whether the erectile dysfunction is a
reversible process. We evaluate whether metformin can
restore the neuroendocrine abnormalities associated
with obesity and recover erectile function. In the present
study, obesity was induced by high fat diet for 4 months
and metformin (300 mg/kg/day) was treated for 4 weeks
of the last experimental period. Penile nitric oxide synthase (NOS) expression and luteinizing hormone releasing hormone (LHRH), luteinizing hormone (LH),
follicle stimulating hormone (FSH), testosterone,
leptin, corticotropin releasing factor (CRF), adrenocorticotropin (ACTH), and penile NADPH diaphorase
activity were evaluated in vehicle or metformin treated
control and high fat (HF) fed obese rats.
Four months of HF feeding increased body weight
and visceral fat mass compared to control chow diet
rats. Penile nNOS and eNOS were suppressed
markedly in HF rats. Serum levels of leptin and FSH
were increased in HF rats compared to controls,
however, LHRH was not differed between two groups.
Metformin treatment for 4 weeks restored penile
nNOS and eNOS expression in HF rats. Metformin
treatment decreased serum leptin, LHRH, FSH, and
CRF in HF rats. Serum testosterone concentration was
not changed signicantly in the experiemental groups.
NADPH diaphorase activity in the penis showed
increasing tendency in HF rats and revealed decreasing
tendency by metfromin treatment. Proopiomelanocortin (POMC) expression in the hypothalamus
was decreased in HF rats compared to controls despite
elevated serum leptin concentration, which was
restored by metformin treatment.
THE EFFECT OF OXYTOCIN ANTAGONIST

AND w-CONOTOXIN ON NMDA-INDUCED
PENILE ERECTION THROUGH
PARAVENTRICULAR NUCLEUS OF
HYPOTHALAMUS IN THE RAT
K-K Chen, LS Chang
Division of Urology, Department of Surgery, Taipei
Veterans General Hospital, and Department of
Urology, School of Medicine and Shu-Tien Urological
Research Center, National Yang-Ming University,
Taipei, Taiwan, Republic of China
Purpose: Our previous study has shown that administration of N-methyl-D-aspartic acid (NMDA) into paraventricular nucleus of hypothalamus (PVN) induces a
penile erection in the rat. Penile erection induced by
activation of PVN may be possibly through stimulation
of oxytocinergic receptors in the PVN. Oxytocin
released from PVN in a Ca2+-dependent fashion.
Therefore, the purpose of this study is to investigate the
effect of oxytocin antagonist and w-conotoxin on
NMDA-induced penile erection through PVN in the
rat.
Materials and Methods: Male Sprague-Dawley rats
anesthetized with pentobarbital were used. A 26-gauge
needle was inserted into corpus cavernosum to measure
the intracavernous pressure (ICP). Three groups of
study were conducted: 1) stereotaxically delivery of
saline 500 nl into intracerebral ventricle (ICV) followed
by NMDA (50 ng/100 ml) into PVN 15 minutes later;
2) administration of oxytocin antagonist [d(CH2)5Tyr(ME)2-Orn8]-vasotocin (3 pmol/100 nl) into ICV
followed by NMDA (50 ng/100 ml) into PVN 15
minutes later; 3) administration of Ca2+ channel blocker
w-conotoxin 20 pmol/500 nl into ICV followed by
NMDA (50 ng/100 ml) into PVN 15 minutes later.
Results: Following ICV saline, administration of
NMDA into PVN elicited a signicant increase of mean
ICP from resting 9.2 mmHg to peaked at 74.3
10.0 mmHg with a duration of 101.7 seconds. There was
no signicant change of resting ICP (10.0 1.6 mmHg)
upon administration of NMDA into PVN following
ICV [d(CH2)5-Tyr(ME)2-Orn8]-vasotocin. No signicant change of resting ICP (9.0 2.0 mmHg) was
observed upon administration of NMDA into PVN following ICV w-conotoxin, either. The sites of stimulation were histologically veried to be at ICV (saline,
vasotocin, w-conotoxin) and PVN (NMDA).
J Sex Med 2006;3(suppl 2):108170
126
Conclusions: The results of this study suggest that
either oxytocin antagonist or Ca2+ channel blocker (wconotoxin) may eliminate the NMDA-induced penile
erection through PVN in the rat.
Book of Abstracts
THE EFFECT OF DA-8159, A NOVEL PDE5
INHIBITOR, ON ERECTILE FUNCTION IN THE
RAT MODEL OF HYPERCHOLESTEROLEMIC
JY Yu, KK Kang, BO AHN, JW Kwon, M Yoo
EFFECTS OF CHRONIC TYPE 5 PDE

INHIBITION ON THE ERECTILE FUNCTION OF
THE ATHEROSCLEROTIC RATS
Research Institute, Dong-A Pharmaceutical Company

47-5 Sanggal, Kiheung, Youngin, Kyunggi 449-905,
S.Korea
Kwanjin Park1, Dae Jung Lim 2, Ji Hyun Yang 2,

Ja Hyun Ku 2, Soo Wonng Kim 2, Jae-Seung Paick
Purpose: This study examined the effects of a new

phosphodiesterase type 5 inhibitor, DA-8159, on erectile function associated with hypercholesterolemia.
Materials and Methods: To investigate whether
chronic administration of DA-8159 prevents the development of erectile dysfunction (ED) associated with
hypercholesterolemia, male rats were divided into 4
groups (normal control, hypercholesterolemic control,
DA-8159 5 or 20 mg/kg/day). Over a ve-month
period, the animals were fed a 2% cholesterol diet and
administered DA-8159 orally once a day. After 5
months, the electrostimulation-induced penile erection
and the vascular function using acetylcholine-induced
vasodilation with endothelium-intact aortic rings were
examined. Furthermore, the plasma lipid proles,
endothelin and NG,NG-dimethylarginine (asymmetrical
dimethylarginine, ADMA) concentrations were measured. In order to investigate the acute treatment effect
of DA-8159 on the erectile function in an established
hypercholesterolemic model, additional animals were
given a 2% cholesterol diet for ve months without
DA-8159. At the end of 5 months, the rats were divided
into three groups (hypercholesterolemic control, DA8159 0.3 or 1 mg/kg). DA-8159 was administered intravenously one minute prior to the intracavernous
pressure (ICP) measurement.
Results: In a chronic treatment study, while the hypercholesterolemic control showed a signicantly lower
erectile function, vascular reactivity, and increased
plasma cholesterol, endothelin and ADMA concentration, the chronic DA-8159 treatment clearly restored
the erectile responses by electric stimulation, preserved
the potential of thoracic aortic relaxation in a dosedependent manner, and signicantly decreased the
plasma endothelin and ADMA concentrations. In an
acute treatment study, DA-8159 induced a dose- and
frequency-dependent increase in ICP. The ICP/BP
ratio and the corresponding AUC values, and the
detumescence time were also signicantly increased
compared to the hypercholesterolemic control.
Conclusion: These results suggest that DA-8159 is
benecial for ED in a rat hypercholesterolemic model and
provided a rationale for the potential use of DA-8159
for treating ED secondary to hypercholesterolemia.
Korea Cancer Center Hospital, 2Seoul National

University Hospital
Introduction and Objective: It is well known that

PDE5 inhibitor augments nitric oxide (NO) bioavailability, which is critical to the endothelial function
as well as erectile function. Recent experiments have
shown that therapeutic efcacy of sildenal is maintained and apparently more pronounced during chronic
treatment. Our aims are to conrm this nding in rats
with atherosclerosis and to investigate the probable
reasons of improvement.
Methods: Thirty 12 week old male Sprague-Dawley
rats were equally divided into two groups. Group 1-atherosclerosis, Group 2-atherosclerosis with treatment.
Both groups received 1% cholesterol diet for 6 weeks
plus NG-nitro-L-arginine methyl ester (3 mg/ml) for
initial 2 weeks for eliciting atherosclerosis. After establishment of atherosclerosis, group 2 was further treated
with DA-8159 (10 mg/kg/day) for another 4 weeks by
oral gavage. Erectile function was assessed by cavernous
electrostimulation (5 msec, 6 V, 20 Hz, 50 sec).
Intima/media of internal pudendal artery (IPA) and
plasma vWF was measured to evaluate the changes in
pelvic atherosclerosis and systemic endothelial function
respectively. Penile signal transduction pathway of
eNOS activation was assessed by Western blot.
Results: Compared to group 1, group 2 showed significantly (P < 0.05) increased ICP/MAP (55.6 vs 76.2) and
area under the curve. Plasma vWF clearly declined in
group 2 (155% vs 95%), whereas there was no signicant improvement in the degree of atherosclerosis.
Western blot shows that chronic treatment of PDE 5
inhibitor increased phosphorylated form of akt and
eNOS which reects activation of penile signal transduction pathway.
Conclusions: Consistent with previous in vivo experiments, chronic dosing of PDE5 inhibitors will improve
erectil dysfunction rather than treatment resistance.
Furthermore it prevents the deterioration of systemic endothelial function in the presence of overt
atherosclerosis.
J Sex Med 2006;3(suppl 2):108170
127
Book of Abstracts
EFFECT OF DA-8159, A PDE5 INHIBITOR, ON
INTRAURETHRAL PRESSURE IN STEROID INDUCED
BENIGN PROSTATIC HYPERPLASIA IN RATS
JY Yu, YS Sohn, KK Kang, BO Ahn, JW Kwon, M Yoo
Research Institute, Dong-A Pharmaceutical Company
47-5 Sanggal, Kiheung, Youngin, Kyunggi 449-905,
South Korea
Purpose: We investigate the effect of a selective PDE5

inhibitor (DA-8159) on electrostimulation-induced
intraurethral pressure (IUP) responses in benign prostatic hyperplasia (BPH) rats.
Materials and Methods: Male Wistar rats were divided
into ve groups. Group 1 is a normal intact control.
Group 2~5 are castrated and sub-divided into 4 groups;
castrated control (Group 2), BPH control (Group 3),
BPH treated with DA-8159 5 mg/kg (Group 4) or
20 mg/kg (Group 5). During 8 weeks, animals were subcutaneously administered with steroid hormone (testosterone plus 17b-estradiol) and orally administered with
DA-8159. At the end of treatment, electrostimulationinduced intraurethral pressure was measured. Then
prostate weight was measured. To investigate the acute
treatment effect of DA-8159 on urethral pressure
responses in an established BPH rats, additional animals
were castrated and treated with steroid hormone for 8
week without DA-8159. At 8 weeks, BPH rats (BPH
control, DA-8159 0.3 or 1 mg/kg) and one age-matched
normal control were assigned to measure the intraurethral pressure. DA-8159 was administered intravenously one minute before the IUP measurement.
Results: In BPH rats, both the baseline and electrostimulated IUP were signicantly increased. The prostate
weight was also signicantly increased. Chronic DA8159 treatment potently inhibited the IUP response in a
dose- and frequency-dependent manner. In an acute
treatment study, electrical stimulation induced a doseand frequency-dependent decrease in IUP.
Conclusion: These results showed that DA-8159
might have a benecial effect on BPH in a rat model
and provided a new clue for potential use of PDE5
inhibitor for treating lower urinary tract problems.
Purpose: L-arginine is a nitric oxide (NO) precusor

catalyzed by NO synthase to produce NO and citrulline. With the presence of NO after sexual stimulation, sildenal, a phosphodiesterase 5 (PDE5) inhibitor
may enhance penile erection in human. Therefore, the
purpose of this study is to investigate the effect of NO
precursor and sildenal on penile erection in the rat.
Materials and Methods: Male adult Sprague-Dawley
rats anesthetized with pentobarbital were used. A 26gauge needle was inserted into the corpus cavernosum
to monitor the intracavernous pressure (ICP) on a polygraph. Intracavernous administration of L-arginine
(150 mg/50 ml) followed by intracavernous application of
sildenal (80 mg/50 ml) 10 minutes later was executed.
Intracavernous administration of larger dose of Larginine (1000 mg/50 ml) followed by sildenal (160 mg/
50 ml) 10 minutes later was also carried out. Saline was
injected intracavernously as a vehicle control.
Results: Upon intracavernous administration of Larginine 150 mg and the subsequent sildenal 80 mg,
there was no signicant change of resting ICP (17.0
2.0 mm Hg vs. 17.7 2.0 mm Hg, p = 0.157, Wilcoxon
signed rank test). However, there was a signicant
increase of ICP from resting 7.8 0.7 mm Hg to peaked
at 88.3 5.5 mm Hg (P = 0.028, Wilcoxon signed rank
test) with a mean duration of 22 minutes after intracavernous application of L-arginine (1000 mg/50 ml) followed
by sildenal (160 mg/50 ml). Intracavernous administration of saline failed to elicit an increase of ICP.
intracavernous administration of L-arginine 1 mg may
elicit a signicant increase of ICP in the rat. Combination of intracavernous L-arginine and sildenal may
further enhance the increase of amplitude and duration
in ICP induced by L-arginine alone.

MECHANISMS OF ACTION OF HUMAN
GROWTH HORMONE ON ISOLATED HUMAN
PENILE ERECTILE TISSUE
Stefan ckert, Bjrn O Ness, 2Armin J Becker,
2
Christian G Stief, 1Friedemann Scheller, Udo Jonas
Hannover Medical School, Depts of Urology and
Nuclear Medicine, Hannover; 2Ludwig-MaximilianUniversity, Academic Hospital Grosshadern, Dept of
Urology, Munich, Germany
1

THE EFFECT OF INTRACAVERNOUS
ADMINISTRATION OF L-ARGININE AND
SILDENAFIL ON PENILE ERECTION IN THE RAT
K-K Chen, LS Chang
Objectives: Human growth hormone (GH) has been

suggested to play a regulatory role in male reproductive
function. GH was shown to reverse the adrenergic
tension of isolated human corpus cavernosum (HCC)
and increase tissue levels of cGMP. Moreover, it was
demonstrated that GH rose in the systemic and cavernous blood of healthy males with the initiation of
penile erection ( J. Urol. 164: 21382142, 2000). Nevertheless, it still remains unclear which intracellular
pathways mediate the physiological effects of GH on
J Sex Med 2006;3(suppl 2):108170
128
the HCC. The purpose of our study was to evaluate
further the mechanisms of GH action on isolated
human penile erectile tissue.
Methods: Using the organ bath technique, the effects
of GH on electrically (EFS)-induced relaxation of isolated HCC in the absence and presence of the guanylyl cyclase inhibitor ODQ and nitric oxide synthase
inhibitor L-NOARG (10 mM) were investigated. EFS
parameters were set as follows: Frequency 10 Hz, supramaximal current, 0.8 msec pulse, 5 sec train, interval
120 sec. Effects of GH on the production of tissue
cGMP in the absence and presence of ODQ and LNOARG were also elucidated by means of a radioimmunoassay. In the experiments, sodium nitroprusside
(SNP) was used as a reference compound.
Results: ODQ and L-NOARG abolished the relaxation of the tissue induced by EFS whereas amplitudes
were increased by physiological concentrations of SNP
and GH (1 nM100 nM). The attenuation of EFSinduced activity by L-NOARG but not ODQ was in
part reversed by GH. The production of cGMP
induced by 10 nM GH was completely abolished in the
presence of 10 mM ODQ. In contrast, the combination
of GH (10 nM) + L-NOARG (10 mM) maintained
cGMP-production signicantly above baseline (0.68
0.36 versus 1.07 0.48 pmol cGMP/mg protein).
Conclusion: Our data provide evidence that GH may
act on human HCC by an NO-independent effect on
guanylyl cyclase activity and may thus explain how
growth factors regulate male erectile function.

LOCALIZATION OF INCREASED INSULIN-LIKE
GROWTH FACTOR BINDING PROTEIN-3 IN
THE DIABETIC RAT PENIS: IMPLICATION FOR
Jintetsu Soh, Masato Katsuyama*, So Ushijima,
Yasuyuki Naitoh, Kimihiko Yoneda, Yoichi Mizutani,
Akihiro Kawauchi, Chihiro Yabe-Nishimura* and
Tsuneharu Miki
Diabetes-induced erectile dysfunction (ED) is assumed

to be based on neurovascular abnormalities. However,
the entire picture of the molecular mechanisms underlying ED has not been claried yet. To elucidate the
possible elements involved in ED in diabetes mellitus,
we carried out a broad-scale gene expression proling
in the penis of streptozotocin (STZ)-induced diabetic
rats. Among the genes investigated, the expression level
of insulin-like growth factor binding protein 3 (IGFBP3) was highly increased in the hyperglycemic group at
12 weeks after STZ treatment. On the other hand, the
levels of ErbB3 EGF receptor-related proto-oncogene,
G1/S-specic cyclin D2, hepatic neutral cholesteryl
ester hydrolase precursor, UDP-galactose: ceramide
galactosyltransferase, and serine protease RNK-Met-1
were markedly decreased. By Northern blot analyses,
J Sex Med 2006;3(suppl 2):108170
Book of Abstracts
increased levels of IGFBP-3 mRNA were demonstrated
at as early as 2 weeks after induction of hyperglycemia.
Increased IGFBP-3 protein, conrmed by Western blot
analyses, was localized to the epithelium of the urethra,
the cell layer surrounding the cavernous space, and to
the smooth muscle in the corpus cavernosum. Signicant depletion of the smooth muscle density relative to
the connective tissue was rst observed in the penis of
the 8 week-diabetic rats, whereas a signicant reduction
in the intracavernous pressure was demonstrated only
at 12 weeks after induction of hyperglycemia. These
results suggest that the increased expression of IGFBP3 under hyperglycemia may limit availability of IGF-I
in the corpus cavernosum, which leads to depletion of
the smooth muscle density in the organ, and ensuing
refractory ED.
Key Words: erectile dysfunction; hyperglycemia; IGFI; IGFBP-3; intracavernous pressure; penis

EFFECT OF ANDROGEN DEPRIVATION ON
THE EXPRESSION OF APOPTOTIC PROTEINS
AND GROWTH FACTORS IN RAT PENILE
TISSUE
B Hong, S Song, TY Ahn
Department of Urology, University of Ulsan College of
Medicine, Asan Medical Center, Seoul, Korea
Purpose: Apart from the role androgens play in erectile function via NOS activity, they have been suggested
to be necessary for maintaining the construction of
penile tissue. We investigated whether castration
changes the expression of apoptotic proteins, vascular
endothelial growth factor (VEGF), and transforming
growth factor (TGF)-b1.
Materials and Methods: Fourteen male SpragueDawley rats aged 8 weeks underwent orchiectomy. Six
sham operations were performed as age-matched
normal controls. The rats were sacriced on postoperative week 2 and their 7 mm length-strips of penises
were harvested. The expressions of pro-apoptotic Bax
and anti-apoptotic Bcl-2 proteins, as well as those of
VEGF and TGF-b1 proteins, were compared by
western blot analysis and immunohistochemistry
between the groups.
Results: While the penile weight was not signicantly
different between the groups, the amount of total
protein extracted was signicantly decreased from
1942.6 356.7 mg/400 ml to 1357 128.7 mg/400 ml after
castration. The expressions of anti-apoptotic Bcl-2
protein were signicantly decreased after castration,
and the pro-apoptotic Bax protein was comparably
expressed in the two groups. The expressions of TGFb1 proteins were denite in only castrated penile strips,
and the VEGF expressions were signicantly decreased
after castration.
129
Book of Abstracts
Conclusions: The increased expression of TGF-b1
and down regulation of VEGF and anti-apoptotic Bcl2 after castration indicates a possible molecular background for penile apoptosis, brosis and vascular
compromise induced by androgen deprivation.
Key Words: androgen, penis, apoptosis, growth factor

OPTIMAL PRESCRIPTION OF ORAL
TESTOSTERONE UNDECANOATE FOR
INCREASING SERUM CONCENTRATION
OF TESTOSTERONE
DG Moon, JH Bae, SH Kang, KS Shim, HS Park,
JJ Kim
Department of Urology, Korea University Hospital,
Seoul, Korea
Objectives: Testosterone undecanoate (Andriol, NV

organon, Netherlands) has been widely prescribed for
late onset hypogonadism. But we believe that the major
limitation of Andriol is not ineffectiveness but poor
bioavailability. We evaluated the changes of serum
testosterone level correlation of daily dose and time to
taking medicine, retrospectively.
Methods: We reviewed 135 medical records of late
onset hypogonadism patients who have been prescribed
testosterone undecanoate. Statistical analysis was done
to identify the correlation of dosage, medication timing
(after meal or during meal), age, serum testosterone
level (initial, peak during therapy, nal), and duration
of therapy.
Results: Mean age, duration of therapy and daily
dosage was 50.1 14.2 years, 311 283 days and 3.5
1.3 tablets, respectively. Initial, nal and peak serum
testosterone level (ng/dl) was 1.9 1.1, 2.7 1.7 and
3.4 1.8, respectively. The peak and nal testosterone
level were highly correlated (r = 0.80) and signicantly
elevated compared to initial level (p < 0.01, both).
Taking medicine during the meals showed signicant
high increment of peak testosterone level compared to
those after meals (p = 0.04). The serum testosterone
level was positively correlated to dosage until 4 tablets
per day, but not after 5 tablets. Initial serum testosterone level was negatively correlated to the nal increment of testosterone level. Duration of therapy, age of
patient was not correlated to nal increment of testosterone level.
Conclusions: In this study, oral testosterone undecanoate effectively elevated serum testosterone level.
And it was more effective for the patients of lower initial
serum testosterone. However, daily dosage over 4
tablets was not effective in elevating serum testosterone
level. Taking medicine during the meals effectively elevated serum testosterone level compared to after meal.
These results suggest that optimal prescription of oral
testosterone undecanoate can effectively increase the
serum concentration of testosterone. For a conclusive

of effectiveness of oral testosterone undecanoate, large
prospective studies are required.

IMPACT OF TESTOSTERONE DEPLETION ON
HUMAN ISCHIOCAVERNOSUS MUSCLE (ICM)
CONTRACTILITY
M Sakaki1, Y Kawanishi1, H Fujisawa1, H Takahashi1,
A Numata1, T Kishimoto2, H Kanayama2
Department of Urology, Takamatsu Red Cross
Hospital, Department of Urology, Tokushima
University. Bancho 4-1-3, Takamatsu, Kagawa, Japan
760-0017
It is well claried that androgen depletion affects the

pelvic nerve system. We assessed the effect of testosterone on perineal muscle contractility.
Study subject were 41 patients with prostate cancer,
among whom 17 cases underwent androgen depletion
therapy, while 24 did not. Evaluation of the ischiocavernasus muscle (ICM) contractility was done by a
method previously ( JSIR, 2001), whereby a strap tted
to a spring balance was placed around the coronal
groove of the glans penis and tensioned to measure the
patients voluntary contraction of the ICM. Three
parameters were evaluated. (1) The length of ICM contraction after pre-tensioning to 100 g. (2) Duration of
the ICM contraction against a tension of 500 g. (3)
Maximum contractile power along the axis of the penis.
The serum free testosterone level varied from 0.6 ng/
ml to 10.3 ng/ml (mean: 2.62 ng/ml) and 0.6 ng/ml to
13.7 ng/ml (mean: 7.80 ng/ml) in patients who underwent androgen depletion therapy versus those who did
not, respectively. In the low and normal free testosterone groups, results were as follows: Mean ages were
73.26 6.48 and 70.23 5.64 yrs, respectively (no signicant difference). ICM contraction varied from 0
3 mm (mean: 1.53 mm) and 03 mm (mean: 1.77 mm),
respectively (no statistical signicance).
Endurance varied from 05 sec (mean: 2.58 sec) and
09 sec (mean: 2.68 sec), respectively (no statistical signicance). Maximum contractile force achieved varied
from 02000 mg (mean: 752 369 mg) and 5002000 mg
(mean: 1045 505 mg), respectively (statistically significance; p = 0.039).
Low free testosterone is signicantly linked to
decreased ICM contraction, suggesting it may have an
effect on the pelvic oor function in the human male.
J Sex Med 2006;3(suppl 2):108170
130
THE EFFECT OF TESTOSTERONE ON
POTASSIUM CHANNELS IN HUMAN
CORPORAL SMOOTH MUSCLE CELLS
Book of Abstracts
smooth muscle cells and this response was mediated by
accumulation of cyclic GMP. The activation of potassium channel by testosterone can be one of mechanisms
in regulating the tone of the corpus cavernosum.
SW Lee1, DH Han 2, MR Chae3, I So4

1
Department of Urology, Samsung Medical Center,

Sungkunkwan University School of Medicine, Irwondong Gangnam-gu Seoul 165-710 Korea,
drsw.lee@samsung.com,
2
deokhyun.han@samsung.com,
3
meeree.chae@samsung.com,
4
Department of Physiology, Seoul National University
College of Medicine, Yeongeon-dong Jongno-gu Seoul
110-799 Korea, insuk@plaza.snu.ac.kr
Purpose: The role of testosterone in penile erection

remains unclear. Recent studies have showed that
testosterone administration induced a signicant
increase in arterial inow to cavernous arteries and a
signicant improvement in erectile function. Although
the data support the role of testosterone in the preservation of libido and nocturnal erectile function, its
effect on reexogenic erection is less clear. To dene the
cellular mechanism of testosterone in regulating the
tone of the corpus cavernosum, we investigate the effect
of testosterone on potassium channels activity in human
corporal smooth muscle cells.
Materials and Methods: The conventional patch-clamp
technique was applied to short-term cultured smooth
muscle cells of human corpus cavernosum. Singlechannel currents (cell-attached conguration and insideout patches) and whole-cell currents were recorded.
Results: The application of testosterone (200 nM) signicantly increased whole cell K+ currents by 443.4
83.4% (at +60 mV; n = 11), and this effect was abolished
by TEA (1 mM), blocker of calcium-activated potassium
(BKCa) channels. Consistent with the whole cell results,
testosterone increased the single channel activity. With
pretreatment of cells with vardenal (1 nM), testosterone produced a markedly stimulating effect on BKCa
channels activity. Testosterone also, induced glibenclamide-sensitive currents at -60 mV. ATP-sensitive K+
channel (KATP channels) could be activated in the same
patch by testosterone and pinacidil. Testosterone
increased cGMP levels in corporal smooth muscle cells
in a concentration-dependent fashion but showed no
effect on cAMP. These nding indicated that testosterone induced relaxation of corporal smooth muscle
predominantly by activation of potassium channels.
Conclusions: The present study is the rst to report
the testosterone induced the activation of potassium
channel (BKCa and KATP channels) in human corporal
J Sex Med 2006;3(suppl 2):108170

STUDY ON THE EFFECTS IN THE
TESTOSTERONE-TREATED LYEDIG CELLS
TIS Hwang1,2, Shu-huei Kao3
1
Division of Urology, Department of Surgery

Shin Kong WHS Memorial Hospital
2
Department of Urology, Taipei Medical University
3
Institute of Biomedical Technology, Taipei Medical
University
Objective: In the testes, Leydig cells synthesize and

secrete testosterone. As yet, the mechanism by which
ageing Leydig cells lose steroidogenic function is not
known. The role of testosterone supplementation in
Leydig cells is still unclear and needs to be claried.
Materials and Methods: TM3 cell line was cultured in
the medium with 1 : 1 mixture of Hams F12 medium
and Dulbeccos modied Eagles medium with 4.5 g/L
glucose, 1.2 g/L sodium bicarbonate and 15 mM
HEPES, 92.5%; horse serum, 5% fetal bovine serum,
2.5%. For testosterone supplementation studies, testosterone was administered at the dose of 0.1, 1, 10, and
100 nmol/L testosterone for appropriate time periods.
For time-related studies, testosterone was administered
at the dose of 10 nM testosterone for 0, 12, 24, 36 and
48 hours time periods. A combination of FITC-annexin
V and PI was used for simultaneous ow cytometric and
uorescence imaging analysis of cell viability. The effect
of testosterone on cell growth was determined by the
using the cell proliferation assay kit of WST-1 method.
Results: Fluorescent intensity ROS (reactive oxidation
species) generation (FITC) revealed obviously at 8 hrs
post-H2O2 treated. Moreover, 500 uM H2O2 resulted
potent damage to TM3 cells, while 10 nM testosterone
provided considerable protection, but increased to 50 uM
showed otherwise. Furthermore, the dose-responsive
effect on lipid peroxidation by testosterone treatment
revealed that TM3 cells protected by increased concentration of testosterone from 0.1 uM through 1, 10,
50 uM, and even upto 100 uM level; however more
higher concentration demonstrated detrimental effect.
Conclusion: In this study, we propose that the testosterone supplementation will provide anti-apoptotic
response in the H2O2-treated Leydig cells. It may
suggest that successful management of testosterone
replacement therapy requires appropriate evaluation
and an understanding of the benets and risks of
treatment.
131
Book of Abstracts
TRANSDERMAL TESTOSTERONE GEL IMPORT
THE SERUM TESTOSTERONE LEVEL AND
ERECTILE FUNCTION IN HYPOGONADAL
MEN
HS Chiang1, T I-S Hwang2
1
College of Medicine, Fu Jen Catholic University, Hsin

chuang, Taipei, Taiwan,
2
Division of Urology, Department of Surgery, Shin
Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
Thirty-eight hypogonadal men, average age 47.9 and

56.1 in two groups, was recruited in this doubleblinded, placebo controlled trial for a 3 months, 50
mg/day Testosterone gel in 5 g gel (AndroGel) transdermal application study. The mean value of the total
or free serum Testosterone (T) level returns to normal
range in the AndroGel group (N = 20) in the rst month
with a signicant increase from the baseline (Total T
from 213.1 to 392.7, p = 0.024; Free T from 9.32 to
14.04, p = 0.020). Patients in the AndroGel group
persist to have the normal range of serum T in the
second and the third month with continuous AndroGel
application. The most remarkable effect can be identied by the increase of the mean value of the serum free
T in the second month (p = 0.004 in comparison to the
baseline), and it is statistically signicant when compares to the placebo group (N = 17, p = 0.014). We
measure the serum DHT, E2, SHBG, LH and FSH in
the end of the trial, and nd that the mean value of
serum FSH, serum LH decreased from the normal
baseline in the AndroGel group with signicance (LH
from 5.05 to 3.29, p = 0.014; FSH from 5.54 to 3.03, p
= 0.019). Improvement of the erectile function can be
conrmed by the change from baseline at endpoint in
International Index of Erectile Function (IIEF). The
domain scores of erectile function (the sum of IIEF
questions 1, 2, 3, 4, 5 and 15), orgasmic function (the
sum of IIEF questions 9 and 10) and intercourse satisfaction (the sum of IIEF questions 6, 7 and 8) are
increased with statistical signicance. We conclude that
transdermal testosterone gel can efciently treat the
hypogonadal men for their sexual function with biochemical evidence.

MOLECULAR EXPRESSION OF CLC-3
CHLORIDE CHANNEL ON RAT CORPUS
CAVERNOUS SMOOTH MUSCLE
Y-C Kuo1, J-T Hsieh2
1
Department of Urology, Taipei City Hospital, Taipei,

Taiwan, 2Department of Urology, National Taiwan
University, Taipei, Taiwan
Purpose: Chloride channels have been proved to be

of functional importance in the regulation of vascular
smooth muscle tone. Based on the obvious similarities in the structural and pharmacological properties
between cavernous myocytes and vascular smooth
muscle cells, Cl- might be expected to play a role in the
regulation of the cavernous smooth muscle tone, and
thus, the erectile function. We conducted this experiment to study the expression and distribution of CLC3 chloride channels in rat corpus cavernous smooth
muscle.
Materials and Methods: 1214 week old adult
Whistar rats were used for this study. Western blot
analyses were performed using anti-CLC-3 antibodies
(Alomone Labs) for the detection of proteins extracted
from rat corpus cavernous smooth muscle and tissue.
Immunohistochemical methods were done using the
same antibodies to study the distribution of CLC-3
chloride channel protein on rat penis. Total RNA was
extracted from rat corpus cavernous smooth muscle
cells by using TRIzol. Northern blots are prepared and
the target RNA was detected.
Results: The protein of CLC-3 chloride channel could
be detected by Western blot methods. Its molecular
weight was about 70 kD. Immunohistochemical studies
revealed increased uorescent uptakes of Anti-CLC-3
antibody over smooth muscle cells on rat penile corpus
cavernous tissue. Northern blot studies could also disclose the target CLC-3 RNA extracted from cultured
rat corpus cavernous smooth muscle cells.
Conclusion: CLC-3 chloride channels could be
expressed molecularly on rat corpus cavernous smooth
muscle. Further functional studies should be performed
to dene its role on regulation of the cavernous smooth
muscle tone.

EXPLORING NEW THERAPEUTIC TARGET FOR
ED: CHLORIDE CHANNELS IN CORPUS
CAVERNOSUM
LC Lau and PG Adaikan
Department of Obstetrics & Gynaecology, National
University Hospital, National University of Singapore,
5 Lower Kent Ridge Road, Singapore 119074
email: obglaulc@nus.edu.sg
Recent electrophysiological recordings have identied

the existence of outward, excitatory chloride (Cl-) currents in rat, rabbit and human corpus cavernosum (CC)
muscle cells. The aim of this study is to investigate the
physiological role of Cl- currents in the maintenance of
cavernosal muscle tone in isolated rabbit (NZW) CC
tissues. Cavernosal contractions elicited either by eld
stimulation or administration of established smooth
muscle constrictors are examined in the presence of
chloride channel (CLC) blockers.
J Sex Med 2006;3(suppl 2):108170
132
In CC strips exhibiting instrinsic myogenic tone,
both CLC blockers, niumic acid (NFA; 30 and 100 mM)
and anthracene-9-carboxylic acid (9AC; 1 and 3 mM)
caused relaxation of the tone. In addition, spontaneous
contractile activity in CC was abolished in the presence
of either CLC blocker. NFA and 9AC specically inhibited the neurogenic as well as noradrenaline-, histamineand endothelin-1 (ET1)-induced contractions in a
concentration dependent manner without signicantly
affecting K+-induced tone. The characteristic tonic contraction produced by ET1 is particularly susceptible to
CLC blockers. The inhibitory effect of 9AC on neurogenic and agonist-induced contractions was readily
reversible in contrast to NFA that exerted persistent
inhibition of neurogenic contraction. In CC strips precontracted with noradrenaline, NFA (100 mM) and 9AC
(3 mM) signicantly reversed the tone whereas DMSO
(nal bath concentration <0.01%), the vehicle for the
CLC inhibitors, was inert.
These results underline the importance of Cl- currents as a mechanism in the maintenance of cavernosal
tone produced by adrenergic and various endogenous
contrictors. Thus, modulation of Cl- current could be
an attractive and effective approach to regulate penile
erection while CLC blockers could be potential erectogenic agents.

MODULATORY ROLE OF PROTEIN KINASE A
(PKA) IN 5-HT3-INDUCED CALCIUM
TRANSIENTS IN PARASYMPATHETIC NEURONS
OF RAT MAJOR PELVIC GANGLIA
Yun Seob Songr1, In Deok Kongr2
1
Soonchunhyang University, Seoul, Korea,

Wonju Yonsei University, Wonju, Korea
Serotonin is regarded as inhibitory effect of penile erection. Pelvic ganglia provide autonomic innervations to
the penis, and thereby play physiologically important
roles in the erection. 5-HT3, ionotropic receptors, are
less examined than 5-HT1 or 5-HT2, metabotropic
receptors about the effects on the erection. This study
was performed to examine the modulatory role of
protein kinase A (PKA) in 5-HT3 induced calcium transients at single neuron of male rat major pelvic ganglia
using patch clamp and uorescence Ca2+ measurement
techniques.
Parasympathetic neurons only did respond to 5-HT
application and MDL7222 (10-6 M) and Y25130
(10-5 M), selective 5-HT3 receptor antagonists, completely abolished the 5-HT-induced inward current and
depolarization. Action of 5-HT3 receptor was blocked
by SQ22536 (2 10-5 M), an adenyl cyclase (AC)
inhibitor, and myristoylated PKA inhibitor (10-7 M).
Furthermore, forskolin (10-6 M) augmented the 5-HTinduced changes in [Ca2+]i. increase.
J Sex Med 2006;3(suppl 2):108170
Book of Abstracts
Activation of AC/PKA-dependent pathway could
enhance 5-HT-induced calcium transient in rat MPG
neurons and these can be helpful for the better understanding the peripheral physiologic role of serotonin in
penile erection.

THE EFFECT OF RHO-KINASE AND MYOSIN
LIGHT CHAIN KINASE INHIBITOR, AND
ANGIOTENSIN II RECEPTOR ANTAGONIST ON
PENILE CAVERNOUS TISSUESIN VITRO STUDY
K-K Chen, LS Chang
Purpose: The RhoA/Rho-kinase signal pathway is

suggested to be involved in Ca2+ sensitivity muscle
contraction. In addition, angiotensin II and myosin
light chain kinase (MLCK) may induce smooth muscle
contraction too. Therefore, the purpose of this study is
to investigate the effect of Rho-kinase and MLCK
inhibitors, and angiotensin II receptor antagonists on
the elicitation of relaxation of penile cavernous smooth
muscle cells.
Materials and Methods: The penile corpora cavernosa
tissues from the male New Zealand rabbit (about 3 Kg)
were harvested and cut into few tissue strips with about
2 2 7 mm in size for each. The tissue strips were
mounted in the organ bath. The tissue strips were
contracted with the concentration (1 10-5 M) of
phenylephrine (PE) having the maximal contraction.
Different concentrations (10-8 ~ 3 10-5 M) of Rhokinase inhibitor (+)-(R)-trans-4-(1-aminoethyl)-N-(4pyridyl)cyclohexanecarboxamide (Y-27632), MLCK
inhibitor 1-(5-iodonaphthalene-1-sulfonyl)-1H-hexahydro-1, 4-diazepine hydrochloride (ML7), angiotensin
II receptor antagonists (losartan and PD 123319) were
applied into organ bath to evaluate the relaxation effect
in separate experiments, respectively. In each of above
experiments, the relaxation effect of the Y-27632, ML7,
losartan, and PD 123319 was expressed as percentage
of contraction induced by PE.
Results: There was a dose-response relaxation effect on
rabbit penile cavernous smooth muscles after administration of Y-27632 into organ bath. After application of
3 10-5 M of Y-27632 and ML-7, there were mean
100.0% and 8.0 1.1% relaxation of the tension precontracted with PE, respectively. There were no significant relaxation of the cavernous smooth muscle after
application of losartan (6.1 1.5%) or PD123319 (5.4
1.2%), respectively.
Conclusions: The results suggest that Rho-kinase
inhibitor (Y-27632) elicits a relaxation of rabbit penile
133
Book of Abstracts
cavernous smooth muscles. However, MLCK inhibitor
and angiotensin II receptor antagonists (losartan and
PD 123319) are ineffective to induce a signicant relaxation of rabbit cavernous smooth muscles.
by elevating the concentration of cAMP and cGMP

simultaneously in an endothelium dependent manner.
*Contact person email: jhliu@tjh.tjmu.edu.cn

EFFECTS AND MECHANISMS OF TISSUE
KALLIKREIN IN RELAXATION OF RAT CORPUS
CAVERNOSUM SMOOTH MUSCLE
Liu Jihong1, Wang Tao1, Yin Chunping2,
Xiao Hengjun1, Chen Jun1, Wang Shaogang1,
Ye Zhangqun1
Department of Urology, Tongji Hospital; 2Department
of Pharmacognosy, School of Pharmacy, Tongji
Medical College, Huazhong University of Science and
Technology, Wuhan 430030, China
1
Objectives: To investigate the effects and mechanisms

of tissue kallikrein in relaxation of rat corpus cavernosum smooth muscle.
Methods: The isolated rat corpus cavernosum smooth
muscle strips were precontrated with phenylephrine in
organ bath, 100 mu tissue kallikrein were added to relax
the contracted strips after the contraction reach equilibration, and the relaxation effects were recorded by
PowerLab 4SP data acquisition system. Meanwhile,
specic primer sets were designed to amplify the gene
of tissue kallikrein and bradykinin B2 receptor by
reverse-transcriptase polymerase chain reaction in rat
penis and heart. And after tissue kallikrein were incubated with cultured rat corpus cavernosum smooth
muscle cells (loss of endothelium) and fresh rat corpus
cavernosum tissue (containing endothelium) separately,
the concentration of cyclic adenosine monophosphate
(cAMP) and cyclic guanosine monophosphate (cGMP)
were detected by radioimmunoassay.
Results: 100 mu human tissue kallikrein caused (54.9
9.7)% relaxation of rat corpus cavernosum contracted
by phenylephrine, the equal excipient of kallikrein
caused (11.50 3.58)% relaxation only. The difference
was very signicant, P < 0.01. The relative content of
kallikrein and bradykinin B2 receptor in rat corpus cavernosum and heart were 0.0652 0.0047 vs. 0.0670
0.0038 and 0.0920 0.0045 vs. 0.0872 0.0054 respectively, the difference were both not signicant, P > 0.05.
And 100 mu kallikrein elevated the concentration of
cAMP and cGMP simultaneously in fresh corpus cavernosum tissue (cAMP, from 333.15 26.03 fmol/mg
tissue to 709.57 57.36 fmol/mg tissue and cGMP,
from 122.78 6.99 fmol/mg tissue to 312.00 23.76
fmol/mg tissue), the differences were very signicant, P
< 0.01, however, it could not elevate the concentration
of cAMP and cGMP simultaneously in cultured corpus
cavernosum cells.
Conclusions: Tissue kallikrein exist in corpus cavernosum and can relax corpus cavernosum strips in vitro
THE EFFECT OF TESTOSTERONE ON

L-ARGININE-INDUCED PENILE ERECTION
THROUGH PARAVENTRICULAR NUCLEUS OF
HYPOTHALAMUS IN THE RAT
K-K Chen, LS Chang
Purpose: Testosterone may activate nitric oxide synthase in the brain of animals with intact gonads. Larginine/nitric oxide pathway is involved at the
paraventricular nucleus of hypothalamus (PVN) in
regulation of penile erection in the rat. Therefore,
the purpose of this study is to investigate the effect of
testosterone on L-arginine-induced penile erection
through activation of PVN in the rat.
Methods: Male adult Sprague-Dawley rats were used.
A 26-gauge needle was inserted into the corpus cavernosum to measure intracavernous pressure (ICP).
Six groups of study were arranged: 1) stereotaxically
delivery of L-arginine 500 nmol/500 nl into PVN; 2)
bilateral orchiectomy in a young rat, then L-arginine
500 nmol into PVN 6 weeks later; 3) bilateral orchiectomy followed by subcutaneous implantation testosterone replacement, then L-arginine 500 nmol into
PVN 8 weeks later; 4) sham operation, then L-arginine
500 nmol into PVN 6 weeks later; 5) injection of saline
500 nl into PVN; and 6) intracavernous injection of Larginine 250 nmol.
Results: Upon administration of L-arginine 500 nmol
into PVN, there was a signicant increase of ICP from
resting 11.3 3.4 mm Hg to a peak at 65.5 11.9 mm
Hg. However, there was no signicant change of ICP
upon administration of L-arginine into PVN in the castrated rats. After testosterone replacement, administration of L-arginine into PVN induced a signicant
increase of ICP to peaked at 59.2 13.7 mm Hg. In the
sham operation group, administration of L-arginine
500 nmol into PVN elicited a signicant increase of
ICP. Application of saline 500 nl into PVN or intracavernous administration of L-arginine 250 nmol failed to
elicit a signicant change of ICP.
Conclusions: The results reveal that testosterone
deprivation by bilateral orchiectomy may eliminate Larginine-induced penile erection through PVN in the
rat, and this L-arginine-induced penile erection may
recover after testosterone replacement in the castrated
rats.
J Sex Med 2006;3(suppl 2):108170
134
CHANGES OF BRAIN ELECTRICAL SOURCE
DISTRIBUTION BY AUDIO-VISUALLY
STIMULATED SEXUAL AROUSAL: A CROSS
SPECTRAL ANALYSIS USING LOW
RESOLUTION BRAIN ELECTROMAGNETIC
TOMOGRAPHY
JS Hyun, SM Choi, SC Gam, OH Kweon
From the Department of Urology, Gyeongsang
National University Hospital, Chinju, Korea
Purpose: LORETA (low resolution brain electromagnetic tomography) is a kind of functional image and upto-date technique of electroencephalography analysis.
This technique localizes current sources of cerebral
activity using current density reconstruction. We tried
to investigate the locations of cerebral cortex which are
activated by audio-visually stimulated sexual arousal.
Materials and Methods: The thirty-three heterosexual male volunteers among right-handed medical
students were enrolled in this study. All recordings of
electroencephalography (EEG) were done using international 1020 system with true anterior temporal electrodes (21 channels). The EEGs included the segments
recorded during resting, watching a music-video, intermission and watching a porno-video. Each segment was
recorded for 5 min respectively. Among the recorded
EEGs, 20 artifact-free EEGs were selected. The mean
age of selected 20 students was 25-year-old (25.2 1.6,
mean SD). An artifact-free segment with the average
referential montage of 5 sec was selected during the
recording of watching a music-video or a porno-video
in each EEG. The LORETA images of cross-spectral
analysis were obtained using the segments by
LORETA-KEY software (KEY Institute for BrainMind Research, Switzerland). The statistical nonparametric maps (SnPM) between the segments of watching
a music-video and the segments of watching a pornovideo were obtained in each frequency spectrum (delta
13/sec, theta 47/sec, alpha 812/sec, beta-1
1318/sec, beta-2 1921/sec, and beta-3 2230/sec).
Results: In the SnPM of each spectrum, the delta
slowing showed the point of maximal current density on
the middle frontal gyrus of left hemisphere (Brodmann
area 11). The fast frequency waves (alpha, beta-1, and
beta-2) showed the point of maximal current density on
the superior frontal gyrus (Brodmann area 10). The
maximal points were on the left hemisphere in the cases
of alpha and beta-2 activities, and on the right hemisphere in the case of beta-1 activity. The points of
maximal current density of theta slowing and beta-3
activity were on the rectal gyrus (Brodmann area 11).
Conclusion: The both of activation and inhibition
were occurred on the anterior association area of prefrontal cortex with left hemisphere preference and little
different location. Thus the sexual arousal induced by
audio-visual stimulation in human male may be paraJ Sex Med 2006;3(suppl 2):108170
Book of Abstracts
doxically associated with higher cortical function such
as judgment. This may explain the unique sexual arousal
pattern of human male compared with animals.

THE STUDY OF THE 1H MRS ON THE
HIPPOCAMPUS AND ANTERIOR CINGULATE
CORTEX OF THE PSYCHOGENIC ERECTILE
DYSFUNCTION
Jihong LIU1, Tao WANG1, Bo Yang 2, Yichen Zhou 2,
Shogang WANG1, Zhangqun YE1
Department of Urology 2Department of Radiology,
Tongji Hospital, Tongji Medical College of Huazhong
University of Science and Technology, Wuhan, Hubei
430030, China
Objective: To study the metabolic changes of the functional brain region associated with the regulation of
emotion (hippocampus and anterior cingulate cortex)
by magnetic resonance spectroscopy, and provide the
clues in exploring the possible underlying unrecongnised aetiological factor and pathophysiology mechanisms of the patients with psychogenic erectile
dysfunction.
Methods: Patients with the psychogenic erectile dysfunction and normal matched subjects (the control subjects) were performed on a clinical 1.5 T MRI/MRS
system. Proton multi-voxel spectroscopy imaging
(1H-MRSI) was obtained from tow sides of the hippocampus and anterior cingulate cortex region. The
measurement of metabolic changes included Nacetylaspartate (NAA), creatine and phosphocreatine
(Cr), choline-containing compounds (Cho). The ratios
of NAA/Cr and Cho/Cr were calculated respectively.
Results: The NAA/Cr ratio in hippocampus of patients
(left: 1.03 0.18; right: 1.05 0.12) was signicant
lower than that in the control subjects (left: 1.25 0.10;
right: 1.21 0.07), the difference was signicant, P <
0.05. there was no signicant difference (P > 0.05) of
the Cho/Cr ratio in hippocampus between both groups
(patients: left 1.20 0.82, right 1.22 0.95; control: left
1.21 0.93, right 1.18 0.12). The NAA in anterior
cingulate cortex of patients was signicant lower than
that in the control subjects, there was no signicant difference of the Cho and Cr between the two groups.
Conclusions: Psychogenic erectile dysfunction may be
not only a functional disease. The hippocampus and
anterior cingulate cortex may participate in the pathophysiology of psychogenic ED, the abnormalities of the
function and/or structure of the hippocampus and anterior cingulated cortex of the patients with psychogenic
ED may be the one of the underlying anaetiological
factors of psychogenic ED.
135
Book of Abstracts
Plenary D: Endothelial Dysfunction
THE ED/ED INTERFACE
THE ERECTILE-ENDOTHELIAL DYSFUNCTION
NEXUS
modelling and pulmonary hypertension. Their cardiovascular benets in combination with agents that regulate the biology of NO (eg statins, ACE inhibitors) also
warrant further investigation.
Gerald F Watts
Plenary E: Sex and Cancer
Internal Medicine and Lipid Disorders Clinics, Royal

Perth Hospital, School of Medicine and Pharmacology,
University of Western Australia
IATROGENIC SEXUAL DYSFUNCTION IN

ONCOLOGY
Erectile and endothelial dysfunction (ED1 and ED2,

respectively) are inextricably linked. Both have there
origin in the pathobiology of nitric oxide (NO). Risk
factors for cardiovascular disease (age, smoking, hypercholesterolaemia, diabetes, hypertension) are causally
related to EDs. ED2 is the earliest phase of atherosclerosis, the most common cause of vasculogenic EDl.
Accordingly, ED1 is highly prevalent amongst patients
with cardiovascular disease. ED1 could be viewed as a
classical surrogate symptom for ED1 and early risk of
cardiovascular disease.
Two constitutive isoforms of NOS (nNOS, eNOS)
present in penile tissue operate in response to psychogenic and reexogenic stimuli to initiate and sustain
a penile erection. Vasodilation of the corpora cavernosal
sinusoids is effected by the release of NO, production
of cGMP and activation of protein kinase G; this
decreases cytosolic calcium thereby relaxing the smooth
muscle of the penis. Detumescence takes place owing
to hydolysis of cGMP to GMP by a specic phosphodiesterase (PDE-5). Cavernosal, coronary and peripheral circulatory endothelium share the same
NO-cGMP pathway which is subject to similar perturbations (eg oxidative stress, glycation, uncoupling) that
decrease the release and action of NO.
Observational studies have shown that postischaemic dilatation of the brachial artery is impaired in
men with ED1. The degree of ED1 is related to the
number of risk factors for cardiovascular disease, but
ED2 may also be seen in those without risk factors.
That GTN-mediated dilatation of the brachial artery is
also impaired in ED1, in the absence of changes in
carotid wall thickness and arterial stiffness, indicates
that affected individuals may also have a functional
defect at the level of the smooth muscle of the brachial
(and by implication, cavernosal) artery. In diabetics,
both ED2 and autonomic dysfunction that impairs
nNOS activity account for ED1.
PDE-5 inhibitors increase intracellular cGMP
levels, resulting in smooth muscle cell relaxation and
restoration of erectile function. Sildenal has been
demonstrated to improve endothelial function in
patients with either type 2 diabetes, chronic heart
failure or coronary artery disease. Reversal of ED2 may
explain the improvements in arterial stiffness in treated
hypertensives. Beyond treatment of ED1, PDE-5
inhibitors may have extended applications in the control
of platelet aggregation, reperfusion injury, vascular re-
L Incrocci
Erasmus MC-Daniel den Hoed Cancer Center, PO
Box 5201, 3008 AE Rotterdam, The Netherlands.
Email: L.Incrocci@erasmusmc.nl
Despite the decrease in overall cancer incidence and

mortality rates in developed countries since the early
1990s, cancer remains a major public health problem.
Among men, the most common cancers are cancers of
the prostate, lung, colon and rectum. Sexual dysfunction is one of the more common consequences of cancer
treatment. Men are less likely than women to seek professional help for mental and physical health problems.
Sexual dysfunction in cancer patients may result from
biological, psychological and social factors, just as they
do in healthy men. Biological factors such as anatomic
alterations (rectum amputation, penile amputation),
physiological changes (hormonal status) and secondary
effect of medical intervention may preclude normal
sexual functioning even when sex desire is intact. The
patients physical status is related to both the stage of
the disease and the type of medical intervention. Side
effects of the treatment such as nausea, vomiting,
fatigue, hair loss can result in adverse effects on sexuality together with disguring surgery. Negative emotional states such as anxiety, depression, anger may
disrupt sexual activity. Disturbances of body image can
contribute to the development of sexual dysfunction:
orchiectomy is such an example. Other important psychological factors etiologically signicant for sexual
dysfunction are nancial difculties and occupational
changes.
Evaluating sexual functioning in an oncology population is different from evaluating it in a healthy population because of its specic medical, psychological and
social factors. In busy oncology clinics where outpatient
visits must include educating patients about their
disease, prognosis and treatment, physicians and nurses
often do not have the time of assessing quality of life
issues. A large number of instruments already exist to
assess sexuality. It is important to standardize procedures and to use validated questionnaires. Collecting
data on an ongoing basis before and for as long as possible is mandatory, also control groups must be used.
J Sex Med 2006;3(suppl 2):108170
136
Plenary F: ED and the Prostate
ERECTILE DYSFUNCTION AND PROSTATIC
DISEASE
Han-Sun Chiang
Professor and Dean
Medical College, Fu-Jen Catholic University, Taipei,
Taiwan
With increasing age, sexual dysfunction and prostatic

disease become more prevalent. Both conditions are
also signicant contributors to overall quality of life.
Sexual dysfunction mainly manifests as majorly erectile
dysfunction (ED), ejaculatory disorders, decreased
libido, or a combination of these symptoms. Penile
erection is a neurovascular event modulated by neurotransmitters and hormonal status. With the neurovascular bundles responsible for the erectile response
intimately related to the prostate gland, disease of the
prostate, surgery or radiation therapy may interfere
with this mechanism.
Benign Prostatic Hyperplasia (BPH)/Lower
Urinary Tract Symptoms (LUTS) and Treatment
Because sexual dysfunction is much more prevalent in
patients with BPH/LUTS than in men without
BPH/LUTS, even after controlling for confounding
variables such as age or comorbidities. Some thought
BPH/LUTS is considered an independent risk factor
for sexual dysfunction [12]. However, whether this is
because of a common underlying pathology, or whether
the considerable bother associated BPH/LUTS leads to
reduced sexual functioning, remains to be elucidated.
Although many articles suggested a causal relation
between BPH and sexual dysfunction, some thought the
relation is coincidental because there is little evidence
to support a link between BPH and ED [34].
The main objectives of treatment for BPH/LUTS
are to provide fast and sustained relief of bothersome
symptoms and to improve quality of life. However, the
benecial effects of treatment for LUTS or BPH have
to be balanced against the morbidity associated with
treatment. Some treatments for BPH may affect sexual
function. Different surgical treatments have different
effects on sexual function, and each class of drug having
a unique affect on sexual function. Several clinical trials
have indicated that the 5a-reducatase is associated with
a negative effect on sexual functioning: decreased libido
(210%), ED (316%), ejaculatory disorders (08%)
[1]. This might be explained by its anti-androgen effect.
By contrast, a1-antagonists have no negative effects on
sexual desire or ED. Abnormal ejaculation had been
reported in 4% to 11% of patients; <1% of patients discontinue because of this adverse event [5]. Despite their
effect on ejaculatory function in a minority of patients,
several studies have showed a benecial effect of a1antagonists on overall sexual function. Invasive surgery,
such as transurethral resection of the prostate (TURP)
or open prostatectomy, has been associated with irreJ Sex Med 2006;3(suppl 2):108170
Book of Abstracts
versible complications such as impotence or retrograde
ejaculation. The rate of ED after TURP observed in
AUA cooperative study was 13% [1]. Although the
cause of ED after TURP is poorly known, neuropraxia
from thermal injury or the emotional stress of surgery
have been proposed as possible mechanisms.
Prostate Cancer and Treatment
Radical prostatectomy is very frequently performed in
patients with clinically localized prostate cancer. Postoperative erectile function has been reported as being
satisfactory in the majority of the patients operated on
in centers of excellence for this procedure. Criteria that
inuence recovery of erections after surgery include
younger patient age, stronger erections before operation, preservation of the neurovascular bundles, and
attention to ne details in the surgical technique.
Recovery of erections occurs in 68% of preoperatively
potent men treated with bilateral nerve-sparing surgery
and in 47% of those treated with unilateral nervesparing surgery [6]. Attempts to improve postoperative
potency include the intraoperative use of cavernous
nerve stimulation and grafting of peripheral nerves to
restore the innervation of the corpora cavernosa [7].
However, overall, the results for postoperative potency
are disappointing in view of the large amounts of data
available from community practices. In a large population based cohort study assessing sexual function 5 years
following radical prostatectomy [8], only 28% of the
men had erections rm enough for intercourse compared with 22% at 24 months (p = 0.003). Sildenal was
the most commonly used erectile aid (43% ever used)
and 45% of users reported that it helped.
ED has also been associated with prostate radiotherapy. It has been shown that both ultrasound-guided
brachytherapy and three-dimensional conformal radiation therapy cause an impairment of erectile function
that is usually seen some time after the completion of
therapy. The etiology of erectile dysfunction after radiation for prostate cancer is not completely understood.
Radiation is thought to produce ED by accelerating
microvascular angiopathy causing cavernosal brosis or
stenosis of the pelvic arteries and by accelerating existing arteriosclerosis, leading to vascular impotence.
Rates of erectile dysfunction vary from 6 to 84% after
external beam radiotherapy and from 0 to 51% after
brachytherapy [9]. Several factors including preimplant
potency, patient age, the use of supplemental externalbeam irradiation, radiation dose to the prostate gland,
radiation dose to the bulb of the penis, and diabetes
mellitus appear to exacerbate brachytherapy-related
erectile dysfunction [10].
Prostatitis
Prostatitis and prostatodynia remain a confusing disease
which affects men mainly at ages before BPH. Most
patients are potent and the disorders in sexual function
are painful ejaculations [11]. In acute prostatitis, the
contractions of prostate that occur during ejaculation
may aggravate pain. However, whether sexual inactivity
137
Book of Abstracts
improves the condition is rather uncertain. In chronic
prostatitis, it could be argued that regular ejaculation
may help the prostate to drain more completely.
1. Treatment of lower urinary tract symptoms suggestive of

benign prostatic hyperplasia: sexual function. BJU Int.
2005 Jun;95 Suppl 4:128. Review.
2. Erectile Dysfunction and Lower Urinary Tract Symptoms
Secondary to BPH. Eur Urol. 2005 Jun;47(6):83845.
Epub 2005 Feb 22.
3. Benign prostatic hyperplasia and erectile dysfunctionis
there a link? Curr Med Res Opin. 2000;16 Suppl 1:s637.
Review.
4. Sexual function in patients treated for benign prostatic
hyperplasia. Lancet. 2003 Jan4;361(9351):602. Review.
5. Lower urinary tract symptoms/benign prostatic hyperplasia: minimizing morbidity caused by treatment. Urology.
2003 Sep;62(3 Suppl 1):2433. Review.
6. Counselling the patient with prostate cancer about treatment-related erectile dysfunction. Curr Opin Urol. 2001
Nov;11(6):6117. Review.
7. Erectile dysfunction after surgical treatment. Int J Androl.
2003 Jun;26(3):13740. Review.
8. 5-year urinary and sexual outcomes after radical prostatectomy: results from the prostate cancer outcomes study. J
Urol. 2005 May;173(5):17015.
9. Sexual (dys)function after radiotherapy for prostate
cancer: a review. Int J Radiat Oncol Biol Phys. 2002 Mar
1;52(3):68193. Review.
10. Management of sexual dysfunction after prostate brachytherapy. Oncology (Huntingt). 2003 Jan;17(1):5262;
discussion 62, 6770, 73. Review.
11. Prostate and sexuality: An overview. Eur Urol.
1999;35(3):17784. Review.
component of erectile dysfunction. Superoxide radicals

may have a very detrimental effect on smooth muscle
function through many different pathways as evidenced
by different pathways affecting smooth muscle in the
disease of diabetes mellitus. Endocrine causes of erectile dysfunction may be more central in man while in
rodent research models endocrine effect may be more
pronounced in the corpora cavernosal tissue.
Lifestyle factors such as sedentary lifestyle smoking
and the use of alcohol also play etiological roles in erectile dysfunction. Many of these lifestyle factors affect
smooth muscle function as well. Some pelvic surgery,
including curative surgery for carcinoma, may affect
both urological pathways as well as vascular pathways
to the corpora cavernosal tissue. Depression and the
treatment of depression and hypertension and the treatment of hypertension are also etiologically linked to
erectile dysfunction. To state that erectile dysfunction
is equivalent in all cases to endothelial dysfunction is a
simplication of the complexity of this disorder.
Explaining a direct link to lower urinary tract symptoms, or LUTS, and erectile dysfunction is evidence of
the complex factors that are often involved in linking
one disorder to another, other than that they occur at
the same age in a patient. Certainly there is a role in
aging of all tissue, vascular and smooth muscle, but
there is a great variation in effects of age from one individual to another. We have come to know a lot more
about etiology of erectile dysfunction through animal
models but sometimes this extrapolation is less than
perfect, for instance in the hormonal eld. An examination in the intricacies of etiological factors in male
erectile dysfunction forms a basis of this presentation.
Symposium C: Male Sexual Dysfunction
THE ETIOLOGICAL FACTORS OF MALE

MALE SEXUAL DYSFUNCTION AND THE

DIABETIC PATIENT
Ronald W Lewis, MD (Augusta)
Doug Lording (Melbourne)
Erectile dysfunction can be considered a symptom of

multiple disease entities. Traditionally, classication has
consisted of placing this disorder into organic or psychological causes. This has proved to be articial
because many of the psychogenic centrally mediated
erectile difculties may either be due to hormonal deciencies or problems with central cell messengers. A
more realistic classication of ED embraces the concept
of whether the main region for this disorder exists in
the corpora cavernosal tissue itself or in centers above
this area. Generally, from a molecular mechanistic
concept, disorders producing erectile dysfunction
consist of problems with primary and secondary chemical messengers, smooth muscle deterioration, vascular
abnormalities, or neurological abnormalities. Even
these etiological classication systems are interactive.
As man ages there is chance in endothelial function
leading to endothelial dysfunction which is a major
The pivotal role of endothelial dysfunction in the pathogenesis of erectile dysfunction (ED) is critical in diabetic
men. Non Insulin Dependant Diabetes Mellitus
(NIDDM) is a complex disorder involving insulin resistance, and is frequently part of the metabolic syndrome.
This represents an association with obesity, hypertension and hyperlipidemia (and overt vascular disease), all
of which contribute to endothelial dysfunction.
In diabetes autonomic neuropathy may lead to ED
and ejaculatory failure including retrograde ejaculation.
Obesity, chronic ill-health and depression may all lower
testosterone and reduce libido and contribute to ED.
The management of sexual dysfunctions in diabetes
will be similar to non-diabetic men. The same hierarchy of treatments will apply in ED, although there will
be reduced responsiveness to PDE5 inhibitors.
Attention to control of metabolic abnormalities may
improve endothelial dysfunction but there is a need for
References
J Sex Med 2006;3(suppl 2):108170
138
further studies to demonstrate how responsive ED is to
such measures. Similarly, the concept of prevention of
ED by strict metabolic control, or by the use of medications that enhance endothelial dysfunction requires
further study.

MALE SEXUAL DYSFUNCTION IN SPINAL
CORD INJURY
Y Kimoto
Department of Urology, Spinal Injuries Center Iizuka,
Japan
Spinal cord injury is an unexpected and catastrophic

event not only for the patient but also for the family
members. With the advanced medical cares, the life
expectancy of spinal cord injured patients increased. It is
reported that in spinal cord injured patients erectile
function is preserved in 54 to 95% but successful intercourse is preserved only in 5 to 75%. The discrepancy
between these two events is due to the nature of erection
(most of preserved erections are not psychogenic nature
but reexogenic one). ED has a big impact on QoL of
male spinal cord injured patients. Fortunately, PDE5
inhibitors (sildenal or vardenal or tadalal) have the
efcacy of as high as around 80%. It is reported that
PDE5 inhibitors improve the QoL signicantly.
Neither autonomic dysreexia (AD) nor priapism was
reported so far. If PDE5 inhibitors are ineffective, intracavernosal injection (ICI) of PGE1 or vacuum constriction device (VCD) will be the next options. Since penile
prosthesis surgery has a high risk of complications in this
population, I discourage this surgical intervention.
It is reported that the ejaculatory ability is preserved
in 0 to 55% and the obtained sperm is poor in its
quality. PDE5 inhibitors or ICI or VCD can restore
erectile function but cannot restore ejaculatory function. Consequently, the goal of therapy will be not to
get ejaculation through intercourse but to get sperm for
the articial insemination. Electroejaculation (EEJ) and
penile vibratory stimulation (PVS) are the treatment
options for the patients who cannot ejaculate. This articial ejaculation rate is reported to be in 80 to 100%
with EEJ and in 19 to 91% with PVS. AD and muscle
spasm are main adverse events.
Treatment of sexual dysfunction in spinal cord
injured patients is an important part of rehabilitation.

PSYCHOLOGICAL FACTORS IN MALE SEXUAL
DYSFUNCTION
Rudi Yuwana, MD PhD
Male Sexual Dysfunction (MSD) is a generalized term,

for a range of sexual problems in men. MSD can be clasJ Sex Med 2006;3(suppl 2):108170
Book of Abstracts
sied in to four catagories: 1. Sexual desire disorders or
libido; 2. erectile dysfunction disorders; 3. ejaculatory
disorders; 4. orgasm disorders.
Men can have each of the problems individually or
in combination. But the most occurance problem is
Erectile Dysfunction (ED). Causes which can lead to
MSD are psychological factors and organic factors.
Sexual desire disorders and orgasm are mostly caused
by psychological factors, whereas ED and ejaculatory
disorders are mostly organic.
After the improvement of many diagnostic methods
it becomes obvious that more organic causes can be
identied. But most of the cases seems to be a combination of organic and psychological factors. Psychological factors can worsened the disease in the presence of
organic factors.
Most common psychological factors are: depression,
anger, stress or low self-esteem. The problem is, how
can we identify objectively the presence of those psychological factors? Previous diagnostic tools to diagnose psychologic factors are psychometric methods,
like: a. Standardized personality questionnaire; b. The
depression inventory; c. Questionnaire for sexual relationship factors called the Minnesota Multiphasic Personality Inventory (MMPI). All this methods are not
objective measurements to weigh seriousness of the
psychological factors.
More objective methods are now being developed.
Based on a psychoneuro-immunological paradigm, psychogenic stressors can cause immune-modulation and
through the theory of oxidative stress of the endothelium can develop damage to the target organs. The
presence of a psychogenic stressor can be measured
by determining the catacholamine (Adrenalin, Noradrenalin) level in the blood serum. The immunological reactions are seen through the presence of several
cytokines in the epithelium cells, which can be count
objectively.
The treatment for MSD in general is therefor
also important to take the psychological factors in
considerations.

OESTROGENS AND PHYTOESTROGENS:
THEIR ROLE IN MALE SEXUAL DYSFUNCTION
B Srilatha, PG Adaikan
Email: obgsb@nus.edu.sg
Oestrogens are not exclusive female hormones but

occur in moderate circulating levels of 2570 pg/ml in
men (compared to 44153 pg/ml in women). Arising
from aromatisation of testosterone (T), oestrogen is
considered to have many opposing functions and the
progressive decline in testosterone in aging male is seen
Book of Abstracts
together with signicantly higher oestradiol (E2) levels.
Considerable loss of sexual interest and erectile dysfunction (ED) are more prevalent in older men and it
is likely that the pathophysiological drift in E2-T
balance is a contributory factor to loss of libido and ED.
In our pioneering study on animal models, the signicant correlation between high circulating oestrogen
(and low testosterone) levels and male sexual dysfunction was seen as impairment of normal sexual behaviour
in male rats and interference with neurotransmitters
and/ mediators of erectile function in rabbits. Similarly,
phytoestrogen isoavone daidzein, a structural and
functional oestrogen mimic also interfered with physiological parameters of sexual function. Our further
studies indicated presence of specic sites of distribution of oestrogen alpha and beta receptors in the rabbit
cavernosum. In primary cultures of cavernosal smooth
muscle cells from rats, a mild increase in both cAMP
and cGMP activity was observed in the presence of
oestradiol and daidzein, while cGMP release was signicantly enhanced by testosterone. Positive controls
prostaglandin E1 and nitroglycerin produced concentration dependent increase of the respective second
messenger.
Hormone prole data from a small cohort of 30
patients presenting with history of loss of libido and
erectile dysfunction at our centre were analysed and
compared with results from basic studies of experimental hyperoestrogenism. These patients had signicantly
higher levels of E2 and low T values and the age-related
increase in oestradiol probably compromised the management outcome. Our ndings indicate that both
oestradiol and the dietary phytoestrogen can precipitate
erectile dysfunction; this can be compounded by the
endocrine imbalance of oestradiol with T levels. From
this insight, it is likely that in addition to testosterone
supplements, use of antioestrogens or aromatase
inhibitors may resolve the functional antagonism of
hormonal ED and improve patient prognosis during
standard ED management in this group of patients.

Complementary Medicine in Sexual
Dysfunction
THE METABOLIC SYNDROME AND ERECTILE
DYSFUNCTION: GREATER THAN THE SUM
OF PARTS?
Gerald F Watts
Lipid Disorders Clinic, Royal Perth Hospital,School of
Medicine and Pharmacology, University of Western
Australia
The metabolic syndrome (MetS) is a common subtype

of obesity characterised by insulin resistance and
increased risk of cardiovascular disease and type 2 diabetes. The most recent IDF Consensus (Berlin 2005)
139
denes MetS as central obesity (sex and ethnic specic
cut-offs) plus any two of elevated triglycerides, low
HDL-cholesterol, elevated blood pressure and
impaired fasting glucose or diabetes. Beyond a pragmatic approach, factor analysis has identied MetS as a
specic factor distinct from impaired glucose tolerance
and hypertension within the domain of the insulin
resistance syndrome.
The metabolic syndrome increases with age and
varies amongst ethnic groups, being particularly prevalent in Asians and Mexican Americans. Its actiology
relates to environmental factors that induce central
obesity and to a series of susceptibility genes that
govern the expression of hypertension, dyslipidaemia
and hyperglycaemia in the setting of insulin resistance.
The development of insulin resistance is critical and has
recently been linked to altered secretion of adipocytokines, including leptin, adiponectin and visfatin, from
adipose tissue. Other factors that may contribute to its
increased risk of cardiovascular disease include procoagulopathy, inammation, oxidative stress and sleep disordered breathing. Erectile dysfunction (ED) is highly
prevalent in obesity and besides smoking relates to
several cardiovascular risk factors seen in the MetS, in
particular age, diabetes, small dense LDL particles and
inammation. The prevalence of ED in MetS is 2-fold
greater than controls and increases with the number of
components of the syndrome. The basis for this association is likely to be widespread endothelial dysfunction
that distributes to the cavernosal endothelium.
The essence of managing the MetS is early detection
and rigorous implementation of lifestyle changes,
including weight reduction and practicable forms of
exercise, as well as the institution of pharmacotherapies
aimed at preventing diabetes and regulating dyslipidaemia and hypertension. Clinical trials have demonstrated that as little as 8% weight reduction with 30
minutes of moderate exercise per day can prevent the
emergence of diabetes in obese subjects with impaired
glucose tolerance; similar benets have been shown
with metformin, acarbose, troglitazone and xenical.
Lifestyle changes can improve ED and sexual function
in at least one-third of obese men. Agents that regulate
dyslipidaemia and hypertension, such as statins and
ACE inhibitors, have also been suggested to decrease
the development of diabetes and this implies ED.
Whether improvement in endothelial dysfunction
translates into reversal of ED with the above therapies
in MetS remains to be shown. Specic improvements
in both these endpoints have, however, been shown in
other patient groups with the PDE-5 inhibitors.
While insulin resistance is likely to be the central
abnormality in the metabolic syndrome, insulin sensitisation alone may not fully correct the full phenotype of
risk factors. In practice, a multiple risk factor approach
involving intensive lifestyle modications and low-dose
multiple pharmacotherapies may be the best option, as
recently demonstrated in a clinical trial in patients with
the type 2 diabetes. However, the acceptability and costJ Sex Med 2006;3(suppl 2):108170
140
effectiveness of this approach remains to be fully established in those who do not have diabetes. The combination of PPAR-a and g-agonists, so called glitazars,
and use of endocannabinoid type 1 receptor blockers
offer compelling tools for correcting the fundamental
biochemical abnormalities in the metabolic syndrome,
but again their efcacy requires to be conrmed in clinical end-point trials and their impact on ED is
unknown. The contribution of MetS to sexual dysfunction in women is likely to be similar to that in men and
this another important general area for future research.

Complementary Medicine Sexual
Dysfunction
LIFESTYLE FACTORS IN SEXUAL DYSFUNCTION
Large epidemiology studies suggest that heart-healthy

lifestyle changes may reduce the risk for ED. The
MMAS found a fairly consistent association between
cardiovascular disease and ED. Most recently, results of
the Health Professionals Follow-up Study were published regarding lifestyle risk factors for ED. Physical
activity correlated with a 30% reduced risk for ED.
Obesity, Smoking, alcohol intake, and televisionviewing time also were associated with an increased risk
for ED. Males with the lowest risk of ED were those
without chronic medical conditions and who regularly
participated in health activities. Thus, clinicians
working in urology should adhere to the same guidelines that are observed in cardiovascular medicine when
dealing with a patient with ED. The time is more than
ripe for patients to understand the heart health is tantamount to erectile health. Finally even if drug therapy
is initiated, lifestyle changes should continue to be
emphasized because of potential synergistic effects, and
because the goal of patients is increased quality and
quantity of life, not just ED treatment.

Dysfunction
THE USE AND MISUSE OF COMPLEMENTARY
MEDICINE IN SEXUAL DYSFUNCTION
A Adimoelja, S Hutama, S Sartono, J Soedjono
School of Medicine Hang Tuah University, Naval
Hospital Dr Ramelan, Indonesia
To function sexually men should be self-condent, free

from anxiety; able to concentrate and arousing sexual
stimulation to get erection, penetration, ejaculation/
orgasm and sexual satisfaction. Sexual function is a
holistic concept, that is up to recently not very well
J Sex Med 2006;3(suppl 2):108170
Book of Abstracts
understood and let to irrational medical therapeutic
maneuver and the use and misuse of alternative and
complementary medicine. As the human male might
rst notice this problem with his erection, he may
become worried and develop performance anxiety
resulting in psychogenic either organic sexual dysfunction. Leonardo Da Vinci was the rst proclaiming that
penile erection has occurred as resulting of the lling
of blood into the penis. Later in 1952 Conti elucidated
the rst concept of the mechanism of erection. This
milestone led to the current chemo-pharmacological
treatment by Virag (papaverine intra-corporal injection,
1982), followed by other vaso-active agents (phentolamine, VIP, PGE-1) up to the years 1998. Approaching the new millenium oral treatment for erectile
dysfunction (ED) with sildenal citrate, followed by
vardenal, tadalal, and others became the madona to
by-pass ED, hence sexual dysfunction as such. Failures
of chemical pharmacy to treat (ED) sexual dysfunction
and its long-life usage of erectogenics urge men turning
to look for alternative aids and complementary issues.
Alternative and complementary medicine sounds nave
as desperate aids for men seeking medication for sexual
dysfunction. To mention a few of complementary
medicine are: acupuncture, ayuverdic medicine, aromatherapy, aqua-therapy, homeopathy, hypnotherapy,
naturopathy, nutritional therapy (health food), osteopathy, reexology, acupressure, yoga, herbal medicine.
Traditional medicine, includes herbalism is most
popular for treating sexual dysfunction. On the contrary
many herbal remedies in fact were already adopted in
the modern pharmacopoeia: Currently phyto-pharmacy
is becoming more acceptable in medicine, because of
the holistic pharmaco-dynamic hypothesis that integrates in to the biochemical process of the human body.
The use and misuse of few herbals (phyto-chemcals)
only will be focused in this context of complementary
medicine. Examples are soy-been extracts, phytoestrogens, phyto-DHEA, melatonin are among the
popular ones that have been clinically proven for the
treatment of some metabolic diseases, sexual dysfunction, menopause, and andropause, improving quality of
life when man aged. Misuse of these herbal extracts was
known not only by patients but also by manufacturer
unawareness to produce safe and efcacy products. The
FDA should take special care in this short future.

Dysfunction
MANAGING SEXUAL DYSFUNCTION IN
GENERAL PRACTICE
Michael Gillman (Brisbane)
Erectile Dysfunction is a relatively common condition

in men presenting to Primary Care Physicians (1)
however the problem is dealt with in a minority of cases.
141
Book of Abstracts
(2) There are many factors contributing to the reasons
for this situation, ranging from patient embarrassment
through to time poor Doctors working in a General
Practice setting.
This presentation will give an overview of Erectile
Dysfunction within the primary care setting and a
suggested protocol that deals with the identication,
diagnosis and management of this condition in a comprehensive and time efcient manner that can be
utilised by most General Practitioners in their day to
day workload.

Dysfunction
SEXUAL DYSFUNCTION IN ASIA PACIFIC
COUNTRIES: SOCIO-CULTURAL FACTORS AND
MANAGEMENT STRATEGIES
WY Low
PhD, AFBPsS, CPsychol
Professor & Head, Health Research Development
Unit, Faculty of Medicine, University of Malaya, 50603
Kuala Lumpur, Malaysia
Email: lowwy@um.edu.my
Sexuality is dened within a cultural setting and

depends greatly on socialization. The interpretation of
sexual dysfunctions varies across cultures, particularly in
the Asia Pacic region. Variations in the perception and
attitudes towards sexual dysfunction are linked to cultural, ethnicity and other social factors, and these pose
a challenge to the healthcare practitioners. Societal and
cultural values have a profound effect on the way people
learn to interact sexually and on sexual expression or
communication. In certain cultures, self-reporting of
sexual problem is considered shameful. Psychosocial
and cultural factors indeed play a great role in inuencing ones perception towards sexuality and sexual
behavior. In some cultures, traditional remedies or
alternative medicines for preventing or treating sexual
dysfunctions are commonly recognized. Therefore,
health care professionals have to be culturally sensitive
and considered social, educational level, religious and
cultural aspects in the management of sexual problems
in their patients. Sexual counseling or therapy needs to
be adapted to suit the needs of different cultures and
sub-cultures.

EXPRESSION OF MESSENGER RNA (MRNA)
ENCODING FOR DIFFERENT
PHOSPHODIESTERASE (PDE) ISOENZYMES IN
HUMAN CLITORAL AND VAGINAL TISSUE
Stefan ckert, Peter Ellinghaus 4, Knut Albrecht 2,
Hans-D. Trger 2, Wolfgang Kauffels3, Udo Jonas
Hannover Medical School, Depts of Urology, 2Forensic
Medicine and 3Gynaecology, Hannover; 4Bayer Vital
GmbH, Wuppertal, Germany
Objectives: Based on basic research ndings indicating

a putative signicance of the cAMP- and cGMPpathway in the regulation of female genital tissues, the
use of inhibitors of phosphodiesterase 5 (PDE5) to treat
symptoms of female sexual dysfunction (FSD) has been
suggested. Nevertheless, there has been relatively low
success of PDE5 inhibitors in FSD in comparison to
male sexual dysfunction. The elevated expression of
PDE5 in the human corpus cavernosum is considered
the reason for the high clinical efcacy of PDE5inhibitors in the pharmacotherapy of male erectile dysfunction. The aim of our study was to evaluate by means
of molecular biology the expression of mRNA encoding for various PDEs in female genital tissues.
Methods: Human clitoral and vaginal (vaginal wall,
epithelium) tissue was obtained from four female cadavers (age at death: 1842 years). The expression of
mRNA encoding sequences specic for PDE1, 2A, 4A,
5A, 10A and 11A was elucidated using RT-PCR analysis. Human corpus cavernosum (HCC) was used as a
reference tissue.
Results: RT-PCR revealed that mRNA encoding for all
PDEs are expressed in vaginal and clitoral tissue. Different magnitudes of mRNA expression were observed:
While there was a predominant expression of mRNA
encoding for PDE1A, only little amounts of PDE1C,
1B, 10, and 11A mRNA were registered. With PDE1A
and 11A being the only exception, the intensity of
mRNA expression was always higher in the HCC than
in the female genital tissues. Especially, the expression
of mRNA encoding for PDE5 was several-fold higher
in the HCC.
Conclusion: Our results demonstrate that, on the
mRNA level, various PDE isoforms are expressed in the
clitoris and vagina. It remains to be established as to
whether the low expression of PDE5 in female genital
tissue might be a negative predictor as to the success of
PDE5 inhibitors in the treatment of FSD.
J Sex Med 2006;3(suppl 2):108170
142
THE EFFECT OF INTRACAVERNOUS
ADMINISTRATION OF VASOACTIVE AGENT ON
RABBIT CLITORAL INTRACAVERNOUS
PRESSURE
K-K Chen, LS Chang
Veterans General Hospital and Department of Urology,
School of Medicine and Shu-Tien Urological Research
Center, National Yang-Ming University, Taipei, Taiwan,
Republic of China
Purpose: Intracavernous administration of pharmacological agent, such as papaverine may induce an increase
of intracavernous pressure in the human and rat penis.
The purpose of this study is to investigate the effect of
intracavernous administration of vasoactive agent on
rabbit clitoral intracavernous pressure.
Materials and Methods: Female New Zealand white
rabbits (3.54.0 kg), anesthetized with ketamine and
xylazine were used. A 26-gauge needle was inserted into
the rabbit clitoral corpus cavernosum to monitor the
intracavernous pressure (ICP) on a polygraph. Intracavernous administration of papaverine hydrochloride
3 mg/0.2 ml, 6 mg/0.2 ml was executed, respectively.
Saline 0.2 ml was injected intracavernously as a vehicle
control. The ICP was monitored for at least 2 hours
after each administration of experimental agent.
Results: Upon intracavernous administration of
papaverine 3 mg, there was a signicant increase of ICP
from resting 4.7 1.5 mmHg to a peak of 41.6
8.5 mmHg (p = 0.043, Wilcoxon signed rank test) with
a duration of 14.8 min. There was also a signicant
increase of ICP to peaked at 70.5 10.3 mmHg (P =
0.028, Wilcoxon signed rank test) with a mean duration
of 64 minutes after intracavernous application of.
papaverine 6 mg. The change of ICP (peak ICP resting ICP) induced by papaverine 6 mg was signicantly greater than that induced by papaverine 3 mg.
However, intracavernous administration of saline failed
to elicit a signicant increase of ICP.
intracavernous administration of vasoactive agent
(papaverine) may elicit a signicant increase of clitoral
ICP in the rabbit.

EFFECTS OF KOREAN RED GINSENG ON
VAGINAL BLOOD FLOW AND STRUCTURE IN
CASTRATED RAT
K Park, KJ Oh, Y Xui , SO Kim, HS Lee, KY Ahn*
Department of Urology and *Anatomy, Chonnam
National University Medical School, Gwangju, Korea
Department of Urology , Jinan University Medical
School, Peoples Republic of China
J Sex Med 2006;3(suppl 2):108170
Book of Abstracts
Purpose: Ginseng is a traditional Asian remedy for
sexual dysfunction. The purposes of this study were to
investigate the effects of Korean red ginseng (KRG) on
the vaginal blood ow and structure in castrated rats.
Materials and Method: Female Spaque-Dawley rats
(200210 gm) were divided into 4 groups; control, castration, castration plus oral administration of KRG
extracts (50 and 100 mg/kg/day). After 1 month of treatment, serum estrogen and total cholesterol levels were
measured. And vaginal blood ow was measured using
laser Doppler owmeter before and after pelvic nerve
stimulation (PNS). Vaginal tissue was processed for
Massons trichrome stain, immunohistochemistry and
Western blot.
Result: The serum estrogen level was signicantly
decreased in castration group (0.8 1.9 ng/ml), however, it increased up to control level (2.2 1.3 ng/ml)
in both KRG administration groups (p < 0.05). PNS
induced vaginal blood ow tended to improve in KRG
treatment groups. In histology, vaginal epithelial layer
and submucosal microvasculatures showed an improvement in KRG treatment groups. The expression of
estrogen receptor increased in KRG treatment groups
compared to castration group.
Conclusion: These results suggested that KRG
extracts seem to have an estrogenic effect in castrated
female rats. It implies that the KRG extracts may have
an ameliorating effect of sexual function in menopausal
woman.

EFFECT OF TADALAFIL CITRATE ON SIGNAL
TRANSDUCTION DURING TREADMILL
EXERCISE IN HEALTHY WOMEN
Jong Kwan Park, Myung Ki Kim, Jae Hyung Park,
Hyun Suk Kim, Heung Jae Park, Kyung Woo Cho
Department of Urology, Cardiology and Physiology,
Chonbuk National University and Sungkyunkwan
University
Objectives: We evaluated the acute effect of tadalal

on signal transduction of cardiovascular system in
healthy women during treadmill exercise.
Research Methods: 10 healthy women were admitted
the study. Sitting blood pressure (BP) and heart rate
(HR) were monitored throughout the study, and blood
samples for the measurement of plasma cGMP and
cAMP and atrial natriuretic peptide (ANP) concentration and plasma renin activity (PRA) were collected.
After an initial control measurements, the subjects
ingested a 20 mg of tadalal. 2 hr after medication, BP
and HR were checked and blood samples were collected. After the second blood sampling, the subjects
underwent treadmill exercise for 30 min following the
modied Bruce protocol. Blood samplings were performed at 10 and 30 min of the treadmill exercise. A
Holter recording system was used to obtain all ambu-
143
Book of Abstracts
latory ECGs. Echocardiographies were performed
before and after treadmill exercise.
Results: cGMP increased at 30 min after exercise compared to cGMP at before medication (189.9 10.1 to
252.6 10.4 fmol/ml). cAMP increased at 30 min after
exercise compared to cAMP at before medication (13.4
1.3 to 20.5 1.7 pmol/ml). PRA but not ANP
increased signicantly after treadmill.
Conclusion: Tadalal increased plasma cGMP and
cAMP concentrations without statistical signicance.
Treadmill exercise enhanced tadalal produced cAMP
and cGMP.

EPIDEMIOLOGIC STUDY FOR SEXUAL
DYSFUNCTION-RELATED FACTORS IN
KOREAN WOMEN
KweonSik Min1, Dong Il Kang1, Heung Jae Park 3,
Joo Hack Ihm 2, Sung Hyup Choi 2, Jung Ih Bae 2
Pack Institute of Clinical Research1, Inje University
Medical School 2, Sungkyunkwan University 3
Email: kweonsikmin@medimail.co.kr
Objectives: Although concerns for female sexual dysfunction (FSD) are increasing in Korea, it is very
limited in basic study for prevalence of FSD or sexual
dysfunction-related factors. The aim of this study was
to establish the basic data for FSD and FSD-related
factors in regional urban and rural area of Korea.
Materials and Methods: Three hundred twenty ve
women aged over 20 year-old and resident in regional
urban and rural area were analyzed by visit-survey with
an organized questionnaire. Female sexual function
index (FSFI) for measurement of sexual dysfunction,
and sexual distress scale, sexual attitude, depression
scale, marital adjustment scale, crisis scale, stress event
for sex-related factors were used. Signicance between
degree of sexual dysfunction and characteristics of the
participants was analyzed by student t-test and ANOVA
test. Relationship of degree of sexual dysfunction and
related factors was analyzed by Pearsons correlation
coefcient.
Results: All analyzing tools including FSFI had high
validation for measuring. FSFI in Korean women was
19.97 4.87 ranged 7 to 29. Of participants characteristics, old age, co-morbidity, menopause, medication,
no contraception, longer marital duration and lower
education were signicantly related with lower FSFI
score. Pearsons correlation coefcient revealed the signicance in sexual stress (r = -0.441), degree of depression (r = -0.257), marital adjustment scale (r = 0.303),
crisis scale (r = -0.229) and stress event (r = -0.166) with
sexual function index score.
Conclusion: The women with sexual dysfunction
should be evaluated for these sexual function-related
factors in history taking, and these data would be a basis
for study for sexual dysfunction.

MAGNETIC RESONANCE IMAGING ANATOMY
OF FEMALE GENITALIA IN PREMENOPAUSAL
AND POSTMENOPAUSAL KOREAN WOMEN
DG Moon1, SH Kang1, JH Bae1, DJ Sung2, JJ Kim1
1
Department of Urology, Korea University Hospital,

Seoul, Korea
2
Department of Radiology, Korea University Hospital,
Seoul, Korea
Objectives: We performed this study to describe the

normal appearance of female genital organs on MRI
and the anatomical differences of MRI image between
premenopausal and postmenopausal women.
Methods: A total of 19 premenopausal and 18 postmenopausal women were studied. All subjects did not
have any history of gynecologic disease, medication,
surgery, current pregnancy or delivery within last 12
months and known anatomical abnormality of the
genitalia. Using a torso phased array coil of 1.5T MRI
system, Axial T1, TSE T2 and fat suppressed Gdenhanced axial T1-weighted images were obtained.
Two radiologists measured the wall thickness of vagina,
urethra and labium minora, the width of clitoral crura
and vestibular bulb and the sectional dimensions of the
clitoral glans. Structural dimensions were compared
using the unpaired Student t-test.
Results: All genital structures were delineated more
clearly on fat suppressed Gd-enhanced axial T1weighted images than noncontrast axial T1 and TSE
T2-weighted images. The separate three layers of
vaginal wall were well visualized in premenopausal subjects but not clearly dened in postmenopausal subjects.
The urethra had a target-like appearance with three
layers in premenopausal and postmenopausal women.
Postmenopausal subjects were observed to have significantly smaller vaginal wall thickness, urethral wall
thickness and vestibular bulb width than premenopausal
subjects (p < 0.01). The clitoral crura were well delineated as a wishbone-shaped structure surrounding the
urethra and vagina. The two vestibular bulbs were paramedian in location and lying just posterior to the clitoral crura as oval and elongated, enhanced structures.
p Valuea
Mean Mm SD
Before
menopause
(mm)
Vaginal wall
Urethral wall
Clitoris
Clitoral crura width
Vestibular bulb width
Labium minora width
7.0
7.7
26.6
6.3
5.6
4.6
0.9
0.8
4.6
0.8
0.8
0.2
After
menopause
(mm)
5.1
5.9
23.1
6.2
4.9
4.2
0.7
0.8
4.8
0.6
0.5
0.6
<0.001
<0.001
0.052
0.622
0.016
0.065
Conclusions: The normal anatomy and differences of

the female genital organs between premenopausal and
postmenopausal women were well discernible on fat
J Sex Med 2006;3(suppl 2):108170
144
Book of Abstracts
suppressed Gd-enhanced axial T1-weighted images.

This study may provide valuable information for the
future studies of female sexual function.
Abdalla M Attia, Nagla M Ghanayem* & Alaa H Mariee
MALE SEXUAL DYSFUNCTION SEEN IN A MEN

ONLY PRIMARY CARE PRACTICE
SH Teoh, TK Gan, CSK Yeo
Singapore Mens Health Clinic, 472 Geylang Rd,
Singapore 389431, Singapore
Introduction: The social construction of male roles

and paucity of professional health services targeting
men have made it difcult for men to address issues
related to sexual health. The success of Phosphodiesterase-5 Inhibitors (PDE5I) in the treatment of erectile dysfunction and the gendered concept of health
provided an avenue of change. As a men-only primary
care practice, the Singapore Mens Health Clinic
(SMHC) has seen problems related to sexual health as
the commonest problems for which men patients seek
help. With a specic interest in mens health, the
SMHC pursues opportunities to address health concerns of men patients including that of sexual health.
Objective: To make a study of patients presenting with
sexual dysfunction among the rst consecutive 200 new
patients seen since the SMHC started practice from
17/11/2003 through 6/3/2004.
Results: Out of 200 new patients, 58 patients presented
with Erectile Dysfunction (ED) and 16 with premature
ejaculation. ED was a secondary diagnosis in a further
21 patients while premature ejaculation (PE) was a secondary diagnosis in 1 other patient. The commonest
age group of patients with ED was 40 to 49 years old
and for PE 30 to 39 years old. Of all patients with ED,
37 had associated medical conditions of which diabetes
and hypertension were the commonest. In addition to
sexual counseling, PE was treated with selective serotonin reuptake inhibitors and ED with one of the three
PDE5I currently available depending on patient
preference.
Conclusions: Men feel comfortable seeking help for
sexual dysfunction in a male only primary care practice.
With a proactive approach, ED was further diagnosed
in patients who presented to the clinic for other problems. The high incidence of co-morbidities among sufferers of ED provides opportunity for the primary care
physician to encourage patients to treat these conditions
and prevent complications arising therefrom.
J Sex Med 2006;3(suppl 2):108170
REPRODUCTIVE & SEXUAL FUNCTIONS IN

BLIND EGYPTIAN MALES
Dermatology & Andrology and Biochemistry
*Depts. Faculty of Medicine, Minoufiya University,
Shibin ElKom, Egypt
Objectives: Totally blind males dont have control on

the pineal secretion of melatonin (M). The latter is
expected to be elevated. M has antigonadotrophic
actions. So, blind males may be subjected to reproductive & sexual problems. To the best of our knowledge,
very few studies exist and the results are controversials.
This work aims to study these functions in such males.
Designs & Subiects: Twenty two congenitally totally
blind, adults (aging 2550 years), married (>2 years),
healthy, have no any other medical, surgical or congenital problems or receive any drug that may affect their
reproductive or sexual functions.
Another 26 non blind, healthy, age matched, married
(>2 years) volunteers were selected as a control group.
Settings: Andrology & Biochemistry Depts., Faculty of
Medicine, Miouya University.
Intervention: All individuals were:
- Asked for: age of puberty libido, frequency of intercourse, rigidity of erection and the state of ejaculation, as well as the number of children.
- Subjected to measurement of melatonin (M), follicle
stimulating hormone (FSH), prolactin (PRL) & free
testosterone (FT) in blood samples collected at
1012 a.m
Results: No statistically signicant differences were
detected in any of the items studied between both
groups.
Conclusions: Totally blind males did not differ in their
reproductive and sexual functions or in the levels of M,
FSH, PRL & FT levels from the non blind males. We
assumed that; this may be due to: the totally blind males
may develop other central mechanismsrather than
light that control the pineal gland production of M or
in such people the eyes may convey photic informationalthough totally blindto the suprachiasmatic
nucleus sufcient for controlling the pineal secretion
of M.
Key Words: Blind males, Sexual, Reproductive, Pineal
gland, Melatonin, Follicle stimulating hormone, Prolactin, Free testosterone.
Correspondence to be sent to:
Prof Dr Abdalla M Attia.
Address: 10th Abo-Baker AI-Sedik St., Heliopolis,
Cairo, Egypt.
002/02/6376636
022/01/06603417
022/02/6378662
145
Book of Abstracts
MEN WITH ERECTILE DYSFUNCTION AND
THEIR HEALTH SEEKING BEHAVIOR
WY Low 1, EM Khoo 2, HM Tan1
Health Research Development Unit, 2Department of
Primary Care Medicine, Faculty of Medicine,
University of Malaya, 50603 Kuala Lumpur, Malaysia
This paper examined the health-seeking behavior of

Malaysian men with erectile dysfunction (ED). 351 men
aged above 50 years old participated in this populationbased study carried in Klang Valley, Malaysia. 38.7% of
the men were having moderate and severe erectile dysfunction as determined by the International Index for
Erectile Function (IIEF-5). Among these, 34.6% were
Chinese men, 33.8% were Indians and 29.4% were
Malays; half the proportion of these men have had
smoked; 31% consumed alcohol and 10% were exalcohol drinker. A signicantly higher proportion of
men without ED rated their present state of health as
good and very good as compared to men with ED.
Among men with ED, they rst experienced difculty
in getting or keeping an erection was 3 years ago. These
men have spoken to someone about their problem
(26%) and apart from their wife (14%), they
approached doctors (17.5%), friends (10.3%), family
members (1.5%), religious authorities (0.7%) and
others (0.7%). Only 9.6% said that their doctors have
ever discussed sexual problems with them during consultation. Among those who did not seek help for their
problem, the reasons given were: due to the medication
they are taking (58%), believed their condition is a
normal part of aging (39%), felt embarrassed to tell
anyone (24.2%), knew that their erection difculty is
due to their other health conditions (21.3%), did not
feel comfortable talking about their erection problem
with their doctor (16.2%), the condition is not important to them (14.7%), the condition is temporary (9.6%)
and couldnt afford the treatment (8.8%). Only 1.5% of
the ED men are currently using Viagra, Tongkat Ali
(1.5%) and traditional Chinese medicine (0.7%). It can
be concluded that these patterns of health seeking
behavior warrants medical attention, public education
and further research into motivating men to seek help.

HELP-SEEKING PATTERN OF MEN WITH ED:
AN URBAN MALAYSIAN MODEL
CJ Ng 1, EM Khoo1, WY Low 2, HM Tan 3
1
Department of Primary Care Medicine, University of

Malaya Medical Centre, 2Health Research
Development Unit, University of Malay Medical Centre,
3
Subang Jaya Medical Centre, Subang, Selangor
It has been well established that doctors only see a small

fraction of the health problems experienced by the
general population. Before seeking medical attention,

most individuals would have practiced self-care, sought
advice from family and friends, purchased over-thecounter health products, tried traditional or alternative
therapies. However, the decision to choose which therapeutic pathways depends on many biopsychosocial
factors.
Erectile dysfunction is a unique mens health
problem which involves the sensitive eld of male sexuality. PDE5-inhibitor has been marketed in Malaysia
since 1999 and there has been widespread publicity on
ED. As such, it will be interesting to study what is the
current help-seeking behaviour of men with ED. This
paper aims to discuss the help-seeking model of men
with ED based on a community survey.
This study was conducted at an urban area in
Malaysia (Klang Valley) in 2003. A sample of 500 men
above 50 years of age was randomly selected from an
electoral list and 351 men responded (70%). Majority
had high income and education level and there were
27.9% Malays, 40.7% Chinese and 28.8% Indians.
68.9% of the men had at least mild ED (Validated IIEF5) while 38.7% had moderate to severe ED. However,
only 26.8% self-reported to have difculty in getting or
maintaining an erection. Among those with moderate to
severe ED, only 35.3% had talked to someone about it,
and 33.8% had ever sought modern (16.9%) or complementary therapies (16.9%) or both (5.1%). Currently,
only 6.6% were on active treatment (n = 5 herbal medicine, n = 3 Viagra, n = 1 traditional Chinese medicine).
The help-seeking pattern of men in this urban area
ts in with the traditional model, where majority did
not seek medical help and traditional medicine
remained popular.

ATTITUDES OF MEN AND THEIR PARTNERS
TO ERECTILE DYSFUNCTION AND ITS
TREATMENT: THE AUSTRALIAN MALES STUDY
M McCabe1, H Matic1, M Sand1
1
Deakin University, Melbourne, Australia,

Bayer HealthCare, Wuppertal, Germany
Objectives: Little data exist regarding Australian mens

attitudes toward ED, ED treatments and their longterm satisfaction with therapy. Additionally, there is
little knowledge of the role that partners play in inuencing men to seek treatment for their condition.
Methods: 652 Australian men and 62 partners were
recruited through various online and print advertisements. 594 (83.2%) participants participated online,
while 125 (16.8%) took part via post. A mens health
questionnaire was constructed and was designed to
assess mens attitudes towards sex, frequency of sexual
activities, medical problems, sexual and relationship
satisfaction, masculinity, self-esteem, and QOL.
J Sex Med 2006;3(suppl 2):108170
146
Results: Of the participants, 410 (62.8%) men reported
that they had experienced some degree of ED at some
point in their lives, while 242 (37.2%) reported that
they had never experienced this difculty. The mean
age of men with ED was 55.7 years compared to 34.1
years for men without ED. The majority of both men
with ED (92.3%) and those without ED (85.5%)
reported that their relationship was very or extremely
important to them, while more men with ED rated sex
as being very or extremely important to them (72.9%)
than did men without ED (58.2%). Men with ED also
reported more frequent pressure to perform sexually.
Pressure directly received from partners, and pressure
subjectively perceived by men, swas higher in men with
ED than in men without ED. No differences were
found between these groups on the importance of their
relationship in their life.
Conclusion: The ndings from this study are discussed
in terms of the impact of ED on mens relationships.
Men with ED report increased importance of sexual
activity compared to men without ED and perceive
greater pressure from partners to perform sexually.

DOES QUALITY OF LIFE DIFFER BETWEEN
MEN WITH AND WITHOUT ERECTILE
DYSFUNCTION? PRELIMINARY RESULTS FROM
THE ASIAN MENS ATTITUDES TO LIFE EVENTS
AND SEXUALITY STUDY (ASIAN M.A.L.E.S.)
W-Y Low1, C-J Ng1, H-M Tan 2, W Fisher 3, M Sand 4
1

2
3
4
Objectives: To examine perceived quality of life among

men with and without erectile dysfunction (ED) in
Korea, Malaysia, China, and Taiwan.
Methods: 9,055 men recruited via random-digit dialing
participated in the Asian MALES study in Korea (n =
2,000), Malaysia (n = 3,000), China (n = 2,055) and
Taiwan (n = 2,000). A questionnaire previously utilized
in a similar multinational study modied to ensure
appropriate Asian context was used to assess self-reports
of satisfaction with various aspects of quality of life.
Satisfaction was assessed using a 5-point Likert-type
scale (1 = not at all satised, 5 = perfectly satised). For
this analysis, those answering 1 or 2 were considered
dissatised.
Results: Men with ED exhibit signicant dissatisfaction with all aspects of their quality of life, including
different constructs such as family life, work life, partnered relationship, sex, health, and general happiness.
J Sex Med 2006;3(suppl 2):108170
Book of Abstracts
% Men With and Without ED Citing Dissatisfaction with Quality of Life
Korea
ED
n = 150
Your family
life/home
life
Your work-life
or career
Relationship
with partner/
wife
Your sex life
Your health
Overall
contentment
or happiness
Malaysia
No ED
n = 1850
China
ED
n = 85
No ED
n = 2915
ED
n = 121
Taiwan
No ED
n = 1934
ED
n = 77
No ED
n = 1923
13*
8*
19*
15
5*
11
19*
12*
4*
10*
31*
25*
19*
11
10
14
5*
7*
0
2
1
1
24*
7*
1
8
2
3
25*
16*
9*
5
4
4
*p < 0.001.
Conclusion: Asian men with ED exhibit signicantly

greater dissatisfaction with many aspects of their quality
of life compared to men without ED. These results are
similar to ndings of other studies conducted in nonAsian populations. Our ndings highlight the negative
impact of ED on mens quality of life.

EFFICACY OF SILDENAFIL CITRATE FOR
TREATMENT OF ERECTILE DYSFUNCTION IN
MEN WITH DIABETES
H Sasaki 1, M Shimada1, R Fukasawa1, K Aoki1,
K Shiiki 1, S Sugawara1, Hideki Yoshida 2
Showa University Northern Yokohama Hospital1,
Showa University2
It is considered that correlation with erectile dysfunction (ED) to life-style related diseases is related with
affection, especially to arterial sclerosis. In addition, ED
and diabetic relation are well known for a long time.
Therefore we assessed efcacy of Sildenal citrate in
treatment ED with diabetes.
Materials and Methods: From April 2001 to March
2005, a total of 47 patients were enrolled in this study.
The age was 3076 years old (mean age 58.3 years).
Results: It was 80.9% in 50 and 60 patients. 6 patients
didnt re-visit after prescription of Sildenal. And 2
patients could not receive Sildenal prescription,
because of taking a pill for ischemic heart disease.
Within the Japanese approval (maximum 50 mg), the
efcacy was 61.5% (24/39 patients) and poor responder
was 38.5% (15/39). However, after the dosage of Sildenal was changed up to 100 mg, the efcacy was
increased to 87.2% (34/39) and invalidity was decreased
to 12.8% (5/39). The causes of 5 poor responders were
3 neurogenic ED, 2 vasculogenic ED and 1 poor controlled diabetes. Adverse events were generally mild to
moderate in severity, with ushing (12.8%), dyspepsia
(5.1%), epigastralgia (2.6%) and photophobia (2.6%)
Conclusion: Treatment with Sildenal for ED was
effective and was well tolerated in men with diabetes.
147
Book of Abstracts
THE COMPARATIVE EFFECTS OF PDE5
INHIBITORS (ZAPRINAST, SILDENAFIL,
VARDENAFIL) ACCORDING TO THE ROUTE OF
ADMINISTRATION IN THE RABBIT MODEL
Seong Choi, Il Moon
Dept of Urology, Kosin University Hospital, Busan,
South Korea
Aim: It is reported that intracavernosal (IC) PDE5

(phosphodiesterase type5) inhibitors at tissue levels
approaching millimolar concentrations can cause penile
erection in the absence of sexual stimulation. The
objectives of this study are to conrm the efcacy of
PDE5 inhibitors as IC agents without PNS (pelvic
nerve stimulation) and to compare the efcacy of these
agents on penile erection after IV administration with
PNS to IC administration without PNS.
Methods: Anesthetized male New Zealand White
rabbits (3.54.0 kg) were divided into two groups and
penile hemodynamics were assessed by intracavernosal
pressure (ICP) monitoring after penile erection induced
by PNS (2.5 Hz, 10 V, 0.8 msec for 30 seconds) with IV
administration of 3 PDE5 inhibitors or IC administration without PNS. ICP recordings were normalized to
systemic systolic arterial pressure (SAP). The intracavernosally or intravenously administered doses of
zaprinast, sildenal and vardenal were 301000 mg/kg,
130 mg/kg and 130 mg/kg, respectively.
Results: PNS with IV administration of 3 PDE5
inhibitors caused signicant frequency-dependent
increase in penile ICP. IC administration of zaprinast,
sildnal and vardenal produced signicant increases in
ICP as a function of increasing drug consentration. The
ICP/SAPs with highest doses of zaprinast, sildenal and
vardenal tested were 0.656, 0.550, 0.654 in group of
PNS with IV administration and 0.625, 0.609, 0.666 in
group of IC administration without PNS, respectively.
Conclusions: All 3 PDE5 inhibitors showed increased
ICP/SAP as dose dependent manner in response to IC
administration in the absence of PNS as well as PNS with
IV administration. IC administration was a much more
effective route in penile erection than IV administration.
Key Words: PDE5 inhibitors, erectile dysfunction
Presenting author name: SEONG CHOI
Address: Dept. of Urology, Kosin University Hospital,
34 Amnam-Dong, Seo-Gu, Busan, South Korea
e-mail: schoi@ns.kosinmed.or.kr

PREDICTION OF EFFICACY IN SILDENAFIL FOR
THE DIABETIC PATIENTS WITH ED
Y Takahashi, S Chin
Department of Medicine,Tokyo Womens Medical
University Daini Hospital, Tokyo, Japan
In order to predict the efcacy of sildenal on diabetic

ED, we evaluated the backgrounds of diabetic patients
with ED before the treatment with sildenal. The subjects were 71 patients with diabetic ED, who wanted the
treatment of ED and assigned the medication with
sildenal. The mean age of the patients was 54 years
old, mean duration of diabetes was 13 years and mean
level of HbA1c was 7.5%. They were initially treated
with Sildenal 25 to 50 mg on demand and then
increase the dosage up to 100 mg. The efcacy was estimated by IIEF and subjective global efcacy of sildenal on ED and divided into three groups; that is, good
response for sildenal 25 to 50 mg, fair response for
sildenal 75 to 100 mg and poor response with no effect.
In the results, 36 patients with diabetic ED were in
good response, 20 in fair response and 15 in poor
response. There were no differences in age, duration of
diabetes, BMI and glycemic control during the treatment with sildenal, however signicant difference in
duration of ED, erectile function (IIEF) and the degree
of diabetic complications within the three groups. In
conclusion, sildenal is more effective to diabetic ED
with shorter duration of diabetes, with less diabetic
complications and with much erectile function.

A RATIONAL COMBINATION
PHARMACOTHERAPY IN MEN WITH ERECTILE
DYSFUNCTION WHO INITIALLY FAILED TO
ORAL SILDENAFIL CITRATE ALONE
R Taneja1, MF Hussain1
1
Pushpawati Singhania Research Institute for Liver,

Renal and Digestive Diseases, Press Enclave Road,
Sheikh Sarai, Phase II, New Delhi-110017, India
Objective: To evaluate the efcacy of combination of

Trazodone with Sildenal Citrate in treatment of erectile dysfunction (ED) in men with initial failure of
Sildenal Citrate.
Introduction: Erectile Dysfunction (ED) is a complex
condition where in men with minimal organic ED may
develop variable degree of psychogenic component sufcient enough to reduce the efcacy of medical management. A combination of Trazodone with Sildenal
has been used to overcome both organic as well as psychogenic components thus improving the results of
medical management.
Material and Methods: 18 men with ED who initially
failed to respond to Sildenal Citrate alone were
enrolled in the study between February, 2004 and
December, 2004. All these men were given a priming
dose of Trazodone for a two week period before giving
them Sildenal Citrate. In addition they all received
counselling sessions at day 1 and day 14. Their symptoms were evaluated using Erectile Dysfunction Intensity Scale before and after the treatment.
J Sex Med 2006;3(suppl 2):108170
148
Results: Out of 18 men, 12 responded favorably to the
above treatment and continued to enjoy good sexual
activity while on Trazodone and Sildenal. The score on
ED Intensity Scale improved considerably in 12 men,
marginally in 2 men and did not improve at all in 4 men.
Conclusions: Priming the patients with Trazodone
appears to be reasonably good alternative in patients
who have initial failure to oral Sildenal Citrate.
However, large double blind studies are required to
potentiate this fact.

VARDENAFIL IMPROVES TREATMENT
SATISFACTION AND SEXUAL PLEASURE IN
MEN WITH ERECTILE DYSFUNCTION AND
THEIR PARTNERS
WA Fisher1, RC Rosen 2, G Brock 3, G Karlin4,
P Pommerville5, F Giuliano6, I Saenz de Tejada7,
XY Huang 8, K Bangerter 8, T Taylor 8, L Derogatis9,
Vardenafil Study Group
1
University Of Western Ontario, London, Ontario,

Canada, 2Robert Wood Johnson Medical School,
Piscataway, NJ, USA, 3St Josephs Medical Center,
London, Canada, 4Lawrenceville Urology Practice,
Lawrenceville, NJ, USA, 5Can-Med Clinical Research
Inc, Victoria, BC, Canada, 6Academic Hospital of
Bicetre, Le Kremlin Bicre, France, 7Hospital Ramon y
Cajal, Madrid, Spain, 8Bayer Healthcare
Pharmaceuticals, West Haven, CT, USA, 9University of
Maryland, Baltimore, MD, USA
Objectives: To assess the inuence of vardenal (VAR)

on sexual quality-of-life and treatment satisfaction in
men with erectile dysfunction (ED) and their partners.
Material and Methods: This double-blind, multicenter, 12-week randomized trial enrolled 229 men with
ED and their partners. Men received placebo (PLA) or
VAR 10 mg for 4 weeks, with option to stay on 10 mg,
or titrate to 5 mg or 20 mg at 4 and 8 weeks. Primary
efcacy variables were the mean per-patient success rate
of erection maintenance to intercourse completion
(SEP3), and improvement of partners sexual quality-oflife (modied Sexual Life Quality Questionnaire
quality-of-life domain [mSLQQ-QoL]). Secondary
efcacy variables included responses to the Treatment
Satisfaction Scale (TSS).
Results: Mean baseline EF domain of the ITT population (112 PLA and 113 VAR patients) was 13.2 and
13.5, respectively (moderate ED). VAR signicantly
improved overall LS mean per-patient SEP3 success
rates vs PLA (67.7% vs 27.8%, p < 0.0001), and partner
mSLQQ-QoL (65.8 vs 32.1, p < 0.0001, LOCF). VAR
signicantly improved all TSS domains (mean values at
LOCF, all p < 0.0001 vs PLA). Relative to PLA, VAR
improved condence in the patient (59.7 vs 26.0) and
partner (57.6 vs 20.9), erection ease in the patient (61.2
vs 35.0) and perceived by the partner (60.9 vs 30.8),
J Sex Med 2006;3(suppl 2):108170
Book of Abstracts
pleasure in the patient (65.2 vs 38.1) and partner (62.7
vs 40.2), erectile function satisfaction in the patient
(53.2 vs 10.5) and partner (53.2 vs 16.9), orgasm satisfaction in the patient (60.8 vs 27.8) and partner (61.1 vs
37.2), and medication satisfaction in the patient (53.8 vs
9.2) and partner (53.1 vs 11.1). VAR was generally well
tolerated. The most frequently reported adverse events
included ushing, nasal congestion, headache, and
dyspepsia (all <11%).
Conclusions: VAR signicantly improved erectile
function, condence, ease of erection, pleasure, and satisfaction with erectile function, orgasm and medication
in men with ED and their partners.

VARDENAFIL IMPROVES ERECTION QUALITY
ASSESSED BY THE NOVEL ERECTION QUALITY
SCALE IN THE BROAD POPULATION OF MEN
WITH ERECTILE DYSFUNCTION
WA Fisher1, RC Rosen 2, G Brock 3, G Karlin 4,
P Pommerville5, F Giuliano6, I Saenz de Tejada7,
XY Huang 8, K Bangerter 8, T Taylor 8, L Derogatis 9,
Vardenafil Study Group
1
University Of Western Ontario, London, Ontario,

Canada, 2Robert Wood Johnson Medical School,
Piscataway, NJ, USA, 3St Josephs Medical Center,
London, Canada, 4Lawrenceville Urology Practice,
Lawrenceville, NJ, USA, 5Can-Med Clinical Research
Inc, Victoria, BC, Canada, 6Academic Hospital of
Bicetre, Le Kremlin Bictre, France, 7Hospital Ramon
y Cajal, Madrid, Spain, 8Bayer Healthcare
Pharmaceuticals, West Haven, CT, USA, 9University of
Maryland, Baltimore, MD, USA
Objectives: To assess the inuence of vardenal (VAR)

on erection quality in men with erectile dysfunction
(ED).
Material and Methods: This double-blind, multicenter,
12-week randomized trial enrolled 229 men with ED
and partners. Men received placebo (PLA) or VAR 10
mg for 4 weeks, with option to stay on 10 mg, or titrate
to 5 mg or 20 mg at 4 and 8 weeks. Primary efcacy variables were the mean per-patient success rate of erection
maintenance to intercourse completion (SEP3), and
improvement of partners sexual quality-of-life (modied Sexual Life Quality Questionnaire quality-of-life
domain [mSLQQ-QoL]). Secondary efcacy variables
included responses to the Erection Quality Scale (EQS).
Results: Mean baseline EF-domain score (ITT population: 112 PLA, 113 VAR) was 13.2 and 13.5, respectively (moderate ED). VAR signicantly improved
overall LS mean per-patient SEP3 success rates vs PLA
(67.7% vs 27.8%, p < 0.0001), and partner mSLQQQoL (65.8 vs 32.1, p < 0.0001, LOCF). Vardenal signicantly improved all EQS variables (p < 0.0001) vs
PLA at LOCF, including total score (36.1 vs 14.6), ease
of getting erection (2.4 vs 0.9); frequency of getting
149
Book of Abstracts
erection easily (2.6 vs 1.1), condence getting erection
(2.3 vs 1.0); satisfaction in ability getting erection (2.4
vs 0.7); frequency of lasting long enough for penetration (2.8 vs 1.4); frequency of lasting long enough for
ejaculation (2.7 vs 1.3); condence keeping erection (2.3
vs 0.7); satisfaction with erection duration (2.2 vs 0.4);
erection hardness (2.4 vs 1.1); frequency of erections
hard enough for penetration (2.8 vs 1.3); satisfaction
with erection hardness (2.2 vs 0.5); pleasurable feeling
(2.5 vs 1.4); satisfaction with pleasurable feeling (2.6 vs
1.6); frequency worrying about erections (1.9 vs 0.8);
overall erection quality satisfaction (2.2 vs 0.4). VAR
was generally well tolerated. The most frequently
reported adverse events included ushing, nasal congestion, headache, and dyspepsia (all <11%).
Conclusions: VAR signicantly improved perceived
erection quality on all measures of the EQS and
improved partner sexual QoL.

UPTITRATION OF VARDENAFIL DOSE FROM
10-MG TO 20-MG IMPROVED ERECTILE
FUNCTION IN MEN WITH SPINAL CORD
INJURY
Y Kimoto1, S Sakamoto2, N Yamamoto3, T Tachibana3,
K Fujikawa3, T Otani 4
1
Department of Urology, Spinal Injuries Center,

Fukuoka, 2Department of Urology, Nakamura Hospital,
Oita, 3Product Development Division, Bayer Yakuhin,
Ltd, Osaka, 4Department of Urology, Chubu-Rosai
Hospital, Nagoya, Japan
Background: Vardenal is a highly selective and potent

phosphodiesterase type-5 inhibitor for the treatment of
erectile dysfunction (ED). The efcacy of vardenal has
been demonstrated in a broad range of ED populations,
but had not been previously assessed in Japanese
patients with ED due to spinal cord injury (SCI). This
study investigated the efcacy and safety of vardenal,
including the impact of dose titration from 10 to 20 mg,
in this subpopulation.
Methods: The study was a 12-week, open-label, multicentre, exible-dose study. Patients aged 2161 years
with SCI >6 months and ED due to SCI, were enrolled.
Patients received vardenal 10 mg for 4 weeks, and
based on efcacy, tolerability and patient preference,
the investigator decided on the dose (10 or 20 mg) for
the remaining 8 weeks. Erectile function (EF) domain
score of the International Index of Erectile Function
was considered the primary efcacy parameter.
Results: Among 32 patients, 10 patients continued
10 mg throughout the study and 22 patients uptitrated
to 20 mg after 4 weeks treatment with 10 mg. In
patients receiving 10 mg throughout the study, EF
domain score was increased to 25.0 at LOCF from 12.2
at baseline; in patients receiving 10 mg followed by 20
mg, the score increased to 22.5 at LOCF from 10.3 at
baseline. Drug-related adverse events were observed in

22% of patients. The most common events were hotush (9%) and headache (6%), which were mild in
intensity and transient, and expected due to the pharmacological activity of PDE5 inhibitors. There was no
adverse event leading to discontinuation in the study.
Conclusions: Vardenal 10 and 20 mg are effective and
well tolerated as treatment for ED in SCI patients.
Dosing with vardenal 20 mg offered increased efcacy
in SCI patients who were not sufciently treated with
vardenal 10 mg.

VARDENAFIL IMPROVES ERECTILE FUNCTION
IN ASIAN MEN WITH ERECTILE DYSFUNCTION
HM Tan, CM Chin, CB Chua, E Gatchalian,
A Kongkanand, C Lei, B Mendoza, FC Ng,
K Ratana-Olarn, D Serrano, A Taher, I Tambi,
A Tantiwong, M Wong, AWC Yip
Objectives: Vardenal is indicated for the treatment of

men with erectile dysfunction (ED). This study assessed
the efcacy and safety of vardenal in an Asian patient
population.
Materials and Methods: 358 Asian men with ED were
randomized to vardenal 10 mg or placebo taken as
needed at a 4 : 1 ratio in 14 centers in Hong Kong,
Indonesia, Malaysia, the Philippines, Singapore, and
Thailand. Treatment duration was 12 weeks. Primary
efcacy criteria were the Erectile Function (EF) domain
score of the International Index of Erectile Function
(IIEF), success rate in penetration (SEP2), and success in
maintaining erection during intercourse (SEP3).
Results: Mean age was 54.6 years (range 23 to 78
years), 36% of patients had hypertension, and 32% had
diabetes mellitus. ED symptoms had been present for a
mean of 4.1 years. Subjects had a mean of 2.8 (vardenal) and 2.4 (placebo) sexual attempts per week.
At endpoint EF domain score had increased from
14.6 to 22.4 (vardenal group) and from 13.4 to 14.3
(placebo group). The difference of 8.1 points was highly
statistically signicant (P < 0.001) and of a clear clinical relevance. Success rates of penetration (SEP2)
increased from 51.5% to 82.2% with vardenal,
whereas they decreased from 49.0% to 43.6% with
placebo. Success rates of maintenance of erection
(SEP3) increased from 19.4% to 66.1% (vardenal) and
from 15.9% to 24.0% (placebo) (P < 0.001). In addition, vardenal compared to placebo was effective in
improving secondary efcacy parameters and overall
assessment of improvement in erection (global assessment question).
25.4% (vardenal) and 16.7% (placebo) of patients
reported adverse events mostly of mild or moderate
intensity. Headache and ushing were more common
with vardenal treatment reecting the pharmacological action of the drug.
J Sex Med 2006;3(suppl 2):108170
150
Conclusion: Vardenal 10 mg is a highly effective and
safe treatment of ED in Asian men. Results are comparable to and conrm those obtained in Caucasian patients.

QUANTITATIVE RIGISCAN MEASUREMENTS
OF ERECTILE RIGIDITY AND SUSTENANCE
FOLLOWING ADMINISTRATION OF CIALIS
20 MG
Andromeda Andrology Center, Post Box 1563,
Email: krishnamurti@andrology.com:
URL: www.andrology.com: Fax: +91 40 23405096
Introduction: When orally effective erectogenic drugs

are administered to patients in clinical practice, efcacy
is usually evaluated only by subjective means, e.g. by
questionnaires. Hence, one does not know whether any
claimed erectile improvement is truly pharmacological,
or placebo. Likewise, if a patient says that the drug has
not made any difference to his erections, it may or may
not be pharmacologically accurate. We employed the
Rigiscan device (Dacomed, Timm Medical) to check
this out in a small group of patients. The tenet here is
that any purely placebo effect improvement will not
show in the Rigiscan graphs, but true drug-induced
erectile improvement will.
Materials and Methods: 8 patients have been selected
for inclusion in this study. 6 of these claimed moderate
to excellent improvement in erections with Cialis
20 mg. 2 claimed no improvement. Rigiscan evaluations
were performed on all these patients while they were
receiving Cialis and compared with the Rigiscan
tracings obtained before Cialis was started.
Results: Of the 6 patients who claimed improvement
with Cialis 20 mg, it was found on Rigiscan that
there was signicant improvement in erectile rigidity
and/or sustenance in 4 of these. In the other two, there
was no signicant difference between the recordings
obtained before and after Cialis. Of the 2 who claimed
no improvement, the Rigiscan graphs corroborated
the patients observation in 1. In the other, there was
improved rigidity seen on Rigiscan but not during sex
in the waking state.
Conclusions: This preliminary study is inconclusive,
but it seems that psychological factors can probably
affect the efcacy of oral drugs for ED both favourably
and unfavourably.
J Sex Med 2006;3(suppl 2):108170
Book of Abstracts
Podium H: Prostate and Penile Disorders
WHAT IS HIGHLY CORRELATED WITH
REQUIRING SEXUAL FUNCTION TO BE
PRESERVED WHEN CONSIDERING TREATMENT
OPTIONS FOR PROSTATE CANCER?
T Kishimoto1, M Yokota2, H iriguchi2, R Taue1,
S Tanimoto1, H Izaki1, M Takahashi1, T Fukumori1,
M Nishitani1, H Kanayama1
1
Department of Urology, University of Tokushima

School of Medicine
2
Department of Urology, Kochi Municipal Hospital
Background: Since several years, quality of life considerations are becoming increasingly important
in prostate cancer management. Most treatments for
prostate cancer appear to have signicant effects on
patients sexual function. However, importance of
sexual function decreases in some patients. The objective of our survey is to identify factors highly correlated
with requiring sexual function to be preserved when
considering treatment options for prostate cancer.
Methods: This study included 151 men undergoing
prostate biopsy with any suspicion for cancer. They
were asked to complete a questionnaire containing the
International Index of Erectile Function 5 (IIEF-5) and
a series of questions evaluating sexual function(SF) and
sexual bother (SB) from the UCLA Prostate Cancer
Index (UCLA PCI). An additional questionnaire, How
do you think about the treatment for prostate cancer
and sexual function? was asked.
Results: Patients were divided into two groups. One
group consists of patients who were requiring sexual
function to be preserved, and another group consists
of patients who were not. The multivariate analysis,
requiring sexual function to be preserved as the dependent variable and age, PSA, IIEF5, SF, SB as independent variables, was done. Signicant independent
predictors for requiring sexual function to be preserved
were SF and SB (p < 0.05). The odds ratio of selfevaluation for sexual function was signicantly high
when the multivariate analysis, 8 question items of SF
as independent variables, was done.
Conclusion: Sexual function, particular self-evaluation
of sexual function, is highly correlated with requiring
sexual function to be preserved when considering treatment options for prostate cancer.
151
Book of Abstracts
COMPLIANCE TO PENILE REHABILITATION

PROGRAM FOLLOWING RADICAL
PROSTATECTOMY: ONE YEAR DATA
EFFECTS OF DOXAZOSIN ON SEXUAL

FUNCTION IN PATIENTS WITH BENIGN
PROSTATIC HYPERPLASIA
R Wang1,2, MD, N Huber 2, PA, L Madsen 2, RN,

C Wood 2, MD, R Babaian 2, MD
Kyung Seop Lee, Young Ha Cho, Ki Hak Moon 1,

In Rae Cho2, Young Jin Seo, Dae Gon Kim
Department of Urology, College of Medicine,

1
Yeungnam University, Daegu, 2Inje University, Ilsan,
Dongguk University, Gyeongju, Korea
University of Texas Health Science Center and

MD Anderson Cancer Center, 6431 Fannin Street,
Suite 6.018, Houston, Texas 77030, USA, Email:
Run.Wang@uth.tmc.edu
Introduction: Our previous studies have demonstrated

that programmed penile rehabilitation after radical
prostatectomy is benecial to recovery of penile function, especially for patients with good compliance to the
program. This study evaluated the long term compliance to penile rehabilitation program following radical
prostatectomy.
Methods: The patients who underwent unilateral
nerve-sparing prostatectomy, with or without unilateral
sural nerve grafting, were enrolled in this randomized
prospective study. Penile rehabilitation was initiated six
weeks postoperatively with vacuum erection device
(VED), intracavernosal injection (ICI) and patientdirected use of sildenal up to two years. Compliance
was evaluated according to the times each week that the
VED or ICI was performed. Sildenal use was not evaluated in this study.
Results: A total of 100 patients have been enrolled in
the study to date. 45, 27 and 17 patients were evaluable
for compliance at 4, 8 and 12 months, respectively. At
the 4 month evaluation, 73.3% patients were using
VED 5 times/week as instructed. This number dropped
to 66.7% and 47.1% at 8 and 12 month evaluation (p <
0.05). At the 4 month evaluation, 52.3% patients were
using ICI 2 times/week as prescribed. This number
dropped to 25.9% and 35.3% at 8 and 12 month evaluation (p < 0.05). There were 6.7%, 7.4% and 5.9%
patients who did not use VED and 9.1%, 22.2% and
23.5% patients who did not perform ICI at 4, 8 and 12
month follow-up. Patients with age 57 or older had
better compliance than younger ones (p < 0.05). There
was no difference in compliance between the patients
who received a nerve graft and those who did not.
Conclusion: There are signicant amount of patients
who do not comply with the long term penile rehabilitation program after radical prostatectomy, especially
the younger patients. Further study is necessary to identify the etiology of non-compliance with the rehabilitation program.
Purpose: The goal of this study is to estimate the effect

of doxazosin GITS on sexual function in patients with
benign prostatic hyperplasia using the validated international index of erectile function (IIEF).
Materials and Methods: We prospectively examined
115 patients with benign prostatic hyperplasia who were
treated with doxazosin GITS by using the IIEF questionnaires prior to treatment and after 3 months of
medication. The patients whose total IIEF scores were
under 21 and treated with 5-alpha reductase inhibitor
were excluded.
Results: The mean total IIEF scores after treated with
alpha-blocker increased from 41.9 10.1 to 45.4 9.8 (p
< 0.001). Mean scores of IIEF according to the patients
age for the men in their fties, sixties and seventies were
50.0 7.2, 43.3 8.8 and 34.4 8.6, respectively and the
mean scores decreased as increased age of the patient.
Among the mean scores of each IIEF domain, the erectile function scores increased from 16.7 4.7 to 18.6
4.4 (p < 0.001), the intercourse satisfaction increased
from 6.9 2.2 to 7.3 2.1 (p < 0.001), the orgasm function scores increased from 6.9 2.2 to 7.3 2.1 (p <
0.001), the sexual desire scores increased from 6.7 1.5
to 6.8 1.5 (p = 0.02), and the overall satisfaction scores
increased from 5.5 2.0 to 6.0 1.6 (p < 0.001).
Conclusions: With IIEF questionnaire, the generalized sexual function increased after doxazosin GITS
treatment in patients with benign prostatic hyperplasia.
Doxazosin GITS treatment will improve the lower
urinary tract symptoms and return the sexual condence. Before determine the treatment modality in
patients with benign prostatic hyperplasia, patients age
and sexual function must be considered.
Key Words: doxazosin, international index of erectile
function, sexual dysfunction

PEYRONIES DISEASE AND THE PENILE DERMAL
FLAP OPERATION FOR PENILE DEFORMITY
CORRECTION16 YEARS AND 80 CASES
Email: krishnamurti@andrology.com:
URL: www.andrology.com: Fax: +91 40 23405096
J Sex Med 2006;3(suppl 2):108170
152
Book of Abstracts
Introduction: Peyronies disease (PD) (syn. penile bromatosis, IPPinduratio penis plastica) is not uncommon.
An usually painful plaque or nodule, deformity, and
erectile dysfunction are the classical presenting symptoms. The exact etiopathogenesis of PD has still not
been understood. Similarly, although many treatment
modalities have been described, none is ideal. The sheer
multiplicity of available options, both conservative and
surgical, bears testimony to their collective overall inefcacy. About a quarter to a third of patients with PD
will eventually require surgery.
Materials and Methods: Disappointed with the high
complication rates of available operations for penile
straightening in PD, the author, in 1989, devised a
penile dermal ap (PDF) operation, based on the well
known principle that aps are superior to grafts. This
ap is created from dermabraded distal penile skin,
which is raised on the vascular dartos fascia pedicle as a
local ap. This technique was rst performed in 1989,
rst presented in 1992, and rst published in 1995*.
Results and Discussion: 80 patients have undergone
PDF surgery for PD with the author. The success rates
are impressive and the complication rates low. Rationale, operative technique, and gures are presented. It
is urged that this is an effective, under-exploited operation for defect closure in PD and the tendency to
persist with other, hyped but much less effective grafts,
should be seriously reviewed.
Results: Preoperative complaints included difcult

intercourse in 51 (63.1%), poor self-image in 18 and
partner discomfort in 12. Curvature ranged from 35 to
80 degree (average: 66.7). Postoperatively, 77 of 81
cases (95.1%) had a successful out come, based on the
self-documentation of a straighter penis. Three cases
were under corrected and 1 was over corrected. All of
4 cases were recorrected within 1 month.
As time went on, 7 (8.6%) patients had reoccurred
which four patients had their rst re-operation, two
patients had second re-operation, and one patient had
third re-operation to resolve the reoccurrence. One
year after the last operation, 95% of patients reported
straight erections and 5% reported almost straight but
acceptable erections.
Conclusions: Modied penile plication is a simple, safe
method and also, as seen in the reoccurrence, it is efcacious in the operation and superior on the treatment.
In long term results, we think that it is a good method
to correct congenital penile curvature.
Key Words: Modied penile placation, curvature,
reoccurrence
*KRISHNAMURTI S. Penile Dermal Flap for Defect Reconstruction in Peyronies Disease: operative technique and four
year experience in seventeen patients. Int J Impotence Res
(1995) 7, 195208. (This paper won the Herbert Newman
prize for best clinical impotence research in 1994.)
Masao Deguchi, Koichi Nakajima, Koichi Nagao,

Nobuhisa Ishii

THE LONG TERM RESULTS OF MODIFIED
PLICATION OF THE TUNICA ALBUGINEA IN
THE CONGENITAL PENILE CURVATURE
Gyung-woo Jung, Yoon-cheol Ok, Eun-ho Choi
Busan Medical Urology, Busan, Korea
Introduction and Objectives: To determine the longterm effectiveness of modied plication technique performed under PGE1 induced erection in correcting
congenital penile curvature. We had evaluated from the
patients whom at least one year have past after their last
operation.
Methods: Charts and telephone interviews were conducted on 81 consecutive patients from 15 to 36 years
old (average; 28.6) who underwent modied penile plication between March 1997 and January 2004. The
operation was performed under local anesthesia and
PGE1 induced erection. Parallel incision 5 mm. apart
and about 8 mm. long were made through tunica albuginea. Then outer edges of incisions are approximated
with sutures using 3-zero absorbable polypropylene in
way that buries knot.
J Sex Med 2006;3(suppl 2):108170

THE EXPERIENCE OF TREATMENT FOR
PEYRONIES DISEASE IN TOHO UNIVERSITY
Department of Urology, School of Medicine, Toho

University 6-11-1, Omori-nishi, Ota-ku, Tokyo, Japan
ZIP code:143-8541 Tel: 1-3-3762-4151, ext6690, Fax:
81-3-3768-8817
email deguma0919@yahoo.ne.jp
Background: Peyronies disease is a benign disease that

forms brosis on Tunica Albuginea. However, the conservative treatment has not been established. In a surgical treatment, the adaptation of the treatment and the
material, which wraps up an excision part of brosis are
still argued. We evaluated outcome about our treatment
for 93 patients with Peyronies disease.
Methods: The mean age of 93 patients with Peyronies
disease, who consulted Toho University from 1996 to
2005, was 51.4 years. Patients received vitamin E and
tranilast as a conservative treatment, and plication and
saphenous vein graft were enforced as surgical treatment.
Results: The chief complaints were 45 curving, 28
palpable brosis of the penis, 26 pain, 13 erectile dysfunction, 8 disturbance for coitus and 8 others. Most
things were 28 cases of curved penis to upper direction.
Subsequently, there were 16 cases curving to the left,
and lower right, 11 cases to the straight, and 21
unknown cases.
The treatment methods were internal use and surgical treatment. There 31 cases improved only with internal use, and 12 cases that didnt return for post-therapy.
In a surgical treatment, there were 29 cases with saphe-
153
Book of Abstracts
nous vein graft and plication, and 8 cases with plication
only. Penis was normalized in 28 cases of 29 cases with
vein graft, and 1 case was needed an additional plication
for penis normalization. The complication was not
found.
Conclusion: We demonstrated that saphenous vein
graft of patient with Peyronies disease was an effective
treatment.

CYLINDER SIZING DIFFERENCE BETWEEN
EXISTING FURLOW INSERTER TOOL AND
MODIFIED FURLOW INSERTER TOOL FOR
PENILE PROSTHESIS IMPLANTATION
JM Heo, KS Sim, YJ Seo
Department of Urology, Busan Veteran Hospital,
Busan, Korea
Introduction and Objectives: In inatable penile

prosthesis implantation, cylinder sizing techniques frequently result in penile cylinders that are slight short
for the corpus cavernosum. This can result in poor
support of the glans penis. Blunt tip of the Furlow
inserter tool is one of the cause of sizing error. To
correct this sizing error, prospective investigation was
done using modied Furlow inserter tool.
Material and Methods: In 63 patients (126 corpora
cavernosa), corpora cavernosa sizing was investigated
using existing Furlow inserter tool and modied Furlow
inserter tool during penile prosthesis implantation. All
of the measurement was done by the same operator and
the same tension. The cases with severe corpoal brosis as much as number 8 dilator does not penestrate
were excluded. The tip size of the modied Furlow
inserter tool is identical to the one of number 8 dilator.
Results: The average corpora cavernosa length by the
existing Furlow inserter tool was 15.7 (13.520.6) cm.
The average corpora cavernosa length by the modied
Furlow inserter tool was 16.3 (14.021.2) cm. The
Minimum difference value was 0.2 cm, the maximum
difference value was 1.2 cm, and the average difference
value was 0.6 cm. But there was no statistical signicance between two groups (p > 0.05).
Conclusions: The length of corpora cavernosa by the
modied Furlow inserter tool was slightly longer and
more accurate than that by the existing Furlow inserter
tool even though there was no statistical signicance.

ARTIFICIAL ERECTILE PENIS WITH A
WINDOWS-SHAPED CORONA GLANDIS
OPENING THAT ACTS AS A SEXUAL SENSOR
T Iwai, Y Inoue, Y Hata*, K Sato**, K Tomosada***
Tokyo Medical and Dental University, Vascular
Surgery Division, Department of Surgery. *Plastic
Surgery, **Anatomy and Physiological Science,
***Revive Inc.
The usual articial penis, which is not an implant or

prosthesis type, has a major demerit; the male feels no
sexual sensation. We developed a new articial penis
using medical-use silicon for erectile dysfunction (ED)
patients. This soft and smooth device is equipped with
slightly hard silicon semi-cylinder plates inside to
prevent sexual interruption by unexpected penis accidity. Two window-shaped openings are placed in the
lateral site of the corona glandis, which is the most sensitive part. Windows were made in two 10 20 mm
areas. Preliminary results (n = 5) showed excellent usefulness and safety, and the men experienced good sexual
intercourse sensations through the windows. The
partner also seemed to be satised with this device. Two
patients achieved ejaculation. We concluded that this
articial penis with two windows is acceptable for all
types of ED patients.
Using this device, embarrassing or painful examinations for impotence might be not necessary, especially
for oral medicine (sil- or var-denal) non-effective
elderly ED. In addition ED patients are able to escape
from pain or infection by a PGE1 penis injection or
prosthesis implant or by even negative pressure penis
expansion methods. From our results, erectile dysfunction does not preclude satisfactory sexual intercourse
when the new articial penis with windows openings
as sexual sensor that we developed is used. (US and
Japanese patents pending.)

DOES PENILE COLOR DUPLEX DOPPLER
ULTRASOUND INFLUENCE THE DECISION FOR
PENILE PROSTHESIS IMPLANTATION?
R Wang1,2, MD, M Dang1, BS, AC Stage1, MD,
PC Chen1, MD
1

Introduction: Penile color penile duplex Doppler

ultrasound (CDDU) combined with intracavernosal
injection (ICI) of vasoactive agents is considered as the
most informative and minimally invasive diagnostic
study in the evaluation and selection of appropriate
J Sex Med 2006;3(suppl 2):108170
154
Book of Abstracts
therapy for erectile dysfunction (ED), especially when

surgical treatment of ED is planned. This prospective
study was sought to evaluate whether CDDU inuences
the decision for penile prosthesis implantation.
Methods: The study included a cohort of 33 patients
who were referred to our institution for penile prosthesis implantation. They either failed previous nonsurgical treatment (28 patients) or were unwilling to try
ICI (5 patients) for ED. All patients underwent CDDU
before the decision was made for penile prosthesis
implantation. CDDU was performed before and after
ICI of 0.25 ml of a Trimix (combination of PGE1, phentolamine and papaverine). A second injection and repeat
CDDU were performed if clinical erection was not
induced by the initial injection. Treatment options for
ED were discussed again with patients based on the
CDDU results. Analysis was performed regarding the
types of therapy ultimately chosen and the role of
CDDU ndings in guiding therapy.
Results: 78.8% (26/33) of patients still decided to have
penile prosthesis implantation regardless of the CDDU
ndings, including 4 patients with good erection
induced by ICI at the time of CDDU. 21.2% (7/33) of
patients decided to use ICI therapy after having a good
clinical response to Trimix injection at the time of
CDDU. Two of these patients were unsatised with
previous ICI therapy.
Conclusion: CDDU combined with ICI of vasoactive
agents can change the decision for penile prosthesis
implantation in one fth of patients who have failed
previous non-surgical treatment or are unwilling to try
ICI for ED. Even though CDDU can provide important information regarding the specic vascular etiology
of ED, it is the clinical erectile response to ICI that
ultimately inuences the therapeutic decision-making
process.
Funding Source: National Institute of Diabetes and
Digestive and Kidney Disease, T35 DK007676-12.
Methods: In this prospective study, eight patients with

a full erection induced by ICI of 0.25 ml of Trimix
(papaverine, phentolamine, and PGE1) at the time of
penile color duplex Doppler ultrasonography were
included in this study. Erect penile length was measured
from the pubic bone to the tip of the glans penis. A full
erection was dened as an erection with an angle to the
body 90 degrees. The patients subsequently underwent inatable penile prosthesis implantation as the
ultimate treatment for their erectile dysfunction. Erect
penile length provided by the penile implant was measured 6 weeks after surgery; at this time all patients had
been taught how to use the device. The erect penile
length provided by the two methods was compared
using a paired Student t-test.
Results: Erect penile length induced by ICI was 13.0
1.2 cm (mean SD) whereas the length attained with
penile implants was 12.1 1.0 cm. There was a 0.9
0.9 cm decrease of erect penile length with penile prosthesis implantation compared to that induced by ICI
(p < 0.05). Decreases in erect penile length were largely
due to the lack of engorgement of the glans penis with
penile implants. However, only patients with a reduction of penile length 1.0 cm complained of the penile
shortening.
Conclusion: To our knowledge, this is the rst study
to demonstrate that decreases in erect penile length can
be signicant when comparing ICI to penile prosthesis
implantation. Prior to surgery, it is important to educate
and counsel patients of a possible reduction in erect
penile length. This is especially important for patients
with adequate erections induced by ICI.
Y Kawanishi1, K Kimura1, M Sakaki1, T Fukawa1,

A Numata1, T Kishimoto2, H Kanayama2
ERECT PENILE LENGTH INDUCED BY

INTRACAVERNOSAL INJECTION VERSUS THAT
OBTAINED WITH PENILE PROSTHESIS
R Wang1,2, MD, JM Chaves1, MD,
KM Jacobsohn1, MD
1

Introduction: Even though penile prosthesis implantation provides excellent patient satisfaction for the treatment of erectile dysfunction, many patients complain of
reductions in penile length. This prospective study
compares the erect penile length induced by intracavernosal injection (ICI) to that provided by inatable
penile prosthesis implantation.
J Sex Med 2006;3(suppl 2):108170

IMPROVEMENT IN PROCEDURES FOR
HARVESTING THE INFERIOR EPIGASTRIC
ARTERY FOR PENILE REVASCULARIZATION
Department of Urology, Takamatsu Red Cross

Hospital, 2Department of Urology, Tokushima
University. 1Bancho 4-1-3, Takamatsu, Kagawa, Japan
760-0017
Most penile revascularization procedures use the inferior epigastric artery as a neoarterial source. A long
pararectal incision was traditionally required to harvest
this artery and complications related to this incision
were many. Laparoscopic approaches have been
employed to solve these problems. However, laparoscopic procedures are time-consuming and costly. We
attempted to establish a surgical procedure for videoassisted inferior epigastric artery harvesting and
obtained an excellent outcome.
We harvested the artery using a video-assisted dissector. This vessel dissector is a kind of internal retractor
with an endoscope, having a grip at the proximal end for
Book of Abstracts
ease of retraction and a translucent spoon-shaped shield
at the distal end that maintains the visualizing cavity. A 30
degree 5 mm optical lens is loaded in the shaft.
We have performed this video-assisted epigastric
artery harvesting for penile revascularization in 12 cases
to date with just a small skin incision, avoiding any
major complication or the need to resort to open conversion. Total operation time ranged from 175 minutes
to 260 minutes. The follow up period was 2.3 to 44.2
months. The patency of the anastomosis was conrmed
by colour Doppler ultrasonography in 11 cases at follow
up. CT angiography showed that the epigastric artery
was induced straight to the base of the penis. Eleven
patients have shown the complete restoration of their
erectile function.
Although long-term follow up and a larger number of
cases are needed to prove its general clinical usefulness,
nevertheless based on our initial experience, endoscopic
inferior epigastric artery harvesting can be performed
safely, effectively, efciently and inexpensively.
Plenary G: Ejaculatory Dysfunction

EJACULATORY DYSFUNCTION: WHAT IS NEW?
XIN Zhong-Cheng MD
Andrology Center, Peking University First Hospital,
Beijing, China
Ejaculatory dysfunction is a common type of male

sexual dysfunction, includes premature ejaculation
(PE), delayed ejaculation, anejaculation and retrograde
ejaculation. Among of them, PE is the most frequent
ejaculatory dysfunction, with a prevalence rate of more
than 30%, and affects man of all ages from 18-years old
to elderly, unlike erectile dysfunction (ED), which
mostly affects elderly man and more differs from PE.
PE and ED often coexist, and evolving data indicated
that PE is often disguised or misdiagnosed as ED in
many men, due to absence of careful clinical evaluation.
Although ejaculation and orgasm are coordinated to
constitute the nal phase of the sexual response cycle,
the mechanisms that produce them are different. Progresses in basic and clinical studies on ejaculation were
made recently, which demonstrated more clearly that
the neuro-control mechanism of ejaculatory function
involve sensory receptors and areas, afferent pathways,
cerebral sensory areas, cerebral motor centers, spinal
motor centers and efferent pathways. Many neurochemicals maybe play important roles in the control of
ejaculation, such as dopamine, serotonin, gammaaminobutric acid (GABA), nitric oxide and adrenergic
and/or cholinergic materials.
The psycho-sexual factors (anxiety-related, behavioral) and biological factors (pelvic oor alteration,
hypersensitivity of the glans penis, accelerated conduction and cortical amplication of the genital stimuli)
play important roles in the etiology of PE, both sharing
the neurobiological assumption of serotonergic media-
155
tion. Clinical assessments of patients with ejaculatory
dysfunction are used with questionnaire forms and laboratory evaluation. To the former, it was mainly emphasized on psychophysiological evaluation and SCL-90-R,
DSM-IV-R, ICD-10 and some of questionnaires are
introduced in clinical PE evaluation recently. To the
latter, penile sensory threshold evaluation using penile
biothesiometry, dorsal nerve somatosensory evoked
potentials (DNSEPs) are used for evaluation peripheral
sensory nerve function.
Selective serotonin reuptake inhibitors (SSRIs) are
widely used because of their safety and tolerability and
their efcacy were demonstrated in a broad range of
clinical conditions. Medical literature supports the use
of SSRIs for the treatment of many conditions besides
the indications approved by the U.S. FDA. SSRIs offer
a reasonable alternative to traditional therapy for generalized anxiety disorder. But a side effect of SSRIs prolongs the ejaculatory latency so that it could provide
therapy for PE. The introduction of SSRIs has revolutionized our understanding of the treatment of PE,
which has been proven to be safe and effective on PE
by clinical studies. Recently, a new SSRI (Dapoxetine)
for PE was reported and some of previous study demonstrated that Dapoxetine had a unique pharmacokinetic
prole: rapidly absorption and higher peak concentration, short half-life and minimal accumulation following daily dosing compared with other SSRIs.
The efcacy of phosphodiesterase-5 inhibitors seems
excellent in PE patients associated with ED. Therefore,
SSRIs should be used in young patients with hyperorgasmic forms, while the PDE5 inhibitors should be
used in hypo-orgasmic forms, in old age or PE patients
associated with ED. Some researches indicated SSRIs
and PDE5 inhibitors combined administration could
alleviate the side effect on ED.
The use of topical local anesthetics such as lignocaine and/or prolocaine gel or spray, and SS-cream,
were well established and they might be effective for
treating PE. Some topical agents could decrease the
hypersensitivity of the glans and provide satisfactory
results in PE and physiotherapy on the pelvic oor
muscles were proved successful in cases associated with
pelvic oor dysfunction. Recently, Renewal SS-cream
was introduced with similar local desensitizing activity
compared with the original SS-cream but no herbal
smell and color.
Some of study reported that glans penis augmentation with injectable Hyaluronic Acid gel is a safe and
effective method to reduce sensitivity of glans penis.
However, a safe and efcacious and invasive methods
need to be investigated.
Therefore, among of ejaculatory dysfunction, PE is
the most frequent ejaculation dysfunction. Although the
evidence-based researches focused on the etiological
and pathophysological study demonstrated that neurochemical and neurocontrol mechanism of ejaculation
and ejaculatory dysfunction, the further exploration is
needed.
J Sex Med 2006;3(suppl 2):108170
156
Plenary H: Sex Therapy
SEX THERAPY: WHAT IS ITS ROLE IN SEXUAL
DYSFUNCTION?
Margaret Redelman (Sydney)
Sexuality is determined by psychological, anatomical,

hormonal, vascular and neurological components.
No matter how beautiful a car is, it wont go without
petrol. Once the tank is full, the car still wont go
without a driver. How the car drives depends on that
driver. And then, what about the road conditions
(partner, environment, society)?
So the question, what is the role of sex therapy in
our strategy in dealing with sexual dysfunctions? There
can only be one answer. Sex therapy needs to be the cornerstone of all strategies dealing with sexual dysfunctions, and medical, hormonal and surgical interventions
are the adjuncts that make sex therapy increasingly
more successful.
Sexual difculties or differences only become
dysfunctions when human beings are distressed or
unhappy about the situation ie psychological effect on
the individual or couple.
Some degree of either positive or negative sex
therapy occurs as soon as patients mention their sexual
difculty and the clinician responds, or doesnt respond.
One cannot give an opinion or diagnosis or a prescription, without some degree of meaningful interaction
that inuences the patient.
We are very fortunate that pharmaceutical companies can make money on sexual health drugs and
research is increasing so we can be increasingly successful in the assistance we give our patients/clients.
However, it is here that the ethical professional training of the clinician is paramount in determining the
balancing act between traditional talking/homework
therapy and adjunctive medicalisation.
This balance will be different in each category of
male and female sexual dysfunction. The application
and limitation of each strategy needs to be clearly
understood and applied to each patient/client or couple
with an understanding of their individual dynamics.
Plenary I: Surgery for Male Sexual

Dysfunction
SURGERY FOR MALE SEXUAL DYSFUNCTION:
OPTIONS AND INDICATIONS
Sae-Chul Kim
Department of Urology, Chung-Ang University
Hospital, Seoul, Korea
The three major surgeries for male sexual dysfunction

are penile prosthetic or vascular surgery for erectile dysfunction (ED) and surgical managements of Peyronies
disease. The penile prosthesis is considered a nal
option for the treatment of patients in whom second
J Sex Med 2006;3(suppl 2):108170
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and third lines of treatment fail or are rejected by the
patients and partners. The vascular surgery is indicated
only in young men with traumatic or congenital ED.
Peyronies disease which fails to respond to pharmacologic therapy and have had penile curvature for more
than 12 months are considered candidates for surgical
intervention. The operative intervention that is selected
for the individual patient is base on the preoperative
erectile function, preoperative penile length and the
magnitude and complexity of the curvature. Penile plication is a good solution for the patients with normal
erectile function, ample penile length and a simple
curvature, while patients with shorter penile length,
irrespective of their degree or complexity of penile
curvature are ideal candidates for the plaque incision/
excision and grafting. The placement of penile implants
is reserved for men with combined ED and penile
curvature.
APSSAM Symposium: Mens Health and

Ageing in Asia Pacific Countries
MENS HEALTH IN THE ASIA PACIFIC REGION
HM Tan
Subang Jaya Medical Centre, Petaling Jaya, Selangor,
Malaysia
Asian countries are rapidly aging as the peak population

growth in Asia occurred between 1950s to 1970s. Life
expectancy of Asian men has increased tremendously
over the last 50 years. However, the health expectancy has lagged behind our Western counterparts
signicantly.
The health of an aging male is the net effect of both
current health related factors and factors that prevailed
during earlier periods in the life course. The health
status of the elderly population has tremendous far
reaching consequences to the family, society and
their respective countries. Asian countries desperately
need to strive for a healthier elderly population to maintain productivity, to reduce healthcare cost and nancial burden to the family, community and countries
respectively.
Generally, health care providers give mens health
issues short shrift in standard clinical interactions.
Rightfully, they tend to focus, on common conditions
such as hypertension, heart disease and diabetes mellitus. However, majority of men are not forthcoming to
see their doctors for both primary or secondary preventions in these non-communicable diseases.
Mens health issues need a revamp in our approach.
A multidisciplinary, well concerted effort to refocus and
reorientate our thoughts to provide a holistic care for
mens health problems is desperately needed. Physicians
should not just focus on men with chronic diseases or
cancer. They must take a wider perspective on mens
health issues which affects their quality of life. Medical
conditions and diseases like prostatitis, lower urinary
157
Book of Abstracts
tract symptoms (LUTS), sexual dysfunction and Androgen Decline in Aging Male (ADAM) must be bought
into centre stage as those life threatening diseases.
These conditions which have signicant impact on
mens quality of life are more likely to draw the men to
their doctors.

MENS HEALTH AND AGING:
TAIWAN PERSPECTIVE
Han-Sun Chiang
Professor and Dean
Medical College, Fu-Jen Catholic University, Taipei,
Taiwan
Elderly population in Taiwan has been increasing

signicantly in both number and its proportion during
the past decade. The promotion of healthy aging and
the prevention of disability in all old people must be
assumed a central role in medical practice as well as in
the formation of national health and social policies. In
light of this, male hypogonadism in the aging needs to
be as one of the important issues for both of the medical
staff education and public awareness. Based on the
recent epidemiological study of 650 subjects lived in
northern (242), middle (206) and southern (202) part of
Taiwan, aged between 40 to 79 years old, there are
18.7%, 32.1% and 24.4% persons have the lower blood
level of total testosterone (<11 n mol/L) calculated free
testosterone (<0.23 n mol/L) and bioavailable testosterone (<145 ng/dl). The most prominent symptom of
clinical hypogonadism of the aging male is sexual dysfunction. In a community-based survey among 1002
Taiwanese men aged over 40 years old, the prevalence
of erectile dysfunction is 17.7%, and the frequently
increased with age. It was also found that erectile dysfunction was associated with various chronic diseases
and that it exerted a negative impact upon sexual activity and the level of satisfaction. Presently, more effective oral medications for the erectile dysfunction
appeared in the market and really encourage more
aging patients come out for a denite treatment. It is
also true for the more acceptable new dosage form of
androgen preparation, such as gel, offer more optional
treatment for the male hypogonadism. With the
modern concept of patients-oriented management, we
are going to overcome anxiety and frustration for
the mens problem in our traditional society and reestablished the self-condence for their health.

PROBLEMS IN MENS HEALTH AND AGING IN
INDIA
Hyderabad 500082, INDIA
Email: andrologist@gmail.com;
URL: www.andrology.com
Besides being a large country with a massive population,

India is a land of great social disparity. On the one hand,
there are the impoverished rural millions. In addition
to the usual morbidity associated with the aging process,
these men suffer the consequences of nutritional (e.g.
calcium deciency, anemias) and medical deprivation.
At the other end of the spectrum, there are the wealthy,
overfed, under-exercised, highly stressed drinkers and
smokers of polluted, modern urban India. The agerelated diseases in this population group are wellknown. Further, India is fast emerging as the diabetes
and coronary artery disease capital of the world. This
automatically translates into greater morbidity in those
who live long enough to suffer it. Thus, one sees
cerebrovascular and ischemic heart disease, diabetes,
cancer, respiratory diseases, depression, osteoporosis,
Alzheimers, hepatorenal disease, trauma etc.the
whole spectrum.
Though things are changing slowly, on the whole,
the approach to aging in India is a fatalistic rather than
a pro-active one. Little is done to combat or reverse
aging. Consequently, many give up sexual expectations
of themselves and their partners in the sixties and
beyond.
In a country that is still trying to eradicate polio,
aging-related quality of life health issues are hardly a
national priority. There is no organized national health
program for aging males. Aging-related heath care is
usually provided as an incidental health service in pensioners programs and employees insurance schemes. A
lot of health care is nowadays being provided by the
fast-growing private medical sector.
The silver lining on the dark cloud of aging in India
is provided by the fact that the aged are usually loved
and venerated in this part of the world, and continue to
occupy positions of respectability and power as heads of
families until their death. Moreover, they have excellent
family and social support systems. Very few aged Indian
males are left to die in homes for the aged.
J Sex Med 2006;3(suppl 2):108170
158
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RELATION BETWEEN PADAM SYMPTOM AND

TESTOSTERONE IN JAPAN
HYPOGONADISM IN THE AGING MALE

IN TAIWAN
Akira Tsujimura and Akihiko Okuyama
Thomas IS Hwang
Department of Urology, Osaka University Graduate

School of Medicine
Division of Urology, Department of Surgery

Shin Kong WHS Memorial Hospital, Taipei, Taiwan
Department of Urology, School of Medicine, Taipei
Medical University, Taipei, Taiwan
Department of Urology, School of Medicine, Fu-Zen
Catholic University, Taipei, Taiwan
The mean life-length in male is over 80 years in Japan.

Thus, partial androgen deciency of the aging male
(PADAM) has received widespread attention in the
popular and medical media in Japan. Although it has
been well accepted to take care of PADAM, several
problems are now found out. Useful questionnaire
written in or translated into Japanese for PADAM is not
available yet. A measurement of testosterone is limited
by national health insurance. High-quality testosterone
preparations that can maintain a physiologic testosterone level have not been available in Japan. Furthermore, the most serious problem is that a criterion of
PADAM by serum testosterones concentration is not
dened for Japanese patient yet. The International
Society for the Study of the Aging Male (ISSAM)
recommends using cut-off values of total testosterone,
calculated free testosterone or calculated bioavailable
testosterone to diagnose hypogonadism in PADAM.
However, it is still obscure whether hypogonadism of
patients with PADAM is related to PADAM symptoms
and which criteria of testosterone recommended by
ISSAM is suitable for Japanese patients. Thus, we investigated PADAM symptom and endocrinologic proles
among Japanese patients. Symptoms for PADAM were
judged according to the aging males symptoms scale,
the short version of International Index of Erectile
Function for erectile function and the self-rating
depression scale for depressive status. Voiding function
was also judged according to the International Prostate
Symptom Score and quality-of-life index and Kings
Health Questionnaire. We found that even when any
criterion of testosterone was used for diagnosis of
hypogonadism, PADAM symptoms did not differ signicantly between patients classied as having and not
having hypogonadism. PADAM symptoms are not
related to testosterone level and it is still obscure
whether ISSAMs criterion can be adopted for Japanese
patients with PADAM.
Purpose: To elucidate correlations between different

biochemical measurements of androgen deciency and
clinical symptoms in male residents of Taiwan.
Materials and Methods: An investigation of the serum
biochemical markers for androgen deciency in 650
males, including total testosterone, calculated free
testosterone, and bioavailable testosterone, was conducted. Measurements of clinical symptoms were
obtained using a questionnaire of the androgen deciency in the aging male (ADAM) of St. Louis University (SLQ). Correlations among the biochemical
markers, correlations of the biochemical markers and
age, and relationships between the biochemical markers
and the SLQ were evaluated. The sensitivity and specicity of the SLQ were determined.
Results: Bioavailable and calculated free testosterone
correlated better with age than did total testosterone.
Eighty percent of the men had a positive SLQ, and 20%
had a negative SLQ. The percentage of positive SLQ
results increased with age. No statistically signicant
difference was noted between the biochemical markers
of bioavailable and calculated free testosterone levels
and the SLQ status except for men aged over 70 years.
The SLQ in this study showed an acceptable sensitivity of about 80%, but the specicity was poor (about
20%).
Conclusions: Bioavailable testosterone and calculated
free testosterone were more-closely correlated with age
and may be better biochemical markers for androgen
deciency. SLQ might not be a suitable single measurement for androgen deciency and should be used
together with biochemical markers.

LIFESTYLE FACTORS IN SEXUAL
DYSFUNCTION
Large epidemiology studies suggest that heart-healthy

lifestyle changes may reduce the risk for ED. The
MMAS found a fairly consistent association between
cardiovascular disease and ED. Most recently, results of
J Sex Med 2006;3(suppl 2):108170
159
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the Health Professionals Follow-up Study were published regarding lifestyle risk factors for ED. Physical
activity correlated with a 30% reduced risk for ED.
Obesity, Smoking, alcohol intake, and televisionviewing time also were associated with an increased risk
for ED. Males with the lowest risk of ED were those
without chronic medical conditions and who regularly
participated in health activities. Thus, clinicians
working in urology should adhere to the same guidelines that are observed in cardiovascular medicine when
dealing with a patient with ED. The time is more than
ripe for patients to understand the heart health is tantamount to erectile health. Finally even if drug therapy
is initiated, lifestyle changes should continue to be
emphasized because of potential synergistic effects, and
because the goal of patients is increased quality and
quantity of life, not just ED treatment.

THE IMPACT FACTORS OF QUALITY OF
SEXUALITY AMONG THE ELDERLY
Yi-Chia Lin1, Te-Fu Tsai12, Mau-Roung Lin2,
Thomas I.S. Whang1
1
Department of Surgery, Division of Urology, Shin

Kong Wu Ho-Su Memorial Hospital
2
Institute of Injury Prevention and Control, College of
Public Health and Nutrition, Taipei Medical University
Purpose: Owing to the advancement of public health,

life expectancy of human-being is continuing to grow
and therefore the elderly comprise the fastest increasing segment of the global population in Taiwan. The
impact factors of quality of sexuality among the elderly
are still unclear. This study was conducted to investigate the potential factors which impact the sexual
quality of the elderly.
Materials and Methods: At August 2002, 794 residents
aged 65 and over in Shin-Sher Township, Taichung
County agreed to participate in the study. Personal interviews with structured questionnaires were conducted at
the subjects residences by trained interviewers. The
major component of the interview was to assess the
demographic data, activities of daily life, geriatric depression scale, recognition, numbers of comorbidity, and
quality of sexuality. ANOVA and Chi-square tests were
used to explore which factors impact the sexual quality of
the elderly. Pearson correlation coefcient was used to
examine the relationships between the impression of sexuality and the quality of sexuality. General linear model
was used to adjust the potential confounders.
Results: There is a statistical signicant difference
between sexual quality and marital status among the
whole older people ( p < 0.05). Among the older men,
there is no statistical signicant difference between these
factors and quality of sexuality. Among the older women,
there is a statistical signicant difference between sexual
quality and marital status ( p < 0.05). The impression of
sexuality was positively related to the quality of sexuality

among the older men and women (p < 0.05).
Conclusions: Marital status was a important factor which
impacted the quality of sexuality among the elderly. The
impression of sexuality was positively related to the quality
of sexuality among the older men and women.

PREVALENCE STUDY OF ADULT
HYPOGONADISM IN TAIWAN
TIS Hwang 1, CR Yang 2, HC Wu 3, etc
Division of Urology, Department of Surgery,
1
Shin Kong WHS Memorial Hosp., 2Taichung Veterans
General Hosp., 3China Medical University Hosp, etc
Purpose: Since the association of total testosterone

with clinical symptoms of andropause are controversial,
bioavailable testosterone (BT) is considered to be the
most ideal screening. We investigate the BT and the
prevalence of the aging male rst time in Taiwan.
Materials and Methods: Six hundred and fty subjects
lived in Northern (242), middle (206) and Southern
(202) part of Taiwan, aged of (40 ~ 79 years) were
recruited into the study. Total testosterone (TT), calculated free testosterone (FT calc), bioavailable testosterone (BT), as well as luteining hormone (LH), follicle
stimulating hormone (FSH), sex hormone binding
globulin (SHBG) were measured. Androgen deciency
in aging male (ADAM) questionnaire and global quality
of living (QoL) were conducted. The association
between TT, FT and BT, and ADAMs questionare as
well as QoL were investigated.
Results: Based on the criteria of adult hypogonadism
recommended by International Society of Sexual Medicine (ISSM), there were 18.7%, 32.1%, 24.4% persons
below the level (TT = 11 n mol/L, FT calc = 0.23 n
mol/L and BT = 145 ng/dL). TT correlated FT calc (r
= 0.62, p < 0.0001), with BT (r = 0.62, p < 0.0001), and
FT calc correlated extremely with BT (r = 0.99, p <
0.001). However, no signicant correlation between
TT, FT, BT and ADAM questionnaire and QoL were
demonstrated.
Conclusion: There are 24% to 32% of subjects were
considered to be hypogonadal. Both BT and FT calc in
this study correlated well and may be the ideal screening test for adult hypogonadism in Taiwan.

COMPARISON OF SERUM TESTOSTERONE,
ADAM QUESTIONNAIRE AND IIEF SCORES IN
ANDROPAUSE SCREENING IN KOREAN
HJ Park, JK Nam, NC Park
Department of Urology, Pusan National University
Hospital, Pusan, Korea
J Sex Med 2006;3(suppl 2):108170
160
Introduction and Objective: Andropause is a clinical
and biochemical syndrome characterized by a decline in
levels of serum testosterone, and results in various physical and mental disabilities in aging males. We aimed
to investigate the epidemiology of andropause, as well
as the relation between serum testosterone level and
andropause symptoms by ADAM questionnaire and
IIEF scores in aging males.
Methods: We examined ADAM questionnaires and
IIEF for clinical symptoms, and serum total testosterone levels for biochemical diagnosis.
Results: The mean age of the 272 men was 59.9
(4086) years, and the mean serum testosterone level
was 457 164 ng/dl. According to age, the serum testosterone level was 484 173, 454 173, 469 159, and
422 141 ng/dl in the 5th, 6th, 7th, and 8th decades,
respectively. Among the men, there was a 85.3% positive response on the ADAM questionnaire. The mean
IIEF-5 score was 12.52 6.13. The percentage of
patients whose serum testoterone was less than 350 ng/ml
in a positive ADAM questionnaire was 25.7% (70 cases).
The mean serum testosterone level in a positive or negative ADAM questionnaire was 441 157 or 482
160 ng/dl: there was not a difference (p > 0.05). The
mean serum testosterone level according to the IIEF
scores was 432 144, 456 146, 458 168, 490 201,
and 419 112 ng/dl in score 17, 811, 1216, 1721,
and 2225, and there was no relation between them.
Conclusions: Among men over 40 years of age, 25.7%
met the both of clinical and biochemical diagnostic criteria for andropause in our study. There was no relation
between serum testosterone level and andropause
symptoms.

CYBER-SEXUAL COUNSELLING
OLD PROBLEMS AND NEW WAYS
CC Lu1, JS Roan2
1
Education Department/Urology, Chiayi Veterans

Hospital, 2Department of Information Management,
National Chung Cheng University, Taiwan
Purpose: The internet provides an anonymous and

convenient cyber environment. This study is to evaluate the internet as a way for sexual counseling in the
urological website.
Materials and Methods: This was a retrospective
study. The rst government-selected and informationqualied urological website in Taiwan was produced in
2004. The written language used in the website was
Chinese (complex characters) but no limitation in the
e-mail. The contents of questions and answers including e-mail were analyzed.
Results: In this urological website and e-mail counseling, available 301 questions were collected. More than
86% (259/301) questions were about sexual medicine,
such as exogenital problems, erectile dysfunction, preJ Sex Med 2006;3(suppl 2):108170
Book of Abstracts
mature ejaculation, and penile curvature. The other
questions were about uro-oncology (20), stone management (13) and pediatric urology (9), listing by downward frequency. Several questions (19) were not asked
for the people themselves but for their related individuals, such as homefolk or the sexual partner.
Conclusions: In the internet era and the computerized
medical environment, this study suggests that cybersexual medical opinions from expertise become a feasible way for communication and education. The
urologists are encouraged to be devoted to this new area
for the people who still keep their sexual problems
uncovered or not correctly informed.

BRAIN ACTIVATION BY VISUAL EROTIC
STIMULI IN ELDERLY HEALTHY MALES
SW Kim, DW Sohn, DB Kim, Y-H Cho, MS Yoon, Lee
Choong Bum
Department of Urology, Catholic University, Seoul,
Korea
Purpose: We performed this study to identify cerebral

regions whose activity changes are related to sexual
arousal visual stimuli in elderly, healthy, heterosexual
males.
Materials and Methods: Ten heterosexual, right
handed males with normal sexual function were entered
into the present study (mean age 52 years, range 46 to
55). Real-time visual stimulation was performed with
alternatively combined erotic and nonerotic lms to
identify the activated brain regions associated with
sexual response. Brain activity was mapped using a
blood oxygen level dependent (BOLD) fMRI on a 1.5T
MR scanner. After functional scanning, high-resolution
data were acquired via a T1-weighted 3D volume acquisition obtained using a gradient echo pulse sequence
The brain areas, a set of coordinates was calculated by
taking the average for each orthogonal axis X, Y and
Z of reported Talairach coordinates. Predetermined
regions of interest (ROI) were limited by spheres having
a radius of 9 mm and for center, the calculated average
reported coordinates. For these priori ROIs, height
threshold was set at p < 0.001 (z = 3.09), uncorrected
for multiple comparisons.
Results: The BOLD activity associated with viewing
the emotionally neutral lm segment was decreased
than that associated with viewing the erotic segment,
signicant (p < 0.001, uncorrected). The major areas of
activation associated with sexual arousal to visual stimuli
were occipitotemporal area, anterior cingulate gyrus,
insula, orbitofrontal cortex, caudate nucleus. However,
hypothalamus and thalamus were not activated.
Conclusion: We have identied by using BOLD-based
fMRI the functional neuroanatomy of the brain associated with sexual arousal in elderly males. We suggest
that the nonactivation of hypothalamus and thalamus in
161
Book of Abstracts
elderly males may be responsible for the lesser physiological arousal in response to the erotic visual stimuli.

CLINICAL EFFICACY OF YOHIMBINE FOR
EJACULATORY INCOMPETENCE
1
T Amano , T Imao , K Takemae , A Yonezawa

1
Department of Urology, Nagano Red Cross Hospital,

Japan, 2Center for Laboratory Animal Science and
Department of Pharmacology, Tohoku College of
Pharmacy, Japan
Objective: Our previous data shows that yohimbine,

which is an alpha 2-adrenoceptor antagonists and serotonin antagonist at low doses facilitate the ejaculatory
response. The serum level of yohimbine shows
maximum 1 hr after oral administration. The metabolic
product of yohimbine is also considered to promote
ejaculation, and the serum level of that product reveals
the max concentration at 5 hr after taking yohimbine.
Based on these data, we administrated yohimbine for
patients with ejaculatory incompetence, and evaluate
the clinical efcacy of yohimbine for ejaculation
deciens.
Material and Methods: The clinical efcacy of yohimbine was assessed in 33 patients, aged 20 to 78, with
ejaculation dysfunction. Five mg of yohimbine was
administered 1 hr before sexual intercourse on demand.
Some patients also took additional 5 mg of yohimbine
5 hr before coitus. The efcacy of yohimbine was evaluated when the patients can complete ejaculation after
taking yohimbine.
Results: The causes of ejaculation dysfunction of the
33 patients were as follows: 21 functional, 4 psychological and 8 organic. The 10 patients without erectile dysfunction (ED) were treated with yohimbine alone, while
yohimbine was later used to treat the 23 with ED upon
treatment of their ED. The efcacy of yohimbine
for ejaculation dysfunction was analysed in 22 of 33
patients. Yohimbine was effective for ejaculation dysfunction in 13 of 22 assessed patients or 59.1%. Specifically, yohimbine was effective in 9 of 14 with
functional, 2 of 3 with psychological and 2 of 5 with
organic ejaculation dysfunction. No side effects were
observed.
Conclusions: Although, the treatment of ejaculation
dysfunction is rather complex, yohimbin appears to be
a promising and safe agent for treatment in some
patients.

VIBRO-EJACULATION & ELECTROEJACULATION CAN AVOID NEEDLESS ICSI
PROCEDURES
Andromeda Andrology Center, P. O. Box 1563,
Email: andrologist@gmail.com; URL:
http://www.andrology.com; Fax: +91 40 2340 5096
Introduction and Aims: Some men are unable to

collect a semen sample by masturbation for use in the
reproductive laboratory on the IUI/ IVF day. Such ejaculatory failure is usually situational, and these same men
have perfectly normal ejaculation at other times. Since
ovulation has already occurred and either the couple or
the physician, or both, are keen not to waste the cycle,
the couple is asked to undergo an ICSI procedure and
a hasty TESA (testicular sperm aspiration) is performed. The aim of this paper is to draw attention to
this entity, and point out that such invasive and expensive procedures are almost never necessary in these situations. The vibro-ejaculator and the electro-ejaculator
can collect semen in these men with a very high success
rate.
Materials, Methods, and Results: 48 patients with
this problem have been treated at the authors center so
far. 41 (85.4%) of these responded to the Multicept
vibro-ejaculator. 6 (12.5%) responded to the Seager
electroejaculator. In 1 patient (2%), a semen sample
could not be collected.
Discussion: In the old days, the male factor in infertility was rst evaluated by the uro-andrologist, and
the rst semen analysis was performed at the uroandrology lab. Ever since IVF (in vitro fertilization) and
ICSI (intra-cytoplasmic sperm injection) became commonplace procedures, however, the rst semen analysis
is usually performed at the IVF lab, and the male factor
in infertility is seldom investigated thoroughly. Not all
IVF labs have uro-andrologists on their panel. Thus,
correctable causes of male infertility are usually
bypassed, and the couples are offered assisted reproductive alternatives instead. This can and should be
avoided.

OUR EXPERIENCE WITH
ELECTROJACULATION (EEJ) FOR
ANEJACULATION OVER A SIX YEAR PERIOD
JANUARY 1999DECEMBER 2004
TR Murali, R Ravichandran, K Venugopal,
S Gurubalaji, Hidayathulla
Department of Urology & Andrology
Meenakshi Mission Hospital, Lake Area, Melur Road,
Madurai, India
J Sex Med 2006;3(suppl 2):108170
162
Introduction: Anejaculation is a condition difcult to
treat. It can be psychogenic, organic or situational. We
report our experience with forty ve anejaculatory
patients who underwent EEJ.
Materials and Methods: Over this period we evaluated
120 patients with anejaculation. Those who had ejaculated earlier but could not ejaculate at intercourse were
diagnosed as psychogenic, those who have never ejaculated at all could be psychogenic or organic. Our protocol involved a thorough examination including full
laboratory checkup (serum testosterone). Counselling
through educational videos and vibrator therapy along
with visual stimulation was the initial approach. 51 were
sucessfully treated thus. 9 had extensive tuberculosis. 8
had ejaculatory duct obstruction as a cause of low volume
ejaculate. 7 of the 120 had vassal and seminal vesical
aplasia/hypoplasia diagnosed by clinical exam/trans
rectal ultrasound. 45 of the remaining underwent EEJ.
25 were diabetics, 6 of these were paraplegics 2 had
bladder neck surgery in childhood and the remaining 12
were resistant psychogenic cases. EEJ was done with the
Seager model 14 machine under general/regional anaesthesia except in paraplegics. In 4 men EEJ could not
produce an ejaculate and they had either severe diabetes
or had brous ejaculatory duct obstruction. Surprisingly
subsequent to EEJ with recounselling 9 patients
regained spontaneous ejaculation.
Conclusion: EEJ is the ultimate therapy producing an
ejaculate in anejaculatory patients. We have found that
in psychogenic/paraplegic patients the semen obtained
could be used for insemination. EEJ can also diagnose
obstruction of ejaculatory ducts missed by trans rectal
ultrasound.

CLINICAL EFFICACY OF RENEWAL SS-CREAM
IN PATIENTS WITH PREMATURE EJACULATION
Young Deuk Choi, Won Jae Yang, Hyung Ki Choi
Department of Urology, Yonsei University College of
Medicine, Seoul, Korea
Objectives: To investigate the clinical efcacy of

renewal SS-cream, the topical agent made from the
extracts of nine natural products for the treatment of
premature ejaculation (PE), we performed randomized,
a double-blind, placebo-controlled phase II study of
patinents with PE.
Methods: Thirty-two patients (mean age 38.3 6.41
years) completed this study. The patients were divided
into 2 groups by applied dose and each group were
instructed to apply the cream on the glans penis 5- and
10-minutes before sexual intercourse in a double-blind
randomized fashion (table). The ejaculatory latency
measured by stopwatch and sexual satisfaction ratio of
patient were investigated twice in screening period and
once after each treatment (2 placebo, 2 5-minutes
before, 2 10-minutes before for a total of six treatJ Sex Med 2006;3(suppl 2):108170
Book of Abstracts
ments). Clinical efcacy was compared with the prolongation of ejaculatory latency and improvement of
the sexual satisfaction ratio before and after each
treatment.
Results: In the screening period, the mean ejaculatory
latency of low and high dose group was assessed at 1.82
0.72, 2.02 0.66 minutes, respectively and neither the
patients nor their partners were satised with their
sexual lives. After treatment, the mean ejaculatory
latency was prolonged to 5.22 4.72 (group A, p =
0.0011), 5.80 4.45 (group A, p = 0.0002), 3.93 2.25
(group B, p < 0.0001), 6.18 4.88 minutes (group B, p
< 0.0001). The improvement of sexual satisfaction to a
grade higher than effective was 8090%. Of 120 trials
of renewal SS-cream, 13 (10.8%) resulted in a sense of
mild local burning and mild pain and there is no statistical difference in each groups. No adverse effect on
sexual function or partner and no systemic side effects
were observed.
Conclusions: According to these results, renewal SScream is effective and safe in the treatment of PE, with
mild local side effects.
Time
Dose
5-minutes before
10-minutes before
Low-dose
(0.1 g)
High-dose
(0.2 g)
Group A
Group A
Group B
Group B

THE RELAXANT EFFECT ON THE RABBIT
CORPUS CAVERNOSUM TISSUE IN VITRO,
WITH SIX EXTRACTS FROM CHINESE HERBAL
MEDICINES
Liu Jihong1, Chen Jun1, Yin Chunping 2, Wang Tao1,
Xiao Hengjun 1, Chen Zhi 1, Sun Chengliang1,
Ye Zhangqun1
1
Objectives: To study the relaxation effects of six extractions from Chinese herbal medicines (neferine, tetrandrine, kakonein, scutellarin, ginsenoside Rg1 and
ginsenoside Rb1) on the corpus cavernosum tissue of
rabbit in vitro.
Methods: Isolated strips of rabbit corpus cavernosum
tissue were precontracted with 10-5 mol/L phenylephine (PE). Relaxation in response to cumulative doses
of six extractions at (10-8 ~ 10-3) mol/L was determined.
Results: On rabbit cavernosal muscle stripes precontracted with PE (10-5 mol/L), neferine, tetrandrine,
kakonein and scutellarin showed dose dependent relaxation, and their IC50 values were 4.60 10-6, 3.73 10-5,
8.03 10-4 and 3.33 10-3 mol/L, respectively.
163
Book of Abstracts
However, in the meantime, it was found that the relaxant effects of ginsenoside Rg1 and ginsenoside Rb1 less
signicant to stripes precontracted with PE, when the
nal concentration was 10-3 mol/L, the relaxations were
only 16.32 5.45% and 11.21 3.10%.
Conclusions: Among the six extracts which showed
relaxant effects to rabbit cavernosal muscle stripes precontracted with PE, neferine was greater signicant
than the other ve extracts.

PREVALENCE OF ERECTILE DYSFUNCTION
AND TREATMENT: PRELIMINARY RESULTS
FROM FOUR COUNTRIES IN THE ASIAN MENS
ATTITUDES TO LIFE EVENTS AND SEXUALITY
STUDY (ASIAN M.A.L.E.S.)
HM Tan1, C-J Ng 2, W-Y Low 2, WA. Fisher 3, M Sand 4
1

3
4
2
Objectives: To examine the prevalence of erectile

dysfunction (ED) and its treatment in a population of
men aged 2075 years in China, Korea, Malaysia, and
Taiwan.
Methods: Participants in the Asian MALES study were
recruited via random-digit dialling in China (n = 2,055),
Korea (n = 2,000), Malaysia (n = 3,000) and Taiwan (n
= 2,000). ED and treatment was assessed via self-report
using a questionnaire previously utilized in a similar
multinational study, modied to ensure appropriate
Asian context.
Results: Prevalence rates of ED varied by country and
increased with age. The proportion of men with ED
who had sought treatment varied by country (Korea
19%, Malaysia 36%, China 27%, Taiwan 31%). These
ndings are consistent with other epidemiological
studies of ED and treatment conducted in other countries and regions of the world.
% Prevalence Rate of ED by Age (years) and Country
Korea
Malaysia
China
Taiwan
2029
3039
4049
5059
60+
1
2
2
1
4
2
3
1
8
4
4
5
15
6
7
8
24
11
24
11
Conclusions: ED is common and increases with age.

However, the majority of men with ED have never
sought treatment despite the availability of safe and
effective therapies. A concerted effort to understand
and address the unmet needs of these Asian men is
urgently required.

STUDIES OF NATURAL COMPONENT ICARIIN
ON ERECTILE DYSFUNCTION
X Zhong-Cheng MD, PhD
Andrology Center of Peking University First Hospital,
Beijing, China
ICARIIN (C33H40O15, molecular weight 676.67) is a

falvonoid isolated from natural drug Epimedii herba,
which is believed to have the effects of enhancing sexual
function traditionally. In order to understand the pharmaceutical mechanisms of ICARIIN on erectile dysfunction, the relaxation effects of ICARIIN on corpus
cavernous smooth muscle (CC) and the effects on intracavernosal pressure (ICP) were investigated through in
vitro and in vivo studies. The effects of ICARIIN on
cGMP/cAMP formation in CC and the inhibiting
activities of PDEs, and the effects of ICARIIN on erectile function (ICP) and NOS isoforms mRNA and
protein expression in CC of castrated and vasculargenic
rats ED models after long term oral administration
were also investigated.
In in vitro study, the results showed ICARIIN have
the signicant relaxation effects on CC of rabbit in a
dose dependent manner (p < 0.001), and IC50 was 4.67
10-4 M. The relaxation effects of ICARIIN on CC
were signicantly inhibited by pre-treating NOS
inhibitors (LNNA) and gunylate cyclase (GC)
inhibitors (ODQ) (p < 0.05). The study in vivo showed
ICARIIN signicantly increased ICP to improve erectile function of rats. However, it was no signicant
inuence on systematic Bp. These results indicated that
ICARIIN might improve erectile function mediated by
NO-cGMP signaling pathway.
In the results of in vivo study with 125I, investigated
cGMP/cAMP formation in rabbit CC showed ICARIIN
signicantly increased cGMP levels in a dose dependent
manner (p < 0.001), in the results of inhibiting activities
on cGMP specic PDE5 and cAMP specic PDE4 by
radioisotope procedure with [3H]cGMP/[3H]cAMP,
ICARIIN showed specic inhibiting activity on PDE5 in
a dose dependent manner (p < 0.001).
In the results of long term oral administration of
ICARIIN (1 mg/kg/day, 5 mg/kg/day, 4 weeks) on erectile fuction (ICP) and NOS isoform mRNA and protein
expression in CC of castrated and vasculargenic rats ED
models, ICARIIN signicantly increased erectile function (ICP) and nNOS and iNOS mRNA and protein
expression in CC by RT-PCR, Western blot and by
immunohistochemical analysis.
With these results we conclude that ICARIIN have
the relaxation effects on CC to enhance erectile function and the pharmaceutical action mechanism of
ICARIIN on erectile dysfunction mediated by specically inhibiting effects of PDE5 activity to increase
cGMP levels in CC. Long term oral administration of
ICARIIN could increase nNOS and iNOS mRNA and
protein expression and improve erectile function, which
J Sex Med 2006;3(suppl 2):108170
164
results indicated that icariin could have prophylactic
and/or therapeutic effects on ED.

ANDROGEN AND SLEEP-RELATED ERECTION
IN VEGETATIVE STATE PATIENTS
Dae Yul Yang, Chang Duk Seo, Sung Yong Kim,
Hayoung Kim
Department of Urology, Hallym University, Kangdong
Sacred Heart Hospital 445 Gildong, Kangdong Ku,
Seoul, 134-701, Korea. yang1408@hallym.or.kr
Introduction: Sleep-related erections occur in all sexually, potent healthy men and it is widely believed that
testosterone and rapid eye movement sleep are related.
The aim of this study is to determine whether sleeprelated erections in vegetative state occur and if so, to
investigate which androgenic factors are related.
Material and Method: 13 vegetative state men ages
1665 years were selected from Hallym university hospital. The men who had erectile dysfunction before
brain injury and mean blood pressure under 90/60
mmHg were excluded. Testosterone, albumin, sex
hormone binding globulin (SHBG), DHEAs were
checked, and calculated bioavailable testosterone and
free testosterone. Erectile functions were assessed using
the RigiScanTM during three nights. Data on the
number of erections, erection duration, minimal and
maximal base tumescence, minimal and maximal tip
tumescence, base and tip rigidity were checked. Erections number were counted and analyzed with androgenic factors.
Results: Sleeprelated erections were noted in 12
patients, ranging in number 19/36 hr and lasted for 2
to 49 min. Sleeprelated erections were signicantly
correlated with age (-0.849, p < 0.01), DHEAs (0.607,
p < 0.05). There was no signicant correlation between
erection number and total testosterone (0.404, p =
0.172), calculated bioavailable testosterone (0.499, p =
0.083), free testosterone (0.400, p = 0.176).
Conclusions: These preliminary ndings suggest that
sleep related erections in vegetative patients decrease
with age independently with testosterone level. Androgenic factor such as DHEAs and bioavailable testosterone also may have a role in sleep related erections.
Further study in a larger sample is needed.

ANALYSIS OF HEART RATE VARIABILITY IN
PATIENTS WITH ERECTILE DYFUNCTION
JB Choi1, BC Ahn1, YS Heo1, MH Cha1, KS Seo1,
YS Kim1, HJ Kim2
Department of Urology, 1Ajou University School of
Medicine, Suwon, 2Dankook University School of
Medicine, Cheonan, Korea
J Sex Med 2006;3(suppl 2):108170
Book of Abstracts
Objectives: The aim of this study is to dene autonomic dysfunctions in patients with erectile dysfunction
(ED) because we cannot explain the cause of ED
without any organic disease like as Diabetes or neurological disorder and so on.
Materials and Methods: Using SA-3000P (Medicore
Inc., Seoul, Korea) electro-cardiographic signals were
obtained from 32 male patients (mean age 53.1 6.60
years) and 85 healthy male controls (mean age 51.4
4.26 years) in a resting state. During rest state, we calculated the mean heart rate, the standard deviation of
the NN interval (SDNN), the square root of the mean
squared differences of successive NN intervals
(RMSSD). At rest we also determined the sympathetic
and parasympathetic heart rate modulation by means of
frequency domain methods like as total power (TD),
very low frequency (VLF), low frequency (LF), high
frequency (HF) and LF/HF ratio. These parameters of
HRV in the ED patients were compared with normal
controls.
Results: There was evidence of decreased TP signals
in patients with ED (P < 0.05) but no signicant differences in other parameters such as RMSSD, SDNN,
VLF, LF, HF or LF/HF ratios.
Conclusions: This preliminary study shows that
patients with ED have different results on HRV study
comparing to controls. Patients with ED exhibit different HRV parameters compared with normal controls.
TP of HRV in patients with ED was lower than normal
controls. This decreased value means that they may
have some kinds of disease or imbalance in the autonomic nervous system we cannot prove it. Thus, we
suggested that ED may be occurred by the autonomic
nervous dysfunction and a study of HRV may serve as
a tool to evaluate altered autonomic nervous system
activity in such patients.

LUTS AND ERECTILE DYSFUNCTION
HM Tan1, EM Khoo2, WY Low 3, WS Tan4, CJ Ng 5
Health Research Development Unit, 2,5Department of
Primary Care Medicine, University of Malaya, Kuala
Lumpur, Malaysia
4
School of Medicine, Cardiff University
1,3
Objective: To examine the association between LUTS

and erectile dysfunction (ED).
Method: A community based study where 500 men
aged 50 years and above living in the Klang Valley,
Malaysia, were randomly selected from the electoral
poll listing. 351 participated (70% response rate).
One-to-one interview were conducted using structured
questionnaires that included demographic data, IPSS,
IIEF-5, lifestyle and health behaviors, self-reported
medical conditions, sexual health and health seeking
behavior.
165
Book of Abstracts
Results: Mean age was 58 7 years with a range of
5093 years old. 41% are Chinese, 29% Indians, 28%
Malays and 3% others. Almost 90% of the men had at
least a secondary, college or tertiary education. Using
IIEF-5, 68.9% men have ED; 30.2%, 16%, 22.8% are
in the mild, moderate and severe categories respectively.
Using IPSS, the prevalence for mild, moderate and
severe LUTs is 70.9%, 24.2% and 4.8% respectively.
The prevalence of LUTS and ED increases with age (p
< 0.05, p < 0.001 respectively). The prevalence of mild,
moderate and severe ED were 29.7%, 14.5%, 18.9%
(total 63.1%) for mild LUTs; 31.8%, 16.5%, 32.9%
(total 81.2%) for moderate LUTS and 29.4%, 35.3%,
29.4% (total 94.1%) for severe LUTs. There was a signicant association between LUTS and ED (p < 0.001,
OR = 2.93, 95% CI 1.639, 5.237).
Conclusions: ED is associated with LUTS as expected.
The prevalence of LUTS and ED increases with age.
As the severity of LUTS increases, the prevalence of
ED increases.
and CASOP, testosterone and EP, Testosterone and

CASOP, and negative linear correlation was following
EP and PD, EP and FTM, PD and CASOP, CASOP
and FTM, testosterone and PD, testosterone and FTM.
Key Words: Dynamic infusion cavernosometry,
Hemodynamic parameters, Testosterone.
RELATIONSHIPS BETWEEN HEMODYNAMIC

PARAMETERS AND SERUM TESTOSTERONE IN
IMPOTENT MEN DURING DYNAMIC INFUSION
CAVERNOSOMETRY
Seong Choi, In Keun Kim, II Moon, Du Yong Kim,
Taek Sang Kim
From the Department of urology, Kosin University
Hospital, Busan, South Korea
Aim: To evaluate relationships between hemodynamic

parameters and serum testosterone and free testosterone and IIEF-5 in impotent men during dynamic
infusion cavernosometry.
Methods: The charts of 110 patients undergoing
dynamic infusion cavernosometry from January 2002 to
June 2005 were prospectively reviewed. We compared
equilibrium pressure (EP, mmHg), cavernosal artery
occlusion pressure (CASOP, mmHg), pressure-decay
(PD, mmHg) ow-to-maintain (FTM, ml/minute) as
hemodynamic parameters and serum testosterone
(ng/ml) and free testosterone and IIEF-5. We analyzed
each variable with coefcient of correlation and calculated Pearsons coefcient (r) and signicance was
dened as p < 0.05.
Results: Testosterone and EP, testosterone and
CASOP, EP and CASOP, PD and FTM reveals positive
linear correlation, EP and PD shows strong negative
linear correlation (r = -0.704), Testosterone and PD,
Testosterone and FTM, EP and FTM, PD and CASOP,
CASOP and FTM shows negative linear correlation.
Free testosterone shows positive linear correlation with
testosterone and no relations with other parameters.
IIEF-5 shows no relations with other parameters.
Conclusions: Positive linear correlation was following
Testosterone and free testosterone, PD and FTM, EP
Presenting author name: SEONG CHOI

Address: Department of Urology, Kosin University
Hospital, 34 Amnam-Dong, Seo-Gu, Busan, South Korea
email: schoi@ns.kosinmed.or.kr

COLOR DOPPLER ULTRASOUND ASSESSMENT
OF PENILE VASCULAR SYSTEM IN MEN WITH
Y-C Kuo1, Y-H Lai1, C-S Hung1, T-P Huang1,
S-D Chung1, J-T Hsieh2
Department of Urology, Taipei City Hospital, Taipei,
Taiwan,
2
Department of Urology, National Taiwan University,
Taipei, Taiwan
Purpose: We evaluated the penile vascular function by

color Doppler ultrasonography (CDU) in patients with
erectile dysfunction.
Materials and Methods: A total of 102 gentlemen
received color Doppler ultrasonography to evaluate
their penis in our ED clinic. Intracavernous injection
with alprostadil 20 mg was given rst. About 5 to 10
minutes later, penile hemodynamics were measured by
CDU subsequently. Parameters including maximal
diameters of right and left cavernous arteries, peak systolic velocity (PSV), end diastolic velocity (EDV) and
resistive index (RI) were recorded. All cases were examined by the same operator (Y-C Kuo).
Results: Thirty-four percent of the patients were 60
years old or older. The older the patient, the lower PSV
and higher EDV of cavernous arteries were measured.
Consequently, RI of both sides of cavernous arteries was
lower in older patients than that in younger ones. (0.74
0.12, 0.72 0.09 in patients aged 80 s and 1.03 0.06,
1.04 0.05 in patients aged 20 s). Of these 102 patients,
3 (2.9%) had both sides and 27 patients (26.5%) had
one side arterial insufciency. 56 patients (54.9%) were
diagnosed as veno-occlusive incompetence. Overall
penile vascular abnormalities could be detected in
83.3% of all patients. They were found more frequently
in patients aged 60 or older than those aged less than
60 (97% versus 65%, p = 0.001).
Conclusions: Veno-occlusive dysfunction accounts for
the most common cause of erectile dysfunction in men.
Penile vascular abnormalities can be observed in 83.3%
of patients with erectile dysfunction. The function of
penile vascular system goes down as the aging process
proceeds.
J Sex Med 2006;3(suppl 2):108170
166
Book of Abstracts
WATER-SOLUBLE LIPOPOLYMER AS A NOVEL

GENE CARRIER TO CORPUS CAVERNOSUM
INHIBIT THE EXPRESSION OF PDE5A3 GENE IN

HUMAN CORPUS CAVERNOSUM SMOOTH
MUSCLE CELLS BY RNA INTERFERENCE
M Lee1, JK Ryu2, SM Oh2, E Lee1, HY Shin2,

SU Song1, S Piao2, JK Suh1,2
1
Clinical Research Center, Department of Urology,

Inha University School of Medicine, Republic of Korea
Correspondence to JK Suh, MD, PhD, 7-206 3rd ST.
Shinheung-Dong Jung Gu, 400-711, jksuh@inha.ac.kr
Objectives: Adenovirus or naked plasmid DNA

(pDNA) has been used to deliver the therapeutic gene
into corpus cavernosum. However, potential risk of viral
vector and inefciency of naked pDNA have limited
their clinical application. In this study, water-soluble
lipopolymer (WSLP) was evaluated as a gene carrier to
corpus cavernosum.
Methods: The gene delivery efciency of
WSLP/pCMV-Luc to A7R5 and human corpus cavernous smooth cells was evaluated by luciferase assay
and compared to poly (ethylenimine) (PEI)/pCMV-Luc
or pCMV-Luc group. To optimize the N/P (nitrogen
atom of polymer/phosphate of pDNA) ratio of the
complex in vivo, the WSLP/pCMV-Luc complex was
formulated at a different ratio and injected into the
corpus cavernosum of Sprague-Dawley rat (300
350 gm). Based on this result, transfection efciency of
the WSLP/pDNA complex (20/1 N/P ratio) was compared to the group injected with the PEI/pDNA
complex (5/1 N/P ratio) or pDNA at day 2. We also
evaluated the effect of different DNA dose and duration of penile base compression on the transfection efciency 2 days after injection of the WSLP/pDNA
complex (20/1 N/P ratio).
Results: In vitro study revealed that the luciferase
expression by WSLP was comparable to PEI and much
higher than that of pDNA (p < 0.01). pDNA did
not show any cytotoxicity and WSLP has much less
cytotoxicity compared to PEI (p < 0.01). In vivo
study showed the highest transgene expression of
WSLP/pDNA at a 20/1 N/P ratio. Both WSLP and
PEI showed much higher gene transfer efciency than
pDNA in vivo (p < 0.01). Transfection efciency was
increased in dose-dependent and compression timedependent manner.
Conclusions: WSLP has high transfection efciency
and very low cytotoxicity to both smooth muscle cells
in vitro and cavernosum in vivo, which suggest that it is
an efcient and safe gene carrier to corpus cavernosum
for future gene therapy.
Jihong LIU, Zhaohui ZHANG, Tao WANG, Zhan YIN,

Hengjun XIAO, Shogang WANG, Zhangqun YE
Department of Urology, Tongji Hospital, Tongji Medical
College, Huazhong University of Science and
Objectives: To construct the expression plasmids of

small hairpin RNAs (shRNAs) targeted human
PDE5A3 gene and evaluate their activities of inhibiting
the expression of PDE5A3 gene in the human corpus
cavernosum smooth muscle cells.
Methods: Six pairs of template DNA sequences against
small hairpin RNA (shRNA) of human PDE5A3 gene
were designed and synthesized, then they were subcloned to pGenesil-1 expression plasmids after reannealing, which construct the recombinant plasmids
HPDE5A3-n-pGenesil-1 (n = 1 ~ 6). The recombinant
plasmids were transfected into smooth muscle cells of
human corpus cavernosum lasting 48 h. The effect
of the recombinant plasmids on the expression of
PDE5A3 gene in smooth muscle cells were detected by
RT-PCR and Western blot.
Results: It was conrmed that the aim sequences of
recombinant plasmids were obtained by restrictive
enzyme digestion and sequence analysis. RNAi was
induced successfully after transfecting the recombinant
plasmids into the smooth muscle cells. The PDE5A3
mRNA and protein in the transfected smooth muscle
cells was knocked down 64.14%, 49.21%, 17.07%,
29.85%, 0.86%, 8.57% by the recombinant plasmids
HPDE5A3-n-pGenesil-1 (n = 1 ~ 6) respectively.
Conclusion: Successful RNAi of shRNAs targeted
human PDE5A3 have the characteristics of sequence
selectivity in vitro. RNAi can inhibit the expression of
PDE5A3 gene in the smooth muscle cells of human
corpus cavernosum. So RNA Interference is a possible
new approach for ED gene therapy.

THE USEFULNESS OF NONCONTACT
ERECTIONS FOR POTENCY CHECK IN MALE
RATS
YS Lho1, SH Paick1, HG Kim1, H Wessells2, HW Lee3
Konkuk University, 2University of Washington,
Harborview Medical Center, 3Dongguk University
1
Potency check is important and should be preceding in

most researches about the sexual function with male
rats. Male rats could display penile erections in the presence of inaccessible females. We examined the usefulJ Sex Med 2006;3(suppl 2):108170
167
Book of Abstracts
ness of these noncontact erections (NCEs) for the
potency check.
The 25 Long-Evans male rats (8 weeks old) were
used in this study. We checked their potency by observation of copulations with estrous females. After then,
NCEs were checked. All rats were retested under the
same conditions at least three times.
19 of 25 male rats (76%) were potent. And 11 of 25
male rats (44%) displayed NCEs. All these 11 rats were
potent. 6 impotent male rats didnt show NCE.
These results indicated that NCEs in male rats could
be a useful method for potency check.

EFFECT OF GINSENOSIDE RB1 ON HUMAN
SPERM MOBILITY OF ASTHENOSPERMIA IN
VITRO
Liu Jihong1, Chen Zhi1, Yin Chunping 2
1
Objectives: To study the effects of different concentration ginsenoside Rb1 on human sperm mobility of
asthenospermia in vitro and to investigate its possible
mechanisms.
Methods: By using computer-assisted sperm analysis
(CASA), we have observed the effects of different concentration ginsenoside Rb1 on human sperm mobility
in vitro. The sperm that obtained by masturbation and
prepared by swim-up technique from 25 men with
asthenospermia were incubated in different concentration ginsenoside Rb1 respectively. Measurements were
carried out at 30, 60 and 90 minutes in all specimens.
Results: Low concentration ginsenoside Rb1 can
increase human sperm mobility of asthenospermia.
1 mmol/L, 10 mmol/L and 100 mmol/L ginsenoside Rb1
can increase percentage of viability (Mot), percentage
of progressive mobile sperm, the curvilinear velocity
(VCL), the straight line velocity (VSL) and average path
velocity (VAP). Compared with control group, the difference is distinct (P < 0.05). The effect of 100 mmol/L
ginsenoside is not signicant. Rb1 High concentration
ginsenoside Rb1 can inhibit sperm mobility of
asthenospermia.
Conclusion: Low concentration ginsenoside Rb1
increase human sperm mobility of asthenospermia in
vitro while high concentration has inhibition effect. 1 ~
100 mmol/L is the effective concentration and ginsenoside Rb1 in the level is valid in each time segment. The
mechanism may be activation of NO/cGMP pathway
and reinforcement of sperm metabolism.

EFFECTS OF TETRANDRINE ON CYTOSOLIC
FREE CALCIUM CONCENTRATION IN CORPUS
CAVERNOSUM SMOOTH MUSCLE CELLS OF
RABBITS
Jihong LIU 1, Jun CHEN 1, Tao WANG 1, Chunping Yin 2,
Hengjun XIAO1, Bo LIU 1, Zhi CHEN 1, Zhangqun YE 1
1
Department of Urology, Tongji Hospital, 2Department
of Pharmacy, Tongji Medical College of Huazhong
University of Science and Technology, Wuhan, Hubei
430030, China
Objective: To study the effects of tetrandrine (Tet) on

Cytosolic free calcium concentration [Ca2+]i in cultured corpus cavernsum smooth muscle cells of rabbits.
Methods: After Tet (1 mmol/L, 10 mmol/L, 100 mmol/L)
were incubated with cultured rabbit corpus cavernosum
smooth muscle cells separately, [Ca2+]i was measured
by cation measuring system using Fluo-2/AM as a
Ca2+-sensitive uorescenct indicator.
Results: Tet (1 mmol/L, 10 mmol/L, 100 mmol/L) had
no effect on the resting [Ca2+]i (P > 0.05); In the presence of 2.5 mmol/L extracellular Ca2+, Tet (1 mmol/L,
10 mmol/L, 100 mmol/L) had inhibitory effects on
[Ca2+]i elevation induced by high potassium and
Phenylephrine (PE) in concentration-dependent
manner (P < 0.05); In the absence of extracellular Ca2+
containing egtaic acid (EGTA), at the concentration of
1 mmol/L and 10 mmol/L, Tet had no inhibitory effects
on [Ca2+]i elevation induced by PE (P > 0.05).
However, 100 mmol/L Tet inhibited [Ca2+]i elevation
induced by PE (P < 0.05).
Conclusions: Tet inhibited the Ca2+ inux from
extracellular via voltage-actived Ca2+ channel and PEreceptor-operated Ca2+ channel. At a high concentration, Tet might inhibit the cytosolic calcium pool
release in cultured rabbit corpus cavernsum smooth
muscle cells.

ANGIOTENSIN CONVERTING ENZYME (ACE)
GENE POLYMORPHISM INTERACTION WITH
HYPERTENSION IN ERECTILE DYSFUNCTION
Wardihan-Sinrang), I. Jusuf*), I. Patellongi*),
S. Bakri*), S. Rauf*), S. Sartono**), A. Adimoelja**)
*) School of Medicine Hasanuddin University
Makassar, Indonesia
**) School of Medicine Hang Tuah University,
Surabaya, Indonesia
Aim of the study: The incidence of erectile dysfunction (ED) is well known in patients with hypertension.
The role of Angiotensin Converting Enzyme (ACE)
gene in hypertension has also been documented in
several studies. This study is focused to highlights the
J Sex Med 2006;3(suppl 2):108170
168
interaction between ACE gene in patients with hypertension and the incidence of ED.
Methods: 153 patients were recruited in the study (age
4070 years): 87 subjects with hypertension and 66 were
normo-tension subjects. ED was diagnosed with the aid
of the International Index of Erectile Function-5 (IIEF5) questionnaires. The ACE polymorphism genes were
detected by the polymerase chain reaction (PCR).
Results: 52 (59.8%) from the 87 hypertension subjects
indeed suffered ED, while only 16 (24.2%) from the 66
normo-tension subjects were observed of having ED. A
signicant (p < 0.05) correlation were observed by Yates
Correction X2. In the hypertension subjects with genotype DD more EDs were observed with an odd ratio of
15.9 when compared to normo-tension subjects with
non-DD genotype. In the normo-tension subjects with
genotype DD, EDs were found with an odd ratio of
4.9 when compared to normo-tension subjects with
non-DD.
Conclusion: Hypertension and ACE gene with genotype DD inuenced the occurrence of ED, both may
interact and potentiate the incidence of ED with an odd
ratio of 15.9.
Key Words: gene polymorphism angiotensin converting enzyme, hypertension, erectile dysfunction.
Plenary J: Arousal and Orgasm in the

Fairer Sex
WHAT ARE THE ISSUES?
Lorraine Dennerstein
1
Office for Gender and Health, Department of

Psychiatry, The University of Melbourne
This lecture will review current revisions to diagnostic

categories for female sexual arousal disorder and orgasmic disorder. Data from epidemiological studies will be
reviewed for prevalence of these disorders in different
countries and different age groups. Where possible
these studies will be used to demonstrate any associations between these aspects of sexual function and
various other factors including relationship, psychological, physical and lifestyle factors. The relative effect of
relationship, hormonal and psychosocial factors on
arousal will be modeled using longitudinal data from
the Melbourne Womens Midlife Health Project. This
is the longest running population-based longitudinal
detailed study of mid-aged women worldwide. Underlying neurotransmitter mechanisms for arousal and
orgasm will be described. Lastly current approaches to
management of female sexual arousal disorder and
orgasmic disorder will be summarized.
J Sex Med 2006;3(suppl 2):108170
Book of Abstracts
Plenary K: Sex Steroids in Female Sexual
Dysfunction
SEX STEROIDS IN FEMALE SEXUAL
DYSFUNCTION: ISSUES, ASSESSMENT &
TREATMENT
JV Conaglen1, HM Conaglen2
1
Faculty of Medical and Health Sciences, University of

Auckland, Hamilton, New Zealand. Waikato Clinical
School, Peter Rothwell Academic Centre, Waikato
Hospital Pembroke Street, Private Bag 3200,
Hamilton. Email: conaglen@xtra.co.nz
2
Psychology Department, University of Waikato,
Hamilton, New Zealand. The Psychology Centre, 2
Von Tempsky Street, P O Box 4423, Hamilton. Email:
helen@tpc.org.nz
This presentation examines current issues, controversies and treatment approaches for several female sexual
dysfunctions. Framed around the sexual response cycle,
discussion of denitional issues is followed by a review
of recent research and clinical approaches to sexual
desire problems, womens arousal and orgasm difculties. The role of oestrogen replacement therapy in postmenopausal women following recent landmark studies
will be presented. The pitfalls in the assessment of
testosterone levels and subsequent use of testosterone
in the treatment of low sexual desire in women will be
critically appraised, with suggestions regarding an evidence-based approach for women with these problems.
Findings from a range of studies investigating aspects
of female sexual desire and arousal will be reviewed and
the talk will conclude with a brief review of the clinical
approach for the assessment and management of female
sexual dysfunction.
Plenary L: Research in Sexual Medicine

CURRENT TRENDS AND FUTURE DIRECTIONS
PG Adaikan
The last three decades have witnessed exciting transformations in the diagnosis and treatment of sexual
medicine concerns in men. These clinical developments
have been meticulously preceded by scientic evidence
in the form of basic research investigations and the
translation has contributed in many ways to our understanding of physio-pharmacology of penile erection,
prognosis of erectile dysfunction (ED) and related
sexual problems in men. The therapeutic advents have
extended from prostheses to unprecedented search for
pharmacological measures leading to clinical cure. Such
progress included identication of the physiological,
pathophysiological and psychological components of
169
Book of Abstracts
erectile function and dysfunction, the multifaceted
receptoral pathways, intracavernosal use of papaverine,
phentolamine and prostaglandin E1 and the appropriate
manipulation of NO-cGMP pathway to improve erection through phosphodiesterase (PDE) inhibition. With
the recent identity that patients with low testosterone
are poor responders to PDE inhibitors, boosting of
testosterone levels has claimed considerable attention
lately. The relentless quest for the best treatment for
ED has led to many agents including nitric oxide
donors, guanylate cyclase activators, potassium channel
openers and Rho-kinase inhibitors with the potential to
overcome some limitations of the other measures and
promise of clinical application in refractory cases. Basic
and clinical studies have also tested the efcacy of
yohimbine, L-arginine, adenylate cyclase activators,
dopamine receptor agonists, melanocyte-stimulating
hormone analogues, endothelin antagonists in addition
to vasoactive intestinal polypeptide and calcitonin gene
related peptide with variable success rates. Once commonly used penile prostheses and vacuum devices now
have a limited role in the management of ED, only in
patients in whom all other therapeutic measures have
failed. Cloning of nitric oxide synthase, hMaxiK,
growth and neurotrophic factors has opened a new era
in the use of gene therapy for ED and the day for autologous penile tissue implants and stem cell related technology is not too far. To compliment the advances in
male sexual concerns, our focus has also oriented
towards fundamental scientic research in female sexual
dysfunctions (FSD) in the last few years. Together with
the drug-management for ED and FSD (sexual arousal,
desire and pain disorders), the co-existent conditions in
males such as ejaculatory problems, desire, arousal and
orgasmic dysfunctions and interpersonal conicts have
to be recognised and managed for better long-term
therapeutic outcome and satisfaction.

ANDROGENS AND THE MIDDLE-AGED AND
OLDER AUSTRALIAN MALE: MEN IN
AUSTRALIA TELEPHONE SURVEY (MATES)
DM de Kretser on behalf of the Andrology Australia
Longitudinal Study Working Group1
1
Andrology Australia, c/o Monash Institute of Medical

Research, Monash Medical Centre, 246 Clayton Road,
Clayton, Vic 3168. http://www.andrologyaustralia.org
Background: Advancing age impacts on male reproductive health. While the diagnosis and treatment of
androgen deciency in younger men is clearly dened,
there is yet no consensus on the denition of androgen
deciency in older men. Nonetheless, with the popularisation of terms such as male menopause there is a
growing belief that testosterone treatment may be a
cure-all for symptoms of ageing. Using the Men in
Australia Telephone Survey (MATeS), this study

describes the use of testosterone replacement therapy
(TRT), concerns and health behaviours in a representative sample of Australian men aged 40 years and over.
Methods: A stratied random national sample of 5990
men agreed to participate in a 20-minute standardised
computer assisted telephone interview (78.5% response
rate). Equal numbers of men in the age strata 4049,
5059, 6069 and 70+ years were surveyed with ndings census-standardised to the national population.
Broad aspects of mens health and well-being, including
reproductive health, were explored.
Results: An age-related increase in the proportion of
men being tested to check testosterone levels was seen,
(4.5% of men aged 4049 years to ~12% of men aged
60+ years). While 2.2% had been prescribed TRT, less
than 1% of men were currently using testosterone.
Mens knowledge about testosterone was limited with
~25% of men overall being unfamiliar with the term,
increasing to ~50% of men over 70 years. While more
men over 70 years thought they suffered from symptoms of androgen deciency (35%) compared to
younger men (40 to 59 years, 12%), younger men were
more concerned about male menopause.
Conclusion: This study represents the rst Australiawide survey of reproductive health and attitudes of
middle aged and older men. While prevalence rates for
androgen deciency could not be estimated, an agerelated increase in the proportion of men being tested,
prescribed and treated with testosterone is apparent.
While androgen deciency may be under-diagnosed
and under-treated in young men, older men in the community may be overtreated which may be partly related
to mens lack of understanding and awareness of these
conditions.

TESTOSTERONE REPLACEMENT IN THE OLDER
MALE
B Stuckey
Keogh Institute for Medical Research, Nedlands, WA
6009
Recent studies have documented temporal and regional

trends in testosterone prescribing in Australia1.
Increases in testosterone prescribing have been shown,
which corresponds with the promotion of androgen
therapy for the ageing. In Western Australia, this rise
in prescribing has been the most obvious and corresponds with the opening of entrepreneurial clinics
aimed at the ageing-male market.
Testosterone therapy clearly benets patients with
documented hypogonadism associated with conditions
such as Klinefelters Syndrome and hypopituitarism.
Current prescribing guidelines allow for this, regardless
of age. However, for the use of testosterone in middle
J Sex Med 2006;3(suppl 2):108170
170
aged and older men with borderline low serum levels of
testosterone, the evidence for both efcacy and safety is
yet to be established. The original description of the
effectiveness of testosterone therapy for the vicissitudes
of age has been shown to be no more than a powerful
placebo effect.2
Most studies show a gradual decline in testosterone
levels with age, but the clinical consequences of this are
not known. Other age related conditions include muscular frailty, loss of bone mass, cognitive decline and
erectile dysfunction, but whether testosterone deciency has a causal role is not clear. More importantly,
it has not yet been established that testosterone therapy
has a role in correcting these conditions.
Compared to women, knowledge about the safety of
sex hormone replacement in men is, by contrast, in
its infancy. No studies have been conducted for long
enough to identify the long-term risks of androgen
therapy in ageing. Large, long-term, prospective, randomized, placebo-controlled studies are needed to
establish if there is benet for specic symptoms and to
identify potential risks in regard to testosterone therapy
in ageing men.
Handelsman DJ. Trends and regional differences in testosterone prescribing in Australia, 19912001. Med J Aust
2004; 181: 419422.
Cussons AJ, Bhagat CI, Fletcher SJ, Walsh JP. Brown-Sequard
revisited: a lesson from history on the placebo effect of
androgen treatment. Med J Aust 2002; 177: 678679.

DIAGNOSTIC ISSUES FOR ANDROGEN
DEFICIENCY
K Sikaris1 on behalf of the Andrology Australia
Androgen Testing Working Group1, RCPA-AACB QAP
Programs, c/o Melbourne Pathology, 103 Victoria
Parade, Collingwood, Vic 3066
Background: The need for well-dened reference

intervals for reproductive hormones is essential in the
J Sex Med 2006;3(suppl 2):108170
Book of Abstracts
diagnosis of androgen deciency but many current assay
protocols fail to meet these requirements, particularly
for testosterone (T).
Methods: As part of an external National Quality
Assurance Program supervised by the Royal College of
Pathologists of Australasia (RCPA) and the Australasian
Association of Clinical Biochemists (AACB), a survey
was conducted to determine the reference intervals and
methods used by laboratories in Australia for measuring total T, LH and FSH in men. Furthermore, sera
from 124 healthy and reproductively normal men
(2135 years), the performance of 8 fully-automated
multiplex assay platforms currently used for routine
assay of total T, LH and FSH was also examined in
order to dene method specic reference intervals
using non-parametric analyses. These intervals were
then compared both between platforms and with those
provided by kit manufacturers or reported by the
laboratories.
Results: The ndings of the survey conrmed that reference intervals varied widely between laboratories,
even those using the same analytical system. Very few
laboratories developed reference intervals in-house on
reference populations, instead relying on kit inserts or
historical data. Using the serum panel, total T reference
intervals showed wide variation at the lower end
(7.612.4 nM) and were up to 6.5 nM (median 2.6 nM)
higher than those in current use. Serum FSH and LH
values showed better agreement between assays but
these new intervals also varied widely from those
currently in use.
Conclusion: Clinically signicant differences in existing T assay reporting protocols are apparent that would
affect the diagnosis of androgen deciency. The results
highlight the need for calibration of T assays against
a mass standard to provide uniform results.
Gonadotropin assays show less variability between platforms potentially allowing the use of a common reference interval, but current quoted intervals are not
optimal for assisting in the diagnosis of azoospermia or
androgen deciency.

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Asia Pacific Society for Sexual

Cairns Convention CentreHall A

The Journal of Sexual Medicine Debate:

Day 2: Wednesday 5 October 2005

Cairns Convention CentreHall A

The Scientific Program

Michael Lowy (Sydney) / Yasusuke Kimoto (Fukuoka)

Plenary A: ED: Prevalence and Clinical Correlates

Sudhakar Krishnamurti (Hyderabad) / Hui Jiang (Beijing)

Kuang-Kuo Chen (Taipei) / Hyung-Ki Choi (Seoul)

Plenary C: Genes and Gene Therapy

MORNING TEA IN THE EXHIBITION AREA

Symposium A: Phosphodiesterase Inhibition

Symposium B: Iatrogenic Sexual Dysfunction

Ganesh Adaikan (Singapore) / Tai Young Ahn (Seoul)

Sae-Chul Kim (Seoul) / Thomas Hwang (Taipei)

Phosphodiesterase (PDE) inhibition and its implications

Iatrogenesis: A cause of sexual dysfunction

Maximising the safe and efficacious use of

Iatrogenic sexual dysfunction in oncology

Phosphodiesterase 5 inhibitors for ED: What are the

Cardiovascular medications and sexual dysfunction

Phosphodiesterase 5 inhibition: Applications beyond

Iatrogenesis and sexual dysfunction: The Urologists

Non-surgical alternatives to phosphodiesterase 5

Managing the patient with penile fibrosis

Podium Presentations (Concurrent)

J Sex Med 2006;3(suppl 2):108170

APSSM 2005 Final Program

Podium B: Basic Science Research 1

Michael Lowy (Sydney) / Sung Won Lee (Seoul)

Edsal Gatchalian (Manila) / Johnny S Lin (Taipei)

70 Role of intracavernous vasoactive self injections

10 Penile expression of nitric oxide synthase isoforms and

84 Comparison of satisfaction rates and erectile

30 Effects of metformin on the expression of nitric

23 Prevalence of metabolic syndrome in the Klang

49 The effect of oxytocin antagonist and w-conotoxin on

76 Prevalence of comorbidities among men with

45 Effects of chronic type 5 PDE inhibition on the erectile

36 Coronary heart disease risk of men with erectile

46 The effects of DA-8159, a novel PDE5 Inhibitor

32 What difference causes chronic arterial insufficiency

47 Effects of DA-8159, a PDE5 inhibitor, on intraurethral

20 Erectile dysfunction caused by fear of infertility

51 The effects of intracavernous administration of L-Arginine

Cairns Convention CentreHall B

Lunch and Pfizer Symposium

Welcome and Introduction

Delivering better erections for better sex

Mechanisms of sildenafil citrate: The science behind better erections

Question and answer session

AFTERNOON TEA IN THE EXHIBITION AREA

Podium Presentations (Concurrent)

Podium C: Hormone-Related Research

Podium D: Basic Science Research 2

John Conaglen (Auckland) /

Michael Gillman (Brisbane) /

6 Mechanisms of action of human growth hormone

28 Molecular expression of CLC-3 Chloride channel

J Sex Med 2006;3(suppl 2):108170

APSSM 2005 Final Program

44 Exploring new therapeutic target for ED: Chloride channels