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Association Between Ejaculatory Dysfunction and Post-Void Dribbling After Urethroplasty. Urology 2021; 153:320-326. [PMID: 33901530 DOI: 10.1016/j.urology.2021.04.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 04/07/2021] [Accepted: 04/12/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To determine whether ejaculatory dysfunction (EjD) and post-void dribbling (PVD) after urethroplasty are associated, providing evidence for a common etiology. METHODS We reviewed a prospectively maintained database for first-time, anterior urethroplasties. One item from the Male Sexual Health Questionnaire (MSHQ) assessed EjD: "How would you rate the strength or force of your ejaculation". One item from the Urethral Stricture Surgery Patient-Reported Outcome Measure (USS-PROM) assessed PVD: "How often have you had slight wetting of your pants after you had finished urinating?". The frequency of symptoms was compared after penile vs. bulbar repairs, and anastomotic versus augmentation bulbar repairs. Associations were assessed with chi-square. RESULTS A total of 728 men were included. Overall, postoperative EjD and PVD were common; 67% and 66%, respectively. There was a significant association between EjD and PVD for the whole cohort (p<0.0001); this association remained significant after penile repairs (p=0.01), bulbar repairs (p<0.0007), and bulbar anastomotic repairs (p=0.002), but not after bulbar augmentation repairs (p=0.052). EjD and PVD occurred at similar rates after penile and bulbar urethroplasty. The rate of EjD was similar after bulbar augmentation and bulbar anastomotic urethroplasties, but PVD was more common after bulbar augmentation (70% vs. 52%) (p = 0.0001). CONCLUSION EjD and PVD after anterior urethroplasty are significantly associated with one another, supporting the theory of a common etiology. High rates after penile repairs argue against a bulbospongiosus muscle damage etiology, and high rates after anastomotic repairs argue against graft sacculation. More work is needed to better understand and prevent symptoms.
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Ko K, Lee WK, Cho ST, Lee YG, Shin TY, Choo MS, Han JH, Lee SH, Oh CY, Cho JS, Jeong HC, Yang DY. Effect of udenafil administration on postmicturition dribbling in men: a prospective, multicenter, double-blind, placebo-controlled, randomized clinical study. Aging Male 2020; 23:571-578. [PMID: 30651036 DOI: 10.1080/13685538.2018.1545834] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
PURPOSE Postmicturition dribbling (PMD) is a stressful symptom in middle-aged men characterized by urinary leakage after the completion of normal voiding. Appropriate treatments have not yet been introduced. This study assessed the efficacy of treatment of PMD with 75 mg udenafil daily. MATERIALS AND METHODS The study included 138 men with regular sexual lifestyles. The Hallym PMD questionnaire (HPMDQ) was used to assess PMD symptoms. After all basic examinations, patients were randomly assigned to either udenafil or placebo. Patients completed the surveys, uroflowmetry (UFM), a bladder scan, and the paper test during the follow-up visit. RESULTS The mean age of the patients was 57.6 years. PMD with one of every three urinations was experienced by 59 patients (42.8%), whereas 45 patients (32.6%) experienced PMD with two of every three urinations. PMD with every urination was experienced by 34 patients (24.6%). More than half of the patients (89 patients, 65.4%) indicated that persistent PMD symptoms would likely result in moderate to severe discomfort in their daily activities. As time passed, the udenafil group showed significant improvement in PMD symptoms (p = 0.001). CONCLUSION Udenafil 75 mg once daily can be an effective treatment for patients with PMD symptoms.
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Affiliation(s)
- Kyungtae Ko
- Department of Urology, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Won Ki Lee
- Department of Urology, Hallym University Chuncheon Sacred Heart Hospital, Chuncheon, Korea
| | - Sung Tae Cho
- Department of Urology, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea
| | - Young Gu Lee
- Department of Urology, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea
| | - Tae Young Shin
- Department of Urology, Hallym University Chuncheon Sacred Heart Hospital, Chuncheon, Korea
| | - Min Soo Choo
- Department of Urology, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
| | - Jun Hyun Han
- Department of Urology, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
| | - Seong Ho Lee
- Department of Urology, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
| | - Cheol Young Oh
- Department of Urology, Hallym University Hallym Sacred Heart Hospital, Gyeonggi, Korea
| | - Jin Seon Cho
- Department of Urology, Hallym University Hallym Sacred Heart Hospital, Gyeonggi, Korea
| | - Hyun Cheol Jeong
- Department of Urology, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Dae Yul Yang
- Department of Urology, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea
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Yang DY, Jeong HC, Ko K, Lee SH, Lee SK, Shin TY, Cho JS, Lee WK. Effect of tadalafil 5 mg on post-micturition dribble in men with lower urinary tract symptoms: a multicentre, double-blind, randomized, placebo-controlled trial. BJU Int 2019; 124:862-869. [PMID: 31207030 DOI: 10.1111/bju.14849] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To compare the effects of taking tadalafil 5 mg and placebo once daily on post-micturition dribble (PMD) in men with lower urinary tract symptoms (LUTS). PATIENTS AND METHODS Our prospective, randomized, double-blind, placebo-controlled, multicentre trial enrolled 102 men with PMD and other LUTS. PMD was assessed using the Hallym Post-Micturition Dribble Questionnaire (HPMDQ) and according to PMD volume. Over a 12-week period, patients took either tadalafil 5 mg (n = 51) or placebo (n = 51) once daily and their HPMDQ and PMD volume results were evaluated. Adverse events (AEs) were also reported. RESULTS Over the course of 12 weeks, total HPMDQscores and PMD volumes improved significantly more in the tadalafil group than in the placebo group (reduction of total HPMDQ score of ≥2 points in the tadalafil and placebo group in 68.8% and 31.9% of patients (P < 0.001) and decreased mean PMD volume in the tadalafil and placebo group at 0.48 mL and 0.22 mL, respectively (P = 0.046). Specifically, PMD frequency decreased and quality of life increased significantly more in the tadalafil group than in the placebo group (P = 0.029 and P < 0.001, respectively). Furthermore, 66.7% of the tadalafil group reported moderate and significant PMD improvement, whereas only 4.2% reported that tadalafil was ineffective. Treatment-emergent AEs did not significantly differ between the groups (all P > 0.05), and no serious AEs were observed. CONCLUSION Taking tadalafil 5 mg once daily reduced PMD symptom severity and PMD volume in men with PMD, without inducing serious AEs, more effectively than placebo, suggesting that taking tadalafil 5 mg once daily may be an effective and well-tolerated PMD treatment.
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Affiliation(s)
- Dae Yul Yang
- Department of Urology, College of Medicine, Kangdong Sacred Heart Hospital, Hallym Unversity, Seoul, Korea
| | - Hyun Cheol Jeong
- Department of Urology, College of Medicine, Kangdong Sacred Heart Hospital, Hallym Unversity, Seoul, Korea
| | - Kyungtae Ko
- Department of Urology, College of Medicine, Kangdong Sacred Heart Hospital, Hallym Unversity, Seoul, Korea
| | - Seong Ho Lee
- Department of Urology, College of Medicine, Dongtan Sacred Heart Hospital, Hallym Unversity, Hwaseong, Korea
| | - Sang Kon Lee
- Department of Urology, College of Medicine, Chuncheon Sacred Heart Hospital, Hallym Unversity, Chuncheon, Korea
| | - Tae Young Shin
- Department of Urology, College of Medicine, Chuncheon Sacred Heart Hospital, Hallym Unversity, Chuncheon, Korea
| | - Jin Seon Cho
- Department of Urology, College of Medicine, Hallym University Sacred Heart Hospital, Hallym Unversity, Anyang, Korea
| | - Won Ki Lee
- Department of Urology, College of Medicine, Chuncheon Sacred Heart Hospital, Hallym Unversity, Chuncheon, Korea
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Yang DY, Lee WK. A current perspective on post-micturition dribble in males. Investig Clin Urol 2019; 60:142-147. [PMID: 31098420 PMCID: PMC6495033 DOI: 10.4111/icu.2019.60.3.142] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 04/19/2019] [Indexed: 01/22/2023] Open
Abstract
Post-micturition dribble (PMD) is the involuntary loss of urine immediately after urination. It is classified as a post-micturition symptom and is more common in males. Traditionally, PMD has been considered to be part of the aging process, to have a low prevalence, and to be less bothersome than other lower urinary tract symptoms (LUTS). However, recent evidence suggests that PMD is not less common and does not elicit less discomfort compared with other LUTS in males. Also, PMD seems to commonly overlap with other LUTS and to be associated with erectile dysfunction. Although the etiology of PMD is not fully understood, a weakness or failure of the pelvic floor muscles is considered to be the most important factor. Although bulbar urethral massage and pelvic floor exercises are known to be effective in treating PMD, pharmacologic treatment has not yet been introduced. Recently, the possibility of treating PMD with phosphodiesterase-5 inhibitor has been suggested.
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Affiliation(s)
- Dae Yul Yang
- Department of Urology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Won Ki Lee
- Department of Urology, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea
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Cotter KJ, Flynn KJ, Hahn AE, Voelzke BB, Myers JB, Smith TG, Elliott SP, Alsikafi NF, Breyer BN, Vanni AJ, Buckley JC, Zhao LC, Erickson BA. Prevalence of Post-Micturition Incontinence before and after Anterior Urethroplasty. J Urol 2018; 200:843-847. [DOI: 10.1016/j.juro.2018.03.134] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2018] [Indexed: 10/17/2022]
Affiliation(s)
| | - Kevin J. Flynn
- Department of Urology, University of Iowa, Iowa City, Iowa
| | - Amy E. Hahn
- Department of Urology, University of Iowa, Iowa City, Iowa
| | | | | | | | | | | | | | - Alex J. Vanni
- Lahey Hospital and Medical Center, Burlington, Massachusetts
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Regional Structural and Functional Specializations in the Urethra of the Female Rat: Evidence for Complex Physiological Control Systems. Anat Rec (Hoboken) 2018; 301:1276-1289. [DOI: 10.1002/ar.23795] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 11/22/2017] [Accepted: 11/30/2017] [Indexed: 12/11/2022]
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Yang DY, Ko K, Lee SH, Cho JS, Lee SK, Shin TY, Lee WK. Postmicturition Dribble Is Associated with Erectile Dysfunction in Middle-Aged and Older Men with Lower Urinary Tract Symptoms. World J Mens Health 2018; 36:263-270. [PMID: 30168300 PMCID: PMC6119842 DOI: 10.5534/wjmh.180042] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 07/11/2018] [Accepted: 07/18/2018] [Indexed: 11/15/2022] Open
Abstract
PURPOSE Lower urinary tract symptoms (LUTS) are correlated with erectile dysfunction (ED), but research on whether postmicturition dribble (PMD) is related to ED is limited. We assessed the correlation between PMD and ED in middle-aged and older Korean men with LUTS. MATERIALS AND METHODS In our prospective, cross-sectional, observational, multicenter study, we enrolled 205 men (age >40 years) with LUTS. LUTS and ED were assessed using the International Prostate Symptom Score (IPSS) and International Index of Erectile Function-5 (IIEF-5), respectively. PMD was assessed using the Hallym PostMicturition Dribble Questionnaire, Question 1, and the PMD volume was calculated in a paper test. Age, prostate volume, serum prostate-specific antigen, maximum urinary flow rate, and postvoid residual urine were also evaluated. RESULTS There were significant differences in the total and voiding IPSS between men with and without ED (p=0.042 and 0.043, respectively). The Hallym PostMicturition Dribble Questionnaire 1 score was inversely well correlated with the IIEF-5 score (r=-0.388, p<0.001). Also, the PMD volume was inversely correlated with the IIEF-5 score (r=-0.138, p=0.042). ED prevalence increased as the Hallym PostMicturition Dribble Questionnaire 1 score increased (p=0.002). Further, incorporating the Hallym PostMicturition Dribble Questionnaire 1 into the IPSS tended to increase the predictive accuracy of LUTS by 4.2% in ED patients (p=0.082). CONCLUSIONS PMD was significantly correlated with ED and reinforced the relationship between LUTS and ED in middle-aged and older men. PMD might be an important component of the association between LUTS and ED.
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Affiliation(s)
- Dae Yul Yang
- Department of Urology, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Kyungtae Ko
- Department of Urology, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Seong Ho Lee
- Department of Urology, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
| | - Jin Seon Cho
- Department of Urology, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Sang Kon Lee
- Department of Urology, Hallym University Chuncheon Sacred Heart Hospital, Chuncheon, Korea
| | - Tae Young Shin
- Department of Urology, Hallym University Chuncheon Sacred Heart Hospital, Chuncheon, Korea
| | - Won Ki Lee
- Department of Urology, Hallym University Chuncheon Sacred Heart Hospital, Chuncheon, Korea.
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Botti M, Ragionieri L, Cacchioli A, Panu R, Gazza F. Striated Perineal Muscles: Location of Somatic and Autonomic Neurons Projecting to the Male Pig Ischiocavernous Muscle. Neurochemical Features of the Sympathetic Subset. Anat Rec (Hoboken) 2017; 301:837-848. [PMID: 29193823 DOI: 10.1002/ar.23735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 06/13/2017] [Accepted: 07/23/2017] [Indexed: 11/09/2022]
Abstract
The location, number and size of the central and peripheral neurons innervating the ischiocavernous muscle (ICM) were studied in male pigs by means of Fast Blue (FB) retrograde neuronal tracing. Moreover the immunohistochemical properties of the sympathetic ganglia were investigated combining the double immunolabeling method. After injection of FB into the left ICM, a mean number of 245.3 ± 134.9 labeled neurons were found in the ipsilateral ventral horn of the S1-S3 segments of the spinal cord (SC), 129.7 ± 45.5 in the L6-S3 ipsilateral and S2-S3 contralateral spinal ganglia (SGs), 2279.3 ± 622.1 in the ipsilateral L2-S2 and contralateral L5-S2 sympathetic trunk ganglia (STGs), 541.7 ± 158 in the bilateral caudal mesenteric ganglia (CMGs), and 78.3 ± 35.8 in the microganglia of the pelvic plexus (PGs). The mean area of the ICM projecting neurons was 1217 ± 69.7 μm2 in the SC, 2737.5 ± 176.5 μm2 in the SGs, 982.8 ± 36.8 μm2 in the STGs, 865.9 ± 39.14 μm2 in the CMGs and 426.2 ± 24.72 μm2 in the PGs. The FB positive neurons of autonomic ganglia contained Dopamine β hydroxylase, vesicular acetylcholine transporter, neuronal nitric oxyde sinthase, calcitonine gene related peptide, leu-enkephaline, neuropeptide Y, substance P, vasoactive intestinal polypeptide, and somatostatine often colocalized with tyrosine hydroxylase. The particular localization of the motor somatic nucleus, the abundant autonomic innervation and the qualitatively different content of ICM projecting sympathetic neurons suggest a complex regulation of this striated muscle involved in involuntary functions, such as the erection, ejaculation, micturition and defecation. Anat Rec, 301:837-848, 2018. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Maddalena Botti
- Department of Veterinary Science, Via del Taglio, 10, Parma, 43126, Italy
| | - Luisa Ragionieri
- Department of Veterinary Science, Via del Taglio, 10, Parma, 43126, Italy
| | - Antonio Cacchioli
- Department of Veterinary Science, Via del Taglio, 10, Parma, 43126, Italy
| | - Rino Panu
- Department of Veterinary Science, Via del Taglio, 10, Parma, 43126, Italy
| | - Ferdinando Gazza
- Department of Veterinary Science, Via del Taglio, 10, Parma, 43126, Italy
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Peikert K, May CA. Muscle spindles in the human bulbospongiosus and ischiocavernosus muscles. Muscle Nerve 2015; 52:55-62. [DOI: 10.1002/mus.24500] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2014] [Indexed: 12/31/2022]
Affiliation(s)
- Kevin Peikert
- Department of Anatomy; Medical Faculty Carl Gustav Carus; TU Dresden, Dresden Germany
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