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Clinical Management of Priapism: A Review
Kazuyoshi Shigehara,Mikio Namiki 대한남성과학회 2016 The World Journal of Men's Health Vol.34 No.1
Priapism is defined as a persistent and painful erection lasting longer than four hours without sexual stimulation. Based on episode history and pathophysiology, priapism is classified into three subtypes: ischemic (low-flow), non-ischemic (high-flow), and stuttering priapism. Ischemic priapism is characterized by a persistent, painful erection with remarkable rigidity of the corpora cavernosa caused by a disorder of venous blood outflow from this tissue mass, and is similar to penile compartment syndrome. Stuttering priapism is characterized by a self-limited, recurrent, and intermittent erection, frequently occurring in patients with sickle cell disease. Non-ischemic priapism is characterized by a painless, persistent nonsexual erection that is not fully rigid and is caused by excess arterial blood flow into the corpora cavernosa. Because ischemic and non-ischemic priapism differ based on emergency status and treatment options, appropriate discrimination of each type of priapism is required to initiate adequate clinical management. The goal of management of priapism is to achieve detumescence of the persistent penile erection and to preserve erectile function after resolution of the priapism. To achieve successful management, urologists should address this emergency clinical condition. In the present article, we review the diagnosis and clinical management of the three types of priapism.
Testosterone Deficiency and Nocturia: A Review
Kazuyoshi Shigehara,Koji Izumi,Atsushi Mizokami,Mikio Namiki 대한남성과학회 2017 The World Journal of Men's Health Vol.35 No.1
Nocturia causes lack of sleep and excessive daytime somnolence, reducing overall well-being, vitality, productivity, and mental health. Nocturia is significantly associated with testosterone deficiency, lower urinary tract symptoms (LUTS), and sleep disorders. The development of LUTS is commonly associated with testosterone deficiency in elderly men, and recent studies have suggested that testosterone has an ameliorative effect on nocturia. In hypogonadal men with nocturia, a negative feedback cycle can arise, in which testosterone deficiency leads to the development of nocturia, and nocturia contributes to the decline in testosterone levels. Therefore, patients with nocturia should receive appropriate treatment in order to improve their quality of life. Nocturia is generally treated by restricting nighttime water intake, as well as by the administration of medications, such as alpha-1 blockers, anticholinergic drugs, and desmopressin. Testosterone replacement therapy (TRT) is used worldwide as a treatment for many hypogonadal conditions. TRT represents an alternative treatment option for nocturia in hypogonadal men. However, limited information is currently available regarding the effects of TRT on nocturia in hypogonadal men, and further studies are required to reach more definitive conclusions.
Late-Onset Hypogonadism Syndrome and Lower Urinary Tract Symptoms
Kazuyoshi Shigehara,Mikio Namiki 대한비뇨의학회 2011 Investigative and Clinical Urology Vol.52 No.10
Androgen replacement therapy (ART) is a widely accepted form of treatment worldwide for aging men with late-onset hypogonadism (LOH) syndrome. Concurrent with the progressive decline in testosterone from middle age, there is a gradual increase in prostate volume, reflecting the development of benign prostatic hyperplasia (BPH). Prostate growth is dependent on the presence of androgens, and conversely, antiandrogen agents or orchidectomy can decrease prostate volume in patients with BPH. Thus, it is important to investigate whether ART could have any negative effects on prostatic disease or lower urinary tract symptoms (LUTS). Although only limited amounts of information on the correlations between androgen levels in aging men and clinical manifestations of LUTS are available, a few recent studies have suggested that testosterone levels may have some beneficial effects on various urinary functions in men. Androgen receptors are found in the urothelium, urinary bladder, prostate, and urethra, and testosterone could have an impact on the autonomic nervous system, bladder smooth muscle differentiation, nitric oxide synthase, phosphodiesterase-5 and Rho/Rho-kinase activities, and pelvic blood flow. In addition, some previous studies demonstrated that ART had little effect on LUTS or urinary function in aging men with LOH syndrome. Furthermore, some recent randomized controlled trials indicated that short-term ART may be effective in the improvement of LUTS in hypogonadal men with mild BPH. However, only limited information is available regarding the effects of longer-term ART or the safety of ART in men with severe BPH and LUTS, and further studies are required to reach more definitive conclusions.
Lithium polymer battery composed by aluminate polymer complex as single - ionic solid electrolytes
Onishi, Ken,Matsumoto, Michiko,Shigehara, Kiyotaka 한국공업화학회 1999 응용화학 Vol.3 No.1
Single-ionic conductors, which promote solely the lithium ion migration (without any anion migration), have been realized as the polymeric solid electrolytes with lithium orthoaluminate repeating units carrying oligo(oxyethylene) main-chain and two side-chains of endomethoxy{oligo(oxyethylene)}. The ionic conductivity of the aluminate polymer complexes was about 10^-6∼10^-7S/cm at room temperature. Thin film lithium secondary batteries were fabricated into 5.5×4.5×O.02(thick) cm cells from TiS₂(cathode), aluminate polymer complex and lithium foil (anode). These batteries showed minimal decay of output voltage upon constant current discharging and their capacity of first cycle was about 147mAh/g. A typical bi-lonic conductor of (5%LiClO₄+aluminate polymer complex) hybrid system showed, on the contrary, rapid decay of output voltage due to the polarization.