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양대열 대한의사협회 2020 대한의사협회지 Vol.63 No.6
Male sexual disorders, which are the target of clinical treatment, can be largely divided into erectile dysfunction (ED), ejaculation disorder, infertility, sexual desire disorder, hypogonadism, and other diseases related to penile structure changes, such as Peyronieʼs disease. Current approaches to ED treatment for most men are based on pharmacotherapy. Pharmacotherapy has evolved since the introduction of papaverine and phenoxybenzamine in the early 1980s. Sildenafil, a phosphodiesterase type 5 inhibitor (PDE5I), was the first approved drug for ED. Currently, PDE5Is are the most widely prescribed drugs and have an overall efficacy of 60% to 80% in all categories of ED. Most drugs used in ED are peripheral agents that act on the penis. If a combined treatment with a central nervous system agent and peripheral agents is possible, it may be an effective treatment strategy with higher efficacy. Premature ejaculation (PE) is the most frequent ejaculatory disorder. The absence of a consensus on the definition of PE has served as an obstacle in the investigation of its prevalence and the effectiveness of treatment strategies. Although the etiology of PE is unknown, some biological and psychological hypotheses, including anxiety, penile hypersensitivity, and 5-hydroxytryptamine receptor dysfunction have been suggested. Dapoxetine hydrochloride, a short-acting selective serotonin reuptake inhibitor, was approved for on-demand treatment of PE. Off-label use of antidepressants, topical anesthetic agents, tramadol, and PDE5Is is now available as a pharmacological option. The aim of this review is to describe recent advancements in the pharmacological treatment of male sexual disorders, especially focused on ED and PE.
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양대열,고경태,이성호,조진선,이상곤,신태영,이원기 대한남성과학회 2018 The World Journal of Men's Health Vol.36 No.3
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 middleaged and older men. PMD might be an important component of the association between LUTS and ED.
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A current perspective on post-micturition dribble in males
양대열,이원기 대한비뇨의학회 2019 Investigative and Clinical Urology Vol.60 No.3
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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양대열 대한남성과학회 2009 The World Journal of Men's Health Vol.27 No.2
Erectile dysfunction following radical prostatectomy is significant quality of life issue even with increased understanding of the anatomy and advancement of surgical skills such as nerve sparing prostatectomy, laproscopic, and robotic surgery. The changes of neuropraxia, ischemic and hypoxic injury vascular damage, fibrotic remodeling, and venous leak are all believed to contribute to erectile dysfunction. Penile rehabilitation is the use of any drug or device at or after radical prostatectomy to preserving penile function and earlier return of potency. There are no generally accepted guidelines for penile rehabilitation regiments. There exist several popular options such as PDE5I (phosphodiesterase type 5 inhibitor), intracorporeal injection of vasoactive agent, vacuum device, intraurethral alprostadil, and combination of these modalities. Current animal and human data support the primary use of PDE5I (phosphodiesterase type 5 inhibitor) for nerve sparing and injection of vasoactive agent for supposed nerve injury patients. Some experimental modalities including hyperbaric oxygen therapy, neuromodulator, and stem cell strategies are under preclinical study. This paper will review the literatures involving both basic and clincial evidences for rehabilitation approaches following radical prostatectomy.
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양대열,고경태,이원기,박현준,이성원,문기학,김세웅,김수웅,조강수,문두건,민권식,양상국,손환철,박광성 대한남성과학회 2013 The World Journal of Men's Health Vol.31 No.3
Purpose: According to previous studies, the prevalence of premature ejaculation (PE) in Korea ranges from 11.3% to 33%. However, the actual practice patterns in managing patients with PE is not well known. In this study, we have endeavored to determine how contemporary urologists in Korea manage patients with PE.Materials and Methods: The e-mailing list was obtained from the Korean Urological Association Registry of Physicians. A specifically designed questionnaire was e-mailed to the 2,421 urologists in Korea from May 2012 to August 2012. Results: Urologists in Korea diagnosed PE using various criteria: the definition of the International Society for Sexual Medicine (63.4%), Diagnostic and Statistical Manual of Mental Disorders (43.8%), International Statistical Classification of Disease, 10th edition (61.7%), or perceptional self-diagnosis by the patient himself (23.5%). A brief self-administered questionnaire, the Premature Ejaculation Diagnostic Tool, was used by only 42.5% of the urologists. Selective-serotonin reuptake inhibitor (SSRI) therapy was the main treatment modality (91.5%) for PE patients. 40.2% of the urologists used phosphodiesterase type 5 inhibitors, 47.6% behavior therapy, and 53.7% local anesthetics. Further, 286 (54.3%) urologists managed PE patients with a surgical modality such as selective dorsal neurotomy (SDN).Conclusions: A majority of Korean urologists diagnose PE by a multidimensional approach using various diagnostic tools. Most urologists believe that medical treatment with an SSRI is effective in the management of PE. At the same time, surgical treatment such as SDN also investigated as one of major treatment modality despite the lack of scientific evidence.
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Energy Storage Properties of Dy3+ Doped Sr0.5Ba0.5Nb2O6 Thick Film With Nano-Size Grains
양대열,강수빈,임지호,윤송현,류정호,최종진,Thamil Selvi Velayutham,김형선,정대용 대한금속·재료학회 2017 METALS AND MATERIALS International Vol.23 No.5
We studied the temperature stable high-energy storage capacitors. Sr0.5Ba0.5Nb2O6 (SBN) is the lead-free ferroelectricsolid solution between BaNb2O6 and SrNb2O6. By doping Dy into SBN, the Curie temperature was loweredand dielectric constant was increased. To improve the breakdown behavior of Dy-doped SBN, the aerosoldeposition(AD) was applied to fabricate the dense films with nano-sized grains. These nano-grain give a largenumber of grain boundaries, suppressing the electron conduction in ceramics. The dielectric constant and breakdownelectric field of the AD films annealed at 650 °C were measured as 2307 and 9.9 MV/m, while bulk were1080 and 4 MV/m. Energy density and efficiency of the AD films annealed at 650 °C were also enhanced as 0.65 J/cc and 90.2% and bulk were 0.08 J/cc and 72.1%, respectively. In addition, the dielectric constant of AD filmannealed at 550 °C and 650 °C were quite stable up to 150 °C.
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