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Sexual dysfunction is a common condition in patients taking antipsychotics, and is the most bothersome symptom and adverse drug effect, resulting in a negative effect on treatment compliance. It is known that hyperprolactinemia is a major cause of sexual dysfunction. Based on the blockade of dopamine D2 receptors, haloperidol, risperidone, and amisulpride are classed as prolactin-elevating antipsychotics, while olanzapine, clozapine, quetiapine, ziprasidone, and aripiprazole are classed as prolactin-sparing drugs. Risperidone and the other typical antipsychotics are associated with a high rate of sexual dysfunction as compared to olanzapine, clozapine, quetiapine, and aripiprazole. With regard to treatment in patients suffering from sexual dysfunction, sildenafil was associated with significantly more erections sufficient for penetration as compared to a placebo. Subsequent studies are needed in order to provide physicians with a better understanding of this problem, thereby leading toward efficacious and safe solutions.

PurposeTo investigate any associations between lower urinary tract symptoms (LUTS)/benign prostate hyperplasia (BPH) and metabolic syndrome (MetS).Materials and MethodsIn all, 1,224 male police officers in their 50s who had participated in health examinations were included. LUTS/BPH was assessed by serum prostate-specific antigen, International Prostate Symptom Score (IPSS), transrectal ultrasonography, maximum urinary flow rate (Q max), and postvoid residual urine volume (PVR). In addition, testosterone was also examined. The MetS was defined using NCEP-ATP III guidelines. We used the multiple linear regression test and logistic regression analyses to examine the relationships.ResultsMetS was diagnosed in 29.0% of participants. There was no significant difference in the percentage of cases of BPH (IPSS >7, Q max <15 ml/sec, and prostate gland volume ≥ 20 ml) (14.2% in the non-MetS group vs. 17.2 in the MetS group; p value=0.178). The total IPSS score and the Q max were not significantly different. The prostate volume and PVR were significantly greater in the subjects with MetS. After adjusting for age and testosterone, the presence of MetS was not associated with BPH (multivariate odds ratio, 1.122; 95% confidence interval, 0.593~2.120). Additionally, MetS was not related to IPSS (Beta, -0.189; p value=0.819), prostate volume (Beta, 0.815; p value=0.285), Q max (Beta, -0.827; p value=0.393), or PVR (Beta, 0.506; p value=0.837).ConclusionsAccording to our results, the MetS was not clearly correlated with LUTS/BPH in Korean men in their 50s.

PurposeTo evaluate the correlation between the Visual Prostate Symptom Score (VPSS) and International Prostate Symptom Score (IPSS).MethodsWe enrolled 240 new male patients who had visited National Police Hospital more than twice during a 6-month period starting from July 2013. At initial visit, the Korean version of the IPSS and VPSS, uroflowmetry, and transrectal ultrasonography were used to evaluate urinary symptoms. After medication, IPSS and VPSS questionnaires were issued again. The Spearman correlation test and the Mantel-Haenszel test were used to evaluate the relationship between the IPSS and VPSS.ResultsThe median age, total prostate volume, total IPSS, and total VPSS were 59.0 years, 28.0 mL, 12, and 9, respectively. Total VPSS, VPSS obstructive symptoms, VPSS irritative symptoms, and VPSS quality of life (QoL) significantly correlated with the total IPSS, IPSS obstructive symptoms, IPSS irritative symptoms, and IPSS QoL, respectively (correlation coefficient, P-value: 0.632, <0.001; 0.431, <0.001; 0.696, <0.001; and 0.799, <0.001; respectively). The change in the total IPSS after treatment also significantly correlated with the change in total VPSS after treatment (correlation coefficient, P-value: 0.364, <0.001). There were significant correlations between maximal flow rate and IPSS/VPSS obstructive symptoms (correlation coefficient, P-value: -0.190, 0.004; -0.269, <0.001, respectively). Additionally, there was a significant increase in the ratio of the maximal flow rate <15 mL/sec to VPSS obstructive symptoms as the severity of the VPSS obstructive symptoms increased (P trend <0.001).ConclusionsVPSS might be useful in evaluating lower urinary tract symptoms at the initial visit and assessing these symptoms at longitudinal follow-up examinations.

Purpose We examined the association between thyroid hormone and lower urinary tract symptoms (LUTS)/benign prostatic hyperplasia (BPH). Materials and Methods A total of 5,708 middle aged men were included. LUTS/BPH were assessed using the international prostate symptom score (IPSS), total prostate volume (TPV), maximal flow rate (Qmax), and a full metabolic workup. Thyroid stimulating hormone (TSH) and free thyroxine (FT4) levels were measured using chemiluminescence immunoassay. We divided participants into quartiles based on their TSH and FT4 levels: first to fourth quartile (Q1–Q4). Results There was a significant increase in the percentage of men with IPSS>7, Qmax<10 mL/s, and TPV≥30 mL with increase of FT4 quartile. The adjusted odds ratio (OR) for TPV≥30 mL and IPSS>7 were significantly different between FT4 quartile groups (ORs; [5–95 percentile interval], p; TPV≥30 mL, Q1: 0.000 [references]; Q2: 1.140 [0.911–1.361], p=0.291; Q3: 1.260 [1.030–1.541], p=0.025; Q4: 1.367 [1.122–1.665], p=0.002; IPSS>7: Q1: 0.000 [references]; Q2: 0.969 [0.836–1.123], p=0.677; Q3: 1.123 [0.965–1.308], p=0.133; Q4: 1.221 [1.049–1.420], p=0.010). In men with above median levels of testosterone, the FT4 correlated positively with TPV, even after adjusting for confounders. However, the FT4 was not correlated with TPV in men with below median levels of testosterone. TSH was not related to LUTS/BPH measurements. Conclusions TPV, IPSS, and Qmax were significantly related to FT4. TPV and IPSS were significantly and independently related to FT4. Additionally, the relationship between FT4 and TPV was distinct when testosterone levels are high.