Aim:We assessed the value of scrotal color Doppler ultrasonography as a routine examination in infertile men. Methods: Color Doppler ultrasonography was performed in 545 infertile men with a mean age of 35.8 years to detect intrascrotal abnormalities. Findings were compared with those of physical examination. Results: Intrascrotal abnormalities were detected by ultrasonography in 65.3% of patients. Of 374 abnormalities, 58.3% were undetected by physical examination. Left varicocele was found in 313 patients (57.4%); testicular microlithiasis in 30 (5.5%); epididymal cyst in 21 (3.9%); right varicocele in 4 (0.8%); and testicular cysts in 3 (0.6%). One occurrence each (0.2%) was found for testicular tumor, intrascrotal hemangioma, and hydrocele of the spermatic cord. Compared to ultrasonography, sensitivity in detecting left varicocele by physical examination was 58.4%; specificity, 79.3%; accuracy, 67.3%; and positive predictive value, 79.3%. Venous diameters in the pampiniform plexus were 3 mm or more in 61.5% of 130 subclinical left varicoceles. Of 30 patients with testicular microlithiasis, 14 had varicocele, 2 had epididymal cyst,s 3 had a history of mumps orchitis, 1 had retractile testis, and 1 had a history of orchiectomy for contralateral testicular tumor. Conclusions:The routine Color Doppler ultrasonography is valuable for diagnosing scrotal abnormalities in infertile men, frequently detecting non-palpable lesions.

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Aim : Hemodynamic changes with aging in the penile arterial circulation, including the helicine arteries, were evaluated with power Doppler imaging in erectile dysfunction patients with a normal response to prostaglandin injection. Methods : In 36 patients with erectile dysfunction and no definite vascular risk factors, 72 corpora were examined using power Doppler imaging. Patients were classified by age: younger than 40 years, from 40 to 49, or 50 and older. Hemodynamic variables in the cavernous arteries, helicine arteries and dorsal arteries were measured after intracavernous injection of prostaglandin E 1 (20 m g).Results : All cavernous arteries had a maximum peak systolic velocity of greater than 35 cm/s and a minimum end-diastolic velocity of less than 0 cm/s. Mean peak systolic velocity in the cavernous artery differed between groups ( P = 0.016), especially between the younger than 40 age group and the 40-49 age group. Peak systolic velocity correlated negatively with age ( P = 0.0048). In the helicine arteries and dorsal arteries, peak systolic velocity did not differ between groups and showed no correlation with age. End-diastolic velocity, resistance index and acceleration time did not differ between groups, or correlate with age for any artery.Conclusions : Hemodynamic change with aging occurs predominantly in the cavernous arteries, where peak systolic velocity decreases. The arterial circulation beyond the cavernous arteries, including the helicine arteries, as well as veno-occlusive mechanisms, may have an important role in maintaining erectile function in aging.

Purpose) To conduct a prospective study on the efficacy and safety of desmopressin for nocturnal polyuria.(Materials and methods) We selected 51 Japanese men, aged !50 years, with complaints of nocturia and a nocturnal polyuria index of !0.33. We administered 25 or 50 μg desmopressin (Minirinmelt Orally Disintegrating Tablet Ⓡ ), once daily at bedtime. We evaluated the nighttime urinary frequency and urine volume, nocturnal polyuria index, time to the first urination after falling asleep, and International Prostate Symptom Score (IPSS) at baseline and at 4, 8, and 12 weeks after administration. In addition, they underwent clinical examinations and blood tests at 1, 4, and 12 weeks to evaluate the safety of the drug.(Results) We observed a decrease in the nighttime urinary frequency and urine volume, and nocturnal polyuria index, increased prolonged time to the first urination after falling asleep, and improved IPSS at and after 4 weeks, compared to baseline data. Furthermore, the drug remained effective even at 12 weeks for all parameters. We observed adverse events in 31.3% of the patients. The incidence of hyponatraemia was particularly high in 15.7% of the patients.Those with a lower serum sodium level and lesser body weight at baseline were more likely to develop hyponatraemia.(Conclusion) Desmopressin was identified as a potential drug for the treatment of nocturnal polyuria. However, hyponatraemia, an important adverse event, resulted in treatment discontinuation in several patients. A sodium level lower than the normal level and low body weight at baseline were the risk factors for hyponatraemia.

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(Objectives) Alpha1-blockers have been widely used for the treatment of lower urinary tract symptoms (LUTS)/benign prostatic hyperplasia (BPH). As improvement of symptoms occur relatively early after the administration of alpha-1 blockers, the blockers are considered to be extremely beneficial. However, some patients respond poorly to the blockers, providing additional treatment is difficult. Here we examined the efficacy of tadalafil that was additionally administered to patients receiving an oral alpha-1 blocker. (Subjects and methods) The subjects were patients who had been diagnosed with BPH/LUTS, had received an oral alpha1-blocker for at least 1 month, and had responded poorly to the alpha-1 blocker treatment (International Prostate Symptom Score IPSS ≥8 and/or QOL index ≥3). Tadalafil 5 mg was administered on consecutive days to patients orally receiving an alpha-1 blocker. The following were measured before and at 4 and 8 weeks after the administration of tadalafil to evaluate the add-on effect of Tadalafil: IPSS, QOL index, Overactive Bladder Symptom Score (OABSS), maximal urinary flow rate, residual urine volume, and International Index of Erectile Function-5 (IIEF-5). (Results) We studied 41 patients until 8 weeks after the drug administration. Tadalafil produced significant improvement in IPSS, QOL index, OABSS, and IIEF-5 at 4 weeks after the administration, as compared with before administration (P < 0.05). The improvement was even more significant at 8 weeks. However, the maximal urinary flow rate or residual urine volume did not differ significantly at any time point. (Conclusions) The results of this study revealed that additional administration of tadalafil improves not only urinary conditions but also sexual function in patients with BPH/LUTS.

Objectives To investigate the correlation between the Erection Hardness Score and both erectile function and metabolic and lifestyle factors. Methods This study included 548 men who underwent a complete standard medical checkup at Yokohama Shin‐midori General Hospital between 1 July 2016 and 31 August 2018, and answered the question about erectile hardness. The following variables were evaluated: age, erectile hardness on the Erection Hardness Score, erectile function on the Sexual Health Inventory for Men, current medical history (diabetes, hypertension, dyslipidemia, heart disease, stroke), metabolic risk factors (abdominal circumference, hyperglycemia, high blood pressure, lipid abnormality) and lifestyle factors. First, to examine the correlation between erectile hardness and erectile function, the mean Sexual Health Inventory for Men score by Erection Hardness Score grade was determined for each age group. Then, an analysis was carried out to examine the association between erectile hardness and age, current medical history, metabolic risk factors, and lifestyle factors. Results In each age group, a lower Erection Hardness Score grade was associated with a lower mean Sexual Health Inventory for Men score. Lipid abnormality, diabetes and age were independent risk factors for decreased erectile hardness. Conclusions Erection Hardness Score is a useful tool that can easily and accurately assess erectile function in the settings of medical checkups and clinical practice. Diabetes and lipid abnormality affect erectile hardness.