Oral Abstracts

O01

Effects of androgen deprivation on glycaemic control and on biochemical cardiovascular risk factors in men with diabetes

A. Yassin¹, F. Saad², A. Guillaume³, K. Heinemann³, A. Haider⁴

¹Segeberger Kliniken, Norderstedt-Hamburg, Germany, and Department of Urology, Gulf Medical College School of Medicine, Ajman, UAE; ²Schering AG, Berlin, Germany, and Gulf Medical College School of Medicine, Ajman, UAE; ³ZEG Centre for Epidemiology and Health Research Berlin, Berlin, Germany; ⁴Urology Office, Bremerhaven, Germany

Introduction and objective: Treatment of prostate cancer by androgen deprivation may result in loss of bone mass, changes in body composition, and a deterioration of arterial stiffness. The present study monitored the effects of administration of GnRH agonists to 29 men with insulin-dependent diabetes on glycaemic control and on biochemical cardiovascular risk factors.

Methods: 29 patients from a urology practice were included. All men had insulin-dependent diabetes mellitus prior to being diagnosed with prostate cancer. In a retrospective analysis, levels of fasting glucose, HbA1c, total cholesterol, HDL-C, LDL-C, triglycerides, fibrinogen, PAI-1, tPA, C-reactive protein as well as insulin requirement on 5 to 8 occasions (depending on survival time) over a period of up to 24 months were evaluated.

Results: After 5 measurements (all 29 men), glycaemic control worsened substantially with increases of serum glucose (from 143.2 ± 26.823 to 187.3 ± 30.229 mg/dL) requiring increases in insulin dosages (from 26.1 ± 7.219 to 48.2 ± 9.948 units). HbA1c levels rose from 6.3 ± 1.045% to 9.3 ± 1.198% indicating impaired glycaemic control. All biochemical cardiovascular risk factors deteriorated: CRP from 1.3 ± 0.504 to 2.3 ± 0.556 mg/dL, total cholesterol from 252.0 ± 41.143 to 322.3 ± 41.097 mg/dL, HDL-C from 31.4 ± 6.349 to 20.9 ± 2.226 mg/dL, LDL-C from 184.5 ± 16.311 to 229.1 ± 21.006 mg/dL, triglycerides from 207.4 ± 39.301 to 283.9 ± 49.679 mg/dL, fibrinogen (data from n = 13) from 3.0 ± 1.134 to 13.0 ± 0.583 g/L, PAI-1 (data from n = 6) from 36.9 ± 7.590 to 69.0 ± 13.957 μ/L, and t-PA (data from n = 6) from 124.9 ± 36.245 to 185.7 ± 22.322%.

Conclusion: In men with (insulin-dependent) diabetes, androgen deprivation may have profound negative effects on their glycaemic control and aggravate the biochemical risk profile of cardiovascular disease to which diabetics are predisposed. This observation is in agreement with the emerging role of low levels of testosterone in metabolic syndrome and insulin resistance.

O02

The benefit of testosterone administration to men not responding to PDE-5 inhibitors: State of the art

A. Yassin¹, F. Saad²

¹Clinic of Urology and Andrology, Segeberger Kliniken, Norderstedt-Hamburg, Germany, and Department of Urology, Gulf Medical College School of Medicine, Ajman, UAE; ²Male Healthcare, Bayer Schering Pharma, Berlin, Germany, and Research Department, Gulf Medical College School of Medicine, Ajman, UAE

Introduction: Delivery of the phosphodiesterase type-5 inhibitors (PDE-5 inhibitors) has been a step forward in the treatment of erectile dysfunction. The success of the PDE-5 inhibitors rendered androgens as treatment for erectile problems in the average patient as something of the past.

Methods: Over the last 15 years the age-related decline of circulating testosterone in men has received serious attention. Moreover, new research has presented convincing evidence that testosterone has profound effects on tissues of the penis involved in the mechanism of erection and that testosterone deficiency impairs the anatomical and physiological substrate of erectile capacity, at least in part reversible upon androgen replacement.

Results: There are androgen receptors in the human corpus cavernosum. The expression of nitric oxide (NO) synthesis is regulated by androgens. Several studies show that androgen plays a critical role in restoring and maintaining the penile trabecular smooth muscle structure and function as well as regulating the cell apoptosis. Testosterone deficiency induces both biological and structural/functional changes in the trabecular cavernosal tissues. Adipocyte accumulation in penile subtunical area of the corpus cavernosum emphasised the potential mechanism for veno-occlusive dysfunction in androgen deficiency.

Conclusion: So, in androgen-deficient men, testosterone may restore the anatomical/biochemical substrate on which the PDE-5 inhibitors act. The above argues for measurement of testosterone in men with complaints of erectile dysfunction. Several studies, including our own, show that testosterone treatment alone, or in addition to PDE-5 inhibitors, may restore erections in these men.

O03

Two modern modes of testosterone treatment compared: transdermal testosterone gel and injectable long-acting testosterone undecanoate

A. Yassin¹, A. Haider², F. Saad³

¹Clinic of Urology and Andrology, Segeberger Kliniken, Norderstedt-Hamburg, Germany, and Department of Urology, Gulf Medical College School of Medicine, Ajman, UAE; ²Urology Office, Bremerhaven, Germany; ³Male Healthcare, Schering AG Berlin, Germany, and Research Department, Gulf Medical College School of Medicine, Ajman, UAE

Objective: The introduction of transdermal testosterone (T) gel and injectable long-acting T undecanoate in recent years is a major improvement in the treatment of androgen deficiency. Both fulfil criteria for adequate androgen treatment. Are there differences in their profiles that would make one preferable over the other in certain patients and in certain clinical conditions?

Patients and methods: 34 proven hypogonadal men (49–70 yrs) previously 9 months treated with transdermal T gel 50 mg/day, transitioned to injectable long-acting T undecanoate (1000 mg/12 weeks) for 9 months.

Results: T levels rose upon treatment with T gel but rose further with T undecanoate, but remained in physiological range. Waist circumference, cholesterol, triglycerides, low density lipoprotein declined and high density lipoprotein increased upon T gel. Symptoms of the Aging Male Scale improved. There were no serious side effects (haemoglobin, prostate size, PSA, IPSS). Continuation of T administration with long-acting T undecanoate led to further improvements and neither side effects.

Conclusion: T treatment of hypogonadal men improves their metabolic condition significantly. The higher T levels achieved with T undecanoate compared to T gel, led to further improvements.

O04

Natural bioidentical hormone restoration therapy

A.H. Siregar

Indonesian Society for Anti Aging Physicians, Jakarta, Indonesia

An evolution is taking place in healthcare, especially in anti-aging intervention. It is quite obvious as more natural medicines gain acceptance that they are becoming part of the mainstream. What has driven this growing acceptance is that the public is gaining access to reliable, sound information on the value of these natural medicines, as well as increased scientific investigation. During the past decade, natural medicine has grown in attractiveness to Western medicine. One of the great myths about natural medicine, such as natural hormone therapy has been the belief that there is no firm scientific evidence to support them. However, this argument is quickly becoming outdated. There is more than enough reasonable certainty to employ a natural medicine for virtually every common aging condition.

‘Midlife crisis’ is often a transitional period for men when they experience what is termed as the ‘second childhood’. This aging male period is also called andropause or male menopause. All men are affected, although some to a larger degree than others. A thorough knowledge of the underlying hormonal and physiological changes will better prepare all males to deal with this phase of life. The hallmark of andropause is a slightly decreased production of testosterone levels and an increase in the circulating fraction of testosterone bound to SHBG. A decline in the testosterone level is associated with decrease in sex drive and libido. Testosterone replacement therapy (TRT) re-energises the entire body, increases lean muscle mass, and reverses the fat accumulation and muscular atrophy characteristic of aging. Restoration of testosterone level in men with natural substances has shown significant anti-aging effects.

Clinically, hormone modulation with bio-identical hormone restoration has been proven to be effective in helping to reinvigorate men's sex lives, as well as fight the symptoms of aging. Bio-identical hormones are hormones manufactured to have the same molecular structure as the hormones made by our own body. By contrast, synthetic hormones are intentionally different. In contrast, bio-identical hormones are usually extracted from natural bioactive compounds then synthesised to a bio-identical form and formulated by pharmacies for the individual patient. The body accepts and metabolises natural hormones as if it made them. European medical studies suggest that bio-identical hormones are safer than synthetic versions. The term ‘natural’ can be confusing when used in connection with hormones. A natural hormone has a chemical structure that is identical to the hormone naturally produced by the body, which is why natural hormones are also called ‘bio-identical’ hormones.

The use of phytochemicals as a form of anti-aging male intervention is an evolving science. Male enhancement phytochemicals are a natural way to curb aging male problems. These natural enhancers are a safer option to prescription medications and also a better solution to restore the body to a state of healthy functionality, which can result in a series of health benefits. Recently, several experiments on this topic have developed a lot of combinations of male enhancement herbs. Various clinical studies have shown that certain plants and herbs may provide benefits for male sexual health, including those for libido, performance, endurance, sperm production and incontinence. These include an assortment of exotic herbs that have been shown in studies to offer potential properties for male sexual potency and performance, as well as their general health. These include: Coleus forskohlii, Avena sativa, long Jack, Tribulus, horny goat weed, stinging nettle, chrysin, saw palmetto, beta sitosterol, Pygeum, Ginkgo, Muira puama extract, Circuligo orchioides, Asian ginseng and maca.

Conclusively, natural bio-identical hormone restoration therapy aims at achieving a level of the normal physiological range – consistent with our normal biochemistry – with less chance for unpredictable side effects often observed with synthetic hormone.

O05

The incidence of erectile dysfunction after transurethral resection of the prostate and transvesical prostatectomy on benign prostatic hyperplasia patients in Dr Sardjito Hospital

A. Alpendri¹, T.K. Utomo², T. Utomo², P. Singodimedjo²

¹Divison of Urology, Department of Surgery, Faculty of Medicine, University of Indonesia, Dr Cipto Mangunkusomo Hospital, Jakarta, Indonesia; ²Subdivison of Urology, Department of Surgery, Faculty of Medicine, Gadjah Mada University, Dr Sardjito Hospital, Yogyakarta, Indonesia

Introduction: Benign Prostatic Hyperplasia (BPH) is the second most common urology disease in male. Transurethral resection of the prostate (TURP) and transvesical prostatectomy (TVP) are common procedures for BPH. Both procedures might lead to immediate, early and late complications including retrograde ejaculation, urethral strictures, bladder neck stenosis and erectile dysfunction (ED). The aim of this study was to find the incidence of ED after TURP and TVP.

Methods: Data were collected in the 1 year period from January to December 2005 with cross-sectional study design. There were 60 patients who met the inclusion and exclusion criteria and patients who participated in this study underwent TURP and TVP and divided into TURP group and TVP group. Erectile dysfunction was measured by the International Index of Erectile Dysfunction-5 (IIEF-5) questionnaire, and data was analysed by statistical chi-square and independent t-test.

Results: Sixty patients were included in this study, with 30 patients in each group. The mean age of TURP was 64 ± 5.68 and TVP was 63.23 ± 4.83 with age ranging from 50 to 70 years. The incidence of ED after TURP and TVP was 36.67% and 16.70% respectively with p = 0.08. The IIEF-5 scores for TURP and TVP were 10.41 ± 3.95 and 21.03 ± 2.57 respectively and by statistical analysis the differences were not significant.

Conclusions: The incidence of ED after TURP showed higher than TVP but by statistical analysis the difference was not significant.

O06

The effect of low osmolar non ionic contrast media on cystatin-C serum levels in Oryctolagus cuniculus

A.S. Bintoro, Soetojo, D.M. Soebadi

Department of Urology, School of Medicine, Airlangga University Surabaya, Indonesia

Objective: To determine the effect of low osmolar non ionic contrast media on Cystatin-C serum levels in Oryctolagus cuniculus.

Subjects and method: Twenty-two Oryctolagus cuniculus were divided into two groups, 11 were given an intravenous injection of low osmolar non-ionic contrast media and the others were given an intravenous placebo injection (NaCl 0.9%) as the control group. Data of cystatin-C serum were collected before the injection, day 1, 3, 7, and 10 from each sample. Cystatin-C serum levels were analysed with Sandwich ELISA. The data was statistically analysed with t-test.

Result: The mean of cystatin-C serum level before injection was 0.00337 ± 0.00101 mg/L. Meanwhile, 1,3,7,10 days after injections were 0.00498 ± 0.00153 mg/L; 0.00565 ± 0.00247 mg/L; 0.00468 ± 0.00157, and 0.00339 ± 0.00188 mg/L respectively. All these cystatin-C serum levels were examined by Sandwich ELISA method.

Conclusion: There were significant escalation of Cystatin-C serum on day 1, 3, and 7 but by day 10 no significant escalation was observed. There were significant differences in the increase of Cystatin-C serum on day 1 and 3 of the intervention group compared to the control group, but there were no significant differences on the 7^th and 10^th days after injection.

O07

The relation of TGF beta-1 and estrogen with prostate volume in BPH patients, old patients with no BPH, and young patients

B. Soebhali, Soetojo, D.M. Soebadi, Hendromartono, E. Retnowati, P.P. Widodo

Department of Urology, Soetomo Hospital, School of Medicine, Airlangga University, Surabaya, Indonesia

Objective: To find the relations of TGF β-1 and estrogen with prostate volume in BPH patients, old patients without BPH and young patients.

Materials and method: We enrolled 30 patients and divided them into three groups. The first group consisted of BPH patients, the second group consisted of old male patients (more than 55 years of age) and the third group consisted of young male patients (less than 40 years of age). We analysed the level of TGF β-1 and estrogen in these patients. Transrectal USGs Ultrasonography were used to measure the prostate volume. We analysed the relations of TGF β-1 and estrogen level with prostate volume.

Results: We found a strong relation between estrogen and prostate volume in the BPH patient group (r = 0.001, coeff = 0.573). The other groups showed no significant relation.

Conclusion: Estrogen plays an important role in BPH pathophysiology.

O08

Androgen therapy – advantages and disadvantages

F. Saad

Male Healthcare, Schering AG Berlin, Germany, and Research Department, Gulf Medical College School of Medicine, Ajman, UAE

Testosterone deficiency can occur early in life and may be diagnosed when boys do not develop signs of puberty. As testosterone levels decline with age, there is also late-onset hypogonadism.

Clinical signs of testosterone deficiency affect many tissues and organ systems: bone density is regulated by testosterone. Chronic testosterone deficiency leads to a decrease in bone mineral density and a higher incidence of fractures. Testosterone has an anabolic effect on muscle tissue. It increases lean body mass and reduces fat mass. Also, muscle function and strength are improved. Testosterone modulates the central nervous system. Testosterone deficiency may be associated with impaired mood and depressive disorders. Several recent studies have indicated that testosterone therapy could improve depressive disorders. Lipid pattern and glucose metabolism are influenced by testosterone. Special attention is paid to the risk factors of the metabolic syndrome. In studies performed in Sweden, obese men were treated with testosterone resulting in reduction of waist and hip circumference, indicators of visceral obesity. All parameters of a disturbed glucose metabolism and insulin resistance were improved.

Testosterone deficiency may lead to sexual dysfunction. When hypogonadal men are treated with testosterone, sexual satisfaction, erection, desire, enjoyment of sexual activity improve. Non-responders to treatment with 100 mg sildenafil became responders when they received additional testosterone.

Prostate cancer must be excluded prior to treatment, and monitoring of the prostate every three months during the first year of treatment is recommended. Monitoring of haemoglobin and haematocrit are also recommended, especially in older men.

O09

Association of metabolic syndrome, hypogonadism, and erectile dysfunction

F. Saad¹, A.A. Yassin²

¹Male Healthcare, Schering AG Berlin, Germany and Research Department, Gulf Medical College School of Medicine, Ajman, UAE; ²Clinic of Urology and Andrology, Segeberger Kliniken, Norderstedt-Hamburg, Germany and Department of Urology, Gulf Medical College School of Medicine, Ajman, UAE

Objectives: Metabolic syndrome, characterised by central obesity, insulin resistance, dyslipemia and hypertension, is highly prevalent. When left untreated, it significantly increases the risk of diabetes mellitus and cardiovascular disease.

Methods: It has been suggested that hypogonadism may be an additional component of metabolic syndrome. Metabolic syndrome appears to have a major association with erectile dysfunction (ED). On a mechanistic level, their common grounds may involve endothelial dysfunction; the conditions of oxidative stress understood to be a pathologic element of the syndrome also may affect various components of the vascular biology of the penis. 771 ED patients were screened on co-morbidities within 2 years.

Results: The average abdominal girth was 104 cm, in the hypogonadal subgroup it was 112.2 cm. 18.3% with hypogonadism; 35% diabetics, eight of them with latent disease; 31% with arterial hypertension, twelve of them with latent disease; 21% with dyslipemia, nine of them with latent disease; 29% with BPH or LUTS; 14% with coronary disease, five of them with latent disease.

Conclusion: Erectile dysfunction is predictive not only of metabolic syndrome alone, but also of silent killers or diseases, and a very important factor in male health issues. This finding suggests that erectile dysfunction may provide a warning sign and an opportunity for early intervention in men otherwise considered at lower risk for metabolic syndrome and subsequent cardiovascular disease. Our own studies have shown that normalising testosterone levels in men with metabolic syndrome improves ED.

O10

Comparison of the effects of testosterone gel with parenteral testosterone undecanoate on features of the metabolic syndrome

F. Saad^1,2, L. Gooren³, A. Haider⁴, A. Yassin^2,5

¹Bayer-Schering, Berlin, Germany; ²Gulf Medical College, Ajman, UAE; ³Vrije Unniversiteid Medisch Centrum (VUMC), Amsterdam, Netherlands; ⁴Bremerhaven, Germany; ⁵Segeberger Kliniken, Norderstedt, Germany

Context: Sex steroid hormones are involved in the metabolism, accumulation and distribution of adipose tissues. Androgens may be involved in the control of preadipocyte proliferation and differentiation. Longer term studies of androgen administration to elderly men show an effect on loss of fat tissue reductions in waist circumference, and improvements in lipid profiles.

Patients and methods: The effects on two testosterone (T) treatment modalities on features of the metabolic syndrome of two cohorts of elderly with late-onset hypogonadism, over a nine-month period, were compared. Group 1 (28 men; mean age 61 yrs; mean T 2.07 ± 0.50 ng/ml) were treated for 9 months with long acting T undecanoate (1000 mg at weeks 0 and 6, and thereafter every 12 weeks). Group 2 (27 men, mean age 60 yrs, mean T 2.24 ± 0.41) were treated with T gel (50 mg/day) for 9 months.

Results: (* statistical significance) With T gel plasma T rose from 2.24 ± 0.41 to 2.95 ± 0.52* at 3 months, to 3.49 ± 0.89* at 6 months, to 3.80 ± 0.73 at 9 months (T at 6 months* compared to T at 3 months). With TU plasma T rose from 2.08 ± 0.56 to 4.81 ± 0.83* at 3 months, to 5.29 ± 0.91 at 6 months, to 5.40 ± 0.77 at 9 months. With TU administration maximum plasma T was reached at 3 months, with T gel at 6 months. With TU administration plasma T was *higher than with T gel at 3, 6 and 9 months.

Effects on variables of the metabolic syndrome: waist circumference (cm) TU: −3.38, T gel: −1.89*. Systolic/diastolic BP mm Hg TU: −2/−1 ; Tgel: 0*/0*. SHBG (nmol/L) TU: +2; T gel: −9. Cholesterol (mg/dL) TU: −94; T gel: −39*. LDL (mg/dL) TU: −32; T gel −19*. HDL (mg/dL) TU; +9; T gel: +4. Triglycerides (mg/dL) TU: −167; T gel: −79*. Haemoglobin (g/dL) TU +1; T gel: +0.3*. Haematocrit (%) TU: +5; T gel: +4*. T gel suppressed SHBG, while TU increased SHBG slightly but significantly.

With both treatments, changes in waist circumferences correlated with changes in cholesterol, LDL and HDL but not triglycerides. Low SHBG may be an indicator of the severity of metabolic syndrome. SHBG fell with T gel, probably due to increases in plasma T but increased with TU, maybe indicating an improvement of metabolic syndrome.

Conclusion: T administration has a beneficial effect on features of metabolic syndrome. The higher plasma levels of T generated with TU than with T gel (50 mg/day) were clearly more effective indicating that there is a plasma level of T/effect relationship.

O11

Effects of androgen deprivation on glycaemic control and on biochemical cardiovascular risk factors in men with diabetes

F. Saad¹, A. Yassin², A. Haider³

¹Male Healthcare, Bayer Schering Pharma, Berlin, Germany & Research Department, Gulf Medical College School of Medicine, Ajman, UAE; ²Segeberger Kliniken, Norderstedt-Hamburg, Germany and Department of Urology, Gulf Medical College School of Medicine, Ajman, UAE; ³Urology Office, Bremerhaven, Germany

Introduction and objective: Androgen deprivation therapy (ADT) may result in loss of bone mass. The present study monitored the effects of administration of GnRH agonists to 29 men with insulin-dependent diabetes on glycaemic control and cardiovascular risk factors.

Methods: 29 patients were included. All men had insulin-dependent diabetes mellitus prior to being diagnosed with prostate cancer. In a retrospective analysis, levels of fasting glucose, HbA1c, total cholesterol, HDL-C, LDL-C, triglycerides, fibrinogen, PAI-1, tPA, C-reactive protein as well as insulin requirement over a period of up to 24 months were evaluated.

Results: Serum glucose increased from 143.2 ± 26.823 to 187.3 ± 30.229 mg/dL requiring increasing insulin dosages (from 26.1 ± 7.219 to 48.2 ± 9.948 units). HbA1c levels rose from 6.3 ± 1.045% to 9.3 ± 1.198%. Cardiovascular risk factors deteriorated: CRP from 1.3 ± 0.504 to 2.3 ± 0.556 mg/dL, total cholesterol from 252.0 ± 41.143 to 322.3 ± 41.097 mg/dL, HDL-C from 31.4 ± 6.349 to 20.9 ± 2.226 mg/dL, LDL-C from 184.5 ± 16.311 to 229.1 ± 21.006 mg/dL, triglycerides from 207.4 ± 39.301 to 283.9 ± 49.679 mg/dL, fibrinogen (data from n = 13) from 3.0 ± 1.134 to 13.0 ± 0.583 g/L, PAI-1 (data from n = 6) from 36.9 ± 7.590 to 69.0 ± 13.957 μ/L, and t-PA (data from n = 6) from 124.9 ± 36.245 to 185.7 ± 22.322%.

Conclusion: In diabetics, ADT may have profound negative effects on their glycaemic control and aggravate the risk profile of cardiovascular disease to which diabetics are predisposed.

O12

Hormone deficiency in aging man: An update on testosterone treatment

F. Saad¹, D. Huebler², A. Yassin³, M. Zitzmann⁴, F. Jockenhoevel⁵, M. Oettel⁶

¹Schering AG, Berlin, Germany and Gulf Medical College, Ajman, UAE; ²Jenapharm, Jena, Germany; ³Segeberger Kliniken, Norderstedt, Germany and Gulf Medical College, Ajman, UAE; ⁴University of Muenster, Muenster, Germany; ⁵Ev. Hospital Herne, Herne, Germany; ⁶Jenapharm, Jena, Germany

According to guidelines issued jointly by the International Society for the Study of the Aging Male (ISSAM), the International Society of Andrology (ISA), and the European Association of Urology (EAU), late-onset hypogonadism (LOH) is characterised by: diminished sexual desire (libido) and erectile quality and frequency, particularly nocturnal erections; changes in mood with concomitant decreases in intellectual activity; sleep disturbances; decrease in lean body mass with associated diminution in muscle volume and strength; increase in visceral fat; decrease in body hair and skin alterations; decreased bone mineral density resulting in osteopenia, osteoporosis and increased risk of bone fractures.

In the Massachusetts Male Aging Study, the prevalence of androgen deficiency, defined as the combination of measured low serum testosterone and at least three of 40 and 79 years. However, co-morbidities are a better predictor for LOH than age.

Testosterone preparations have been in use since the 1940s. The majority of the marketed products were inconvenient and/or had unfavourable pharmacokinetic properties. Only in the 1990s, transdermal testosterone administration for daily use became available. Patches had good pharmacokinetics but local tolerance problems. Testosterone gels, introduced in 2000, became a breakthrough. The most recently introduced formulation is a long-acting testosterone ester for intramuscular injection.

Testosterone undecanoate (TU) for injection was developed in Germany and received its first approval in 2004. The clinical development followed the classical standards and started with a single-dose application in hypogonadal men. The kinetic pattern suggested that testosterone levels were maintained for 6 weeks. However, the following multiple-dose kinetics study with 4 injections given in 6-week intervals showed accumulating levels of testosterone with each new injection. It was then decided to extend injection intervals with the result that an optimal regimen for the majority of patients could be achieved with 12-week intervals.

In a direct comparison trial of TU (Nebido®) and the gold standard, testosterone enanthate (TE), TU was demonstrated to be equally effective with considerably fewer injections (usually 4 per year compared to 16 to 26 with TE). Efficacy parameters were body composition, muscle strength, bone mineral density, and an array of subjective parameters including sexual function. Safety was monitored by measuring PSA, prostate volume, haemoglobin, haematocrit, and serum lipids.

Since Nebido® is commercially available in most European, Latin American and Asian countries, a number of studies have been conducted under field conditions. In a study by Yassin et al., 122 hypogonadal men presenting with erectile dysfunction were treated with testosterone monotherapy using TU injections. After 3 months, 54% of patients responded with restored erectile function according to the International Index of Erectile Function (IIEF). All patients showed an improvement of libido. Interestingly, testosterone therapy non-responders had a higher prevalence of co-morbidities than responders.

A series of hypogonadal men were diagnosed upon cavernosography with venous leak, one of the most severe forms of erectile dysfunction. They were treated with Nebido®. Six out of 12 men regained their erectile function after as little as 3 months and as much as 11 months of treatment. The hypothesis for this recovery is that penile structure impaired through chronic testosterone deficiency had been restored as previously shown in animal experiments.

Jacobeit et al. showed in 33 elderly men (mean age: 59.2 years) that treatment with Nebido® was safe and well tolerated during an observation period of 30 weeks. Behre et al. conducted a study in 96 men (mean age: 48.6 years, range: 18–77). They demonstrated subjective improvement in all three domains of the Aging Males Symptoms scale (AMS). 92.5% of the patients were satisfied with the therapy. Glycaemic control and lipid patterns improved during Nebido® treatment. Safety criteria (PSA, prostate volume, and haematocrit) were assessed and all values remained within the normal range.

Up to now, approximately 9 years of clinical experience in a limited number of patients has been documented. In summary, Nebido® appeared to be efficacious and safe for testosterone treatment in men with both classical and late-onset hypogonadism.

O13

Male aging – clinical signs and symptoms of testosterone deficiency

F. Saad¹, A.A. Yassin²

¹Male Healthcare, Schering AG Berlin, Germany and Research Department, Gulf Medical College School of Medicine, Ajman, UAE; ²Clinic of Urology and Andrology, Segeberger Kliniken, Norderstedt-Hamburg, Germany and Department of Urology, Gulf Medical College School of Medicine, Ajman, UAE

Testosterone deficiency or hypogonadism can occur early in life and is usually diagnosed when boys do not develop signs of puberty appropriate for their age. It may be found in men presenting with fertility problems. As testosterone levels decline with age, there is also an age-related or late-onset hypogonadism.

Clinical signs of testosterone deficiency affect many tissues and organ systems: The structure of bones is regulated by testosterone. Chronic testosterone deficiency leads to a decrease in bone mineral density and a higher incidence of fractures. In hypogonadal men, testosterone was shown to enhance erythropoiesis by increasing haematocrit and hemoglobin. In terms of body composition, testosterone has an anabolic effect on muscle tissue. It increases lean body mass and reduces fat mass. Also, muscle function and strength are improved when administering testosterone to hypogonadal men.

Testosterone has an influence on the central nervous system. Testosterone deficiency may be associated with impaired mood and depressive disorders. Although the literature is somewhat controversial, several recent studies indicated that testosterone therapy could improve depressive disorders. In one particular study, men with major depression who had been treated unsuccessfully with antidepressants, responded very well to an additional treatment with testosterone.

Lipid pattern and glucose metabolism are also modulated by testosterone. Special attention is paid to the risk factors of so-called metabolic syndrome, a pre-diabetic state. In studies performed in Sweden, obese men were treated with testosterone. Results were a reduction of waist and hip circumference, indicators of visceral obesity, the most important risk factor for metabolic syndrome. All parameters of a disturbed glucose metabolism and insulin resistance were improved.

Testosterone deficiency will sooner or later lead to sexual and erectile dysfunction. When hypogonadal men are treated with testosterone, parameters such as sexual satisfaction, erection, sexual desire, enjoyment of sexual activity improve. It was recently shown in several studies that patients with erectile dysfunction who were non-responders to treatment with 100 mg sildenafil became responders when they received additional testosterone. At the 2003 2^nd International Consultation on Erectile and Sexual Dysfunctions in Paris it was recommended to measure testosterone levels in all patients presenting with erectile dysfunction.

O14

Testosterone and obesity

F. Saad¹, A.A. Yassin²

¹Male Healthcare, Schering AG Berlin, Germany and Research Department, Gulf Medical College School of Medicine, Ajman, UAE; ²Clinic of Urology and Andrology, Segeberger Kliniken, Norderstedt-Hamburg, Germany and Department of Urology, Gulf Medical College School of Medicine, Ajman, UAE

Obesity is a worldwide problem. It is often clustered with so-called metabolic syndrome consisting of (visceral) obesity, hypertension, decreased insulin sensitivity and dyslipemia, which predisposes to cardiovascular disease and diabetes. Increasingly, a role for testosterone is recognised in metabolic syndrome. A large number of studies have documented that visceral obesity and diabetes are associated with low plasma total testosterone levels. A recent study demonstrated a positive correlation between serum testosterone levels and insulin sensitivity in men across the full spectrum of glucose tolerance: men with prostate cancer, treated with androgen deprivation, develop an increase of body mass, fat mass, hyperinsulinaemia, hyperglycaemia, and insulin resistance. There is growing insight into the relationship between testosterone and adipose tissue. Testosterone regulates lineage determination in mesenchymal pluripotent cells. Testosterone promotes development of muscle cells of pluripotent cells and inhibits differentiation into the adipogenic cells through an androgen receptor-mediated pathway. The observation that differentiation of pluripotent cells is androgen dependent provides a unifying explanation for the reciprocal effects of androgens on muscle and fat mass in men. From this it would follow that restoration of testosterone levels to normal would lead to an increase of muscle mass and a decrease of fat mass, which is the case. Some studies indicate that raising testosterone levels in viscerally obese men leads to a reduction of visceral fat and an improvement of the cardiovascular and diabetogenic risk factors associated with it, but others do not confirm this result. Treatment of obesity is notoriously difficult. Obesity is often associated with mood disorders and testosterone has mood elevating effects. Obesity is also a risk factor for erectile dysfunction. Increasingly, studies document that restoration of testosterone levels to normal improves erectile dysfunction and can remedy failures of the phosphodiesterase type 5 inhibitors.

O15

The aging male – an invention or reality? Demographic and hormonal changes

F. Saad¹, A.A. Yassin²

¹Male Healthcare, Schering AG Berlin, Germany and Research Department, Gulf Medical College School of Medicine, Ajman, UAE; ²Clinic of Urology and Andrology, Segeberger Kliniken, Norderstedt-Hamburg, Germany and Department of Urology, Gulf Medical College School of Medicine, Ajman, UAE

With an increasing life expectancy and a decreasing reproduction rate, the population structure changes. Many researchers investigate the endocrinology of aging men. In men, a decrease in production of sex steroids and other hormones can be observed. The typical patterns of daily rhythmicity become less distinct.

Declining testosterone levels are one of the most important causes for the symptoms which may be experienced by aging men: loss of libido, erectile dysfunction, insulin receptor resistance, obesity, osteoporosis, disturbances of lipid metabolism, myocardial and circulatory disturbances, impaired well-being and mood. Many data are derived from studies in hypogonadal men treated by testosterone replacement. In such patients under testosterone treatment libido increases, fat mass decreases, muscle strength, bone mineral density and erythropoiesis increase. There is more and more evidence that the symptoms of symptomatic late-onset hypogonadism (SLOH) in aging men can successfully be treated by testosterone administration.

Growth hormone is another hormone which gradually declines with age in men (and women). In many aspects, growth hormone seems to have similar effects in men as testosterone. Concerning its therapeutic use, however, there is limited experience. Moreover, the application of growth hormone is still inconvenient and expensive.

A very interesting hormone showing a negative correlation with age is dehydroepiandrosterone (DHEA). Due to the unrestricted availability of DHEA in the US as a nutritional supplement, there is a lot of experience but a limited number of controlled studies. Although discussed controversially, there is evidence that the use of DHEA may be a useful compound in the treatment of aging men's symptoms.

Finally, melatonin, a hormone which plays a central role in the regulation of biological rhythms, also declines with age. There is some information that melatonin may help in restoring normal sleep patterns. Moreover, melatonin regulates the release of growth hormone.

The latter observation is an indicator for a very complex picture in which not only isolated hormones are involved, but also the influence of hormones on each other. Many factors from the external and internal environment mediated by neurotransmitters constantly affect the highly sensitive hormonal balance. Therefore, aging has also been defined as ‘the gradual dysfunction of homeostatic processes’.

O16

Metabolic syndrome and erectile dysfunction: Testosterone may be a common denominator

F. Saad¹, A. Traish², A. Yassin³, S. Kalinchenko⁴, R. Shabsigh⁵

¹Schering AG, Berlin, Germany and Gulf Medical College, Ajman, UAE; ²Boston University, Boston, Massachusetts, USA; ³Segeberger Kliniken, Norderstedt-Hamburg, Germany and Gulf Medical College, Ajman, UAE; ⁴Centre of Endocrinology, Moscow, Russia; ⁵Columbia University, New York, New York, USA

The definition of metabolic syndrome has recently been updated and lists 5 risk factors for cardiovascular diseases and type 2 diabetes of which 3 are considered sufficient for the diagnosis. Adjusted parameters are now available for Asian men. Several recent studies show an association between metabolic syndrome and erectile dysfunction and the common denominator might well be testosterone. Epidemiological studies find negative correlations between plasma testosterone on the one hand and central obesity, triglycerides and blood pressure and negative correlations with HDL cholesterol and insulin resistance on the other. Hypogonadism may be diagnosed in up to 50% of diabetic men.

These observations have been corroborated by findings in men receiving androgen deprivation therapy for prostate cancer treatment: body composition, lipid pattern and insulin resistance deteriorate soon after medically or surgically induced testosterone deficiency.

When hypogonadal men receive treatment with testosterone a consistent improvement in body composition (reduction of fat mass and increase of muscle mass), in particular related to central obesity, lipids, and insulin resistance (insulin, glucose, and HbA_1c) has been observed. It could be shown that testosterone has a direct and immediate effect on insulin sensitivity which is not mediated by changes in body composition. Testosterone also improves inflammatory cytokines profiles towards a more favourable anti-inflammatory, anti-atherosclerotic profile. So, studies are warranted to investigate the role of testosterone deficiency in metabolic syndrome to test whether testosterone deficiency is a pivotal component of metabolic syndrome. In animal models, castration leads to a deterioration of anatomical components of the mechanism of erection, for instance the corpus cavernosum smooth muscle and the tunica albuginea. Adipocyte accumulation in the subtunical compartment contributes to impairment of the veno-occlusive mechanism. Biochemical parameters such as the expression and function of both endothelial and neuronal nitric oxide synthase as well as phosphodiesterase type 5 are modulated by testosterone.

In men, the effect of testosterone on sexual functioning has been well documented. In men with hypogonadism and erectile dysfunction, treatment with testosterone undecanoate (Nebido®) alone for three months could restore erectile function in 54% of the patients. In men who did not respond to PDE-5 inhibitor monotherapy, testosterone could convert non-responders to responders. Hypogonadism was identified as a predictor for PDE-5 inhibitor response in a Korean study. It further could be shown that the combination of testosterone and PDE-5 inhibitors were more efficacious in terms of quantity and quality of nocturnal erections than either treatment alone.

Hypogonadism is not rare in men presenting with erectile dysfunction. Moreover, many studies reveal that co-morbidities such as hypertension, diabetes, dyslipidemia, and cardiac diseases are common in ED patients. The more severe the erectile dysfunction, the higher the prevalence of these concomitant diseases, and vice versa: the more severe the co-morbidities, the higher the likelihood of erectile dysfunction.

In summary, testosterone is pivotal in erectile physiology. Erectile dysfunction and metabolic syndrome share the same risk factors and hypogonadism is often part of metabolic syndrome, and testosterone may be the common denominator. ED may be the first symptom prompting men to seek medical advice. The time has come to view ED no longer as an entity in itself but as an expression of multiple underlying pathologies which require medical attention promoting general health and therewith also sexual functioning.

O17

What do men think about male fertility control?

F. Saad¹, K. Heinemann²

¹Schering AG, Berlin, Germany and Gulf Medical College School of Medicine, Ajman/UAE; ²ZEG Centre for Epidemiology and Health Research Berlin, Berlin, Germany

Introduction: Male fertility control (MFC) is becoming a realistic perspective but little is known about its potential users. How much information do they have, what are their wishes and attitudes? A survey of 9342 men aged 18–50 years was conducted in nine countries in four continents between April and June 2002. The results from Europe (Germany, France, Spain, Sweden), the US, Latin America (Mexico, Brazil, Argentina), and Indonesia will be presented. This allowed a cross-cultural comparison regarding knowledge, attitudes, and acceptability of male fertility control, about administration routes and intervals; it allowed differences and their determinants across various groups of potential users to be defined.

Subjects and methods: In the European and North American studies there are panels which are all representative regarding age, sex, regional structure and social status (e.g., educational level, income level), some even regarding some parameters of medical history. These panels have been broadly used in market research or election research in the respective countries for years already. In these countries, participants were chosen by random sample of males aged 18 to 50 years from existing panels (ACCESS panels, except for Sweden). In the Latin American countries and in Indonesia no household panel has been established, but a similar approach was used: the questionnaire was distributed by interviewers on the basis of a quota sample. Interviewers were sent to certain areas, and, by going from house to house, recruited men of the required age group who were willing to participate in the study. When 1000 men were interviewed, the field work was regarded as complete in the respective country. Therefore, no participation rates are available. Data were collected about the socio-demographic situation, knowledge about contraceptive methods, marital status and reproductive history/desires, personal attitudes towards contraception and the role of males, wishes regarding administration routes and duration of action of potential forms of MFC, factors that may positively or negatively influence the decision to use MFC, and many other related issues.

Results: About 50–80% of men currently used contraceptive methods, and 55% (France) to 78% (Argentina) decided together with their partner on the contraceptive method. 31% (Mexico) to 83% (France) of the respondents were not at all willing to undergo a permanent sterilisation (vasectomy). The general acceptance of a new hormonal male fertility control was favourable: 49.2% (USA), 57.6% (Latin America), and 62.7% (Europe) expressed their willingness to use such a method. Indonesia with 29% showed the lowest acceptance. More than 93% of men would seek advice on hormonal MFC from a physician. Among the types of physician, the ‘andrologist’ (described as the specialist for male healthcare) ranked highest (86.4%), followed by the urologist (80%), the GP (73%), and the gynaecologist (61.8%). If accepted at all, the first choice would be a pill taken daily (64%), followed by monthly injections (46%), and a once per year implant (41%). However, there were variations across countries. Efficacy of contraception (80–100%) and minimal side effects (80–100%) were considered as highly important with little differences across all countries. Fast onset and fast reversibility were also considered as important – as was the independence from females' fertility control. Improvement of well-being, enhancement of masculinity, sexual desire, performance, and satisfaction were considered as more important in Indonesia and Latin America (60–80%) than in the US and in European countries.

Conclusion: While the overall acceptance of MFC was broad across various cultures, there are obvious differences across cultures which might be related to socioeconomic, cultural and maybe religious factors of potential users.

O18

Efficacy of vardenafil for ED treatment

H. Sasaki, K. Oshinomi, N. Sato, T. Shichijo, T. Aso, M. Ota

Showa University, Fujigaoka Hospital, Japan

Aim: Since 1998, PDE-5 Is have been the first therapeutic option of ED treatment. However, Japanese approval of Vardenafil is different from other countries. So, we investigated the efficacy of Vardenafil in Japanese ED patients.

Method: From April 2001 to March 2007, a total of 47 patients were enrolled in this study. We evaluated patients suffering from ED aged from 24 to 80 (average 53.2 years old). IIEF5 score is ranged from 3 to 20.

Result: The efficacy rate is 76.5%, no efficacy 22.0%, withdrawal 1.5% within the Japanese approval (until 10 mg). However, we re-evaluated the efficacy up to high dose Vardenafil (20 mg), the efficacy is 85.3%, no effect 13.2%. Seven patients had DM, three hypertension, two hyperlipemia and one patient pelvic bone fracture. The causes of ED are two psychogenic, three arterial, two venogenic and one neurogenic. Only one patient withdrew due to headache and flashing. However, there were no severe adverse events.

Summary: Vardenafil is very effective and well tolerated with ED patients. However, we look forward to an approved high dose Vardenafil in Japan.

O19

Evaluation of the all natural virile™ cream for men, a unique personal care cream in the form of penis care cream as an effective way of creating genital consciousness, genital pride and firmer erection

M.T.M. Ismail

Damai Service Hospital, Jalan Ipoh, Kuala Lumpur, Malaysia

Genes and ethnicity influence the size of the penis. However, penis dimension depends on the filling up of the trabaculae spaces of the penile smooth muscle fibres by blood during erection and the power of the pelvic floor muscle. Increased relaxation of the smooth muscle contributed by epimedium, tissue energy contributed by the mudskipper extract containing alanine, as well as the nerve stimulatory effects of muira pauma could provide that extra increase in the penile dimension during erection and a virile cream for men with all these natural ingredients could be just the answer. The principal objective of the trial is to evaluate the health benefits of rubbing virile cream in strengthening and enhancing the dimension. The secondary objectives include the development of penis pride and penis consciousness, namely hygiene, natural aroma representing penis pride, and skin appearance, turgor and suppleness. These objectives were evaluated at every follow-up. Fifty men were recruited for the study. The first forty were provided with virile cream for 2 months. The last ten men were given a placebo cream with similar packaging to the virile cream and they were the study control. Each man was taught how to apply the cream to the penis as well how to monitor the length and circumference of the penis during erection on a weekly basis at home. The men filled out the Sexual Health Inventory in Men (SHIM) and the Grades of Erection Score. The penis size and diameter at rest were recorded. Penis Pride and Penis Consciousness Scores were recorded as well, using the scale of 1–3, where 1 is low and 3 is high. All these were repeated at two weeks, one month, six weeks and two months follow-up. Out of 40 men on the active cream, 39 completed the study period. One discontinued due to swelling of the penis. This is attributed to the paprika extract. The rest experienced a mild warming effect, which they accepted. Three men on the placebo cream discontinued the trial on the grounds of dissatisfaction. The remaining 7 continued till the end. They did not get any benefit from using the cream. All 39 registered improvement with the girth and diameter of ½ to 1 cm of the penis at rest. All 39 men showed improvement in the SHIM score over a period. Those who registered low score in item 4 of SHIM improved over time, indicating ability to maintain erection to completion of intercourse. There were no changes with the SHIM with men on the placebo group. All 39 men on active cream experienced improvement in control of ejaculation as sensitivity is under control. No such effect with placebo. All 39 men became hygiene conscious and found gentle manipulation provides responsiveness and quality erections for them. There was improved dimension at rest than during erection. Quality of erection improves due to greater sensitivity and responsiveness. Those with placebo eventually ceased using the cream because of no effect. All 39 men have better Grade Erection most of the time. Men with placebo experienced mixed grade Placebo improves skin dryness. The genital health care cream appeared to benefit the penis in making the skin healthy and responsive, the tissues nourished and the structures firm. Men who have poor control of ejaculation have better control due to biofeedback mechanism and those with mild erection experience better erections. Clients with placebo or bland cream did not give any positive effect to the user.

O20

Estrogen receptor pattern on benign prostate hyperplasia: The comparison between middle lobe to the two lateral lobes of the prostate gland

J. Ismy¹, P. Singodimedjo², Harijadi³

¹Division of Urology, Department of Surgery, Faculty of Medicine, Indonesia University, Jakarta, Indonesia; ²Division of Urology, Department of Surgery, Faculty of Medicine, Gadjah Mada University, Yogyakarta, Indonesia; ³Department of Anatomical Pathology, Faculty of Medicine, Gadjah Mada University, Yogyakarta, Indonesia

Introduction: Except androgen which plays a central role in the pathogenesis of benign prostate hyperplasia (BPH), estrogen has also been suggested for a long time as playing a synergetic or distinct role in the growth of the prostate gland. The exact functional roles of estrogen and its receptors in normal and neoplastic prostates are still unclear. Both prostate stroma and epithelium have estrogen receptors (ER). A previous study showed that the number of epithelial cells and androgen receptors (AR) in the middle lobe was fewer than in the two lateral lobes of the prostate. A further question was: is the ER number in the middle lobe of the prostate gland also fewer than in the two lateral lobes? The aim of this study was to find out the ER pattern of each prostatic lobe.

Method: Prostate samples were obtained from 22 BPH patients treated by transurethral prostatectomy. The tissues were collected from the middle, left and right lateral lobes and then grouped as A, B, and C. They were fixed in 10% buffered formalin, and separately kept in bottles. Samples were processed and immunohistochemically stained by Human Estrogen Receptor Antibody (NCL-ER-6F11) in the Department of Anatomical Pathology. The ER number in every sample was enumerated under light microscopy and the mean of the ER number were analysed by ANOVA and continued with Paired Samples t-test.

Results: The mean age was 66.64 ± 7.51 yr. The mean weight of the resected prostate gland was 47.05 ± 23.2 grams. The mean of ER number in the groups A, B and C were 14.05 ± 0.65, 10.91 ± 0.41 and 10.61 ± 0.18 respectively. By statistic analysis, the difference of ER number between group A to B and A to C were significant (P < 0.05), but the difference of ER number between group B to C was not significant (P > 0.05). The Paired Samples t-test for group A to B and to C was significant (P < 0.05).

Conclusion: The difference of ER number between the middle lobe to the two lateral lobes of the prostate gland in BPH patients was statistically significant (P < 0.05), while the difference of ER number in the left lateral lobe to the right lateral lobe was not statistically significant (P > 0.05).

O21

The profile of urine culture and antimicrobial susceptibility of patients with urolithiasis in Dr Soetomo hospital January 2004-December 2005. A retrospective analytic study

K.B. Santosa, Tarmono

Department of Urology, Soetomo Hospital, School of Medicine, Airlangga University, Surabaya, Indonesia

Introduction: Urolithiasis is often associated with infection secondary to obstruction and stasis proximal to the calculus. Culture-directed antibiotics should be administered before elective intervention. Epidemiology and urine culture features can help us to appropriately tailor specific treatment for each patient.

Materials and methods: The method used in this study is retrospective analytic study. We collected all patients with urolithiasis in Soetomo Hospital from January 2004 to December 2005. They were classified based on age, sex, stone location, urine culture and antimicrobial susceptibility. Data were analysed with chi-square test using SPSS 11.5.

Results: We collected 559 patients with available data, 388 male and 171 female. A positive urine culture was found in 241 cases, 73% of them had colony count more than 10⁵ CFU/ml. Escherichia coli was the most commonly found organism (36.9%) followed by Staphylococcus sp. (14.5%) and Pseudomonas sp. (14.1%). Cefotaxime, ceftazidine and cefoperazone sulbactam have the highest susceptibility to all uropathogens (51.7%, 49.5% and 49.3%). However, Escherichia coli was mostly sensitive to ceftazidine (56.2%) and cefotaxime (52.8%). A positive urine culture of Escherichia coli was more likely found in female and young patients (p < 0.05). There was no significant association between the types of bacteria and stone location (p > 0.05).

Conclusions: Positive urine culture was found in less than half of the patients. Escherichia coli was the most commonly found. Cefotaxime, ceftazidine and cefoperazone sulbactam were susceptible to most of uropathogens.

O22

Administering change from sildenafil to vardenafil in ED patients

K. Kuratsukuri, T. Naganuma, Y. Nitta, T. Nakatani

Department of Urology, Osaka City University, Graduate School of Medicine, Osaka, Japan

Objectives: We changed to administering Vardenafil at patients' request for ED patients who had previously received Sildenafil, and made a comparative study of the effect and the adverse events of both medicines.

Method: 35 patients of ED that consulted the ED outpatient department in the Osaka City University Hospital were administered. All patients who had changed from Sildenafil to Vardenafil at the patients' request were evaluated. IIEF5, the satisfaction rating was used for evaluation, and the reason and any adverse event of the change of prescription were investigated by a questionnaire form.

Results: The average age was 57 years (33–78). All patients changed from Sildenafil 50 mg to Vardenafil 10 mg excluding one case. In the comparison of both medicines by IIEF5, 46% of patients had equal effect from both medicines. An increase IIEF5 scores was observed in 34% of patients using Vardenafil after using Sildenafil. Moreover, it was an almost similar result for both satisfaction ratings. There were no adverse events reported with the use of both drugs.

Conclusion: Improvement was observed in 34% of patients who switch to Vardenafil, which mostly concerns the erectile function. Vardenafil may be effective in patients who have had insufficient effect with Sildenafil. Although there is a possibility that the expectations for Vardenafil (as the newer medicine) produces an added placebo effect.

O23

The difference of IPSS, Q max and prostate volume before and after treatment with combination of dutasteride and tamoxifen in BPH patients without urine retention (an experimental study pre post control group design)

K.P. Seputra, Soetojo, D.M. Soebadi, Hendromartono, Widayat, J.P. Widodo

Department of Urology, Soetomo Hospital, School of Medicine Airlangga University Surabaya, Indonesia

Objective: To compare the IPSS, Q max and volume of the prostate pre- and post-treatment using 5α reductase inhibitor and tamoxifen in patients with BPH without urine retention.

Materials and method: We collected 40 patients diagnosed with BPH without urine retention. They were classified into 4 groups; each group consists of 10 patients and were given tamoxifen, dutasteride, combination tamoxifen with dutasteride and placebo. We recorded IPSS, uroflowmetry and volume of the prostate before and after 3 months of treatment. Data were analysed by SPSS 12.

Results: there was no significant improvement of Q_max (7.75 ± 3.5538 to 9.15 ± 2.9448) and IPSS (z score −1.633) after treatment with tamoxifen (p > 0.05). We found significant decreasing of prostate volume (40.124 ± 7.9129 to 36.323 ± 8.2573) after treatment with tamoxifen (p < 0.05). We also found significant improvement of Q_max (9.55 ± 3.2793 to 15.12 ± 4.3522), IPSS (z score −2.887) and decreasing of prostate volume (30.93 ± 9.0031 to 24.506 ± 7.3267) after treatment with dutasteride (p < 0.05). There was significant improvement of Q_max (6.55 ± 2.5435 to 8.86 ± 4.4475), IPSS (z score −2.449) and decreasing of prostate volume (31.403 ± 9.0031 to 26.78 ± 7.3267) after treatment with combination dutasteride and tamoxifen (p < 0.05). None of the parameters was improved in the placebo group.

Conclusion: Q_max and IPSS were significantly improved in the dutasteride and combination groups. There was significant decreasing prostate volume in all groups except the placebo group.

O24

Benign prostatic enlargement and bladder outlet obstruction is present in men with low PSA level

K.B. Lim, F.J. Lee, H.S.H. Ho, K.T. Foo

Department of Urology, Singapore General Hospital, Singapore

Aim and introduction: Traditionally, men presenting with LUTS and have PSA of ≤1.5 μg/L and prostate volume (PV) ≤ 20 mls were considered unlikely to have BPE. In our management of LUTS, we also considered intravesical prostatic protrusion (IPP) as an important factor in the assessment of BPE. Hence, in this study, we attempt to characterise the true nature of a normal prostate gland, i.e., PSA ≤ 1.5 μg/L, PV ≤ 20 ml and IPP ≤ 5 mm.

Methods: 276 of 444 participants (62.2%) age between 50 and 75 years old in a public PSA screening programme were found to have serum PSA ≤ 1.5 μg/L. These participants were later offered further evaluation via symptom score, uroflowmetry, digital rectal examination, PV and IPP measurement via transabdominal ultrasound. Among the 276 participants with PSA ≤ 1.5 μg/L, 105 accepted the invitation to partake in this study.

Results: Of these 105 participants, 4 were excluded (1 had carcinoma of the bladder, 1 had TURP before and 2 had incomplete assessments). Their demographics were: mean age 60.8 ± 6.7 years, PSA 0.84 ± 0.37 μg/L, PV 18.4 ± 6.9 ml (mean ± SD). 74 of the 101 participants had an IPP ≤ 5 mm. Their PSA, PV and Q_max were 0.76 ± 0.38, 18.1 ± 6.3 and 14.8 ± 6.2 respectively. The remaining 27 with IPP > 5 mm had PSA, PV and Q_max of 0.82 ± 0.33, 23.2 ± 7.2 and 13.3 ± 6.2 respectively. Only 47 participants fulfil the criteria of normal prostate gland, i.e., PSA ≤ 1.5 μg/L and PV ≤ 20 ml. 6 of them had uroflow <10 ml/s. Of these 6 men, 5 had IPP more than 3 mm.

Conclusions: Among men with low PSA ≤ 1.5 μg/L and PV ≤ 20 ml, more than 50% have evidence of BPE and BOO based on uroflowmetry and ultrasound derived measurement. An IPP of ≤3 mm will help identify those who are truly not having BPE.

O25

Testosterone and free testosterone level in copd rabbit

N. Rasyid, A. Taher, B.P. Priosoeryanto, W. Manalu, D.A. Astuti

Division of Urology, Department of Surgery, Faculty of Medicine, University of Indonesia, Cipto Mangunkusumo Hospital, Indonesia

It is known that incidence of COPD is related with older age and there is a tendency for decreasing testosterone levels in elderly patients even with or without COPD. This study is to confirm the effect of COPD in adult rabbit to decrease the testosterone and free testosterone level.

Materials and methods: Two groups with 12 rabbits in each group. Group I were control and group II were exposed in a biochamber with SO₂ in increasing doses from 50 ppm to 300 ppm over 4 to 5 weeks. PO₂ concentration in arterial blood was measured every week, and after 4 weeks the rabbits were sacrificed to confirm lung pathological result of COPD due to chronic bronchitis.

Testosterone and free testosterone were measured before and after the study.

Results: Chronic bronchitis was confirmed in the pathology result after exposure with SO₂ in the biochamber, and PO₂ concentration was decreased 1 week after exposure and maintained until week 4. PO₂ control group and exposed rabbit before study 75.34 ± 8.52 vs. 78.85 ± 645, P = 0.204. Quite similar one week after exposure control group = PO₂ level 76.5 + 0.1 vs. 59.9 ± 8.16 (P = 0.000) significantly different and until end of study control 83.4 ± 10.88 vs. 61.8 ± 8.43 (P = 0.000).

Testosterone levels before and after study control group 0.951 ± 0.957 became 1.611 ± 1.885 was increased and in COPD group 0.703 ± 0.943 became 0.638 ± 0.93 was decreased but there are no significant differences.

Free testosterone levels before and after study in the control group was increased from 0.883 ± 1.309 to 1.125 ± 1.772; and in the COPD group was decreased from 1.158 ± 1.304 to 1.133 ± 1.755 but both changes were not statistically significant.

Conclusion: In this study testosterone and free testosterone levels of COPD rabbit were decreased and testosterone and free testosterone levels in the control group were increased but not statistically different.

O26

Prostate biopsy guiding trus with prostate specific antigen to diagnose prostate carcinoma: Results of a two-year retrospective study

E. Sunarno, Tarmono

Department of Urology, Soetomo Hospital, School of Medicine, Airlangga University, Surabaya, Indonesia

Introduction: Prostate specific antigen (PSA) has been shown to be useful, alone and in conjunction with other tests in the diagnosis of prostate carcinoma. Previously, we demonstrated that a PSA level of greater than 4.0 ng/ml was the initial diagnostic test.

In the present investigation we performed digital rectal examination and transrectal ultrasound as well as ultrasound guided biopsy.

Objective: To find information about the pathological result of prostate biopsy guiding TRUS in patients with PSA > 4 ng/ml or suspected prostate carcinoma in rectal examination.

Material and methods: We collected data from the Department of Urology and Pathology between January 2004 and December 2005. Data of 598 men with LUTS and urine retention caused by enlargement of the prostate were collected. TRUS guided biopsies were performed in 289 men with PSA greater than 4 ng/ml and PSAD greater than 0.15 ng/ml/gr or clinically suspected prostate carcinoma.

Result: Carcinoma were detected in 2 men (0,69%) with PSA 4–10 ng/ml, 4 men (1.38%) with PSA 10–20 ng/ml, 13 men (7.95%) with PSA 20–10 ng/ml, 28 men (9.67%) with PSA > 100 ng/ml. The other 266 men had BPH and 3 men had PIN.

Millin's prostatectomy was performed in 20 men and 266 men were given TURP.

Conclusions: In this study, the prevalence of prostate cancer was lower than in the literature. Prostate carcinoma were detected in patients with PSA > 4 ng/ml (57 men, 19%). The result of this study is lower than others.

The PSA level will increase with catheterisation, rectal examination, inflammation of prostate, urinary retention, not only with malignancy.

O27

The difference of PSA and TGF-beta1 plasma level before and after treatment using a combination of dutasteride and tamoxifen in non-obstructive BPH patients (an experimental pre- and post-control group study design)

R.B. Prasetyo, Soetojo, D.M. Soebadi, Hendromartono, Widayat, J.P. Widodo

Department of Urology, Soetomo Hospital, School of Medicine, Airlangga University Surabaya, Indonesia

Objective: To compare the PSA and TGF-β1 plasma level before and after administration of 5α-reductase inhibitor (dutasteride) and anti estrogen (tamoxifen) in non obstructive BPH patients.

Material and Methods: We enrolled 40 patients diagnosed with BPH without urinary retention. They were classified into 4 groups consist of 10 patients and were given tamoxifen, dutasteride, combination of tamoxifen and dutasteride, and placebo for each group. We analysed the PSA and TGF-β1 plasma level before and after 3 months administration.

Results: There was significant increase (p < 0.05) of TGF- β1 as high as 54% (2.18 ± 0.88 to 3.36 ± 1.06) in the tamoxifen group, 26% (2.75 ± 0.62 to 3.47 ± 0.82) in the dutasteride group and 92% (2.37 ± 0.75 to 4.56 ± 1.98) in combination group. PSA was not significantly decrease in all groups (p > 0.05), it was 28% (4.25 ± 3.28 to 3.06 ± 3.08) in the tamoxifen group, 27% (2.20 ± 2.17 to 1.60 ± 0.982) in the dutasteride group, and 19% (2.95 ± 1.22 to 2.40 ± 1.78) in the combination group. There was no significant difference of both parameters in the placebo group.

Conclusion: TGF-β1 was significantly increased in all groups except for placebo. PSA was decrease in all group but statically not significant. TGF-β1 can be considered as a better biomarker compared to PSA in evaluation and management of BPH.

O28

Indirect consequences on gerontonomic aspects of aging (focused on Indonesian personnel at the naval base in Surabaya)

S.J. Poerwowidagdo

Hang Tuah University, Surabaya, Indonesia

Analysis on economic needs for the aging population should be a paramount aspect in gerontology. Comparison of spending budget on health care of retired active military personnel and civilian peers as compared to the still active personnel working at the Naval Base in Surabaya were studied. Metabolic diseases and other co-morbids were significantly increased in the retired aging group as compared to the group of still active military personnel as well as civilian peers. This study reported that increasing routine budget for retired personnel was unavoidable and significantly increased year to year. Security, health care and other administrative/insubstantial financial needs were other financial obligations that should be anticipated by the Indonesian Navy.

O29

Anabolic-androgenic steroid effects on early morbid symptoms after open prostatectomy

G. Pourmand, S. Salem, A. Karami, A. Emamzadeh, A. Mehrsai

Urology Research Centre, Sina Hospital, Medical Sciences, University of Tehran, Tehran, Iran

Introduction and objectives: Anabolic-androgenic steroids such as nandrolone phenpropionate (NP) dramatically improve the tolerance to acute stress conditions, strength, and subsequently quality of life in elderly men. We hypothesise that preoperative pulse-dose supraphysiological NP administration might improve early morbid symptoms in older patients undergoing open prostatectomy.

Method: From March 2005 to March 2006, 54 patients with a mean age of 70, diagnosed as benign prostatic hyperplasia and hospitalised for open prostatectomy, were randomised to receive preoperative supraphysiological NP administration (100 mg, intramuscularly, pulse-dose) or sesame oil placebo prospectively. Early postoperative morbid symptoms, including subjective urinary symptoms (dysuria, bladder retention sensation), incision site pain and general satisfaction of their current urinary condition, were assessed by the 5-point scale self-administrated questionnaire at 24 and 48 hours postoperatively. Sex hormone binding globulin and testosterone level were also measured.

Results: 24 hours postoperative symptoms were significantly reduced in the NP group compared to placebo (6.18 ± 2.81 vs. 9.77 ± 2.15; P < 0.001), whereas 48 hours postoperative symptoms revealed a decline, though statistically insignificant in the NP group (4.48 ± 2.32 vs. 5.55 ± 1.84; P = 0.06). There was no complication attributed to NP therapy.

Conclusion: The data supported the hypothesis that the preoperative supplementation of an anabolic steroid agent (NP) could result in better postoperative endurance of elderly men undergoing open prostatectomy. For further studies, longer and repeated pulse injections in larger numbers of older men are mandatory to prove the claim.

O30

Association of waist circumference with partial androgen deficiency in aging male (PADAM) and morbidity among older men

S. Hudaya, D. Rahardjo, A. Taher

Division of Urology, Dept of Surgery, Faculty of Medicine, University of Indonesia, CiptoMangunkusumo Hospital, Indonesia

Introduction: Partial androgen deficiency in the aging male (PADAM) was associated with decreased total testosterone, free testosterone, biologically accessible testosterone, dehydroepiandrosterone level and produced sexual and non-sexual effects including decreased libido, erectile dysfunction, decreased lean muscle mass, increased body fat (visceral adiposity), osteoporosis, and depression. Visceral adiposity, which can be determined by waist circumference (WC), in older men also associated with some morbidities such as diabetes mellitus and cardiovascular disease.

Aim: To determine the association of WC with PADAM, total testosterone (TT), and morbidity in the aging male.

Method: The study was designed as a cross sectional study to examine the association between aging male symptoms (AMS), testosterone level, morbidity and WC in aging men.

Results: There were 347 men participating in this study with a mean of age 59.4 years old. Mean of WC was 85.1 cm (SD 13.3 cm). Mean of total AMS, psychological, somatic, and sexual subscale were 30.0 (SD 8.2), 7.1 (SD 2.7), 12.9 (SD 4.0), and 10.0 (SD 3.5) respectively. TT levels were examined only in 210 men with mean testosterone level 543.7 (SD 189.9). Waist circumference has inverse correlation with total AMS score (p = 0.021), AMS somatic subscale (p = 0.004), and TT level (p = 0.00). Waist circumference is also associated with diabetes mellitus.

Conclusion: Waist circumference associated with TT, total AMS scale, AMS somatic subscale, and diabetes mellitus in aging male.

O31

Relationship between testosterone deficiency, obesity and metabolic syndrome in a group of older malaysian men

C.J. Ng¹, H.M. Tan^1,3, T.H. Timothy², W.Y. Low¹, E.M. Khoo¹

¹University of Malaya Medical Centre, Kuala Lumpur, Malaysia; ²University of Melbourne, Australia; ³Subang Jaya Medical Centre, Selangor, Malaysia

Objective: The association between testosterone deficiency (TD), obesity and metabolic syndrome (MS) is well established in the Caucasian population. This relationship remains uncertain in the Asian population. This study aimed to determine the relationships between TD, obesity and MS in a multi-ethnic Asian population.

Methodology: This cross-sectional community study was conducted in 2005–2006, involving 1046 urban-dwelling Malaysian men of age ≥ 40 years (Chinese 48.9%; Malay 34.5%; Indian 14.8%). All men were evaluated with a clinical history, physical examination and blood investigation for fasting blood glucose, lipids and total testosterone. Anthropometric measurements included weight, height and waist circumference.

Results: The mean age of men was 55.8 years (±8.4). 19.1% (n = 198/1037) were testosterone deficient (total testosterone <11 mmol/l), 31.6% (n = 316/1001) had metabolic syndrome (IDF criteria), 52% (n = 531/1022) were obese (by Asian classification BMI ≥ 25) and 53.4% had central obesity (waist circumference ≥ 90 cm). Univariate analysis showed an association between TD and MS (p < 0.0005), BMI ≥ 25 (p < 0.0005) and central obesity (p < 0.0005). However, after adjustment for confounders using logistic regression, the association between TD and MS became insignificant, but its association with BMI (OR 2.3; 95% CI 1.5 to 3.8) and central obesity (OR 1.9; 95% CI 1.1 to 3.5) remained. TD was also significantly associated with some components of MS: TG ≥ 1.7 mmol/l (OR 2.1; 95% CI 1.4 to 3.4), HDL ≤ 1.0 mmol/l (OR 5.6; 95% CI 2.4 to 13.1) and hypertension (OR 2.0; 95% CI 1.2 to 3.2).

Conclusions: Obesity, but not metabolic syndrome, is associated with an increased risk of testosterone deficiency in this group of older Asian men. This research finding is different from the West and it warrants further investigations into the complexity of classifying TD and MS, and establishing their relationships in Asian men.

O32

Prevalence of co-morbidities in men with erectile dysfunction in the Subang men's health study – an urban community-based research

H.M. Tan^1,3, W.S. Tan², C.J. Ng¹, E.M. Khoo¹, W.Y. Low¹, P.K. Yap³

¹University of Malaya Medical Centre, Kuala Lumpur, Malaysia; ²School of Medicine, Cardiff University, UK; ³Subang Jaya Medical Centre, Selangor, Malaysia

Objective: Erectile dysfunction (ED) is common among men with co-morbidities. It reflects the health status of aging men. This study aimed to determine the prevalence of co-morbidities in a population of urban men with ED.

Method: 1667 Malaysian men aged ≥ 40 years were randomly selected via the electoral roll. 1046 (63%) responded. Demographic data, lifestyle parameters, self-reported chronic diseases, IIEF and IPSS were administered. Fasting blood samples were taken for biochemical evaluation.

Results: Mean age of respondents was 56 ± 8.37 years (41 to 93). 49% were Chinese 34.3% Malay and 14.9% Indian. Using IIEF-5, prevalence of ED was 56.3% (mild – 37.4%, moderate – 11.7% and severe – 7.3%). The prevalence of co-morbid illnesses, biochemical diabetic (FBS > 7.0 mmol/l) and prediabetic status (FBS > 5.6 mmol/l) (p ≤ 0.001), moderate to severe IPSS (p ≤ 0.001), waist circumference > 90 cm (p ≤ 0.05) and blood pressure > 140/90 (p ≤ 0.001) were significantly higher among men with ED (p ≤ 0.001). The prevalence of ED was also associated with ethnicity (p ≤ 0.001). The proportion of men with each abnormal self reported medical conditions/parameter (% ED vs. % no ED) was hypertension (34.5% vs. 20.4%), diabetes mellitus (18.4% vs. 5.0%), coronary heart disease (13.6% vs. 6.0%), BPH (9.7% vs. 3.4%), waist circumference >90 cm (59.8% vs. 52.1%), BP measurement ≥140/90 mm Hg (42.6% vs. 30.1%), BP measurement ≥130/85 mm Hg (63.5% vs. 52.0%), IPSS moderate to severe (29.9% vs. 18.2%), FBS ≥ 6.1 mmol/L (20.9% vs. 9.6%), IFG 5.6–6.9 mmol/L (72.6% vs. 27.4%), FBS > 7.0 mmol/L (13.2% vs. 4.5%), PSA 4–10 ng/ml (79.2% vs. 20.8%) and Metabolic Syndrome – Asian Criteria (35.0% vs. 24.9%).

Conclusion: This Subang Men's Health Study, involving three main Asian ethnic groups, revealed significantly higher prevalence of co-morbidities in men with ED than in men without ED. The data provide strong evidence to screen for co-morbidities in men with ED and to screen for ED among men with co-morbidities in Asian communities.

O33

The Subang men's health research – a multiethnic community based study

H.M. Tan^1,2, C.J. Ng¹, W.Y. Low¹, E.M. Khoo¹, P.K. Yap², W.S. Tan³

¹University of Malaya Medical Centre, Kuala Lumpur, Malaysia; ²Subang Jaya Medical Centre, Selangor, Malaysia; ³School of Medicine, Cardiff University, UK

Objective: Men's health has become a lay concern and challenge for health care professionals and policy makers. The Subang Men's Health Research aims to determine the health status of multiethnic aging men in Malaysia.

Method: Between August 2005 and February 2006, a community-based cross-sectional study was conducted in an urban area with a population of about 110,000. 1167 men aged ≥ 40 years were randomly selected via the electoral roll. 1046 (63%) responded. Demographic data, lifestyle parameters, self reported chronic diseases, IIEF-5 and IPSS were administered. Fasting blood samples were taken for biochemical evaluation.

Results: Mean age of respondents was 56 ± 8.37 years (41 to 93). 49% were Chinese, 34.3% Malay and 14.9% Indian. Using IIEF-5, prevalence of ED was 56.3% (mild 37.4%, moderate 11.7%, severe 7.3%). The prevalence of LUTS (IPSS score ≥ 8) was 27.1%. Prevalence of other co-morbidities include the following: overnight and obesity (AP criteria) 76.7%, hypertensive blood pressure ≥ 140/90, 38.8% diabetes mellitus 18%, self reported heart disease 12.3%, dyslipidaemia 75%, low testosterone 18.5%.

Conclusion: This urban multiethnic community-based study involving all 3 main Asian ethnic groups revealed a huge disease burden and co-morbidities among men who are ≥ 40 years old.

O34

Partial androgen deficiency in the aging male (PADAM) in haemodialysis patients

T. Naganuma, K. Kuratsukuri, N. Yujiro, R. Yoshimura, Y. Takemoto, T. Nakatani

Department of Urology, Osaka City University Medical School, Osaka, Japan

Background: Partial androgen deficiency in the aging male (PADAM) is a syndrome caused by a decrease in androgen due to aging. It is well known that testosterone levels are lower in male haemodialysis (HD) patients than in age-matched control men. However, PADAM in HD patients has yet to be elucidated. In this study, we examined the prevalence and severity of PADAM in HD patients.

Methods: A cross-sectional study was conducted to determine the prevalence of PADAM in HD patients. Total testosterone (TT) levels were measured in 62 consecutive HD patients. PADAM was diagnosed when the patient had more than 27 points on Heinemann's aging males' symptoms (AMS) rating scale as well as hypogonadism with a serum TT level of less than 317.3 ng/dl. We investigated the prevalence of PADAM and compared various clinical parameters between those with and without PADAM.

Results: In 51 patients (82.3%), the AMS scores were greater than 27 points. A total of 20 patients (32.3%) had hypogonadism with serum TT levels of less than 317.3 ng/dl. As a result, 18 patients (29%) were diagnosed as PADAM. Moreover, there was no significant difference in the AMS scores (total, psychological, somatovegetative, and sexual subscales) between those with and without PADAM.

Conclusion: These results suggest that PADAM might be prevalent in male HD patients.

O35

The comparison of the epithelial cell number between the middle lobe to two lateral lobes of the prostate gland on benign prostatic hyperplasia (BPH) patient

E.Y. Rahman¹, P. Singodimedjo², Harijadi²

¹Division of Urology, Department of Surgery, School of Medicine, Indonesia University, Jakarta, Indonesia;²Division of Urology, Department of Surgery, School of Medicine, Gadjah Mada University, Yogyakarta, Indonesia

Introduction: Many authors wrote that in the year 2001 or third millennium there are many older people, worldwide demographic shifts are leading towards an increasingly aged society. One of the problems in older males is lower urinary tract symptom (LUTS). The most common cause of LUTS in older men is benign prostatic hyperplasia (BPH). The prevalence of histological, clinical and symptomatic BPH all increase with age. The experience since 1986 during cystoscopy examination for BPH patients before TURP, the microscopic pattern shows that the middle lobe of the prostate gland is smaller than the left and the right lobes. The objective of this study is therefore to find the epithelial cell number in each lobe of the prostate gland in BPH.

Methods: Samples were selected from patients with moderate and severe BPH who had undergoing transurethral resection of the prostate (TURP) in Diponegoro Dua Satu Surgery Hospital from May to November 2006 were included in this study. The tissue collected from the three lobes of the prostate gland was then grouped, namely the middle (A), left lateral (B), right lateral lobe (C). The samples were routinely fixed with formalin, embedded in paraffin and sectioned as 4 micrometer. After staining with HE, the epithelial cells were counted and statistically analysed using t-test (p < 0.05).

Results: Twenty-two patients were included in this study, mean age was 66.64 ± 7.6 (54–88) yr. The common occupation was farmer. Almost all patients had chronic urinary retention. Length of stay in hospital was 8.77 ± 2.7(6–17) days, mean weight of the prostate gland was 47.05 ± 23.2(5–90) g. The mean number of cells in group A, B, and C were 23.67 ± 8.4(13.6–44.4), 29.22 ± 8.8(16.4–41.2), and 29.11 ± 8.7(16.4–41.2) respectively. Significant difference was shown between group A and B, also between group A and C (p < 0.05).

Conclusion: The difference of the epithelial cell number between the middle lobe to the lateral lobes of the prostate gland was statictically significant (p < 0.05).

O36

The comparison of androgen receptor pattern between the middle lobe to the two lateral lobes of the prostate gland in benign prostatic hyperplasia (BPH) patients

Indrawarman¹, P. Singodimedjo¹, Harijadi²

¹Division of Urology, Department of Surgery, Faculty of Medicine, Gadjah Mada University, Yogyakarta, Indonesia;²Department of Anatomical Pathology, Faculty of Medicine, Gadjah Mada University, Yogyakarta, Indonesia

Introduction: Benign Prostatic Hyperplasia (BPH) is the most common benign tumour in men, and its incidence is age-related. One of the theories for BPH pathogenesis is the dihydrotestosterone (DHT) hypothesis. Testosterone produced by the Leydig cells enters the prostate cell and is metabolised by 5-α reductase to DHT. DHT is a potent androgen that will be bound to androgen receptor (AR) and promotes cell growth. Previous study showed that the number of epithelial cell in the middle lobe was fewer than the two lateral lobes of the prostate. A further question was: is the AR number in the middle lobe of the prostate gland was also fewer than the two lateral lobes? The aim of this study was to find the AR pattern of each prostatic lobe.

Methods: Twenty-two BPH patients underwent TURP in Diponegoro Dua Satu Surgery Hospital, Klaten from May until September 2006 and were included in this study. The tissues were collected from the middle, left and right lateral lobe and then grouped as A, B, and C group. They were fixed in 10% buffered formalin, and separately kept in bottles. Samples were processed and immunohistochemically stained by Androgen Receptor Antibody (NCL-AR-318) in the Laboratory of Anatomical Pathology, Gadjah Mada University. AR number in every sample was enumerated under light microscopy and the mean of AR number was analysed by ANOVA and Student's t-test.

Results: The mean age was 66.64 ± 7.51 yr (54–88 yr). The most common occupation was farmer. Twenty-one of the subjects (95.5%) came to the hospital with the chief complaint of chronic urinary retention. The mean weight of the resected prostate gland was 47.05 ± 23.2 g (5–90 g). The length of stay was 8.77 ± 2.60 days (6.0–17.0 days). The mean of AR number in the group A, B and C was 6.52 ± 1.72 (4.80–9.20), 24.36 ± 4.90 (17.60–34.40), and 26.54 ± 5.44 (20.00–37.60) respectively. By statistic analysis, the difference of AR number between group A to B and A to C was significant (p < 0.05), but the difference of AR number between group B to C was not significant (p > 0.05). The ANOVA test group for group A to B and to C was significant (p < 0.05).

Conclusion: The difference of AR number between the middle lobe to the two lateral lobes of the prostate gland in BPH patients was statistically significant (p < 0.05), while the difference of AR number in the left lateral lobe to the right lateral lobe was not statistically significant (p > 0.05).

O37

Low HDL cholesterol in relation with elevated s ICAM-1 as risk factor of acute myocardial infarction among elderly population in Denpasar, Bali

I.G.P.S. Aryana¹, A. Santoso², K. Suastika³

¹Geriatric division, ²Department of Cardiology and Vascular Medicine;³Endocrinology and Metabolism Division, Department of Internal Medicine of the Medical Faculty of Udayana University, Sanglah Hospital, Denpasar, Bali

Objective: The precise protective mechanism of high density lipoprotein (HDL) cholesterol underlying the development of atherosclerotic vascular disease has not been fully elucidated. Soluble intercellular adhesion molecules 1 (s ICAM-1) play a critical role in the homing of leucocytes to the site of atherosclerotic lesion. This study aims to prove that low HDL cholesterol increased risk of acute myocardial infarction (AMI) in relation with elevated level of s ICAM-1 in Denpasar, Bali.

Design and methods: This study was a case control study. Cases were matched to controls according to age, gender, history of diabetes and smoking status. Data are presented as group mean ± SD and analysed by t-test, chi-square and log regression with SPSS 13 software.

Results: Eighty-four subjects (38 cases and 37 controls) were recruited and examined. Mean of age was 63.67 ± 8.98 years, HDL cholesterol 40.02 ± 13.44 mg/dL, and s ICAM-1 261.20 ± 135.85 ng/ml. The mean of HDL cholesterol was significantly lower in case than control: 35.45 ± 8.25 mg/dL vs. 44.60 ± 15.82 mg/dL respectively with p < 0.001. Prevalence of low HDL cholesterol was significantly higher in case than control: 71.4% vs. 38.1% with p = 0.002. Low HDL cholesterol was higher risk of IMA with odds ratio 4.06 (95% CI 1.63–10.14, p = 0.002) than hypertriglyceridemia with odds ratio 2.75 (95% CI: 1.11–6.78, p = 0.026). Log regression analysed found that only HDL cholesterol was a consistently significant risk of AMI I = 0.014 but hypertriglyceridemia was excluded. The HDL cholesterol has significant correlation with s ICAM-1 in case group (p = 0.005, R = 0.438).

Conclusion: The low of HDL cholesterol increased risk of AMI around 4 times than normal HDL cholesterol. There was significant correlation between HDL cholesterol and plasma s ICAM-1 in IMA patients. Increased risk of AMI in patients with low HDL cholesterol might be related to increased expression of adhesion molecules in endothelial cells in Bali population.