bluuebunny/crossref_metadata_2025 huggingface dataset:
202 Impact of Urinary Incontinence on Sexual Function in Patients Presenting for Lower Urinary Tract Symptoms
Authors: Fallara G. , Boeri L. , Candela L. , Costa A. , Capogrosso P. , Cazzaniga W. , Schifano N. , Pozzi E. , Belladelli F. , Cignoli D. , Colandrea G. , Cornelius J. , Mattei A. , Montorsi F. , Salonia A.
Published: May 2022

Introduction

Patients with low urinary tract symptoms (LUTS) frequently complain some sexual dysfunction and sometimes even episodes of bothersome urinary incontinence (UI).

Objective

We aimed to assess the relationship between UI (as measured with the ICIQ-UI-SF), and sexual disfunction (as measured with the IIEF), in men presenting with LUTS at a tertiary-referral centre.

Methods

In this cross-sectional study, data were retrospectively retrieved from 938 consecutive patients aged >18 years seeking first medical help for self-reported LUTS (i.e., all patients had IPSS≥1). All patients had a complete clinical assessment and completed the IPSS, the ICIQ-UI-SF, the OAB-q and the IIEF questionnaires. Patients were stratified into “no UI” (ICIQ-UI-SF=0), “mild UI” (ICIQ-UI-SF=1-7), “moderate UI” (ICIQ-UI-SF=8-13) or “severe UI” (ICIQ-UI-SF=14-21). ANOVA test assessed differences in baseline characteristics among these groups. Spearman correlation test was applied to evaluate the correlation between ICIQ-UI-SF and IIEF domain scores. A linear regression analyses tested putative risk factors associated with increased ICIQ-UI-SF scores.

Result

Of 938, 589 (63%) patients had no UI, 237 (25%) had mild UI, 76 (8%) moderate UI and 36 (4%) severe UI. There were no substantial differences in total PSA levels and uroflowmetry parameters among UI groups, whereas prostate volume, IPSS and OAB-q scores were higher as UI symptoms increased (all p≤ 0.03). A negative correlation was found between IIEF-total, IIEF-Erectile Function, IIEF-Intercourse Satisfaction and IIEF-Overall Satisfaction scores and ICIQ-UI-SF scores (i.e., the worse UI symptoms, the worse the overall sexual function (rho= -0.12; p<0.001), IIEF-EF (rho= -0.15; p<0.001), IIEF-IS (rho = -0.1; p=0.004) and IIEF-OS (rho = -0.12; p<0.001). Sexual desire and orgasmic function domains were not correlated with ICIQ-UI-SF. Finally, higher BMI (Coeff 0.12; 95% CI 0.03-0.32; p=0.011), diabetes (Coeff 1.76; 0.35-3.18; p=0.015) and presence of comorbidities (Coeff: 0.9; 0.06-0.1.74; p=0.035) were associated with higher ICIQ-UI-SF scores. Main limitations of the study were that ICIQ-UI-SF does not discriminate between urge or stress UI.

Conclusion

In patients presenting with LUTS, the presence of urinary incontinence was associated with worsening of overall sexual function (i.e., erectile function, intercourse satisfaction and overall satisfaction).

Disclosure

Work supported by industry: no.
208 Age, Testosterone Levels, and Hypogonadism-Related Symptoms Among Men with Azoospermia
Authors: Iwatsuki S. , Umemoto Y. , Takeda T. , Nozaki S. , Yasui T.
Published: May 2022

Introduction

Considering that most men who complain of infertility are of an age traditionally defined by social and physical activity, disability in performing these activities may worsen their quality of life. Among those who complain of infertility, it is suspected that some of them have hypogonadism or symptoms intrinsic to aging; however, these associations have not been completely elucidated in current literature.

Objective

This study aimed to assess the prevalence of aging- or hypogonadism-related symptoms among men with azoospermia. We also assessed relationships between serum testosterone levels and severity of symptoms under the domains of the Aging Males' Symptoms (AMS) -scoring system.

Methods

Clinical records of 494 patients with azoospermia (106 from obstructive and 388 from nonobstructive etiologies) who underwent surgical sperm extraction at Nagoya City University were retrospectively reviewed. Correlations between age and serum total testosterone (TT) and AMS scores (total and by each of three domains) were evaluated using the Spearman's rank correlation coefficient.

Results

Moderate or severe (total AMS score of≥ 37) symptoms were present in 9.5% and 12.7% of patients with obstructive and nonobstructive azoospermia, respectively. Symptoms were present regardless of etiology of azoospermia. Among our study population, no significant correlation between age and TT was observed (R=-0.057, p=0.21). However, there was positive correlation between age and total (R=0.090, p<0.05) or sexual (R=0.218, p<0.01) scores among the AMS scale's domains. Moreover, there were negative correlations between serum TT level and total (R=-0.177, p<0.01), psychological (R=-0.149, p<0.01), somatic (R=-0.183, p<0.01), and sexual (R=-0.097, p<0.05) domain scores. Multiple comparisons using Bonferroni-Holm's correction showed statistically significant correlations between aging and sexual symptoms and between hypogonadism (decreased serum TT) and psychological or somatic domains in the AMS-scoring scale.

Conclusions

This study revealed that men with azoospermia have not only underlying deterioration in sexual symptoms with aging, but that psychological and somatic symptoms also deteriorate as a function of hypogonadism. Our results indicate that assessment, treatment, and supportive management of underlying hypogonadism-related symptoms should be considered for patients with azoospermia who are currently undergoing infertility treatment.

Disclosure

Work supported by industry: no.
218 Using Mini-Jupette Slings to Treat Post Radical Prostatectomy Urinary Incontinence: Foreplay Incontinence, Climacturia, and Stress Incontinence
Authors: Brady J , Choi E , Foley B , Wilson S , Yafi F
Published: May 2022

Introduction and Objective

The Mini-Jupette has been successfully used concomitantly with inflatable penile prostheses (IPP) to treat erectile dysfunction (ED), climacturia and stress urinary incontinence (SUI) secondary to radical prostatectomy (RP). This is the largest single surgeon report of the original Andrianne Mini-Jupette sling and IPP placements in men with ED and climacturia, mild SUI and/or foreplay incontinence.

Methods

This was a retrospective study on a prospectively managed database of 32 patients who underwent IPP and Mini-Jupette placement using Tutoplast® cadaver pericardium graft by a single surgeon between July 2016 and February 2020. Patients were surveyed pre- and post-operatively and asked to score the severity of their foreplay incontinence (FI), climacturia, and SUI from 0 (“dry”), 1 (“1 drop”), 2 (“few drops”), 3 (“small dribble”), or 4 (“squirt of urine”). Patient surveys were compared pre- to post-operation using Fisher's exact test.

Results

Of the 32 men, 27 (84%) had FI, 26 (81%) with climacturia, and 27 (27%) with SUI (Table 1). At a mean follow-up of 17.9 months, FI (p<0.001), climacturia (p<0.001), and SUI (p<0.001) all significantly improved (Table 2). FI improved in 78.9% (15/19) and resolved in 47.4% (9/19); climacturia improved in 82.3% (14/17) and resolved in 64.7% (11/17); SUI improved in 71.4% (15/21) and resolved in 57.1% (12/21). Sexual Health Inventory for Men (SHIM) scores significantly improved from 5.0 to 23.8 (p<0.001) for the entire group. Three patients (9.4%) required an artificial urethral sphincter (AUS) for the management of persistent incontinence. One patient underwent IPP revision due to foreskin irritation and another experienced pump-related issues.

Conclusions

The Mini-Jupette in tandem with an IPP is a safe and effective treatment option for men with severe ED experiencing sexually related incontinence as well as SUI post-RP. This is the first report of IPP placement with a Mini-Jupette sling successfully treating foreplay incontinence.

Disclosure

Work supported by industry: no. A consultant, employee (part time or full time) or shareholder is among the authors (Antares Pharma, Clarus Therapeutics, Coloplast, Promescent, Viome).
224 Prevalence of Genitourinary Syndrome of Menopause in Japanese Peri- and Post-Menopausal Women: A Cross-Sectional Online Survey
Authors: Ozaki Y , Tomoe H , Kuwajima M , Ninomiya N , Sekiguchi Y , Sato Y , Nagao K , Takahashi S
Published: May 2022

Introduction

Genitourinary syndrome of menopause (GSM) is a symptom complex that occurs secondary to vulvovaginal atrophy. It is generally accepted that GSM is more prevalent in postmenopausal women, and that it can affect their quality of life (QOL). However, there is little data regarding GSM in Japan.

Objective

The aim of this survey was (i) to determine the prevalence of vulvovaginal symptoms of GSM among Japanese peri- and post-menopausal women and (ii) to examine whether sexual activity affected the prevalence of GSM.

Methods

We conducted an online survey of 4,134 Japanese women aged 40 – 79 years in the general population. In this primary study, we focused on vulvovaginal symptoms of GSM. GSM was defined as a condition characterized by presenting at least one vaginal symptom such as vulva dryness, vulva hurting, dryness during sexual activity, and dyspareunia using the vulvovaginal symptoms questionnaire. The correlations between age, sexual activity, and GSM were analyzed.

Results

The prevalence of GSM was 11.6%. The respondents who reported GSM were more likely to be younger. The most common symptom was vulva dryness (6.0%). Only 22.0% of respondents were currently sexually active. Sexual activity was significantly correlated with GSM (P<0.01). The participants aged their 40s – 60s who had sexual activity showed an age-dependent increase in the prevalence of GSM such as vulva dryness and hurting. The respondents aged their 70s who were sexually active reported less dyspareunia than the other ages.

Conclusions

The vulvovaginal symptoms of GSM were not found with high frequency in Japanese peri- and post-menopausal women. This primary study was conducted in limited areas of GSM. We are planning to analyze the features of GSM including urinary symptoms and QOL more comprehensively with our whole database.

Disclosure

Work supported by industry: yes, by KOBAYASHI Pharmaceutical Company Limited. A consultant, employee (part time or full time) or shareholder is among the authors (KOBAYASHI Pharmaceutical Company Limited).
233 Association Between Physical Activity and Sexual Dysfunctions in Medical Students from Southern Brazil
Authors: Tronco G , Castralli H , Salatino L , Motta G , Zancan M
Published: May 2022

Introduction

Physical activity is likely to be associated with sexual activity, being a modifiable risk factor to female sexual dysfunction. This condition is a highly prevalent medical issue, affecting 41% of reproductive-age women worldwide. In a study by Cabral et al., the presence of a sexual dysfunction, measured by the Female Sexual Function Index (FSFI), was found in 67% of the sample and associated with a sedentary lifestyle. In another study, menopausal women have a better body image when they exercise regularly, improving their self-esteem, emotion expression, and maintaining an adequate BMI. Despite the importance of sexuality disorders and physical activity to the quality of life and health of women, studies that evaluate the relationship between these aspects in young women are scarce.

Objective

This research aims to analyze the association between physical activity and sexual dysfunctions in a female population of medical students.

Method

Cross-sectional study developed with young female adults that answered an online survey with 34 questions covering sociodemographic, behavioral and sexuality aspects. The validated Portuguese version of the Female Sexual Function Index questionnaire (FSFI-6) was applied, which is composed of six questions scored from 0 to 5, addressing the main sexual domains: desire, arousal, lubrication, orgasm, satisfaction and pain. A total FSFI-6 score ≤ 19 was considered a positive screening for female sexual dysfunction. The practice of physical activity was divided into: not practice, practice 1 or 2 times, 3 or 5 times and 6 or more times. We used the Kruskall-Wallis statistical test for quantitative analysis.

Results

Of the 169 participants, 29% (n = 49) reported not practicing physical activity during the week, while 24.9% (n=42) practiced it 1 or 2 times, 36.7% (n=62) 3 or 5 times and 9.5% (n=16) 6 or more times. The FSFI-6 analysis revealed an association between 6 or more times of physical activity and better scores in desire (p=0,10), excitation (p=0,12), orgasm (p=0,015), satisfaction (p=0,01) and total scores (p=0,001). Also, there is an association between 3 and 5 times of physical activity and better scores in desire (p=0,011), satisfaction (p=0,019) as well as in the total FSFI-6 distribution (p=0,001). They were all compared with no physical activity.

Conclusion

We found an association between a sedentary lifestyle and worst scores in desire, excitation, orgasm, satisfaction and the total of FSFI-6 distribution. Therefore, there is a lower risk of presenting sexual dysfunctions when the woman is physically active.

Disclosure

Work supported by industry: no.
247 Comparison of Non-Invasive Measurements of Penile Curvature in Peyronie's Disease
Authors: Pedrenho Neto R , C G Nascimento B. , Machado Barbosa Neto C , de Bessa Junior J , Srougi M , Carlos Nahas W
Published: May 2022

Introduction

Peyronie's disease (PD) is a fibrotic disorder of the tunica albuginea, leading to penile deformities. Non-invasive estimates of penile deformities are practical, but have low accuracy when compared to objective measurements with induced erection and a goniometer. Our aim was to evaluate the agreement between different non-invasive methods of measuring penile curvature and the objective measurement.

Methods

We retrospectively reviewed medical records of patients who underwent surgery in a sexual medicine tertiary center. During the clinical visit, pre-operatively, a set of different non-invasive estimates were performed including asking the patient to explain their primary curvature with a goniometer, a drawing of the penis and a malleable implant prosthesis to be molded. Also, at home photography were required with maximal erection. The agreement of those methods and intra-operative measurement using a goniometer after saline induced erection was analyzed. A tolerable error was considered if a difference smaller than 10o or 20% of the gold standard measurement was found.

Results

The sample consisted of 69 men with a mean age of 62 ± 6 y. The direction of the curvature was dorsal in 59%, left in 35%, right in 5% and ventral in 1%. Mean curvature with of estimates with the goniometer was 57o (±31), drawing 60 o (±28), Prosthesis 60o (±25), Photography 57 o (±27), and mean intra-operative measurement was 51 o (± 24). Overall precision considering the above mentioned tolerable error definition was 45%, and the single non-invasive method with better precision was Prosthesis with 46,5% fo concordance. There was no statistical difference between them (p=0.99) for concordance and disagreement by the Dunnett's multiple comparisons test.

Conclusion

In our comparison study of 4 non-invasive curvature assessment methods, we found a low precision (approximately 45%), regardless of the chosen method. Formal curvature assessment with induced erection and a goniometer appears to be imperative.

Disclosure

Work supported by industry: no.
249 Influence of Pretreatment Sperm Cryopreservation on Psychological State of Sexual Function in Male Patients with Cancer
Authors: Takeshima T
Published: May 2022

Introduction

With the development of cancer treatment in recent years, the prognosis of AYA (Adolescent and young adult: 15-39 years old) generation cancer survivors has significantly improved. In particular, among cancer survivors, there are no reports on how the psychological state of male sexual function is affected by whether or not fertility preservation was performed before cancer treatment.

Methods

Male patients diagnosed with malignant diseases and treated with anticancer drugs at the participating institution were asked to complete a 15-item questionnaire based on the Prostate Cancer Symptom Index and the Sexual Function Domain of the Distress Scale to assess male self-efficacy among patients who underwent pretreatment sperm cryopreservation and those who did not. The results were subjected to principal component analysis (PCA) to reduce the dimensionality, and the factors explaining the difference between the two groups were examined, and logistic regression analysis was used to examine the differences between groups.

Results

The analysis was conducted on 118 subjects in the freezable group (Group A) and 53 subjects in the non-freezable group (Group B). A complete-case analysis was conducted excluding those with missing responses. The mean age was 31.2 years in group A and 39.0 years in group B. The disease breakdown was 46.5% testicular tumor, 41.0% hematologic malignancy, and 4.7% malignant bone and soft tissue tumor in group A, and 58.5% testicular tumor, 32.0% hematological malignancies, and 1.9% malignant bone and soft tissue tumor in group B. In the principal component analysis, the first principal component was characterized as “self-evaluation of male function”, and the second principal component was characterized as “anxiety about the primary disease”. The cumulative contribution rate was 56.3% for the second principal component. Group A had tendency to have higher self-evaluation of male function and higher anxiety about the primary disease compared to Group B. Logistic regression analysis was performed with the first principal component as the explanatory variable, but no significant difference was found between the groups.

Conclusion

Patients who were able to cryopreserve their sperm tended to be more anxious about the primary disease because they had a better understanding of the disease. In addition, patients who were not able to cryopreserve sperm had tendency to have low self-evaluation of male function, suggesting that psychological support such as counseling is necessary.

Disclosure

Work supported by industry: yes, by Ministry of Health, Labour and Welfare.
250 Psychosexual Issue Affecting Men with Klinefelter Syndrome Seeking Fertility Management
Authors: Al-Hussini M , Allchorne P , Yap T , Frodsham LC
Published: May 2022

Introduction and Objective

Klinefelter Syndrome (KS) is the commonest hypo-androgenic chromosomal anomaly affecting fertility (1:600 men). KS frequently goes undiagnosed until middle age during fertility investigations. However, beyond fertility issues there is little known of the psychological effect of KS on these newly diagnosed men. This study aims to examine the psychosexual impact of newly diagnosed KS in couples presenting to a multidisciplinary KS clinic.

Methods

Prospectively compiled data from 18 recently diagnosed KS patients with subfertility attending a multidisciplinary KS clinic were analyzed. A baseline patient-centered psychosexual function questionnaire (NSOG) was used to identify issues with body image, sexual function and wellbeing whilst erectile dysfunction (ED) issues were specifically sought using the validated IIEF-5 questionnaire. Ethics approval was obtained.

Results

89% (17/18) of KS men rated their sex life as highly important but less than 44% rated the quality of intercourse and a similar proportion were anxious about having sexual intercourse. This was in keeping with a mean IIEF-5 score of 16 (range 24- 12) in this group indicating mild to moderate ED. 56% felt that their body could adequately work sexually but 17% felt their mood negatively affected influencing sexual performance, with only 38% satisfied in their sex life. 50% of men also reported perceived delayed ejaculation. Whilst the majority reported noticed libido issues, 5% of men reported hyperactive sexual desire which impacted on social functioning.

Conclusions

Psychosexual difficulties are common in KS patients undergoing fertility treatments and yet this aspect of their management is often neglected. Psychosexual treatment should be discussed with all KS patients as all patients reported wanting to receive help and advice on improving their sexual lives. A study is now in place to determine the longer-team outcomes of targeted psyhosexual therapy in this cohort of KS men on general wellbeing and memntal health.

Disclosure

Work supported by industry: no.
257 Breast Cancer and Sexual Dysfunction: Does Surgery Matter?
Authors: Tovim Rodrigues C , Nobre P , Quinta Gomes A
Published: May 2022

Introduction

It is well known that breast cancer and its associated treatments have negative effects on women's physical, emotional, and overall sexual health. Studies have shown that the incidence of sexual dysfunction is significantly higher after the diagnosis and associated treatments of breast cancer. For surgical procedures, there is evidence of an increase in sexual problems 6 months after surgery. .

Objective

The aim of this review is to examine the available research on the impact of breast cancer surgery on women's sexuality.

Methods

A comprehensive search of Medline, Scopus, and Web of Science databases was conducted to find Englishlanguage articles published since January 2000. We used a list of keywords combining "breast cancer" AND "surgery" AND "sexual function" AND "sexual dysfunction".

Results

We found 1947 results, and after selecting quantitative and original articles on the effects of breast cancer surgery on female sexuality, there were 14 eligible articles. Three articles from other sources were included.

Studies comparing the sexuality of the general population with that of women who had undergone breast cancer surgery found a higher risk of sexual dysfunction in these women. When comparing different types of surgery, namely mastectomy with or without reconstruction and breast-conserving surgery, different results were obtained. Four studies found no differences in sexual function between the different types of surgery. Mastectomy without reconstruction was associated with a negative impact on sexual function in four other studies, with all sexual domains affected in some of these studies. In contrast, two studies found lower scores in women who had undergone breast-conserving surgery. Axillary lymph node removal has also been associated with genital arousal disorder. Two studies found no association between sexuality and breast cancer surgery.

Conclusions

Breast cancer and related treatments, including surgery, have a negative impact on women's sexuality. Different types of surgery appear to have different effects, with mastectomy without reconstruction associated with worse outcomes, while breast-conserving surgery was associated with lower sexual function scores in only two studies. All of these studies relied on different methods and populations with different expectations, which may explain some of the disparity in outcomes. By pointing out the surgical consequences of mastectomy preoperatively, surgeons can make patients' expectations of esthetic and functional outcomes after breast cancer surgery more realistic and help patients make better treatment decisions.

Disclosure

Work supported by industry: no.
259 Anathema: Promoting Sexual Health and Sexual Well-Being in Patients with Colorectal Cancer
Authors: Quinta Gomes AL , Pereira R , Vasconcelos PA , Carneiro B , Nobre PJ
Published: May 2022

Introduction

Sexual health is an important dimension of global health and is strongly related to physical and psychological health, as well as to people's perception of general well-being and quality of life. However, sexual health and sexual well-being in patients with colorectal cancer still lack a systematic and strategic management in the survival of these patients. Specialized and accessible care is of utmost importance to meet patients’ specific needs regarding sexuality and sexual health.

Objective

This presentation will focus on “Anathema: Technology for ageless sexual health”, an European project aimed to develop and implement an e-Health sexual health promotion program based on scientific evidence and designed to meet the specific needs of patients with colorectal cancer.

Methods

The project comprises different phases and its execution is based on a multimodal and participatory approach.

Results

By adopting a participatory design and a multimodal approach in the different phases of the project, Anathema is a very promising therapeutic intervention tool for promoting sexual health and to address unmet sexual needs of colorectal cancer survivors.

Conclusions

This project will make a significant contribution in addressing the sexual health and quality of life of patients with colorectal cancer.

Disclosure

Work supported by industry: no.
275 Correlation Between Libido and Testosterone: Estradiol Ratio in Men with Sexual Dysfunction
Authors: Pedrenho Neto R , dos Santos Sobreira Nunes R , C G Nascimento B. , Machado Barbosa Neto C , de Bessa Junior J , Srougi M , Carlos Nahas W
Published: May 2022

Introduction

Sexual desire drives men to seek sexual activity, positively impacting cognitive function, emotional affective state and affecting the quality of life. This dynamic process is impacted by several factors including the cognitive, neurophysiological and affective spheres. Hormonal balance is also one of the known factors affecting libido. Our aim was to evaluate correlation between libido reduction and hormonal profile (HP), including the Testosterone(T):Estradiol(E) ratio.

Methods

Retrospective analysis of medical records of sexual medicine consultations in a tertiary care center. Patients were systematically questioned if they perceived their libido decreased using the following question (“Do you believe your libido or sexual desire has decreased in the last few months?”), and all had morning HP checked (Total and free testosterone, SHBG, E2, LH, FSH). HP was categorized into the following groups: Low T (T<300ng/dl) and Normal T (T≥300ng/dl); normal T:E ratio > 100 and Low T:E ratio <100. All patients with hyperprolactinemia (>35ng/dl) were excluded. Comparison of HP between men who referred decreased libido and those who did not was performed, and the relationship between the different parameters and sexual desire were studied by univariate and multivariate analysis.

Results

A total of 194 patients were evaluated, with a mean age of 61 ± 21 y. 188 (97%) reported being heterosexual and 154 (79%) had a steady partner. From this sample, 24% had low T levels. The percentage of patients referring decreased libido was 32.5%. In the Low T group, 67,5% reported decrease of Libido (OR 2,4; 95% IC: 1,2-4,8; p=0,01) and 67% of the Low T:E ratio group reported decrease of Libido (OR 3,7; 95% IC: 1,6-8,2; p=0,001). In multivariate analysis, after adjusting for age, we found the T:E ratio was associated with decreased of libido irrespective of T status.

Conclusion

In our sample of men seeking treatment for sexual dysfunction, low T and low T:E ratio was significantly correlated with perceived decreased libido. Recognizing the imbalance of T:E ratio can help clinicians to identify men with low sexual desire and their best management. Further studies are necessary to confirm this data and understand how treatment affects those parameters.

Disclosure

Work supported by industry: no.
005 Assessment of Combination Therapies Versus Phosphodiesterase Type 5 Inhibitor Monotherapy for Erectile Dysfunction: A Systematic Review and Meta-Analysis
Authors: Mykoniatis I. , Pyrgidis N. , Sokolakis I. , Ouranidis A. , Sountoulides P. , Haidich A. , Van Renterghem K. , Hatzichristodoulou G. , Hatzichristou D.
Published: May 2022

Introduction

Combining two first-line treatments for erectile dysfunction (ED) or initiating other effective modalities on top of phosphodiesterase type 5 inhibitors (PDE5i) may produce beneficial outcomes.

Objective

To assess the efficacy and safety of different combination therapies with PDE5i compared to PDE5i monotherapy in various subgroups of patients with ED through a systematic review and meta-analysis.

Methods

We considered randomized trials on males with ED that assessed the effect of combination therapy versus PDE5i monotherapy with validated questionnaires. Studies were identified by searching Medline, Cochrane Library and Scopus databases We undertook a meta-analysis for the mean international index of erectile function (IIEF) change, and for the number of adverse events (AEs) based on different treatment modalities and subgroups of patients.

Results

We included 3,853 individuals (44 trials). Combination therapy with PDE5i, compared to PDE5i monotherapy, was associated with a mean IIEF improvement of 1.92 points (95% CI: 1.41 to 2.44, I2=82%). Adding to PDE5i: daily tadalafil, low-intensity shockwave therapy, vacuum erectile device or antioxidants resulted in a significant IIEF improvement. The latter was not observed with a-blockers. Compared to monotherapy, combination treatment improved IIEF in patients with hypogonadism, monotherapy-resistant or prostatectomy-induced ED. The treatment-related AEs did not differ between combination treatment with PDE5i and PDE5i monotherapy (OR:1.10, 95% CI: 0.66 to 1.85, I2=78%). Still, despite multiple subgroup and sensitivity analyses, the levels of heterogeneity for all outcomes remained high.

Conclusions

Combination therapy with PDE5i and antioxidants improves ED without increasing the AEs, while treatment with PDE5i and daily tadalafil, shockwaves or vacuum device seems effective, but data are scarce. Combination treatment should be initially preferred in patients with hypogonadism or prostatectomy-induced ED. Conversely, the addition of a-blockers to PDE5i does not provide additional efficacy in patients with urinary symptoms. Overall, combination therapy with PDE5i is safe and effective and should be considered as first-line treatment for refractory or difficult-to-treat cases of ED.

Disclosure

Work supported by industry: no.
038 Differences in the Gut Microbiome Composition Between Men with Peyronie's Disease and a Matched Cohort: A Pilot Study
Authors: Osman M.M. , El-Khatib F.M. , Dianatnejad S. , Nguyen J. , Choi E. , Towe M. , Yafi F.A.
Published: May 2022

Introduction

There have been no studies to-date that have attempted to establish an association between the gut microbiome (GM) and Peyronie's disease (PD). There are numerous inflammatory diseases that are associated with both the GM and PD, making an association between the two highly likely.

Objective

To analyze stool samples from patients with PD and compare them to matched controls for differences in their GM.

Methods

We collected stool samples from 27 patients with PD and 41 control. All samples were processed by a third-party company, Viome Inc. The samples were analyzed by metatranscriptome sequencing which allows for data to show both the taxonomy of the microbiome and its KEGG orthology (KO). KO is defined as the current molecular functions and pathways that are occurring in the GM. We compared richness and prevalence of the taxa and KOs between the PD and control groups.

Results

1,477 taxa and 4,762 KOs were detected in the 68 samples. The Mann-Whitney non-parametric test showed that the richness of both the taxa and KOs were non-significantly higher in the control samples (p=0.1168 and p=0.1672), respectively. One taxon, Massilioclostridium coli, was found to be significantly higher in the control group (adjusted Benjamini-Hochberg p-value=0.044). There were, however, no significant differences in prevalence of KOs between the two groups.

Conclusions

This is the first study to look at associations between the GM and PD. We found a non-significant higher richness for both taxa and KOs in the control group. One taxon, Massilioclostridium coli, was present in significantly higher proportion in the control group (p=0.044). The clinical relevance of this finding is yet to be elucidated.

Disclosure

Work supported by industry: yes, by Viome Inc.. A consultant, employee (part time or full time) or shareholder is among the authors (Antares. Clarus. Coloplast. Promescent.).
046 A Novel Artificial Conduit for Peripheral Nerve Regeneration Rescues Erectile Function after Cavernous Nerve Injury
Authors: Kobayashi K. , Takayanagi A. , Hashimoto K. , Tanaka T. , Masumori N.
Published: May 2022

Introduction

Postoperative erectile dysfunction after radical prostatectomy can occur due to surgical injury of the cavernous nerves, which can adversely affect quality of life.

Objective

We evaluated the treatment effects of a novel artificial conduit for peripheral nerve regeneration (Nerbridge), which is commercially available, on erectile dysfunction in a cavernous nerve injury model.

Methods

Male Sprague-Dawley rats were used this study. The rat cavernous nerve was resected bilaterally. We interposed a nerve gap with the artificial conduit as a treatment group. After resecting the rat cavernous nerve, we did not do any treatment in an untreated group. Sham-operated rats were used as a control group. We measured the intracavernous pressure (ICP) and arterial pressure (AP) at 8 weeks after surgery in these 3 groups.

Results

In the untreated group, ICP/AP was significantly decreased compared to that in the control group (mean ICP/AP: 0.138 vs. 0.566, respectively; p<0.05). On the other hand, ICP/AP in the treated group (mean: 0.284) was not significantly decreased compared to that in the control group.

Conclusions

The commercially available artificial conduit may prevent the decrease in erectile function after cavernous nerve injury.

Disclosure

Work supported by industry: no.
051 Redo Surgery Improves Sexual Function in Patients with Sequelae of Failed Hypospadias Repair
Authors: Gamidov S. , Shatylko T. , Gasanov N. , Dusmukhamedov R. , Mammaev R.
Published: May 2022

Introduction

Despite major improvements in management of congenital abnormalities of male external genitalia, non-pediatric urologists still encounter late complications of failed hypospadias repair. Such patients represent a complex group burdened with lower urinary tract symptoms, subfertility and sexual dysfunction. Psychological problems related to appearance of external genitalia are also common. It is currently unknown whether redo surgery improves sexual well-being in adults with sequelae of failed hypospadias repair.

Objective

To evaluate improvement in sexual function in patients with late complications of hypospadias repair.

Methods

We performed an analysis of symptoms related to sexual dysfunction in 112 patients with late complications of hypospadias repair who were admitted to our department for redo surgery. Average age of patients at admission was 32.1 years (min-max: 18-62). All patients consented to interview, completion of questionnaires, endocrine evaluation and penile doppler ultrasound when indicated. We compared prevalence of specific sexual symptoms before and after redo surgery using McNemar's test.

Results

Prevalence of erectile dysfunction following redo surgery decreased from 40.2% to 23.2% (p < 0.0001). Prevalence of low libido decreased from 59.8% to 30.3% (p < 0.0001). Asthenic ejaculation also became less frequent; initially it was present in 63.4% patients, and after surgery it was present only in 24.1% (p < 0.0001). Incidence of painful ejaculation decreased from 10.7% to 0.9% (p = 0.0026). Redo surgery didn't have positive or negative impact on premature ejaculation, delayed ejaculation, anejaculation and orgasmic dysfunction.

Conclusion

Redo surgery for complications of hypospadias repair seems to positively impact libido and erectile function, probably through improvement of body image and alleviation of psychogenic factors for erectile dysfunction. However, most ejaculation-related disorders, except asthenic ejaculation and painful ejaculation, remain unaffected.

Disclosure

Work supported by industry: no.
052 Sexual Aspects of Patients after Treatment of Penile Cancer: Reports of Patients Accompanied at Urology Oncology Service of a Public Hospital
Authors: Silva I. , Naccarato A. , Denardi F. , Ferreira U. , Matheus W.
Published: May 2022

The penile cancer is a rare neoplasia affecting mostly the lower income and scholarship socioeconomic levels. Patients with penile cancer live for several months with the symptoms before seeking a urologist. The delay of seeking medical assistance is mainly due to the fact that own recognition of having a serious disease, fear of treatment and surgery. Delayed treatment affects the severity of prognostic and quality of life of patients. For the advanced stages, penectomy is still the best available treatment.

This study aims to comprehend the meaning of the experience of patients with penile cancer who underwent partial or total penectomy.

The medical records of patients who were surgically treated due to this neoplasia were reviewed in the hospital database. After reviewing the data, the researchers contacted the patients and offered the interview with the psychology group of the Oncology Urology outpatient clinic. On the scheduled return day, patients met with the psychologist, which applied semi-structured interviews seeking the meaning of the lived experience.

After conducting the interview, the literal transcription and subsequent synthesis of what was transcribed was carried out. From the collected data, two more syntheses will be made in search of the units of meaning and then analysis of the collected speeches, seeking to understand the meaning of the lived experience. After completion of the process, the syntheses will be submitted to 2 independent psychologist colleagues for a better understanding of the described phenomena. Were interviewed 7 men who had penile cancer and underwent treatment, with total or partial penectomy. The average age among survey participants is 57,3 years. Of the interviewed patients, 4 are married, 2 are single but in a relationship, and 1 is divorced. All patients reported unfavorable sociocultural and socioeconomic aspects, lacking basic information on self-care and on who cared for them.

The research was developed considering the ethics principles of confidentiality and privacy. This study does not offer any physical or psychological risk for the participants. Prior to the interview the “Termo de Consentimento Livre e Esclarecido (TCLE)” was provided, as well as every detail of the research. It is also explained that participation is voluntary and that the participant can leave the research at any time, without causing harm to their treatment and monitoring.

The results are in a qualitative analysis. There are indications of significant themes, such as heredity, fear, faith, acceptance, care, neglect and suffering.

Disclosure

Work supported by industry: no.
057 Ceiling Effect of Clomiphene Citrate on Testosterone to Estradiol Ratio in Eugonadal Infertile Men
Authors: Liao Y. , Chang H.
Published: May 2022

Introduction

Study has shown that the Testosterone to Estradiol ratio (T/E2 ratio) has more impact over semen quality and sexual desire than Testosterone does alone. Clomiphene Citrate is a Selective Estrogen Receptor Modulator that had long been used as an empirical option in the management of idiopathic oligozoospermia. Clomiphene may change the Hypothalamus-Pituitary-Gonad axis and result in the T/E2 ratio alteration. There were no reliable data about the T/E2 ratio change after Clomiphene use in eugonadism.

Objective

The aim of this preliminary study was to determine whether clomiphene citrate has an effect on T/E2 ratio in infertile patient with eugonadism.

Methods

This study included a total of 24 male patients who was diagnosed as idiopathic infertility with Eugonadism. They all take Clomiphene Citrate (25mg/day) as empirical treatment. Blood test including Testosterone, estradiol, prolactin, LH and FSH were done before and 4 weeks after Clomiphene use. Paired T test was used to evaluate the significance of the hormone level change.

Results

For all the patients, the T/E2 ratio did not show significantly increase after Clomiphene use. In the subgroup analysis, if the T/E2 ratio less than 0.2, clomiphene can yield a significant increase of T/E2 ratio, not vice versa.

Conclusions

In conclusion, Clomiphene citrate may significantly increase Testosterone to Estradiol Ratio in eugonadal men under the premise of its ceiling effect (T/E2 ratio <0.20), providing us a possible guidance to the use of Clomiphene in this group of patients.

Disclosure

Work supported by industry: no.
061 The Study of the Effectiveness of Topical Testosterone and Estrogen for Urinary Tract Symptoms of GSM
Authors: Ninomiya N. , Sekiguchi Y.
Published: May 2022

Introduction

Genitourinary Syndrome of Menopause (GSM) causes atrophic changes in the vulva and vagina due to a decrease in the amount of sex hormones with aging, causing unpleasant physical symptoms in the genital area. GSM symptoms are vulvar mucosa atrophy findings, vaginal dryness, lack of moisture during sexual intercourse, dyspareunia, frequent urination and urgency of urination, etc. Routine moisturizer use is recommended to prevent the progression of GSM symptoms, but the effect is insufficient from the perspective of mucosal improvement. In Europe and the United States, testosterone treatment is approved in addition to estrogen for GSM treatment, but it has not yet been approved in Japan. And its effect on GSM symptoms in Japanese women has not been investigated.

Objective

The aim of this study is to examine the efficacy and safety of topical treatment with testosterone and estrogen for GSM.

Methods

The survey was conducted from September 2019 to September 2020. Menopausal women with atrophy of the vulvar / vaginal mucosa and either urinary tract symptoms (frequent urination, urine leakage) or vaginal symptoms (vulvar pain, dryness) or sexual function symptoms (dyspareunia) was diagnosed as GSM and was included in the study. Patients with a history of surgery within 1 year and/or those with pelvic organ prolapse were excluded.An anatomical explanation of the vulva was given to the patient using a mirror during examination. Patients used topical hormone cream once daily for 1 month on the labia minora, external urethral meatus, and vestibule. The topical hormone cream contained 0.3% testosterone, 0.008% estradiol, and 0.003% ethinyl estradiol. The daily usage was 0.5 g.The effectiveness was evaluated as follows. The attending physician evaluated the vulvar moistness and the redness on a four-point scale. A Visual Analogue Scale (VAS) was used for contact pain. The Overactive bladder symptom score (OABSS) was used to assess urinary tract symptoms. All surveys were evaluated before and 1 month after use.

Results

The survey was conducted on 30 patients aged 48 to 75 years (mean 58.3 years, median 58.5 years). The vulvar moistness was significantly improved. The redness was improved in the labia minora. No major changes were observed in vestibular region. Contact pain was significantly improved. OABSS improved significantly.Itching of the vulva was observed in 10%. Abnormal bleeding was observed in 10%. Nipple discomfort was noted in 5%. All side effects were not serious.

Conclusions

Topical testosterone and estrogen are effective for GSM symptoms in Japanese women.

Disclosure

Work supported by industry: no.
063 Testosterone (T) Recovery Profiles after Short-Term Androgen Deprivation Therapy (ADT)
Authors: Martinez J. Flores , Nascimento B. , Benfante N. , Schofield E. , Mulhall J.P.
Published: May 2022

Introduction

ADT plays a major role in several scenarios for men with prostate cancer. T recovery after ADT cessation may be incomplete with 10% of men estimated to suffer persistent castrate levels after long-term ADT.

Objective

The objective of this study was to evaluate T recovery after short courses of ADT.

Methods

Study population included men treated with ≤6 months of ADT in association with radiation therapy (RT). Early morning T levels were collected at baseline and periodically after ADT cessation. T recovery after ADT cessation was analyzed in 2 ways: improvement to non-castrate level (T ≥50 ng/dL), and recovery to normal (T ≥ 300 ng/dL). Recovery rates and median survival time were estimated using Kaplan-Meier statistics and predictors analyzed using Cox proportional hazard ratios.

Results

88 men with a mean age of 68 ± 8 years at time of ADT were analyzed. Median duration of ADT was 3.1 months; 56% had an ADT duration between 1-3 months and 44% between 4-6 months. Mean pre-ADT T level was 390 ± 158 ng/dL. After cessation of ADT, median time to non- castrate levels was 9.3 (IQR = 6.3 – 18.5) months and 15.8 (IQR = 8.3 - 33.8) ‘months for recovery to T ≥300 ng/dL. Higher baseline T levels (T > 400 ng/dL) was associated with a faster recovery to normal T level (HR = 1.80, 95% CI = 1.09 – 2.95), but not to non-castrate level. Neither age > 65 years, prevalent diabetes, nor ADT duration of 4-6 months vs ≤ 3 months were significantly associated with a slower T recovery.

Conclusions

Most of our patients remained with low T levels one year after the cessation of ADT. Higher baseline T was associated with faster T recovery to normal (T ≥ 300 ng/dL).

Disclosure

Work supported by industry: no.
Introduction to Graph Signal Processing
Authors: Ortega Antonio
Published: May 2022

An intuitive and accessible text explaining the fundamentals and applications of graph signal processing. Requiring only an elementary understanding of linear algebra, it covers both basic and advanced topics, including node domain processing, graph signal frequency, sampling, and graph signal representations, as well as how to choose a graph. Understand the basic insights behind key concepts and learn how graphs can be associated to a range of specific applications across physical, biological and social networks, distributed sensor networks, image and video processing, and machine learning. With numerous exercises and Matlab examples to help put knowledge into practice, and a solutions manual available online for instructors, this unique text is essential reading for graduate and senior undergraduate students taking courses on graph signal processing, signal processing, information processing, and data analysis, as well as researchers and industry professionals.
Dark patterns in online shopping: do they work and can nudges help mitigate impulse buying?
Authors: Sin Ray , Harris Ted , Nilsson Simon , Beck Talia
Published: May 2022

Dark patterns – design interfaces or features that subtly manipulate people in making suboptimal decisions – are ubiquitous especially in e-commerce websites. Yet, there is little research on the effectiveness of dark patterns, and even lesser studies on testing interventions that can help mitigate their influence on consumers. To that end, we conducted two experiments. The first experiment tests the effectiveness of different dark patterns within a hypothetical single product online shopping context. Results show that, indeed, dark patterns increase the purchase impulsivity across all dark patterns, relative to the control. The second experiment tests the effectiveness of three behaviorally informed interventions on four different dark patterns also in a hypothetical online shopping scenario, but this time offering multiple products instead of a single product. Between-subject analysis shows that not all interventions are equally effective, with uneven impact across dark patterns. However, within-subject results indicate that all interventions significantly reduce purchase impulsivity pre- versus post-intervention, indicating that any intervention is better than none when it comes to combating dark patterns. We then end by discussing the policy implications of our results.