bluuebunny/crossref_metadata_2025 huggingface dataset:
(292) 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 , Lanzaro F , Bertini A , Cornelius J , Abbate C , Mattei A , Montorsi F , Salonia A
Published: May 2023

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.

Results

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.

Conclusions

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

No
(304) Relevance of Self-masturbation-related vs. Coital Erectile Function in the Real-life Management of Patients with Erectile Dysfunction
Authors: Fallara G , Pozzi E , Belladelli F , Corsini C , Raffo M , Candela L , Costa A , Cignoli D , Schifano N , Lanzaro F , Bertini A , D'arma A , Capogrosso P , Boeri L , Cazzaniga W , Matloob R , Montorsi F , Salonia A
Published: May 2023

Introduction

The Masturbation Erection Index (MEI) has been recently validated in the setting of the investigation of men presenting with erectile dysfunction (ED).

Objective

We sought to analyze the correlation between MEI and the findings of the widely used International Index for Erectile Function (IIEF) in a cross-sectional study in men seeking medical help for ED.

Methods

Data from the last 87 consecutive men presenting for ED at a tertiary referral centre were analyzed. All patients were asked to complete both IIEF and MEI at the same time. Complete sociodemographic and clinical data were collected. ED severity was defined according to Cappelleri’s criteria. Linear regression model tested the association between MEI, IIEF total and IIEF domains scores. Violin plot was used to display distribution of MEI scores into IIEF-EF categories. Loess curve was applied to investigate the probability of MEI to predict ED as a function of age.

Results

Median (interquartile range [IQR]) age at presentation was 44 (3.5-53.5) years. According to IIEF-EF scores, ED severity was: no ED in 9 (10%), mild ED in 14 (16%), mild-to-moderate ED in 19 (22%), moderate ED 12 (14%) and severe ED in 33 (38%) patients, respectively. The more severe the ED, the higher the MEI scores (Figure 1); indeed, median MEI scored 7 (3-8) in men with no ED and 19 (10-26) in men with severe ED (p<0.05). Of note, 16 patients (18%) depicted low MEI scores (i.e., under the median), but moderate or severe ED as for their IIEF scores. Finally, a univariable negative association between MEI scores and IIEF-overall satisfaction and IIEF-intercourse satisfaction scores was found [i.e. the higher the MEI scores, the lower the intercourse and overall sexual satisfaction (p<0.001)]. Although MEI decreased throughout aging, it was not significantly different in younger vs. older men with ED.

Conclusions

As expected, there is a strong association between IIEF and MEI scores, which does not lower with aging. Of all, one out of 5 patients presented with lower overall and intercourse satisfaction notwithstanding high MEI scores, thus outlining the clinical relevance of both investigations in the real-life setting.

Disclosure

No
(308) Oxytocin Troches as an Adjunctive Intervention to Conventional Testosterone and Erectile Dysfunction Medication for Men with Sexuality Concerns
Authors: Krychman M , Ayers R , Allshouse A , Ramos E
Published: May 2023

Introduction

Oxytocin (OT), a peptide hormone, is known to be involved in social interaction and the pleasure we derive from it is produced from the posterior pituitary. This neurotransmitter has a potential role in love, female reproductive functions, and social bonding. OT is released by both males and females, during skin to skin contact sexual arousal and orgasm/ejaculation (1,2). OT effects on the brain are dependent on its interactions with sex homes such as estrogen, progesterone, testosterone, and corticosterone. Oxytocin levels are implicated in male sexual responsivity. Oxytocin biological effects may include decrease social anxiety, increased pair bonding, intimacy and closeness enhance sexual receptivity, enhance perineal contractility, enhances pair bonding, nurturing, trust “cuddle hormone, increased intensity of orgasm in men and women, decreased latency to orgasmic release, increased pleasurable sensations and increased sexual desire and lubrication. Oxytocin troches have been used as an off label investigational compounded oxytocin as an adjunctive therapy for men’s sexual health.

Objective

We report the preliminary responder analysis results of a random retrospective survey on users of this medication.

Methods

A random convenience sample of 26 men from 5 centers ( Hawaii, Washington, Portland, Salt Lake City and Tulsa) who tried compounded oxytocin were surveyed. Surveys were anonymous, and participation was voluntary and uncompensated. Doses of Sublingual oxytocin were to be titrate up from 25 international units (IU) for optimization, but not to exceed 100 IU)

Results

Fourteen out of 26 participants (56%) were considered responders. Mean age was 43 and range was 22-77. Eighty-six of the participants had used between 50 IU and 100 IU and 50% were on TRT replacement whereas 57% were on Erectile medications. Only 21% were on both ED medications and TRT replacement. 86% of responders reported enhanced intimacy and connection with their partners, 100% would recommend the product to their friends. 93% of users planned to continue the medication. 86% noted increased overall pleasure and sexual satisfaction. 86% reported improved overall quality of their orgasm. There were no adverse events reported. Responders reported positive feedback which included: longer lasting before orgasmic release, increased nipple sensation, improved control with premature ejaculation, improved feelings during climax and increased ejaculate volume.

Conclusions

Oxytocin compounded troches appear to be a helpful addition to a preexisting treatment paradigm for erectile difficulty or testosterone replacement. This is a preliminary report with small numbers, and further larger randomized clinical trials are warranted and planned.

Disclosure

No
(319) The Pandemic, Telemedicine, and Andrology: What Have We Learned?
Authors: El-Achkar A , Hammad M A M , Nguyen T , Barham D W , Jenkins L , Yafi F A
Published: May 2023

Introduction

Telemedicine has gained wide acceptance during the COVID-19 pandemic. It was critical for patient care when lockdowns were implemented worldwide. While there has been evidence to suggest that urology patients were receptive to telemedicine, no systematic review has been done to date on andrology patients and their perception of telemedicine.

Objective

To assess the perception of andrology patients to telemedicine during the COVID-19 pandemic

Methods

Three electronic databases: PubMed, Scopus, and Web of Science, were searched from their inception until June 2022 for relevant articles. Two independent teams reviewed abstracts and extracted data from the selected manuscripts. A meta-analysis was completed in line with PRISMA 2020 and AMSTAR Guidelines. For our study, we limited telemedicine to communication through videoconferencing or telephone encounters between patients and medical professionals. Positive response to telemedicine was defined as patients “wishing for telemedicine consultation”, “preferring telemedicine over in person”, “accepting the current telemedicine arrangement”, “having needs addressed with teleconsultation”, or “willingness to do a teleconsultation”.

Results

Of the 1128 retrieved abstracts, 56 underwent full-text review and 11 were included in the final analysis, comprising a total cohort of 2195 cases. Video visits were used in 7 studies, 2 used only telephone encounters, and one used both methods. 3 studies showed andrology and sexual medicine are compatible with telemedicine with a few 30 and 90-day in-person revisit rates. Telemedicine was shown to save an average cost of $149-252 per patient. All 8 studies that assessed the perception of andrology patients to telemedicine showed that most patients had a “positive perception”. Pooled analysis of the positive response to telemedicine was 73.7% (Figure 1) and that of patients who recommended telemedicine was 58.5%. While the percentage of patients (97%) recommending telemedicine is high among studies using videoconference, the percentage drops to 26.3% in studies using telephone visits only. In the latter group, up to 27.1% of patients preferred in-person visits, with security and privacy of either mode of telecommunication being a concern.

Conclusions

Most patients have a positive perception of telemedicine, particularly with videoconferencing, and less so with telephone visits. These results suggest that telemedicine will likely continue to play a pivotal role in andrology and sexual medicine practices.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast, Clarus Therapeutics, Antares Pharma, Acerus, Hims & Hers Health, Inc.
(330) Trends of Reporting Premature Ejaculation Among Men with Erectile Dysfunction – Findings From a Real-life Cross-sectional Study
Authors: Pozzi E , Fallara G , Belladelli F , Corsini C , Raffo M , Candela L , Costa A , Cignoli D , Schifano N , Bertini A , Lanzaro F , D'arma A , Capogrosso P , Boeri L , Ventimiglia E , Matloob R , Montorsi F , Salonia A
Published: May 2023

Introduction

Patients with erectile dysfunction (ED) may have an increased risk to report concomitant premature ejaculation (PE)

Objective

We aimed to explore the trend of reporting PE across three different age groups of a homogenous cohort of men seeking first medical help for ED (< 40 yr, 40-60 yr, > 70yr) over a 16-year period at a single tertiary academic centre.

Methods

Complete data of 1258 men consecutively assessed for ED as primary complaint by a single Sexual Medicine expert between 2005 and 2021 were analysed. Patients were divided into three age categories: i) <40 years, ii) 40-69 years, and iii) ≥ 70 years. All patients were assessed with a comprehensive medical and sexual history. Comorbidities were scored with the Charlson Comorbidity Index (CCI). All patients completed the International Index of Erectile Function (IIEF) at baseline. Between the three groups i) descriptive statistics tested the sociodemographic and clinical differences; ii) regression models tested the probability of reporting concomitant PE over time; and, iii) local polynomial regression models graphically explored the probability of reporting PE (primary/secondary) together with ED over the analysed time frame.

Results

Overall, median (IQR) age was 51 (40-61) years. Of all, 326 (25.9%) reported either life-long or acquired PE at time of first clinical assessment. Among the three age groups (70) there were no significant differences in terms of baseline IIEF domains. Younger patients reported higher rates of PE in respect to older ones (0.5% vs. 0.4% vs. 0.3%, p=0.001). Logistic regression analysis showed a statistically significant trend of reporting PE over the years among the < 40yr (OR: 1.4; 95%CI: 1.3-1.5) and 40-69yr (OR: 1.3; 95%CI: 1.2-1.4) groups respectively (all p<0.0001). A not significant trend was found in the ≥ 70yr group. Figure 1 graphically displays the probability of reporting PE in the whole cohort and among the three age-matched groups between 2005 and 2021.

Conclusions

Almost one out of four patients seeking first medical help for ED also reports to suffer from PE. The probability of reporting PE (either primary or secondary) has been exceptionally increasing over the last 15 years among young (<40) and middle-age (40-69) men with ED. This finding is of major clinical relevance in order to a better tailored therapeutic work-up in the real life setting.

Disclosure

No
(337) The Impact of COVID-19 Related Restrictions on the Prevalence of Intimate Partner Violence in the Republic of Armenia
Authors: Sahakyan S , Grigoryan A , Azatyan R , Hakobyan A
Published: May 2023

Introduction

Intimate partner violence (IPV), which is domestic abuse committed by an intimate partner, is the most prevalent type of violence against women. Growing evidence shows that the incidence of IPV has increased since the application of COVID-19 related restrictive measures. Evidence from past pandemics and crises has revealed that the most common factors that increase the risk for violence include economic insecurity, poverty-related stress, job loss or reduced working hours, quarantine, and social isolation.

Objective

This research aimed to identify the impact of COVID-19 related restrictive measures on the prevalence of IPV during the pandemic in the Republic of Armenia.

Methods

This study was an online cross-sectional survey conducted as part of the second round of the International Sexual Health and Reproductive Health (I-SHARE), a series of surveys conducted in more than 30 countries to study sexual and reproductive health during COVID-19 measures. The instrument consists of 14 sections of which only the IPV section was used for this analysis. In order to be eligible for the study the participants had to be 18 years of age or older, currently reside in the Republic of Armenia, speak Armenian, and be able to provide informed consent online. The data collection was conducted during a 4-week period (from 22 October until 20 November 2021).

Results

Overall 296 people participated in this study of which 196 (66.2%) were female at the time of birth. 14% of the respondents were physically abused by their partner at least once during the last three months. Meanwhile 13% of the respondents were sexually assaulted many times of which 72.4% were also physically abused during the same period. 30% and 33% of people who were physically and sexually abused, respectively, began to experience more violence after COVID 19 restrictions.

Conclusions

To the best of our knowledge, this is the first study to examine the incidence and prevalence of IPV as a result of COVID-19 related restrictive measures in the Republic of Armenia. It is worth noting that approximately one third of the people who were physically and/or sexually abused, began to experience more violence after the COVID-19 restrictions. Meanwhile, the situation with sexual and physical violence among the majority of people who are silent about violence has generally worsened since the restrictions of COVID-19.

Disclosure

No
(352) Erection Hardness Score (EHS) Correlates With Resistive Index but Not Cavernosal Artery Dilation During Penile Doppler for Erectile Dysfunction and Peyronie's Disease
Authors: Myrie A , Leelani N , Bole R , Lundy S , Bajic P
Published: May 2023

Introduction

Penile Doppler Ultrasound (PDU) is a non-invasive diagnostic test used to assess organic erectile dysfunction (ED) and Peyronie’s disease and characterize functional changes in penile blood flow. Quantitative measurements taken during penile Doppler testing include changes in cavernosal artery diameter, the velocity of blood flow in the cavernosal artery in systolic and diastolic phases, and a calculated resistive index. It remains poorly understood which of these parameters best predict response to intracavernosal injection therapy and how they are influenced by comorbidities such as age, diabetes, smoking, hypertension, and obesity.

Objective

The objective of this study is to assess which parameters best predict response to intracavernosal trimix injection and determine the utility of measuring cavernosal artery diameter during penile Doppler testing.

Methods

This study is a single institutional retrospective cross-sectional review of men undergoing workup for organic ED and/or Peyronie's disease who elected to undergo penile Doppler testing. Only patients who received a standardized 30-1-10 trimix injection were included. Dosing was determined based on age and risk factors using a nomogram, and redosing was performed if the erection quality was below subjective optimal erection quality at home. Baseline cavernosal artery and plaque imaging were performed, and repeat measurements were obtained at 10 minutes following trimix injection.

Results

93 men were included in the study with a median age of 59 (IQR 51-67). 47% carried a diagnosis of Peyronie's, 41% had hypertension, 29% were obese, and 30% were smokers. 40% met the criteria for venous leak (RI <0.8). Erectile hardness scale (EHS) scores of 1-4 were documented in 5, 21, 61, and 5 patients, respectively. Linear regression demonstrated no significant relationship between the change in cavernosal artery diameter and trimix dose, resistive index, comorbidities or other Doppler parameters measured. There was no direct relationship between the EHS scores and cavernosal artery dilation. However, there was a statistically significant relationship between EHS and age (p=0.004), trimix dose (p=0.008), and resistive index (p=0.001) on univariate regression. A multivariable model containing age, comorbidities, and these parameters correctly explained 31% of the variance demonstrated (p=0.001).

Conclusions

Provider-determined EHS scores were directly proportional to patient age, trimix dose, and resistive indices but not to changes in cavernosal artery diameter. Our findings suggest that this measurement may be safely omitted during the evaluation of organic ED and Peyronie’s Disease without changes in diagnostic or management pathways.

Disclosure

No
(361) Novel treatments for Erectile Dysfunction and Peyronie’s Disease - A Survey of Clinics Across the USA
Authors: Best J , Sencaj M , Thomas J , Zucker I , Ghomeshi A , Ramasamy R
Published: May 2023

Introduction

Over the past several years there has been a rise in the number of clinics offering novel treatments for erectile dysfunction and Peyronie’s disease such as stem cell therapy, platelet rich plasma, and shockwave therapy

Objective

In this study, we attempt to identify to identify experimental treatment approaches for ED and PyD used by various clinics across the country.

Methods

Using a systematic search of online website directories, we identified 26 clinics were surveyed for PRP treatment, 27 for shockwave therapy, and 26 for stem cell therapy A standard questionnaire was used to retrieve information from all clinics regarding cost of treatment, duration of therapy, medical staff involved, and patient outcome data.

Results

We found that the cost of treatment varied widely between groups. PRP cost between $500 to $2400, Shockwave total cost was between $1500 - $7500, and stem cell therapy cost ranged between $3,800 to $16,000 USD. Across all clinics surveyed, a physician was involved in 67% of treatments and over 75% of clinics reported patient satisfaction following treatment.

Conclusions

Although the number of human clinical trials evaluating novel treatments for ED and PyD are limited, several clinics are offering these therapies with promises of success without evidence to support the claims. Our data demonstrates the wide use of experimental therapies for ED and PyD across the US. Clinical outcome data available for patients is largely up to the clinics discretion, and was only given to us in subjective measurements and testimonials.

Disclosure

No
(369) Sexual Satisfaction After Wearable Device Use For Erectile Dysfunction
Authors: Body A , Kyle C
Published: May 2023

Introduction

Erectile dysfunction (ED) is the inability to achieve and maintain an erection firm enough for sexual performance. ED devices such as pumps and constriction devices and prescription oral phosphodiesterase inhibitors are commonly known ED treatments.

Objective

Our aim was to evaluate an alternative therapy for ED for the approximately 80 percent of men who currently do not use any form of the aforementioned ED treatment options. Eddie by Giddy™ is a device that allows patients to use a novel constriction device to enhance the normal physiology of an erection to treat ED. Medical comorbidities such as anxiety, ADHD, obesity, hypertension, diabetes and depression, as well as medications such as antidepressants, anti anxiety medications, opioids and cardiac medications can impact erectile function. Our goal was to specifically evaluate the efficacy of the device in the general patient populations.

Methods

Our research team surveyed 60 male participants (59 who completed the study), 26 to 81 years of age, about their erectile performance over a 12 week period of time, during which participants utilized the Eddie by Giddy device. Participants completed an intake assessment, medical history, and reported on their sexual behavior and erectile performance as they used the device over the 12 weeks, during which patients rated their experience with the device, self-esteem, quality of life changes, the impact on their relationships, frequency of erections, duration of erections and the quality of erections.

Results

Participants showed improvement in all but one question in the survey over the 12 week period, with a particularly higher improvement between weeks 4 and 8, and sustained that improved sexual function and erection quantity and quality through week 12. Of the participants who concluded the study, 95 percent reported having overall positive results from using the Eddie by Giddy device. With respect to the survey questions, participants on average showed a 63 percent improvement in number of times attempting to receive oral sex, a 53 percent improvement in ability to maintain an erection during masturbation, a 52 percent improvement in confidence to perform sexually, and a 47 percent improvement in satisfaction of erections when attempting sexual intercourse.

Conclusions

Attitudes of participants with ED using Eddie® showed strong, significant improvement in erectile function, quality of life, hopefulness for future sex life and overall self-esteem in all categories of patients. Eddie by Giddy use over 12 weeks was shown to improve satisfaction among male participants of sexual health and mental health without the need for oral medication.

Disclosure

Yes, this is sponsored by industry/sponsor: Giddy, Inc

Clarification

Industry funding only - investigator initiated and executed study

Any of the authors act as a consultant, employee or shareholder of an industry for: Giddy, Inc.
(374) Reviewing the Long-Term Effectiveness of Artificial Urinary Sphincter and Urethral Sling Insertion for Post-Prostatectomy Male Stress Urinary Incontinence
Authors: Goetz J , Labagnara K , Cheung T , Loloi J , Babar M , Bernstein A , Davuluri M , Maria P
Published: May 2023

Introduction

Stress urinary incontinence is the second-most common complication male patients face post-prostatectomy. Artificial urinary sphincters (AUS) and urethral slings are two effective surgical treatments recommended for patients with incontinence who have failed conservative therapy. Slings are often preferred in cases of mild to moderate SUI, whereas AUS is preferred in severe cases. Although prior studies have shown the AUS to be superior in restoring continence, few have compared them in a diverse patient population. We aim to determine the effectiveness of both devices both in the short-term and long-term postoperative setting.

Objective

To review the 1 and 3 year effectiveness of both AUS and urethral slings in post-prostatectomy patients, measured as the change in median pads per day.

Methods

This was a single-institution retrospective chart review study of 124 patients who received either an AUS or sling between the years 2015-2022. Patients were divided into one of two groups depending on if they underwent surgery for a urethral sling or AUS. Demographic, intra-operative, and post-operative characteristics were collected. Median pads used per day was the primary measure of outcome. A two-sample t-test, chi-square, or Mann-Whitney U test was used to compare baseline characteristics based on distribution normality. Wilcoxon signed-rank tests were used to compare 1 and 3 year pad usage to baseline.

Results

A total of 116 patients were included, of which 72 (62.1%) underwent sling placement while 44 (37.9) received an AUS. Patients receiving an AUS were older (67.2 [7.5] vs 64.0 [7.1], p=0.024), had a higher rate of prior radiation therapy (29.5% vs 11.1, p=0.012), and used more pads per day preoperatively (3 [2-5] vs 2 [1-3], p<0.001). Patients with an AUS showed statistically significant lower usage of pads per day at 1 year (1 [0-2]; p<0.001) and 3 years (2 [1-3]; p<0.017). The sling cohort showed a significant difference at 1 year (1 [0-1]; p<0.001) but not at 3-years (1 [0-2], p=0.123).

Conclusions

Post-prostatectomy insertion of an AUS results in a significant improvement to continence at 1 and 3 years, while the urethral sling is only significantly effective at 1 year.

Disclosure

No
(378) Still One Out of Five Men Presenting for Erectile Dysfunction are Young than 40 years of Age: Findings of a Real-life Cross-sectional Study over Last Decade
Authors: Pozzi E , Capogrosso P , Fallara G , Boeri L , Belladelli F , Corsini C , Cignoli D , Bertini A , Lanzaro F , Raffo M , Candela L , Schifano N , D'arma A , Matloob R , Montorsi F , Salonia A
Published: May 2023

Introduction

Erectile dysfunction (ED) has been demonstrated to be reasonably prevalent among young men (≤40 yr).

Objective

We aimed to i) assess changes in patterns of reported ED in men ≤ 40 yr, and ii) compare the sociodemographic and clinical characteristics of ED men ≤ 40 yr vs. > 40 yr of age over a 8-yr period at a single academic centre.

Methods

Comprehensive data of 1179 patients seeking first medical help for ED and assessed by a single Sexual Medicine expert between 2013 and 2021 were analysed. Health-significant comorbidities were scored using the Charlson comorbidity index. All patients completed the International Index of Erectile Function (IIEF) at baseline. Descriptive statistics tested the sociodemographic and clinical characteristics of ED men ≤ 40 yr vs. > 40 yr of age. Within the two groups, multivariable linear regression models tested the association between advancing age and IIEF scores. Local polynomial regression models were applied to explore and graphically display ≤ 40 yr patients’ likelihood to report ED over the analysed time frame and to display changes of the IIEF-EF scores over increasing age between the two groups (≤ 40 yr vs. > 40 yr).

Results

Overall, median (IQR) age was 52 (41-62) yr. Median (IQR) IIEF-EF was 18 (15-22) at baseline. Of all, 268 (22.7%) were ≤ 40 yr whereas 911 (77.3%) were > 40 yr at baseline. Rates of severe ED according to IIEF-EF did not differ between men ≤ 40 yr and >40yr (60 (22.4%) vs. 155 (17%)). No significant differences were found for the IIEF domains (-IS, -OS, -SD) but IIEF-OF domains, which scored higher in younger men (9 () vs. 8 (), p=0.002). At baseline, younger patients reported less comorbidities, less active smoking, lower BMI, higher total testosterone (tT) levels than older patients (all p 40 yr, increasing age was linearly correlated with decreasing IIE-EF (all p 40 yr).

Conclusions

We observed that one out of five men seeking first medical help for ED at a single academic centre were younger than 40 yr. This trend has remained stable over the last 8-years, but slightly lower than the previous decade. Increasing age among younger patients is not associated with worse erectile function as oppositely occurs among patients > 40 yr.

Disclosure

No
(379) The Effectiveness of Low-intensity Shock Wave Therapy as an Emerging Non-invasive Management of Erectile Dysfunction Among Adult Males: A Systematic Review and Meta-analysis
Authors: De Guzman S
Published: May 2023

Introduction

Erectile dysfunction (ED) is the penile inability to sustain erection necessary for sexual function due to physiological, psychological, or emotional factors. While the WHO promotes sexual health for all individuals, ED remains a major influence in attaining satisfying sexual performance among the aging population of men. The effective management and treatment of ED has been primarily pharmacologic and the research to support other non-invasive management such as low-intensity shock wave therapy (Li-ESWT) is apparently limited.

Objective

This systematic review and meta-analysis of available randomized controlled studies investigates the effectiveness of Li-ESWT for ED among adult males based on the International Index of Erectile Dysfunction (IIEF) score.

Methods

The literature search was conducted using the PubMed database. The search was limited to randomized controlled trials on the effectiveness of Li-ESWT on ED, written in English from Medline and Nursing journals, and are publicly accessible without monetary cost published from 2012 to 2020. PRISMA guidelines were used as framework for literature search and review. The RevMan software was utilized for data collection and analysis. A fixed effect model was used in the meta-analysis.

Results

A total of 19 randomized controlled trials were reviewed of which three were included in this meta-analysis. There were total of 120 participants with overall mean age ranges from 41 to 61 years, 61 were enrolled in Li-ESWT group and 59 in the sham group. The heterogeneity of the data shows □2 = 7.70, df= 2, (p= <0.05); I2 = 74%, the overall effect is Z= 3.35, p = <0.05. This meta-analysis demonstrates that the control group (sham) was favored over the experimental group (Li-ESWT) (SMD= 0.64, 95% CI, [0.27, 1.02]) based on the mean IIEF score at the end of the studies.

Conclusions

The use of shock wave therapy in addition to pharmacologic and non-invasive modalities in the treatment and management of ED is promising. However, while the dearth of randomized clinical trials using Li-ESWT for ED management is evident, the decision to proceed with treatment is based on the informed and collaborative decision between the urologist and the patient. This review highlights that sham therapy is not inferior to Li-ESWT treatment. The urologists may consider the cost, adverse effects, time, and effort of using Li-ESWT provided that there is no significant difference in the effectiveness of Li-ESWT compared with sham treatment. Further research is needed to support effectiveness and safety of Li-ESWT in managing ED compared to current pharmacologic regimen.

Disclosure

No
(383) Sexual Healthcare in Oncology: Description of a Sexual Health Clinic Utilizing an Innovative Blended Model of In-person and Facilitated Virtual Care
Authors: Matthew A , Guirguis S , Jamnicky L , Ferguson S , Croke J , Finelli A , Fleshner N , Incze T , Elterman D
Published: May 2023

Introduction

Sexual health is compromised by the diagnosis and treatment of virtually all cancer types. Although sexual dysfunction (SD) can manifest uniquely within each cancer population, it consistently involves biological, psychological and relational elements that affect overall health-related quality of life. Breast and pelvic cancers constitute 53% of cancer cases diagnosed in Canada with over 30% of colorectal, 73% of breast, 90% of prostate/gynecological, and 20% of non-breast/non-pelvic cancer survivors experiencing long-term SD. Despite the prevalence and negative impact of SD, sexual health clinics are the exception in cancer centres worldwide. Unfortunately, this gap in care hinders cancer survivors from achieving optimal sexual health recovery, sexual satisfaction, and relationship intimacy post-treatment.

Objective

We are establishing an innovative Sexual Health Clinic (SHC) that fosters accessibility and efficiency via virtual care, and personalized medicine via in-person care. The goal of the SHC is to assist patients/couples in achieving optimal sexual function, satisfaction (vs distress), and relational intimacy.

Methods

The SHC evolved from a fusion and expansion of the Prostate Cancer (Sexual) Rehabilitation Clinic (in-person care) at Princess Margaret, and the TrueNorth Sexual Health And Rehabilitation e-Clinic (virtual care). The SHC is theoretically founded in a biopsychosocial framework and utilizes a blended model of in-person and facilitated virtual care. The SHC virtual visits are tailored to the patient via content (text, videos, animations, and graphics) based on gender, cancer type, and treatment type. The SHC virtual platform also allows for chat-based synchronous and asynchronous facilitation with highly trained sexual health counsellors. In-person visits are designed to provide for a comprehensive sexual health assessment and sexual medicine prescription. A Hybrid Type 3 implementation research design will be used as a methodological framework for ensuring seamless integration of the SHC into the patient workflows of a high-volume cancer centre.

Results

An empirically-based, systematic approach to the development of a SHC based on a blended care model will be presented. Outcomes will include the process of developing: 1) personalize care pathways in a virtual setting; 2) efficient modes of digital facilitation; 3) approaches to integration of in-person and virtual care; and 4) empirically-based procedures for patient workflow implementation.

Conclusions

Innovative care provision is essential given the prevalence of sexual dysfunction and the limitations of resources within cancer centres. If successful, the proposed SHC will offer an efficient and effective model of care without compromising personalized patient care.

Disclosure

No
(390) Therapeutic Groups of Men With Penile or Testicular Cancer
Authors: Silva I , Naccarato A , Denardi F , Ferreira U , Matheus W
Published: May 2023

Introduction

Testicular cancer (TC) primarily affects men aged 15 to 40 years, and the incidence is around 5/100000. Tumors are usually aggressive and have a great psychological impact on patients. Penile cancer (PC) represents 2 of all types of tumors that affect men in Brazil Most of the affected population are elderly men. Usually, the tumor is identified at an advanced stage, when the only treatment available is total or partial penectomy, causing a great emotional impact.

Objective

This work aims to evaluate the impact of psychotherapy, in an open group, on Health Related Quality of Life (HRQOL) and Sexuality in patients with TC and PC who have been diagnosed, are undergoing treatment - surgery, radiotherapy, chemotherapy or hormone therapy - or who are being followed up after treatment

Methods

Data is been collected through an initial interview (Identification, Anamnesis, Health Anamnesis, Degree of Satisfaction with Life and Sexuality, Affective Emotional Assessment and Treatment Data), SF 36 short form and IIEF 5 short form questionnaire, in patients who are diagnosed, who have undergone treatment - surgery, radiotherapy or supervised monitoring - or who are being monitored at the clinic, and reapplication after 12 sessions At each session 5 questions related to the perception of the previous session will be answered. The group will be available for 2 years, once a week, and the patient will attend 12 sessions. The sessions last 90 minutes, conducted by the same psychologist. The research will be developed considering the ethical principles of secrecy, privacy, confidentiality and non identification of the interviewees' data. The study will not pose risks to the subjects and invasive techniques of the body or psychological suffering will not be used Before starting the process, the Informed Consent Form (will be delivered, as well as the provision of all details regarding the research It will also be explained that participation is voluntary and that the participant can leave the research at any time, without prejudice to their treatment and monitoring. Only patients who meet all these criteria will be included, after signing the informed consent.

Results

Currently, the screening of patients is being carried out to offer the possibility of participating in the open group. The project was on hold due to developments related to the COVID-19 pandemic.

Conclusions

As the work is at the beginning of development, there are still no preliminary conclusions.

Disclosure

No
(395) Our Experience with Subcutaneous Injection of Non-Proprietary Testosterone Cypionate as a Novel Approach for Hypogonadism
Authors: Spellman A , Alter K , Levine L
Published: May 2023

Introduction

Subcutaneous injection of testosterone has been investigated as a method of testosterone replacement therapy (TRT) in hypogonadal men. We have been investigating the use of a non-proprietary subcutaneous (SubQ) injection of testosterone cypionate using a ½ inch 27g needle for replacement to treat hypogonadism. This is an update on our work which includes a larger sample size and longer follow up.

Objective

To assess the use of non-proprietary SubQ TRT as treatment in hypogonadal men and its effect on HCT, PSA, and patient satisfaction.

Methods

This study is a retrospective chart review of patients receiving SubQ TRT with a mean follow up length of 9.8 months (range 0-24 months). Patient data was collected prior to initiation of therapy and at subsequent visits. Testosterone, HCT, and PSA were determined through regular blood draws and a patient satisfaction survey was performed over the phone. Univariate analysis and paired t-tests were used to analyze study variables.

Results

41 total patients received SubQ TRT. Mean changes in total testosterone level (increased 281.3 + 81.1, p-value=0.0008), hematocrit (increased 1.5 + 1.0), PSA (increased 0.4 + 0.4), SHIM score (increased 3.8 + 1.4, p-value=0.0088) and AUA symptom score (decreased 0.9 + 1.6) were calculated at the patients’ initial visit and most recent follow up while still on SubQ TRT (Table 1). A total of 30 patients had been on various combinations of TRT before switching to SubQ including IM (13), CC (13) Testopel (8), HCG (2) SubQ (2), T gel (1) and Anastrozole (1). Data on the most frequent TRTs is demonstrated in Table 2. Patient satisfaction surveys were completed by 32 patients (78%), with 26 (81.2%) patients reporting overall satisfaction with SubQ TRT versus 45% (9/20) with past forms of TRT. 93.7% (15/16) reported SubQ TRT was both easier and less painful, and 73.6% (14/19) preferred SubQ injections over their previous form of TRT. Reasons for stopping SubQ TRT included unrelated stroke (1), prostate cancer (1), development of scar tissue (1) or bruising (1), ineffective therapy (1), difficulty drawing up the syringe (1), cost (1), and trouble obtaining medication from the pharmacy (1).

Conclusions

The use of non-proprietary testosterone cypionate SubQ as treatment for hypogonadism results in an elevation in serum total testosterone and improvement on both SHIM and AUA symptom scores at follow up. PSA and HCT rose over the span of treatment, but the rises were not statistically significant, and no patient developed erythrocytosis. Our data demonstrate SubQ TRT is easier and less painful to use and scores higher on overall patient satisfaction compared to other forms of TRT.

Disclosure

No
(404) Early Experience of Penoscrotal Decompression for Refractory Ischemic Priapism and Its Impact on Sexual Function
Authors: Elkholy M , Yafi F , Zahran A , Assem A , Hassan W
Published: May 2023

Introduction

Outcomes after distal shunting have low rates of success in cases of refractory ischemic priapism lasting more than 48 hours.

Objective

Our objectives are to report our institutional experience using penoscrotal decompression for the surgical treatment of prolonged and refractory ischaemic priapism. The primary end point is to assess priapism resolution in the patients. While the secondary end point is to assess erection recovery in those patients.

Methods

We prospectively evaluated refractory and prolonged ischemic priapism patients treated with proximal decompression from 2020-2022 at Alexandria Main University Hospital. Priapisms were confirmed as ischaemic based on clinical presentations, cavernosal blood gas abnormalities, and doppler ultrasound. Treatment with irrigation and injection of α-agonists in all patients had failed prior to PSD. Patient characteristics, peri-operative variables and outcomes, and changes in International Index of Erectile Function (IIEF) scores were evaluated.

Results

Thirteen patients with priapism who had treated with penoscrotal decompression from 2020 to 2022. Their age was 28-53 years. The duration of ischemic priapism was 48 hours to 10 days. Nine patients had previously undergone shunt surgery. All patients were successfully treated with Penscrotal deecompression without additional intervention and noted immediate relief of pain postoperatively. Of the 10 patients with documented sexual function status at last follow-up, six reported spontaneous erectile function adequate for penetration, while four reported erectile dysfunction.

Conclusions

Penoscrotal decompression proved to be an effective and safe way of managing refractory ischemic priapism. The technique showed to produce favorable results while maintaining adequate sexual function.

Disclosure

Yes, this is sponsored by industry/sponsor: alexandria main university hospital.

Clarification

Industry initiated, executed and funded study

Any of the authors act as a consultant, employee or shareholder of an industry for: alexandria main university hospital.
(412) Concurrent Penile Plication and Extratunical Pericardial Grafting for Peyronie's Disease: A Step-by-Step Technique
Authors: Watts H , Casado C , Tanguilig G , Raheem O
Published: May 2023

Introduction

Surgical indications for Peyronie's Disease (PD) may constitute severe penile curvature or deformity including unilateral/bilateral corporal indentation/hinging, hour glassing, and concomitant erectile dysfunction. Penile plication, incision/excision of tunical plaques with grafting techniques are widely used. Recently, extratunical grafting has emerged as newer surgical technique that aims to treat corporal indentation, deformities, or tunical tissue loss in select PD cases.

Objective

In this video, we demonstrated step by step surgical technique for concurrent penile plication and extratunical pericardial grafting via circumcision incision in patient with severe ventral PD.

Methods

Video demonstration was edited using surgical footage with additional explanatory slides and audio.

Results

Video demonstration attached.

Conclusions

This video demonstrates step by step surgical technique for concurrent penile plication and extratunical pericardial grafting that can be used as an adjuvant surgical technique in treating corporal indentation, hinge effect or deformity with or without penile plication.

Disclosure

No
(417) Erectile Function after Treatment for Non-ischemic Priapism
Authors: Gordon P , Ralph D
Published: May 2023

Introduction

Non-ischemic priapism (NIP) is a rare subtype of priapism that typically arises from a straddle injury leading to the formation of an arterial-sinusoidal fistula, which results in partial penile tumescence. NIP can be managed conservatively, with selective arterial embolization, or, rarely, with surgical arterial ligation. These treatments have varying rates of success and post-treatment erectile dysfunction (ED), but there is a paucity of studies that include long-term outcomes. We present long term follow up of 23 three patients in a large centre offering all interventions.

Objective

Follow up 23-patients presenting with non-ischemic priapism, evaluating long term erectile function in both those who did and didn’t require intervention in the form of embolization.

Methods

We conducted a single-centre retrospective cross-sectional study looking at erectile function (EF) in a cohort of 23 patients over a median follow-up of 61 months. Patients’ EF was assessed using the erectile function domain (IIEF-EF) of the British Association of Urological Surgeons (BAUS) International Index of Erectile Function (IIEF) questionnaire, and ED was defined as a score ≤ 25 and/or the use of pharmacological adjuncts to assist EF. This is the largest and longest study in this field of its type.

Results

o Our cohort had a median IIEF-EF score of 28, and 4 patients (17.4%) reported using adjuncts. 21 patients were treated with embolization, and 2 were managed conservatively. o 91.3% required treatment with embolization, 17.4% needed adjunctive agents o 4.3% reported suffering a further episode of priapism (single iatrogenic episode) o 0% ED in conservative management group, 47.6% ED in embolization group.

Conclusions

We had a higher ED rate with embolization compared to the literature (47.6% vs 15-22%). Although no patients treated conservatively had ED at follow-up, there were only 2 patients in this group. Our study’s validity is negatively affected by many factors: its retrospective nature, a small sample size, and confounding from a heterogeneous group of patients. Ultimately, NIP is a rare condition with good treatment outcomes which are constantly improving and evolving.

Disclosure

No