(321) Penile Doppler Ultrasound (PDUS) Procedure Anxiety and Its Impact on the Erection Hardness (EH) and Corporo-venocclusive Dysfunction (CVOD) Diagnosis
Authors: Ljubetic BM , Novaes LF , Gonzalez A , Mulhall JP , Flores JM 
Published: February 2024

Abstract

Introduction
Procedure anxiety is an excessive fear of medical, dental, or surgical procedures that result in acute distress or interference with completing necessary procedures. Previous work has shown that anxiety affects penile hemodynamics.

Objective
This study aims to examine the impact of PDUS procedure anxiety on the erection hardness (EH) achieved during and after PDUS and the diagnosis of CVOD.

Methods
The patient population included (i) men with poor response to erectogenic agents or (ii) who need curvature assessment due to Peyronie’s disease (PD), (iii) who underwent PDUS, (iv) using ICI vasoactive agent redosing schedule. We performed a descriptive assessment of demographics and comorbidities. We reported EH reached before and 30 minutes after PDUS, which was evaluated by a sexual medicine-trained physician for each case. EH was measured on a 0 (no erection) to 10 (erection hard as a rock). We also described the number of injections, the dose, and PDUS hemodynamic parameters, including peak systolic velocity (PSV) and end-diastolic velocity (EDV). Arterial insufficiency (AI) diagnosis was made with PSV values ≤30 cm/sec bilaterally, and CVOD diagnosis with EDV values ≥5 cm/sec bilaterally. A visual analog scale (VAS) evaluated the anxiety related to the procedure using a single question: “How anxious are you about your PDUS procedure?” This was measured on a 0 (not at all anxious) to 10 (extremely anxious) Likert scale. 7 or higher was defined as high anxiety, 4 to 6 as moderate anxiety, 1 to 3 as mild anxiety, 0 was no anxiety. We compared the EH pre and post-PDUS and the prevalence of CVOD based on the procedure anxiety category (high vs. no high anxiety). Predictors of persistent EH (6/10 or higher) after PDUS was analyzed using a logistic regression model. Factors entered into the model included: patient age, PD, and procedure high anxiety. A p-value ≤0.05 was considered statistically significant.

Results
162 individuals were included. The median age of 65 (59,72) years. 19% had diabetes, 19% reported ≥ 3 comorbidities, 10% had a history of depression, and 11% had a history of anxiety. 72% had prostate cancer, 6% had bladder cancer, 3% had other cancer, and 19% had no cancer history. 35% reported PD. The VAS procedure anxiety median was 3 (1, 5), on which 22% reported no anxiety, 34% mild, 26% moderate, and 18% high anxiety. For men with high anxiety procedure, the median EH before and after PDUS was 6 (4, 8) and 5 (2, 8), respectively; 62% had CVOD diagnosis, 48% remained with an EH 6 or greater after PDUS, and 45% needed a reversal injection. No significant differences were observed compared to men without high anxiety procedures. In the MVA, only age significantly predicted EH 6 or greater after PDUS (Table 1).

Conclusions
High PDUS Procedure Anxiety does not affect EH pre and post-PDUS, CVOD diagnosis, or reversal rate after PDUS. Only younger age significantly predicted persistent EH 6 or greater after PDUS.

Disclosure
No.