(193) Sleep Related Painful Erections: A Survey Based Analysis of Patient Reported Experiences with Diagnosis and Management
Authors: Wong R , Chung D , Yafi F , Patel P 
Published: May 2023

Abstract

Introduction
Sleep related painful erection disorder (SRPE) is a debilitating condition which is currently not well understood. It is characterized by frequent nighttime awakenings due to painful nocturnal erections. Various theories surrounding the pathophysiology of this condition include increased testosterone levels, obstructive sleep apnea, altered autonomic function and psychosomatic factors, amongst others. To our knowledge, there have been no controlled studies investigating this, with literature consisting mostly of case reports. We sought to survey those affected to determine a unifying cause, treatment, and assess the impact on their quality of life

Objective
Understand the collective experience and unifying themes in the presentation, diagnosis and treatment of patients with SRPE.

Methods
A group of 63 men diagnosed with SRPE were administered a 30 item questionnaire consisting of both multiple choice, short and long answers from January 2021 to July 2021. Question items were generated based on existing literature. Survey items were reviewed by two academic Urologists specializing in treatment of sexual dysfunction. Information about demographics, clinical history, social history, symptomatology, and both surgical and medical interventions were captured. Quality of life was captured on a 5 point likert scale.

Results
Overall, 40 patients diagnosed with SRPE responded to the survey. The median age of those surveyed was 43.5 (range 21-69). Majority of respondents (66%, n=21) had no pertinent past medical history related to disorders of erectile function, while 50% (n=20) of subjects reported definitely or possibly having sleep apnea, and 38% (n=12) reported a mental health disorder. The most common current medication among subjects was baclofen (55%, n=22), followed by clonazepam (10%, n=4). However, baclofen proved to be beneficial in only 36% (n=8) of responders who had trialed it. The interventions which were most commonly reported as helpful by those who attempted were sleep repositioning (50%, n=4) and oxygen device use (43%, n=3). Majority of patients have not required intervention in the emergency department 92.5%, n=37), and only 7.5% (n=3) patients have required penile aspiration. Responders described their quality of life as being severely impacted by SRPE, with 14 choosing a severity of 5 (35%). The median score for this response category was 4.

Conclusions
SRPE is a poorly described condition which should be distinguished from other erectile pathologies such as priapism. The majority of our patients reported OSA, and previous studies have suggested a sleep-cycle association. Sleep reposition and oxygen use appear to provide the most relief for the majority of our patients, although this was not a reliable treatment option. From a medication perspective, there was no consistent class of medication that provides symptom relief. Majority of patients appear to manage their erections without requiring a visit to ED. An overwhelming majority of our patients identified with a mental health disorder, and similarly the average response was that this had a severe impact on their quality of life. Based on these responses and the impact on quality of life, further studies must be done to better elucidate this condition.

Disclosure
No