AB0649 Morphofunctional penile alterations with severe sperm abnormalities in antiphospholipid syndrome associated with systemic lupus erythematosus
Authors: C.N. Rabelo-Júnior, E. Bonfa, J.F. Carvalho, M. Cocuzza, O. Saito, C.H. Abdo, C.A. Silva
Journal: Annals of the Rheumatic Diseases (2013)

<h3>Background</h3> We identified severe sperm abnormalities associated with intravenous cyclophosphamide (IVCYC) use and reduced penile dimensions with no deleterious effect in erectile function in systemic lupus erythematosus (SLE) patients.<sup>1</sup> In contrast, our group recently observed normal testicular function in primary antiphospholipid syndrome (PAPS) patients, in spite of morphofunctional penile abnormalities. Previous arterial thrombosis seemed to underlie this penile alteration in PAPS.<sup>2</sup> There is, however, no systematic study assessing the overall gonadal function in SLE-APS patients. <h3>Objectives</h3> To perform global gonadal and sexual function assessments in SLE-APS patients. <h3>Methods</h3> We screened initially 38 male APS patients, 28 patients were excluded: previous vasectomy(n=3), refusal to collect sperm sample(n=9), PAPS(n=12) and APS with others rheumatic diseases (n=4). A cross-sectional study was conducted in 10 SLE-APS patients and 20 healthy controls assessed by demographic data, clinical features, systematic urological examination, sexual function, testicular ultrasound, seminal parameters according to WHO, seminal sperm antibodies and hormone profile. <h3>Results</h3> The median of current age was similar in SLE-APS patients and controls (36.9 vs. 32.4years, p=0.310), with a higher frequency of erectile dysfunction in the former group (30% vs. 0%, p=0.029). Further analysis revealed that the median penis circumference was significantly reduced in SLE-APS patients with erectile dysfunction compared to patients without this complication [8.17(8-8.5) vs. 9.14(7-10.5)cm, p=0.0397]. In addition, SLE-APS patients with previous arterial thrombosis had a significantly reduced median penis circumference compared to those without this complication [7.5(7-8) vs. 9.18(8-10.5)cm, p=0.039]. Comparing SLE-APS patients and controls, the former had a significant lower median of sperm concentration (41.1 vs. 120.06×10<sup>6</sup>/mL, p=0.003), percentages of sperm motility (47.25 vs. 65.42%, p=0.047), normal sperm forms evaluated by WHO guidelines (11 vs. 23.95%, p=0.002) and Kruger criteria (2.65 vs. 7.65%, p=0.02). The median of FSH levels was significantly higher in SLE-APS group (9.73 vs. 3.32 IU/liter, p=0.025). Regarding seminal analysis, the median of sperm concentration and total sperm count were significantly lower in SLE-APS patients treated with IVCYC <i>versus</i> untreated with this drug [6.87(0-23.5) vs. 63.9(7.5-145)×10<sup>6</sup>/mL, p=0.04; 16.12(0-55.5) vs. 226.25(8.5-471)×10<sup>6</sup>/mL, p=0.035, respectively]. <h3>Conclusions</h3> We identified that IVCYC was the major factor for severe and potentially permanent damage to the tests in SLE-APS patients, and observed for the first time an association of reduced penile size with erectile dysfunction and previous arterial thrombosis in these patients. <h3>References</h3> Vecchi A,et al.Penile anthropometry in systemic lupus erythematosus patients.Lupus 2011;20:512-8 Rabelo-Júnior CN,et al.Primary antiphospholipid syndrome:morphofunctional penile abnormalities with normal sperm analysis.Lupus 2012(in press). <h3>Disclosure of Interest</h3> None Declared