(122) Erectile Hemodynamics Asessment In ED Patients With Self-Diagnosed Post-finasteride syndrome (PFS)

Abstract

Abstract Introduction Much debate exists regarding the concept of PFS and its etiology. There exists data suggesting abnormal erectile hemodynamic alterations in this population. Objective This analysis was performed to define erectile hemodynamics in this population. Methods Patients attending the sexual medicine clinic at our institution presenting with (i) new onset ED after commencement of 5-ARI (ii) 5-ARI use specifically for hair loss (iii) with no prior ED history (iv) presenting ≥6 months after cessation of 5-ARI (v) and with at least 3 months use of 5-ARI (finasteride). All completed the IIEF EF domain questionnaire. B-mode assessment was conducted at 15MHz. Duplex ultrasound (PDDU) was conducted using a vasoactive agent-redosing schedule using trimix. On PDDU, a best quality erection (BQE) (equivalent to the best erection obtainable at home without erectogenic medication) was required for inclusion. Redosing was conducted if the patient failed to obtain a BQE up to a maximum of three doses. The criteria for normalcy on DUS included a peak systolic velocity (PSV) >30cms/s and an end-diastolic velocity (EDV) <5 cms/s. Results 141 men were included in the analysis. Mean patient age was 31±12 (18-42) years. All had used finasteride 1mg. Median vascular risk factor (VRF) number = 1 (0,1). Median duration of 5-ARI exposure = 16 (4, 46) months. Median duration off 5-ARI at first presentation to clinic = 11 (6, 28) months. No patients had ED prior to 5-ARI use. One third developed ED only after cessation of finasteride, at a mean duration off finasteride of 6±3 months. Median IIEF EFD score at presentation = 14 (6,18). Median (range) number of injections needed for BQE sufficiently suitable for DUS measurement was 2 (1, 3). Overall, mean PSV and EDV values were 60±18cm/s and 1.5±1.5 cm/s respectively. 29% required phenylephrine reversal before discharge from clinic. Conclusions These data suggest that hemodynamic alterations are not present in men complaining of ED with self-diagnosed PFS. Disclosure No