Erectile Dysfunction In Patients Research Articles

Long-term effects of combination treatment comprising low-intensity extracorporeal shockwave therapy and tadalafil for patients with erectile dysfunction: a retrospective study.

This study retrospectively examined the effects of low-intensity extracorporeal shockwave therapy and tadalafil on erectile dysfunction patients. 116 patients got low-intensity extracorporeal shockwave therapy twice weekly for 3 weeks, 5 mg of tadalafil daily for 3 weeks, and adjuvant therapy for 6 months. Group A (1 year), Group B (2 years), Group C (3 years), and Group D (4+ years) were treated patients' follow-up groups. The patients' International Index of Erectile Function-5 (IIEF-5) scores were gathered at the start of treatment via face-to-face interviews and at the end of follow-ups by telephone conversations. IIEF-5 scores and the minimal clinically significant differences were the main outcomes. Mean follow-up length, age, and IIEF-5 scores of the patients were 2 ± 1.16 years, 47.34 ± 12.65 years, and 12.09 ± 3.66 points, respectively. Compared to baseline, treatment increased the median IIEF-5 scores of patients in groups A, B, C, and D by 7 [3-12], 6 [0-8], 7 [1-9], and 6.5 [2.5-10] points, respectively (p = 0.001). 71%, 63%, 65.8%, and 65% of treated patients in groups A, B, C, and D met the minimal clinically significant differences criteria (n = 77). Mild disease patients were 9.14 times more likely to respond to treatment than severe illness patients (OR, 9.14; 95% CI, 1.28-65.46; P = 0.02). Low-intensity extracorporeal shockwave therapy and 5 mg of tadalafil can treat erectile dysfunction for up to 4 years with sustained outcomes. This treatment is optimal for mild illnesses.

Survey of the quality and origins of websites on penile low-intensity shockwave therapy in Canada.

The aim of this study was to establish the quality of patient-facing websites advertising low-intensity shockwave therapy (LISWT) for erectile dysfunction (ED) and Peyronie's disease (PD) patients in Canada. Canadian websites offering LIWST for ED or PD were identified using online web searches. The characteristics of these websites were reviewed, along with examining the presence of HONCode certification, assigning a brief DISCERN score (a tool designed to evaluate health information online) and readability scores. We also examined the LIWST technology advertised, as well as benefits of LIWST cited by the websites. Twenty-five unique websites linked to 46 clinics were identified and reviewed. Twenty-four percent of websites were run by a urologist. Other specialties offering LISWT included general practitioners, anesthesiologists, naturopaths, nurse practitioners, physiotherapists, and registered massage therapists. Twenty-four percent of the websites advertised the use of a focused shockwave generator. Forty percent of the websites had peer-reviewed references. The average brief DISCERN score was 14 (standard deviation 3.4). There was no association between the physician-or non-physician-led websites and the use of peer-reviewed references, readability scores, the number of clinic locations, or higher brief discern scores. LISWT is readily advertised online for ED and PD patients in Canada; however, only a minority use a focused shockwave generator. There is a wide diversity of practitioners offering LISWT. Websites offering LISWT are generally of poor quality and do not provide adequate information for patients to make educated treatment decisions.

Serum folic acid: an effective indicator for arteriogenic erectile dysfunction.

The present study is the first to explore the correlation between serum folic acid (FA) level and penile arterial peak systolic velocity (PSV) as measured via penile color Doppler ultrasonography (PDU), which directly reflects endothelial function in the penile artery. A total of 244 consecutive erectile dysfunction (ED) patients and 72 healthy controls, recruited from the Andrology department and the Healthy Physical Examination Center of our hospital, respectively, from June 2020 to April 2022, were included in the study. Serum FA was measured in ED patients and healthy controls, and PDU examinations were conducted for all eligible ED patients. The Pearson method was used to evaluate the correlation between FA levels and PDU parameters in ED patients. A receiver operating characteristic (ROC) curve analysis was also performed to calculate the sensitivity and specificity of these parameters for prediction of arteriogenic ED. After the PDU test, the average serum FA level among patients diagnosed with arteriogenic ED was 8.08 ± 2.64 ng/ml, lower than the average of 10.78 ± 2.87 ng/ml among healthy controls. There were no statistically significant inter-group differences on any basic parameters, including age, body mass index, fasting blood glucose, total cholesterol, and triglyceride. For further analysis, we divided the arteriogenic ED group into three subgroups by PSV range to compare serum FA levels among these subgroups. The mean FA levels in each of these groups were 5.97 ± 1.51ng/ml, and 8.21 ± 2.37ng/ml, and 10.55 ± 2.56ng/ml, while the corresponding PSV values were 15.75 ± 2.39cm/s, 23.53 ± 2.19cm/s, and 32.72 ± 1.64cm/s. Overall, a positive correlation between PSV and FA level was found among patients with arteriogenic ED (r=0.605, P<0.001). Furthermore, when FA level was used, with a cut-off value of 10.045 ng/ml, as a criterion to distinguish patients with arteriogenic ED from healthy controls, the area under the curve (AUC) was 0.772 (95% confidential interval: [0.696, 0.848]), for a sensitivity of 0.611 and specificity of 0.824. Serum FA level is positively correlated with PSV in ED patients, and has the ability to distinguish patients with arteriogenic ED from healthy controls. Taking these findings together, FA deficiency should be regarded as an independent risk factor for arteriogenic ED.

(219) AUTOLOGOUS PLATELET-RICH PLASMA IMPROVES ENDOTHELIAL AND TADALAFIL-INDUCED RELAXATIONS IN CORPUS CAVERNOSUM FROM PATIENTS WITH ERECTILE DYSFUNCTION

Abstract Objectives Available clinical evidence suggests the potential therapeutic use of intracavernosal injections of platelet-rich plasma (PRP) to treat erectile dysfunction (ED). However, the effects of PRP on human cavernosal function have not been elucidated. Our aim was to evaluate the effects of acute exposure to autologous PRP on relaxant capacity of human corpus cavernosum (HCC) from patients with ED. Methods HCC strips were obtained from four ED patients undergoing penile prosthesis insertion and giving informed consent. Previous to intervention, PRP and platelet-poor plasma (PPP) were obtained from patients by apheresis and stored at -20°C until functional procedures. Endothelial relaxation to acetylcholine (ACh) was evaluated before and after 60 min exposure to PRP or PPP (1% v/v) in organ chamber. Relaxant response to the PDE5 inhibitor, tadalafil, was also evaluated in PRP or PPP (1%) treated HCC from the same patient. Results Average age of patients was 67-years-old (range 61-71) while hypertension and smoking history was present in 3/4, diabetes in 2/4, and obesity in 1/4. Mean platelet content in PRP was 1,096x10 9 /L (range 786 to 1,284 x109/L) while negligible platelet content was obtained in any PPP. Exposure to autologous PRP but not PPP significantly enhanced (p&amp;lt;0.0001 by two-factors ANOVA) ACh-induced endothelial relaxations (pEC50 5.75±0.65 vs. 7.16±0.50; Emax 57.3±14.8% vs. 88.5±2.0%; before and after 1%PRP, respectively). Additionally, HCC treated with autologous PRP displayed augmented relaxant responses to tadalafil (p=0.0018 by two-factors ANOVA) with respect to those treated with PPP (pEC50 6.08±0.5 vs. 6.82±0.51 for PPP and PRP, respectively). Conclusions Acute exposure to autologous PRP improves endothelial function and functional response to PDE5 inhibition. These results support the reported clinical improvement of erectile function in patients with ED and suggest that PRP injection might induce a functional effect on cavernosal tissue in addition to the claimed restorative/regenerative effect. Conflicts of Interest None

(47) MAJORITY OF ERECTILE DYSFUNCTION PATIENTS WOULD HAVE PREFERRED EARLIER IMPLANTATION OF THEIR PENILE PROSTHESIS: VALIDATION OF THE RECENTLY CHANGED EAU GUIDELINES

Abstract Objectives Until 2019, the European Association of Urology (EAU) guidelines recommended the implantation of a penile prosthesis as a third-line therapy, which has since then changed to "if other treatments fail or depending on the patient's preference", thus a more patient oriented approach. The primary endpoint of this study was to assess whether patients with a penile prosthesis and their partner would have preferred earlier implantation. Secondary endpoints were how much earlier and why patient and partner wanted earlier implantation, satisfaction of patient and partner and if patient and partner would have recommended the intervention. Methods We selected patients operated between April 2013 and December 2019. Inclusion criteria were a virgin implantation of an inflatable penile prosthesis (IPP) and a signed informed consent with agreement for a telephonic interview. Exclusion criteria were combined implants and follow-up less than one year. This resulted in a series of 155 patients and 65 partners. Telephonic interview was conducted in a structured manner. Further data were collected retrospectively. Results The preference for earlier implantation was reported in 59.4% of patients and 46.2% of partners. Of them, respectively 53.2% and 46.6% would have wanted the prosthesis more than five years earlier. Satisfaction was seen in 83.2% of patients and 73.8% of partners. Respectively 82.6% and 78.4% of patients and partners would recommend the procedure. Conclusions The majority of erectile dysfunction patients would have preferred earlier implantation of their IPP. Our results indicate that a more patient-oriented approach with good counseling is desirable and that the “three-level” concept must be abandoned. Conflicts of Interest The authors declare no competing interests.

Low-intensity Extracorporeal Shock Waves for Treatment of Erectile Dysfunction in Patients Not Responding to Phosphodiesterase Type 5 Inhibitors, Its Durability, and Factors That May Influence the Outcome: A Clinical Trial

Background: Non-invasive treatments, such as low-intensity extracorporeal shock waves treatment (Li-ESWT), can be a safe and effective alternative for patients with erectile dysfunction (ED) who are resistant to phosphodiesterase type 5 inhibitors (PDE5Is). Objectives: This clinical trial study aimed to evaluate the effect of Li-ESWT on ED in non-responders to PDE5Is, its durability, and factors predicting its success. Methods: This study was conducted on 128 patients with ED who were resistant to PDE5Is. Before any intervention, written informed consent was obtained, demographic characteristics were collected, and the severity of the ED score was determined using the international index of erectile function (IIEF). Patients were treated with Li-ESWT, and ED severity was remeasured by the IIEF scale at the end of the intervention, three months, and six months after the intervention. The data were analyzed by chi-square, repeated measure ANOVA, Bonferroni post hoc, and binary logistic regression tests. Results: A total of 128 patients with ED who had not responded to PDE5Is, with a mean age of 58.35 ± 8.28 and an average ED of 3.41 ± 1.78 years, were included. At the end of the intervention, the IIEF score significantly increased. Moreover, this score was significantly higher three months and six months after the intervention. Three and six months later, the IIEF score decreased significantly. However, the score was significantly higher all three times than before the intervention. Being younger than 60 years, having an ED duration of fewer than three years, being non-smoking, being non-diabetic, and having no lower urinary tract symptoms (LUTS) were the most prominent predictors of a successful ED treatment. Conclusions: Low-intensity extracorporeal shock waves treatment is a safe and effective method for short and long-term treatment of ED patients. Identifying predicting factors can be beneficial for urologists in selecting suitable patients and avoiding the overtreatment of those who are not suitable candidates.

Use of Phytotherapy in the Treatment of Patients with Erectile Dysfunction

Erectile dysfunction (ED) is one of the most common sexual disorders. In men with a mild stage of ED, it is possible to achieve a therapeutic effect from the use of phytotherapy. The objective: analysis of the effectiveness of the combination of natural compounds in patients with mild ED. Materials and methods. 28 patients (average age – 35±5.3 years) with mild ED participated in the study of the effectiveness of the dietary supplement. All patients were examined before and 1 month after the use of the combination of natural compounds, namely: collection of a detailed medical and sexual history, ultrasound dopplerography of the vessels of the penis, lipidogram, blood glucose level and total testosterone level were measured in the laboratory. The patients received the dietary supplement, which includes zinc citrate, L-arginine, an extract of the fruits of slanky anchovies, an extract of epimedium leaves, an extract of the root of Tongkat Ali, an extract of the root of Korean red ginseng, 1 capsule 2 times a day. Results. During the study, a psychogenic form of ED was found in 12 (42.9%) men, an organic cause of ED in 3 (10.7%), and a mixed form in 13 (46.4%) men. 1 month after the end of the use of the complex, it was established that all indicators of the «International Index of Erectile Function-15» (MIEF-15) questionnaire improved in ED patients. Conclusions. The results of the study showed that the use of the complex significantly improved sexual satisfaction, sexual desire, orgasmic function and quality of life in men with mild ED.

An atypical erectile dysfunction patient with infertility treated with penile prosthesis implantation and testicular epididymal sperm aspiration (TESA)-intracytoplasmic sperm injection (ICSI): A case report.

Erectile dysfunction (ED) is common in middle-aged and elderly men, affecting more than 100 million males worldwide. Most ED cases can be attributed to organic and/or psychological factors. Here we report an atypical ED case with no clear manifestation fitting the diagnosis for recognized types of ED. The 35-year-old male is unable to have normal erection since puberty, and unable to complete intercourse with his wife. He had no history of trauma, surgery or psychiatric/psychological disease. The patient has a normal male karyotype. There is no significant finding in physical examination, nocturnal penile tumescence test, and ultrasound measurement of penis vascular functions. The serum levels of major hormones are all in normal ranges. Atypical ED, psychogenic ED not excluded; infertility. Oral phosphodiesterase inhibitors Tadalafil (20 mg, BIW) or Sildenafil (50 mg, BIW) had no effect in this patient. Penile prosthesis implantation helped the patient to acquire normal sexual life, but did solve the ejaculation failure and infertility. Motile sperms were obtained by testicular epididymal sperm aspiration under the guidance of ultrasound, and intracytoplasmic sperm injection was performed with occytes retrieved from his wife. The patient sexual life was significantly improved after penile prosthesis implantation; the patient wife is currently in the first trimester of pregnancy as the result of in vitro fertilization. The no response to phosphodiesterase type 5 inhibitors (PDE5) treatment may suggest an impediment of PDE5-related pharmacological pathways or the presence of defect/injury in the neural system. This special case raises a question if some patients with persistent ED may have similar manifestations and can be treated with the same procedures.

Erectile dysfunction and associated factors among patients with diabetes attending follow-up at a public hospital, Harar, Eastern Ethiopia. A cross-sectional study design.

The global prevalence of erectile dysfunction among patients with diabetes is high. It is the most underestimated problem but has a great physical, psychological, and social impact on the individual with the disease, family, and society in general. Thus, this study aimed to assess the magnitude of erectile dysfunction and associated factors among patients with diabetes attending follow-up at a public hospital, Harar, Eastern Ethiopia. Facility-based cross-sectional study was conducted on selected 210 adult male patients with diabetes attending follow-up at a public hospital, Harar, Eastern Ethiopia, from 1 February to 30 March 2020. Simple random sampling was used to select study participants. A pre-tested interviewer-administered structured questionnaire was used to collect the data. The data were entered to EpiData version 3.1 and exported to SPSS version 20 for analysis. Bivariate and multivariable binary logistic regression were carried out, and a P-value of <0.05 was taken as statistically significant. A total of 210 adult male patients with diabetes participated in the study. The overall magnitude of erectile dysfunction was 83.8%, with 26.7% suffering from mild, 37.5% mild to moderate, 29% moderate, and 6.8% severe erectile dysfunctions. Age 46-59 years [adjusted odds ratio (AOR): 2.560; 95% confidence interval (CI) (1.73, 6.53)], age ≥ 60 years [AOR: 2.9; 95% CI (1.48, 5.67)], and poor glycemic control [AOR: 2.140; 95% CI (1.9, 7.44)] were significantly associated with erectile dysfunction among patients with diabetes. The present study revealed a high magnitude of erectile dysfunction among population with diabetes. The age categories of 46-59 and ≥60 and having poor glycemic control were the only variables significantly associated with erectile dysfunction. Thus, routine screening and management for erectile dysfunction in patients with diabetes should be part of routine medical care particularly for adult male patients and those with poor glycemic control.

Efficacy of Low-Intensity Extra Corporal Shockwave Therapy (LI-ESWT) in Patients With Erectile Dysfunction.

Erectile dysfunction (ED) is a common cause of sexual disorders in men with limited treatment options. This study aimed to determine the efficacy of low-intensity extra corporal shockwave therapy (LI-ESWT) in patients suffering from ED. A single-group, pre-test, and post-test pre-experimental study were conducted. Thirty-one ED patients were prospectively selected according to the eligibility criteria. In each session, 3000 shocks were applied at 5 points over the penis. Eight sessions were delivered in total with a 2-3-day interval. The patient's condition was assessed using the International Index of Electric Function (IIEF-5) questionnaire at baseline and one month after the last treatment session. Paired t-test was used to determine the difference between the pre-test and post-test. Mean age of the patients was 44.6 (± 14.70) ranging from 25 to 78 years. The majority of them were married (83.9%) and service providers (51.6%). We have also found 51.6% overweight, 9.7% obese, 48.4% diabetic, 45.2% hypertensive, 12.9% with enlarged prostate, 45.2% smoker, 25.8% alcoholic, and 71% with sleep disturbances. During the pre-test, 9.7% had severe ED and 51.6% had moderate ED. After the treatment, no patients were found with severe ED, and few of them had moderate ED (9.7%). The mean difference in IIEF-5 score during the pre-test and post-test was statistically significant (p= < 0.001). The study showed efficacy of LI-ESWT in a subset of patients with ED. Future studies with larger sample size, placebo group, and longer follow-up periods are recommended.

Hyperestrogenism is associated with sexual function impairment in men-findings from a cross-sectional, real-life study.

Hyperestrogenism is believed to be harmful to male sexuality. We aimed to investigate the prevalence of and the impact of hyperestrogenism on sexual functioning in a cohort of men seeking medical attention for new-onset erectile dysfunction. Data from 547 men seeking first medical help for new-onset erectile dysfunction at a single andrology center were analyzed. Patients were assessed with a thorough medical and sexual history. Comorbidities were scored with the Charlson comorbidity index. All patients completed the International index of erectile function; the International index of erectile function-erectile function domain was categorized according to Cappelleri's criteria. Circulating hormones were measured in every patient. Hyperestrogenism was defined as estradiol levels >42.6 pg/mL (Tan etal., 2015). Descriptive statistics and logistic/linear regression models tested the association between hyperestrogenism and International index of erectile function domains score. Overall, 96 (17.6%) participants had serum estrogen levels suggestive of hyperestrogenism. Men with hyperestrogenism were older (median [interquartile range]: 46 [35-59] vs. 44 [31-56] years; p<0.001), had a higher rate of comorbidities (Charlson comorbidity index ≥1: 26.0% vs. 7.4%; p<0.001), and higher serum total testosterone values (5.4 [5.2-8.0] vs. 4.3 [4.1-5.7] ng/mL; p=0.01) than those with normal estradiol values. A higher prevalence of severe erectile dysfunction (135 [29.9%] vs. 47 [48.9%] men; p=0.01) and of hypogonadism (22 [4.8%] vs. 6 [6.3%] men; p=0.004) were found in men with hyperestrogenism. Serum estradiol levels were positively correlated with total testosterone levels (β = 0.26, p<0.001) but negatively correlated with International index of erectile function-orgasmic function (β = -0.24, p=0.002) and International index of erectile function-erectile function scores (β = -0.03, p<0.001). When International index of erectile function scores was used to stratify erectile dysfunction patients, hyperestrogenism (odds ratio 2.44, p=0.02) was associated with severe erectile dysfunction. One out of five men seeking first medical help for erectile dysfunction showed elevated serum estradiol values suggestive of hyperestrogenism. Hyperestrogenism was associated with health-significant comorbidities, orgasmic function impairment, and erectile dysfunction severity.

Carotid artery intima media thickness can predict the response to phosphodiesterase 5 inhibitors in patients with moderate erectile dysfunction.

Increased carotid artery intima-media thickness (CIMT) has been shown to be associated with erectile dysfunction (ED), but studies evaluating the efficacy of CIMT in predicting drug response are lacking in the literature. We aimed to evaluate the efficacy of CIMT in predicting the response to phosphodiesterase-5 inhibitors (PDE5-I). A total of 274 subjects were divided into two groups: ED patients (n = 150) and controls (n = 124). The patients in the ED group were further divided into the subgroups of severe, moderate, mild-moderate, and mild ED. Blood tests, carotid ultrasonography, and the International Index of Erectile Function-5 (IIEF-5) diagnostic tool were applied to all subjects. Tadalafil was administered to each patient. The patients were re-evaluated using the IIEF-5 questionnaire after 2 months of treatment. According to their response to medication, the patients were evaluated as responders or nonresponders. Increased CIMT was significantly associated with the failure of PDE5-I therapy, especially in patients with moderate/mild-moderate ED. Fasting blood glucose, body mass index, and CIMT were significantly higher in the ED group compared to the control group (P =.021, P = .006, and P < .001, respectively). The IIEF-5 score was significantly lower in the ED group (P < .001). CIMT was significantly correlated with the IIEF-5 score. When the total patient group was evaluated, the CIMT value of the responders was significantly lower than that of the nonresponders (P = .001). CIMT was significantly higher among the nonresponders with moderate/mild-moderate ED compared to the responders (P = .004 and .008, respectively), while there was no significant difference in CIMT between the responders and nonresponders with severe or mild ED. A receiver operating characteristic (ROC) analysis of CIMT was performed for discrimination between nonresponders and responders with moderate/mild-moderate ED. The area under the ROC curve was 0.801 (0.682-0.921) (P = .001), and the cutoff value was determined to be 0.825mm, at which CIMT predicted the response to treatment with 65% sensitivity and 89% specificity. Using a validated CIMT cutoff value can help the physician inform the patient about the possibility of drug failure and avoid attempting second-line therapy too soon. There are three main limitations to our study. First, the number of participants was low. Second, ultrasound is a relatively subjective method, and third, all measurements were made by the same radiologist. CIMT can be used as a predictor of response to PDE5-I therapies in patients with moderate/mild-moderate ED.

Evaluation of the relationship between perirenal fat thickness and severity of erectile dysfunction: A prospective study

Objective: To investigate whether perirenal fat thickness (PRFT) is associated with erectile dysfunction (ED). Materials and Methods: Male patients aged 30-70 years who applied to the urology outpatient clinic due to ED were prospectively evaluated in this study. Patients having the similar age without ED complaints were included in the control group. Age, body mass index (BMI), fasting blood glucose (FBG), lipid profile, total testosterone and HB1Ac levels of the patients were recorded. Patients presenting with ED were asked to fill the International Index of Erectile Function (IIEF-5) form. According to the total IIEF scores, ED patients were divided into 4 groups as severe, modarate, mild-moderate and mild. PRFT of all patients was measured by ultrasonography. Baseline demographic, biochemical and PRFT values were compared between groups. Results: The patients were divided into 2 groups as ED (Group 1, n:61) and control (Group 2, n:61). The mean age was 50.5 ± 10.6 years (min-max 30-70), mean BMI and mean PRFT values were also found as 24.6 ± 4.1 kg/m2 (min-max 17.6-35.1) and 4.6 ± 2.2 mm (min-max 1.5-12), respectively. While no statistically significant difference was observed between the two groups in terms of mean age, FBG, high- density lipoprotein (HDL), triglyceride, HBA1c values, BMI, total testosterone, total cholesterol, low-density lipoprotein (LDL), the mean PRFT was found to be statistically higher in Group 1 (p&lt;0.001). According to the results of the correlation analysis, severity of ED, IIEF total score, duration of ED, BMI, FBG and HBA1c were significantly correlated with PRFT. Conclusion: PRFT is a simple measurement that can be used to predict the severity of ED.

Quality of life and erectile dysfunction in patients with benign prostatic hyperplasia

Quality of life and erectile dysfunction in patients with benign prostatic hyperplasia

(084) Analysis of BMP4 and GREMLIN as targets of SHH signaling and regulators of the collagen axis in the penis.

Abstract Introduction Increased collagen deposition occurs in erectile dysfunction (ED) patients and animal models, and the underlying causes of these fibrotic changes have not been well defined. The Sonic hedgehog (SHH) pathway is critical for the response of the penis to denervation. Decreased SHH in the penis due to cavernous nerve (CN) injury, causes smooth muscle apoptosis and ED. As smooth muscle is lost, increased collagen occurs by a largely unknown mechanism. We have shown that collagen abundance is responsive to SHH signaling in the penis. Microarray analysis identified increased GREMLIN (BMP4 antagonist) in corpora cavernosa of ED patients, and SHH is a regulator of GREMLIN in the limb bud. Objective We hypothesize that SHH regulation of collagen occurs through a BMP4/GREMLIN dependent mechanism and will examine BMP4 and GREMLIN signalling in corpora cavernosa of ED patients and a rat prostatectomy model. Study of how collagen induction occurs after prostatectomy would be useful to determine the underlying mechanism of penile remodeling. Methods Corpora cavernosal tissue (n=36) from prostatectomy, diabetic and Peyronie’s (control) patients were examined by immunohistochemical and western analysis for BMP-4 and GREMLIN proteins. Localization was determined by dual staining with ACTA2 and CD31. Collagen was quantified by hydroxyproline assay and trichrome stain with Image J analysis. Primary cultures of patient corpora cavernosa were established and treated with BMP4 and GREMLIN proteins, and smooth muscle cell growth was quantified. Sprague dawley rat penis was treated in vivo with SHH protein by peptide amphiphile, 5E1 SHH inhibitor, BMP4 and GREMLIN via Affi-Gel beads. Collagen was quantified. Results BMP-4 and GREMLIN were identified in smooth muscle of Peyronie’s, prostatectomy and diabetic ED patients. Western analysis identified increased BMP4 and GREMLIN proteins in prostatectomy and diabetic patients where collagen is increased. Primary culture of corpora cavernosal smooth muscle cells showed an increase in growth with BMP4 and decreased growth with GREMLIN treatment. This trend was more pronounced in cells from hypertension and cardiovascular disease patients. BMP4 and GREMLIN proteins increased 1-2 days after CN injury in a rat prostatectomy model that showed decreasing SHH in the penis. SHH inhibition in the penis increases BMP4, GREMLIN and collagen. SHH treatment of the penis after CN injury in the rat decreases collagen, BMP4 and GREMLIN. Conclusions SHH is decreased in corpora cavernosa of prostatectomy and diabetic ED patients while BMP4 and GREMLIN are increased. Decreased SHH increases BMP4 protein and collagen, suggesting a possible mechanism for fibrotic penile remodelling after CN injury. This study is the first step in understanding the mechanism of how SHH regulates collagen abundance in the penis, which is important for clinical translation. Disclosure No

(529) Etiology of Erectile Dysfunction in Patients who Underwent Endourological Procedures for Prostate vs. Robotic and Open Radical Prostatectomy.

Abstract Introduction Erectile dysfunction continues to be a concern for patients and physicians after surgical treatment of prostate pathology. Objective To analyze doppler diagnosis on patients who underwent prostate surgery for benign or malignant pathology of the prostate. Methods We retrospectively analyzed all patients who underwent either robotic assisted prostatectomy (RALP), open retropubic prostatectomy (RRP), endoscopic procedures such as greenlight procedure, laser resection of the prostate or transurethral resection of the prostate (TURP); and High Intensity Focused Ultrasound (HIFU) treatment for prostate pathology and who underwent intracavernous injection followed by Color Doppler Duplex Ultrasound (CDDU) at our institution between 2005 and 2019. CDDU findings were recorded following injection of low dose alprostadil (10-20 mcg) and again after a period of privacy and visual sexual stimulation. CCDU findings including peak systolic velocities (PSV), and resistive indices (RIs) were recorded. Arterial insufficiency (AI) was defined as either a post-stimulation PSV &amp;lt; 25 with any RI or a PSV 25-34.9 with RI≥0.9. Cavernous Venous Occlusion Disease (CVOD) was defined as post-stimulation PSV ≥35 with RI &amp;lt; 0.9. Mixed was defined as post-stimulation PSV 25-34.9 with RI &amp;lt; 0.9. Vascular normal was defined as post-stim PSV ≥ 35 with RI ≥ 0.9. Results 380/1917 (19.8%) patients had a past surgical history of prostate surgery. 111/380 (29.2%) underwent RRP, 168/380 (44.2%) patients underwent RALP, 85/380 (22.3%) underwent endourological resection of the prostate and 2/380 (0.5%) patients underwent HIFU. Median age for the RALP group was 60.5 (IQR 23.7-82.8), RRP group was 64.2 (29.7-87.7), endourological resection of the prostate 64.6 (30.8 – 85.6) and HIFU 65.0 (46.9-79.4). 87.1% of patients who had an endoscopic procedure were using phosphodiesterase-5 inhibitors at the time of CDDU. CVOD was the most common etiology of ED in patients who underwent RRP (28.8%) and Endourological procedures of the prostate (32.9%); In patient who underwent RALP the most common etiology of ED was noted to be AI (28.6%), however none of these values were statistically significant (p=0.428). Conclusions There is no difference in etiology of ED in patients who underwent open, robotic or endoscopic manipulation of the prostate as shown by CDDU. Disclosure No

The retinal neurovascular coupling is impaired in men with vasculogenic erectile dysfunction

The aim of this study was to study the retinal vessels in patients affected by vasculogenic erectile dysfunction (ED), using dynamic vessel analyzer (DVA). Patients with vasculogenic ED and control subjects were prospectively enrolled to undergo a complete urological and ophthalmologic evaluation, including DVA and structural optical coherence tomography (OCT). The main outcome measures were: (1) arterial dilation; (2) arterial constriction; (3) reaction amplitude (the difference between arterial dilation and constriction); and, (4) venous dilation. Thirty-five patients with ED and 30 male controls were included in the analysis. Mean ± SD age was 52.0 ± 10.8 years in the ED group and 48.1 ± 16.3 years in the control group (p = 0.317). In the dynamic analysis, the arterial dilation was lower in the ED group (1.88 ± 1.50%), as compared with the control group (3.70 ± 1.56%, p < 0.0001). Neither arterial constriction nor venous dilation differed between groups. The reaction amplitude was decreased in ED patients (2.40 ± 2.02%, p = 0.023), compared to controls (4.25 ± 2.20%). In the Pearson correlation analysis, the ED severity, was directly correlated with both reaction amplitude (R = .701, p = 0.004) and arterial dilation (R = .529, p = 0.042). In conclusion, subjects with vasculogenic ED are featured by a significant dysfunction of the retinal neurovascular coupling, which is inversely correlated with ED severity.

(117) Should Men Eat More Plants? A Systematic Review of the Literature on the Effect of Plant-Based Diets on Men’s Health in Urology

Abstract Introduction There is considerable evidence describing the benefits of a plant-based diet and cardiovascular and metabolic disease. Emerging studies have evaluated the association between plant-based diets and urologic conditions affecting men’s health. Objective We performed a systematic review of the literature on the potential role plant-based diets may play in the following men’s health topics: prostate cancer (PCa), erectile dysfunction (ED), and benign prostatic hyperplasia (BPH). Methods The Preferred Reporting Items for Systematic Reviews and Meta-Analyses system (PRISMA) criteria were followed to search PubMed and Medline databases for the following search terms: “Diet [Mesh]” OR “Diet Therapy [Mesh]” AND “Prostatic Hyperplasia [Mesh]” OR “Prostatic Neoplasm [Mesh]” OR “Erectile Dysfunction [Mesh]”. Articles in English published from 1989 to 2022 using human participants were analyzed. Data were summarized and bias assessment of the literature performed. Results Initial literature search yielded 345 articles. We excluded 121 articles based on title and abstracts not being pertinent to the study. The remaining 224 articles were screened for relevance resulting in 23 articles that met inclusion criteria. Ultimately, 12 PCa articles, 4 BPH articles, 5 ED articles, and 2 articles related to both BPH and ED were reviewed. Conclusions Several studies support the protective nature of plant-based diets in PCa, ED, and BPH patients. The use of plant-based diets for PCa had the greatest amount of literature supporting positive benefits, with reasonable data from large registry trials supporting the protective effects of a plant-based diet on incident prostate cancer. Strength of association between plant-based diets and condition were variable, and no studies reported a non-association or harmful effects of plant-based diets. Most trials are limited to observational and cohort studies which rely on patient-reported evaluations of diet, limiting the generalizability of most findings. Currently, there is a lack of evidence to guide urologists and men definitively toward plant-based diets for prevention and/or treatment of PCa, ED, or BPH, and thus further studies may be helpful to evaluate this relationship, particularly in the setting of a rising public consumer interest in these diets. Disclosure No

(314) An Evaluation of Race-Based Representation Among Men Participating in Clinical Trials for Prostate Cancer and Erectile Dysfunction

Abstract Introduction Inclusion of ethnic/racial minorities in clinical trials is essential to fully assess therapeutic efficacy. It is well-known that populations respond dissimilarly to interventions. This concept has been research ed thoroughly in the context of urologic oncology research, however research into the impact of demographic characteristics in andrology trials is lacking. Objective To analyze the inclusion of historically under-represented minority men in clinical trials for Erectile Dysfunction (ED) in comparison to Prostate Cancer (PC) trials. Methods We searched ClinicalTrials.gov for the disease keyword: “Erectile Dysfunction” and used “Prostate Cancer” trials for comparison. Completed trials that had available demographic data were included for analysis. Literature was reviewed to determine the prevalence of ED and PC diagnosed among Hispanic, Black, White, and Asian men. The proportion of individuals of each group that participated in trials is divided by the proportion of each group in the disease population to calculate the “Participation to Prevalence Ratio” (PPR). PPRs between 0.8-1.2 indicates adequate representation, 1.2 is over-representation. Results A total of 312 trials were assessed: 289 for prostate cancer and 23 for ED. Hispanic men comprised 11.8% of ED trial participants and 4.61% of prostate cancer trial participants, yet represented 18% of ED patients and 7.3% of PC patients. Black/African-American (AA) men accounted for 10.2% of ED trial participants and 9.4% of PC trial participants, but comprised 16% of ED patients, and 16.3% of PC patients. Hispanic and AA men are under-represented in trials for ED and Prostate Cancer (Hispanic ED PPR=0.66; Hispanic PC PPR=0.63; AA ED PPR=0.42; AA PC PPR=0.58). Conclusions Our findings show that both Hispanic and AA men are underrepresented in both ED and PC clinical trials. A greater emphasis must be placed on achieving representative enrollment in clinical trials for ED and PC in order to address this disparity and improve generalizability of the findings. Disclosure No

ANALYSIS OF HEMODIALYSIS PERIODS, AGE, AND SMOKING TOWARDS THE SEVERITY OF ERECTILE DYSFUNCTION IN PATIENTS WITH CHRONIC RENAL FAILURE ON ROUTINE HEMODIALYSIS

Objective: This study aims to analyze the factors associated such as hemodialysis periods, age, and smoking with ED severity in CKD patients undergoing routine hemodialysis. Material &amp; Methods: A single-center, cross-sectional study was conducted involving a total 101 patients who were on routine hemodialysis who diagnosed with CKD and experienced complaint in sexual function were included. The severity of ED classified based on the International Index of Erectile Function (IIEF-5). The analysis was carried out descriptively and analytically using the ordinal regression method. Results: Hemodialysis duration (p = 0.044) were significantly related to severity of erectile dysfunction in patient with CKD and on routine hemodialysis. Meanwhile, although both older age (p =0.307) and smoking (p = 0.283) showed a positive estimate, they were not statistically significant. Conclusion: The study indicate that prevalence of ED observed in CKD patient with routine hemodialysis remain high. Several factors significantly contribute in ED severity such as shorter hemodialysis duration.