Erectile Dysfunction Inventory Of Treatment Satisfaction Questionnaire Research Articles

(107) Evaluating the Impact of Prior Prostate Cancer Hormonal Therapy on Satisfaction Rates in Post Implantation of Inflatable Penile Prosthesis

Abstract Introduction Androgen deprivation therapy (ADT), a vital treatment modality for prostate cancer, effectively reduces androgens (testosterone & dihydrotestosterone) through inhibiting its production or blocking its action, thereby impeding the growth and even causing shrinkage of prostate cancer cells. It has been utilized in the treatment of early-stage, recurrent, and metastatic cases of prostate cancer. Common side effects were hot flashes, fatigue, decreased bone density, mood changes, decrease libido and sexual dysfunction. Inflatable penile prosthesis (IPP) implantation has already emerged as a highly successful treatment option, garnering significant satisfaction rates among the general population with erectile dysfunction (ED) and specifically in prostate cancer patients who underwent radical prostatectomy (RP) or radiation therapy (XRT). Nevertheless, there remains a dearth of literature examining satisfaction rates specifically in patients with hormonal therapy history post-IPP implantation Objective Our study aims to comprehensively evaluate patient satisfaction rates post IPP implantation for ED, in relation to their ADT status for prostate cancer. Methods A retrospective chart review from our institutional database was conducted to identify 529 patients who underwent IPP at our institution by a single surgeon from 2017 to 2022. Eligible patients for inclusion included those with histological confirmation of prostate cancer treated by RP or XRT with or without hormonal therapy, followed by IPP implantation for ED, and had completed the 11-item Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) validated questionnaire with data available for review. All EDITS questionnaires were administered at least 6 months from operative date or later. Eligible patients were screened for placement into one of two groups depending on their ADT status. To prevent crossover confounding; patients with history of other types of hormonal therapy for non prostate cancer patients were excluded. Results A total of 96 patients were included and categorized into group 1 (ADT, n=30) and group 2 (No ADT, n=66). All patients' demographics were summarised in Table 1. The study revealed notable results regarding the impact of ADT on post IPP satisfaction rates which exhibited a significantly lower EDITS score compared to group 2 (P= 0.034) (Figure 1). Furthermore, group 1 showed no significant changes in post IPP satisfaction with relation to type of prostate cancer treatment offered. While group 2 demonstrated a significantly higher EDITS score post IPP in RP patients compared to XRT, which aligns with the reported literature. Conclusions Our initial findings suggest that despite IPP implantation for managing erectile dysfunction, which is expected to yield high satisfaction rates compared to other available treatment options, Yet the previous or ongoing history of androgen deprivation therapy continues to influence such patients' satisfaction. These observations provide valuable insights; however, further investigation on a larger scale is essential to validate these trends. Additionally, it is crucial to offer proper counseling to these patients regarding the expected outcomes to assist them in making informed decisions regarding the management of their ED. Lastly, the routine use of validated questionnaires has demonstrated significant value in quantifying device and sexual satisfaction following IPP implantation and should be considered as an integral evaluation tool Disclosure No.

(283) Evaluating The Impact of Prior Prostate Cancer Hormonal Therapy on Satisfaction Rates in Post Implantation of Inflatable Penile Prosthesis

Abstract Introduction Androgen deprivation therapy (ADT), a vital treatment modality for prostate cancer, effectively reduces androgens (testosterone & dihydrotestosterone) through inhibiting its production or blocking its action, thereby impeding the growth and even causing shrinkage of prostate cancer cells. It has been utilized in the treatment of early-stage, recurrent, and metastatic cases of prostate cancer. Common side effects were hot flashes, fatigue, decreased bone density, mood changes, decrease libido and sexual dysfunction. Inflatable penile prosthesis (IPP) implantation has already emerged as a highly successful treatment option, garnering significant satisfaction rates among the general population with erectile dysfunction (ED) and specifically in prostate cancer patients who underwent radical prostatectomy (RP) or radiation therapy (XRT). Nevertheless, there remains a dearth of literature examining satisfaction rates specifically in patients with hormonal therapy history post-IPP implantation Objective Our study aims to comprehensively evaluate patient satisfaction rates post IPP implantation for ED, in relation to their ADT status for prostate cancer. Methods A retrospective chart review from our institutional database was conducted to identify 529 patients who underwent IPP at our institution by a single surgeon from 2017 to 2022. Eligible patients for inclusion included those with histological confirmation of prostate cancer treated by RP or XRT with or without hormonal therapy, followed by IPP implantation for ED, and had completed the 11-item Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) validated questionnaire with data available for review. All EDITS questionnaires were administered at least 6 months from operative date or later. Eligible patients were screened for placement into one of two groups depending on their ADT status. To prevent crossover confounding; patients with history of other types of hormonal therapy for non prostate cancer patients were excluded. Results A total of 96 patients were included and categorized into group 1 (ADT, n=30) and group 2 (No ADT, n=66). All patients' demographics were summarised in Table 1. The study revealed notable results regarding the impact of ADT on post IPP satisfaction rates which exhibited a significantly lower EDITS score compared to group 2 (P= 0.034) (Figure 1). Furthermore, group 1 showed no significant changes in post IPP satisfaction with relation to type of prostate cancer treatment offered. While group 2 demonstrated a significantly higher EDITS score post IPP in RP patients compared to XRT, which aligns with the reported literature. Conclusions Our initial findings suggest that despite IPP implantation for managing erectile dysfunction, which is expected to yield high satisfaction rates compared to other available treatment options, Yet the previous or ongoing history of androgen deprivation therapy continues to influence such patients' satisfaction. These observations provide valuable insights; however, further investigation on a larger scale is essential to validate these trends. Additionally, it is crucial to offer proper counseling to these patients regarding the expected outcomes to assist them in making informed decisions regarding the management of their ED. Lastly, the routine use of validated questionnaires has demonstrated significant value in quantifying device and sexual satisfaction following IPP implantation and should be considered as an integral evaluation tool. Disclosure No.

(415) Comparison of Satisfaction With Penile Prosthesis Implantation in Patients With Prostate Cancer Radiation Therapy versus Radical Prostatectomy or Radical Cystoprostatectomy

Abstract Introduction Penile Prosthesis Surgery (PPS) is a commonly used treatment for Erectile Dysfunction (ED), either as first-line therapy or in cases refractory to other treatment options. In patients with urologic malignancies, such as prostate or bladder cancer, surgical interventions like radical prostatectomy (RP) and radical cystoprostatectomy (RCP) as well as alternative treatments such as radiation therapy can all induce ED. PPS as a treatment for ED has high satisfaction rates in the general population. There is limited data available on sexual satisfaction in patients with prosthesis implantation for ED following RP/RCP versus ED following radiation therapy for prostate cancer. Objective The primary objective for our study was to determine if there is a significant difference in device and sexual satisfaction rates between patients receiving PPS for ED post-RP/RCP versus post-prostate cancer radiation therapy quantified via a validated questionnaire. Methods A retrospective chart review from our institutional database was conducted to identify 970 patients who underwent PPS at our institution from 2011 to 2021. Only patients that had Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) questionnaire data at least 6 months from implant operative date available were included. Eligible patients were screened and placed in one of two groups depending on etiology of ED- following RP/RCP or following prostate cancer radiation therapy. To prevent crossover confounding; patients with history of pelvic radiation were excluded from the RP/RCP group and patients with history of RP/RCP were excluded from the radiation group. Data was obtained from 73 patients in the RP/RCP group (RP=66, RCP=7) and 32 patients in the radiation therapy group (Extended Beam Radiation Therapy (EBRT) = 26, Brachytherapy=6). Demographics, surgical information, etiology of ED, and penile doppler results were recorded for both groups. EDITS questionnaire responses were compared between the two groups as a measurement of device and sexual satisfaction. Additional subgroup analysis was conducted between RP and RCP patients. P<0.05 was statistically significant. Results There was a significant difference in mean survey responses for all 11 questions in the EDITS questionnaire between the RP/RCP group and the radiation group. Specifically, the RP/RCP group had a significantly higher mean score in questions surveying overall satisfaction (p=0.01), level to which device has met their expectations (p=0.03), as well as confidence in engaging in sexual activity with their partner (p<0.001). Additional survey questions administered also found RP/RCP patients reported significantly higher rate of satisfaction with size of penis post-operatively versus the radiation group (p=0.01). Subgroup analysis found no difference in satisfaction (p=0.16), device expectations (p=0.37), or confidence in engaging in sexual activity (p=0.82) between the RP and RCP groups. Conclusions These preliminary findings, while requiring large-scale follow up, suggest that there is greater sexual satisfaction and penile prosthesis device satisfaction in patients undergoing IPP placement following RP/RCP versus radiation therapy for prostate cancer. Use of validated questionnaires should continue to be utilized in quantifying device and sexual satisfaction following penile prosthesis placement. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Run Wang, MD, FACS is a consultant for Boston Scientific, Coloplast, and Teleflex.

The Treatment Satisfaction in Patients and Their Partners Treated with Low-Intensity Extracorporeal Shock Wave Therapy and Sildenafil: A Prospective Non-Randomized Controlled Study.

Phosphodiesterase 5 inhibitors (PDE5Is) and other more invasive options merely provide symptomatic relief rather than a permanent improvement in erectile dysfunction (ED), whereas the long-term improvement in ED via low-intensity extracorporeal shockwave therapy (Li-ESWT) has been confirmed. So far, no comparative study of sildenafil versus Li-ESWT has been conducted with respect to treatment satisfaction. In this study, we aim to compare erectile function status and satisfaction rates in patients who received sildenafil or Li-ESWT for ED. Patients complaining of ED were considered candidates. Participants chose to enter one of two active treatment groups according to their treatment intention-either a 9-week Li-ESWT regimen or 100 mg on-demand sildenafil. The erectile function was evaluated using the erectile function domain of the International Index of Erectile Function questionnaires (IIEF-EF), while the treatment satisfaction was evaluated using the Erectile Dysfunction Inventory of Treatment Satisfaction questionnaires (EDITS). We enrolled 72 participants in the study (42 in the Li-ESWT group and 30 in the sildenafil group). Patients in both groups were young men. Four weeks after the last session, the IIEF-EF score for Li-ESWT and sildenafil was 16.3± 5.5 and 18.3± 6.5 (P >0.05), respectively. The total EDITS index of the patient version and the partner version were similar in the two groups. Among EDITS questions measuring overall satisfaction and efficacy duration, the score was higher in the Li-ESWT group. We found that Li-ESWT may have better satisfaction than on-demand sildenafil for young ED patients. However, further studies are needed to determine the factors influencing satisfaction.

Comparison of satisfaction with penile prosthesis implantation in patients with prostate cancer radiation therapy versus radical prostatectomy.

Penile prosthesis surgery (PPS) is a commonly used treatment for erectile dysfunction (ED), either as first-line therapy or in cases refractory to other treatment options. In patients with a urologic malignancy such as prostate cancer, surgical interventions like radical prostatectomy (RP) as well as non-surgical treatments such as radiation therapy can all induce ED. PPS as a treatment for ED has high satisfaction rates in the general population. Our aim was to compare sexual satisfaction in patients with prosthesis implantation for ED following RP versus ED following radiation therapy for prostate cancer. A retrospective chart review from our institutional database was conducted to identify patients who underwent PPS at our institution from 2011 to 2021. Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) questionnaire data at least 6 months from implant operative date available was required for inclusion. Eligible patients were placed in one of two groups depending on etiology of ED-following RP or prostate cancer radiation therapy. To prevent crossover confounding; patients with history of pelvic radiation were excluded from the RP group and patients with history of RP were excluded from the radiation group. Data were obtained from 51 patients in the RP group and 32 patients in the radiation therapy group. Mean EDITS scores and additional survey questions were compared between the radiation and RP groups. There was a significant difference in mean survey responses for 8 of the 11 questions in the EDITS questionnaire between the RP group and the radiation group. Additional survey questions administered also found RP patients reported significantly higher rate of satisfaction with size of penis post-operatively versus the radiation group. These preliminary findings, while requiring large-scale follow-up, suggest that there is greater sexual satisfaction and penile prosthesis device satisfaction in patients undergoing IPP placement following RP versus radiation therapy for prostate cancer. Use of validated questionnaires should continue to be utilized in quantifying device and sexual satisfaction following PPS.

Shaeer's punch technique: Trans-corporeal Peyronie's plaque surgery and penile prosthesis implantation

ABSTRACT Introduction Penile prosthesis implantation in cases of severe Peyronie's disease may require plaque excision/incision and grafting, that may require mobilization of the neurovascular bundle (NVB) or urethra, posing the risks of penile hyposensitivity or urethral injury, and is time consuming, possibly increasing infection risk. Objective Evaluating trans-corporeal debulking of Peyronie's plaques by “Shaeer's Punch Technique”. Methods Penile prosthesis implantation and Punch technique (PPI-Punch) was performed for 26 patients. Following corporotomy and dilatation, Peyronie's plaques were punched-out from within the corpora cavernosa using the punch forceps then a penile prosthesis implanted. Comparison to a matching retrospective group of 18 patients operated upon by plaque excision-grafting and penile prosthesis implantation was performed. Outcomes were in terms of straightness of the erect penis, complication, satisfaction with length on a 5-point scale , the International Index of Erectile Function-5 (IIEF), and the Erectile Dysfunction Inventory of Treatment Satisfaction questionnaire (EDITS). Results Average pre-operative curvature angle was 58.1 ± 11.7 in the Punch group and 58 ± 14.8 in the excision-grafting group, p=0.99. Following surgery, all patients had a straight penis. No tunical perforations, urethral injuries or extrusions were noted. Average additional operative time for Punch technique ranged from 5 to 10 minutes (7.3 ± 1.7), in contrast to the excision-grafting group where plaque surgery duration was 50.8 minutes ± 11.1, an 85% difference, p < 0.0001. Septal plaques in the latter group could not be removed. In the PPI-Punch group, penile sensitivity was preserved in all patients, compared to the excision/grafting group with 7/18 patients reporting hyposthesia of the glans. Infection occurred in 1/26 patients in the PPI-Puch group, compared to 2/18 patients in the excision/grafting group. Satisfaction with length on a 5-point scale was 3.8 ± 0.9 in the punch group, versus 3.1 ± 1.1 in the excision-grafting group, p=0.009.. Conclusions Shaeer's Punch Technique is a minimally invasive procedure for trans-corporeal excavation of Peyronie's plaques prior to penile prosthesis implantation. There is no need for mobilization of the neurovascular bundle or spongiosum, hence low or no risk for nerve or urethral injury and brief plaque surgery time. Disclosure Work supported by industry: no. A consultant, employee (part time or full time) or shareholder is among the authors (Coloplast, BSC, Rigicon).

Does knowing pre-operative penile length influence patient satisfaction post penile prosthesis surgery

ABSTRACT Introduction Patients may undergo penile prosthesis surgery (PPS) as a treatment option for erectile dysfunction (ED). Those who undergo PPS commonly complain of penile shortening after implantation. Furthermore, previous research has shown a decrease in penile length following inflatable penile prosthesis surgery compared to intracavernosal injection at 12 months. Objective Therefore, we conducted a prospective, multicenter cohort study to determine whether knowledge of pre-operative penile length measurement influences post-operative treatment satisfaction and satisfaction with penile length. Methods The cohort included a total of 102 patients undergoing PPS from August 2017 to December 2019. Study group participants underwent pre-operative penile length measurement (n=49) while the control group (n=53) did not undergo pre-operative measurement. Intra-operative and 6-week post-operative penile length measurements were later obtained in both groups. Six months post-operatively, patients were asked to complete the validated 14 item Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) questionnaire to assess both overall treatment satisfaction and satisfaction with penile length. Chi-square analysis was performed to determine whether a difference in satisfaction existed between the two groups. Results We observed high patient satisfaction scores in both groups when using the EDITS questionnaire. Mean scores for overall treatment satisfaction were 3.57 and 3.53 (on a scale from 0 to 4) in the study and control group respectively. Mean scores for satisfaction with penile length were 4.08 and 4.11 (on a scale from 1 to 5) in the study and control group. There was no difference in overall satisfaction of treatment between those who knew their pre-operative length and those who did not (p=0.483). We also found no difference in satisfaction of post-operative penile size between both groups (p=0.645). Moreover, 59% of the combined cohort believed their overall sexual satisfaction was affected by penile length, with no difference between both groups (p=0.463). We observed no significant decrease in mean penile length from pre-surgical intraoperative measurement to 6-week post-operative measurement (0.42 cm and 0.21 cm in study and control group, respectively) with no statistical difference between groups (p=0.251). Conclusions The study suggests that knowledge of pre-operative penile length does not influence 6-month post-operative satisfaction in patients who have PPS. Therefore, performing pre-operative measurement in clinic solely for the purpose of informing the patient may be unnecessary. Current interventions aimed at conserving penile length may be effective at maintaining patients’ satisfaction with their penile length. The effects of other factors such as partner satisfaction, sex therapy, time after PPS, and the use of malleable versus inflatable penile prosthetic should be investigated in future studies. Disclosure Work supported by industry: no.

Comparing patient satisfaction in penile prosthesis surgery after radical prostatectomy versus the general population.

ABSTRACT Introduction Penile prosthesis surgery (PPS) is currently a widely used treatment option for ED. Men who receive PPS following radical prostatectomy (RP) are generally satisfied with the outcome. Objective This study seeks to examine patient satisfaction with PPS and to determine if a difference in satisfaction exists in post-prostatectomy ED patients versus the general population. We hypothesize that the etiology of ED does not affect patient satisfaction following PPS. Methods 164 patients who received PPS at our institution from August 2017 to December 2019 were given a validated 14 item questionnaire, Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS), to assess their satisfaction with PPS. 102 patients responded at 6 months following surgery and were enrolled in this study. These patients’ charts were retrospectively reviewed for demographic information and information regarding the etiology of their ED. Patients were then assigned to one of two groups: patients with post-prostatectomy ED (study) and all other etiologies (control). We found no significant difference in age or race between the two groups. Patients in the study group were further assigned to a subgroup based on the specific procedure they had received: radical prostatectomy (RP) or radical cystoprostatectomy (RCP). Results Responses to three questions were analyzed: overall satisfaction, whether the procedure met expectations in the past four weeks, and confidence in ability to participate in sexual activity. Chi-square analysis was performed to determine the difference in the distribution of response rates. There was no difference in reported overall satisfaction (p=0.96), expectations (p=0.78), or confidence (p=0.78) between post-prostatectomy patients and all other etiologies of ED. On subgroup analysis, there was no difference in reported overall satisfaction (p=0.47) or confidence (p=0.080) between patients with RP compared to patients with RCP. RP and RCP patients differed in whether the PPS met expectations (p=0.033). ‘RP patients reported a mean of 3.5/4 compared to CRP patients who reported an average value of 3.0/4. Conclusions Our analysis suggests that the distribution of responses to the EDITS questionnaire are not significantly different between patients whose etiology of ED is post-prostatectomy compared to all other etiologies. Overall satisfaction, whether the treatment meets expectations, and confidence in the ability to participate in sexual relations are not significantly different between these patients. Disclosure Work supported by industry: no.

293 Satisfaction with Inflatable Penile Prosthesis in Patients with History of ischemic Priapism

Prolonged episodes of ischemic priapism result in significant corporal fibrosis and ultimate loss of erectile function. Implantation of penile prosthesis is a well-established treatment for erectile dysfunction (ED) related to priapism. However, questions regarding optimal device choice and timing of the surgery remain incompletely answered. This report presents surgical and patient-reported outcomes following inflatable penile prosthesis (IPP) implantation in patients with prior history of ischemic priapism. Consecutive records of patients who underwent IPP implantation at our institution between May 2007 and January 2018 were queried retrospectively. Medical records of patients with a history of ischemic priapism who underwent IPP implantation were evaluated. Patient demographics, pre-operative workup, intra-operative maneuvers and post-operative follow-up data were analyzed with use of standard statistics. Patient satisfaction was assessed using a phone-administered EDITS (Erectile Dysfunction Inventory of Treatment Satisfaction) questionnaire. Records of nineteen men were identified. Average patient age was 41 years (range: 21-86yo) and twelve men (63.2%) were African-American. Six men had history of sickle cell disease. Two out of nineteen men underwent an immediate prosthesis implantation. Thirteen men had significant intra-cavernosal fibrosis and required complex reconstructive maneuvers. Only one patient (in the immediate IPP group) necessitated prosthesis removal due to infection. Five out of seventeen (29%) living patients responded to the EDITS questionnaire. Four out of the five patients were overall very satisfied with the treatment while one was very dissatisfied. This was further confirmed with the mean EDITS index score of 67.3, ranging from 6.8 to 100 (indicating extremely low and extremely high treatment satisfaction, respectively).

159 Preliminary study of a specific penile prosthesis conceived for phalloplasty, the ZSI® 475 FtM

Assessing security, feasibility and patient satisfaction of a new type of penile prosthesis specifically designed for phalloplasty. Patients were included from June 2016 to September 2017 at a single institution by a single surgeon. Medical data were collected from the patients’ hospital files. Patients were then proposed to answer a satisfaction questionnaire that included IIEF (International Index of Erectile Function) questionnaire, EDITS (Erectile Dysfunction Inventory of Treatment Satisfaction) questionnaire, SEAR (Self-Esteem and Relationship) questionnaire, and specific items. Twenty patients were included, mean age 37.9 years, and 21 prostheses were implanted. All had gender dysphoria and phalloplasty type were forearm flap (n=15, 75%), suprapubic (n=4, 20%) and pedicled inguinal (n=1, 5%). 17 patients (85%) had functional urethroplasty. Complications were 2 (10%) infections medically treated, 1 (5%) infection treated by explantation, 2 (10%) mechanical failures and 1 (5%) malposition. Mean operating time was 102.6 min (SD 13.2) and mean duration of hospitalization was 2.7 days (SD 0.5%). Fourteen patients (70%) answered the satisfaction questionnaire. Twelve (85.7%) patients had sexual relationship regularly. Mean IIEF was 20.2 over 25 (SD 7.9), mean SEAR was 84.5 over 100 (SD 9.9) and mean EDITS was 82 over 100 (SD 17.5). Thirteen patients (92.8%) were satisfied or very satisfied with the prosthesis.

Satisfaction with the semirigid penile prosthesis among couples from a Semiurban Indian population

Introduction: Insertion of penile prosthesis for treatment of irreversible erectile dysfunction (ED) is a common and well-established treatment in the western countries. Even in the times of the newly available oral medications, penile prostheses continue to have such a nonoptional place in the management of severe ED. In this study, we have assessed the satisfaction among semiurban Indian couples following insertion of the semirigid penile prosthesis. Materials and Methods: Between January 2000 and December 2015, 78 men with ED underwent semirigid penile prosthesis implantation (PPI) at our hospital. The satisfaction of patients and partners was evaluated using the ED Inventory of Treatment Satisfaction (EDITS) questionnaire and EDITS partner survey. Results: The mean age of the patients was 44.84 ± 7.30 years. The mean duration of time with ED in the preimplantation period was 38.69 ± 12.44 months. The satisfaction of patients and partners as assessed by EDITS questionnaire and EDITS partner survey was 80.66 ± 4.49 and 75.66 ± 6.57, respectively, at 12 months after surgery and 71.73 ± 8.10 and 65.6 ± 6.49, respectively, at 24 months after surgery. Conclusions: This study showed a high degree of satisfaction among patients as well as their partners with semirigid PPI. More than 80% of the men reported being very satisfied with their penile implantation surgery.

Long-term patient-reported satisfaction with different inflatable penile prosthesis: Comparison between AMS 700CX and Coloplast Titan

IntroductionErectile dysfunction (ED) is one of the most prevalent male sexual disorders worldwide. When conservative treatment is unsuccessful, contraindicated or causes unacceptable side effects penile prosthesis implantation is a definitive option for the management of ED. Although considered a third-line therapy, it achieves the highest satisfaction rates as compared with non-surgical treatment. Three-piece inflatable penile prothesis (IPP) represents the most sophisticated implantable device, AMS 700CX™ and Coloplast Titan® being the two most commonly used. Although there are several studies evaluating patient satisfaction with either model, there is little published data comparing both models. MethodsWe have compared overall patient satisfaction in 55 patients submitted to either 700CX™ or Titan® implantation. The Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) questionnaire was used to access patient satisfaction. ResultsPatient mean age and follow-up time were 59.1 years and 57.9 months respectively. There was no difference in EDITS score between 700CX™ and Titan® IPP (77.2±12.1 versus 77.5±16.6 respectively, p=0.956). ConclusionOverall patient satisfaction as assessed by EDITS questionnaire was not different between 700CX™ and Titan®.

Quantifying Barriers to Improvement of Treatment Satisfaction in Men With Erectile Dysfunction: Use of Person-Item Maps

IntroductionPatient-reported outcomes are a valuable tool used to gauge treatment satisfaction in different conditions, including erectile dysfunction (ED). AimTo use person-item maps to quantify barriers to improvement of treatment satisfaction in men with ED. MethodsMen 18 to 65 years old with documented ED received sildenafil 50 mg, sildenafil 100 mg, or placebo for 8 weeks in a double-blinded manner. Post hoc analyses were conducted on Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) data (11 items rating treatment satisfaction; each item score range = 0–4). Main Outcome MeasuresPerson-item maps were developed based on Rasch models. To quantify barriers to improvement of treatment satisfaction, responses to the 11 items of the EDITS questionnaire were dichotomized to indicate improvement (responses of 3 or 4 were combined to a score of 1) vs no change or worsening (responses of 0, 1, or 2 were combined to a score of 0). ResultsAnalyses were conducted using data from 278 men who completed the EDITS questionnaire at the end of double-blinded treatment. The person-item map indicated that EDITS item 4 (ease of use of treatment) was the easiest barrier to overcome, whereas the most difficult barrier to improvement of treatment satisfaction was EDITS item 2 (degree to which treatment met expectations). Most men in the sildenafil 100-mg group endorsed most EDITS items, consistent with substantial improvement. The sildenafil 50-mg group was similar, but with smaller frequencies for endorsing improvement of the more difficult EDITS items. In contrast, men receiving placebo endorsed mainly the easiest EDITS items, with only a small number of men endorsing the difficult items. ConclusionA person-item map is a useful means for quantifying barriers to improvement of treatment satisfaction represented by EDITS items in patients with ED.

Clinical Evaluation of Outcomes of Penile Prosthesis Implantation and Partner Satisfaction

Objective: We aimed to compare the outcomes of malleable and inflatable penile prosthesis implantations and partner satisfaction. Materials and Methods: Data of 34 patients who underwent penile prosthesis implantation in two centers between September 2009 and March 2013 were retrospectively analyzed. Types of prosthesis and complication rates were compared. A telephone interview was performed to assess the satisfaction rates of patients and their partners by EDITS (Erectile Dysfunction Inventory of Treatment Satisfaction) questionnaire. Results: The mean age was 56.16±14.49 years for Group 1 and 58.13±10.41 years for Group 2. The mean follow-up dura- tions for Groups 1 and 2 were 29.39±9.38 and 24.13±10.27 months, respectively. The mean hospital stay was 3.56±2.85 and 3.38±2.27 days for Groups 1 and 2, respectively. No significant difference was observed in terms of age, hospital stay, and follow-up duration between groups. Satisfaction questions were similar between the two groups. Patients using the malleable device found it easier to use (p<0.05). Conclusion: Using EDITS, we found that it was easier to use the malleable devices, but both patients and their partners had equal satisfaction rates. Randomized controlled trials addressing bigger populations should be conducted to support our findings.

Distal Penile Shaft Reconstruction and Reinforcement: The “Double-Windsocks” Technique

The management of penile prosthesis protrusion and the implantation of a prosthesis in fibrotic penile corporal bodies represents a challenging task even for experienced surgeons. To demonstrate the long-term efficacy and safety of a new technique for distal shaft reconstruction and reinforcement in cases of penile prosthesis protrusion or cases of penile prosthesis implantation in corporal fibrosis. Between August 2007 and August 2012, 69 patients underwent surgery for penile prosthesis protrusion (45 patients) or severe distal corporal fibrosis (24 patients). The mean age at the time of surgery was 56 years (range 38-69). All patients underwent distal shaft reconstruction using our technique, involving the creation of two neocorpora ("double windsocks"). Functional outcome and patient satisfaction were evaluated with item numbers 1 and 7 of the Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) questionnaire. Furthermore, clinical data concerning the early postoperative outcome were analyzed retrospectively. Mean follow-up time was 22.5 months (range 6-48). Based on answers to EDITS questionnaire item 1, 42 patients (60.9%) were very satisfied and 19 patients (27.5%) were somewhat satisfied with the outcome of the procedure. Furthermore, answers to the self-confidence domain question (EDITS item 7) revealed that 63 patients (91.3%) felt that the treatment had a positive effect with respect to their ability to engage in sexual activity. No patient exhibited device extrusion, postoperative infection, or skin dehiscence, and glans sensation as well as orgasmic ability were also preserved in all cases. Neuropraxia was reported in five cases (3.4%) immediately after the operation. The recovery of orgasmic ability was delayed in 17 (24.6%) patients. All patients were able to perform sexual intercourse postoperatively. The "double-windsocks" technique is an effective option for difficult cases of distal penile shaft reconstruction and reinforcement.

Long term patient satisfaction and quality of life with AMS700CX inflatable penile prosthesis

Penile prosthesis implantation is the solution of choice in patients who have failed or present contraindication to the use of all conservative treatment for erectile dysfunction (ED). Overall, satisfaction rates are high, with more than 80% of patients and partners fully satisfied with cosmetic and functional result of surgery. Chronic postoperative pain, penile shortening, soft or hyposensitive glans, pencil like penis syndrome and difficulty to cycle the device represent the most common causes of patient's dissatisfaction. Satisfaction rates are better assessed with the use of validated questionnaires such as the International Index of Erectile Function (IIEF) and the Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) The aim of our study was to analyze the long-term mechanical reliability of the AMS 700CX/CXM inflatable penile prosthesis and the patient's satisfaction rate using IIEF and EDITS questionnaire as standard reference. A retrospective case notes review of all patients who have undergone implantation of a three pieces inflatable penile prosthesis AMS 700 CX and CXR between October 1997 and December 2010. Overall, 80 patients have undergone implantation of 3 pieces inflatable penile prosthesis AMS 700 CX InhibiZone. Patients have been administered the IIEF-5 and EDITS questionnaires in combination with a non validated 9 domain questionnaire that assesses penile rigidity, sensation, orgasmic function, frequency of intercourse, impact of surgery on the quality of life, satisfaction rate. Overall 10 years survival estimate according to the Kaplan Meier method of AMS 700 CX touch pump and AMS 700 CX momentary squeeze pump are respectively 77.6% and 82.5%. The median postoperative IIEF5 and EDITS score were respectively 21.46 and 73.11, which show a high level of satisfaction. 59 patients (90.8%) were able to cycle the device and were engaging in penetrative sexual intercourse. Penile prosthesis implantation yields excellent results in terms of cosmetic and functional outcome and therefore has a significant impact on patients' satisfaction, sex life and overall quality of life. Overall, long term reliability has been significantly improved and complication rates are low in the hands of experienced surgeons.

Satisfaction and complications with the Titan® one-touch release penile implant

Objective. The aim of this study was to assess complication rates and patient satisfaction with Coloplast Titan® one-touch release (OTR) inflatable penile implants inserted at one university hospital centre between November 2008 and April 2011. Material and methods. Overall, 33 patients with organic erectile dysfunction underwent penile implant surgery during the study period. The Titan OTR inflatable penile implants were inserted using a penoscrotal approach. Patient and partner satisfaction was assessed with the Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) questionnaire. Results. One implant was removed because of infection, and three patients underwent revision surgery due to problems with autoinflation, deflation, and a displaced reservoir, respectively. In all cases the problems were solved and the implants were salvaged. Further complications included one patient with haematoma and sustained scrotal pain, one patient with meatal stenosis, and four patients with infections not related to the implant. In total, 30 EDITS questionnaires were administered and 26 (87%) were completed. Twenty-two patients (85%) reported being satisfied with the implant and two (8%) were dissatisfied. Twenty-four patients (92%) would recommend a penile implant to someone with a similar medical condition. Eighteen patients (72%) believed that their partner was satisfied with the implant. Nineteen patients (76%) felt that the process of achieving an erection with the implant was natural. Conclusion. Although it is important to inform patients about potential problems such as infection, pain and mechanical failure, the results show that inflatable penile implants are a good treatment choice for erectile dysfunction when conservative measures have failed.

A randomized, double‐blind, crossover, placebo‐controlled comparative clinical trial of arginine aspartate plus adenosine monophosphate for the intermittent treatment of male erectile dysfunction

Efficacy and safety of l-arginine aspartate 8 g combined with 200 mg of adenosine monophosphate (AA) with placebo (PL) alone for intermittent treatment of mild-to-moderate erectile dysfunction (ED) were compared. The study design was a double-blind, PL-controlled, two-way crossover randomized clinical trial with 26 patients. Efficacy was assessed by International Index of Erectile Function (IIEF) and two additional validated questionnaires [the Erection Hardness Score (EHS) and the Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS). During each crossover period, separated by a 2-week wash-out period, drugs were administered orally, 1-2 h before sexual intercourse. Primary endpoint was a change in the IIEF. Secondary endpoints were patient and investigator assessments of treatment success. Investigators' and patients' assessment of efficacy was significantly improved by the combination vs. PL (p = 0.01 and p = 0.04 respectively]. EHS and EDITS questionnaires were both improved by the combination (p = 0.015 and p = 0.017 respectively). There was no significant difference in terms of tolerance between AA and PL or severe adverse events. ED patients demonstrated significant improvements in all IIEF domains with the exception of the Sexual Desire and Orgasmic Domains when treated with AA compared with PL. This pilot phase II study showed that the on-demand oral administration at a high dosage of l-arginine aspartate-adenosine monophosphate combination may be effective in patients with mild-to-moderate ED, is very well tolerated and could be tested as a safe first-line therapy in a larger size phase III study.

Aspects of Sexual Satisfaction in Men with Erectile Dysfunction: A Factor Analytic and Logistic Regression Approach

ABSTRACT Introduction The International Index of Erectile Function (IIEF), Sexual Encounter Profile (SEP), and Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) assess efficacy of phosphodiesterase type 5 (PDE5) inhibitor treatment of erectile dysfunction (ED). Aims To determine the degree that multiplicity of satisfaction questions in ED treatment evaluation instruments are congruent, to better understand the concept of sexual “satisfaction,” and to identify factors that correlate with improvement. Methods Questionnaire data from 4,174 placebo- or tadalafil-treated patients with ED were analyzed. Principal component analysis (PCA) was performed on IIEF and SEP satisfaction questions. Spearman correlation coefficients were determined. Data from 431 of the 4,174 patients who completed EDITS questionnaires were analyzed. Logistic regression was used to investigate improvement of each IIEF satisfaction question. Results PCA rotated on three factors explained 91% of total variance and separated IIEF Q6 (intercourse frequency) from a SEP and a remaining IIEF factor. All correlations between and among questions were close (ρ = 0.62–0.98; P &amp;lt; 0.0001), except for those with IIEF Q6 (ρ = 0.28–0.34; P &amp;lt; 0.0001). In a sub-sample, PCA of five IIEF, two SEP, and three EDITS questions identified four factors that explained 90% of all variance: EDITS questions, IIEF questions except Q6, SEP questions, and IIEF Q6. Greater improvement in IIEF-EF domain score was consistently and positively associated with satisfaction measures (P &amp;lt; 0.0001). Conclusions Factor analysis detected close relationships among satisfaction questions in IIEF, SEP, and EDITS instruments, each of which, apart from IIEF Q6 (intercourse frequency), appeared to be an independent measure of satisfaction. Cultural differences may explain different satisfaction correlations with baseline ED severity in different regions. Clinicians may make use of the correlation between intercourse frequency (Q6) and satisfaction when prescribing a PDE5 inhibitor for ED, by explaining that the inhibitor should enable more frequent intercourse.

2008 CUMULATIVE INDEX: Author Index

The International Index of Erectile Function (IIEF), Sexual Encounter Profile (SEP), and Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) assess efficacy of phosphodiesterase type 5 (PDE5) inhibitor treatment of erectile dysfunction (ED). To determine the degree that multiplicity of satisfaction questions in ED treatment evaluation instruments are congruent, to better understand the concept of sexual "satisfaction," and to identify factors that correlate with improvement. Questionnaire data from 4,174 placebo- or tadalafil-treated patients with ED were analyzed. Principal component analysis (PCA) was performed on IIEF and SEP satisfaction questions. Spearman correlation coefficients were determined. Data from 431 of the 4,174 patients who completed EDITS questionnaires were analyzed. Logistic regression was used to investigate improvement of each IIEF satisfaction question. PCA rotated on three factors explained 91% of total variance and separated IIEF Q6 (intercourse frequency) from a SEP and a remaining IIEF factor. All correlations between and among questions were close (rho = 0.62-0.98; P < 0.0001), except for those with IIEF Q6 (rho = 0.28-0.34; P < 0.0001). In a sub-sample, PCA of five IIEF, two SEP, and three EDITS questions identified four factors that explained 90% of all variance: EDITS questions, IIEF questions except Q6, SEP questions, and IIEF Q6. Greater improvement in IIEF-EF domain score was consistently and positively associated with satisfaction measures (P < 0.0001). Factor analysis detected close relationships among satisfaction questions in IIEF, SEP, and EDITS instruments, each of which, apart from IIEF Q6 (intercourse frequency), appeared to be an independent measure of satisfaction. Cultural differences may explain different satisfaction correlations with baseline ED severity in different regions. Clinicians may make use of the correlation between intercourse frequency (Q6) and satisfaction when prescribing a PDE5 inhibitor for ED, by explaining that the inhibitor should enable more frequent intercourse.