Erectile Dysfunction Inventory Of Treatment Satisfaction Research Articles

Is low-intensity shockwave therapy for erectile dysfunction a durable treatment option?-long-term outcomes of a randomized sham-controlled trial.

Low-intensity shockwave therapy (LiSWT) is an emerging non-invasive and restorative therapy for erectile dysfunction (ED) with demonstrated efficacy and few adverse events. Although LiSWT has been shown to improve erectile function amongst men with ED, few studies have examined its long-term durability. We present the long-term results of a randomized controlled trial (RCT) assessing erectile function after LiSWT. A total of 30 patients with baseline ED seen at the University of Virginia were randomized to LiSWT or sham treatment. Patients in the sham group crossed over at 1 month and were unblinded. After initial trial completion, patients enrolled in the long-term outcome study were considered one combined cohort. Patients were treated twice weekly for 3 consecutive weeks with a Storz® Duolith™ device delivering 3,000 shockwaves at 0.1 mJ/mm2 to the distal penis, the base of the penis, and the crura. Primary outcomes were changes in Sexual Health Inventory for Men (SHIM) and Erection Hardness Score (EHS) from baseline (3 months pre-treatment) up to 36 months post-treatment. Changes in SHIM and EHS scores were evaluated using linear mixed effects models. Patient satisfaction was assessed with the Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) index. The mean baseline SHIM score was 10.8±0.94. At 12-, 24-, and 36-month assessment following treatment, the mean SHIM scores were 15.6±1.27 (P<0.001), 15.0±1.14 (P<0.001), and 12.2±1.43 (P=0.31). The mean baseline EHS score was 1.87±0.17. At 12-, 24-, and 36-month assessment following treatment, the mean EHSs were 2.70±0.24 (P<0.001), 2.66±0.21 (P<0.001), and 2.29±0.26 (P=0.10). The median [interquartile range (IQR)] EDITS score was 48.9 (22.7, 74.4), indicating moderate satisfaction with LiSWT. There were no adverse events recorded. Our analysis demonstrates sustained long-term improvement in erectile function after LiSWT for a heterogeneous cohort. While limited by population size, the results suggest durable improvement in erectile function for the first 2 years with a peak treatment effect at 1 year. Treatment effect appears to decline between 2 and 3 years. ClinicalTrials.gov, NCT04434352.

(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 &amp; 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.

(144) The Use of Virtual Reality Systematic Desensitization for the Treatment of Psychogenic Erectile Dysfunction: A Pilot Study

Abstract Introduction Erectile dysfunction (ED) is a sexual dysfunction that affects the sexual health of millions of men around the world. In recent years, the evidence indicates an increase in cases of ED among individuals under 40 years old. In most cases, the etiology is of psychogenic origin. Cognitive-behavioral therapy (CBT) has been proven effective and remains one of the most widely used treatments for ED in these cases although controlled studies are lacking. One of the most effective CBT techniques is a set of activities performed by a couple, known as systematic desensitization (SD). SD involves gradually exposing the patient to feared intimacy-related activities with their partner. However, many patients do not have a stable partner or do not want their partner to participate in the treatment. Technological advances are helping to create virtual SD programs which are able to reproduce the sights, sounds, and other sensations of the feared situation. Objective Our goal is to determine the potential usefulness of a new virtual reality-based SD program for the treatment of psychogenic ED (pED). Methods Six sexually active men diagnosed with pED based on criteria for Erectile Disorder from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) completed virtual SD over 8 weeks. The program consisted of one educational session and five different virtual reality audio exercises which were completed at home using a masturbation aid device called Myhixel ED01, that is connected to a smartphone. The five-item Spanish version of the International Index of Erectile Function (IIEF-5) questionnaire was used to assess symptoms before and after the treatment and the Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) questionnaire was used for evaluating satisfaction with treatment. Results Patients enrolled had a mean age of 34.83 years (range 27–39) and experienced an improvement in erectile function, mean IIEF-5 score pretreatment was 11(range 9–13) mean posttreatment IIEF score was 18 (range 14–21). The mean EDITS index score at the end of the treatment was 64.70 (range 59–70.25). No adverse effects were reported during the treatment. Conclusions This case series suggests that the use of a virtual reality-based SD could be a potentially effective and safe therapeutic option for men with pED. This new treatment would facilitate greater access of men with pED to one of the most commonly used strategies of sexual therapy, as it would no longer require the participation of a partner. Studies with adequate sample sizes, control groups, randomization, and follow-up are needed to determine the effectiveness of this new treatment. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: NEW WELLNESS CONCEPT SL.

(099) A Preliminary Investigation on the Incidence of Complications and Patient Contentment Following the Surgical Implantation of Inflatable Penile Prosthesis After Salvage Radical Prostatectomy

Abstract Introduction Erectile dysfunction (ED) is a common complication post salvage radical prostatectomy (RP). Yet, there is scant data in the literature on complication rates and patient satisfaction in those that undergo inflatable penile prosthesis (IPP) insertion post salvage radical prostatectomy (RP) following targeted radiotherapy for treatment of localized prostate cancer. It is understood that these patients have a higher rate of complications as they have experienced both radiation and prostatectomy adverse events which could alter their overall satisfaction after prosthetic surgeries. Objective Our aim is to conduct a preliminary analysis of IPP complication rates and satisfaction rates in patients that had 3-piece IPP implantation following salvage radical prostatectomy. Methods A retrospective chart review from our institutional database was done from 2018 to 2021. The inclusion criteria were patients that had an inserted 3-piece IPP and a history of salvage RP following radiation therapy. Only patients that participated Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) questionnaire at least 6 months from implant date were included. Data on satisfaction, IPP infection rates, mechanical failure rates, and overall complications was also collected. Complications include hematoma, erosion, reservoir hernia. Results A total of 22 patients were included in the study. The median age (IQR) is 65 (64–67) years and the median time (IQR) from RP to IPP insertion is 23 (11–49) months. All patients were approached in a penoscrotal manner with submuscular placement of reservoir (Table 1). The satisfaction rate was high at 91.8% on follow up. Overall complications rate was observed in 2 patients. One patient had a mechanical pump failure at 37.9 months while another patient had signs and symptoms of scrotal wall infection at 15 months. Both devices were easily replaced with no post op complication and remained functional on further follow up. Conclusions In patients that underwent salvage prostatectomy IPP insertion, they reported high satisfaction rates and low complication rates despite the exposure to both prostate cancer treatments adverse events. Further research is needed to confirm the results obtained and to investigate the underlying causes for the observed outcomes. The scientific process is iterative, and the answers obtained from one study often lead to more questions and the need for additional investigations. Disclosure No.

(161) Is there a Difference in Inflatable Penile Prosthesis Mechanical Failure and Infections Rates in Relation to Prostate Cancer Treatment Modality (Radiation Therapy vs Radical Prostatectomy)

Abstract Introduction Inflatable Penile Prosthesis (IPP) implantation as a treatment for ED has high satisfaction rates in the general population; however, there is limited literature on quantification of complication rates as stratified by ED etiology. Objective Our aim was to compare mechanical failure and infection rates in patients undergoing IPP implantation for ED following Radical Prostatectomy (RP) versus radiation therapy (RT) for prostate cancer. Methods A retrospective chart review from our institutional database was conducted to identify 405 patients who underwent IPP placement at our institution from 2015–2019, then selecting for those whose etiology of ED was following RP or RT. To prevent crossover confounding; patients with history of pelvic radiation or salvage radiotherapy were excluded from the RP group and patients with history of RP were excluded from the RT group. Data was obtained from 75 patients who met criteria for inclusion: 44 patients in the RP group and 31 patients in the RT group. Mechanical failure, infection rates, mean EDITS scores and additional survey questions were compared between the radiation and RP groups. Results Patient demographic information and IPP complication and satisfaction rates are listed below in Table 1 and Figure 1. There was a statistically significant difference in number of patients experiencing IPP complications, 19.4% (n=6) of patients in the RT cohort and 4.5% (n=2) in the RP cohort, respectively. There was no statistically significant difference found in stratified complications- infection rates, device erosion rates, mechanical failure rates, or device removal and/or replacement rates between the two groups. The RP cohort had a significantly higher mean Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) questionnaire score versus the RT cohort, 91.58 to 76.02, respectively. Conclusions These preliminary findings, while requiring large-scale follow up, suggest that there is a higher rate of IPP related complications in patients with device placement following RT for prostate cancer versus RP. Disclosure No.

(195) Penile Implants: Restoring Erectile Function Regardless of Age. A Mini–Case Series

Abstract Introduction Given the overall aging of the population, erectile dysfunction has become an increasingly relevant issue among the elderly. When elective surgery is offered, the patient's age is often taken into consideration as a potential limiting factor. Moreover, the importance of addressing the quality of life and sexual satisfaction of older men tends to be overlooked in the management of erectile dysfunction. Objective The aim of this study is to investigate the safety of implanting penile prostheses (PP) in patients aged 90 years and older, as well as the potential complications associated with this age group. Methods The database of patients was screened between the years 2003 and 2023, to identify patients at least 90 years and older who underwent the implantation of penile prosthesis by a single surgeon at two large volume centers. We collected demographic information for the patients, including their past medical and surgical history, medication list, anesthesia perioperative assessment and recommendations, details of the surgical procedure, intraoperative and postoperative recovery period, as well as clinic follow-up. Results Between 2003 and 2023, a total of 2000 men underwent PP surgery at the two centers. Out of the total number of patients, only two were 90 years or older at the time of implantation. One patient was a first timer, while the other had two previous PP surgeries over the span of 15 years for mechanical failure reasons. Both surgeries were performed using different device types, without any intraoperative or postoperative complications. At their three and six months follow up visits, both patients demonstrated the ability to cycle the implant smoothly, reported satisfactory penetrative intercourse with their partners, and improved sexual intimacy through Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) questionnaire. They were followed for a total of 1 year with no long-term negative effects. Conclusions Despite reporting only two cases in this specific cohort, it demonstrates that implantation of PP is a safe and effective treatment for elderly men with ED. Maintaining satisfactory sexual activity in this age group is vital and achievable through inflatable penile prosthesis (IPP) insertion. There are several complex factors that must be considered prior to operating on an older patient due to medical comorbidities and age. However, with proper patient selection, pre-operative counseling and optimization, this operation can be effectively performed in patients who are at least 90 years old. Simply, age is not a limitation to undergo penile implant. 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 &amp; 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.

(284) A Preliminary Investigation on the Incidence of Complications and Patient Contentment Following the Surgical Implantation of Inflatable Penile Prosthesis After Salvage Radical Prostatectomy

Abstract Introduction Erectile dysfunction (ED) is a common complication post salvage radical prostatectomy (RP). Yet, there is scant data in the literature on complication rates and patient satisfaction in those that undergo inflatable penile prosthesis (IPP) insertion post salvage radical prostatectomy (RP) following targeted radiotherapy for treatment of localized prostate cancer. It is understood that these patients have a higher rate of complications as they have experienced both radiation and prostatectomy adverse events which could alter their overall satisfaction after prosthetic surgeries. Objective Our aim is to conduct a preliminary analysis of IPP complication rates and satisfaction rate in patients that had 3-piece IPP implantation following salvage radical prostatectomy. Methods A retrospective chart review from our institutional database was done from 2018 to 2021. The inclusion criteria were patients that had an inserted 3-piece IPP and a history of salvage RP following radiation therapy. Only patients that participated Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) questionnaire at least 6 months from implant date were included. Data on satisfaction, IPP infection rates, mechanical failure rates, and overall complications was also collected. Complications include hematoma, erosion, reservoir hernia. Results A total of 22 patients were included in the study. The median age (IQR) is 65 (64-67) years and the median time (IQR) from RP to IPP insertion is 23 (11-49) months. All patients were approached in a penoscrotal manner with submuscular placement of reservoir (Table 1). The satisfaction rate was high at 91.8% on follow up. Overall complications rate was observed in 2 patients. One patient had a mechanical pump failure at 37.9 months while another patient had signs and symptoms of scrotal wall infection at 15 months. Both devices were easily replaced with no post op complication and remained functional on further follow up. Conclusions In patients that underwent salvage prostatectomy IPP insertion, they reported high satisfaction rates and low complication rates despite the exposure to both prostate cancer treatments adverse events. Further research is needed to confirm the results obtained and to investigate the underlying causes for the observed outcomes. The scientific process is iterative, and the answers obtained from one study often lead to more questions and the need for additional investigations. Disclosure No.

(366) Potential Effectiveness of Focused Vibration Treatment for Psychogenic Erectile Dysfunction: A Case Series

Abstract Introduction The current non-pharmacological treatment of psychogenic erectile dysfunction (pED) is based on cognitive-behavioral interventions that often involve the participation of the partner, such as desensitization procedures, sensory focusing, and couples counseling. However, it is important to note that in many cases, patients may not have a stable partner or their partner cannot participate in the treatment. The application of local mechanical vibration has shown promising results in increasing skin blood flow and nitric oxide production in healthy young adults. The relaxation of smooth muscle in the penis initiates and maintains an erection. The local release of nitric oxide from autonomic dilator nerves and vascular endothelium is crucial in initiating and sustaining this process. Technological advances have allowed the design of vibrating devices that men can use during sexual encounters. Objective To determine if the on-demand use of a focused vibration device can increase blood flow and promote relaxation of erectile tissue to improve erectile function in patients with pED. Methods Seven sexually active men diagnosed with pED based on criteria for Erectile Disorder from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) and without a stable partner, were instructed to use a vibrating device called TENUTO II during their sexual encounters for duration of 8 weeks. This device generates focal vibrations on the penis and the perineal area in intervals of 10 seconds of vibration followed by 10 seconds of pause, with a frequency of 50Hz and an amplitude of 2mm. The five-item Spanish version of the International Index of Erectile Function (IIEF-5) questionnaire was used to assess symptoms before and after the procedure and the Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) questionnaire was used for evaluating satisfaction with treatment. Results After the using the device, all patients enrolled with a mean age of 36.1 years (range 28-45) experienced an improvement in erectile function, mean IIEF-5 score pretreatment was 11(range 5–13) mean posttreatment IIEF score was 20 (range 18-27). No adverse effects were reported during the treatment. Conclusions This case series suggests that use of an on-demand focused vibration device could be a potentially effective and safe therapeutic option for men with pED. However, further studies with a larger number of participants and a more rigorous research design are needed to confirm these preliminary findings. Disclosure Yes, this is sponsored by industry/sponsor: MysteryVibe. Clarification: Industry funding only - investigator initiated and executed study. Any of the authors act as a consultant, employee or shareholder of an industry for: Mysteryvibe.

(316) Age Is Not a Number When It Comes to Penile Prosthesis Implantation. A Mini–Case Series

Abstract Introduction Given the overall aging of the population, erectile dysfunction has become an increasingly relevant issue among the elderly. When elective surgery is offered, the patient's age is often taken into consideration as a potential limiting factor. Moreover, the importance of addressing the quality of life and sexual satisfaction of older men tends to be overlooked in the management of erectile dysfunction. Objective The aim of this study is to investigate the safety of implanting penile prostheses (PP) in patients aged 90 years and older, as well as the potential complications associated with this age group. Methods The database of patients was screened between the years 2003 and 2023, to identify patients at least 90 years and older who underwent the implantation of penile prosthesis by a single surgeon at two large volume centers. We collected demographic information for the patients, including their past medical and surgical history, medication list, anesthesia peri-operative assessment and recommendations, details of the surgical procedure, intra-operative and postoperative recovery period, as well as clinic follow-up. Results Between 2003 and 2023, a total of 2000 men underwent PP surgery at the two centers. Out of the total number of patients, only two were 90 years or older at the time of implantation. One patient was a first timer, while the other had two previous PP surgeries over the span of 15 years for mechanical failure reasons. Both surgeries were performed using different device types, without any intra-operative or postoperative complications. At their three and six months follow up visits, both patients demonstrated the ability to cycle the implant smoothly, reported satisfactory penetrative intercourse with their partners, and improved sexual intimacy through Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) questionnaire. They were followed for a total of 1 year with no long-term negative effects. Conclusions Despite reporting only two cases in this specific cohort, it demonstrates that implantation of PP is a safe and effective treatment for elderly men with ED. Maintaining satisfactory sexual activity in this age group is vital and achievable through inflatable penile prosthesis (IPP) insertion. There are several complex factors that must be considered prior to operating on an older patient due to medical co-morbidities and age. However, with proper patient selection, pre-operative counseling and optimization, this operation can be effectively performed in patients who are at least 90 years old. Simply, age is not a limitation to undergo penile implant. Disclosure No.

(347) Prediction of Post-operative Sexual Satisfaction after Penile Prosthesis Implantation (With and Without Penile Lengthening Procedures) Using Preoperative Penile Length Measurements

Abstract Introduction `- Penile prosthetic devices are the gold standard treatment of medication-resistant erectile dysfunction, however penile length reduction was reported as one of the main post operative disturbing complaints - Many lengthening procedures during penile prosthesis implantation (PPI) were described to increase postoperative sexual satisfaction. Objective `- To predict post-operative sexual satisfaction after PPI (with or without penile lengthening procedure) using preoperative penile length measurements. Methods `- This study was conducted in our urology department as prospective RCT, in the period between August 2018 till April 2020 - It included 61 male patients with organic ED who are candidates for PPI. - Patients were randomized to 2 groups; group A included 31 patients who underwent suspensory ligament release via penopubic Z-plasty, dorsal phalloplasty, suprapubic lipectomy, +/− ventral phalloplasty (in case of high scrotal insertion); group B included control patients who underwent PPI only via penoscrotal incision. - Measurement of preoperative and postoperative (after 3 months) penile lengths were done, including; the flaccid, visible stretched and functional stretched penile lengths. - Assessment of patients’ sexual satisfaction was done using the Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) score adapted to penile prosthetic implant. - Patients with EDITS scores of 60-80 were considered satisfied, and those with EDITS scores of 80-100 were considered very satisfied. - Receiver operating curve (ROC) analysis was done to detect cutoff value for the preoperative stretched penile lengths (functional &amp; visible) that are predicted to aid the patient to reach a postoperative satisfaction of EDITS ≥90 in each group. Results `- The mean preoperative measurements showed no statistically significant difference between the two groups. - However, the mean postoperative measurements after 3 months demonstrated a statistically significant difference between the two groups. - The mean values of both overall EDITS and the EDITS resting state and malleability scores were higher in group A (91.92 ± 7.22 and 7.38 ± 0.78) Vs. (79.55 ± 15.55 and 5.32 ± 1.12) in group B (p &amp;lt; 0.001) - For EDITS satisfaction level, the percentage of the very satisfied patients [≥ 80] in group A (89.7%) was significantly higher than in group B (64.3%) (p= 0.045) - Also, for the EDITS resting state and malleability satisfaction level, the percentage of the very satisfied patients in group A (55.2%) was significantly higher than in group B (0.0%) (p &amp;lt; 0.001) - ROC curve was done for both groups In group A: - Functional stretched penile length: AUC 0.815 with a cutoff value of 12.75 cm yielding a 81.8% sensitivity and 71.4% specificity (p value = 0.013) - Visible stretched penile length: AUC 0.795 with a cutoff value of 10.75 cm yielding a 81.8% sensitivity and 71.4% specificity (p value =0.020) In group B: - Functional stretched penile length: AUC 0.927 with a cutoff value of 14.50 cm yielding a 77.8% sensitivity and 94.7% specificity (p value &amp;lt; 0.001) - Visible stretched penile length: AUC 0.892 with a cutoff value of 12.50 cm yielding a 66.7% sensitivity and 94.7% specificity (p value &amp;lt;0.001). Conclusions `- Preoperative measurement of functional and visible penile lengths can be of value in predicting post-operative sexual satisfaction after PPI (with or without concurrent penile lengthening procedures). 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&amp;lt;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&amp;lt;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.

(047) A Systematic Review of Partner Satisfaction after Penile Prosthesis and Review of Patient Satisfaction in LGBTQ+ Men after Penile Prosthesis

Abstract Introduction Erectile dysfunction (ED), known to negatively affect both patient and partner quality-of-life (QoL), is estimated to affect more than 30 million men in the United States. Penile prosthesis (PP) implantation has been shown to be a successful surgical option for men with erectile dysfunction refractory to medical treatment. Several recent studies have demonstrated post-surgical patient satisfaction rates of &amp;gt;90% using validated, non-specific tools such as the International Index of Erectile Function (IIEF) and the Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS). Objective Despite the progress in examining the satisfaction of heterosexual male patients with PP implantation, there has been no thorough review of partner satisfaction and QoL. Our objective was to summarize the current literature around partner satisfaction for heterosexual patients and patient satisfaction for LGBQT+ patients, respectively. We specifically conducted a systematic review according to the Cochrane and preferred reporting items for systematic reviews and meta-analyses (PRISMA) standards and stratified studies into three tiers by methodological rigor. Methods A PRISMA systematic literature review was performed using the PubMed database in March 2022. For the heterosexual partner review, a search was conducted to find all relevant abstracts regarding ‘penile prosthesis’, ‘partner satisfaction’, and ‘partner quality of life’. For the LGBQT+ review, ‘MSM’, ‘gay’, ‘homosexual’, ‘queer’, and ‘heterosexual’ were used as additional search terms. The research was limited to English-language articles from January 2000 to March 2022. The list of studies generated by the search was screened to identify eligible studies. Inclusion criteria included a clinical outcome study with primary outcomes related to penile prosthesis, and partner satisfaction was included as an outcome measure. Exclusion criteria included case reports, review articles, animal studies, and patient satisfaction studies that did not include partner satisfaction. Studies for the partner satisfaction review were sorted into three tiers based on the accuracy and external validity of each study’s methods. Results After an initial search of 172 articles, 30 studies met the inclusion criteria for the partner satisfaction review (Table 1). For our LGBTQ review, three studies consisting of 129 patients met the inclusion criteria from an initial search of 13 records (Table 2). For our partner satisfaction review, 10 studies were classified as Tier 1, 11 studies were classified as Tier 2, and 9 studies were classified as Tier 3. Across all the tiers, studies noted partner satisfaction rates between 50%-90% and improved satisfaction and sexual QoL metrics compared to pre-surgery rates. Overall, although partner satisfaction rates were high after PP implantation, many studies noted slightly lower partner satisfaction rates than patient satisfaction rates. Satisfaction rates among LGBTQ patients after PP implantation varied greatly between studies, ranging from 11% to 93% satisfaction. Conclusions Although the quality of evidence varies, the available literature suggests relatively high rates of partner satisfaction after PP implantation, in addition to varying rates of patient satisfaction after PP implantation in LGBTQ patients. Given the diversity of study designs and widespread use of non-validated or non-specific questionnaires in the current literature, future research should focus on prospective studies and/or data collection using validated, PP-specific questionnaires. Disclosure No

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.

The outcomes of penile prosthesis in neurologic patients: a multicentric retrospective series.

Neurological disease is a known entity for causing erectile dysfunction (ED). Pharmacological therapies are not always effective these patients - penile prosthesis implant (PPI) is an established surgical treatment option. For a variety of reasons, neurological patients may experience differing outcomes of PPI compared to those whose ED arises from other causes. We investigated outcomes of PPI in neurological patients using the Italian multi-institutional national registry of penile prostheses [Italian Nationwide Systematic Inventarization of Surgical Treatment for ED (INSIST-ED)]. Patients undergoing PPI were investigated via the INSIST-ED registry, from 2014 to 2021. Data were prospectively recorded by 45 surgeons on a dedicated website (www.registro.andrologiaitaliana.it) and reviewed by a data manager. We subselected patients with neurological disease undergoing PPI for ED, and these patients were reviewed at 3, 6, and 12 months, and annually thereafter. Postoperative complications and functional outcomes were evaluated through validated questionnaires [International Index of Erectile Function-5 (IIEF-5), Sexual Encounter Profile 2-3, and Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS)]. A nonvalidated questionnaire was administered to assess patient satisfaction. A total of 33 patients were included with a median age of 49 [interquartile range (IQR) 41-55]. Median follow-up was 83 months (IQR 67-99.5). A penoscrotal approach for PPI was performed in most cases (90.9%), while infrapubic was used in three cases (9.1%). Inflatable and malleable devices were implanted in 30 (90.9%) and 3 cases (9.1%), respectively. Intraoperative complications occurred in one case (3%). Early postoperative complications (<90 days) were observed in three cases (9.1%): two wound dehiscence (Clavien-Dindo G1 and G3a respectively) and one device infection requiring prosthesis explant (Clavien-Dindo G3a). Mechanical failures of inflatable devices were not observed during the follow-up period. Median IIEF-5 before surgery was 8 (IQR 7-9). At the latest follow-up, IIEF-5 was 22 (IQR 19-23.5), and median EDITS was 79 (IQR 64-88). A total of 28 patients (84.8%) self-reported to be fully satisfied with the PPI. Although PPI in the neurological population has been historically considered to be at increased risk, in our study, PPI complications and infections rates in this cohort did not differ from general population.

The outcomes of pics technique for the management of end-stage peyronie's disease

To present the surgical, the functional and patients’ reported outcomes (PROs) of PICS technique in multicentric series of patients affected by end-stage PD. Patients underwent an IPP implantation followed by PICS technique were recruited in two European tertiary referral center. The primary endpoint of the study was the achievement of a complete straightening of the penis. The secondary endpoints were surgical, functional and PROs. The International Index of Erectile Function (IIEF-5), the Sexual Encounter profile questions 2 and 3 (SEP 2 and SEP 3) and the Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) were used to assess patients’ erectile function. The PICS technique was used in 37 patients. Median patient age was 62 years (IQR 57-70 years). Residual curvature after IPP was 60° (IQR 50–70°). Operative time was 100 minutes (IQR 90–120). Median follow-up resulted of 14 months (IQR 12–17). 27 of 37 patients (72.9%) achieved a totally straight penis. 6 patients (16.2 %) experienced a residual penile curvature: of 10° in 3 patients, 15° in 1 patient and 20° in 2 patients. The residual curvature did not interfere with sexual intercourse in any of the cases. No intraoperative complications were detected. 9 of 37 patients (24.3%) developed an early postoperative complications: 3 (8.1%) manifested a transient fever and 6 (16.2%) experienced a genital hematoma. We detected a single case (2.7%) of acute infection requiring a removal of the IPP. No cases of IPP mechanical failure were described. Median IIEF-5 score increased from 10 (8-12) in postoperative settings to 23.5 (22.2-25) at 12 months follow-up. SEP 2-3 increased from 5 (13.5%) and 0 (0%) to 34 (91.9) in both domains. EDITS scored 25 (21.2-29.5) at 12 months follow-up. The PICS technique represents a safe and effective approach to manage residual penile curvature during IPP placement in patients with end-stage PD. None

Feasibility of an External Erectile Prosthesis for Transgender Men Who have Undergone Phalloplasty.

IntroductionTransgender men interested in achieving penetration after phalloplasty are currently limited to internal devices and makeshift supports. More options are needed to support sexual penetration after phalloplasty.AimThis study was designed to assess the feasibility of an external erectile prosthesis (the Elator) for transgender men who have undergone phalloplasty and wish to use their neophallus for sexual penetration, assess how the device affected the sexual experiences of men and their partners, and identify any side effects and concerns.MethodsTransgender men and their partners were provided with an erectile device to use for one month. They were surveyed at 4 time points: enrollment, measurement, receipt, and after using the device, using a combination of pre-existing and device-specific measures.Main Outcome MeasureThe primary outcome was whether men found it feasible to use an external penile prosthesis for sexual penetration after phalloplasty – defined as interest in, and willingness to, use the device more than once over the study period; intention to continue using the device on the Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS); and no decrease in relationship satisfaction on the Gay and Lesbian Relationship Satisfaction Scale (GLRSS). The secondary outcome was an increase in sexual or relationship satisfaction with use of the device, defined as a statistically significant increase on either the Quality of Sexual Experience Scale (QSE) or the GLRSS.ResultsFifteen couples enrolled in the pilot study. Of the 10 who completed the study, only 3 found device use feasible and endorsed strongly positive experiences, while the remaining 7 found it unusable. There were no changes in QSE or GLRSS scores. Most device issues were related to proper fit.ConclusionThere is a great deal of interest in non-surgical options for achieving penetration after phalloplasty. The tested external erectile device can work well, but its utility is limited to individuals with very specific post-phalloplasty anatomy. Most individuals and couples found the device unsuitable for the neophallus and/or that it could not be used comfortably.Boskey ER, Jolly D, Mehra G, et al. Feasibility of an External Erectile Prosthesis for Transgender Men Who have Undergone Phalloplasty. Sex Med 2022;10:100560.

Satisfaction rates of inflatable penile prosthesis in men who have sex with men are high.

Men with erectile dysfunction (ED) have high patient satisfaction after placement of inflatable penile prostheses (IPP). The impact on satisfaction and quality of life has never been studied in men who have sex with men (MSM). This study sought to assess the satisfaction rates and quality of life of MSM after placement of IPP for ED. This study was a multi-institutional, retrospective study that enrolled adult men who self-identified as MSM and underwent IPP placement. Two questionnaires were administered at one time point post-operatively, the Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS), and the Quality of Life and Sexuality with Penile Prosthesis (QoLSPP) questionnaire. Results of these questionnaires were analyzed with descriptive statistics. Forty-nine MSM were assessed retrospectively with median age of 62 years with average follow-up of 15.2 months. Median EDITS score was 93.2/100 (range, 70.5-100). Median overall QoLSPP score was 72/80 (58-79), with median scores of 22/25 (16-25), 19/20 (13-20), 18/20 (12-20), and 14/15 (9-15), for the functional, personal, relational, and social domains respectively. Overall, MSM report high satisfaction rates and quality of life after IPP placement. A better understanding of the needs and demands of this patient population may lead to improved patient satisfaction and quality of life.

Evaluation of Satisfaction and Outcomes of Patients Who Underwent Two-Piece Inflatable Penile Prosthesis Implantation.

IntroductionThe aim of this study was to evaluate patient and partner satisfaction, device reliability, and complications in patients who underwent two-piece inflatable penile prosthesis (IPP) implantation.Patients and methodsThe data of 22 patients who underwent two-piece inflatable penile prosthesis implantation in our department between 2015 and 2018 were retrospectively analyzed, and a detailed review of all clinical reports was performed. Phone or face-to-face interviews were undertaken to assess the satisfaction rates of the patients and their partners using the modified Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) questionnaire.ResultsThe mean patient age and partner age were 57.95 ± 6.16 and 58.12 ± 6.66 years, respectively. The mean erectile dysfunction (ED) period was 5.33 ± 2.16 years, and the etiologies of erectile dysfunction were radical pelvic surgery (41%), diabetes mellitus (37%), and vascular disorders (22%). The mean operative time and postoperative hospital stay were 102 ± 29 minutes and 1.8 ± 0.66 days, respectively. Over a mean follow-up period of 29.04 ± 14.48 months, two (9%) cases underwent revision surgery due to mechanical device failure in one and infection in the other. The overall patient and partner satisfaction rates were 73% and 59%, respectively.ConclusionsThe two-piece inflatable penile prosthesis is an effective, reliable, and user-friendly prosthesis with acceptable complication and revision rates and provides a high level of patient and partner satisfaction in selected and fully informed patients.

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.