Erectile Function Domain Score Research Articles

(018) Predictors of the Conduct of Nerve Sparing During Radical Prostatectomy

Abstract Introduction The association between nerve-sparing (NS) status at the time of radical prostatectomy (RP) and functional outcomes is well described; however, our profession lacks insight as to whether patient factors such as age and baseline erectile function influence surgeon behavior when it comes to nerve-sparing during RP. Objective We analyzed predictors associated with bilateral nerve damage/resection at the time of RP. Methods The study included patients who underwent RP with surgeon-reported NS scoring. The NS outcome of the right and left sides were independently scored between 1-4: 1 = completely preserved, 2 = partially preserved, 3 = partially damaged, and 4 = completely resected; scores of 1 or 2 indicate nerve-sparing and scores of 3 or 4 indicate non-nerve-sparing. We classified overall NS status as bilateral, unilateral, or not-spared. Demographics, ED-related comorbidities, pre-RP digital rectal exam (DRE), most recent prostate biopsy (bx) results, and pre-RP IIEF Erectile Function Domain (EFD) were analyzed. Pre-RP prostate MRI was used to define prostate volume (PV). EFD score < 24 defined non-functional erections. We created a multivariable (MV) model to define predictors of poorer NS status. The model included patient age, pre-RP EFD, PV, PSA, DRE, noted possible extracapsular extension (ECE) on pre-RP MRI, number of positive bx cores, and predominant Gleason (G) score on bx. Results 3805 men met inclusion criteria. Median age was 64 (57, 67) years. Median pre-RP EFD score was 26 (15, 30); 41% had a pre-RP EFD score < 24. Median PV and PSA were 35 (27, 47) mL and 5.7 (4.2, 8.4) ng/dL, respectively. 64% had a normal pre-RP DRE. Median total bx cores 12 (9, 14). Median positive bx cores 4 (2, 7). Distribution of bx pathology: 17% G6, 64% G7, 10% G8, 8% G9, <1% G10. 65% had predominant G3 and 34% G4 pathology. 26% of MRI reports noted some degree of suspicion for ECE. NS status at RP: bilateral (69%), unilateral (20%), non-spared (11%). Median NS score was 3 (2, 4). On MV analysis, abnormal DRE, number of positive bx cores, and predominance of G4 were predictive of non-NS surgery. Most notably, the non-oncological factors – older patient age and a pre-RP EFD < 24 – were also predictive of non-NS surgery (Table). Conclusions While patient age and baseline erectile function (EF) are not necessarily predictors of a patient’s interest in preserving EF, these non-oncologic factors were identified as predictors of non-NS surgery in this analysis. Surgeons should define the individual patient’s sexual function goals prior to RP. Disclosure No.

(231) Low-Intensity Extracorporeal Shockwave Therapy Twice Per Week for Six Weeks May Result in Transient Subjective Improvements in Erectile Function

Abstract Introduction Low-intensity extracorporeal shockwave therapy (LiESWT) has been reported to result in subjective improvements in erectile function, but the ideal patient population and treatment protocol have not yet been established. Objective We aimed to assess improvements in International Index of Erectile Function – Erectile Function domain (IIEF-EF) scores following treatment with LiESWT of 1500 shocks of 0.2mJ/mm2 per treatment, twice a week for six weeks. We hypothesized that LiESWT results in subjective improvements of erectile function. Methods Patients were prospectively enrolled in a clinical trial examining changes in erectile function following LiESWT. The study was powered to detect a change in IIEF-EF scores of 5 points. Patients received 12 bi-weekly LiESWT treatments of 0.2mJ/mm2 at 5Hz, 1500 shocks delivered per treatment using the Storz Duolith T-Top Ultra shockwave device. Patients completed IIEF-EF, Sexual Encounter Profile (SEP) questions two and three, Global Assessment Questions (GAQ), and Erection Hardness Score (EHS) questionnaires prior to initiation of treatments and following completion of treatments at 1-2 weeks, 4-6 weeks, 3 months and 6 months post-treatment. Changes in questionnaire responses were compared to baseline responses. Data were analyzed using single variant one-tailed T-tests and one-tailed Fisher’s exact test. Values are reported as means ± standard error. Results Twenty-five patients completed all five study visits. Mean pre-treatment IIEF-EF score was 14.24 ± 1.21. Mean IIEF-EF scores increased to 15.80 ± 1.46 1-2 weeks following treatment (Study Time #2), 16.12 ± 1.46 4-6 weeks following treatment (Study Time #3), 18.12 ± 1.57 3 months following treatment (Study Time #4), and 16.36 ± 1.86 6 months following treatment (Study Time #5), though results only reached significance at Study Time #4 (p=0.016) and results were not sustained. Changes in IIEF-EF scores following treatment were evaluated by baseline ED severity (normal IIEF-EF 26-30, N=1; mild IIEF-EF 22-25, N=2; mild-moderate IIEF-EF 17-21, N=7; moderate IIEF-EF 11-16, N=10; severe IIEF-EF 6-10, N=5. Patients with IIEF-EF scores 11-21 reported significant improvements in IIEF-EF scores at all time points (Figure 1). Mean pre-treatment EHS score was 2.1±0.14. There was no significant improvement in EHS score following treatment at any time point, and no differences when analyzed based on pre-treatment ED severity. Similarly, no changes in SEP or GAQ positive response rates were noted following treatment. Conclusions Our results suggest that LiESWT using 1500 shocks per treatment with energy of 0.2mJ/mm2 twice per week for 6 weeks may transiently improve subjective erectile function as measured using IIEF-EF questionnaires, particularly for patients with mild-moderate to moderately severe ED, consistent with other studies. However, improvements may not be sustained 6 months following treatment. Disclosure No.

(403) Pilot Study: Fractional CO2 Laser in the Treatment of Chronic Phase Peyronie’s Disease

Abstract Introduction Peyronie’s Disease (PD) is a fibrosing disorder of the penis which may result in penile curvature and deformity of the erect penis. Fractional CO2 laser therapy has been used to remodel severe skin scarring and more recently led to improvements in Dupytren’s contractures. Objective We sought to evaluate the safety of Fractional CO2 Laser Therapy in treating Peyronie’s disease. The assessment includes changes in penile curvature, Peyronie’s Disease Questionnaire (PDQ) Symptom bother score, and International Index of Erectile Function (IIEF) scores. Methods This pilot study examined the use of fractional CO2 laser therapy with adjuvant topical triamcinolone (10mg/cc) in patients with PD. Each patient underwent three treatment cycles with 6 weeks interval between each treatment. During the interval time period, patients were required to perform at-home penile modeling three times daily. Penile curvature assessments, self-reported questionnaires and any adverse events were collected at baseline, 24 weeks and 52 weeks. Results A total of 5 patients were included. The mean baseline curvature was 41.80 ± 10.57 degrees and at 24-week follow-up mean curvature was found to be 34.20 ±18.21 degrees, resulting in an 18.1% reduction in curve (p=0.44). Mean IIEF scores were 55.40 ± 14.26 vs. 61.40 ± 6.58, (p=0.234) at baseline and 24-week follow-up, respectively. Similarly, the IIEF erectile function domain scores were 24.40 ± 4.72 vs. 28.60 ±1.52, (p=0.061) at baseline and 24-week, respectively. PDQ symptom bother average scores were 7.6 vs. 5.4 at baseline and 24-week, respectively. Mild adverse effects such as temporary bruising and penile pain were reported. There were no significant adverse events noted. Conclusions Preliminary results, at 24 weeks, suggest that fractionated CO2 laser therapy may serve as a well-tolerated therapy for PD. While this pilot trial was not powered to assess effectiveness, initial results are encouraging. Based upon these findings, a dose escalating phase I clinical trial is warranted to further systematically evaluate the tolerability and utility of Fractional CO2 laser therapy in the treatment of PD. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast, Boston Scientific. Allergen/Abvie, Galderma, Johnson and Johnson, Leo, MetOptima, Pfizer.

Outcomes of collagenase Clostridium histolyticum in men with ventral curvatures: an updated series.

The efficacy and safety of collagenase Clostridium histolyticum (CCH) have been demonstrated in the treatment of men with Peyronie's disease (PD); however, the pivotal clinical trials excluded men with ventral penile curvature. The study sought to evaluate outcomes of CCH treatment in men with ventral curvatures secondary to PD. Men with PD treated with CCH were identified from a prospective database. Patients received up to 4 series of CCH injections using a progressively modified protocol over time. Results were compared between those with baseline ventral vs nonventral penile curvatures. Changes in penile curvature, Peyronie's Disease Questionnaire scores, International Index of Erectile Function scores, nonstandardized assessments, and adverse events. A total of 560 men with PD (85 ventral curvature, 475 nonventral curvature) were included in the analysis. Baseline median curvature was 60.0° (interquartile range, 48.8°-75.0°) in the ventral cohort and 65.0° (interquartile range, 45.0°-80.0°) in the nonventral cohort. Median change from baseline penile curvature was -25.0° in the ventral cohort vs -24.0° in the nonventral cohort (P = .08, between-group comparison), which corresponded to curvature reductions of 44.7% and 33.6%, respectively (P = .03). In the subset of patients who completed CCH treatment (ie, received 8 injections or discontinued early because of patient satisfaction with curvature reduction), median change from baseline was -35.0° in the ventral cohort vs -25.0° in the nonventral cohort (P < .05); median percent improvement was 48.3% and 37.5%, respectively (P = .11). Median change from baseline in Peyronie's Disease Questionnaire and International Index of Erectile Function domain scores and adverse events were similar between cohorts, with the exception of possibly higher hematoma rates in the nonventral group (50% vs 37%; P = .05). No urethral injuries were sustained in either cohort. Data support the use of CCH for the treatment of ventral as well as nonventral penile curvatures in men with PD. Study strengths are the inclusion of a general clinical population of men with PD, the prospective design, and the relatively large series of men with ventral curvature. Limitations include the single-center and observational nature of the study. CCH was safe and effective in the treatment of both ventral and nonventral penile curvatures in men with PD.

Platelet-rich plasma intracavernosal injections for the treatment of primary organic erectile dysfunction: a systematic review and meta-analysis of contemporary controlled studies.

We aim to summarize the latest evidence on platelet-rich plasma (PRP) intracavernosal injections efficacy in men affected by primary organic erectile dysfunction (ED). We reviewed the literature for randomized controlled trials (RCTs) or prospective and retrospective comparative studies evaluating PRP alone or in combination for ED treatment. A comprehensive search in PubMed, Scopus, Web of Science, and ClinicalTrials.gov was performed for English language full-text articles or conference abstracts. A qualitative and quantitative data synthesis was provided. Overall, seven records were included: three RCTs evaluated PRP vs. placebo, one study separately tested PRP and low-intensity shock wave therapy (Li-SWT), three studies compared Li-SWT or low-intensity pulsed ultrasound alone with their combination with PRP. Of 641 included patients, 320 received PRP. Despite the heterogeneity among inclusion criteria, dose and protocol of PRP administration, and outcomes measured, most studies independently reported better sexual outcomes in patients who received PRP, without significant severe side effects. In meta-analysis, where only placebo-controlled studies were included, patients treated with PRP showed higher International Index of Erectile Function (erectile function domain) score compared to patients who received placebo: pooled mean difference (95% Confidence Interval) of 2.99 (1.86, 4.13) after 1 month (209 patients) vs. 2.85 (1.61, 4.09) after 3 months (204 patients) vs. 3.21 (1.82, 4.60) after 6 months (199 patients) of follow-up. In men affected by primary organic ED, PRP intracavernosal injections demonstrated an objective improvement or at least a tendency in erectile function recovery. Patient numbers, and the short-term follow-up may limit the generalizability of these observations. High quality, large-scale, and standardized controlled trials are needed before recommending its definitive use in clinical practice.

Mucomucosal anastomotic non-transecting augmentation (MANTA) urethroplasty: a ventral modification for obliterative strictures.

To present a surgical modification for the repair of bulbar urethral strictures containing short, highly obliterative segments and report on long-term objective and patient-reported outcomes. We considered patients undergoing bulbar buccal mucosal graft urethroplasty (BMGU) between July 2016 and December 2019. Eligibility criteria for mucomucosal anastomotic non-transecting augmentation (MANTA) urethroplasty were strictures of ≥2 cm with an obliterative segment of ≤1.5 cm. The stricture is approached ventrally to avoid extensive dissection and mobilisation. Dorsally, the scar is superficially excised and the spongiosum is left intact. Dorsal mucomucosal anastomosis is complemented by ventral onlay graft. Perioperative characteristics were prospectively collected including uroflowmetry data and validated patient-reported outcome measures on voiding, erectile, and continence function. We evaluated functional follow-up, incorporating patient-reported (lower urinary tract symptoms [LUTS] score) and functional success. Recurrence was defined as need of re-treatment. Of 641 men treated with anterior BMGU, 54 (8.4%) underwent MANTA urethroplasty. Overall, 26 (48%) and 45 (83%) had a history of dilatation and urethrotomy, respectively, and 14 (26%) were redo cases. Location was bulbar in 38 (70%) and penobulbar in 16 patients (30%), and the mean (SD) graft length was 4.5 (1.4) cm. At a median (interquartile range) follow-up of 41 (27-53) months, the functional success rate was 93%. Whereas the median LUTS score significantly improved from baseline to postoperatively (13 vs 3.5; P < 0.001), there was no change in erectile function (median International Index of Erectile Function - erectile function domain score 27 vs 24) or urinary continence (median International Consultation on Incontinence Questionnaire - Urinary Incontinence Short Form sum score 0 vs 0; all P ≥ 0.4). All patients were 'satisfied' (27%) or 'very satisfied' (73%) with the outcome of their operation. With excellent long-term objective and patient-reported outcomes, MANTA urethroplasty adds to the armamentarium for long bulbar strictures with a short obliterative segment.

(343) Predictors of Corporo-venocclusive Dysfunction (CVOD) in Men with Bilateral Nerve-sparing Radical Prostatectomy (RP)

Abstract Introduction Nerve-sparing status (NSS) during RP is a significant predictor of erectile function recovery (EFR). Poor nerve sparing is associated with collagenization of cavernosal smooth muscle and CVOD development with typically poor response to PDE5 inhibitors (PDE5i) and intracavernosal injection therapy (ICI). Objective This study aimed to define factors predictive of CVOD in men with bilateral NS RP. Methods Study population consisted of (i) men who underwent bilateral NS (defined by the surgeon using an institutional grading system) RP (ii) with poor response to PDE5i and ICI (iii) ≥2 years post-RP (iv) who underwent penile duplex Doppler ultrasound (DUS) (v) using a vasoactive agent redosing schedule. CVOD diagnosis was made with end-diastolic velocity (EDV) values ≥5 cm/sec bilaterally. ADT and radiation therapy were exclusions. We used multivariable modeling to define factors predictive of CVOD. Factors included in the model: patient age, history of diabetes, history of obstructive sleep apnea, number of vascular comorbidities, baseline EF, peri-RP total testosterone (T) level, and total T at DUS (within 3 months). Results 201 men with a mean age of 66 ± 7 years. 25% of the patients reported 3 or more vascular comorbidities, 17% had diabetes, 36% obstructive sleep apnea, 39% were current or former smokers. Mean baseline PSA and pre-RP total T was 6.7 ± 6 ng/mL and 410 ± 211 ng/dL, respectively. Median baseline EFD score was 24 (13, 29). 49% of the men had an erection less than penetration rigidity during the DUS procedure with a mean total dose administered of 87 ± 21 units of trimix. 69% received 100 units. CVOD was diagnosed in 76%. Mean total T at DUS was 386 ± 177 ng/dL. 32% had low T. Significant predictors of CVOD after RP in men with BL NSS were: OSA (OR = 3.8, 95% CI = 1.7-8.7), ≥ 3 vascular comorbidities (OR = 5.0, 95% CI = 1.7-14.8), age at the time of DUS (per 10 years increase, OR = 1.9, 95% CI = 1.2-3.0), and pre-RP EF domain score (per 1 unit increase, OR = 0.93, 95% CI 0.88-0.98). There was a signal that in a larger sample size, diabetes may be a significant predictor of CVOD in this group of patients (OR = 2.7, 95% 0.9-8.0). Conclusions Baseline clinical comorbidities pre-RP have a significant impact on EFR post-RP, in particular, the presence of venous leak. Despite BL NSS, older patients, men with OSA, higher number of comorbidities pre-RP, and lower pre-RP EF increased the likelihood of developing CVOD post-RP. Disclosure No

Erectile dysfunction after acetabular fracture.

To determine the rate of erectile dysfunction in male patients who have sustained an acetabular fracture with no previously identified urogenital injury. Cross-sectional survey. Level 1 Trauma Center. All male patients treated for acetabular fracture without urogenital injury. The International Index of Erectile Function (IIEF), a validated patient-reported outcome measure for male sexual function, was administered to all patients. Patients were asked to complete the International Index of Erectile Function score for both preinjury and current sexual function, and the erectile function (EF) domain was used to quantify the degree of erectile dysfunction. Fractures were classified according the OTA/AO classification schema, fracture classification, injury severity score, race, and treatment details, including surgical approach were collected from the database. Ninety-two men with acetabular fractures without previously diagnosed urogenital injury responded to the survey at a minimum of 12 months and an average of 43 ± 21 months postinjury. The mean age was 53 ± 15 years. 39.8% of patients developed moderate-to-severe erectile dysfunction after injury. The mean EF domain score decreased 5.02 ± 1.73 points, which is greater than the minimum clinically important difference of 4. Increased injury severity score and associated fracture pattern were predictive of decreased EF score. Patients with acetabular fractures have an increased rate of erectile dysfunction at intermediate-term follow-up. The orthopaedic trauma surgeon treating these injuries should be aware of this as a potential associated injury, ask their patients about their function, and make appropriate referrals. III.

PD26-10 PREDICTING ERECTILE FUNCTION PRESERVATION AFTER PROSTATE CANCER TRIPLE THERAPY

You have accessJournal of UrologyCME1 Apr 2023PD26-10 PREDICTING ERECTILE FUNCTION PRESERVATION AFTER PROSTATE CANCER TRIPLE THERAPY Samantha L. Thorogood, Jose M. Flores, Nicole Benfante, James A. Eastham, Craig E. Grossman, Michael Zelefsky, and John P. Mulhall Samantha L. ThorogoodSamantha L. Thorogood More articles by this author , Jose M. FloresJose M. Flores More articles by this author , Nicole BenfanteNicole Benfante More articles by this author , James A. EasthamJames A. Eastham More articles by this author , Craig E. GrossmanCraig E. Grossman More articles by this author , Michael ZelefskyMichael Zelefsky More articles by this author , and John P. MulhallJohn P. Mulhall More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003304.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Men with prostate cancer initially treated with radical prostatectomy (RP) who later undergo radiation (RT) and androgen deprivation therapy (ADT) in the adjuvant or salvage setting are at high risk for erectile dysfunction; however, this risk is not well quantified. We aimed to identify predictors of erectile function (EF) preservation this cohort treated with “triple therapy” (TTX). METHODS: We included men who underwent RP and subsequent adjuvant or salvage RT+ADT aka TTX but excluded men treated with ADT pre-RP. We extracted data on pre-RP ED-related comorbidities, total testosterone (T) levels, cancer and treatment characteristics, and sexual function. We analyzed International Index of Erectile Dysfunction (IIEF) Erectile Function Domain (EFD) score and phosphodiesterase 5 inhibitor (PDE5i) use documented pre-RP, 12 months (m) post-RP, and 12 m and 24 m post-TTX. PDE5i use was scored on a Likert scale of 0-3 (0: never; 3: routinely). NSS of each side (R/L) was scored on a 1-4 scale: 1 complete vs 2 near complete preservation (both considered nerve-sparing) and 3 partial vs 4 complete resection (both considered non-nerve-sparing). We then classified overall NS status as bilateral, unilateral, or not-spared. Multivariable analysis (MVA) was performed to define factors associated with EFD scores ≤10 (severe ED) and ≥24 (functional erections) at 24 m after TTX completion. RESULTS: We analyzed 163 men with a mean age of 63 years. 47% had ≥2 comorbidities. Median (IQR) total T 361 (26, 456) ng/dL. 18% had pre-RP T<300. 50% had bilateral NS. Median time between RP and start of RT was 18 (9, 34) m. Median duration of ADT: 4 (3, 6) m; 66% received >3 m ADT. Median EFD pre-RP=26 (17, 30) vs 6 (2, 20) at 24 m post-TTX. Mean difference in EFD pre-RP vs 24 m post-TTX was 11 (95% CI 9-12, p<0.0001). 18% had EFD≤10 pre-RP vs 62% at 24 m post-TTX. 60% had EFD≥24 pre-RP vs 15% at 24 m post-TTX. On MVA (Table 1), pre-RP EFD and bilateral NS were found to be significantly (p<0.05) associated with both EFD≤10 and EFD≥24. Age, ≥2 comorbidities, time between RP and RT, duration of ADT, and routine PDE5i use were not significant predictors in either model. CONCLUSIONS: This analysis identified pre-RP EF and surgeon-reported NS score as the only significant predictors of severe ED and functional recovery of erections 24 m after completion of TTX. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e738 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Samantha L. Thorogood More articles by this author Jose M. Flores More articles by this author Nicole Benfante More articles by this author James A. Eastham More articles by this author Craig E. Grossman More articles by this author Michael Zelefsky More articles by this author John P. Mulhall More articles by this author Expand All Advertisement PDF downloadLoading ...

MP27-11 CORRELATION OF PENILE GRAYSCALE PHARMACO-ULTRASONOGRAPHY WITH ERECTILE TISSUE COMPOSITION IN MEN WITH ERECTILE DYSFUNCTION

You have accessJournal of UrologyCME1 Apr 2023MP27-11 CORRELATION OF PENILE GRAYSCALE PHARMACO-ULTRASONOGRAPHY WITH ERECTILE TISSUE COMPOSITION IN MEN WITH ERECTILE DYSFUNCTION Noel Kim, Alyssa Yee, Andrew Goldstein, Sue Goldstein, and Irwin Goldstein Noel KimNoel Kim More articles by this author , Alyssa YeeAlyssa Yee More articles by this author , Andrew GoldsteinAndrew Goldstein More articles by this author , Sue GoldsteinSue Goldstein More articles by this author , and Irwin GoldsteinIrwin Goldstein More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003255.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Previous studies have shown that pre-operative in-office erectile function testing (pharmacocavernosometry) was correlated with erectile tissue composition (ETC) as determined by color histomorphometry on tissue samples removed during penile prosthesis insertion. Corporal veno-occlusive function (CVOF) was found to be normal at 45-50% smooth muscle cell content (SMCC). CVOF significantly worsened in an exponential relationship when SMCC was 40-25%. Below 25% SMCC, there was no recordable CVOF. We previously reported that using Grayscale pharmaco-ultrasonography (GPUS), a less invasive diagnostic assessment for ED than pharmacocavernosometry, % hypoechoic area (HA) in the corpora cavernosa (CC) negatively correlates with the erectile function domain score of the IIEF. In this study, we examined the relationship between % HA on GPUS and ETC in men with ED. METHODS: Pre-operative proximal shaft axial plane GPUS images were obtained using a 15.4 MHz probe (Aixplorer), gain setting 45%, dynamic range 70dB. % HA within the CC was assessed by computer-assisted image analysis using Image J. During penile prosthesis surgery, CC tissue from the proximal shaft was biopsied for histological analysis (n=10). Formalin-fixed (10%), paraffin-embedded tissue sections (5 µm) were stained with Masson’s trichrome. Photomicrographs were also analyzed by Image J using the Masson trichrome vector of the color deconvolution plugin. ETC was determined by assessing fractional areas of cellular content, consistent with SMCC, and extracellular matrix (ECM), consistent with erectile tissue fibrosis, from the red and blue channels, respectively. RESULTS: % HA was poorly correlated to % ECM area by linear regression analysis (r2=0.267). However, a non-linear regression model (exponential growth curve) provided a better fit (r2=0.660) with an inflection point at 40% ECM (see Figure 5). The abrupt shift is similar to the previously reported CVOF curve using pharmacocavernosometry. CONCLUSIONS: Estimation of % HA on GPUS images may be a useful, non-invasive assessment of ETC. Larger cohorts of ED patients are needed to verify the clinical utility of GPUS to predict CVOF. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e366 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Noel Kim More articles by this author Alyssa Yee More articles by this author Andrew Goldstein More articles by this author Sue Goldstein More articles by this author Irwin Goldstein More articles by this author Expand All Advertisement PDF downloadLoading ...

Erectile dysfunction and angiographic correlation between coronary artery stenosis and internal iliac-internal pudendal artery stenosis in patients with suspected coronary artery disease: a retrospective study

This study aimed to assess the angiographic correlation between coronary artery stenosis and internal iliac-internal pudendal artery (II-IPA) stenosis and evaluate its association with erectile dysfunction (ED). We reviewed the data of 91 patients who had undergone pelvic angiography (PA) to evaluate II-IPA stenosis and coronary angiography (CAG) due to suspected coronary artery disease. Erectile function (EF) was evaluated using the International Index of Erectile Function before CAG and PA. CAG was performed first, followed by PA of the bilateral II-IPA. Regardless of the location and number of stenosis sites, based on CAG, we categorized the patients into two groups. Patients with a maximum stenosis &lt;50% and ≥50% on CAG were assigned to Group I and Group II, respectively. Then, the EF domain score and the diameter stenosis (DS) of II-IPA were evaluated and compared. Overall, 55 patients comprised Group I, while 36 patients comprised Group II. ED was present in 96.3% and 97.2% of the patients in Group I and II, respectively. There was no statistical difference between the groups in the severity of ED (p = 0.457). PA revealed that 14.5% and 36.1% of patients in Groups I and II had ≥50% stenosis of the II-IPA. The mean DS of II-IPA in Group II was greater than that in Group I (p = 0.017). There was a statistically significant correlation between the degree of coronary artery stenosis and the degree of II-IPA stenosis (r = 0.295, p = 0.005). This study revealed that coronary artery stenosis correlates with II-IPA stenosis. The presence and degree of coronary artery stenosis or II-IPA stenosis indicate the necessity for more active treatment in patients with ED.

Evaluation of efficacy and safety of the AHPL/AYCAP/0114 capsule in subjects suffering from erectile dysfunction

Abstract Background and Objectives: Oral phosphodiesterase type 5 (PDE5) inhibitors facilitate erections, however, unable to restore sexual desire (SD), overcome sexual resistance, or treat relational discord. The current investigation aimed to assess the safety and effectiveness of the AHPL/AYCAP/0114 capsule in subjects experiencing erectile dysfunction (ED). Materials and Methods: The study design employed a noncomparative, interventional, open-label format. It was conducted at a single center and followed a prospective clinical methodology. A total of 46 patients completed the study. Patients were asked to take two AHPL/AYCAP/0114 capsules two times a day orally after meals with milk for 90 days. Changes in all domain scores of the International Index of Erectile Function questionnaire, hardness of penis, male sexual health, sexual encounter profile, overall improvement, serum total testosterone, AE, and lab parameters were outcomes of the study. Statistical analysis involved the application of the chi-square test, Wilcoxon signed-rank test, and Student t test to examine the relevant data. Results: On day 90, there was a notable and statistically significant increase in the mean Erectile Function Domain Score, with a rise of 42.4%. Significant improvements were observed on day 90 across multiple domains, including mean orgasmic function, mean SD, mean intercourse satisfaction, and mean sexual satisfaction domain scores. On day 90, complete improvement with full penile rigidity was observed in 78.3% of subjects, whereas 67.4% of subjects were very satisfied with the treatment and their sexual health and 78% of subjects showed good to excellent improvement. Serum total testosterone increased significantly by 1.29 times. Following the treatment, there were no significant changes observed in any of the laboratory parameters, indicating the safety of the AHPL/AYCAP/0114 capsule. Interpretation and Conclusions: The AHPL/AYCAP/0114 capsule was found to be safe and effective for the treatment of ED.

Improved erectile function after focal muscle vibrations therapy in a patient with neurogenic erectile dysfunction: a case report

To report a case of improved Erectile Dysfunction (ED) after surgery for colorectal cancer using focal Muscle Vibrations (MV). A 59-year-old male with neurogenic ED following surgery for colorectal cancer 18 months ago with an International Index of Erectile Function (IIEF) score <18, sexually active, fully continent before surgery; and withdrawal from previous treatment for at least three months such as erectogenic aids, antispastics, and psychoactive drugs, was encouraged to use a male vibrator called Tenuto®, three times a week for five consecutive weeks, each session lasting 30 min. The stimulation was delivered to the perineum and suprapubic areas at a frequency of 130 Hz. Changes in the validated erectile function domain of the IIEF were used to estimate the effectiveness of MV in improving ED. It has been suggested that an increase in of 6 points in this domain indicates a clinical improvement. At the end of five weeks, the patient showed improvement over baseline of 8 points for the erectile function domain scores from 7 to 15 with using the device. Although patients experiencing neurogenic ED are a multifaceted group, in this case we believe that MV improves ED through improved spasticity. Previous research shows that muscle MV may improve muscle synergies by counterbalancing the spasticity. Future studies using large sample sizes with longer follow-up and group control could provide more evidence in order to confirm this hypothesis. i have no conflict of interest to declare

Improved Peyronie's Disease Curvature Outcomes Using a Novel Collagenase Administration Protocol

To report outcomes of a novel collagenase clostridium histolyticum (CCH) injection protocol. A prospective, sequential database was maintained of all Peyronie's men undergoing CCH injections since 2015. Our protocol has evolved to include changes with injection technique, timing, aggressive modeling/traction, and wrapping. Results of the "traditional" and "novel" techniques were compared using two definitions: "most recent" assessment and final assessments among men who "completed eight (injections) or were satisfied." A total of 509 men underwent greater than or equal to 1 CCH series (traditional, n=280; novel n=229). Baseline demographic/clinicopathologic characteristics were similar between groups. Results demonstrated significantly greater curve improvements with the novel technique ("most recent" median 30° vs 20° or 46% vs 28%; "completed eight or satisfied" 34° vs 20° or 58% vs 30%). Using the "completed eight or satisfied" definition, 94% vs 66% of men achieved greater than or equal to 20% improvement (odds ratio 7.6), and 60% vs 24% achieved greater than or equal to 50% improvements (odds ratio 5.0) in the novel cohort (all P < .0001). Importantly, the International Index of Erectile Function Erectile Function Domain score was unchanged, and subjective erectile function (50% vs 5%, P < .0001) and sensation improved (17% vs 8% improved, P=.01) with the new protocol. The novel cohort also reported higher rates of surgery prevention (53% vs 18%), restored/facilitated penetration (57% vs 21%), and hematomas (56% vs 26%), necessitating changes to wrapping procedures (all P < .0001). Use of the novel CCH protocol results in significant improvements with curvature without negatively impacting erectile function or sensation. Given its specialized nature, it is not recommended for low-volume CCH injectors.

Predictors of Worsening Erectile Function in Men with Functional Erections Early After Radical Prostatectomy

Prior studies suggest that men with good erectile function shortly after radical prostatectomy (RP) can subsequently have worsened erectile function. To determine the prevalence and predictors of early erectile function recovery post-RP and of worsening erectile function after initial erectile function recovery. We retrospectively queried our institutional database. Men who underwent RP during 2008-2017 and who completed the International Index of Erectile Function erectile function domain both pre-RP and serially post-RP, constituted the population. Functional erections were defined as International Index of Erectile Function (IIEF)-6 erectile function domain scores ≥24. We analyzed factors predicting functional erections at 3 months post-RP as well as factors predicting a decrease in functional erections between 3 and 6 months, defined as ≥2-point drop in the erectile function domain. Multivariable logistic regression models were used to identify predictors of early erectile function recovery and also of subsequent decline. Erectile function recovery rates at 3 months post-RP and predictive factors; rates of erectile function decline between 3-6 months and associated predictors. Eligible patients comprised 1,655 men with median age of 62 (IQR 57, 67) years. Bilateral nerve-sparing (NS) surgery was performed in 71% of men, unilateral NS in 19%, and no NS in 10%. Of this population, 224 men (14%; 95% CI 12%, 15%) had functional erections at 3 months post-RP. On multivariable analysis, significant predictors of early erectile function recovery included: younger age (OR 0.93, P < .001), higher baseline erectile function domain score (OR 1.14, P < .001) and bilateral NS (OR 3.81, P=.002). The presence of diabetes (OR 0.43, P=.028) and a former smoking history (OR 0.63, P=.008; reference group: never smoker) was associated with the erectile dysfunction at 3 months post-RP. Of the men with early functional erections, 41% (95% CI 33%, 48%) had a ≥ 2-point decline in erectile function between 3 and 6 months. No factors were identified as predictors for this decline. Only a small proportion of men have functional erections at 3 months post-RP and a notable number of them will experience a decline in erectile function between 3 and 6 months. Strengths: large patient population and the use of validated questionnaire. single-center retrospective study. A minority of men had functional erections 3 months post-RP, about half of whom had a decline in erectile function by month 6. We recommend appropriately counseling post-RP patients on the risk of such a decline in erectile function. Salter CA, Tin AL, Bernie HL, et al. Predictors of Worsening Erectile Function in Men with Functional Erections Early After Radical Prostatectomy. J Sex Med 2022;19:1790-1796.

Primary organic versus primary psychogenic erectile dysfunction: Findings from a real-life cross-sectional study.

Erectile dysfunction aetiology has been historically identified as organic, psychogenic and mixed. To stratify and compare a cohort of patients seeking medical help for erectile dysfunction for the first time according to the newly proposed binary classification of the European Association of Urology guidelines: 'primary organic' versus 'primary psychogenic'. Complete data from 2009 consecutive patients presenting for erectile dysfunction were analysed. All patients completed the International Index of Erectile Function at baseline. According to the presence of erectile dysfunction-related risk factors indexed by the European Association of Urology Guidelines on Sexual and Reproductive Health, patients were categorised as having primary organic (≥1 risk factor) or primary psychogenic (0 risk factor) erectile dysfunction. Descriptive statistics compared the two groups. Linear regression analysis tested the association between the number of risk factors and erectile dysfunction severity. Locally estimated scatterplot smoothing method graphically explored the relationship between the number of risk factors for erectile dysfunction and the International Index of Erectile Function domain scores. Median (interquartile range) age at first presentation was 50 (39-61) years. Of all, 1632 (86.2%) and 377 (13.8%) were identified as having primary organic and primary psychogenic erectile dysfunction, respectively. Overall, 1488 (74.1%) patients were >40 years of age; in this subgroup, the most frequent risk factors were age, hypertension (29%), active smoking (42%) and alcohol intake (25.1%). Median (interquartile range) International Index of Erectile Function-erectile function score was 15 (7-22). Primary organic erectile dysfunction patients depicted lower International Index of Erectile Function-sexual desire and International Index of Erectile Function-orgasmic function scores (all p≤0.02), whilst groups did not differ in terms of International Index of Erectile Function-erectile function, International Index of Erectile Function-intercourse satisfaction and International Index of Erectile Function-overall satisfaction scores. One out of nine patients complaining of erectile dysfunction depict criteria for primary psychogenic erectile dysfunction. Erectile function severity could be as severe as patients with organic erectile dysfunction. The single-centre-based cross-sectional nature of the study, raising the possibility of selection biases, is our main limitation. One out of nine patients presenting for erectile dysfunction depict criteria suggestive for primary psychogenic erectile dysfunction in the real-life setting. Patients with primary psychogenic and primary organic erectile dysfunction have comparable erectile dysfunction severity, thus outlining the importance of a comprehensive and tailored management work-up in every patient seeking medical help for the first time.

Evaluating the impact of time between radical prostatectomy (RP) and adjuvant radiation therapy (RT) on erectile function recovery (EFR)

ABSTRACT Introduction RT post-RP in men with PSA recurrence improves survival. It is also associated with a higher rate of urinary incontinence and erectile dysfunction (ED). Objective We attempted to evaluate if the time period between RP and adjuvant RT predicts EFR outcomes. Methods Men who received RT post-RP with ≥2 years post-RT follow-up were analyzed. ADT and RT pre-RP were exclusions. Demographics, comorbidities and pathological parameters and IIEF erectile function domain (EFD) scores were recorded. We report median EFD scores and factors correlated with EFR ≥24 months post-RT. Factors included: patient age, comorbidities, smoking status, baseline pre-RP and pre-RT Testosterone (T), prostate specific antigen (PSA), baseline EFD score, Nerve-Vascular bundle (NVB) status, and time between RP and RT. Results 126 men were included. Mean age at RP was 63 ± 7 years. Mean pre-RP T was 390 ± 222 ng/dL, PSA, 10.2 ± 10.4 ng/mL and median EFD score were 27 (IQR = 20-30). Median pre-RT T was 376.9 ± 187 ng/dL, PSA 0.25 ± 0.33 ng/mL, and median EFD score was 9 (IQR = 3-20). 54% of patients had bilateral NVB preservation, and 29.5% unilateral. 71% received ADT with their RT, the median duration of ADT exposure was 4.5 (IQR = 3-8.5) months. Median time between RP and RT was 14.9 months (IQR = 8.5-28.6) months; 41% had ≤1 year between RP and RT. 2 years post RT, median EFD was 9.5 (IQR = 3-22). 22% had a score ≥24. EFD score at follow-up was correlated with age at RP (r=-0.32, p&amp;lt;.001), and pre-RT EFD score (r=0.56, p&amp;lt;.001). Time between RP and RT did not correlate with EFD score at follow up (r=0.08, p=0.39). Conclusions In our prostate cancer patients cohort post-RP/RT, EFR is lower; almost 4 of 5 patients will have some ED degree at two years post-RT. The period time between RP and RT is not correlated with EFR post-RT. Disclosure Work supported by industry: no.

Analyzing the impact of diabetes on erectile function recovery after radical prostatectomy

ABSTRACT Introduction Diabetes (DM) is a known risk factor for ED. The impact of DM on erectile function recovery (EFR) after radical prostatectomy (RP) is poorly understood. Objective We aimed to assess the impact of DM on the EFR after RP. Methods Men who had RP with ≥2 years follow-up constituted the study population. EFR was assessed using International Index of Erectile Function, Erectile Function Domain (EFD) score pre-RP and at 2 years post RP. ADT and radiation therapy before or after RP were exclusions. Demographics, comorbidities, pathological parameters were recorded. We performed univariate and multivariate logistic regression assessments to evaluate predictive factors, including DM, patient age, nerve sparing status (NSS) scored between 1 (preserved) to 4 (resected) for each side, and comorbidity profile, associated with poor EFR post-RP. Results 2024 men were included. Mean age at RP was 61.3±7.1 years. Median baseline and 2-year EFD scores were 27 (IQR = 19-30), and 13 (IQR = 5-25). 10% had DM with a mean pre-RP hemoglobin A1c of 6.6±1.3%. 44% had hypertension, 51% dyslipidemia, 14.5% obstructive sleep apnea, 5% history of coronary artery disease, 8% were current and 34% former smokers. 38% reported two or more comorbidities pre-RP. Median Gleason sum was 7. Nerves were preserved bilaterally in 77% and unilaterally in 16%. Median NS score was 3 (IQR 2-4). Median EFD scores at 2 years with and without DM were 7 (IQR 3-16), and 14 (IQR 5-25), respectively (p&amp;lt;0.001). At 2 years, in men with and without DM, the proportion with EFD ≥24 was 14% and 32% and EFD ≤10 was 63% and 42% respectively. Conclusion In our cohort, DM was a significant predictor of lower EFR at 2 years post-RP. Disclosure Work supported by industry: no.

Effectiveness and safety of the radial pressure waves for the treatment of erectile dysfunction. A randomized clinical trial

ABSTRACT Introduction The current management of vasculogenic erectile dysfunction is based mainly on getting an erection firm enough for sexual intercourse with pharmacologic treatment. Some studies have shown that shock waves improve erectile function and could be a way to treat the endothelium in the corpora cavernosa. Radial wave therapy is commercialized as an option for the management of erectile dysfunction. However, the mechanism of action of the radial waves differs substantially from shock waves, so the evidence gathered for shock wave therapy cannot be extrapolated, and are very few clinical trials with the radial wave. Objective To assess the efficacy and safety of radial wave therapy compared with sham therapy for the treatment of primary erectile dysfunction. Methods This was a randomized, double-blind, sham-controlled clinical trial. Eighty patients with moderate erectile dysfunction, without sickle cell anemia, anticoagulation treatment, comorbidities, or conditions associated with secondary erectile dysfunction were included. Patients were randomized 1:1 to one of two arms: 6 weekly sessions of radial wave therapy (RW group) or 6 weekly sessions of sham therapy (control group). The parameters for radial wave therapy were 1 weekly session, 4,000 pulses in the body of the penis in a sweeping technique and 2,000 pulses in the perineal area (bilateral ischiocavernosus and bulbospongiosus muscles) at 2.4 Bar and a frequency of 17 Hz. The sham therapy group received 6 weekly sessions under the same parameters of radial wave therapy, using an internal bar in the handpiece of the equipment to prevent the patient from receiving the wave. All patients received sildenafil 20 mg. The efficacy and safety were assessed at 6 and 10 weeks after randomization. The primary outcome was the mean change in the International Index of Erectile Function - Erectile Function (IIEF-EF) domain score at 6 weeks after randomization. An intention-to-treat analysis was performed. Results Eighty men were randomized. The average baseline IIEF-EF score was 16.3 +/- 3.2, and the median baseline erection hardness score (EHS) was 3 (range, 1 to 3). At 6 weeks after randomization, the average change in the IIEF-EF score was 3.4 (95% confidence interval [CI] 1.5-5.2) in the RW group and 4.2 (95% CI 2.5-5.9) in the control group (p = 0.742). A total of 36.8% of the patients in the sham therapy arm and 41.7% of the wave therapy arm increased the EHS by at least 1 point at week 6 after the end of treatment (p = 0.671). At week 10, this proportion was 26.3% and 30.6%, respectively, for each group (p = 0.686). There were no changes in the dose of sildenafil in any of the groups. Non-serious adverse events occurred in two (5%) patients after radial wave therapy, and in one (2.5%) patient after sham therapy. Conclusions No difference was found in this study between men with erectile dysfunction treated with radial waves and men treated with placebo sham therapy.

MP21-19 AN ALGORITHM TO PREDICT PENILE DOPPLER ULTRASOUND FINDINGS IN MEN WITH ERECTILE DYSFUNCTION

You have accessJournal of UrologyCME1 May 2022MP21-19 AN ALGORITHM TO PREDICT PENILE DOPPLER ULTRASOUND FINDINGS IN MEN WITH ERECTILE DYSFUNCTION Federico Belladelli, Massimiliano Raffo, Giuseppe Fallara, Edoardo Pozzi, Luigi Candela, Antonio Costa, Christian Corsini, Daniele Cignoli, Nicolò Schifano, Alessia d'Arma, Paolo Capogrosso, Luca Boeri, Eugenio Ventimiglia, Rayan Matloob, Vincenzo Mirone, Francesco Montorsi, and Andrea Salonia Federico BelladelliFederico Belladelli More articles by this author , Massimiliano RaffoMassimiliano Raffo More articles by this author , Giuseppe FallaraGiuseppe Fallara More articles by this author , Edoardo PozziEdoardo Pozzi More articles by this author , Luigi CandelaLuigi Candela More articles by this author , Antonio CostaAntonio Costa More articles by this author , Christian CorsiniChristian Corsini More articles by this author , Daniele CignoliDaniele Cignoli More articles by this author , Nicolò SchifanoNicolò Schifano More articles by this author , Alessia d'ArmaAlessia d'Arma More articles by this author , Paolo CapogrossoPaolo Capogrosso More articles by this author , Luca BoeriLuca Boeri More articles by this author , Eugenio VentimigliaEugenio Ventimiglia More articles by this author , Rayan MatloobRayan Matloob More articles by this author , Vincenzo MironeVincenzo Mirone More articles by this author , Francesco MontorsiFrancesco Montorsi More articles by this author , and Andrea SaloniaAndrea Salonia More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002554.19AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The use of dynamic duplex ultrasound of the penis (DDUP) has been proposed as a second-level test throughout the diagnostic work-up of men presenting with erectile dysfunction (ED). We investigated possible predictor factors for DDUP results. METHODS: DDUP data from 188 patients with ED were prospectively collected to rule out vasculogenic alterations (V-ED) at a single academic centre. Baseline data included: age, cardiovascular risk factors (hypertension, diabetes, total cholesterol levels, waist circumference, regular physical activities), BMI, smoking and alcohol habits and the International Index of Erectile Function – erectile function (IIEF-EF) domain scores. DDUP was performed after intracavernous injection of alprostadil 20 ug and sexual stimulation in all patients. V-ED was defined as a peak systolic velocity (PSV) <35 cm/s and a resistance index (RI) <0.8. We relied on Chi-square Automatic Interaction Detectors (CHAID), a recursive machine learning partitioning algorithm in order to identify risk groups for V-ED. ROC curve was applied to test the accuracy of the prediction for each risk group. RESULTS: Median (IQR) age was 54 (43-60) years and IIEF-EF was 14 (7-20). Of 188, 79 (42%) patients presented with Charlson Comorbidity Index (CCI)≥1. Overall, 57 (30%) and 17 (9%) had hypertension and diabetes, respectively. Median waist circumference was 98.5 (91-105) cm. Of all 164 (87%) patients reported moderate alcohol intake. At DDUP, V-ED was detected in 85 (45%) patients. The CHAID identified three groups: i) age ≤40 years; ii) age >40 years and waist circumference ≤102cm; iii) age >40 years and waist circumference >102cm. We named those groups as low-, intermediate-, and high-risk for V-ED. The risk of V-ED among the groups was: 16.7%, 41.6%, and 64.9%, respectively. ROC curve revealed that this risk classification has a good predictive ability (AUC: 0.67, 95%CI: 0.56-0.72). CONCLUSIONS: Our study challenges current guidelines regarding DDUP. Pending external validation, we propose performing DDUP only in case of intermediate- and high-risk patients, respectively. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e334 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Federico Belladelli More articles by this author Massimiliano Raffo More articles by this author Giuseppe Fallara More articles by this author Edoardo Pozzi More articles by this author Luigi Candela More articles by this author Antonio Costa More articles by this author Christian Corsini More articles by this author Daniele Cignoli More articles by this author Nicolò Schifano More articles by this author Alessia d'Arma More articles by this author Paolo Capogrosso More articles by this author Luca Boeri More articles by this author Eugenio Ventimiglia More articles by this author Rayan Matloob More articles by this author Vincenzo Mirone More articles by this author Francesco Montorsi More articles by this author Andrea Salonia More articles by this author Expand All Advertisement PDF DownloadLoading ...