Erection Hardness Score Research Articles

Low intensity Extra Corporeal Shock Wave Therapy in Patients with Erectile Dysfunction: Our experience in ACKU

Introduction: Oral 5-phosphodiesterase inhibitors (PDE5-I) is the main therapeutical options in erectile dysfunction (ED). It shows good results, but non-responders lack other effective options and its effect is also not long lasting. Since last few years, low-intensity extracorporeal shockwave therapy (Li-ESWT) in the corpora cavernosa showing promising results. This article presents our early experiences in Advanced Center of Kidney disease and Urology (ACKU) with the aim to evaluate clinical efficacy of Li-ESWT. Materials and methods: Thirty four patients with ED were prospectively included in the study during the period of January 2018 to Jun 2019.Treatment was performed using the PiezoWave2 (Richard Wolf, Germany) device with a linear probe. Treatment protocol included a weekly session for four weeks. Each session delivered 2000 shocks on the perineum plus 4000 shocks on dorsum penis with an energy flux density (EFD) of 0.160 mJ/mm2. Every patient has been re-evaluated 1.5 and 3 months after the last session. Pre- and post-procedure International Index Erectile Function – Erectile function domain (IIEF-EF) score, Erection Hardness Score (EHS) and Global Assessment Questionnaire-Question 1 (GAQ-Q1) answers were obtained. Results: Mean age of the study population was 39.4 (±12.9) years, 35.29% diabetic, 20.59% with hypertension and 55.85% smokers. Mean baseline IIEF-EF was 14.6, at 6 week post LiSWT was 16.4 (p >0.05) and at 3 months post LiSWT was 19.2 (p < 0.05). EHS was significantly improved at 3 month in comparison to baseline (p<0.05). 20.59% patients answered positively to GAQ-Q1 at 6 week and 61.76% at 3 months. IIEF-EF score change of >5 and increase of EHS >2 were observed in 62.88% and 70.59% study subjects respectively. Conclusions: Li-ESWT is a safe, harmless and repeatable treatment tool for ED with good outcomes reported. Bangladesh Journal of Urology, Vol. 23, No. 2, July 2020 p.176-180

Effects of "metabolic memory" on erectile function in diabetic men: A retrospective case-control study.

This study was performed to explore the effects of metabolic memory on diabetic erectile dysfunction (ED), especially the severity and response to treatment. Through medical records and follow-up by telephone, 67 patients meeting the criteria with a clinical diagnosis of ED and a diabetic history of more than 5years were enrolled for erectile function analysis. They were divided into a glycemic control group, a glycemic non-control group and a metabolic memory group according to glycemic levels and treatments for diabetes in the past 5years, and they were treated with phosphodiesterase type 5 (PDE5) inhibitors for 4weeks. Erectile function and efficacy were assessed by the International Index for Erectile Function (IIEF), the Erection Hardness Score (EHS), and the Sexual Encounter Profile (SEP). The patients in the glycemic control group performed better in erectile function than those in the other groups. The patients in the glycemic control group received a significantly greater score on both the EHS and the five domains of the IIEF than did the patients in the glycemic non-control group and the metabolic memory group (all P<.001). There were also statistically significant differences favoring the glycemic control group (P<.05) in SEP2 and SEP3 success rates. However, there were no significant differences between the metabolic memory group and the glycemic non-control group in these erectile function assessments (P>.05). Significant negative correlations were seen between HbA1c levels at the time of consultation and the scores on the IIEF-EF and the EHS (Pearson r-values of -0.338 with P=.005 and -0.273 with P=.025, respectively). HbA1c levels at the first diagnosis of diabetes mellitus (DM) were also significantly negatively correlated with scores on the IIEF-EF and the EHS with greater Pearson correlation coefficients (Pearson r-values of -0.478 with P<.001 and -0.392 with P=.001, respectively). Significant improvements on each of the erectile function assessments were observed among diabetic patients with ED, but no significant difference in efficacy was observed between each group. The phenomenon of metabolic memory did have a significant influence on ED in men with diabetes, associated with the severity of ED but not the response to medical treatment. Early hyperglycemia exposure would have long-term disadvantageous effects on erectile function in diabetic patients with ED, which would be sustained even after the patients achieve better glycemic control. In this report, we looked at the erectile functions of 67 patients with a clinical diagnosis of ED and a diabetic history of more than 5years. We found that early hyperglycemia exposure would have long-term disadvantageous effects on erectile function in diabetic patients with ED, which would be sustained even after the patients achieve better glycemic control. We further found that the effects were associated with the severity of ED but not the response to medical treatment in men with diabetes.

Erectile Dysfunction Resistant to Medical Treatment Caused by Cavernovenous Leakage: An Innovative Surgical Approach Combining Pre-operative Work Up, Embolisation, and Open Surgery

Thirty per cent of cases of erectile dysfunction (ED)/male impotence are resistant to oral treatment. Half of these cases are due to blood drainage from the corpora cavernosa occurring too soon, due to cavernovenous leakage (CVL). The aim of this study was to report on an innovative treatment scheme combining pre- and post-operative haemodynamic assessment, venous embolisation, and open surgery for drug resistant ED caused by CVL. An analysis of prospectively collected data, with clinical and haemodynamic pre- and post-operative assessment, was carried out. Forty-five consecutive patients operated on for drug resistant ED caused by CVL were evaluated pre-operatively and three months post-operatively by pharmacologically challenged penile duplex sonography (PC-PDS), pharmacologically challenged Erection Hardness Score (PC-EHS), and pharmacologically challenged computed caverno tomography (PC-CCT). Follow up consisted of patient interview, PC-PDS, PC-EHS and if needed PC-CCT. Mean patient age was 43.9±12.0 years (range 20-67). Forty-nine per cent of patients had primary ED. Patients with diabetes, a smoking habit, hypercholesterolaemia, and hypertension were 18%, 11%, 9%, and 4%, respectively. Three months post-operatively, PC-EHS increased from 2.0±0.7 to 3.1±0.74 (p<.001), with an EHS of 3 being the threshold allowing for penetration. Deep dorsal vein velocity, a haemodynamic marker of CVL, decreased from 14.2±13.0 to 0.9±3.5cm/s (p<.001). After a 14.0±10.7 month follow up, the primary success rate (clinical EHS≥3, possible sexual intercourse with penetration, no vascular re-operation, no penile prosthesis implant) was 73.3%. Four patients (9%) underwent successful re-operation for persistent ED and CVL. Accordingly, compared with a possible penetration rate of 8.9% before surgery, 37 patients (secondary success rate: 82.2%) were able to achieve sexual intercourse with penetration. Type of ED (primary vs. secondary) and diabetes had no influence on the results. Thirty-two per cent of patients with secondary success achieved penetration with no medication. After a 14 month follow up, pre-operative work up, embolisation, and open surgery during the same procedure allowed patients with ED resistant to oral medical to achieve intercourse with penetration.

Effect of Intracavernosal Injection of Prostaglandin E1 on Duration and Rigidity of Erection in Patients With Vasculogenic Erectile Dysfunction: Is It Dose Dependent?

ObjectiveTo assess if the effect of intracavernosal injection of prostaglandin E1 (PGE1) on duration and rigidity of erection is dose dependent in patients with different types of vasculogenic erectile dysfunction (ED)? MethodsA hundred patients with ED were assigned into 4 groups (n = 25/each); group (A) patients with arteriogenic ED, group (B) patients with veno-occlusive ED, group (C) patients with mixed (arteriogenic and veno-occlusive) ED, and group (D) patients who have only psychogenic ED (control). After intracavernosal injection of PGE1, patients were assessed using penile Doppler ultrasonography and erection hardness score together with calculation of erection duration. The starting dose of PGE1 was 5 μg which was increased to 10 µg and 20 µg as a maximal dose when needed. ResultsThe mean PSV of patients in groups A, B, C, and D were 24.38 ± 3.3, 37.74 ± 8.28, 22.24 ± 3.85, and 47.76 ± 6.27, respectively. In group D, 88% have achieved the best response at dose of 5 µg while 5.3%, 21.7%, and 0% have achieved the best response at dose of 5 µg in groups A, B, and C, respectively (P < .05 for each). The rest of patients have required either 10 or 20µg to achieve the best response. Patients in group C have required the highest dose of PGE1 to achieve the best response (P < .05). ConclusionIntracavernosal injection of PGE1 in escalating doses have improved the rigidity and duration of erection in patients with different types of vasculogenic ED. Patients with mixed arteriogenic and veno-occlusive ED have required the highest dose of PGE1 to achieve the best response.

Multicenter Prospective Study of Grafting With Collagen Fleece TachoSil in Patients With Peyronie's Disease

BackgroundA xenograft consisting of equine collagen coated with human fibrinogen and thrombin (TachoSil; Baxter, CA) has recently been introduced in grafting procedures for Peyronie’s disease (PD). AimTo describe the results of a multicenter prospective registry on patients with PD undergoing plaque incision or and grafting (PIG) or plaque excision and grafting (PEG) with collagen fleece TachoSil, to evaluate the efficacy and safety of this procedure. MethodsA prospective non-controlled multicenter study of patients with PD was performed between May 2016 and March 2018. Patients from 10 centers with stable PD for at least 3 months, difficulties in sexual intercourse, normal erectile function with or without pharmacological treatment, curvature >45°, and/or penile shortening and/or complex deformities were included. All patients underwent PIG/PEG with collagen fleece TachoSil. OutcomesThe main outcome measure of this study were penile curvature correction (intraoperative), penile shortening (intraoperative), erectile function with the 5-item version of the International Index of Erectile Function (IIEF-5) and the Erection Hardness Score, subjective patient outcomes with non-validated questionnaires, and complications. ResultsA total of 52 patients were enrolled in the study. The mean (SD) preoperative penile curvature was 72.8° (17.0). PIG was the preferred technique (80.8%). Intraoperatively, complete curvature correction was achieved in 92.3%, and no significant penile shortening was recorded in 80.8% of subjects. Subjective penile shortening was reported in 83.3% of patients at 6 months. No objective measurement of penile curvature and length was recorded during follow-up. No statistically significant difference from the baseline was found in IIEF-5 and Erection Hardness Score at 3 or at 6 months, although 16.7% of men experienced a worsening of IIEF-5 scores and 14.3% required de novo phosphodiesterase type 5 inhibitor use. 6 months after surgery, 78.5% of men were satisfied with intervention. Swelling and ecchymosis/hematoma were the most common perioperative complications (40.4%). 2 cases (3.8%) of wound infection were recorded. At 6 months, 35.7% of patients reported mild penile hypesthesia. Clinical implicationsOur results confirm the high success rate of grafting with TachoSil, and the surgeon perceived low percentage of penile shortening. Strength & LimitationsThis is the first multicentre study on patients with PD undergoing grafting with TachoSil without concomitant placement of penile prosthesis. The main limitations are the short follow-up and the relatively small sample size. ConclusionGrafting with TachoSil after PIG/PEG in patients with PD is an effective and safe procedure. Among the main advantages of this technique, there are ease of use of the graft and reduced operative time.Fernández-Pascual E, Manfredi C, Torremadé J, et al. Multicenter Prospective Study of Grafting With Collagen Fleece TachoSil in Patients With Peyronie's Disease. J Sex Med 2020;17:2279–2286.

Study on the combination of brief psychodynamic psychotherapy with Viagra in the treatment of non-organic ED

BackgroundErectile dysfunction (ED) has gradually become an important issue that seriously affects the quality of life of Chinese men. In addition to classic oral medications, psychotherapeutic interventions are increasingly being...

Efficiency of intracavernosal alprostadil and oral clomiphene citrate combination treatment in penile vasculogenic erectile dysfunction patients accompanied by late-onset hypogonadism.

In this study, the efficiency of intracavernosal alprostadil+oral clomiphene citrate (CC) treatment in late-onset hypogonadism (LOH) accompanied by penile vasculogenic erectile dysfunction (PVED) in patients irresponsive to phosphodiesterase type 5 inhibitor treatment was evaluated. A total of 31 patients with concurrent PVED and LOH were included in the study. The patients were given intracavernosal alprostadil (10-20μg) and oral CC (50mg) every day for 12weeks. Before and after treatment, a 15-question International Index of Erectile Function (IIEF-15) questionnaire, Erection Hardness Score (EHS), Sexual Encounter Profile (SEP)2 and SEP3 levels were analysed, and follicle stimulating hormone (FSH), luteinising hormone (LH), total testosterone and prostate-specific antigen (PSA) levels were measured. In all, 41.9% of patients had pure arterial deficiency, 19.3% had pure venous deficiency, and 38.7% had arterial+venous (mixed) deficiency. A significant increase was detected in total testosterone, FSH, LH and PSA values after treatment when compared to values before treatment (p<.001, p<.001, p<.001 and p=.034 respectively). A significant recovery was observed in IIEF-15 subscores, EHS and SEP2-SEP3 results. In PVED patients accompanied by LOH, intracavernosal alprostadil and oral CC combination is an efficient, low cost, safely applicable and tolerable treatment.

A Critical Analysis of Methodology Pitfalls in Duplex Doppler Ultrasound in the Evaluation of Patients With Erectile Dysfunction: Technical and Interpretation Deficiencies

BackgroundPenile duplex Doppler ultrasound (PDDU) is a minimally invasive tool to evaluate erectile hemodynamics in patients with erectile dysfunction (ED). Despite decades of use, there is still a large variability in PDDU protocols, and a high rate of false diagnosis is reported. AimReview of PDDU methodology in the published literature addressing protocol heterogeneity, technical and interpretation challenges. MethodsA PubMed literature search was performed using the search terms “penile doppler ultrasound”, “penile duplex ultrasound” or “penile ultrasound”, and “Erectile dysfunction”. Studies were analyzed for the presence of the following elements in reporting of the PDDU protocol: (i) intracavernosal vasoactive agents used, (ii) use of a redosing protocol, (iii) means of rigidity assessment, (iv) report of at-home best-quality erection, (v) normative criteria for peak systolic velocity (PSV) and end-diastolic velocity (EDV), and (vi) use of time-based hemodynamics assessment. Inclusion criteria were studies available in English, from 2005 onwards, and with full text. Exclusion criteria were review, descriptive or short communication articles, animal studies, and studies in populations other than those with ED. OutcomesA critical review of the heterogeneity in published literature was performed to guide a structured discussion of methodological challenges and to create a list of recommendations. ResultsSignificant heterogeneity was seen in key methodological aspects. Fifty percent of studies reported the use of prostaglandin E1 only, and 12% of studies did not mention the agent used. Redosing as part of the PDDU protocol was mentioned in only 26% of studies. The majority (56%) did not mention any form of rigidity assessment. The most frequently used grading system was the Erection Hardness Score (14%). Overall, most studies (59%) used a timed-base protocol for hemodynamic assessment. No clear consensus was defined for normative criteria for PSV and EDV, 39% defining a normal PSV as ≥30 cm/s, and 57% using EDV values ≤5 cm/sec as normal. Clinical ImplicationsThe absence of standardization has led to inadequate reporting of key factors which has rendered data interpretation and comparison between studies challenging. Strengths and LimitationsOur strengths include an extensive review of literature, with a structured analysis of the impact of each methodological pitfall. Our main limitation is the fact that protocol reporting, and not its application, was assessed. ConclusionDespite its widespread use, analysis of the literature on PDDU use in the ED population shows marked protocol heterogeneity, rendering data interpretation a problem.Nascimento B, Miranda EP, Terrier JE, et al. A Critical Analysis of Methodology Pitfalls in Duplex Doppler Ultrasound in the Evaluation of Patients With Erectile Dysfunction: Technical and Interpretation Deficiencies. J Sex Med 2020;17:1416–1422.

Use of the ice water test as an early predictor of recovery of erectile function in patients with spinal cord injury.

Retrospective, cross-sectional. To determine the capacity of the ice water test (IWT) to predict erectile function during the early phase of spinal cord injury (SCI). France. This was a retrospective, cross-sectional study. Data from patients with SCI were included if they presented with neurogenic shock causing erectile dysfunction AND detrusor underactivity, and had undergone the following evaluations during the first 6 months post SCI (E1), and again at least 2 years later (E2): a complete neurological examination, urodynamic evaluation with the IWT, and evaluation by the Erection Hardness Score (EHS, from 0 to 4). Patients with cauda equina syndromes were excluded. Data from 62 patients with SCI were included, 37 with a positive IWT and 25 with a negative IWT. E1 was performed at 3.2 months ± 1.9, and E2 at 2.0 years ± 2.9 post SCI. At E2, 95% of patients with an initial positive IWT had reliable erections (EHS 3 or 4), compared with 0% of patients with a negative IWT. Neurogenic detrusor overactivity was found in 89% of patients with a positive IWT compared with 8% with a negative IWT. The IWT had a good sensitivity and negative predictive value: 100% for erectile function, and respectively 94 and 92% for bladder function. The IWT is a reliable and predictive test of erectile potential in patients with sacral and suprasacral SCI.

Association between masturbation and functional outcome in the postoperative course after nerve-sparing radical prostatectomy.

BackgroundPenile rehabilitation after nerve-sparing radical prostatectomy (nsRP) improves the functional outcome, i.e., erectile function and urinary continence. Masturbation as a concept of penile rehabilitation has been practically not investigated. The aim of this observational and explorative study was to evaluate the association between masturbation and the recovery of the functional outcome in patients after nsRP.MethodsPatients after nsRP (11/2013-3/2016) with preoperative International Erectile Function Score-Erectile Function (IIEF-EF) of ≥22 and/or Erection Hardness Score (EHS) of ≥3 without neo- or adjuvant therapy were included in this analysis. Patients were classified according to their masturbation behavior (yes: m; no: nm). Chi-square tests were used to test for association between masturbation and functional outcome. The main outcome measures were rates of erectile function, morning erections, and urinary continence 6, 12, 24, and 36 months after nsRP.ResultsA total of 250 preoperatively potent patients with median age of 63.8 years (1st, 3rd quartile: 59.1, 69.6) at nsRP were included. After 24 months, m-patients had a numerically higher rate of moderate to good erectile function compared to nm-patients (47.5% vs. 37.5%; P=0.193) and had morning erections more often than nm-patients (54.6% vs. 34.9%; P=0.011). Urinary continence rate 12 months after nsRP was higher compared to nm-patients (12 months: 83.1% vs. 70.2%; P=0.042).ConclusionsMasturbation might be a promising approach of both erectile function and urinary continence recovery, and patients could be encouraged to masturbate after nsRP. However, due to the study design, causality cannot be concluded. Thus, masturbation as a possible concept of penile rehabilitation warrants further investigation.

Efficacy of H-shaped incision with bovine pericardial graft in Peyronie's disease: a 1-year follow-up using penile Doppler ultrasonography.

We present our experience with the use of an H-shaped incision and a bovine pericardial graft in patients with Peyronie's disease (PD). In this retrospective study, 21 male patients with PD who underwent an H-shaped incision and received a bovine pericardial graft were included and followed for at least 1 year. The degree of penile curvature in all subjects was >60°. Patients had no erectile dysfunction prior to surgery. Outcomes assessed were resistive index (RI) in penile Doppler ultrasonography, improvements in curvature, erection hardness score, and postoperative patient satisfaction. The median age of the 21 patients was 58 (55, 63) years and the median duration of PD was 7 (6, 12) months. As the efficacy variable, there was no statistically significant change in the RI of the corpus cavernosum at 1 year post-surgery. The degree of penile curvature in the erectile state was remarkably decreased from 70 (60, 90) degree to 5 (5, 15) degree (P < 0.001). There was no significant change in the erection hardness score before and after surgery. Patient satisfaction evaluated via a Likert-type scale at 1 year after surgery was 4 (4, 5). In multiple linear regression analysis, patient satisfaction was correlated with the intraoperative defect size created by H-shaped incision (P = 0.009) and inversely related with the residual curvature (P < 0.001). The results from the subjective symptom score and the objective penile Doppler ultrasonography suggest that the H-shaped incision and the subsequent graft with the bovine pericardium is safe and effective in patients with PD. It is necessary to minimize the remnant curvature during graft surgery, because postoperative patient satisfaction was closely correlated with postoperative residual curvature.

Prevalence of priapism in individuals with sickle cell disease and implications on male sexual function.

ABSTRACTObjective To evaluate epidemiological aspects of priapism in patients with sickle cell disease, and these aspects impact on adult sexual function.Methods This was a cross-sectional study including individuals with sickle cell disease who were evaluated at a reference center for sickle cell. Participants completed a structured questionnaire about their sociodemographic characteristics and priapism events. Sexual function was assessed using validated two instruments, the Erection Hardness Score and one about the sex life satisfaction.Results Sixty-four individuals with median aged of 12 (7 to 28) years were interviewed. The prevalence of priapism was 35.9% (23/64). The earliest priapism episode occurred at 2 years of age and the latest at 42 years. The statistical projection was that 71.1% of individuals of the study would have at least one episode of priapism throughout life. Patients with episodes of priapism (10/23) had significantly worse erectile function Erection Hardness Score of 2 [1-3]; p=0.01 and were less satisfied with sexual life 3 [3-5]; p=0.02.Conclusion Priapism is usually present in childhood, and severe episodes are associated with cavernous damage, impairment in the quality of the erection, and lower sexual satisfaction.

The Comparable Results of Minimally Invasive Therapy versus Primary Anastomosis in the Management of Partial Posterior Urethral Stricture

BACKGROUND: Urinary retention has many etiologies. One of them is urethral stricture or the narrowing of urethral lumen due to fibrotic tissue. Urethral stricture is considered a medical emergency condition because it might cause complications in some extent. At present, there are several surgical techniques introduced with their advantages and disadvantages.&#x0D; AIM: The study aimed to compare the outcome of minimal invasive therapy (MIT) or excision and primary anastomosis (EPA) techniques.&#x0D; METHODS: A retrospective cohort study was performed on patients with partial posterior urethral stricture. The inclusion criteria were all patients with partial posterior urethral stricture who underwent MIT or EPA from 2014 to 2018. The data of International Prostate Symptom Score (IPSS), quality of life (QoL), urinary peak flow rate (Qmax), urine residue, erection hardness score, clean intermittent catheterization (CIC), recurrence, and penile perception scores (PPS) were obtained and analyzed postoperatively.&#x0D; RESULTS: Thirty-four patients included in the study, consisted of 17 patients for each group. EPA group showed significantly superior to MIT in Qmax (p &lt; 0.001), CIC (p = 0.007), and PPS score (p = 0.003). However, no significance differences were found in QoL (p = 0.071), IPSS score (p = 0.083), bladder urine residue (p = 0.688), recurrence (p = 0.225), and erectile function (p = 0.303).&#x0D; CONCLUSION: EPA may be superior to MIT in some aspect. However, other advantages of MIT could be outweighed EPA techniques, such as QoL, IPSS, bladder urine residual, stricture recurrence, and erectile function. MIT still has a place to be the first-line management of partial posterior urethral stricture.

Lipid abnormality, current diabetes and age affect erectile hardness: An analysis of data from complete medical checkups carried out at a single hospital.

To investigate the correlation between the Erection Hardness Score and both erectile function and metabolic and lifestyle factors. This study included 548 men who underwent a complete standard medical checkup at Yokohama Shin-midori General Hospital between 1 July 2016 and 31 August 2018, and answered the question about erectile hardness. The following variables were evaluated: age, erectile hardness on the Erection Hardness Score, erectile function on the Sexual Health Inventory for Men, current medical history (diabetes, hypertension, dyslipidemia, heart disease, stroke), metabolic risk factors (abdominal circumference, hyperglycemia, high blood pressure, lipid abnormality) and lifestyle factors. First, to examine the correlation between erectile hardness and erectile function, the mean Sexual Health Inventory for Men score by Erection Hardness Score grade was determined for each age group. Then, an analysis was carried out to examine the association between erectile hardness and age, current medical history, metabolic risk factors, and lifestyle factors. In each age group, a lower Erection Hardness Score grade was associated with a lower mean Sexual Health Inventory for Men score. Lipid abnormality, diabetes and age were independent risk factors for decreased erectile hardness. Erection Hardness Score is a useful tool that can easily and accurately assess erectile function in the settings of medical checkups and clinical practice. Diabetes and lipid abnormality affect erectile hardness.

Assessment of Intrapelvic Blood Flow with the Penile Brachial Index Using a Toe Blood Pressure Cuff in Japanese Patients with Lower Urinary Tract Symptoms

Purpose: We aim at investigating the relationship between lower urinary tract symptoms (LUTSs) and intrapelvic blood flow. Conventionally, intrapelvic blood flow is assessed using a Doppler blood flowmeter. In this study, the penile brachial pressure index (PBI), which is a simpler tool, was used. Materials and Methods: The participants of this study were 103 male outpatients with LUTS whose PBI was measured using the form pulse wave velocity/ankle-brachial index with a toe blood pressure cuff. Data including age, body mass index (BMI), penile blood pressure, PBI, complications (hypertension, dyslipidemia, and diabetes mellitus), International Prostate Symptom Score (IPSS), and Erection Hardness Score (EHS) were retrospectively examined. LUTS positivity was defined as an IPSS score ≥8 and LUTS negativity as an IPSS score &lt;8. Results: The PBI and EHS scores were significantly higher in the LUTS-negative participants than in the LUTS-positive participants. Furthermore, a multivariate analysis showed a significant difference only in PBI. However, age, BMI, EHS, or previous history of complications did not significantly differ. Conclusion: PBI was found to be an independent factor of LUTS. Recent studies have shown that LUTS and erectile dysfunction are associated with lifestyle-related diseases, and that these conditions are caused due to impaired blood flow in the intrapelvic arteries due to arteriosclerosis. Therefore, LUTS should be treated as a vascular disease.

Prevalence of Premature Ejaculation among Patients with Type 2 Diabetes in a Tertiary Health Institution: A Cross-Sectional Study

Background: Premature ejaculation (PE) is one of the sexual dysfunctions commonly present among patients with diabetes mellitus (DM), but rarely reported and not commonly investigated compared to erectile dysfunction. In this study, we aimed to investigate the prevalence of PE in a group of patients with type 2 DM and explore possible determinants of its occurrence and its association with erectile dysfunction. Methods: This was a cross-sectional study of subjects recruited from the Diabetes clinic and whose sexual function was assessed using the premature ejaculation diagnostic tool (PEDT) and erection hardness score (EHS), who were in heterosexuals relationship and resides together with their wives and had no major organ failure or acute infection within the last 1 month. Other socio-demographic history and diabetes-related questions were assessed. Results: A total of 69 subjects were recruited. The prevalence of PE was 27.5% in the study. There was a significant inverse relationship between the prevalence of premature ejaculation and frequency of sexual intercourse. Almost half 14/30 (46.7%) of those with erectile dysfunction had premature ejaculation. Diabetic patients with erectile dysfunction (ED) showed a significantly higher incidence of PE with significantly lower values of EHS. Higher level of fasting blood glucose was associated with higher prevalence of erectile dysfunction. Conclusions: The prevalence of PE was relatively high at 19/69 (27.5%) among our type 2 diabetic patients. Hence, health care giver should always endeavour to ask about it even when patients do not volunteer the information.

036 A Trial of Low-Intensity Shockwave Therapy for Penile Rehabilitation After Radical Prostatectomy

Erectile dysfunction (ED) is a common complication of radical prostatectomy, usually due to nerve damage. Low-intensity shockwave therapy (LISWT) is an encouraging new treatment for men with vasculogenic ED, but the role of LISWT in the post-prostatectomy setting is unknown, as existing LISWT trials excluded men who underwent prostatectomy. Interestingly, rat models of cavernosal nerve injury suggest LISWT may restore penile blood flow via revascularization and neuronal regeneration. We hypothesize that LISWT-based penile rehabilitation will accelerate recovery of erectile function following nerve-sparing radical prostatectomy. To evaluate the hypothesis that PDE5i therapy combined with LISWT, delivered early in the post-prostatectomy period, will lead to more rapid recovery of erectile function compared to men treated with PDE5i alone. This is an interim analysis of an IRB approved, non-randomized trial of LISWT for penile rehabilitation. Patients were identified for inclusion if their pre-operative sexual health inventory for men (SHIM) score was ≥ 17 and they underwent a bilateral nerve-sparing prostatectomy at our academic referral hospital. Exclusion criteria included: concurrent use of intracavernosal injections or vacuum erectile device; or Gleason Grade Group ≥ 4 disease. Men were enrolled in either the LISWT arm (intervention) or the PDE5i only arm (control) at their own discretion. Beginning two weeks post-operatively, intervention patients received six consecutive LISWT sessions delivered once weekly using the Zimmer enPuls 2.0 device. During each session, settings were 90 mJ and 15 Hz to deliver a total of 10,000 “shocks” distributed to the corpora and cavernosal neurovascular bundles bilaterally. SHIM and erection hardness score (EHS) surveys were mailed to both cohorts at 6, 12, and 24-weeks post-operatively. All patients were prescribed a PDE5i at the discretion of their treating surgeon.

Efficacy and Safety of Combined Phosphodiesterase Type 5 Inhibitors as a Salvage Medical Treatment in Patients with Erectile Dysfunction after Nerve-Sparing Radical Prostatectomy

Purpose Penile rehabilitation therapy using phosphodiesterase type 5 inhibitors (PDE5i) is used widely as a first-line therapy in patients with erectile dysfunction (ED) after radical prostatectomy (RP). However, many patients undergoing such therapy still complain of inappropriate erectile function (EF). Therefore, we evaluated the efficacy and safety of combined PDE5i therapy as a salvage medical treatment in patients nonresponsive to initial penile rehabilitation using daily PDE5i after nerve-sparing RP. Methods We retrospectively reviewed 58 nonresponders (Erection Hardness Score [EHS] of 2 or less) to penile rehabilitation using tadalafil (5 mg) daily for more than 12 weeks and who subsequently received combined PDE5i therapy (tadalafil [5 mg] once daily with sildenafil [50 mg] or udenafil [100 mg] on demand). Success after combined therapy is defined by EHS scores of 3 or 4. Safety was assessed by observing drug tolera-bility and adverse events. Results Of the 58 patients, combined therapy was successful in 39.7% of cases. The mean preoperative International Index of Erectile Function (IIEF-5) score was significantly higher in the success group after combined&nbsp;PDE5i therapy compared with the failure group (success group, 15.9 &plusmn; 5.1 versus failure group, 12.3 &plusmn; 5.6; p = 0.018). According to ED classification based on preoperative IIEF-5 scores, the success rates of no/mild/mild-to-moderate ED group and moderate/severe ED group were 50.0% (18/36) and 22.7% (5/22), respec-tively (p = 0.039). The success and failure groups did not differ significantly in any other characteristic. The drugs were tolerated well by all patients and no serious adverse events were observed. Conclusion Combined PDE5i therapy improves EF in patients nonresponsive to standard penile rehabilitation using daily PDE5i after nerve-sparing RP, especially for patients without preoperative moderate or severe ED. In such patients, combined PDE5i therapy could be considered before invasive therapies.

Sexual life and medication taking behaviours in young men: An online survey of 92620 respondents in China.

To assess sexual life and medication taking behaviours in young Chinese men. An online survey was conducted across China between January 2017 and April 2017. Among the participants, men aged 19-40years were included in the analysis. The respondents filled in the online questionnaire assessing sexual life and medication taking behaviours by themselves, including general information, cognition of erectile dysfunction (ED) and treatment-related questions. Erection hardness score (EHS) was used to measure the erection hardness status. Among the young respondents, 20.54% had grade I-II EHS, 58.14% searched the internet for online ED-related information, 26.49% took an ED medication and 50.89% took an ED medication without the advice of a physician or pharmacist. The respondents who took medication had less sexual intercourse per week (P<.001) and worse EHS (P<.001), and were more willing to seek information from physicians, pharmacists, friends and relatives instead of online sources (P<.001), compared with those not taking medication. The most common comorbidities in patients with grade I-II EHS were hyperlipidaemia, cardiovascular disease (CVD), prostate diseases and diabetes mellitus. About 20% of young Chinese men needed further assessment for ED. The majority of respondents obtained ED-related information by online search and took an ED medication without professional advice. These data could help clinicians understand the current status of sexual life and medication taking behaviours of young Chinese men.

Long-term effectiveness and predictors of success of low-intensity shockwave therapy in phosphodiesterase type 5 inhibitors non-responders

ABSTRACTObjective: To evaluate the long-term (18 months) effectiveness, safety, and factors that may predict the success of low-intensity shockwave lithotripsy (Li-SWT) in patients with erectile dysfunction (ED) who fail to respond to oral phosphodiesterase type 5 inhibitors (PDE5i).Patients and Methods: This prospective study included 52 patients with ED of vascular origin who failed to respond to oral PDE5i. The International Index of Erectile Function-Erectile Function domain (IIEF-EF) and Erection Hardness Score (EHS) questionnaires were used to evaluate EF. Patients under went two Li-SWT treatment sessions per week for 3 weeks, followed by a 3-week treatment-free period, and the cycle was repeated until each patient received 12 treatment sessions. Patients were followed-up after Li-SWT at 3, 6, 12, and 18 months.Results: At the 18-month follow-up, 33 patients (63.5%) were able to achieve an erection sufficient for penetration with or without PDE5i (22 were maintained on oral PDE5i). The remaining 19 patients (36.5%) had a poor response to Li-SWT and oral PDE5i. The initial response showed some decline in 50% of the initial responders. Younger men (aged <45 years), short ED duration (<2 years), and moderate ED severity responded better to Li-SWT. There were no adverse side-effects.Conclusion: In the present study, Li-SWT was a safe and effective treatment in 63.5% of men with ED who failed to respond to oral PDE5i. Factors such as age (<45 years), ED duration (<2 years), and ED severity can predict treatment outcome in such patients.Abbreviations: CDU: colour Doppler ultrasonography; ED: erectile dysfunction; EDV: end-diastolic velocity; EF: erectile function; EHS: Erection Hardness Score; FU: follow-up; IIEF-EF: International Index of Erectile Function-EF domain; Li-SWT: low-intensity shockwave lithotripsy; PDE5i: phosphodiesterase type 5 inhibitors; PGE1: prostaglandin E1; PSV: peak systolic velocity; RI: resistive index; VOD: veno-occlusive dysfunction