IIEF-5 Questionnaire Research Articles

Sauna Bathing Habits and Erectile Dysfunction-Tampere Ageing Male Urologic Study (TAMUS)

Objective: To evaluate a possible effect of Finnish sauna bathing on erectile dysfunction (ED). Materials and Methods: A population-based study was conducted using a mailed questionnaire sent to 5,537 men in 2019. The frequency of sauna bathing was grouped into three categories: once a month or less, once a week and two or more times per week. ED was assessed using the IIEF-5 questionnaire. The questionnaire comprised also items on sociodemographic, medical history; ED and treatment for ED. Chi-square tests and logistic regression analysis were used for statistical analysis. Results: The study cohort included 2,644 men (47.8% response proportion). Frequency of sauna bathing did not affect to IIEF-5 scores (the mean scores for different groups were all close to 20.5) nor to severity of ED. Logistic regression analysis with adjustment for other risk factor showed no association between sauna bathing frequency and ED. Nevertheless, frequency of sexual intercourse was higher among men sauna bathing two or more times per week as mean monthly number of sexual intercourses was 3.5 compared with 2.8-2.5 in the other groups. Other factors than sauna bathing probably explain differences concerning intercourse amounts. There was no statistically significant difference in the use of medication for ED between sauna bathing groups. Conclusions: In our population-based study, sauna bathing does not have effect on ED, although more frequent sauna bathers had more sexual intercourses and had fewer risk factors for ED. Other factors than sauna bathing probably explain differences concerning intercourse amounts.

O-199 Couples presenting to Infertility clinics - Are they really infertile?

Abstract Study question Are couples presenting to infertility clinics actually infertile, or is there an undiagnosed underlying sexual dysfunction whose treatment can lead to natural conception avoiding the need for assisted reproductive techniques? Summary answer All couples presenting with infertility should be asked about sexual function. If sexual dysfunction is diagnosed, a signicant proportion can achieve pregnancy without assisted reproduction What is known already Infertility is defined as the inability to conceive after one year of frequent and regular unprotected sexual intercourse (SI). Although sexual histories are a key part of primary care screening guidelines for infertility, they are often overlooked during the infertility work-up. It is postulated that a large proportion of couples presenting to infertility clinics have underlying sexual dysfunction. Treatment through specialist counselling for couples with sexual dysfunction can help achieve pregnancy, negating the need for complex assisted reproductive techniques such as intravaginal insemination (IVI) and intrauterine insemination (IUl). Study design, size, duration 108 couples were recruited from a national fertility clinic. The duration of the study was 3.5 years, from January 2016 to August 2019. The study was based primarily on surveys, where diagnostic work-up for infertility included tools for measuring sexual dysfunction, such as the IIEF-15 questionnaire. Our objectives were to find the extent of improvement of SI before and after specialist referral, and the time to conceive (TTC) in those with and without sexual dysfunction. Participants/materials, setting, methods Couples who never had successful completion of SI (despite producing an ejaculate sample) prior to clinic attendance were included. Treatment via specialist referral was then offered to these patients. Data were analysed to compare outcomes between those who subsequently had successful SI (“Group A”) and those who had not had successful SI (“Group B”). Both groups were counselled for fertility treatments, such as IVI and IUI. TTC between the groups was analysed using Kaplan-Meier analysis Main results and the role of chance Out of 2057 couples presenting to the Infertility Clinic, 128 (5.98%) had never had successful SI. From this, 108 couples were included in the study. Two-thirds of couples revealed sexual difficulties at the beginning of the initial consultation. In men, erectile dysfunction was the predominant cause (70.4%, n = 76). In women, dyspareunia was the leading problem (18.2%, N = 20). Fertility investigations, which included hormone profiles, revealed normal results in most cases. Treatment via referral to specialist sexual counselling was offered to all couples. Only 33 couples reported successful SI during subsequent visits (Group A). 13 of these 33 couples went on to conceive (11 naturally, 1 by IUI and 1 by IVI). The rest (n = 75), who had no improvement (Group B), had a significantly longer duration of sexual dysfunction, which was also more severe. Out of these 75 couples, 8 conceived (0 naturally, 6 by IVI, and 2 by IUI).The IIEF-15 scores (index for sexual dysfunction) between groups A and B were 10.72 ± 4.28 vs. 8 ± 4.73, P-value 0.0142. Group A couples (less severe sexual dysfunction) conceived earlier than Group B (mean duration 27.2 weeks vs. 48.8 weeks log-rank P value <0.001). Limitations, reasons for caution The main limitations of this study include a small sample size and a small minority of couples refusing to undergo specialist counselling despite having sexual difficulties as they were only interested in assisted reproductive interventions such as IUl and IVI. These limitations hinder the internal/external validity of the study. Wider implications of the findings All couples presenting with infertility should be asked about sexual function. If sexual dysfunction is diagnosed, a signicant proportion can be helped to achieve pregnancy without assisted reproduction. In the cases of couples with persistent sexual difficulty, assisted reproductive techniques like IUI and IVI give a reasonable pregnancy rate. Trial registration number Not applicable

Effectiveness and Safety of a New Nutrient Fixed Combination Containing Pollen Extract Plus Teupolioside, in the Management of LUTS in Patients with Benign Prostatic Hypertrophy: A Pilot Study.

Benign prostatic hyperplasia (BPH) is a common cause of male lower urinary tract symptoms (LUTS) that can reduce quality of life. Even if several drugs can be used in its treatment, the development of adverse drug reactions (ADRs) represents the most common cause of low adherence. In the present study, we evaluate both the efficacy and the safety of a new nutrient fixed combination of Pollen Extract plus Teupolioside, named Xipag®, in patients with LUTS. We conduct a pilot single center open label clinical study between 1 March 2020 and 30 June 2020 in patients with BPH referred to general practitioner’s ambulatories. Male patients > 45 years, sexually active, with clinical symptoms of LUTS and with a diagnosis of HPB were enrolled and received one tablet/day of Xipag® (T0), for three months (T1: end of treatment). The IPSS and IIEF-5 questionnaires were carried out at T0 and T1 and represent the first end point, whereas the primary safety end point was considered the absence of ADR or of drug–drug interactions related to Xipag® administration. During the study period, 25 subjects aged 43 to 76 years (mean 62.7 ± 9) were enrolled and completed the study. The clinical evaluation in T1 documented that Xipag® induced a statistically significant improvement (p < 0.01) in symptoms, as documented by the IPSS questionnaire (range 22.7–88.9; mean 55.2 ± 23.6), without the development of ADRs. In conclusion, this is the first real-world study that showed the efficacy and the safety of Xipag® in the BPH patients with LUTS.

Preliminary results of a national multicenter study on the treatment of LUTS secondary to benign prostatic hyperplasia using the Rezūm® steam system

Introduction and objectiveRezūm® system is a minimally invasive transurethral therapy that uses convective water vapor energy to ablate prostatic tissue. The objective is to report 1-year functional and security outcomes obtained by using this technique in real clinical practice. Material and methodsProspective study conducted in 5 Spanish hospitals for the treatment of LUTS secondary to BPH using the Rezūm® system. Patients with prostatic medium lobe (ML) and urethral catheter carriers were also included. Pre- and post-operative data were collected using IPSS, IIEF-5 and QoL questionnaires, flowmetry and post-void residual volume. Complications and retreatment rate at one-year follow-up were also reported. Results137 patients, including 64 with ML and 10 patients with urinary retention were treated. Median prostate volume was 50 cm3 (15−131). At 3 months follow-up, significant improvement was observed in IPSS (−6.37 points), Qmax (+4.95 mL/s) and QoL (−1.29); and was maintained until 12 months: −10.78 points, +4.62 mL/s and −2.73 respectively (p < 0.001). No significant changes were observed in the sexual sphere. All complications were mild (≤ Clavien II). Retreatment rate at one year was 4%. ConclusionShort-term results of this technique are promising, showing improvement in terms of functional outcomes, with no impact on the sexual sphere or complications. Longer term follow-up should include treatment durability and comparison to standard BPH treatments.

Impact of urinary incontinence on sexual function in patients presenting for lower urinary tract symptoms

ABSTRACT Introduction Patients with low urinary tract symptoms (LUTS) frequently complain some sexual dysfunction and sometimes even episodes of bothersome urinary incontinence (UI). Objective We aimed to assess the relationship between UI (as measured with the ICIQ-UI-SF), and sexual disfunction (as measured with the IIEF), in men presenting with LUTS at a tertiary-referral centre. Methods In this cross-sectional study, data were retrospectively retrieved from 938 consecutive patients aged &amp;gt;18 years seeking first medical help for self-reported LUTS (i.e., all patients had IPSS≥1). All patients had a complete clinical assessment and completed the IPSS, the ICIQ-UI-SF, the OAB-q and the IIEF questionnaires. Patients were stratified into “no UI” (ICIQ-UI-SF=0), “mild UI” (ICIQ-UI-SF=1-7), “moderate UI” (ICIQ-UI-SF=8-13) or “severe UI” (ICIQ-UI-SF=14-21). ANOVA test assessed differences in baseline characteristics among these groups. Spearman correlation test was applied to evaluate the correlation between ICIQ-UI-SF and IIEF domain scores. A linear regression analyses tested putative risk factors associated with increased ICIQ-UI-SF scores. Result Of 938, 589 (63%) patients had no UI, 237 (25%) had mild UI, 76 (8%) moderate UI and 36 (4%) severe UI. There were no substantial differences in total PSA levels and uroflowmetry parameters among UI groups, whereas prostate volume, IPSS and OAB-q scores were higher as UI symptoms increased (all p≤ 0.03). A negative correlation was found between IIEF-total, IIEF-Erectile Function, IIEF-Intercourse Satisfaction and IIEF-Overall Satisfaction scores and ICIQ-UI-SF scores (i.e., the worse UI symptoms, the worse the overall sexual function (rho= -0.12; p&amp;lt;0.001), IIEF-EF (rho= -0.15; p&amp;lt;0.001), IIEF-IS (rho = -0.1; p=0.004) and IIEF-OS (rho = -0.12; p&amp;lt;0.001). Sexual desire and orgasmic function domains were not correlated with ICIQ-UI-SF. Finally, higher BMI (Coeff 0.12; 95% CI 0.03-0.32; p=0.011), diabetes (Coeff 1.76; 0.35-3.18; p=0.015) and presence of comorbidities (Coeff: 0.9; 0.06-0.1.74; p=0.035) were associated with higher ICIQ-UI-SF scores. Main limitations of the study were that ICIQ-UI-SF does not discriminate between urge or stress UI. Conclusion In patients presenting with LUTS, the presence of urinary incontinence was associated with worsening of overall sexual function (i.e., erectile function, intercourse satisfaction and overall satisfaction). Disclosure Work supported by industry: no.

A longitudinal long-term observation study on sexual function and satisfaction rates in men with partial penectomy for penile cancer in a prospectively clinical database

ABSTRACT Introduction Organ-preserving partial penectomy provides a reasonable oncological approach in managing early-stage penile cancer with preservation of normal urinary function and many men can retain some aspects of sexual domains. However, there is limited published data regarding the longer-term sexual outcomes and satisfaction rates in men who remain sexually active in the context of penile cancer survivorship. Objective To evaluate sexual outcomes and satisfaction rates in sexually active men who underwent partial penectomy at a minimum 36-month follow-up study. Methods A prospective database on men treated with penile cancer was set up in 2011 following ethics approval. All men with pre-existing normal erectile function (EF) as defined by the International Index of Erectile Function (IIEF-5) score of 21 and above, and have a stable active sexual lifestyle were included in this study. Patient demographics including EF and sexual satisfaction scores based on IIEF questionnaire, erection hardness scores (EHS) and Brief Sexual Function Inventory (BSFI), use of erectile agents, and sexual satisfaction outcomes were recorded and compared between preoperative vs. 36 months postoperative. Results Of a total of 85 men with partial penectomy identified over the 10-year period, 44 men reported normal EF preoperatively and were in a stable sexual relationship. Six men underwent subsequent completion penectomy during that time while 3 men were lost to follow-up, and only 25 men were identified to be sexually active. Of these, 4 men can achieve satisfactory spontaneous erection for sexual intercourse, while 18 men take regular phosphodiesterase type-5 inhibitor drugs, and 3 men use intracavernosal injections. The median patient age was 54 (38-70) years, and the median follow-up was 44 (38-118) months. The mean penile length measurements were 4.2cm and 6.8cm in flaccid and erect states. Two-thirds of patients maintained the same frequency and level of sexual desire as before surgery and 36-month postoperative, and 80% continued to have ejaculation and orgasm every time they had sexual intercourse. Deterioration in both IIEF-5 and EHS scores were reported in 80% of patients at the 36 months review with lower sexual domains scores in BMSFI recorded in 72% of patients especially with regards to sexual desire (Question 1 and 2) and satisfaction with sex life (Question 11). Multivariate analysis using logistic regression confirmed that older age (OR 1.18, 95% CI 1.02-1.21, p&amp;lt;0.01), shorter penile length (OR 0.45, 95% CI 0.38-0.69, p&amp;lt;0.01) and quality of erection (OR 1.23, 95% CI 1.10-1.41, p&amp;lt;0.01) were significantly associated with lower sexual satisfaction rates. Conclusions While most sexually active men retained the ability to have sexual intercourse following partial penectomy, many required erectile aids and reported clinical deterioration in sexual function and overall satisfaction rates at 36 months. Disclosure Work supported by industry: no.

Variables affecting quality of life after Radical cystectomy and neobladder substitution: Egyptian National Cancer Institute experience.

To evaluate the functional outcomes and quality of life beyond 1 year, in patients treated with radical cystectomy and orthotopic diversion for invasive bladder cancer. To investigate various potential contributing factors on patient's quality of life after radical cystectomy and urinary diversion via orthotopic neobladder. This retrospective study was conducted at the National Cancer Institute (NCI), Cairo; including a total of 97 patients who underwent radical cystectomy and orthotopic diversion. Functional and sexual outcome and patient QoL were assessed by ICIQ-SF, IIEF-5 and QLQ-C30 questionnaires. Potential association of patient QoL with pre-and intraoperative variables was studied. Our results show that preoperative ECOG performance status 0 (P=0.0001), and nerve sparing surgery (P=0.001), were associated with high QoL and functional outcomes. On the contrary, ECOG performance status 2, preoperative comorbidities as ischemic heart diseases (P=0.01), recurrence (0.041), adjuvant chemotherapy (P=0.017) and radiotherapy (P=0.001) were associated with low QoL on univariate analysis. However, only ECOG performance status 2 (P<0.0001), incontinence (P<0.0001), non-nerve sparing surgery (P=0.001) and ureteric stricture (P=0.001) were independent predictors of worse QoL on multivariate analysis. Orthotopic bladder is associated with increased morbidity. Attention should be given to preoprative patient characteristics at the time of patient selection, and intraoperative quality of functional preservation.

Psychosexual issue affecting men with Klinefelter Syndrome seeking fertility management

ABSTRACT Introduction and Objective Klinefelter Syndrome (KS) is the commonest hypo-androgenic chromosomal anomaly affecting fertility (1:600 men). KS frequently goes undiagnosed until middle age during fertility investigations. However, beyond fertility issues there is little known of the psychological effect of KS on these newly diagnosed men. This study aims to examine the psychosexual impact of newly diagnosed KS in couples presenting to a multidisciplinary KS clinic. Methods Prospectively compiled data from 18 recently diagnosed KS patients with subfertility attending a multidisciplinary KS clinic were analyzed. A baseline patient-centered psychosexual function questionnaire (NSOG) was used to identify issues with body image, sexual function and wellbeing whilst erectile dysfunction (ED) issues were specifically sought using the validated IIEF-5 questionnaire. Ethics approval was obtained. Results 89% (17/18) of KS men rated their sex life as highly important but less than 44% rated the quality of intercourse and a similar proportion were anxious about having sexual intercourse. This was in keeping with a mean IIEF-5 score of 16 (range 24- 12) in this group indicating mild to moderate ED. 56% felt that their body could adequately work sexually but 17% felt their mood negatively affected influencing sexual performance, with only 38% satisfied in their sex life. 50% of men also reported perceived delayed ejaculation. Whilst the majority reported noticed libido issues, 5% of men reported hyperactive sexual desire which impacted on social functioning. Conclusions Psychosexual difficulties are common in KS patients undergoing fertility treatments and yet this aspect of their management is often neglected. Psychosexual treatment should be discussed with all KS patients as all patients reported wanting to receive help and advice on improving their sexual lives. A study is now in place to determine the longer-team outcomes of targeted psyhosexual therapy in this cohort of KS men on general wellbeing and memntal health. Disclosure Work supported by industry: no.

Association between erectile dysfunction, cardiovascular risk factors, and coronary artery disease: Role of exercise stress testing and International Index of Erectile Function (IIEF-5) questionnaire.

BackgroundThe exercise stress test (EST) is a non-invasive investigation to diagnose coronary artery disease. This research aimed to determine the relationship between erectile dysfunction (ED), cardiovascular risk factors, and coronary artery disease (CAD) in men referred for EST.MethodsA prospective cohort study enrolling 303 patients from August 2020 through September 2021. All patients filled out the international Index of Erectile Function (IIEF-5) questionnaire. . They underwent an exercise stress test (EST). A two-tailed independent sample t-test, chi-square tests, and binary logistic regression were used for statistical analysis.ResultsEST was positive in 110 (36.3%) patients, negative in 154 (50.8%), and inconclusive in 39 (12.8%) patients. ED was present in 225 (74.3%) patients and absent in 78 (25.8%) patients. 278 (91.7%) had one or more cardiovascular risk factors. This study reported a significant relationship between diabetes mellitus (DM), hypertension (HTN), and the results of EST and ED. Compared to patients without ED, patients with ED had a positive EST result. Definite CAD was diagnosed in 21% of patients with ED compared to 1.3% in patients without ED. For a one-unit increase in age, the odds of ED increased by about 5%. Similarly, a negative EST is compared to a positive EST. Negative EST reduced the likelihood of ED by 82%.ConclusionsThis research found a statistically significant connection between CAD, certain cardiovascular risk factors, and ED using the EST and IIEF-5 questionnaires. This research is significant because it may alter the way cardiovascular risk stratification is done.

How Has the COVID-19 Pandemic Affected Sexual Health of Partnered Men?

Objective: Mental health and human psychology have been negatively affected during the COVID-19 pandemic. Since psychomental status and sexual health are related, it is possible that the sexual health of couples may be affected along with their mental health. We aimed to perform a quantitative evaluation of male partners’ sexual lives during the COVID-19 pandemic. Methods: A hundred-sixteen men filled out our online survey in which International Erectile Index Score (IIEF) was embedded. The relationship between COVID-19 pandemic and stress, economical concerns, workload, etc. was questioned. Results: Twenty-nine people had not had intercourse for more than 1 month. Twenty-one of them (72.4%) showed pandemic-related relationship sexual avoidance behaviour. 55.2% of survey respondents who also filled IIEF questionnaire were economically affected by the pandemic, 66.7% were psychologically affected and 71.2% were significantly or somewhat sexually affected. the total average of the erectile function score was 25.95±5.4. These scores indicate a slight predominance of ED. Conclusion: It is clear the COVID-19 pandemic affects people’s sex lives in myriad of negative ways. We believe that many the domestic problems likely to develop as a result of lockdowns and other measures intended to prevent virus spread can be prevented or reduced by facilitating healthy sex lives between couples.

Utility of Directly Measured Free Testosterone in Predicting Benefit of Testosterone Therapy in Men with Hypogonadal Symptoms and Normal Total Testosterone

ABSTRACT Introduction Hypogonadal symptoms, including decreased libido, erectile dysfunction, and decreased energy/fatigue, often related to a low total testosterone (TT) level, are common among aging men, affecting at least 20% of men age ≥ 45.(1) Testosterone exists in two main forms: bound to proteins (primarily SHBG and albumin) and largely inactive, and as unbound free testosterone (FT). Current guidelines from multiple professional associations advise clinicians to use the presence of hypogonadal symptoms along with low serum TT to determine the need for Testosterone Replacement Therapy (TRT). The use of FT levels to guide treatment has not been established. Equilibrium dialysis is the gold standard for measuring FT, but rarely used clinically due to practical limitations.(2,3) Many guidelines also discourage the use of commercially-available directly measured FT by analog enzyme immunoassay (EIA) due to variability and accuracy concerns.(3) Thus, in guideline-based practice, symptomatically hypogonadal men with normal TT levels but low EIA FT are not offered TRT, despite some evidence that these men may benefit from treatment.(2) Objective To examine the benefits and safety of TRT in men with hypogonadal symptoms who demonstrate a normal TT level but low directly measured FT, as measured by a single national lab company (LabCorp) using EIA. Methods The study is an analysis of prospectively-collected data for 63 consecutive men seen in our clinical practice with hypogonadal symptoms, normal TT (&amp;gt;265 ng/dL) and low FT (normal range 7.2-24.0pg/mL). All men began a standardized regimen of T-cypionate IM injections at a dose of 200mg every 2 weeks.(4) Men with prior TRT were excluded. Baseline blood tests were performed for TT, FT, E2, LH, PRL, CBC, and PSA. Follow up blood tests included TT, FT, E2, CBC, and PSA. Clinical response to TRT was based on documentation of improvement in hypogonadal symptoms, including ED as measured using the IIEF-5 questionnaire, as well as subjective patient reports of changes in libido, energy, etc. Results A total of 63 men with a mean age of 64.0 yrs. (range 34-86 yrs.) were included. Prior to TRT, mean TT was 375.3ng/dL (IQR [312.0-419.5]) and mean FT was 4.7pg/mL (3.9-5.8). At 3-month follow up, mean TT was 690.8 (420.8-883.8) and FT was 11.71 (7.4-14.1). Mean IIEF-5 score prior to TRT was 12.2 (5.0-19.8) and after TRT was 13.3 (5.8-21.3). Within the cohort, 85.4% reported subjective improvement in overall energy and libido after 3 months of TRT, with 59.4% of patients reporting significant improvement and 26% reporting mild but noticeable improvement. The remaining 14.6% reported minimal or no improvement. Nearly half reported improvement in erection function, assessed by IIEF-5 questionnaire. One patient (1.6%) developed de novo erythrocytosis, and three (4.8%) developed pathologic rise in PSA. Conclusions Our findings suggest that many men with hypogonadal symptoms, normal TT, and low EIA FT respond well to TRT, and that such treatment is safe. Until the creation of specific guidelines regarding use of FT to guide TRT treatment decisions, it may be of clinical benefit to treat men based on appropriate symptoms and low directly measured FT levels. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific

The Efficacy of Written Symptom Questionnaires for the Management of Erectile Dysfunction

ABSTRACT Introduction The use of written screening tools and symptom questionnaires within the field of urology is widespread. Urologists regularly utilize such tools to help navigate preoperative counseling, understand the severity of a patient's symptoms, and guide clinical management. Self-administered screening questionnaires however require a baseline level of health literacy and comprehension in order for the results to be considered reliable. Prior work has shown that patient education and health literacy levels significantly impact the results of self-administered American Urological Association (AUA) symptom index questionnaire, which results in misclassification of voiding symptoms and potentially limits access to appropriate care. The International Index for Erectile Function (IIEF-5) is a previously validated self-administered questionnaire that is used to assess a patient's current erectile function. We hypothesize that men with lower health literacy and lower education levels are more likely to demonstrate a decreased understanding of the IIEF-5 and increased rates of symptom misclassification. Objective The aim of our project is to assess the frequency of poor understanding of the IIEF-5 and to determine if patient education and health literacy impact self-administered versus verbally administered IIEF-5 questionnaires. Methods In this pilot study, we prospectively enrolled consecutive, literate, English-speaking patients seen in an academic urology clinic for various complaints. Patients completed a self-administered, written IIEF-5 questionnaire per standard clinic protocol, and were subsequently re-administered the same IIEF-5 questionnaire verbally by a single trained researcher. The researcher answered patient questions and clarified questionnaire items as needed, as well as obtained basic demographic information related to education, health literacy, and race. Responses were compared by calculating the change in overall IIEF-5 scores between written and verbally administered instruments. Health literacy was determined utilizing the Brief Health Literacy Screen (BHLS), a validated health literacy tool. Results A total of one hundred consecutive men were enrolled into this pilot study. The population was primarily Caucasian (83%) with 76% of men having some form of college education or higher level education. The median written IIEF-5 was 14 (IQR: 5, 23) while the median verbal IIEF-5 was 14 (IQR: 5, 23), p=1.00. The median delta IIEF-5 was 0 (IQR: -2, 0). The median BHLS was 14 (IQR: 12, 15). On multivariable model evaluating for the impact of BHLS and education level on delta IIEF-5 while adjusting for age, education level, and race, BHLS (p=0.09) and education level (p=0.23) were not significant. Conclusions In this pilot study, there was no significant variance in overall scores when comparing the written to verbally administered IIEF-5 questionnaire. In contrast to prior studies evaluating the efficacy of other urologic symptom questionnaires, BHLS and education level were not significantly associated with changes in overall IIEF-5 scores. Disclosure No

Peyronie's Disease: Identification of Patients Requiring Additional Therapy

ABSTRACT Introduction Peyronie's disease (PD) is a connective tissue disorder of the penile tunica albuginea, that can often cause penile deformity, pain, sexual dysfunction, and shortening. Therapies available include penile traction, oral medications, intralesional therapy, and surgical management. Many patients undergo multiple therapies for this disease due to poor satisfaction or lack of subjective improvement. Objective We thus sought out to delineate which patients were more likely to undergo a second therapy. Methods A cohort of 385 men who underwent therapy for Peyronie's disease from 2014-2018 were analyzed. A univariate analysis of patient demographics, subjective complaints, IIEF score parameters, primary treatments, and secondary treatment approaches was conducted. Results Of the 385 men identified, 29 patients ultimately decided to undergo a secondary treatment approach with 14 patients undergoing penile traction therapy, 7 intralesional therapy (Xiaflex) and 9 surgical therapy (5 penile plication, 2 insertion of inflatable penile prosthesis, and 2 grafting). 17 patients initially underwent surgery for PD with 23.53% of these patients undergoing a second line therapy (p&amp;lt;0.0469). 148 patients initially underwent Xiaflex injections with 12.16% of these patients undergoing a second line therapy (p&amp;lt;0.0227). Patients with poor orgasmic function as determined by IIEF questionnaire (median scores 8 vs 2, p&amp;lt;0.0420), men with greater objective curvature (median curvature 45 vs 35, p&amp;lt;0.0220), and men with greater stretched penile length (13.5 cm vs 12 cm, p=0.0284) were also more likely to undergo secondary therapy. Table 1 shows all factors associated with increased likelihood for secondary therapy. Conclusions Peyronie's disease is often a complex condition to treat due to the mental, emotional, and physical toll this disease takes on patients. It is helpful to determine which patients could likely require secondary therapy as this may help guide patient counseling and further management. Disclosure No

Expedited algorithm for IPP following Radical Prostatectomy

ABSTRACT Introduction Erectile dysfunction (ED) following radical prostatectomy (RP) is a postoperative result that negatively impacts patient quality of life. The recovery of potency following radical prostatectomy varies depending on a multitude of factors including but not limited to surgical technique, surgeon experience and patient comorbidities. There are several factors that contribute to this decline in erectile function as a result of oncologic control after RP which may be classified as vasculogenic, neurogenic, and psychological. Current guidelines recommend patients wait up to 24 months before IPP surgery. However, no definitive algorithm or guideline has been established for the expedited management of ED in the postoperative setting following radical prostatectomy. Objective We are proposing an expedited algorithm for patients who fail PDE-5 inhibitors at the three-month follow-up following RP. Methods Patients who underwent inflatable penile prosthesis (IPP) surgery for the treatment of ED over a 36-month period following RP were identified from our IRB approved database. All patients completed an IIEF-5 questionnaire and had a penile doppler ultrasound (PDUS) performed preoperatively. Validated scoring for erectile function was performed with the International Index of Erectile Function (IIEF-5), and the Sexual Health Inventory for Men (SHIM) was defined. The relationships, according to Doppler diagnosis, IIEF-5 score, SHIM scale, and erection score were evaluated as well as surgical outcomes and patient comorbidities. Logistic regression and Wilcoxon rank sum tests were performed. Results 1,158 patients were evaluated in this series, of whom 121 met inclusion criteria. PDUS determined that 88 (72.8%) suffered from veno-occlusive disease, while 19 (15.7%) had arterial insufficiency. 101 (83.4%) had a RALP vs 20 (16.6%) who received an open RP. The mean time between RP and IPP was 20 months, with the mean ages of RP and IPP being 58 and 64 years respectively. Ages of patients ranged from 40 to 82 years old. Increased time between RP and subsequent IPP was correlated with lower SHIM scores. Additionally, each month that passed caused a decrease of 1.8% in SHIM scores (p&amp;lt; 0.05), as well as a greater likelihood of developing worsening vasculogenic ED (p= 0.042). Increased patient age during RP and subsequent IPP was also correlated with lower SHIM scores (p= 0.049), while RALP was found to be a predictor of higher patient satisfaction (p= 0.02). Conclusions As a result of the overwhelming diminishing SHIM scores over the 20 month postoperative course following RP as well as the significant prevalence of veno-ccclusive disease in this common patient population, we are strongly recommending a baseline PDUS at the 3 month followup. Furthermore, if veno-occlusive disease is identified upon the 3 month baseline PDUS, we encourage frank discussion of IPP placement with the patient. Equally important is it to consider discussing the degree of veno-occlusive disease and resultant ED will worsen as the postoperative period lengthens. Those patients found to have veno-occlusive etiology should have early surgical intervention mitigating further severity of the subsequent veno-occlusive disease. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast and Boston Scientific

Assessing the influence of cardiovascular risk factors on the severity of erectile dysfunction: a multivariate statistical analysis

Introduction. The American Heart Association identifies 7 major factors that affect the condition of the vascular wall: smoking, blood pressure, total cholesterol, glucose, body mass index, physical activity, and diet. The vascular wall lesions most often manifest clinically as vasculogenic erectile dysfunction (ED). Consequently, evaluating patients for the presence of the above risk factors can not only help in the treatment of ED, but can also significantly increase the chances of early detection of cardiac pathology.Purpose of the study. To assess cardiovascular disorder markers’ role in prognosing of the presence or absence of ED and its severity.Materials and methods. The study included 40 patients aged 33 – 60 years. Erectile function was assessed using the device «Androscan – MIT» ("Minimally invasive technologies" LLC, Moscow, Russian Federation) and the IIEF-15 questionnaire. Statistical data processing was carried out using Statistica 12 («StatSoft Inc.», Tusla, CA, USA) и IBMÒ SPSS Statistics 26 («SPSS: An IBM Company», IBM SPSS Corp., Armonk, NY, USA).Results. For patients with more severe ED, a greater deviation of the parameters studied from normal is typical. The most significant impact on the detection of different ED degrees using the device «Androscan – MIT» had TC, HDL, LDL, RP, BMI, triglycerides и HbA1c levels. Based on the androscanning data, a classification tree with two branches (branching conditions — the level of TC and LDL) and four terminal vertices (depending on the degree of ED) was obtained. There were no classification errors predicting ED degrees, which in this case indicates the good significance of the mathematical prediction. Only IIEF-15 scores had the greatest impact on ED detection using IIEF-15. The only condition for branching when constructing classification trees was the number of IIEF-15 points (two branches with three terminal vertices were obtained).Conclusion. Cardiovascular risk factors are predictors of vascular ED, detected by androscanning, while the widespread IIEF-15 questionnaire remains completely dependent on subjective feelings of patients without relying on laboratory and instrumental research methods.

Adenoprosin in the complex treatment of lower urinary tract symptoms in combination with prostatitis of category III

Introduction.The problem of effective and safe therapy of patients with benign prostatic hyperplasia and prostatitis of category III remains relevant, despite the numerosity of the drugs used in different groups. Under these conditions, the search for new pharmacological agents continues.The study objectivewas to evaluate the efficacy of Adenoprosin in the treatment of lower urinary tract symptoms and erectile dysfunction in patients with chronic pelvic pain syndrome and prostate hyperplasia.Materials and methods.The 90-day study included 60 patients aged 40 to 60 years with chronic pelvic pain syndrome and erectile dysfunction on the background of benign prostatic hyperplasia. Patients of the main group received alfa-1-adrenoreceptor blocker tamsulosin for 30 days in combination with the nonsteroidal anti-inflammatory drug nimesulide for 5 days and Adenoprosin suppositories. The men of the control group took tamsulosin for 30 days and nimesulide for 5 days. Over the next 60 days, the dynamics was evaluated based on the data from the NIH-CPSI (National Institutes Health Chronic Prostatitis Symptom Index), IPSS (International Prostate Symptom Score), QoL (Quality of Life Scale), AMS (Aging Male Symptoms), IIEF-5 (International Index of Erectile Function); urination diary analysis; general urine analysis; blood test for the level of prostate specific antigen, glucose; prostate secretion analysis; transrectal ultrasound examination of the prostate gland with measurement of residual urine; uroflowmetry.Results.Urinary frequency decreased at day 30 in the treatment group from 12.7 ± 1.4 to 7.3 ± 1.8 micturitions per day, in the control group from 13.1 ± 1.8 to 9.6 ± 1.1; subsequently (on days 60 and 90) positive effect persisted in the treatment group, while in the control group urinary frequency increased. Per the NIH-CPSI questionnaire, symptoms decreased at day 30: in the treatment group from 25.4 ± 2.1 to 12.3 ± 1.9 points, in the control group from 24.3 ± 1.7 to 17.6 ± 0.4 points; in the treatment group the trend towards symptom decrease remained, while in the control group symptoms increased at day 90. IPSS score at day 30 decreased in the treatment group from 12.9 ± 0.5 to 5.2 ± 1.4, in the control group from 14.1 ± 0.7 to 8.2 ± 0.9; further decrease was observed in both groups at day 60, but at day 90 the score increased (higher in the control group). Quality of life (QoL) improved in both groups at day 30 (in the treatment group 1.4 ± 0.6 points, in the control group 3.1 ± 0.8). Erectile function improved per the IIEF-5 questionnaire: in the treatment group from 11.5 ± 1.1 to 18.9 ± 1.4 points at day 30 with further positive tendency, in the control group from 10.7 ± 1.4 to 15.3 ± 1.1 points with subsequent negative dynamics. Uroflowmetry showed positive dynamics of Qmaxat the end of treatment in the treatment (from 8.3 ± 1.5 to 14.7 ± 1.1 mL/s) and control (from 8.8 ± 1.3 to 13.1 ± 1.6 mL/s) groups, with its further decrease. Prostate volume in the treatment group was about 33.5 ± 3.1 cm3at day 90 (with baseline volume 42.6 ± 2.5 cm3), in the control group it was 41.6 ± 1.9 cm3(with baseline volume of 43.1±1.4 cm3). No significant changes in urine tests, prostatic fluid, prostate-specific antigen level, and blood glucose were observed during the treatment.Conclusions.The study shows that administration of tamsulosin with Adenoprosin in patients with BPH and category III prostatitis is advantageous compared to administration of only alfa-1-adrenoreceptor blockers.

Significance of hyperhomocysteinaemia as an effective marker for vasculogenic erectile dysfunction: a cross-sectional study.

BackgroundThe primary objective of this cross-sectional study aimed at evaluating serum levels of homocysteinemia (Hcy) in a cohort of erectile dysfunction (ED) patients, and at assessing the correlation between Hcy and vasculogenic ED.MethodsA total of 119 Chinese patients presenting with ED [International Index of Erectile Function (IIEF)-5≤21] were enrolled in this study. The whole cohort was asked to complete the IIEF-5 questionnaire and blood analysis. A detailed medical history, physical examination, nocturnal penile tumescence (NPT) tests and penile color Doppler ultrasonography (pDUS) were performed by a urologist. Based on the pDUS result, they were further categorized into 2 main groups: non-vasculogenic ED (n=79) and vasculogenic ED (n=40).ResultsAge and Hcy levels were significantly higher in the vasculogenic ED group compared to the non-vasculogenic ED group (38.45±8.51 vs. 32.29±7.57 and 22.91±5.85 vs. 16.31±5.23 µmol/L, respectively, P<0.01). Univariate and multivariable regression analyses showed that the incidence of vasculogenic ED raised significantly with the increase of Hcy level. After multivariable adjustment, ED patients with hyperhomocysteinaemia (HHcy) had 13.42 times the odds of vasculogenic ED compared with patients without HHcy (OR: 13.42, 95% CI: 3.78 to 47.64). Moreover, the risk of vasculogenic ED was 1.24 (95% CI: 1.04 to 1.48, P=0.01) per-unit increase in Hyc concentration for ED with HHcy. In addition, the smoothing curve revealed that Hcy levels were inversely correlated with peak-systolic velocity (PSV) (β: −0.48, 95% CI: −0.91 to −0.05, P=0.04) in vasculogenic ED patients by multivariate regression analysis. Furthermore, in the analysis of receiver operating characteristic curve, the area under curve for Hcy to predict vasculogenic ED was 0.81 (95% CI: 0.73 to 89) in patients with ED.ConclusionsThese findings suggest a dose-dependent association between Hcy and vasculogenic ED. HHcy was a risk factor for vasculogenic erectile dysfunction. Therefore, HHcy is likely to be a potential indicator to predict and diagnose vasculogenic ED when using pDUS.

Resultados preliminares de un trabajo multicéntrico a nivel nacional para el tratamiento de STUI secundario a hiperplasia benigna de próstata mediante el sistema con vapor de agua Rezūm®

Introduction and objectiveRezūm® system is a minimally invasive transurethral therapy that uses convective water vapor energy to ablate prostatic tissue. The objective is to report 1-year functional and security outcomes obtained by using this technique in real clinical practice. Material and methodsProspective study conducted in 5 Spanish hospitals for the treatment of LUTS secondary to BPH using the Rezūm® system. Patients with prostatic medium lobe (ML) and urethral catheter carriers were also included. Pre- and post-operative data were collected using IPSS, IIEF-5 and QoL questionnaires, flowmetry and post-void residual volume. Complications and retreatment rate at one-year follow-up were also reported. Results137 patients, including 64 with ML and 10 patients with urinary retention were treated. Median prostate volume was 50cm3 (15-131). At 3 months follow-up, significant improvement was observed in IPSS (−6,37 points), Qmax (+4,95mL/s) and QoL (−1,29); and was maintained until 12 months: −10,78 points,+4,62mL/s and −2,73 respectively (p<0.001). No significant changes were observed in the sexual sphere. All complications were mild (≤Clavien II). Retreatment rate at one year was 4%. ConclusionShort-term results of this technique are promising, showing improvement in terms of functional outcomes, with no impact on the sexual sphere or complications. Longer term follow-up should include treatment durability and comparison to standard BPH treatments.

Proper Use of the International Index of Erectile Function 5 (IIEF-5) Questionnaire in Patients Undergoing Transurethral Resection of the Prostate (TURP)

Background: Our goal was to show how the interpretation of the IIEF-5 questionnaire can lead to a significantly different outcome and propose a modification of the possible responses of the IIEF-5 questionnaire to assess erectile function after transurethral resection of the prostate (TURP). Methods: The results of patients treated with TURP in a randomized clinical trial were analyzed under four scenarios characterized by what patients to include and how to codify the answers for statistical interpretation: scenario (A) only patients who reported sexual intercourse; scenario (B) all patients, recording zero response for patients without sexual activity as one more grade of the scoring scale; scenario (C) same as B but coding 0 as “99” (missing value); and scenario (D) all patients are included, but the zero response remains as 0 for patients who reported not having had sexual intercourse due to the “Inability to penetrate (enter) the partner due to penile flaccidity”, whereas zero response is coded as “99” in those patients reporting “Inability to penetrate (enter) the partner due to other causes”. Results: Eighty-four patients qualified for the analysis. The proportion of patients in each ED category was very similar among the four scenarios, except for the “Severe ED” category. At baseline, scenario B had 36.9% of patients categorized as “Severe ED”, scenario D 18.5%, and scenarios A and C 17.2% (p &lt; 0.01). This relative order remained constant in all postoperative visits. The differences in “Severe ED” rates were directly correlated with the inclusion of patients without sexual activity (higher “Severe ED” rate) and the codification of zero responses (when left as zero, they increase “Severe ED” rate, whereas when coded as 99 they are not included in the analysis and “Severe ED” rates decrease). Taking scenario D as a reference, we found a significant overestimation of “Severe ED” in scenario B up to 21.4% and a slight underestimation in scenarios A and B up to –15.7%. Conclusions: Using the IIEF-5 questionnaire with options 0 and 99 (scenario D) may improve the accuracy of detecting patients with “Severe ED” in the postoperative period of TURP. Clinical Trial Registration: NCT03936244 (https://clinicaltrials.gov/ct2/show/NCT03936244).

GLYCAEMIC YEARS RATHER THAN GLYCAEMIC CONTROL CORRELATES WITH ERECTILE DYSFUNCTION

Purpose:To evaluate the association between the duration of diabetes and glycaemic control (HbA1c) and the severity of erectile dysfunction (ED) in men with diabetes mellitus Material and Methods: it was an observational study; subjects having diabetes mellitus were evaluated for erectile dysfunction. History, examination and investigations were done and data was analysed. IIEF-5 questionnaire was used for assessment. Correlation between severity of erectile dysfunction with duration of diabetes and HbA1C was assessed. Ethical approval and consent from patient was not taken as it was an observational study. Results: With increase in duration of diabetes incidence and severity of erectile dysfunction increases. Among Patients having diabetes for less than 1 year 35.2%, had no erectile dysfunction, 41.4% had mild and 4.8% had severe erectile dysfunction and among patient having diabetes for greater than 10 years 8.4% had no erectile dysfunction, 24.2% had mild and 39.6% had severe ED. However there was no correlation between HBA1C level and incidence or severity of erectile dysfunction. Among patient having HA1C level less than 7% 20.6% had no erectile dysfunction, 34.5% had mild and 19.9% had severe erectile dysfunction. in patients having HBA1C level greater than 9% 17.8% had no erectile dysfunction, 31% had mild and 23.9% had severe erectile dysfunction erectile dysfunction. Conclusion: Duration of diabetes i.e. glycaemic years are statistically associated with higher incidence and severity of erectile dysfunction. Glycaemic control as assessed by HBA1C shows no association