International Index Of Erectile Dysfunction Research Articles

Which is better to predict erectile dysfunction and male sexual function in the context of metabolic syndrome: triglyceride-glucose index or visceral adiposity index?: a retrospective cross-sectional study.

Many factors influence male sexual function, including metabolic disorders such as metabolic syndrome (MetS). We aimed to investigate the effects of two metabolic indices, the triglyceride-glucose (TyG) index and the visceral adiposity index (VAI), on male sexual function. A total of 400 men having sexual dysfunction were included. Anthropological data, comorbidities were recorded. Serum total testosterone, prolactin, and estradiol levels were recorded. Sex-specific VAI was calculated using the [(WC/39.68) + (1.88xMI)] × (TG/1.03) × (1.31/HDL) formula and using Ln (fasting triglycerides) × (fasting glucose)/2] formula, TyG index was calculated. Turkish-validated 15-item long-form of the International Index of Erectile Dysfunction (IIEF) questionnaire and male sexual health questionnaire (MSHQ) were used for erectile function and ejaculatory function, respectively. The ROC analysis was used to evaluate the predictive abilities of TyG and VAI cut-off values for ED risk. A higher TyG index and VAI were associated with an increased risk of ED. The presence of MetS further worsened sexual function, with lower scores in sexual satisfaction, orgasm, desire, and general satisfaction. The TyG index and VAI showed similar predictive abilities for ED. Patients with MetS had worse ejaculation quality compared to those without MetS. These findings highlight the potential of the TyG index and VAI as convenient tools for predicting and assessing sexual dysfunction in men, particularly in the context of metabolic disorders. Early detection and intervention for metabolic syndrome and insulin resistance may help to mitigate their negative impact on male sexual function.

Effect of Mirabegron in Men With Overactive Bladder and Erectile Dysfunction: A Prospective Observational Study.

As it has been observed that the erect penis has been the epitome of virility for the male community for decades, it became necessary to search for alternative treatments for the cause. So, the study was performed to evaluate the potential impact of mirabegron in men with mild to moderate erectile dysfunction (ED) and overactive bladder (OAB). It was a prospective, observational study that was carried out at the Department of Urology at Rajendra Institute of Medical Sciences, Ranchi, for a duration of two years and included a total of two hundred fifty patients. The individuals included had a diagnosis of mild to moderate erectile dysfunction (ED) along with symptoms of OAB. The overactive bladder questionnaire (OAB-q) score and the International Index of Erectile Dysfunction-5 (IIEF-5) score were used, respectively, to measure the impact of mirabegron on ED and OAB. Then, the changes in ED and OAB were evaluated at two, four, eight, and 12 weeks. Among the total 250 patients recruited, around 32.5% of them had mild ED, 17.5% were diagnosed with mild to moderate ED, and 50% suffered from moderate ED. The IIEF-5 scores improved by four points or more in 86.25%, 91.25%, and 71.25% of patients after four, eight, and 12 weeks, respectively. OAB-q scores were likewise shown to decline in the fourth (13.1 ± 4.3) and eighth (12.8 ± 4.2) weeks when compared to the baseline (17.4 ± 5.5). Also, adverse events reported did not hamper the progress of the study. The study concluded that mirabegron has a beneficial impact on controlling OAB symptoms among men diagnosed with mild to moderate ED. The effects last for only eight weeks, and then they decline. Furthermore, mirabegron was well-tolerated among patients and had no safety concerns with its use.

Impact of low-intensity extracorporeal shockwave therapy on vascular parameters and sexual function in patients with arteriogenic erectile dysfunction.

Previous published studies have shown an improvement of penile hemodynamic parameters after low-intensity extracorporeal shockwave therapy (Li-ESWT). However, the clinical significance of these findings remains unclear, and definitive selection criteria for Li-ESWT based on preexisting comorbidities have yet to be established. This was an observational study of 113 patients with ED, evaluated between January 2019 and December 2021 in Andrology Unit at the Department of Urology and Renal Transplantation, University of Foggia (Foggia, Italy). Penile dynamic Doppler was performed to evaluate vascular parameters and 5-item version of the International Index of Erectile Dysfunction (IIEF-5) questionnaire was administered to assess the severity of ED. This was repeated 1 month after treatment. Patients with a peak systolic velocity (PSV) <30 cm s-1 were considered eligible for Li-ESWT. Our protocol consisted of 8 weekly sessions with 1500 strokes distributed in 5 different locations along the penis. After treatment, a significant mean (±standard deviation [s.d.]) PSV increase of 5.0 (±3.4) cm s-1 was recorded and 52/113 (46.0%) patients reached a PSV >30 cm s-1 at posttherapeutic penile dynamic Doppler. A clinically significant IIEF-5 score improvement was observed in 7 patients, 21 patients, and 2 patients with mild-to-moderate, moderate, and severe pretreatment ED, respectively. No different outcomes were assessed based on smoking habits, previous pelvic surgery, or use of oral phosphodiesterase-5 inhibitor (PDE5i). On the other side, only 1 (6.7%) in 15 patients with diabetes mellitus showed an IIEF-5 score improvement after Li-ESWT. Shockwave treatment determined a significant increase in PSV and correlated IIEF-5 improvement in ED patients. This advantage seemed particularly evident for moderate ED and was not affected by smoking habits, previous pelvic surgery, and use of PDE5i. Conversely, diabetic patients did not benefit from the treatment.

Association between Stress and Erectile Dysfunction among Adult Patients in a Tertiary Center in Nigeria

Erectile dysfunction (ED) is a complex disorder with a biopsychosocial etiology that causes chronic stress on the individual thereby worsening the outcome of the disorder. The aim of this study is to establish an association between stress level and erectile dysfunction among adult patients presenting in the general outpatient of our tertiary hospital. A cross sectional study involving 421 adult males selected by simple random sampling was conducted using the International Index of Erectile Dysfunction (IIEF-5) and the Modified Percieved Stress Scale (PSS-10) Among the respondents, 219(52%) had ED while a greater proportion of those who had ED had mild ED 109 (49.8%). The other factors associated with ED on bivariate analysis include tobacco use (p &lt; 0.05), alcohol intake (p &lt; 0.05), diabetes mellitus, hypertension, use of anti hypertensive drugs, use of oral hyperglycaemic drugs, and perceived stress levels. Logistic regression showed that age, tobacco use, alcohol intake, and perceived stress levels were independent predictors of ED among the respondents. Perceived stress level has been found to be associated with ED. Routine evaluation of sexual health and the perceived stress levels of men isrecommended, while stress management as part of management of ER is highly advocated.

Skin-Related Sexual Life Questionnaire (SRSLQ): Creation and Validation of the Questionnaire.

Background and Objectives: The assessment of sexual dysfunction among psoriatic patients still remains a great diagnostic difficulty due to its subjective and embarrassing character. Various questionnaires have been used to assess sexual dysfunctions associated with skin conditions; however, none of them have been approved as a gold standard. The aim of our study was to create and validate the Skin-Related Sexual Life Questionnaire (SRSLQ) for the assessment of possible sexual dysfunction and related psychological burdens in patients with skin diseases. Materials and Methods: A total of 109 patients, including 45 women and 64 men (1:1.4) suffering from psoriasis and aged between 18 and 73 years (mean 48.0 ± 13.4 years), were included in the study. All subjects completed the 11-item SRSLQ and the Dermatology Life Quality Index (DLQI). In addition, all men were asked to fulfil the five-item version of the International Index of Erectile Dysfunction (IIEF-5) at the time of examination and 7 days after enrollment. The disease severity was assessed via the PASI scale. Results: The statistical analysis of internal consistency of SRSLQ showed very good integrity, with a Cronbach α coefficient of 0.94. The reproducibility level assessed with intraclass correlation coefficient (ICC) amounted to 0.96. A significant correlation between the total score of the 11-item SRSDQ and the DLQI (r = 0.39; p < 0.001) was found, confirming congruent validity. Conclusions: The validated 11-item Skin-Related Sexual Life Questionnaire can be successfully implemented in daily clinical practice as well as in clinical research.

One-year Follow-up Results of Transperineal Biopsy For Patients Undergoing Irreversible Electroporation Treatment in Localized Prostate Cancer.

This article reports on the early results of a 1-year follow-up study investigating the efficacy of irreversible electroporation in the treatment of localized prostate cancer. The study included 18 out of 40 patients diagnosed with low- and intermediate-risk prostate cancer who underwent irreversible electroporation. Treatment results were evaluated through confirmation biopsies, comparing prostate-specific antigen levels, international prostate symptom scoring, and international index of erectile dysfunction scores before irreversible electroporation and at the 12-month mark. The mean age of the patients was 61.1 years (SD ±6.5). Out of the 18 patients, 16 were tumor free (88.8%), while 2 experienced recurrences, one within the treatment field and the other outside of it (P < .001). Irreversible electroporation significantly reduced mean prostate-specific antigen levels (6.73 ng/mL vs. 2.05 ng/mL, P < .001), indicating a 69.5% reduction within 12 months. Furthermore, there was a significant improvement in mean international prostate symptom scores at the 12-month followup (10.05 vs. 7.52, P=.003). The mean international index of erectile dysfunction scores before treatment was 19.17 (SD ±5.85), and after irreversible electroporation, it was 18.67 (SD ±6.34), with no statistically significant change (P=.065). The short-term oncological results of irreversible electroporation treatment are promising, particularly for patients in the low- and intermediate-risk groups. Additionally, irreversible electroporation does not negatively impact the international index of erectile dysfunction; however, it may lead to a decrease in international prostate symptom scores.

(379) The Effectiveness of Low-intensity Shock Wave Therapy as an Emerging Non-invasive Management of Erectile Dysfunction Among Adult Males: A Systematic Review and Meta-analysis

Abstract Introduction Erectile dysfunction (ED) is the penile inability to sustain erection necessary for sexual function due to physiological, psychological, or emotional factors. While the WHO promotes sexual health for all individuals, ED remains a major influence in attaining satisfying sexual performance among the aging population of men. The effective management and treatment of ED has been primarily pharmacologic and the research to support other non-invasive management such as low-intensity shock wave therapy (Li-ESWT) is apparently limited. Objective This systematic review and meta-analysis of available randomized controlled studies investigates the effectiveness of Li-ESWT for ED among adult males based on the International Index of Erectile Dysfunction (IIEF) score. Methods The literature search was conducted using the PubMed database. The search was limited to randomized controlled trials on the effectiveness of Li-ESWT on ED, written in English from Medline and Nursing journals, and are publicly accessible without monetary cost published from 2012 to 2020. PRISMA guidelines were used as framework for literature search and review. The RevMan software was utilized for data collection and analysis. A fixed effect model was used in the meta-analysis. Results A total of 19 randomized controlled trials were reviewed of which three were included in this meta-analysis. There were total of 120 participants with overall mean age ranges from 41 to 61 years, 61 were enrolled in Li-ESWT group and 59 in the sham group. The heterogeneity of the data shows □2 = 7.70, df= 2, (p= &amp;lt;0.05); I2 = 74%, the overall effect is Z= 3.35, p = &amp;lt;0.05. This meta-analysis demonstrates that the control group (sham) was favored over the experimental group (Li-ESWT) (SMD= 0.64, 95% CI, [0.27, 1.02]) based on the mean IIEF score at the end of the studies. Conclusions The use of shock wave therapy in addition to pharmacologic and non-invasive modalities in the treatment and management of ED is promising. However, while the dearth of randomized clinical trials using Li-ESWT for ED management is evident, the decision to proceed with treatment is based on the informed and collaborative decision between the urologist and the patient. This review highlights that sham therapy is not inferior to Li-ESWT treatment. The urologists may consider the cost, adverse effects, time, and effort of using Li-ESWT provided that there is no significant difference in the effectiveness of Li-ESWT compared with sham treatment. Further research is needed to support effectiveness and safety of Li-ESWT in managing ED compared to current pharmacologic regimen. Disclosure No

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 ...

MP51-08 IS THE UROLIFT A FERTILITY SPARING TECHNIQUE IN PATIENTS SUFFERED FROM BPH?

You have accessJournal of UrologyCME1 Apr 2023MP51-08 IS THE UROLIFT A FERTILITY SPARING TECHNIQUE IN PATIENTS SUFFERED FROM BPH? Pasquale Annese, Nicola d'Altilia, Ugo G. Falagario, Vito Mancini, Antonella Ninivaggi, Edoardo Tocci, Mariano Bruno, Anna Ricapito, Gian M. Busetto, Carlo Bettocchi, and Giuseppe Carrieri Pasquale AnnesePasquale Annese More articles by this author , Nicola d'AltiliaNicola d'Altilia More articles by this author , Ugo G. FalagarioUgo G. Falagario More articles by this author , Vito ManciniVito Mancini More articles by this author , Antonella NinivaggiAntonella Ninivaggi More articles by this author , Edoardo TocciEdoardo Tocci More articles by this author , Mariano BrunoMariano Bruno More articles by this author , Anna RicapitoAnna Ricapito More articles by this author , Gian M. BusettoGian M. Busetto More articles by this author , Carlo BettocchiCarlo Bettocchi More articles by this author , and Giuseppe CarrieriGiuseppe Carrieri More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003299.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Benign prostatic hypertrophy (BPH) is a common disease in aging males. Although less common, some patients under 50 years of age reported lower urinary tract disorders (LUTS) due to BPH. If desirous of paternity, pharmacological treatment remains the only one due to the risk of anejaculation after surgery. The first aim of the study was to report functional outcomes related to fertility preservation evaluatet by sperm test in a population under 50 years of age who underwent UroLift in a single Center. METHODS: We included 20 young men with symptomatic BPH assessed by the International Prostate Symptom Score (IPSS), with normal erectile function (EF) and ejaculatory function (EjF) assessed by the International Index of Erectile Dysfunction (IIEF-5) and Male Sexual Health Questionnaire for Ejaculatory Dysfunction (MSHQ-EjD-SF).Semen analysis was performed before surgery and repeated at 3 months with evaluation of pH, volume, sperm concentration, total motility, vitality and morphology of sperms. All patients, preoperatively underwent, uroflowmetry (UFM), digital rectal examination, transrectal prostate ultrasound to measure prostate volume, PSA, cystoscopy and urodynamics test if necessary. Urinary function was scheduled at 1, 3, 6, 12 months with UFM, IPSS, IIEF-5, and MSHQ-EjD-SF. First PSA and cistoscopy were repeated at 6 month. RESULTS: The mean age of the patients was 44.5 (36.5, 48) years. Mean operative time was 15 (10, 20) min and 2.5 (2, 4) implats per patients were used. At 3 months there were no difference in terms of total sperm count, volume, pH, motility, vitality, morphology, liquefaction, leucocytes (p=0.9; p=0.8; p=0.7; p=1; p=1; p=1; p=0,2; p=0.5). No patient presented retrograde ejaculation. Q-max increased by 64.4% (p=0.001), PVR decreased by 66.6% (p=0.016), and IPSS decreased by 60% (p<0.001). IIEF and MSHQ-EjD-SF were similarly preserved (p=0.14, p=0.4). CONCLUSIONS: From the results obtained, we can conclude new findings regarding sparing of sperm test parameters following UroLift, furthermore, no one reported retroejaculation or volume alteration. UroLift was confirmed to be effective as a technique in improving urinary functional disorders secondary to BPH. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e695 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Pasquale Annese More articles by this author Nicola d'Altilia More articles by this author Ugo G. Falagario More articles by this author Vito Mancini More articles by this author Antonella Ninivaggi More articles by this author Edoardo Tocci More articles by this author Mariano Bruno More articles by this author Anna Ricapito More articles by this author Gian M. Busetto More articles by this author Carlo Bettocchi More articles by this author Giuseppe Carrieri More articles by this author Expand All Advertisement PDF downloadLoading ...

Effect of CoQ10 Supplement on Spermogram Parameters and Sexual Function of Infertile Men Referred to The Infertility Center of Fatemieh Hospital, Hamadan, Iran, 2019: A Randomized Controlled Trial Study.

The aim of this study was to investigate the effects of the antioxidant supplement of CoQ10 and placebo in the male infertility treatment. The randomized controlled trial study was designed as a clinical trial. Samples in each group consisted of 30 members. The first group received 1 daily dose of 100 mg coenzyme Q10 capsules and the second group received a placebo treatment. Treatment in both groups lasted 12 weeks. Before and after the intervention of semen analysis, hormonal measurement of testosterone, prolactin, luteinizing hormone (LH), follicle-stimulating hormone (FSH) and thyroid stimulating hormone (TSH) were done. Sexual function was assessed before and after the intervention by using the International Index of Erectile Dysfunction questionnare. The mean age of participants was 34.07 (5.26) years in the CoQ10 group and 34.83 (6.22) in the placebo one. Normal volume of semen (P=0.10), viscosity (P=0.55), sperm count (P=0.28), and sperm motility (P=0.33) in the CoQ10 group increased without statistically significant differences. But the normal sperm morphology increased with statistically significant differences in the CoQ10 group (P=0.01). There was an increase in normal FSH levels and testosterone levels in the CoQ10 group compared with the placebo patients, but these differences were not statistically significant (respectively P=0.58, P=0.61). The results also revealed that the scores of erectile function (P=0.95), orgasm (P=0.86), satisfaction with sexual intercourse (P=0.61), overall satisfaction (P=0.69) and the score of the International Index of Erectile Function (IIEF, P=0.82) were greater after the intervention in the CoQ10 group than in the placebo group although the difference was not statistically significant. The use of CoQ10 supplement can improve sperm morphology; however, in other sperm parameters and also in some hormones increased after the intervention, this was not statistically significant and therefore the result is not conclusive (registration number: IRCT20120215009014N322).

Efficacy of tadalafil and l-arginine combination therapy compared with tadalafil-only for the treatment of erectile dysfunction: A systematic review and meta-analysis

Introduction: Phosphodiesterase type 5 inhibitors (PDE5-I) has known to be the treatment for erectile dysfunction (ED), whereas tadalafil is a PDE5-I that has a rapid onset of action with a long duration of action and is not affected by dietary intake. L-arginine is a supplement that can improve erectile function by increasing the endogenous amino acids required for ideal nitric oxide (NO) synthesis and production. The combination of tadalafil and L-arginine can improve erectile function and testosterone levels. Thus, we conducted a meta-analysis to determine the efficacy and safety of the tadalafil and L-arginine combination therapy compared to tadalafil monotherapy for ED. Methods: This meta-analysis study is consistent with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. A total of four included studies were found by performing a systematic search thoroughly on Embase, MEDLINE, and Scopus databases. This study’s protocol is registered on PROSPERO (CRD42022343590). Result: The study analysis revealed that the The International Index of Erectile Dysfunction 5 (IIEF-5) scores in the tadalafil and L-arginine combination therapy significantly increased the IIEF-5 scores (p &lt; 0.00001; MD 1.64; 95% CI: 1.13-2.15) compared to tadalafil monotherapy. Testosterone levels were also observed to increase in the tadalafil and L-arginine combination therapy group (p &lt; 0.00001; MD 3.05; 95% CI: 2.05-4.04). Conclusion: A significant increase in IIEF-5 score and testosterone level is observed in patients with ED who received combination therapy of tadalafil and L-arginine compared to tadalafil monotherapy.

The effect of coronavirus disease 2019 severity on male sexual functions among patients on follow-up after hospital discharge

Objectives Severe acute respiratory syndrome coronavirus 2 has infected millions of people worldwide with extensive affection and damage to body systems and organs; hence, the study of post-coronavirus disease (COVID) sequences is mandatory. Till now, reports are upcoming on the considerable effects of COVID-19 on male sexual health with no final data. Patients and methods Our cohort study included 76 male COVID-19-infected patients, confirmed positive via nasopharyngeal PCR swab. The rationale of this study was to estimate the influence of clinical, laboratory, and radiological severity parameters of COVID-19 on male erectile dysfunction based on erectile scores and male sex hormones (follicle-stimulating hormone, luteinizing hormone, testosterone, and estradiol). Results Our results have demonstrated a highly statistically significant correlation between COVID-19 severity (mild, moderate, and severe cases) and both erectile scores (erection hardness score and International Index of Erectile Dysfunction-5) and testosterone hormones at first and third month after COVID (P<0.001), except for testosterone level at third month and COVID-19 severity, which showed a statistically significant difference, with P value of 0.031. Conclusions The current study correlated the effect of COVID-19 severity in the terms of clinical, laboratory, and radiological presentations on male sexual dysfunction (erectile scores and testosterone hormone) at first and third month after hospital discharge, with statistical significance being highly affected in severe rather than moderate and mild cases. This strengthens the obvious effect of COVID-19 infection on male sexual dysfunction.

Salvage external beam radiotherapy after HIFU failure in localized prostate cancer: A single institution experience

High-intensity focused ultrasound (HIFU) remains investigational as primary treatment for localized prostate cancer but is sometimes offered to select patients. At HIFU failure, data guiding salvage treatment is limited to small retrospective series with short follow-up. We evaluated our institutional experience using salvage radiation therapy (SRT) after HIFU failure. We conducted a retrospective analysis of patients with local failure post-HIFU who received salvage image-guided external beam radiation therapy (EBRT) delivered via intensity-modulated radiotherapy (IMRT). Our primary endpoint was biochemical failure-free survival (bFFS) defined as prostate-specific antigen (PSA) nadir + 2 ng/mL. Secondary endpoints included metastasis-free survival (MFS) and overall survival (OS). Endpoints were evaluated using Kaplan-Meier analysis. From 2013 to 2018, 12 out of 96 patients treated with primary HIFU received SRT via conventional or moderate hypofractionation. Median time from HIFU to SRT was 13.5 months. Seven patients had stage migration to high-risk disease at the time of SRT. Mean PSA prior to SRT was 8.2ug/L and mean nadir post-SRT was 1.2ug/L. Acute International Prostate Symptom Score (IPSS) as well as International Index of Erectile Dysfunction (IIEF) scores were similar to baseline (p = 0.5 and 0.1, respectively). Late toxicities were comparable to those reported after primary EBRT for localized prostate cancer. At a median follow-up of 46 months, the OS was 100%. The 5-year bFFS and MFS were both 83.3%. To our knowledge, we report one of the largest series on contemporary SRT post HIFU failure. We show that SRT is feasible, effective and carries no additional acute or delayed toxicity.

Male Sexual Dysfunction

Male sexual dysfunction is a series of conditions, most notably including erectile dysfunction (ED), Peyronie’s disease (PD), and premature ejaculation (PE), defined by impaired sexual functioning. The prevalence of male sexual dysfunction increases with age and is relatively high with greater than 50% of men aged 40 to 70 describing some degree of erectile dysfunction. Risk factors for male sexual dysfunction include age, diabetes mellitus (DM), cancer, stroke, hypertension, penile trauma, depression, anxiety, and disturbance in central serotonin neurotransmission and 5-HT postsynaptic receptor functioning. Sexual questionnaires including the International Index of Erectile Dysfunction, Sexual Health Inventory for Men, and the Premature Ejaculation Diagnostic Tool are useful in screening for these disorders. Focused history and physical can establish diagnoses. For a condition to be diagnosed as male sexual dysfunction, the patient or their partner must view their sexual functioning as impaired. Treatment of male sexual dysfunction is etiology dependent. For ED, first-line therapy is a phosphodiesterase-5 inhibitor or mental health care for psychogenic ED. More complicated cases may be treated with injections, surgery, or shockwave therapy. PD is either treated with medications for pain management, collagenase clostridium histolyticum injection, corpoplasty, plication, or shockwave therapy. PE may be treated behaviorally or with SSRIs as first line medication.

Sexual well-being and fertility in male renal transplant recipients: A study in a tertiary care centre.

Sexual dysfunction is a common problem among chronic kidney disease (CKD) patients. The uraemia, comorbid conditions, hormonal disturbances, autonomic neuropathy, side effects of medication and psycho-social factors contribute to sexual dysfunction. These factors also affect fertility of CKD patients. It starts early in CKD and gradually deteriorates with time. Renal transplant corrects most of the issues and leads to improvement of sexual function which ultimately leads to improved fertility outcomes. It was a cross sectional study performed in a single institution including 135 male renal transplant recipients. A questionnaire was used to evaluate the socio-economic status, fertility and developmental condition of the off-springs. The International index of erectile dysfunction (IIEF) was used for assessment of sexual well-being of the patient. The data were statistically analysed by SPSS 25.0 version. The mean age at transplant was 40.9 ± 9.9 years and the duration of haemodialysis received 13.6 ± 7.43 months. Among 135 recipients 63 (46.67%) desired but only 49 were successful to father a child. Upper middle class being the largest group to receive renal transplant also had the highest fertility rate in our study. The children born had no development anomaly. Sexual function improved in 85 patients, worsened in 15 and remain unchanged among 35 patients after renal transplant. Overall there was significant improvement in all five parameters of IIEF. Renal transplant corrects most of the metabolic abnormality as well gives a psychological boost to the CKD patients. These lead to improvement of sexual functions which in turn improves the fertility in renal transplant recipients. But the overall fertility rate among the male renal transplant recipients was comparable to the general population.

A Multidisciplinary Approach to the Treatment of Sexual Dysfunction in Couples

ABSTRACT Introduction Sexual dysfunction (SD) affects at least a third of adult women worldwide which makes it a public health concern. Given the complexity of both psychological and biological pathology associated with these conditions, a multidisciplinary approach has been advocated. However, there is a limited amount of literature examining a multidisciplinary treatment approach to a couple's sexual and psychological functioning. This program, emphasizes treatment of the couple. This program includes a multidisciplinary team consisting of psychologists, gynecologists, urologists, dieticians, physical therapists, yoga instructors, and nurses. Our group collaborates in the care of each couple; working together to participate in the diagnosis and treatment of their sexual dysfunction. The treatment approach is a biopsychosocial model. Our couples attended weekly lectures on the follow topics: communication, female sexual functioning, male sexual functioning, stress management, chemistry of love, pelvic floor physical therapy, healthy diet, sexual aids, and gaining momentum. They also received counseling from a dyad therapist team. additionally, the couple was responsible for completing weekly homework consisting of sensate focus exercises and other gestures to help them engage with one another. In therapy sessions, communication and visualization exercises were also utilized. Objective This study prospectively followed couples pre- and post-attendance of a six-week sexual wellness treatment program (SWP) at a single academic medical center. The following outcomes were used: (1) sexual functioning (2) relationship satisfaction (3) mood stability. Methods The study was approved by the IRB. Couples attending the six-week multidisciplinary SWP, were consented and then completed surveys both pre-treatment and at the end of treatment. Surveys administered included the Dyadic Adjustment Scale (DAS), Sexual Functioning Profile (PROMIS), and International Index of Erectile Dysfunction (IIEF) for men only. Linear mixed-effects models were used to estimate the mean change from baseline to first follow-up. A covariance matrix was used to account for dependency. The program included weekly didactic sessions following an initial evaluation. Didactics included cognitive behavioral sex therapy with an attending (psychologist, psychiatrist or gynecologist) paired with a trainee (psychiatry, psychology or gynecology resident or a medical student), and home assignments. Results There were 85 respondents – 42 men, 43 women. Mean age was 49.82 years (Range 25-77). Most frequently reported SD were hypoactive sexual desire (32.2%), erectile dysfunction (21.4%), dyspareunia (14.3%), and female orgasmic disorder (10.7%). controlling for patients’ sex and baseline PHQ severity, all DAS measurements increased from baseline. The largest improvement was on the total DAS score which increased by approximately 5.18 (95% CI: 2.55 – 7.81) points. Similarly, the PROMIS global satisfaction with sex life score, erectile function score, and interest in sexual activity score significantly increased from baseline while the vaginal discomfort score significantly declined from baseline. Overall, the global satisfaction with sex life score increased from baseline by approximately 5.57 (95% CI: 3.03 – 8.10) points. Among male participants, the IIEF erectile, sexual, and satisfaction scores increased from baseline. On average, men reported a 4.33 (95% CI: 0.04 – 8.62) point increase in their IIEF erectile score from baseline. Conclusions The results indicate that a multidisciplinary treatment approach focused on the couple positively impacts multiple aspects of a couple's relationship, including global satisfaction with sex life, relationship satisfaction, interest in sexual activity, and erectile function. These findings emphasize that multidisciplinary sexual therapy programs aimed at the couple can help address multiple aspects of sexual well-being. Disclosure No

Salvage External Beam Radiotherapy After HIFU Failure in Localized Prostate Cancer: A Single Institution Experience

<h3>Purpose/Objective(s)</h3> Standard treatment options for localized prostate cancer include active surveillance, radical prostatectomy, or local radiotherapy. While the use of high-intensity focused ultrasound (HIFU) as a primary treatment remains investigational, it is sometimes offered to select patients. At the time of HIFU failure, there is a lack of data in salvage treatment approach. Available data includes only small retrospective series with short-term follow-up. We therefore sought to evaluate our institutional experience in a cohort of patients treated with salvage radiation therapy (SRT) after primary HIFU failure. <h3>Materials/Methods</h3> We conducted a retrospective analysis of patients who had local failure after HIFU. This cohort of patients received salvage external beam radiation therapy (EBRT) delivered via intensity modulated radiotherapy (IMRT). Our primary endpoint was biochemical failure-free survival (bFFS) based on the 'Phoenix' definition of PSA nadir + 2 ng/mL. Secondary endpoints included metastasis-free survival (MFS) and overall survival (OS). Kaplan-Meier analysis was performed examining bFFS, MFS and OS. Genitourinary and erectile dysfunction adverse events were analyzed. <h3>Results</h3> From 2010 to 2018, 12 patients had local relapse post primary HIFU and received salvage EBRT with or without androgen-deprivation therapy, 75% and 25% respectively. The mean initial PSA prior to salvage EBRT was 8.2ug/L (2.9-14.4ug/L). The median time from HIFU to salvage EBRT was 13.5 months (6-42 months). EBRT was delivered as either conventional (76-78 Gy in 38-39 fractions, n = 11) or hypofractionation (66 Gy in 22 fractions, n = 1). Mean PSA nadir post RT was 1.2ug/L (0.1-2.6 ug/L). Acute International Prostate Symptom Score (IPSS) as well as International Index of Erectile Dysfunction (IIEF) scores were similar to baseline (<i>P</i> = 0.5 and 0.1, respectively). Late toxicities were comparable to those reported in men receiving EBRT as their primary treatment for localized prostate cancer. At a median follow-up of 46 months, only one patient had biochemical recurrence and radiological progression. The 5-year bFFS and MFS were both 83.3%. There were no deaths at the time of this analysis (OS = 100%). <h3>Conclusion</h3> To our knowledge this is one of the largest series reporting on modern SRT post HIFU failure. Our analysis shows that salvage EBRT is feasible, effective and carries no additional acute and delayed toxicity.

Trajectory of Change in Erectile Dysfunction Symptoms Following Coronary Artery Bypass Surgery in Malaysian Population

INTRODUCTION: Despite the advantages of Coronary artery bypass surgery (CABG), this procedure has been reported to have a significant impact on sexual activity. The study aims to assess the trajectory of change in erectile dysfunction (ED) symptoms following CABG.METHODS: 73 adult male participants were recruited. Participant primary data was measured using the International Index of Erectile Dysfunction (IIEF-5) at three-time points. RESULTS: Severe ED was most prevalent during 6 weeks following-operation (86.3%); however, the proportion of severe ED symptoms reduced after 4 months following-operatively (42.5%). There was a statistically significant difference in ED symptoms between pre-operatively and 6 weeks post- operatively (p&lt; 0.001). At 4 months, there was a marginally significant improvement in ED symptoms compared to baseline pre-operatively post CABG (p = 0.064). Age significantly increases the chance in odds of having abnormal ED symptoms by 22% at 4 months postoperatively (aOR=1.22, 95% CI=1.06, 1.41, p&lt;0.05). Other risk factors for abnormal ED symptoms following CABG, which include normal creatinine clearance, being a smoker, and having moderate to good LV function was not statistically significant. CONCLUSION: The present study has demonstrated a high prevalence of ED following CABG and the procedure caused a negative impact on the ED symptoms. However, there was a significant improvement in ED symptoms as the time from surgery increases and patients recovered. Further studies with larger sample size and longer recovery time are needed to assess the trajectory of recovery in ED symptoms in this population.&gt;&lt; 0.05). Other risk factors for abnormal ED symptoms following CABG, which include normal creatinine clearance, being a smoker, and having moderate to good LV function was not statistically significant. CONCLUSION: The present study has demonstrated a high prevalence of ED following CABG and the procedure caused a negative impact on the ED symptoms.

Erectile Dysfunction after Allogeneic Hematopoietic Stem Cell Transplant: Results from a Single Center Experience

▪Erectile dysfunction (ED) is a multidimensional disturbance of the erectile response involving organic, relational and psychological components, which has been reported to affect a significant proportion of patients after allogeneic hematopoietic stem cell transplant (HSCT). Although predictors for ED have been established in the general population, few studies have addressed which variables are associated with ED in HSCT patients.Aims of the study were to establish prevalence and extent of ED in 55 consecutive patients transplanted in our Institution between 2003 and 2015, and to identify within socio-demographic, medical and psychological domains eventual ED predictors.Patients were enrolled in the study upon informed consent. Inclusion criteria were age ≥ 18 years, continuous disease remission, and ≥ 6 months from HSCT. Exclusion criteria were concurrent malignancy, major psychiatric disorder or mental retardation, and hormonal replacement.ED was assessed and measured by the International Index of Erectile Dysfunction (IIEF15).Patient socio-demographics were collected by an ad hoc schedule.Medical data were obtained from hospital records. The andrological visit included testicular measure, penis and genital skin inspection, and penile ultrasound and elastosonography. Free testosterone (FT), inhibin B, follicle stimulating hormone (FSH), luteinizing hormone (LH), prolactin, thyroid stimulating hormone (TSH), free triiodothyronine 3 (FT3), FT4, cortisol, and adrenocorticotropic hormone (ACTH) levels were measured.Anxiety was quantified by the State-Trait Anxiety Inventory (STAI), depression by the Zung Self-rating Depression Scale (SDS).Differences between groups were analyzed by the non-parametric Mann-Whitney test and the Fisher's exact test when testing quantitative and categorical variables, respectively. Logistic regression analysis was used to estimate the association of the variables predictive for ED, when including into the association model the relevant covariates. Chronic graft versus host disease (cGVHD) was diagnosed according to NIH criteria.Fifty-two (94.5%) of the 55 patients eligible for the study returned the self-administered questionnaires and underwent the andrological visit: 32 had acute leukemia, 7 non-Hodgkin lymphoma, 4 myelodysplastic syndrome, 4 chronic myeloproliferative disease, 3 multiple myeloma, 2 B cell chronic lymphocytic leukemia.Median time from HSCT to study assessment was 19 (6-108) months. Thirty-nine patients (75%) had hypogonadism, while 10 (19.2%) presented genital cGVHD, with post-HSCT phimosis in 7 cases, meatal scarring in 2, lichen sclerosis-like lesions in 1. At penile ultrasound and elastosonography, 12 (23%) and 7 (13.5%) patients had a medium-hard and hard penile elasticity.FT and inhibin B were below the range limit in 34 (65.4%) and 33 (63.5%) patients, while FSH was above in 47 (90.4%), thus indicating a large prevalence of gonadal failure. Three patients (5.7%) had a mild hypotyrodism. No prolactin, cortisol or ACTH alterations were observed.Forty-seven (90.4%) of the 52 participants declared a stable sexual partner: the 5 patients [median age 42 (19-50) years, 1 with cGVHD] who reported not having any sexual activity due to partner absence were excluded from the analysis of ED predictors according to IIEF15 requirements.ED was reported by 31/47 (66%) patients: it was severe in 42% cases, moderate in 22.6%, moderate to mild in 6.4% and mild in 29%. There was no difference between patients with and without ED in terms of time from HSCT [25 (6-108) vs 15 (6-79) months, p=0.32].In univariate analysis higher age, low education level, and cGVHD (excluding the isolated genital one) were significantly associated to ED, while the same variables in addition to hypertension maintained their significance in the subgroup of patients with moderate-severe ED only (Table 1). In a logistic regression model, age and cGVHD were the only variables independently associated with ED (any grade, p=0.02 and moderate-severe, p=0.0001, respectively).Our study confirms that ED is a frequent long-term complication of HSCT, with cGVHD being a major predictor. We suggest that an early screening of sexual dysfunction and a close partnership between HSCT clinicians and andrologists could help to implement reliable prevention strategies and/or prompt interventions for patients suffering from ED. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

The Prevalence of Late-Onset Hypogonadism in Middle-Aged Men and Cardiovascular Risk Factors

Background: Life expectancy has increased dramatically worldwide, resulting in a sharp rise of age-associated diseases, including late-onset hypogonadism (LOH) in men. Aim: To assess the prevalence of LOH and to determine its relationships with cardiovascular risk factors in healthy middle-aged men. Material and Methods: A total of 200 men aged 44–55 (median 48.44, interquartile range 45.02–52.50) undergoing regular medical examinations were enrolled in a study. All participants were asked to complete the International Index of Erectile Dysfunction, Aging Male's Symptoms, and Beck Depression Inventory questionnaires. Sex and gonadotropin hormones were measured in all participants. Cardiovascular diseases (CVD) risk was assessed in all participants by using the Systematic Coronary Risk Evaluation scale, and additional risk factors were recommended in the 2019 European Society of Cardiology and European Atherosclerosis Society guidelines for the management of dyslipidemias: lipid modification to reduce cardiovascular risk. Results: Ninety-eight (49%) men suffered from LOH. Men with total testosterone (TT) of <12 nmol/L were considered testosterone-deficient. The mean TT level was 8.9 ± 2.4 nmol/L in the LOH group. Clinical signs and symptoms of LOH were associated with lower TT levels: 7.78 ± 2.49 and 10.15 ± 1.32 in the groups with and without LOH, respectively (p = 0.004). The prevalence of obesity, metabolic syndrome, and depression was significantly higher among men with LOH, compared with men without it. High cardiovascular risk was found only in those participants present with LOH (p = 0.003). After collecting other risk factors, we found that 94.9% of participants assigned to the LOH group had high cardiovascular risk. Conclusion: The prevalence of LOH is high among healthy middle-aged men. Moreover, it is associated with an increased cardiovascular risk. Early measurement of TT levels in this population group may predict the development of CVD and allow the introduction of timely primary prevention measures to reduce cardiovascular morbidity and mortality.