International Index Of Erectile Function Score Research Articles

Alfuzosin vs. Silodosin in the Improvement of Ureteral Stent-Related Symptoms after Endoscopic Surgical Treatment of Urolithiasis: A Retrospective Comparison

Purpose In this study, we aimed to compare the efficacy of two α-blockers, alfuzosin and silodosin, which have different pharmacological properties despite being uroselective, in the treatment of double-J stent (DJS)-related symptoms. Methodology Fifty-six male patients who underwent DJS implantation and for whom all data were available were included in the study. All patients were asked to complete the validated Turkish version of the Ureteral Stent Symptom Questionnaire (USSQ), international prostate symptom score (IPSS), and international index of erectile function-5 (IIEF-5) the day before stent removal and again one month after stent removal. Statistical analysis of these variables was performed in the groups, and a value of p<0.05 was considered statistically significant. Results Significant decreases in IPSS, IPSS-quality of life, and USSQ scores were observed in both Group A and Group S one month after stent removal compared with before stent removal (p<0.05). Whereas no side effects were observed in the alfuzosin group (Group A), retrograde ejaculation was observed in 8 (25.2%) patients in the silodosin group (Group S) (p=0.006). Furthermore, a statistically significant increase in IIEF-5 score was observed in both groups after stent removal compared with IIEF-5 score with stenting (p<0.05). Conclusion The DJS has a significant impact on patients’ quality of life and should only be used when indicated, not routinely after every endoscopic stone procedure. Considering that silodosin may cause more ejaculation problems than alfuzosin, we believe that both drugs can be used in male patients to resolve DJS-related symptoms.

Efficacy of low-intensity shockwave therapy with different tadalafil regimens in patients with PDE5 inhibitor-resistant erectile dysfunction: a retrospective cohort study.

Currently, there is a lack of research comparing tadalafil treatment protocols recommended during low-intensity shock wave therapy (LI-SWT) for patients with erectile dysfunction (ED) who are unresponsive to phosphodiesterase type 5 inhibitors (PDE5i). The objective of this study is to compare the efficacy of only LI-SWT versus LI-SWT plus 5mg tadalafil daily versus LI-SWT plus 20mg tadalafil alternate-day in PDE5i -resistant ED. MATERıALS AND METHODS: In this study, a cohort of 105 patients with PDE5i-resistant ED was recruited and divided into three groups labeled as A (only LI-SWT), B (LI-SWT plus 5mg tadalafil daily), and C (LI-SWT plus 20mg tadalafil alternate-day), comprising 27, 42, and 36 patients, respectively. The patients' International Index of Erectile Function-5 (IIEF-5) scores and the Erection Hardness Score (EHS) were evaluated at the baseline, three months and six months following the treatment. After three months post-treatment, the IIEF-5 scores in group A, B, and C increased by 4.1 ± 0.6, 7.3 ± 0.6, and 8.2 ± 0.6, respectively. These improvements were maintained at six months with IIEF-5 scores increasing by 3.7 ± 0.6, 7.3 ± 0.6, and 8.5 ± 0.7 in groups A, B, and C, respectively. At 3 and 6months post-treatment, groups B and C showed significant improvement in IIEF-5 scores and EHS values compared to group A (p < 0.001). The rate of patients with EHS ≥ 3 and IIEF-5 ≥ 17 was significantly higher in groups B and C compared to group A, while there was no significantly different between groups B and C. CONCLUSıON: In patients with PDE5i-resistant ED, PDE5i combined with LI-SWT is superior to LI-SWT monotherapy. The statistical analysis failed to demonstrate any difference between two distinct tadalafil regimens when administered with LI-SWT treatment.

High-Intensity Focused Ultrasound (Sonablate®) for Prostate Cancer: Preliminary Outcomes in Taiwan.

We reported preliminary outcomes of high-intensity focused ultrasound (HIFU) [Sonablate®] in the combination of transurethral resection of the prostate for localized prostate cancer in Taiwan. Seventy-seven patients using Sonablate® HIFU for localized prostate cancer were enrolled in this study from April 2021 to December 2022. Prostate-specific antigen biochemical recurrence, International Index of Erectile Function (IIEF)-5 scores, International Prostate Symptom Score (IPSS), quality of life (QoL) scores, and postoperative complications were recorded during follow-up. Overall, 19.5% of patients were low-risk, 36.4% were intermediate-risk, and 44.1% were high-risk according to the D'Amico risk classification. The median follow-up was 12.09±5.85 months, and the biochemical-free survival rates for the low-, intermediate-, and high-risk groups were 100% (15/15), 96.4% (27/28), and 79.4% (27/34), respectively. Four patients (5.2%) received salvage radiotherapy and all maintained biochemical-free survival. The mean IPSS and QoL scores before versus after HIFU were 10.4 versus 6.8 (p=0.003) and 3.2 versus 3.0 (p=0.096), respectively. There was no statistically significant change in preoperative and postoperative IIEF scores (20.6 vs. 19; p=0.062) in patients who had an IIEF score of >15 at baseline and received nerve-sparing procedures (subtotal ablation). The results of Sonablate® HIFU in Taiwan indicated adequate short-term cancer control, excellent potency, and continence preservation. HIFU can achieve improvement of IPSS with low complication rates.

Long-term effects of combination treatment comprising low-intensity extracorporeal shockwave therapy and tadalafil for patients with erectile dysfunction: a retrospective study.

This study retrospectively examined the effects of low-intensity extracorporeal shockwave therapy and tadalafil on erectile dysfunction patients. 116 patients got low-intensity extracorporeal shockwave therapy twice weekly for 3 weeks, 5 mg of tadalafil daily for 3 weeks, and adjuvant therapy for 6 months. Group A (1 year), Group B (2 years), Group C (3 years), and Group D (4+ years) were treated patients' follow-up groups. The patients' International Index of Erectile Function-5 (IIEF-5) scores were gathered at the start of treatment via face-to-face interviews and at the end of follow-ups by telephone conversations. IIEF-5 scores and the minimal clinically significant differences were the main outcomes. Mean follow-up length, age, and IIEF-5 scores of the patients were 2 ± 1.16 years, 47.34 ± 12.65 years, and 12.09 ± 3.66 points, respectively. Compared to baseline, treatment increased the median IIEF-5 scores of patients in groups A, B, C, and D by 7 [3-12], 6 [0-8], 7 [1-9], and 6.5 [2.5-10] points, respectively (p = 0.001). 71%, 63%, 65.8%, and 65% of treated patients in groups A, B, C, and D met the minimal clinically significant differences criteria (n = 77). Mild disease patients were 9.14 times more likely to respond to treatment than severe illness patients (OR, 9.14; 95% CI, 1.28-65.46; P = 0.02). Low-intensity extracorporeal shockwave therapy and 5 mg of tadalafil can treat erectile dysfunction for up to 4 years with sustained outcomes. This treatment is optimal for mild illnesses.

Efficacy and Safety of Different Modalities for Treatment of Erectile Dysfunction in Chronic Renal Failure Patients

Background Erectile dysfunction has been found to be significantly more common in men with chronic kidney disease (CKD) than in the general population. Objective of the Study Detection of the safest and most effective medical treatment of erectile dysfunction(ED) in chronic renal failure patients. Patients and Methods . This study was conducted at Ain Shams University Hospitals with a sample size of 60 patients: 15 patients per group. We assessed the improvement in the erectile function through assessment of IIEF (International Index of Erectile Function) score and EHS (Erection Hardness Scale) score pre- and post-administration of the drugs used in the study (oral sildenafil, oral vardenafil, oral tadalafil and intracavernosal injection of alprostadil). Results There is a statistically significant increase in IIEF score post-administration of the drugs used in this study with p value of &amp;lt; 0.001 and a mean difference of 6.92. The mean score of IIEF pre-administration of the drugs used was 8.13 and post-administration was 15.05. There is also a statistically significant difference in EHS score with p value of &amp;lt; 0.001 and mean difference of 1.4. The mean score of EHS pre-administration of the drugs was 1.22 and post-administration was 2.62. From the four drugs used in this study, Alprostadil showed the highest improvement in IIEF and EHS scores. The study also showed a negative correlation between age, duration of haemodialysis and serum creatinine with erectile function. In addition, there was a statistically significant decrease in pre- and- post-treatment IIEF and EHS scores in diabetic cases than in the non-diabetic cases. Conclusion There is high incidence of ED in CKD patients. The drugs used in the study showed improvement in the erectile function with mild side effects. Alprostadil had the best IIEF and EHS scores amongst the four drugs.

Sexual Dysfunction in Diabetes Mellitus – An Observational Cohort Study

Objectives: The objectives of the study are to assess the prevalence and type of sexual dysfunction (SD) in males and females living with diabetes mellitus and to further assess erectile dysfunction in males who score more than 10 points in the Arizona Sexual Experience (ASEX) scale with help of the International Index of Erectile Function-5 (IIEF-5) scale. Materials and Methods: An observational cohort study was conducted on 153 diabetic patients visiting SGRDIMSR hospital, Vallah, Sri Amritsar in the Punjab region of North India. Patients aged between 18 and 50 years who were sexually active and in a healthy sexual relationship with their partner were included in the study after an informed consent. ASEX score was used for the assessment of SD and males who score more than 10 points were further assessed for erectile dysfunction with the help of IIEF-5 scale. SPSS Statistics for Windows, Version 23.0. Armonk, NY, USA: IBM Corp., Chicago, was used for data analysis. Results: SD was prevalent in 64.05% ( n = 98) of study participants overall, 65.9% ( n = 5) in female and 61.5% ( n = 40) in male groups, respectively. Mean scores of each sexual domain were drive (3.85 ± 1.10) &gt; overall satisfaction (3.34 ± 1.06) &gt; orgasm (3.14 ± 0.96) &gt; arousal (3.11 ± 0.84) &gt; erection/lubrication (2.65 ± 0.82) in that order. 69.84% of male diabetic had some degree of erectile dysfunction as assessed further by IIEF-5 score. The prevalence of SD was found to be higher in patients belonging to elderly age group ( P = 0.001), longer duration of diabetes ( P = 0.001), and deteriorating glycemic control ( P = 0.001). Conclusion: Diabetes-related SD is quite prevalent in diabetic patients with 6 out of every 10 patients experiencing this problem. Thus, sexuality needs to be discussed frequently and openly with diabetic patients. In our study, factors such as elderly age of the patient, longer duration of diabetes, and worsening glycemic control of the patient are found to increase the prevalence of SD. Furthermore, the prevalence is higher in patients who already have existing complications of diabetes such as neuropathy, retinopathy, or albuminuria.

Comparison of sexual function of people with colorectal cancer with and without colostomy bag in Iran: a comparative cross-sectional study

The aim of this study was to investigate and compare sexual function in individuals with colorectal cancer, with and without a colostomy bag. A quantitative, descriptive-comparative design was employed, and a cluster random sampling method was used to recruit 252 patients with colorectal cancer. Data collection tools included a participants characteristics form, the International Index of Erectile Function (IIEF) for men, and the Female Sexual Function Index (FSFI) for women. The mean IIEF total score for men with a colostomy was 26.17 ± 15.30, and for men without a colostomy, it was 29.05 ± 17.14. The mean FSFI total score for women with a colostomy was 6.40 ± 7.21, and for women without a colostomy, it was 9.10 ± 14.67. There was no statistically difference in IIEF scores between men with and without colostomy bags (p > 0.05). However, women with colostomy bags had significantly lower FSFI scores compared to women without colostomy bags (p < 0.05). Addressing sexual concerns in individuals with colorectal cancer is crucial for enhancing their sexual well-being and overall quality of life. Comprehensive support, timely interventions, and targeted services are essential to help patients navigate the challenges and improve their overall well-being.

Low-intensity Extracorporeal Shock Waves for Treatment of Erectile Dysfunction in Patients Not Responding to Phosphodiesterase Type 5 Inhibitors, Its Durability, and Factors That May Influence the Outcome: A Clinical Trial

Background: Non-invasive treatments, such as low-intensity extracorporeal shock waves treatment (Li-ESWT), can be a safe and effective alternative for patients with erectile dysfunction (ED) who are resistant to phosphodiesterase type 5 inhibitors (PDE5Is). Objectives: This clinical trial study aimed to evaluate the effect of Li-ESWT on ED in non-responders to PDE5Is, its durability, and factors predicting its success. Methods: This study was conducted on 128 patients with ED who were resistant to PDE5Is. Before any intervention, written informed consent was obtained, demographic characteristics were collected, and the severity of the ED score was determined using the international index of erectile function (IIEF). Patients were treated with Li-ESWT, and ED severity was remeasured by the IIEF scale at the end of the intervention, three months, and six months after the intervention. The data were analyzed by chi-square, repeated measure ANOVA, Bonferroni post hoc, and binary logistic regression tests. Results: A total of 128 patients with ED who had not responded to PDE5Is, with a mean age of 58.35 ± 8.28 and an average ED of 3.41 ± 1.78 years, were included. At the end of the intervention, the IIEF score significantly increased. Moreover, this score was significantly higher three months and six months after the intervention. Three and six months later, the IIEF score decreased significantly. However, the score was significantly higher all three times than before the intervention. Being younger than 60 years, having an ED duration of fewer than three years, being non-smoking, being non-diabetic, and having no lower urinary tract symptoms (LUTS) were the most prominent predictors of a successful ED treatment. Conclusions: Low-intensity extracorporeal shock waves treatment is a safe and effective method for short and long-term treatment of ED patients. Identifying predicting factors can be beneficial for urologists in selecting suitable patients and avoiding the overtreatment of those who are not suitable candidates.

Baseline Lower Urinary Tract Symptoms and Sexual Dysfunction in Men with Newly Diagnosed Localized Prostate Cancer.

We evaluated baseline lower urinary tract symptoms (LUTS) and sexual dysfunction in patients with newly diagnosed localized prostate cancer. Data were obtained from a cohort registry of patients with localized prostate cancer scheduled for radical prostatectomy. Before surgery, patients completed a 3-day voiding diary; International Prostate Symptom Score (IPSS), International Index of Erectile Function-5 (IIEF-5), and Expanded Prostate Cancer Index Composite (EPIC) questionnaires; and a urodynamic study. Data were analyzed according to benign prostatic hyperplasia treatment status and age group. In total, 380 patients (median age, 67 years) were enrolled in this study. On the IPSS, 10.8% of patients had severe symptoms. On the IIEF-5, 8.7% of patients did not have erectile dysfunction and 52.9% had moderate-to-severe erectile dysfunction. On the EPIC, 3% of patients indicated that they did not have urinary control and only 13% responded that their erectile function was good or very good. The mean IPSS and IIEF-5 scores showed significant differences among age groups. Thus, patients with localized prostate cancer show various LUTS and sexual dysfunction at baseline, and these symptoms worsened with increased age.

Effect of COVID-19 On the Sexual Activity of Men.

In December 2019, severe acute respiratory syndrome COVID-19 was found in China. This virus can affect different organs depending on the coronavirus receptors on the cell surface, which allows the organ to be attacked by the coronavirus. Psychological distress and impaired pulmonary hemodynamics seem to be the cause of decreasing libido or sexual dysfunction after contracting COVID-19. This study was performed to assess the effect of coronavirus on the sexual activity of men. We enrolled 200 men with COVID-19, confirmed by an oropharyngeal sample, who had recovered from the coronavirus for 3 months. These men filled out the International Index of Erectile Function 5 (IIEF-5) questionnaire for their current and previous sexual status. Then, according to their IIEF-5 score, sexual activity before and after corona infection was compared. The mean age of the participants was 31.5 ±3.2 years. This study showed a significant difference between the IIEF-5 mean scores before and after COVID-19, which were 20.4 and 18.6, respectively (p = .000). The condition of 56.1% of the patients did not change; however, coronavirus did have a negative effect on 39.6% of the patients. 4.1% of patients reported improvement in sexual performance. 45% of the patients reported no erectile dysfunction (ED) before contracting the coronavirus; while only 27.7% reported no ED after getting COVID-19. Our findings show that COVID-19 could influence the sexual activity of infected men, who also showed a higher ED prevalence after COVID-19 infection; however, hormonal assessment should be observed in the follow-up.

Pilot Study on Feasibility and Outcome of a Nerve-Preserving Aortoiliac Exposure Technique

Dysfunctional ejaculation is a common complication following open aortoiliac aneurysm surgery. It may occur in 49-63% of patients and is caused by iatrogenic damage to the sympathetic lumbar splanchnic nerves (LHN) and superior hypogastric plexus (SHP). A nerve-preserving operative technique based on a unilateral right-sided approach to the abdominal aorta, was implemented in clinical practice. The aim of this pilot study was to establish the safety and feasibility of the technique, and whether a sympathetic pathway and ejaculatory function was preserved.u METHODS: Patients were asked to fill out questionnaires preoperatively, and 6 weeks, 6 months and 9 months postoperatively. The International Index of Erectile Function (IIEF), Cleveland Clinic Incontinence Score (CCIS), Pac-Sym and ICIQ-Mluts were used. Surgeons were asked to complete a technical feasibility questionnaire. Twenty-four patients undergoing aortoiliac aneurysm surgery were included. The nerve-sparing phase of the procedure added an average of 5-10 minutes of operating time and was technically feasible in twenty-two patients. No major complications occurred during nerve-sparing exposure. Fifteen of twenty-four patients were sexually active at some point throughout the study. No postoperative loss of ejaculation was seen in sexually active patients. CCIS, Pac-sym, IIEF and ICIQ-Mluts scores remained similar throughout the study. Nerve-preserving aortoiliac reconstruction surgery is safe and feasible. Ejaculatory function is preserved. Given the low number of patients in the study, further research is needed to provide robust data.

Sexual Functions Following Cardiac Resynchronization Therapy: Evaluation of Male Patients and Their Partners.

Sexual functionality, a critical component of health-related quality of life, can decline for various reasons, including heart failure (HF). Our purpose was to prospectively evaluate male patients with HF scheduled for cardiac resynchronization therapy (CRT) in terms of sexual function, erectile function, and alterations in hormonal and biochemical parameters. In addition, we sought to determine the sexual functioning of the partners of these patients. The study enrolled 103 male patients and their partners. The International Index of Erectile Function-5 (IIEF-5) was administered to all males and the Arizona Sexual Experience Scale (ASEX) questionnaire was completed by all participants, at baseline and three months after CRT. The ASEX scores of patients and partners demonstrated significant declines from baseline to post-intervention analysis. The IIEF-5 scores of patients showed a significant increase from baseline to post-intervention (p=0.001 for all). We conclude that sexual dysfunction is experienced by the partners of male patients with erectile dysfunction before CRT and that reversal of erectile problems with CRT yields improvements in both male and female sexual functions.

Impact of female stress urinary incontinence and related treatments on the sexual function of male partners: a systematic review and meta-analysis.

No conclusions have been reached on whether female stress urinary incontinence (SUI) and related treatments affect male partners' sexual function. To assess the effects of female SUI and related treatments on male partners' sexual function. A comprehensive search of the PubMed, Embase, Web of Science, Cochrane, and Scopus databases was performed up to September 6, 2022. Studies were included that investigated the effect of female SUI and related treatments on male partners' sexual function. Male partners' sexual function. Of the 2294 citations identified, 18 studies with 1350 participants were included. Two studies assessed the effect of female SUI without treatment on male partners' sexual function, finding that partners had more erectile dysfunction, more sexual dissatisfaction, and less sexual frequency than partners of women without urinary incontinence. Seven studies directly assessed the effect of female SUI treatments on male partners' sexual function by surveying the male partners. Among these, 4 assessed transobturator suburethral tape (TOT) surgery; 1 assessed TOT and tension-free vaginal tape obturator surgery; and the remaining 2 assessed pulsed magnetic stimulation and laser treatment. Among the 4 TOT studies, 3 used the International Index of Erectile Function (IIEF). TOT surgery significantly improved the total IIEF score (mean difference [MD] = 9.74, P< .00001), along with erectile function (MD = 1.49, P< .00001), orgasmic function (MD = 0.35, P= .001), sexual desire (MD = 2.08, P< .00001), intercourse satisfaction (MD = 2.36, P< .00001), and overall satisfaction (MD = 3.46, P< .00001). However, the improvements in IIEF items may be of unclear clinical significance, as 4 points in the erectile function domain of the IIEF are typically defined as the minimal clinically important difference. In addition, 9 studies indirectly assessed the effect of female SUI surgery on male partners' sexual function by surveying patients with the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire. The results demonstrated no significant differences in erectile function (MD = 0.08, P= .40) or premature ejaculation (MD = 0.07, P= .54). The effects of female SUI and related treatments on male partners' sexual function were summarized for the first time, providing a reference for future clinical practice and scientific research. A limited number of studies that used various scales met the standardized eligibility criteria. Female SUI may affect male partners' sexual function, and female patients' anti-incontinence surgery does not appear to have a clinically significant improvement on the sexual function of their partners.

Carotid artery intima media thickness can predict the response to phosphodiesterase 5 inhibitors in patients with moderate erectile dysfunction.

Increased carotid artery intima-media thickness (CIMT) has been shown to be associated with erectile dysfunction (ED), but studies evaluating the efficacy of CIMT in predicting drug response are lacking in the literature. We aimed to evaluate the efficacy of CIMT in predicting the response to phosphodiesterase-5 inhibitors (PDE5-I). A total of 274 subjects were divided into two groups: ED patients (n = 150) and controls (n = 124). The patients in the ED group were further divided into the subgroups of severe, moderate, mild-moderate, and mild ED. Blood tests, carotid ultrasonography, and the International Index of Erectile Function-5 (IIEF-5) diagnostic tool were applied to all subjects. Tadalafil was administered to each patient. The patients were re-evaluated using the IIEF-5 questionnaire after 2 months of treatment. According to their response to medication, the patients were evaluated as responders or nonresponders. Increased CIMT was significantly associated with the failure of PDE5-I therapy, especially in patients with moderate/mild-moderate ED. Fasting blood glucose, body mass index, and CIMT were significantly higher in the ED group compared to the control group (P =.021, P = .006, and P < .001, respectively). The IIEF-5 score was significantly lower in the ED group (P < .001). CIMT was significantly correlated with the IIEF-5 score. When the total patient group was evaluated, the CIMT value of the responders was significantly lower than that of the nonresponders (P = .001). CIMT was significantly higher among the nonresponders with moderate/mild-moderate ED compared to the responders (P = .004 and .008, respectively), while there was no significant difference in CIMT between the responders and nonresponders with severe or mild ED. A receiver operating characteristic (ROC) analysis of CIMT was performed for discrimination between nonresponders and responders with moderate/mild-moderate ED. The area under the ROC curve was 0.801 (0.682-0.921) (P = .001), and the cutoff value was determined to be 0.825mm, at which CIMT predicted the response to treatment with 65% sensitivity and 89% specificity. Using a validated CIMT cutoff value can help the physician inform the patient about the possibility of drug failure and avoid attempting second-line therapy too soon. There are three main limitations to our study. First, the number of participants was low. Second, ultrasound is a relatively subjective method, and third, all measurements were made by the same radiologist. CIMT can be used as a predictor of response to PDE5-I therapies in patients with moderate/mild-moderate ED.

(378) Still One Out of Five Men Presenting for Erectile Dysfunction are Young than 40 years of Age: Findings of a Real-life Cross-sectional Study over Last Decade

Abstract Introduction Erectile dysfunction (ED) has been demonstrated to be reasonably prevalent among young men (≤40 yr). Objective We aimed to i) assess changes in patterns of reported ED in men ≤ 40 yr, and ii) compare the sociodemographic and clinical characteristics of ED men ≤ 40 yr vs. &amp;gt; 40 yr of age over a 8-yr period at a single academic centre. Methods Comprehensive data of 1179 patients seeking first medical help for ED and assessed by a single Sexual Medicine expert between 2013 and 2021 were analysed. Health-significant comorbidities were scored using the Charlson comorbidity index. All patients completed the International Index of Erectile Function (IIEF) at baseline. Descriptive statistics tested the sociodemographic and clinical characteristics of ED men ≤ 40 yr vs. &amp;gt; 40 yr of age. Within the two groups, multivariable linear regression models tested the association between advancing age and IIEF scores. Local polynomial regression models were applied to explore and graphically display ≤ 40 yr patients’ likelihood to report ED over the analysed time frame and to display changes of the IIEF-EF scores over increasing age between the two groups (≤ 40 yr vs. &amp;gt; 40 yr). Results Overall, median (IQR) age was 52 (41-62) yr. Median (IQR) IIEF-EF was 18 (15-22) at baseline. Of all, 268 (22.7%) were ≤ 40 yr whereas 911 (77.3%) were &amp;gt; 40 yr at baseline. Rates of severe ED according to IIEF-EF did not differ between men ≤ 40 yr and &amp;gt;40yr (60 (22.4%) vs. 155 (17%)). No significant differences were found for the IIEF domains (-IS, -OS, -SD) but IIEF-OF domains, which scored higher in younger men (9 () vs. 8 (), p=0.002). At baseline, younger patients reported less comorbidities, less active smoking, lower BMI, higher total testosterone (tT) levels than older patients (all p 40 yr, increasing age was linearly correlated with decreasing IIE-EF (all p 40 yr). Conclusions We observed that one out of five men seeking first medical help for ED at a single academic centre were younger than 40 yr. This trend has remained stable over the last 8-years, but slightly lower than the previous decade. Increasing age among younger patients is not associated with worse erectile function as oppositely occurs among patients &amp;gt; 40 yr. Disclosure No

(244) Penoscrotal Decompression: A New Paradigm for Managing Prolonged Ischemic Priapism

Abstract Introduction Outcomes of men with delayed presentation of ischemic priapism (&amp;gt;24 hours) are poor. Management options include forming a proximal corporal shunt (poor evidence of efficacy) or immediate penile prosthesis placement with the associated increased risk of erosion and infection. Penoscrotal decompression (PSD) is thought to relieve the acute compartment syndrome of prolonged ischemic priapism (PIP) and restores perfusion. Experience is currently limited to 31 reported cases from several centers in North America. Objective To further assess the role and efficacy of PSD for PIP. Methods Retrospective review of men presenting with ischemic priapism. Only men following PSD were included. Ischemic priapism was confirmed by cavernosal blood gas and biopsy at time of decompression. Duration of ischemia, prior management and clinical outcomes were analyzed. Change in International Index of Erectile Function (IIEF) score was compared. Results Thirteen patients with a median age of 45 years (IQR 37-43) presented between July 2019 and June 2022. Median duration of PIP was 48 hours (IQR 38-56). Etiology of PIP was idiopathic in 5, iatrogenic or recreational drug-related in 6 and sickle-cell disease (SCD) in 2 men. All patients failed corporal aspiration, irrigation and intracavernosal phenylephrine and 2 failed distal corporo-glanular shunting (T-shunt and Winter shunt). All men had successful detumescence with 9 (69%) requiring bilateral PSD. Immediate pain relief was achieved in all but one man who had a very prolonged priapism (120 hours) where no fresh corporal bleeding was found despite bilateral PSD. He had chronic pain from SCD and was lost to follow-up following discharge. Another patient with SCD recurred within 24 hours following unilateral PSD and was successfully managed with intracavernosal phenylephrine. Only one man without SCD developed a recurrence of priapism the next day and he proceeded to insertion of a malleable penile prosthesis on day 2. There was no association between unilateral or bilateral PSD and recurrence of priapism. IIEF scores fell by a median of 12 (IQR 2.25-15.5) and 6 men developed severe erectile dysfunction. Four men have had a penile prosthesis inserted without complication (2x inflatable, 2x malleable) but 2 are awaiting surgery (one was cancelled due to anesthetic concerns). Follow-up was a median of 17.6 months (IQR 1.3 – 19.7) but 4 men were lost to follow-up. One man was unhappy with penile length following penile prosthesis. Conclusions In the first study outside of North America, PSD successfully relieved PIP in all patients with good pain relief for most (n=12, 92%). Six men developed severe refractory erectile dysfunction while 3 had recurrent priapism due to SCD (n=2) and cocaine abuse (n=1). This suggests that the lack of fresh corporal bleeding following PSD is a risk factor for failure and an immediate penile prosthesis should be considered. PSD averted the need for penile prosthesis insertion in 54% of men. PSD should be considered as a viable option for PIP. Disclosure No

(357) Nocturnal Penile Tumescence Test in Patients with Erectile Dysfunction Associates With Penile and Systemic Vascular Disease

Abstract Introduction Erectile dysfunction (ED) is the most frequent male sexual dysfunction along with premature ejaculation. Moreover, its prevalence is increasing worldwide due to ageing of the population and spreading of risk factors like obesity, diabetes, hypercholesterolemia, hypertension, etc. Also, it represents an important cardiovascular risk marker because of its demonstrated tight association with cardiovascular disease (CVD). We dispose of many diagnostic tools to assess ED and a proper workup includes the anamnesis, a physical exploration, blood tests for hormonal and metabolic evaluation, and ED grading through validated questionnaires such as the International Index of Erectile Function (IIEF). One of the instrumental tests we may indicate is the nocturnal penile tumescence (NPT) test or “Rigiscan”. This test measures the spontaneous erections overnight and helps discriminating between organic and psychological ED. However, this is a highly specific but low sensitive test since a positive (normal) result can roll out an organic ED and suggest a psychological etiology while a negative result cannot confirm or exclude an organic condition. Objectives In this context the aim of this study is to investigate the predictive role of Rigiscan in discriminating patients with an organic ED and the presence of vascular disease in patients with ED. Methods We conducted a prospective study in patient 25 patient who underwent a Rigiscan test as part of ED assessment. Each patient had blood tests for hormonal and metabolic analysis, a measurement of the carotid intima-media thickness (cIMT), a brachial flow-mediated vasodilation test (FMD), and a penile color doppler ultrasound (PCDU) to assess penile hemodynamics. Results Our patients had a mean age of 47.9 ± 13.7 years, with a mean IIEF score of 9.0 ± 6.5. Among them 13 (54.2%) were active smokers, 5 (20.8%) were diabetics, 8 (32%) had dyslipidemia, and 4 (16.7%) had hypertension. Eleven patients (44%) had a normal Rigiscan while 14(56%) had a pathological result. We found that patient with a pathological Rigiscan presented with a cluster of impaired vascular function at different levels. In particular, they had statistically lower peak systolic velocity (PSV) in the PCDU (52.5 vs 80.2 cm/s p=0.014) and a higher prevalence of arterial insufficiency (42.9% vs 0.0% p=0.020). Moreover, in patients with negative Rigiscan, there was a higher cIMT (0.9 vs 0.7 mm) and lower response to FMD (7.7% vs 9.6%) with a more frequent diagnose of impaired FMD (63.6% vs 46.2%) but without reaching a statistically significance. Conclusion We can conclude that a negative Rigiscan is indicative of altered penile hemodynamics and may suggests the presence of systemic vascular disease. Therefore, while a positive Rigiscan excludes organic ED, a negative Rigiscan should be considered a cardiovascular risk marker and induce the clinician to address the cardiovascular risk in that patient. More studies with larger population are warranted to confirm and further investigated these findings. Disclosure No

(019) Longitudinal Observation on the Prevalence and Impact of Psychological Distress Among Patients Treated for Erectile Dysfunction During the COVID Pandemic

Abstract Introduction The COVID global pandemic has significantly affected the delivery of the healthcare system with valued resources diverted to cope with more urgent clinical services. Erectile dysfunction (ED) is considered a non-urgent medical condition and hence, males with ED were not prioritised and invariably faced long delays in clinical management including postponement in surgical waitlist during this pandemic. Objective To assess the prevalence and impact of psychological distress among males with ED during the COVID pandemic based on changes in the outcomes of validated questionnaires such as the International Index of Erectile Function (IIEF), Depression and Anxiety Stress Scales (DASS-21), Sexual Distress Scale (SDS) and Decisional Engagement Scale (DES-10), as well as perceived availability of medical support. Methods Following ethics approval, this prospective longitudinal study tracked males with ED at a tertiary medical centre between June 2020 and June 2022. Inclusion criteria included males aged 20 to 70 years, who have pre-existing ED (greater than 6 months), receiving medical therapies for ED, and had enrolled in the prospective database at the time of the study. Exclusion criteria were those who have undergone penile prosthesis implantation or received major abdominopelvic surgery during the study period that may preclude sexual activity. All patients completed validated questionnaires at 0, 6, 12, 18 and 24 months with additional data collected during the peak periods of local COVID social measure lockdown. Results A total of 80 patients were identified during the 24 months and 20 patients dropped out due to surgery (15 patients) and incomplete follow-up (5 patients). The mean age of males was 46.8 (21-69) years, and the duration of ED was 14.5 (6-33) months. Almost one-third of the patients showed increased DASS scores on depression (38 patients) and anxiety (42 patients) subscales and one-quarter on stress (29 patients) subscales, with worse DASS scores during the peak periods of social measures. On the SDS questionnaire, higher concerns were registered across all domains apart from the question on regrets about your sexuality. The analyses showed a worsening of the IIEF scores (p&amp;lt;0.021), anxiety and stress (DASS score with p=0.045 and p=0.038, respectively) as well as SDS score (p=0.048) during this pandemic. However, the DES-10 scores were more positive with most patients reporting a score above 7 out of 10 in terms of items on accepting current arrangement (75%) and confidence in clinician decision-making about the treatment (80%) although most patients (92%) indicated the desire to be kept updated and provided with more detailed information on their clinical care. Conclusions The COVID pandemic has caused an adverse psychosexual impact on many patients’ erectile function and mental well-being, and social measures lockdown invariably heightened patient psychosexual distress. Our study showed regular clinical contact and medical reassurance coupled with an explanation of reasons for clinical delays in the non-urgent medical condition resulted in a high level of confidence in clinicians and potentially minimised emotional adjustment in the patients. Disclosure No

Abstract #1368352: Significance of LH Estimation While Evaluating Erectile Dysfunction in Male Subjects with Type 2 Diabetes Mellitus

Erectile Dysfunction (ED) is quite common in male subjects with Type 2 Diabetes Mellitus and many of them have Hypogonadism (low testosterone). There are subjects having ED despite having normal testosterone levels and among them some may have Compensated hypogonadism (CH), an entity characterized by normal testosterone with an increase in LH level and is associated with a unique symptomatology. The objective was to determine the prevalence of CH in male subjects with type 2 diabetes having ED and to evaluate its correlations. It was a cross-sectional study among the T2DM subjects attending the OPD of an Endocrinology Specialty Hospital. 500 male subjects with T2DM were screened for ED using International Index of Erectile Function-5 (IIEF-5) questionnaire, which consists of 5 items; a sum score of 21 or less indicates the presence of ED. Out of these 127 (25.4%) subjects were diagnosed as having ED. These subjects underwent clinical and biochemical evaluation including Lipid profile, HbA1c, Testosterone, LH, TSH, Prolactin. Compensated hypogonadism was defined (European Male Aging Study) as total testosterone > 10.5 nmol / L and LH > 9.4 IU /L. The mean age of the participants was 56.4 ± 6.7 years and the mean duration of diabetes was 11.9 ± 7.4 years. Hypertension was present in 51.5% and CAD in 26.6% of subjects. Among the participants 44.2% had hypogonadism (low T) whereas compensated hypogonadism was present in additional 9.5%. CH was positively correlated with older age (>55yrs) (p<0.01), the severity of ED (p-0.02), Hypertension (p-0.02), CAD (p<0.01) and LDL (p-0.012) but not with HbA1c. There was a statistically significant negative correlation between LH level and IIEF-5 score. Hypogonadism is common in males with T2DM and is characterized by clinical and biochemical evidence of testosterone deficiency. Compensated hypogonadism (CH) is a subclinical deficiency of testosterone (normal testosterone and high LH). Symptoms of CH may include ED, low moods, decreased muscle mass, sleep disturbances, mobility issues and fatigue. Our study shows CH to be correlating with sexual dysfunction, hypertension, CAD and LDL in subjects with T2DM. Hypogonadism is treated with testosterone but in CH only limited studies have demonstrated some positive effects of testosterone therapy and the clinical meaningfulness of these findings remains debatable. The present management strategies for CH include healthy lifestyle habits, exercise, nutritious diet, reducing stress and getting good sleep. We suggest larger studies to validate our findings, to essentially include LH estimation in the workup of ED and consider formation of guidelines regarding management of CH in subjects with T2DM including the place of testosterone therapy.

Low Exercise Tolerance as a Marker of Erectile Dysfunction and Depression among Post-Myocardial Infarction Men.

Evidence has grown recently on the correlation between lifestyle and physical activity, and their impact on the functioning of the entire organism. In addition, a decrease in physical efficiency may be an indicator of the early diagnosis of systemic diseases. The aim of this study was to determine whether there is a relationship between exercise tolerance and possible erectile dysfunction or mental disorders. A cross-sectional study was conducted among 254 men in 4 cardiac rehabilitation centers in Poland using the standardized International Index of Erectile Function 5 (IIEF-5) and Beck Depression Inventory (BDI) questionnaires. Erectile dysfunction was directly proportional to the metabolic equivalent of the task (MET) variable. An increase in exercise tolerance by 1 point was associated with an increase in the IIEF-5 score by 1.62 points, indicating a reduction in the severity of erectile dysfunction. The 1-point increase in MET was associated with a 1.8-point decrease in BDI, indicating that an increase in exercise tolerance is associated with a decrease in the severity of depressive disorders. Increasing the tolerance of physical effort has a beneficial effect not only on the general well-being, but also on the sexual and mental health of men. An increase in exercise tolerance is associated with a reduction in the incidence of erectile dysfunction. On the other hand, in patients with depressive disorders, the improvement of exercise tolerance reduces the intensity of depression symptoms. Exercise tolerance can be an early and simple marker at the onset of erectile dysfunction or mood disorders.