International Index Of Erectile Function Erectile Function Domain Score Research Articles

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

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

MP61-05 PREVALENCE OF ORGASMIC DYSFUNCTION AFTER ROBOT-ASSISTED RADICAL PROSTATECTOMY AND ITS RELEVANCE TO THE INTERNATIONAL INDEX OF ERECTILE FUNCTION

You have accessJournal of UrologyCME1 Apr 2023MP61-05 PREVALENCE OF ORGASMIC DYSFUNCTION AFTER ROBOT-ASSISTED RADICAL PROSTATECTOMY AND ITS RELEVANCE TO THE INTERNATIONAL INDEX OF ERECTILE FUNCTION Masashi Honda, Ryutaro Shimizu, Shogo Teraoka, Ryoma Nishikawa, Noriya Yamaguchi, Hideto Iwamoto, Shuichi Morizane, Katsuya Hikita, and Atsushi Takenaka Masashi HondaMasashi Honda More articles by this author , Ryutaro ShimizuRyutaro Shimizu More articles by this author , Shogo TeraokaShogo Teraoka More articles by this author , Ryoma NishikawaRyoma Nishikawa More articles by this author , Noriya YamaguchiNoriya Yamaguchi More articles by this author , Hideto IwamotoHideto Iwamoto More articles by this author , Shuichi MorizaneShuichi Morizane More articles by this author , Katsuya HikitaKatsuya Hikita More articles by this author , and Atsushi TakenakaAtsushi Takenaka More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003319.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The cause of orgasmic dysfunction is not well understood, and how many and which patients undergoing radical prostatectomy, especially robot-assisted radical prostatectomy (RARP), are affected remains unclear. Moreover, relationship between post-RARP orgasmic dysfunction and erectile dysfunction has not been clarified. This study aimed to evaluate the incidence of orgasmic dysfunction in patients after RARP and identify the relevance of orgasmic dysfunction to the International Index of Erectile Function (IIEF). METHODS: We performed a single-center, cross-sectional, questionnaire-based investigation of patients who underwent RARP (n=523). Of the 523 patients, men who received neoadjuvant therapy (n=54), adjuvant therapy (n=46), or died from other causes (n=6) were excluded, leaving 417 patients for analysis. All patients were treated at our institution between 3 and 111 months prior to the start of the study. Six questions on sexual activity, orgasmic function, altered perception of orgasms, dysorgasmia, and climacturia were developed. Questionnaires about orgasmic dysfunction and IIEF were mailed with a letter inviting patients to participate in the study. The primary outcome measure was the prevalence of orgasmic dysfunction. The relationship between orgasmic dysfunction and IIEF domain scores was analyzed. RESULTS: Overall, 259 questionnaires were available for analyses. Among sexually active patients (n=145), 33 (22.8%) reported anorgasmia, 22 (15.1%) reported dysorgasmia, and 44 (30.3%) reported climacturia. The IIEF-erectile function (EF), IIEF-sexual desire (SD), IIEF-intercourse satisfaction (IS), and IIEF-overall satisfaction (OS) scores of the anorgasmia group were significantly lower than those of the non-anorgasmia group (2.33±1.63 versus 7.93±7.94, p<0.001; 3.91±2.05 versus 5.13±1.73, p<0.001; 0.39±1.09 versus 1.92±3.44, p=0.013; 3.73±1.59 versus 5.38±1.78, p<0.001). Also, the IIEF-EF, IIEF-SD, and IIEF-OS scores of the dysorgasmia group were significantly lower than those of the non-dysorgasmia group (4.36±4.86 versus 8.81±8.32, p=0.018; 4.32±1.73 versus 5.32±1.68, p=0.014; 4.46±1.65 versus 5.60±1.75, p=0.006). CONCLUSIONS: Orgasmic dysfunction is a common adverse effect of RARP. Moreover, these results indicate that anorgasmia and dysorgasmia may be associated with erectile function and may affect sexual desire and satisfaction after RARP. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e854 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Masashi Honda More articles by this author Ryutaro Shimizu More articles by this author Shogo Teraoka More articles by this author Ryoma Nishikawa More articles by this author Noriya Yamaguchi More articles by this author Hideto Iwamoto More articles by this author Shuichi Morizane More articles by this author Katsuya Hikita More articles by this author Atsushi Takenaka More articles by this author Expand All Advertisement PDF downloadLoading ...

The Association of the COVID-19 Pandemic on Male Sexual Function in the United States: A Survey Study of Male Cannabis Users.

IntroductionInternational studies have suggested that social disruptions caused by the COVID-19 pandemic have led to sexual dysfunction, but the impact on males in the United States is less defined.AimTo examine changes in male sexual function during the COVID-19 pandemic and to evaluate associated demographic variables.MethodsPrepandemic survey data was collected between October 20, 2019 and March 1, 2020 on adult males in the United States. Follow-up survey data collected for comparison during the COVID-19 pandemic between August 1, 2020 and October 10, 2020 included International Index of Erectile Function (IIEF) scores, Patient Health Questionnaire for Depression and Anxiety with 4 items (PHQ-4) scores, and questions regarding sexual frequency. Questions were also asked about mask-wearing habits, job loss, relationship changes, and proximity to individuals who tested positive for COVID-19.Main Outcome MeasuresDifferences in prepandemic and pandemic male sexual function assessed by self-reported IIEF domain scores and sexual frequencyResultsSeventy six men completed both prepandemic and pandemic surveys with a mean age of 48.3 years. Overall, there were no differences in either overall IIEF score or any subdomain score when comparing men's pre-pandemic and pandemic survey data. There was an increase in sexual frequency during the pandemic with 45% of men reporting sex ten or more times per month during the pandemic compared to only 25% of men prior to the pandemic (P = .03). Among the subgroup of 36 men who reported a decrease in IIEF, the decrease was an average of 3.97, and significantly associated with higher PHQ-4 depression subscale scores (1.78 vs 1.03, P = .02).ConclusionThe COVID-19 pandemic is associated with increased sexual frequency and no change in overall sexual function in males in the United States. Interventions intended to promote male sexual health during the COVID-19 pandemic should include a focus on mental health. Chen T, Bhambhvani HP, Kasman AM, et al. The Association of the COVID-19 Pandemic on Male Sexual Function in the United States: A Survey Study of Male Cannabis Users. J Sex Med 2021;9:100340.

Effect of Edentulism and Oral Quality of Life on Sexual Functions in Men: A Cohort Prospective Study.

IntroductionEdentulism has a serious impact on quality of life (QoL), and changes in QoL can affect sexual functioning.AimTo assess the correlation between oral health-related quality of life (OHQoL) and sexual function in edentulous men.MethodsA total of 148 men (18–70 years) with incomplete natural dentition completed the International Index of Erectile Function (IIEF) and Oral Health Impact Profile (OHIP-14) at 4 time points: before (T0), during (T1), 4 weeks after (T2), and 1 year (T3) after dental treatment. Kruskal–Wallis, Friedman, and Spearman's rank correlation tests were used for statistical analyses (significance at P < .05).ResultsIIEF total scores differed significantly between the time points (P < .001), with medians and interquartile ranges (IQR) of 46 (7), 42 (8), 49 (6), and 52 (5) at T0, T1, T2, and T3, respectively. The highest rate of sexual dysfunction was detected at T1 (42.2%) and the lowest at T3 (26.6%). IIEF domain scores also decreased at T1 and increased at T2 and T3 compared with T0 (P < .05). Median (IQR) OHIP-14 scores were 26.0 (8), 28.0 (8), 20.0 (6), and 18.0 (5), respectively (P < .001). OHIP score was significantly correlated with IIEF domain scores (P < .05) and there were strong negative correlations between OHIP and total IIEF scores at T0 (r = −0.737), T1 (r = −0.802), T2 (r = −0.831), and T3 (r = −0.722) (P = <.001 for all).Main Outcome MeasureChanges and correlations in IEFF and OHIP-14 scores; SD and ED prevalances at T0; T1; T2 and T3 periods.Clinical ImplicationsSexual functions was significantly correlate with OHQoL; thus patients with ED should also be examined in terms of toothlessness.ConclusionOHQoL was significantly associated with sexual function in men. However, correcting the problem of edentulism improved OHQoL and sexual function, with the best results observed after 1-year follow-up.H Turgut, S Turgut. Effect of Edentulism and Oral Quality of Life on Sexual Functions in Men: A Cohort Prospective Study. Sex Med 2021;9:100305.

A Survey of Male Sexual Functioning in the General Population in the Northern Netherlands

Aim. To describe age-related male sexual functioning in a representative Dutch general population using internationally accepted and validated questionnaires. Material and Methods. A random selection of 1404 men from the general populations in the Netherlands were asked to participate. Men primarily completed the International Index of Erectile Function (IIEF), but also provide medical history, details of daily activities, the Body Image Scale, the SF-36 Health Survey, the Hospital Anxiety and Depression Scale, and the Multidimensional Fatigue Inventory. Participants’ representativeness was assessed by comparison with data from the Dutch Central Agency for Statistics and the Dutch Health Monitor. Main outcome measurements were the age-related domain scores of the IIEF. Results. Responses were obtained from 333 of 1404 men (24%). Participant characteristics were broadly comparable to those of the Dutch population, except for underreporting homosexuals, immigrants, age &lt;40 years and mid-level educations. Overall, 39% of respondents were sexually inactive, and inactivity increased significantly with advancing age. All IIEF domain scores decreased markedly with increasing age, except for overall satisfaction. The prevalence rates of mild and severe erectile dysfunction were 22% and 5%, respectively, and both increased significantly with advancing age. Conclusion. Four of the IIEF domain scores (i.e., erectile function, orgasmic function, sexual desire, and intercourse satisfaction) decrease with increasing age, whereas the overall satisfaction domain scores remain stable throughout life.

The Effect of Hyperbaric Oxygen Therapy on Erectile Functions: A Prospective Clinical Study

Introduction: We aimed to evaluate the effects of hyperbaric oxygen therapy (HBOT) on erectile function in patients who had no cavernosal or urethral injury by using International Index of Erectile Function (IIEF) questionnaire. Materials and Methods: The male patients who were treated by HBOT for several diseases between July 2017 and September 2017 were examined. All patients filled the IIEF questionnaire form before the first day and after the last day of HBOT and a questionnaire including demographic characteristics and medical history. The effects of demographic characteristics and risk factors on erectile function were evaluated, and the IIEF domain scores of patients in first day and last day of HBOT were compared. Results: Totally, 50 patients were included in the study between July 2017 and September 2017 and the mean age was 59.38 ± 13.77. The mean post-HBOT IIEF-EF score of patients was significantly higher than the mean pre-HBOT IIEF-EF score of patients (15.74 ± 10.52 vs. 19.50 ± 10.91; p < 0.001). The mean post-HBOT IIEF scores of other domains including intercourse satisfaction, orgasmic function, sexual desire, and overall satisfaction were also significantly higher than pre-HBOT scores. Conclusions: HBOT may be a good alternative treatment or adjunctive treatment for erectile dysfunction.

Combination therapy for erectile dysfunction involving a PDE5 inhibitor and alprostadil.

The phosphodiesterase-5 inhibitors (PDE5Is) are the first-line treatment option for men with erectile dysfunction (ED), with alprostadil considered a second-line choice. Consideration has to be given to patients who fail these treatments and what their options are. This review evaluates the data on the combination of a PDE5I with alprostadil in patients who have previously failed therapy with either drug. A PubMed search was conducted and identified nine publications relating to combination treatment with alprostadil as intracavernosal, intraurethral or topical application. The results indicate that with all three formulations the combination therapy resulted in an improved outcome compared with either of the drugs as monotherapy. This was demonstrated by the increased total International Index of Erectile Function (IIEF) scores as well as IIEF erectile function domain scores. This finding was also valid for patients with post-prostatectomy ED. The associated side effects of the combined treatment did not result in treatment discontinuation. These findings suggest that combination therapy with a PDE5I and alprostadil might be considered a treatment option in patients who have previously had a poor response to either drug.

25 - The effect of hyperbaric oxygen therapy on erectile functions: A prospective clinical study

INTRODUCTION We aimed to evaluate the effects of hyperbaric oxygen therapy (HBOT) on erectile function in patients who had no cavernosal or urethral injury by using International Index of Erectile Function (IIEF) questionnaire. MATERIALS AND METHODS The male patients who were treated by HBOT for several diseases between July 2017 and September 2017 were examined. All patients filled the IIEF questionnaire form before the first day and after the last day of HBOT and a questionnaire including demographic characteristics and medical history. The effects of demographic characteristics and risk factors on erectile function were evaluated, and the IIEF domain scores of patients in first day and last day of HBOT were compared. RESULTS Totally, 50 patients were included in the study between July 2017 and September 2017 and the mean age was 59.38 ± 13.77. The mean post-HBOT IIEF-EF score of patients was significantly higher than the mean pre-HBOT IIEF-EF score of patients (15.74 ± 10.52 vs. 19.50 ± 10.91; p < 0.001). The mean post-HBOT IIEF scores of other domains including intercourse satisfaction, orgasmic function, sexual desire, and overall satisfaction were also significantly higher than pre-HBOT scores. CONCLUSIONS HBOT may be a good alternative treatment or adjunctive treatment for erectile dysfunction.

Clinically important difference on the Erectile Dysfunction Inventory of Treatment Satisfaction questionnaire in patients with erectile dysfunction.

To determine what constitutes a clinically important difference (CID) on the Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS), an 11-item validated questionnaire assessing treatment satisfaction used in clinical trials for patients with erectile dysfunction (ED). Erectile Dysfunction Inventory of Treatment Satisfaction data were evaluated from a double-blind, fixed-dose trial of 279 men aged 18-65years with ED who were treated with sildenafil 50 or 100mg or placebo. The primary anchor measure was the erectile function (EF) domain of the International Index of Erectile Function (IIEF), which has a 4-point minimal CID. The CID on the EDITS index score was determined using a regression analysis comparing EDITS and IIEF EF scores at the end of the 8-week treatment. A similar analysis was performed for EDITS and the Erection Hardness Score (EHS) instrument, a single-item questionnaire measuring hardness, which was used as a secondary anchor measure. Erectile Dysfunction Inventory of Treatment Satisfaction and IIEF EF domain scores were highly correlated (Pearson correlation coefficient=0.75). EDITS total scores across treatments at week 8 averaged (mean±standard deviation [SD]) 67.5±21.6 (range, 0-100; higher scores indicate greater treatment satisfaction); IIEF EF domain scores averaged 22.2±6.9 (range, 1-30; higher scores indicate higher erectile functioning). The calculated CID for EDITS scores was 9.5 (95% CI, 8.5-10.4; 0.44 SD units), corresponding to a medium effect size. EDITS and EHS instrument scores also correlated highly (Pearson correlation coefficient=0.64). Placebo-adjusted EDITS mean scores were more than twice the CID, at 23 (95% CI, 17-28) and 28 (95% CI, 23-33) for the 50- and 100-mg doses, respectively. Approximately 10 points on the EDITS index score is considered a CID. Serving as a benchmark, this finding aids interpretation of the clinical relevance of a difference in mean EDITS index scores between treatments for patients with ED.

180 Increased Orgasmic Intensity After Radical Prostatectomy: Prevalence And Predictors

Little exploration has occurred on orgasm quality after radical prostatectomy (RP). It is well recognized that some men report increased orgasmic intensity (IOI) after RP. Only survey data exist on its prevalence, of approximately 5% but no analysis of predictors or chronology of this entity has been conducted. Men who underwent RP, who were sexually active within the first 12 months (mo) of RP, who had orgasm data recorded and were followed for 24 mo after their operation were studied. Demographic, comorbidity, RP and sexual function data were recorded. Patients were followed serially with the international index of erectile function (IIEF) questionnaire. Multivariable analysis was performed to look for possible predictors of IOI after RP with the following factors being entered into the model: patient age, partner status, partner age, RP nerve sparing status, presence of dysorgasmia, erectile function. 1963 men were analyzed. 137 (7%) reported IOI at any time point after RP. Those reporting IOI were compared to those who did not report such a change in orgasm. Mean age of the entire cohort was 62±13 years; 81% were partnered; 69% married; 79% had bilateral nerve sparing RP (no difference between the two groups in any of these factors). Median time to the first orgasm after RP was different between groups 2mo (IOI) vs 4 mo (p<0.01). Reporting dysorgasmia within the first 6mo after RP: 19% (IOI) vs. 6% (p<0.01). The mean IIEF erectile function domain scores (using any erectile aid) at 24mo were different: IOI 21±6 vs. 16±9 (p<0.01). 67% of patients with IOI were capable of sexual intercourse at 24mo (with or without aids) vs. 49%. Over 24mo, of those men with IOI: 12% had reduction in orgasmic intensity back to preoperative levels; 8% had reduction to lower than preoperative levels; 80% maintained their IOI level. The only predictor of IOI occurrence was ability to participate in penetrative sexual relations: odds ratio 2.3, 95% confidence interval 1.4-.4.4 (p<0.01).

Efficacy and Safety of MED2005, a Topical Glyceryl Trinitrate Formulation, in the Treatment of Erectile Dysfunction: A Randomized Crossover Study

BackgroundCurrent treatments for erectile dysfunction (ED) have some limitations. AimThis study evaluated the efficacy and tolerability of MED2005, a 0.2% glyceryl trinitrate topical gel, formulated into an enhanced absorption topical delivery system (DermaSys), administered on demand, in the treatment of ED. MethodsThis randomized, double-blinded, placebo-controlled, phase II crossover trial involved 232 men with ED (231 treated, 230 assessed for efficacy) and their partners. After a 4-week run-in period, patients were randomized to 1 of 2 treatment sequences, MED2005-placebo or placebo-MED2005. Each treatment was given for 4 weeks, separated by a 1-week washout interval. Efficacy was assessed by the International Index of Erectile Function (IIEF), the Sexual Encounter Profile, a Global Assessment Questionnaire (GAQ), and specific questions about the onset and offset of action and treatment preferences (patients and partners). OutcomesThe primary outcome measure was the IIEF erectile function domain (IIEF-EF) score. Other efficacy assessments were secondary outcomes. ResultsThe mean baseline IIEF-EF score was 17.1 (SD = 5.7), and this increased to 19.6 (SD = 7.5) after MED2005 treatment and 18.5 (SD = 6.7) after placebo (P = .0132). Overall, 23.1% of patients showed a clinically relevant (≥4-point) increase in IIEF-EF scores after treatment with MED2005 only compared with 14.5% who responded after MED2005 and placebo, 14.0% who responded after placebo only, and 48.4% who did not respond after either treatment (P = .0272). MED2005 also was associated with significant improvements compared with placebo in the other IIEF domains, and this was consistent with patients’ and partners’ responses to the GAQ. For all assessments, significant effects of MED2005 were seen primarily in patients with mild ED. The start of erection was noticed within 5 and 10 minutes in 44.2% and 69.5%, respectively, of all intercourse attempts with MED2005. Patients and partners showed significant preferences for MED2005 over placebo. The most commonly reported adverse events during MED2005 treatment were headache (patients, n = 18 [7.9%]; partners, n = 3 [1.3%]) and nasopharyngitis (patients, n = 13 [5.7%]; partners, n = 2 [0.9%]). Clinical ImplicationsThese findings suggest that topical glyceryl trinitrate could be a useful treatment option in ED. Strengths and LimitationsStrengths of this study include the use of a validated outcome measure. Limitations include the use of only 1 dosage. ConclusionFurther studies are warranted to investigate the efficacy of topical glyceryl trinitrate to include higher doses, thereby improving clinical significance, especially in cases of moderate and severe ED.Ralph DJ, Eardley I, Taubel J, et al. Efficacy and Safety of MED2005, a Topical Glyceryl Trinitrate Formulation, in the Treatment of Erectile Dysfunction: A Randomized Crossover Study. J Sex Med 2018;15:167–175.

Ethnicity and age as factors in sildenafil treatment of erectile dysfunction.

Sildenafil has been evaluated in >16000 men with erectile dysfunction (ED) in double-blind, placebo-controlled trials. To assess efficacy and safety of sildenafil in ED by ethnicity (white, black Asian) and age (≤45, 46-60, ≥61years). Data were pooled from 38 double-blind, placebo-controlled, flexible-dose trials. Most had starting sildenafil doses of 50mg once daily, ~1hour before sexual activity, with adjustment to 100 or 25mg as needed. Change from baseline in International Index of Erectile Function erectile function (IIEF-EF) domain score assessed with analysis of covariance and a Global Assessment Question (GAQ; "Did the treatment improve your erections?") at endpoint assessed with logistic regression analysis. 4120 and 3714 men received sildenafil and placebo, respectively (2740 and 2671 White; 407 and 385 Black; 973 and 658 Asian). For sildenafil vs. placebo groups, overall treatment differences for IIEF-EF domain and GAQ were significant for each ethnic and age group (P<.0001); significant treatment-by-ethnicity and treatment-by-age interactions were also observed for change in IIEF-EF domain scores (P<.05), with differences significantly greater for White vs. Black (P<.0001), White vs. Asian (P=.0163), and Asian vs. Black (P=.0036) men. A significant treatment-by-ethnicity interaction was observed for GAQ (P=.0004). The OR comparison for GAQ was significantly greater (P=.0001) with sildenafil vs. placebo in White (OR=11.2) or Asian (OR=12.4) men vs. Black men (OR=5.1). Adverse-event rates were generally similar, with some age variations. Sildenafil is effective and well-tolerated regardless of ethnicity or age; however, treatment effects can vary.

Long-term outcomes of AMS Spectra® penile prosthesis implantation and satisfaction rates.

The aim of this study was to evaluate the surgical implantation techniques of AMS Spectra malleable penile prosthesis, its intraoperative and postoperative complications, and the rates of patient and partner satisfaction. Forty-six patients on whom AMS Spectra malleable penile prosthesis implantation was performed between 2009 and 2014 were retrospectively examined. Any complications seen intraoperatively and postoperatively were determined. International Index of Erectile Function (IIEF)-5, total IIEF erectile function domain scores were calculated preoperatively. IIEF-5, total IIEF erectile function domain and Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) scores were calculated in the postoperative third, sixth and twelfth months. The mean age of the patients was 63.6±7.28 (38-80) years. The mean erectile dysfunction period was 4.29±2.51 years, and the mean follow-up period was 3.19±1.6 years. The mean IIEF-5 score was 5.86±0.92 before surgery, and it was 22.5±0.62 at the end of the follow-up. The mean total IIEF erectile function domain score was 6.02±1.09 before surgery, and it was 26.02±0.21 at the end of the follow-up. The mean EDITS score was 71.06±3.16 at the end of the follow-up. The mean EDITS score of the patients partners was 65.08±4.34 at the end of the follow-up. The overall satisfaction rates were 96.2% for the patients and 84.6% for the partners. As a result of this study, the AMS Spectra penile prosthesis implantation is an effective, reliable and economic method. It can be used in the treatment of erectile dysfunction in selected patient groups offering high patient and partner satisfaction rates.

Treatment response to sildenafil in men with erectile dysfunction relative to concomitant comorbidities and age.

To evaluate treatment response in men with erectile dysfunction (ED) and concomitant comorbidities. Data were pooled from 42 placebo-controlled, flexible-dose sildenafil trials. In most trials, the sildenafil dose was 50mg, taken ~1hour before sexual activity but not more than once daily, with adjustment to 100 or 25mg as needed. The overall population (N=9413) was stratified by age (<45, 46-64, ≥65years). Treatment response was defined as a minimal clinically important difference (MCID) from baseline in the International Index of Erectile Function-Erectile Function (IIEF-EF) domain score of >2, >5 and >7 for men with mild, moderate and severe ED at baseline, respectively, or an IIEF-EF domain score ≥26 (no ED) at end-point. In the overall population, treatment response using the IIEF-EF MCID definition was significantly greater (P<.0001) with sildenafil vs placebo in men with no comorbidity (77% vs 33%), cardiovascular disease/hypertension only (71% vs 27%), diabetes only (63% vs 24%) or depression only (78% vs 29%). Using an IIEF-EF score ≥26, treatment response was significantly greater (P<.0001) with sildenafil vs placebo in men with no comorbidity (49% vs 17%), cardiovascular disease/hypertension only (48% vs 12%), diabetes only (40% vs 12%) or depression only (60% vs 17%). With each definition, the treatment response for each age and comorbidity was significantly greater (P≤.0065) with sildenafil vs placebo. The treatment response was significantly greater with sildenafil vs placebo in men with ED and each comorbidity regardless of age.

Sexual functioning mirrors overall men's health status, even irrespective of cardiovascular risk factors.

Erectile dysfunction has been described as a sentinel marker of co-existing and undetected cardiovascular disease. Beside cardiovascular diseases, a correlation between erectile dysfunction and other major comorbidities has been also reported. The study was aimed to analyze the association between sexual functioning and overall men's health in sexually active, Caucasian-European men with new-onset sexual dysfunction. Data from the last 881 consecutive patients seeking first medical help for sexual dysfunction were cross-sectionally analyzed. The International Classification of Diseases, 9th revision, Clinical Modification was used to classify health-significant comorbidities, which were scored with the Charlson Comorbidity Index (CCI). A modified CCI score from which all potential cardiovascular risk factors (CCI-CV) were subtracted was then calculated for every patient. Patients were requested to complete the International Index of Erectile Function (IIEF). The main outcome of the study was the association between the IIEF domain scores and CCI, which scored health-significant comorbidities even irrespective of cardiovascular risk factors (CCI-CV). The final sample included 757 patients (85.9%) (Median age: 48years; IQ range: 37-59). Overall, erectile dysfunction was found in 540 (71.4%) patients. Of these, 164 (21.6%) had a CCI≥1 and 138 (18.2%) had a CCI-CV≥1, respectively. At the analysis of variance, IIEF-Erectile Function (EF) scores significantly decreased as a function of incremental CCI and CCI-CV scores (all p<0.01). At multivariable logistic regression analysis, both IIEF-EF and IIEF-total score achieved independent predictor status for either CCI≥1 or CCI-CV≥1, after accounting for potential confounders (p<0.01). We report novel findings of a significant association between erectile dysfunction severity and overall men's health, even irrespective of cardiovascular risk factors. Thereof, erectile dysfunction severity could serve as a proxy for general men's health, thus encouraging physicians to comprehensively assess patients complaining of sexual dysfunction in the real-life everyday clinical practice.

Sexual Function After Hypofractionated Versus Conventionally Fractionated Radiotherapy for Prostate Cancer: Results From the Randomized Phase III HYPRO Trial

IntroductionHypofractionated radiotherapy could increase the radiobiological tumor dose for localized prostate cancer. The effects of hypofractionation on sexual function are not well known. AimTo compare sexual function in patients with prostate cancer treated with 78 Gy in 39 fractions of 2 Gy or 64.6 Gy in 19 fractions of 3.4 Gy. MethodsIn total, 820 men with intermediate- to high-risk T1b-T4NX-0MX-0 prostate cancer were enrolled in the phase III HYPRO trial (2007–2010) and randomized to conventional fractionation (39 × 2 Gy) or hypofractionation (19 × 3.4 Gy). Sexual function was assessed at baseline and at 6, 12, 24, and 36 months after treatment using the International Index of Erectile Function (IIEF). For this analysis, patients (n = 322) with a baseline assessment, at least one follow-up assessment, and no or short-term (6-month) androgen-deprivation therapy were included. Main Outcome MeasuresMean IIEF domain scores were compared between treatments in the total population and the hormone-naïve population (n = 197) using the independent t-test. Incidences of severe erectile dysfunction (domain score < 11) at last follow-up were calculated in patients with partial or full baseline function. Binary logistic regression analyses were applied to calculate the odds ratio of hypofractionation vs conventional fractionation and to adjust for clinical factors. ResultsMedian age was 71 years (interquartile range = 67–71) and median follow-up was 37 months (interquartile range = 25–38). Androgen-deprivation therapy was prescribed in 125 (39%). IIEF domain scores decreased after treatment but were comparable between treatment arms at baseline and during follow-up. Orgasmic function scores in hormone-naïve patients were significantly higher at 3 years after hypofractionation (4.08 vs 2.65, P = .031). In patients (n = 120) with partial or full baseline erectile function, the incidence of erectile dysfunction at last follow-up was 34.4% for hypofractionated treatment vs 39.3% for conventional treatment (adjusted odds ratio = 0.84, 95% CI = 0.37–1.90, P = .67). ConclusionNo significant differences in erectile functioning between conventional and hypofractionated radiotherapy were found. Hormone-naïve patients reported significantly higher orgasmic function scores at 3 years after hypofractionation.

Editorial Comment Regarding “Multivariate Analyses of the Factors Associated With Sexual İntercourse, Marriage, and Paternity of Hypospadias Patients”

Hypofractionated radiotherapy could increase the radiobiological tumor dose for localized prostate cancer. The effects of hypofractionation on sexual function are not well known.To compare sexual function in patients with prostate cancer treated with 78 Gy in 39 fractions of 2 Gy or 64.6 Gy in 19 fractions of 3.4 Gy.In total, 820 men with intermediate- to high-risk T1b-T4NX-0MX-0 prostate cancer were enrolled in the phase III HYPRO trial (2007–2010) and randomized to conventional fractionation (39 × 2 Gy) or hypofractionation (19 × 3.4 Gy). Sexual function was assessed at baseline and at 6, 12, 24, and 36 months after treatment using the International Index of Erectile Function (IIEF). For this analysis, patients (n = 322) with a baseline assessment, at least one follow-up assessment, and no or short-term (6-month) androgen-deprivation therapy were included.Mean IIEF domain scores were compared between treatments in the total population and the hormone-naïve population (n = 197) using the independent t-test. Incidences of severe erectile dysfunction (domain score < 11) at last follow-up were calculated in patients with partial or full baseline function. Binary logistic regression analyses were applied to calculate the odds ratio of hypofractionation vs conventional fractionation and to adjust for clinical factors.Median age was 71 years (interquartile range = 67–71) and median follow-up was 37 months (interquartile range = 25–38). Androgen-deprivation therapy was prescribed in 125 (39%). IIEF domain scores decreased after treatment but were comparable between treatment arms at baseline and during follow-up. Orgasmic function scores in hormone-naïve patients were significantly higher at 3 years after hypofractionation (4.08 vs 2.65, P = .031). In patients (n = 120) with partial or full baseline erectile function, the incidence of erectile dysfunction at last follow-up was 34.4% for hypofractionated treatment vs 39.3% for conventional treatment (adjusted odds ratio = 0.84, 95% CI = 0.37–1.90, P = .67).No significant differences in erectile functioning between conventional and hypofractionated radiotherapy were found. Hormone-naïve patients reported significantly higher orgasmic function scores at 3 years after hypofractionation.

A Comparison of Sexual Function, Psychological Status, and Sociodemographic Characteristics of Turkish Men within Polygamous and Monogamous Marriages.

A limited number of studies within the literature have entailed objective evaluations of psychological, sexual, and emotional features of women within polygamous marriages. However, there is a lack of studies reporting these features among polygamous and monogamous men. The aim of this study was to investigate sociodemographic characteristics, sexual function, and psychological status of polygamously and monogamously married men. Cross-sectional study. The study sample comprised two groups: 35 polygamous and 45 monogamous men in Kahramanmaraş Province, Turkey. Door-to-door surveys covered sociodemographic factors and adopted Beck Depression Inventory (BDI), and International Index of Erectile Function - Erectile Function Domain (IIEF-EFD) scales. Polygamous men showed considerably higher IIEF-EFD scores (p<0.05). While the median score of IIEF-EFD was 25.0 for polygamous men, it was 22.0 for monogamous men. A comparison of the two groups revealed that polygamous men had lower BDI scores. However, the difference between the groups was statistically non-significant (p>0.05). Odds ratios and 95% confidence intervals of monogamous men for erectile dysfunction and depression were 14.4 (95% CI: 3.1-67.5) and 7.4 (95% CI: 0.9-61.9), respectively. The main reasons for multiple marriages reported by polygamous men, in descending order, were: 1) decreased satisfaction of sexual desires by a wife (37.1%); 2) falling in love with the second wife (22.8%); and 3) incompatibility with the first wife (17.1%). However, 62.9% of them responded negatively to the question: "Would you recommend polygamous marriage to other men?" Our results showed that polygamous men had higher erectile function and lower depression scores than monogamous men. Further studies investigating the effects of polygamy on men's psychosexual function are warranted. Additionally, studies that address the perspectives of offspring and women's expectations within polygamous marriages should be conducted.

Impact of Baseline Total Testosterone Level on Successful Treatment of Sexual Dysfunction in Men Taking Once-Daily Tadalafil 5 mg for Lower Urinary Tract Symptoms and Benign Prostatic Hyperplasia: An Integrated Analysis of Three Randomized Controlled Trials.

Controversy exists as to whether erectile response to phosphodiesterase type 5 inhibitors is compromised in men with low total testosterone (TT) levels. This is amplified by reports of improved response to phosphodiesterase type 5 inhibitor therapy after coadministration of testosterone replacement therapy in hypogonadal men unresponsive to phosphodiesterase type 5 inhibitors. To determine whether TT and luteinizing hormone levels influence efficacy of tadalafil for erectile dysfunction in men with concomitant lower urinary tract symptoms and benign prostatic hyperplasia. This integrated analysis included 1,075 men randomized to once-daily tadalafil 5 mg (n= 540) or placebo (n= 535) for 12 weeks in three prospective clinical trials who had not received concomitant testosterone replacement therapy. Subjects were categorized at baseline by low vs normal TT levels (n= 1,049; <300 vs ≥300 ng/dL) andnormal vs high luteinizing hormone levels (n= 1,058; ≤9.4 vs >9.4 mIU/mL). Treatment-group differences inInternational Index of Erectile Function (IIEF) by hormone subgroups were assessed using analysis of covariance. Changes in IIEF erectile function domain and other domain scores. The overall study population was comprised primarily of white men (>86%) with a mean age range of 64 to 70 years. Median baseline TT level in the integrated population was 355 ng/dL; levels were lower than 300ng/dL (cutoff for normal) in 32.4% of men. Men with low TT levels reported diabetes (21.8%), cardiovascular disease (54.1%), and hypertension (49.1%) numerically more often than men with normal TT levels (10.6%, 43.2%, and 36.7%, respectively). Low TT and high luteinizing hormone levels were associated with numerically, but not statistically significantly, lower 12-week IIEF domain scores compared with those with normal levels. Changes in most 12-week IIEF domain scores showed that tadalafil was significantly more effective than placebo (P < .02). Low TT levels at baseline did not negatively influence response to tadalafil in men of advancing age with concomitant lower urinary tract symptoms and benign prostatic hyperplasia and erectile dysfunction.

Simplified Interpretation of the Erectile Function Domain of the International Index of Erectile Function.

This report describes a post hoc analysis of data from a randomized, double-blinded, placebo-controlled, flexible-dose, sildenafil trial in men with erectile dysfunction. To simplify interpretation of erectile function (EF) domain scores of the International Index of Erectile Function (IIEF). Men at least 18 years old with erectile dysfunction were randomized to receive sildenafil or placebo for 12 weeks. Men taking nitrates or nitric oxide donors were excluded. Responses for each IIEF EF domain question (questions 1-5 and 15) were combined into two broad categories ("success" for responses of the two most favorable categories of a question and "no success" for other responses). Each question was expressed in a logistic regression model (sildenafil and placebo groups combined) as a function of overall EF domain score. IIEF EF domain score and items. A four-point increase in the IIEF EF domain score was associated with an odds ratio of success of 6.1 for getting an erection, 29.2 for having a firm erection, 10.0 for able to penetrate,12.8 for maintaining erection, 4.0 for maintaining erection to completion, and 3.7 for erection confidence. An EF domain score of 22 was associated with a probability of success of 81% for getting an erection, 86% for having a firm erection, 89% for able to penetrate, 67% for maintaining an erection, 70% for maintaining an erection to completion, and 32% for erection confidence. For an EF domain score of 16, the corresponding probabilities of success were 22%, 4%, 20%, 4%, 22%, and 6%, respectively. These results provide stakeholders with a simplified and meaningful interpretation of IIEF EF domain scores based on six key aspects of EF.