Mean IIEF-5 Score Research Articles

Low-intensity shockwave therapy for erectile dysfunction in kidney transplant recipients. A prospective, randomized, double blinded, sham-controlled study with evaluation by penile Doppler ultrasonography.

To study the efficacy of Low intensity Extracorporeal Shockwave Therapy (Li- ESWT) for the treatment of erectile dysfunction (ED) in kidney transplanted men. Twenty men (mean age = 53.7 years) were selected. This was a double-blinded, prospective, randomized, sham-controlled trial. The ESWT protocol was based in a 2 treatment sessions per week for 3 weeks. The sham treatment was performed using the same device replacing the effective probe for one that emits zero energy. Baseline and follow-up assessment was performed with International Index of Erectile Function Questionnaire (IIEF) score and Erection Hardness Score (EHS) after 1, 4 and 12 months. Penile Doppler was performed before and after treatment. A total of 20 patients were recruited, 10 patients in each group. Baseline scores were similar. The mean EHS in after 1 month were 2.5 ± 0.85 (Li-EWST) and 2.4 ± 0.7 (Sham therapy), p = 0.724 . After 4 months it was 2.4 ± 0.7 and 2.6 ± 0.84, p = 0,0004 (between the moments) . The baseline IIEF score was 14.9 ± 3(Sham Theraphy) and 10.9 ± 5.1 (Li-EWST). The mean IIEF score after 1 month was 15.6 ± 6.1 (Li-EWST) and 16.6 ± 5.4 (Sham therapy). The mean IIEF score after 4 months was 17.2 ± 5.7 (Li-EWST) and 16.5 ± 5 (Sham therapy), p < 0.0001 (between the moments). IIEF score improvement was higher than 5 in 70% (ranged from 0-10) and in 10% (ranged from 1-14) in Li-ESWT and Sham groups, respectively. The mean change in IIEF score after 12 months was 4.8 in Li-ESWT group .Penile Doppler parameters were similar between groups and did not present improvements. Li-ESWT is a treatment with clinical efficacy. Despite evidences suggesting neoagiogenesis, our short protocol had no impact in penile Doppler parameters.

102 A Randomised Controlled Study Evaluating Sildenafil-pentoxifylline Combination Therapy in the Management of Erectile Dysfunction

The aim of this study was to evaluate the efficacy of pentoxyfiline (a non-specific PDE inhibitor) as an adjunctive treatment for patients with severe ED. This study compares the relative efficacy when sildenafil is used as monotherapy with sildenafil-pentoxyfiline combination therapy. The study was a prospective, randomized, double-blind, placebo-controlled trial, single centre study. Subjects were recruited between April 2014 and November 2016 from the National University Hospital, Singapore. The treatment period/ duration of study was for 8 weeks. Efficacy was measured via IIEF-5 at week 8. Fifty patients were randomized into 2 groups (27 belonging to the group receiving combination therapy, 23 belonging to the group receiving sildenafil monotherapy). Patients in the 2 groups were comparable in terms of the demographic and clinical characteristics with no significant difference in age, comorbidities and baseline IIEF-5 scores (13±5SD). The mean IIEF-5 score of combination group vs monotherapy group was 14.11 and 14.87 respectively. There was no significant difference between the outcomes of these 2 groups even after adjusting for baseline IIEF-5 scores. There was a significant improvement in the “Overall satisfaction” portion of the IIEF score for the combination group compared to the monotherapy group- even after adjustment for baseline scores (Mean difference 1.11, 95% CI 0.10 to 2.12, p = 0.032). Adverse events (AEs) include gastrointestinal, neurological, musculo-skeletal and dermatological. Of these, gastrointestinal AEs like abdominal discomfort and distension were most common (40% overall).

292 The effect of real-time erectile rigidity tested by Rigiscan on diagnosis of erectile dysfunction

Penile color duplex ultrasonography (CDU) is believed as an effective measure for penile artery and venous function and a common objective test for etiological diagnosis of erectile dysfunction(ED). But it is an invasive test and some patients are unwilling to undergo this test. This study aimed to investigate if real-time rigidity test by Rigiscan could predict the CDU results. 306 patients suspected ED were included in this study from 2014 to 2016. All patients were performed real-time rigidity test by Rigiscan after taking sildenafil 100mg one hour and receiving audiovisual sexual stimulation (AVS). All patients were performed CUD in another day after intracavernous injection of Alprostadil 10mg 15 minutes. The median age was 29 years old. The median course of ED was 1.5 (range from 0.5 to 4) years. The mean IIEF-5 score was 6.25. The median maximal rigidity tested by AVS-Rigiscan was 30% (0-40%) at the tip and 35% (0-50%) at the base. The median duration was 6 (1-18) minutes. The vascular function tested by CDU was normal in 137 patients and abnormal in 169 patients. There was no statistical correlation between CDU results and age (p=0.869), duration of disease (p=0.596) and IIEF-5 score (p=0.450). As for the relationship with AVS results, although not related to erectile duration (p=0.180), significant higher maximal rigidity was noted both at tip (p=0.035) and at base (p=0.019) in patients with normal CDU results. The ROC curves indicating the relationship between CDU results and the maximal rigidity were made with an AUC of 0.575 for tip and 0.571 for base. A maximal Youden’s index was found when maximal rigidity was over 37.5% at tip and 30.5% at base. A combined ROC curved was generated and the highest Youden’s index was achieved when a cut-off was set at rigidity over 37.5% at tip and 30.5% at base, with satisfied sensitivity and negative predictive value.

Impact of anabolic androgenic steroids on sexual function.

BackgroundTo describe the impact of supra-physiologic anabolic-androgenic steroid (AAS) use, including agent, dosage, and duration of therapy, on sexual function.MethodsWe reviewed data from an online survey of AAS users to evaluate their sexual function on and off AAS. The online survey consisted of questions addressing demographics, anabolic steroid use and patterns, ancillary medications, testosterone (T)-related symptoms while on and off of therapy, as well as sexual function which was assessed using the 5-item, International Index of Erectile Function (IIEF-5).ResultsA total of 321 men responded to the survey, of which 90 failed to meet inclusion criteria, for a final cohort of 231 AAS users. The majority of men were Caucasian (85%), employed (62%), and younger than 35 years (58%), while an equal mix were single (47%) or married (46%). The mean IIEF-5 was 22.5, with higher scores associated with increased T dosages (>600 mg/week), use of 17-alpha alkylated hormones and anti-estrogens, and absence of concurrent medical conditions. Lower mean IIEF scores were associated with current and pre-AAS low T symptoms, self-reported angry or violent tendencies, self-reported erectile dysfunction (ED), decreased libido, decreased energy, and depression. After controlling for age, low T symptoms and decreased energy remained significantly associated with lower IIEF scores. Among 127 men reporting de novo decreased libido when not taking AAS, several factors were significantly associated including frequency and duration of T and use of adjunctive therapies, while post-cycle therapies were protective. Men who reported any other de novo symptom (decreased energy, libido, muscle mass or depression) after discontinuing T were also more likely to report de novo ED, as well as those using >10 years or for >40 weeks per year.ConclusionsThe long-term impact of high dose AAS use on sexual function remains poorly defined. Although high T dosages appeared to be protective of erectile function during use, de novo symptoms such as decreased libido and ED occurred more frequently after discontinuing T, particularly among those using more frequently and for longer durations. Given the importance of these findings, long-term studies evaluating the impacts of discontinuing T on sexual dysfunction are indicated.

Inflatable Penile Prosthesis Placement, Scratch Technique and Postoperative Vacuum Therapy as a Combined Approach to Definitive Treatment of Peyronie’s Disease

Peyronie's disease is a devastating condition resulting in penile malformation, erectile dysfunction, pain and emotional distress. In this prospective, 2 institution study we evaluated a multimodal surgical and mechanical combined approach to the definitive treatment of Peyronie's disease and concomitant erectile dysfunction. A total of 145 select patients underwent endocavernous disruption of Peyronie's disease plaques via the scratch technique, followed by inflatable penile prosthesis insertion. Postoperatively patients were assigned to vacuum device therapy for 3 minutes twice daily to continue penile curvature correction. Followup continued for 1 year after surgery. Anatomical and functional results were assessed. Patients with plaques in the proximal third, middle third and subcoronal areas of the penis had a mean ± SD postoperative residual curvature of 21.5 ± 4.5, 17.3 ± 4.8 and 14.1 ± 3.1 degrees, respectively. After 24 weeks of vacuum therapy the mean penile curvature deviation decreased to 8.7 ± 2.5, 9.1± 2.9 and 7.7 ± 0.9 degrees, respectively. The mean IIEF-5 (International Index of Erectile Function) score was 9.8 ± 2.3 preoperatively, 18.9 ± 3.1 at 6 months (p <0.001) and 24.1 ± 3.6 at 1 year (p <0.001). The mean EDITS (Erectile Dysfunction Inventory of Treatment Satisfaction) score at the end of followup was 64.6 ± 11.8. Operative and postoperative complications were minimal. Our novel combination of intraoperative and postoperative therapies in the treatment of patients with Peyronie's disease and an inflatable penile prosthesis was safe and efficacious with excellent functional outcomes. Penile curvature corrections were statistically significant and complications were negligible.

MP67-20 MULTICENTER PROSPECTIVE STUDY OF PATIENTS WITH PEYRONIE'S DISEASE (PD) WHO UNDERWENT INCISION OR PARTIAL-PLAQUE EXCISION WITH COLLAGEN-FIBRINOGEN-THROMBIN FLEECE GRAFTING

You have accessJournal of UrologySexual Function/Dysfunction: Peyronie's Disease I1 Apr 2018MP67-20 MULTICENTER PROSPECTIVE STUDY OF PATIENTS WITH PEYRONIE'S DISEASE (PD) WHO UNDERWENT INCISION OR PARTIAL-PLAQUE EXCISION WITH COLLAGEN-FIBRINOGEN-THROMBIN FLEECE GRAFTING Esaú Fernández-Pascual, Josep Torremadé, François Peinado, Joaquim Sarquella, Javier Romero, Rodrigo García-Baquero, Jorge Turo, Agustín Fraile, Mariano Roselló, Félix Campos, Alejandra Egui, Ignacio Moncada, Joaquín Carballido, Claudio Martínez-Ballesteros, and Juan Ignacio Martínez-Salamanca Esaú Fernández-PascualEsaú Fernández-Pascual More articles by this author , Josep TorremadéJosep Torremadé More articles by this author , François PeinadoFrançois Peinado More articles by this author , Joaquim SarquellaJoaquim Sarquella More articles by this author , Javier RomeroJavier Romero More articles by this author , Rodrigo García-BaqueroRodrigo García-Baquero More articles by this author , Jorge TuroJorge Turo More articles by this author , Agustín FraileAgustín Fraile More articles by this author , Mariano RosellóMariano Roselló More articles by this author , Félix CamposFélix Campos More articles by this author , Alejandra EguiAlejandra Egui More articles by this author , Ignacio MoncadaIgnacio Moncada More articles by this author , Joaquín CarballidoJoaquín Carballido More articles by this author , Claudio Martínez-BallesterosClaudio Martínez-Ballesteros More articles by this author , and Juan Ignacio Martínez-SalamancaJuan Ignacio Martínez-Salamanca More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.2204AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Multiple surgical techniques have been proposed for patients with clinically significant PD. The technique of grafting with hemostatic self-adhesive fleece of collagen-fibrinogen-thrombin has been popularized in Europe (single surgeon, single institution) with potential advantages (shorter surgery duration, less technically demanding procedure and relatively cheaper than other graft materials). However, there is no prospective or multicenter evidence to evaluate the outcomes of this technique. Our aim is to evaluate the preliminary outcomes in patients who underwent this technique in 11 Spanish centers after 16 months of recruiting. METHODS Between July 2016 and October 2017, 43 patients underwent surgery in 11 Spanish centers using the previously described technique. Preoperative, intraoperative and post-surgical data were collected prospectively and follow up at 3 and 6 months with questionnaires (PDQ, EHS, IIEF-5 and satisfaction) was performed. All patients provided consent and protocol was approved by IRB. RESULTS Mean age was 53.8 years (SD 5.9). Most patients had a single dorsal plaque, with an average size of 17.1 mm, and average curvature of 71.8° (SD 16.88). All patients underwent surgery after, at least, 3 months of stable phase disease, and 65.1% of them had tried other previous treatments. Mean surgery duration was 91.3 min, with a complete intraoperative resolution of the curvature in 93% of cases. Seven (16.3%) of the patients presented postoperative hematoma, managed conservatively. No vascular complications were observed. Mean follow-up time was 9.4 months (SD 4.6). Mean IIEF-5 and EHS scores remained stable at 6 months (6m) vs preoperative scores (PS) (19.5 VS 20.7 and 3.2 VS 3.5, respectively), while a statistically significant improvement was observed in PDQ and PDQ-bother scores at 6m vs PS (10.8 VS 31.1, p <0.001 and 3.9 VS 10.5, p <0.001, respectively). Thirty-six (83.7%) of the patients considered that their penis was totally or practically straight at 6m, 65.1% complained of shortening of between 1-3 cm and 55% of some glans hyposensitivity at 6m. 95.3% of the patients reported a clear improvement. Three patients were re-operated. CONCLUSIONS The technique of incision of plaque plus collagen fleece grafting seems to be safe and effective with good aesthetic and functional results and should be considered as an option in the therapeutic arsenal of the management of PD. To extend this initial experience, the study will continue to collect data from more patients. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e915 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Esaú Fernández-Pascual More articles by this author Josep Torremadé More articles by this author François Peinado More articles by this author Joaquim Sarquella More articles by this author Javier Romero More articles by this author Rodrigo García-Baquero More articles by this author Jorge Turo More articles by this author Agustín Fraile More articles by this author Mariano Roselló More articles by this author Félix Campos More articles by this author Alejandra Egui More articles by this author Ignacio Moncada More articles by this author Joaquín Carballido More articles by this author Claudio Martínez-Ballesteros More articles by this author Juan Ignacio Martínez-Salamanca More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Effects of Anastomotic Posterior Urethroplasty (Simple or Complex) on Erectile Function: a Prospective Study.

Purpose: Although improvements in urological function have been less challenged, concern about andrological problems following urethral stricture surgeries has been growing in recent years. The aim of this study is to evaluate the role of the anastomotic urethroplasty itself on erectile function in patients with posterior urethral injuries. Materials and Methods: In this prospective cohort study, patients with urethral strictures referring to Tajrish Hospital during October 2013 to August 2016 for anastomotic urethroplasty, were included. All subjects underwent radiologic studies along with rigid and flexible cystoscopy before surgery. Erectile function was evaluated before surgery (twice, addressing pre-traumatic and pre-operational conditions) and after surgery (3 and 6 months post-operatively) via IIEF-5 erectile function questionnaire and color Doppler ultrasound assessment of penile vasculature. Results: A total of 65 patients with an average age of 30.6 ± 6.1 years were included. A significant decline was observed in erectile function of patients after the injury based on IIEF-5 questionnaire filled twice separately addressing patient conditions before and after trauma (mean IIEF score 23.15 ± 0.93 to 13.45 ± 5.43, P = .001). There was also a significant difference in erectile function of subjects with pelvic fractures compared to those without pelvic fractures (10.43 ± 3.78 vs. 18.96 ± 3.18 P = .001). Univariate and multivariate analyses showed that urethroplasty itself does not significantly affect erectile function in patients according to penile color Doppler ultrasonography (peak cystolic velocity at cavernosal arteries before and after surgery: right 26.87 ± 6.93 vs26.16 ± 6.53 respectively and left 27.23 ± 5.21 vs 26.52 ± 4.38 respectively) and IIEF-5 erectile function questionnaire (13.12 ± 5.38 vs. 13.54 ± 5.44; P = .26). Conclusion: The results of this study showed that urethroplasty does not significantly affect erectile function in patients with urethral strictures. The marginal results showing a negatively affected erectile function in patients with complex strictures may be attributed to a real impact of the surgery in this subgroup or lower number of these cases in our study.

The PICS Technique: A Novel Approach for Residual Curvature Correction During Penile Prosthesis Implantation in Patients With Severe Peyronie's Disease Using the Collagen Fleece TachoSil

BackgroundCorrection of residual curvature during inflatable penile prosthesis (IPP) implantation in patients with Peyronie's disease (PD) by plaque incision and grafting is a common approach. AimTo present a novel technique for residual curvature correction during IPP implantation using collagen fleece (TachoSil, Baxter Healthcare Corp, Deerfield, IL, USA). MethodsAfter the IPP (Titan Touch, Coloplast, Minneapolis, MN, USA) is placed, the implant is inflated maximally. When residual curvature exceeds 40°, the PICS (penile implant in combination with the Sealing technique) technique is performed. The device is deflated, and a circumcising skin incision and penile degloving are performed. After elevation of the neurovascular bundle, the device is reinflated maximally. Plaque incision is performed at the point of maximum curvature using electrocautery. This leads to penile straightening because the tension is removed. In the next step, the defect of the tunica is closed with collagen fleece, which sticks to the tunica and defect without any sutures needed. The neurovascular bundle is reapproximated and the Buck fascia is closed. This is followed by closure of penile skin. OutcomesPrimary outcome measurements were straightening rates, operative times, 5-item International Index of Erectile Function (IIEF-5) scores at follow-up, immediate and late complications, and patient satisfaction. ResultsThe PICS technique was applied to 15 patients. Mean patient age was 61.7 years (52–79 years). Mean residual curvature after IPP was 66.7° (50–90°). Mean operative time was 117.3 minutes (100–140 minutes). Mean follow-up was 15.1 months (1–29 months). 12 of 15 patients (80%) showed a totally straight penis. 3 patients (20%) had residual curvature of 10° at follow-up, which did not interfere with sexual intercourse. Mean IIEF-5 score at follow-up was 24.2 (22–25). No immediate or late complications occurred. All patients were satisfied with the surgical outcomes. Clinical ImplicationsThis novel technique prevents puncture or injury of the device, because the collagen fleece does not require suture fixation into the defect after plaque incision. Strengths and LimitationsThis technique can be applied to patients with severe PD who display residual curvature greater than 40° after IPP placement. It is a fast approach with low complication rates. Limitations include the small patient population and short follow-up. ConclusionThe PICS technique represents a safe and time-saving approach for residual curvature correction during IPP placement in patients with PD and prevents device puncture.Hatzichristodoulou G. The PICS Technique: A Novel Approach for Residual Curvature Correction During Penile Prosthesis Implantation in Patients With Severe Peyronie's Disease Using the Collagen Fleece TachoSil. J Sex Med 2018;15:416–421

The combination of penile revascularization surgery with penile corrective techniques as an alternative to prosthesis implantation in patients with peyronie's disease accompanied by erectile dysfunction: Long-term results.

This study aimed to investigate the long-term outcomes of the surgical combination of revascularization and penile corrective techniques after having obtained promising preliminary results from a previous study. Between 2008 and 2015, the combined treatment was undertaken for 60 patients with Peyronie's disease and erectile dysfunction. A preoperative urological evaluation was performed with penile color Doppler ultrasonography, electromyography of the corpus cavernosum and cavernosometry. All the patients completed 15-item and 5-item IIEFs preoperatively and at postoperative follow-up. The mean age of the patients was 53.78 ± 6.48 years ranging from 47 to 63. The mean follow-up period was 48 (14-68) months. The degree of penile angulation was >40 in all the patients. Urethra dissection was required in five patients. Penile disassembly was performed on one patient due to distal complex corporeal deformity. None of the patients reported complications after surgery. The mean total IIEF score was reported to be 25.4 ± 2.8 before the operation and 52.23 ± 1.2 at the end of the follow-up (p < 0.05). The mean IIEF-5 score was 7.3 ± 1.3 preoperatively and 20.9 ± 1.9 at the end of follow-up (p < 0.05). The results of IIEF-15 for erectile function demonstrated that 32 patients had a cutoff value of >26, indicating no ED. Although all patients had complete penile straightening, 7 (11.66%) reported shortening of the penis but was not dissatisfied with the treatment. The number of patients satisfied with the outcomes of the operation was 53. The statistically significant improvement and satisfactory results achieved with the IIEF questionnaires suggest that the proposed combined treatment could be an alternative to penile prosthesis in highly selected patients with Peyronie's disease, particularly those with erectile dysfunction; however, more studies are needed to confirm these results.

Effectiveness and Safety of Oro-Dispersible Sildenafil in a New Film Formulation for the Treatment of Erectile Dysfunction: Comparison Between Sildenafil 100-mg Film-Coated Tablet and 75-mg Oro-Dispersible Film

BackgroundA new oro-dispersible film (ODF) formulation of sildenafil has been developed for the treatment of erectile dysfunction (ED) to overcome the drawbacks that some patients experience when taking the conventional film-coated tablet (FCT). AimTo assess the effectiveness and safety of sildenafil ODF formulation in patients with ED who were using the conventional FCT. MethodsFrom May 2017 through July 2017, 139 patients with ED were enrolled. Data from penile color-duplex ultrasound, medical history, hormonal evaluation, and patient self-administered questionnaires were collected. All patients were administered sildenafil 100-mg FCT for 4 weeks. Thereafter, they underwent a 2-week washout period and subsequently took sildenafil 75-mg ODF for 4 weeks. OutcomesThe International Index of Erectile Function (IIEF-15), Hospital Anxiety and Depression Scale (HADS), Patient Global Impressions of Improvement (PGI-I), and Clinician Global Impressions of Improvement (CGI-I) questionnaires were administered and severity of ED was classified as severe (IIEF-15 score ≤ 10), moderate (IIEF-15 score 11–16), or mild (IIEF-15 score = 17–25). ResultsAll patients completed the final protocol. Differences in mean IIEF scores for erectile function, orgasmic function, sexual desire, and intercourse satisfaction were significantly in favor of sildenafil 100-mg FCT, whereas the mean score for overall satisfaction was in favor of sildenafil 75-mg ODF. A significant difference in changes in HADS score was found from washout to final follow-up (mean difference = −0.19; P < .01). For the ODF formulation, the median CGI-I score was 3.5 (interquartile range [IQR] = 2.5–4.5) and the median PGI-I score was 3.0 (IQR = 2.0–4.0). The median action time was 20.0 minutes (IQR = 15.0–30.0) and the median mouth time was 60.0 seconds (IQR = 30.0–120.0). Clinical ImplicationsThe ODF formulation of a widely known drug, with the same safety and effectiveness of the FCT, was better appreciated by patients in overall satisfaction. Strengths and LimitationsThis is the first clinical trial to assess the efficacy of a new formulation of sildenafil in patients with ED. The limitations of the study are related to the methodology used: it was not a case-control study and the patients were not drug-naïve for ED treatment. Therefore, only the “additional” side effects of the ODF formulation compared with FCT are reported. ConclusionThe new ODF formulation is as efficient and safe as the FCT formulation and offers a new choice of treatment to specialists for more precisely tailored therapy.Cocci A, Capece M, Cito G, et al. Effectiveness and Safety of Oro-Dispersible Sildenafil in a New Film Formulation for the Treatment of Erectile Dysfunction: Comparison Between Sildenafil 100-mg Film-Coated Tablet and 75-mg Oro-Dispersible Film. J Sex Med 2017;14:1606–1611.

Prospective evaluation of a specific technique of sexual function preservation in external beam radiotherapy for prostate cancer.

Sexual preservation is an important issue in the treatment of localized prostate cancer. A technique of irradiation was developed to better preserve this function and has been evaluated. Eleven patients, with no erectile dysfunction (ED), were treated with daily IMRT-IGRT (total dose: 76-78 Gy). The pudendal arteries, penile bulb and cavernous body were delineated on the planning CT scan. The doses to these structures (with a 5 mm margin) were optimized to be as low as possible. The erectile function was documented using IIEF-5 scores at baseline, 6 months, 1 and 2 years. No ED was defined by an IIEF5 ≥ 20/25, a mild ED by an IIEF5 score of 17-19 and an important ED by a score <17. The mean age was 68.4 years. At the median follow-up of 36 months, there was no biochemical relapse. Before RT, the mean IIEF5 score in all 11 patients was 23.4 (range, 20-25). At 6, 12, 18 and 24 months after RT, the mean IIEF scores were 21.2 (14-25), 21.3 (14-25), 21.8 (16-25) and 21.8 (16-25), respectively. At 2 years, 8 patients (72.7%) had no ED and 2 patients (18.2%) experienced a mild ED. The only patient with an important ED had a medical treatment and recovered a satisfactory IIEF score from 16 to 24. The results of this technique of optimisation for sexual preservation are encouraging. Despite a mean age close to 70 years at the time of treatment, 90.9% of the patients had no to mild ED at 2 years. This rate increases at 100% with medical treatment. Advances in knowledge: Dose optimization on sexual organs is possible and could decrease the ED rates.

Low intensity shock wave therapy for erectile dysfunction: 6 months followup results

Introduction. Low intensity extracorporeal shock wave therapy (ESWT) is a novel promising method of treatment for men with erectile dysfunction (ED). The efficacy of ESWT is not clearly determined and need further investigation. Aim of the study: To investigate 6 months followup efficacy and safety results from ESWT trial in patients with ED. Patients and methods. This open-label, longitudinal observational study investigated 6 months followup results in 19 men (mean age = 59.5 years) with organic ED (including 6 (32%) patients with type 2 diabetes mellitus and 6 (32%) patients after nerve-sparing radical prostatectomy) treated with 5-session weekly ESWT protocol using DornierAries delivery system (7500 shock waves, 1500 each session, 4 Hz). Information about adverse events was recorded. Effectiveness was assessed according to the International Index of Erectile Function and Sexual Health Inventory for Men after the 5th ESWT session and also in 1, 3 and 6 months. Results. No patient reported treatment-related adverse events. In 12 (63%), 11 (57%), 11 (57%) and 9 (47%) patients IIEF increased after the 5th ESWT session (also in 2 (33%) men with ED caused by radical prostatectomy), and in 1, 3, 6 months after treatment respectively, so the mean IIEF score in the group has become higher (p = 0.003, p = 0.050, p = 0.022, р &gt; 0.1 respectively) as well as the IIEF general satisfaction domain score (p = 0.006 и p = 0.014, р = 0.011 и p = 0.028, respectively). Mean SHIM score growth was significantly higher after the 5th ESWT session only (р = 0.020), also in patients with diabetic ED (р = 0.041). Individual variability of both IIEF and SHIM scores after treatment was high, with IIEF lower in patients with advanced age (р = 0.015). Conclusions. In 6 months followup ESWT was safe in all and effective in many patients with ED. High individual variability of treatment efficacy needs further evaluation. (For citation: Korneyev IA, Telegin IV, Davydov IV, et al. Low intensity shock wave therapy for erectile dysfunction: 6 months followup results. Urologicheskie vedomosti. 2017;7(3):5-13. doi: 10.17816/uroved735-13).

Does topical hemostatic agent (Floseal®) have a long-term adverse effect on erectile function recovery after nerve-sparing robot-assisted radical prostatectomy?

To investigate the long-term effects of Floseal® on erectile function recovery (EFR) after nerve-sparing robot-assisted radical prostatectomy (RALP). We prospectively collected results of the self-administered International Index Erectile Function Questionnaire 1-5 and 15 (IIEF 1-5 and 15) of 532 consecutive patients who underwent RALP for prostate cancer in our institution between October 2007 and December 2015. Patients were divided into two groups according to Floseal® application after prostatectomy. They were enrolled according to the following criteria: (a) bilateral nerve-sparing procedure; (b) preoperative IIEF≥17; adherence to our erectile rehabilitation protocol; (c) 1-year follow-up. Outcomes were measured as mean IIEF score, EFR (IIEF<17 or ≥17), grade of ED: severe (IIEF<17), moderate (17-21), mild (22-25) and no ED (>25). A total of 120 patients were enrolled. Group A included 40 consecutive patients who received traditional hemostasis, and Group B included 80 consecutive patients in which Floseal® was additionally used. No differences were observed in terms of preoperative mean IIEF score (p=0.65). Group B patients showed a trend toward a higher mean IIEF score 3months after surgery (p=0.06) but no differences in terms of EFR (p=1.000). Long-term results (6, 9, 12months after surgery) showed a significantly and progressively higher mean IIEF score (p=0.04, 0.003, 0.003) and EFR (p=0.043, 0.027, 0.004) in Group A patients. Comparison between the groups in terms of severe, moderate, mild and no ED becomes significant at 9 and 12months (p=0.002, 0.006). The results of our study suggest that local use of Floseal® worsens the long-term erectile function recovery in patients selected for nerve-sparing RALP.

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.

Metabolic Syndrome Does Not Increase the Risk of Ejaculatory Dysfunction in Patients With Lower Urinary Tract Symptoms and Benign Prostatic Enlargement: An Italian Single-center Cohort Study

To evaluate the relationship between metabolic syndrome (MetS) and ejaculatory dysfunction (EjD) in patients with lower urinary tract symptoms and benign prostatic enlargement. From 2012 to 2016, a consecutive series of men with lower urinary tract symptoms and benign prostatic enlargement who were attending our prostate clinic were evaluated using the International Prostate Symptom Score (IPSS) and were subsequently enrolled into a prospective database. All patients were assessed using the short form of the International Index of Erectile Function (IIEF-SF) and the Male Sexual Health Questionnaire ejaculatory dysfunction short form (MSHQ-EjD-SF) that evaluates the ability to ejaculate, the ejaculation force, the ejaculation volume, and subjective bother associated with EjD. MetS was defined according to the Adult Treatment Panel III criteria. A total of 220 patients were enrolled; 48 of 220 patients (22%) presented a MetS. Mean age was 70 ± 8 years, mean IPSS was 8.3 ± 6.2, mean IIEF score was 17.3 ± 7.9, and mean MSHQ-EjD-SF was 9.9 ± 4.7. Overall, 109 of 220 patients (50%) were affected by a moderate or severe EjD. On multivariate analysis, age (odds ratio [OR]: 1.058, 95% confidence interval [CI]: 1.016-1.123; P = .007), IIEF score (OR: 0.899, 95% CI: 0.856-0.943; P = .000), and IPSS (OR: 1.065, 95% CI: 1.011-1.123; P = .018) were found to be predictors of EjD. In our series MetS was not found to be predictive of EjD. In our single-center study, MetS has no influence on the EjD evaluated with the MSHQ-EjD-SF.

MP25-16 PENILE REVASCULARIZATION SURGERY IN PATIENTS WITH DIABETIC ERECTILE DYSFUNCTION : LONG TERM RESUTS

You have accessJournal of UrologySexual Function/Dysfunction: Surgical Therapy I1 Apr 2017MP25-16 PENILE REVASCULARIZATION SURGERY IN PATIENTS WITH DIABETIC ERECTILE DYSFUNCTION : LONG TERM RESUTS Onder Kayigil, Emrah Okulu, and Fatih Akdemir Onder KayigilOnder Kayigil More articles by this author , Emrah OkuluEmrah Okulu More articles by this author , and Fatih AkdemirFatih Akdemir More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.766AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To determine the overall long-term success of penile revascularization surgery in the treatment of vasculogenic erectile dysfunction and also to investigate the effect of risk factors on the results of a modified Furlow-Fisher technique.We completed our revascularization surgery results in our 50 erectile dysfunction patients having no risk factors except diabetes with a long term follow-up. METHODS Between 2004 and 2015,225 patients with a mean age of 47.2(range:23–73) years underwent penile revascularization surgery.Among them, 50 patients were diagnosed as having diabetes mellitus and completed the mean 60,94±1,34 months follow-up.All the patients were routinely interviewed in the Departments of internal Medicine,Neurology,Psychiatry,and Anaesthesiology.Preoperative urological evaluation was performed with penile colour Doppler ultrasonography,corpus cavernosum electromyography(CC-EMG) and cavernosometry.At least five points of increase in the IIEF-5 score during the latest patient visit in the postoperative period compared with the preoperative period was regarded as improvement(surgical success). RESULTS The mean total IIEF score was 28.1±5.7 before surgery,and it was 42.2±6.3 at the end of the follow-up(P<0.05).The mean IIEF-5 score was 8.3±2.2 before surgery,and it was 17.7±2.1 at the end of the follow-up(P<0.05).Before surgery, the mean Erectile Function-domain score was 11.6±3.4,and it was 21.7±6.1 at the end of the follow-up(P<0.05).According to the IIEF-15,32 patients achieved a no-ED threshold value of >26.According to the IIEF-5, the surgery was again successful in 35 of 50 diabetic patients(70%). CONCLUSIONS We suggest that penile revascularization surgery could be an alternative choice before penile prosthesis implantation in those patients having no risk factors except diabetes which is under control. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e316-e317 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Onder Kayigil More articles by this author Emrah Okulu More articles by this author Fatih Akdemir More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Incidence of De Novo Erectile Dysfunction after Urethroplasty: A Prospective Observational Study.

PurposeDe novo erectile dysfunction (ED) is a known complication after urethroplasty. Incidence and natural history of de novo ED after urethroplasty is underreported. We assessed the incidence of de novo ED after urethroplasty.Materials and MethodsConsecutive consenting urethroplasty (n=48) patients aged 21 to 50 years from February 2014 to July 2016 with normal preoperative erectile function as determined by an International Index of Erectile Function-5 (IIEF-5) score ≥22 were included and interviewed at 3, 6, and 12 months.ResultsIn patients with anterior stricture (n=40), substitution urethroplasty (SU) was performed in 22 patients (55.0%) and end-to-end anastomotic urethroplasty (EEAU) in 18 patients (45.0%). Their mean IIEF-5 score was 24.15±0.8 preoperatively, 20.10±4.2 at 3 months (p<0.001), 22.70±2.3 at 6 months (p=0.0012), and 23.70±1.7 at 12 months (p=0.03), showing a recovery of erectile function with time. All 8 patients with pelvic fracture urethral injury (PFUI) underwent progressive perineal urethroplasty. Their mean IIEF score was 24.0±1.2 preoperatively, 18.8±5.4 at 3 months (p=0.002), 20.9±3.5 at 6 months (p=0.37), and 22.0±1.5 at 12 months (p=0.427). The incidence of ED was similar at 1 year postoperatively between patients with anterior stricture and PFUI and between patients who underwent EEAU or SU for anterior stricture.ConclusionsIncidence of ED at 1 year after PFUI is similar to that after surgery for anterior stricture in patients with normal preoperative erectile function. Among the cases of anterior stricture, recovery was better with SU at 3 months and was similar between SU and EEAU at 1 year.

Are erectile functions affected by AB0 blood group?

The aim of this study was to investigate whether there is a relationship between erectile dysfunction (ED), thought to be a vascular disease, and AB0 blood group. The study included 350 people abiding by the study criteria who applied to our clinic from April 2012-April 2015. The patients were divided into two groups including those with ED (Group 1) and those without (Group 2). Age, blood group, IIEF-5 score and presence of additional diseases were recorded. Erectile functions were analyzed according to blood group. There was no difference between the mean age of 111 patients with ED and that of 239 patients without ED included in the study (p = 0.284). There was no difference between patients in the two groups in terms of smoking, alcohol use, hypertension and diabetes (p &gt; 0.05). Among patients in the ED group, the mean IIEF-5 score according to blood group was 19.8 ± 5.04 in the 0 blood group, 16.5 ± 5.2 in the A blood group, 17.2 ± 5.3 in the B blood group and 13.3 ± 3.02 in the AB blood group. The IIEF-5 scores of individuals in the 0 blood group were significantly high compared to individuals in other blood groups (p = 0.004). Logistic regression analysis found that compared to the 0 blood group, the erectile dysfunction risk was 3.9 times greater for the A blood group, 3.5 times greater for the B blood group and 4.7 times greater for the AB blood group (p = 0.001) (Table 3). The risk of erectile dysfunction was significantly increased for individuals in the A, B and AB blood groups compared to individuals in the 0 blood group.

368 Clinical Safety and Efficacy of Penile Low-Intensity Extracorporeal Shockwave Therapy for Erectile Dysfunction in Non-Responders to PDE5 Inhibitors

Erectile dysfunction (ED) in men is associated with vascular risk factors such as diabetes, hypercholesterolemia and aging. Low-intensity extracorporeal shock wave therapy (LI-ESWT) is currently being developed for the treatment of ED. The present study investigates the safety and efficacy of penile LI-ESWT in men with ED who could not achieve satisfactory intercourse even after treatment with phosphodiesterase type 5 inhibitors (PDE5i). A prospective study of LI-ESWT was conducted in 50 patients with vasculogenic ED initially treated with PDE5i (singly or in combination) for a minimum of three months. The subjects were treated with shock waves of intensity 0.09 mJ/mm (1500 pulses/session, 10 sessions spread over 5 weeks). All of the patients were evaluated at baseline, and at 5 weeks and 12 weeks post-treatment using the International Index of Erectile Function - Erectile Function (IIEF-EF) questionnaire. Forty eight patients aged 40.1 ± 10.2 years (Mean ± SD) included into the study were categorized, based on IIEF score at baseline, into ‘Severe ED’ group (IIEF score ≤ 11, n = 32) and ‘Moderate ED’ group (IIEF score > 11, n = 16). The mean IIEF scores improved significantly for the ‘Severe ED’ group (8.56 ± 2.42 to 17.53 ± 5.09, P < 0.0001) as well as for the ‘Moderate ED’ group (13.63 ± 1.02 to 21.56 ± 1.55, P < 0.0001) after 12 weeks of LI-ESWT treatment, without any adverse events.

Prospective Evaluation of a Specific Technique of Sexual Function Preservation in External Beam Radiation Therapy for Prostate Cancer

Sexual preservation is an important issue in the treatment of localized prostate cancer. A specific technique of irradiation was developed to better preserve this function and has been evaluated. Between 2010 and 2014, 13 patients, with no erectile dysfunction (ED), were treated with intensity-modulated radiation therapy (total dose: 74-78Gy, 2Gy/fraction) and daily set-up on 3 intra-prostatic gold markers (for a low- or intermediate-risk prostate cancer). The pudendal arteries, penile bulb and cavernous body were delineated on the planning CT scan. The doses to these structures (with a 5 mm margin) were optimized to be as low as possible. The erectile function (EF) was documented using IIEF-5 (International Index of Erectile Function) scores at baseline (before RT), 6 months, 1 year and 2 years. No erectile dysfunction was defined by an IIEF-5 >20/25, a mild ED by an IIEF-5 score of 17-19 and an important ED by a score<17. The mean age was 69.2 years [58-76]. At the time of follow-up, there was no biochemical relapse. Before RT, the mean IIEF5 score in all 13 patients was 23.4 [20-25]. At 6, 12 and 24 months after RT, the IIEF scores were 19.5 [5-25], 18.8 [5-25] and 20.3 [6-25], respectively. At two years, 8 patients (61.5%) had no ED and 2 patients (13.3%) experienced a mild ED. The mean reduction of the IIEF5 score was 3.15. Among the 3 patients with important ED, 2 had a medical treatment (Sildenafil Citrate) and recovered a satisfactory IIEF score at 22 and 24. The primary results of this technique of optimization for sexual preservation are encouraging. Despite a mean age close to 70 years at the time of treatment, almost 75% of the patients had no to mild sexual dysfunction at two years. This rate increases at 92% with the use of Sildenafil Citrate.