New-onset Erectile Dysfunction Research Articles

Prevalence of new onset erectile dysfunction among Damietta governorate men after contracting COVID-19

BackgroundSeveral reports showed that sexual function was affected during and after the COVID-19 pandemic.AimsThe objective of the study was to demonstrate whether a realistic association exists between the COVID-19 pandemic and erectile dysfunction (ED) among a sampled Egyptian population in Damietta governorate.MethodsThis cross-sectional study consisted of 330 adult males diagnosed with COVID-19 infection. They were categorized in three age groups (18–29, 30–39, and 40–50 years, respectively). COVID-19-confirmed cases were assessed by the Arabic version of the International Index of Erectile Function questionnaire (IIEF) scores.ResultsThe prevalence of ED according to the IIEF was 55.1%. The ED was categorized into mild ED which represents 25.8% of the patients, mild to moderate which represents 22.4% of the patients, moderate which represents 7% of the patients, and severe which represents 0% of the patients. We found a significant negative correlation between the age of the patients and the IIEF score. Also, we found an association between the severity of COVID-19 infection and the IIEF score.ConclusionAn association of new-onset ED in men who suffered COVID-19 infection was established. This may be due to virus-induced endothelial cell dysfunction; however, an underlying mechanism and causation have not yet been clearly elucidated. While it appears that COVID-19 infection may be a risk factor for ED, additional research is needed to establish causality.

The Oncological and Functional Prognostic Value of Unconventional Histology of Prostate Cancer in Localized Disease Treated with Robotic Radical Prostatectomy: An International Multicenter 5-Year Cohort Study

Background and objectiveThe impact of prostate cancer of unconventional histology (UH) on oncological and functional outcomes after robot-assisted radical prostatectomy (RARP) and adjuvant radiotherapy (aRT) receipt is unclear. We compared the impact of cribriform pattern (CP), ductal adenocarcinoma (DAC), and intraductal carcinoma (IDC) in comparison to pure adenocarcinoma (AC) on short- to mid-term oncological and functional results and receipt of aRT after RARP. MethodsWe retrospectively collected data for a large international cohort of men with localized prostate cancer treated with RARP between 2016 and 2020. The primary outcomes were biochemical recurrence (BCR)-free survival, erectile and continence function. aRT receipt was a secondary outcome. Kaplan-Meier survival and Cox regression analyses were performed. Key findings and limitationsA total of 3935 patients were included. At median follow-up of 2.8 yr, the rates for BCR incidence (AC 10.7% vs IDC 17%; p < 0.001) and aRT receipt (AC 4.5% vs DAC 6.3% [p = 0.003] vs IDC 11.2% [p < 0.001]) were higher with UH. The 5-yr BCR-free survival rate was significantly poorer for UH groups, with hazard ratios of 1.67 (95% confidence interval [CI] 1.16–2.40; p = 0.005) for DAC, 5.22 (95% CI 3.41–8.01; p < 0.001) for IDC, and 3.45 (95% CI 2.29–5.20; p < 0.001) for CP in comparison to AC. Logistic regression analysis revealed that the presence of UH doubled the risk of new-onset erectile dysfunction at 1 yr, in comparison to AC (grade group 1-3), with hazard ratios of 2.13 (p < 0.001) for DAC, 2.14 (p < 0.001) for IDC, and 2.01 (p = 0.011) for CP. Moreover, CP, but not IDC or DAC, was associated with a significantly higher risk of incontinence (odds ratio 1.97; p < 0.001). The study is limited by the lack of central histopathological review and relatively short follow-up. Conclusions and clinical implicationsIn a large cohort, UH presence was associated with worse short- to mid-term oncological outcomes after RARP. IDC independently predicted a higher rate of aRT receipt. At 1-yr follow-up after RP, patients with UH had three times higher risk of erectile dysfunction post RARP; CP was associated with a twofold higher incontinence rate. Patient summaryAmong patients with prostate cancer who undergo robot-assisted surgery to remove the prostate, those with less common types of prostate cancer have worse results for cancer control, erection, and urinary continence and a higher probability of receiving additional radiotherapy after surgery.

Unrecognised orgasmic phase disorders in men presenting with new-onset erectile dysfunction-Findings from a real-life, cross-sectional study.

Orgasmic phase disorders in men worsen the burden of erectile dysfunction on sexual satisfaction. To investigate the prevalence of and predictors of unreported orgasmic phase disorder in a cohort of men looking for their first urological assessment for new-onset erectile dysfunction in a real-life setting. Data from 1107 heterosexual, sexually active men consecutively assessed for new-onset erectile dysfunction were analysed. Throughout a comprehensive medical and sexual history, all patients were asked to self-report any orgasmic phase disorder and to complete the International Index of Erectile Function and the Beck's Inventory for Depression (depressive symptoms scored as Beck's Inventory for Depression ≥11). Men self-reporting orgasmic phase disorder during the interview were excluded from further analyses. The median value of the International Index of Erectile Function-orgasmic function domain was arbitrarily used to categorise men with (International Index of Erectile Function-orgasmic function ≤5) and without unreported orgasmic phase disorder (International Index of Erectile Function-orgasmic function >5). Circulating hormones were measured in every patient. Descriptive statistics and logistic regression models were used to test the association between clinical variables and unreported orgasmic phase disorder. Of 1098 patients with non-self-reporting orgasmic phase disorder, 314 (28.6%) had International Index of Erectile Function-orgasmic function ≤5. Patients with erectile dysfunction + unreported orgasmic phase disorder were older (median [interquartile range]: 58 [44-66] years vs. 51 [40-60] years), had higher body mass index [25.8 (23.7-28.1) kg/m2 vs. 25.2 (23.3-27.4) kg/m2 ], higher prevalence of type 2 diabetes (36 [11.5%] vs. 45 [5.7%]) and lower International Index of Erectile Function-erectile function scores (6 [2-10] vs. 18 [11-24]) than men with erectile dysfunction-only (all p<0.05). Patients with erectile dysfunction + unreported orgasmic phase disorder depicted higher rates of severe erectile dysfunction (75.5%vs. 25%) and Beck's Inventory for Depression ≥11 (22.6%vs. 17.9%) (all p<0.05). In the multivariable logistic regression analysis, older age (odds ratio: 1.02) and lower International Index of Erectile Function-erectile function scores (odds ratio: 0.83) were independently associated with unreported orgasmic phase disorder (all p<0.05). Almost one in three men seeking first medical help for erectile dysfunction depicted criteria suggestive of unreported orgasmic phase disorder. Men with unreported orgasmic phase disorder were older and had higher rates of severe erectile dysfunction and concomitant depressive symptoms. These real-life findings outline the clinical relevance of a comprehensive investigation of concomitant sexual dysfunction in men only complaining of erectile dysfunction to more effectively tailor patient management.

Hyperestrogenism is associated with sexual function impairment in men-findings from a cross-sectional, real-life study.

Hyperestrogenism is believed to be harmful to male sexuality. We aimed to investigate the prevalence of and the impact of hyperestrogenism on sexual functioning in a cohort of men seeking medical attention for new-onset erectile dysfunction. Data from 547 men seeking first medical help for new-onset erectile dysfunction at a single andrology center were analyzed. Patients were assessed with a thorough medical and sexual history. Comorbidities were scored with the Charlson comorbidity index. All patients completed the International index of erectile function; the International index of erectile function-erectile function domain was categorized according to Cappelleri's criteria. Circulating hormones were measured in every patient. Hyperestrogenism was defined as estradiol levels >42.6 pg/mL (Tan etal., 2015). Descriptive statistics and logistic/linear regression models tested the association between hyperestrogenism and International index of erectile function domains score. Overall, 96 (17.6%) participants had serum estrogen levels suggestive of hyperestrogenism. Men with hyperestrogenism were older (median [interquartile range]: 46 [35-59] vs. 44 [31-56] years; p<0.001), had a higher rate of comorbidities (Charlson comorbidity index ≥1: 26.0% vs. 7.4%; p<0.001), and higher serum total testosterone values (5.4 [5.2-8.0] vs. 4.3 [4.1-5.7] ng/mL; p=0.01) than those with normal estradiol values. A higher prevalence of severe erectile dysfunction (135 [29.9%] vs. 47 [48.9%] men; p=0.01) and of hypogonadism (22 [4.8%] vs. 6 [6.3%] men; p=0.004) were found in men with hyperestrogenism. Serum estradiol levels were positively correlated with total testosterone levels (β = 0.26, p<0.001) but negatively correlated with International index of erectile function-orgasmic function (β = -0.24, p=0.002) and International index of erectile function-erectile function scores (β = -0.03, p<0.001). When International index of erectile function scores was used to stratify erectile dysfunction patients, hyperestrogenism (odds ratio 2.44, p=0.02) was associated with severe erectile dysfunction. One out of five men seeking first medical help for erectile dysfunction showed elevated serum estradiol values suggestive of hyperestrogenism. Hyperestrogenism was associated with health-significant comorbidities, orgasmic function impairment, and erectile dysfunction severity.

(526) Association of Prior COVID-19 Infection With Newly Diagnosed Erectile Dysfunction: Evaluation of 42,406 COVID-19 Recovered Men

Abstract Introduction The SARS-CoV-2 virus and associated COVID-19 infection is known to cause endothelial cell dysfunction. This has led some to hypothesize that COVID-19 infection may increase the risk of erectile dysfunction. Initial studies evaluating this association have been limited to small, single institution studies or have utilized electronic medical record databases that lack universal follow-up given they only capture follow-up care at a small proportion of health care facilities. Objective To assess if COVID-19 infection recovery is associated with increased rates of newly diagnosed erectile dysfunction (ED) using an insurance claims database. Methods Using IBM MarketScan, a commercial claims database, men with prior COVID-19 infection between January 2020 and January 2021 were identified using ICD-10 diagnosis codes. Using this cohort along with an age-matched cohort of men without prior COVID-19 infection, we assessed the incidence of newly diagnosed erectile dysfunction (ED). Men with ED secondary to prostatectomy or radiation were excluded. Covariates were assessed using a multivariable model to determine association of prior COIVD-19 infection with newly diagnosed ED. Results 42,406 men experienced a COVID-19 infection between January 2020 and January 2021 of which 610 (1.44%) developed new onset ED within 6.5 months follow up. On multivariable analysis while controlling for diabetes, cardiovascular disease, smoking, obesity, hypogonadism, thromboembolism, and GU malignancy, prior COVID-19 infection was associated with increased risk of new onset ED (HR 1.27; 95% CI 1.1-1.5; P=0.001). COVID-19 infection carried a similar association with new onset ED as did diabetes and BMI 25-30, HR 1.3 and 1.29, respectively. Conclusions Prior to the widespread implementation of the COVID-19 vaccine, the incidence of newly diagnosed ED is higher in men with prior COVID-19 infection compared to age-matched controls. Prior COVID-19 infection was associated with a 27% increased likelihood of developing new-onset ED when compared to those without prior infection. Additional longitudinal studies are needed to evaluate the risk of erectile dysfunction after following asymptomatic infection and in the setting prior vaccination. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Cooper Medical, Boston Scientific, Acerus, Coloplast, Endo, Turtle Health, Maximus, FirmTech, StreamDx, Inherent Bioscience.

Prior COVID-19 infection associated with increased risk of newly diagnosed erectile dysfunction.

We sought to assess if COVID-19 infection recovery is associated with increased rates of newly diagnosed erectile dysfunction. Using IBM MarketScan, a commercial claims database, men with prior COVID-19 infection were identified using ICD-10 diagnosis codes. Using this cohort along with an age-matched cohort of men without prior COVID-19 infection, we assessed the incidence of newly diagnosed erectile dysfunction. Covariates were assessed using a multivariable model to determine association of prior COVID-19 infection with newly diagnosed erectile dysfunction. 42,406 men experienced a COVID-19 infection between January 2020 and January 2021 of which 601 (1.42%) developed new onset erectile dysfunction within 6.5 months follow up. On multivariable analysis while controlling for diabetes, cardiovascular disease, smoking, obesity, hypogonadism, thromboembolism, and malignancy, prior COVID-19 infection was associated with increased risk of new onset erectile dysfunction (HR 1.27; 95% CI 1.1-1.5; P = 0.002). Prior to the widespread implementation of the COVID-19 vaccine, the incidence of newly diagnosed erectile dysfunction is higher in men with prior COVID-19 infection compared to age-matched controls. Prior COVID-19 infection was associated with a 27% increased likelihood of developing new-onset erectile dysfunction when compared to those without prior infection.

Prevalence and predictors of unrecognized low sexual desire in men with new onset erectile dysfunction – findings from a cross-sectional, real-life study

The interrelationship between sexual desire and erectile dysfunction (ED) has been variously investigated. We aimed to investigate the prevalence of and the predictors of unrecognized low sexual desire (LSD) in the real-life setting. Data from 1509 men seeking first medical help for new-onset ED at a single andrology centre were analyzed. All participants self-reported the presence of LSD. Moreover, patients completed the International Index of Erectile Function (IIEF) and the Beck Depression Inventory (BDI). Depressive symptoms were defined as BDI ≥11. The median value of the IIEF-Sexual desire domain (IIEF-SD = 7) was arbitrarily used to categorize the cohort in low vs. normal SD. Hypogonadism was defined as total testosterone (tT) < 3.0 ng/mL. Descriptive statistics and logistic regression models tested the association between clinical variables and unrecognized LSD. Of 1197 (79.3%) patients not self-reporting LSD, 369 (30.8%) had IIEF-SD <7. Patients with unrecognized LSD were older [median (IQR) 54 yrs (41-63) vs. 49 yrs (36-59), p<0.001], had lower IIEF-EF [10 (5-20) vs. 22 (11-28)] but higher BDI [6 (3-12) vs. 4 (1-8)] and lower tT [4.3 (3.2-5.7) vs. 4.7 (3.2-7.3) ng/ml] (all p<0.001). Overall, men with unrecognized LSD presented a higher rate of severe ED (50% vs. 24%, p<0.001), and of BDI suggestive for depressive symptoms (30.6% vs. 18.3%) and of hypogonadism (19.9% vs. 10%) (all p<0.001). At multivariable logistic regression analysis, lower tT, not suggestive for hypogonadism (OR 0.91, p=0.03), lower IIEF-EF (OR 0.94, p<0.001) and BDI suggestive for depressive symptoms (OR 1.83, p<0.001) were independent predictors of unrecognized LSD, after accounting for age. One out of three men seeking first medical help for ED showed unrecognized LSD. Men with unrecognized LSD were older, had higher rates of severe ED and depressive symptoms and lower tT values than men with normal SD. None

The effect of testicular trauma on male infertility

We aim to evaluate the effect of testicular trauma on male reproductive outcomes. The electronic medical record was retrospectively searched using diagnosis codes for testicular trauma and procedure codes for testicular trauma repairs, at Los Angeles County and Parkland Hospitals, for males aged 18–55 years. Charts were reviewed for trauma details, reproductive hormones, and semen analyses. Men were contacted by phone for a fertility and sexual performance survey. Fifty-six patients were identified as having testicular trauma. Twelve were reached by telephone, of which 33.3% had blunt and 66.7% had penetrating traumas. The mean duration since trauma was 41 months. One quarter reported new-onset erectile dysfunction post-trauma, 16.7% endorsed new-onset dysuria, 8.3% endorsed long-term testicular pain. Only two males (16.7%) attempted paternity post-trauma, both with primary infertility. One patient (8.3%) was attempting paternity post-trauma and experiencing primary infertility for 42 months. Two patients (16.7%) had undergone semen analysis testing, both patient-reported as ‘normal’. None of the 12 patients we reached were under the care of a urologist. Both short and long-term urologic follow-up is crucial for testicular trauma patients. Despite some experiencing lasting consequences, none of these men were under the care of a urologist.

PD09-07 HYPERESTROGENISM IS ASSOCIATED WITH SEXUAL FUNCTION IMPAIRMENT IN MEN—FINDINGS FROM A CROSS-SECTIONAL, REAL-LIFE STUDY

You have accessJournal of UrologyCME1 May 2022PD09-07 HYPERESTROGENISM IS ASSOCIATED WITH SEXUAL FUNCTION IMPAIRMENT IN MEN—FINDINGS FROM A CROSS-SECTIONAL, REAL-LIFE STUDY Luca Boeri, Paolo Capogrosso, Giuseppe Fallara, Walter Cazzaniga, Luigi Candela, Federico Belladelli, Edoardo Pozzi, Massimiliano Raffo, Antonio Costa, Christian Corsini, Daniele Cignoli, Nicolò Schifano, Gianmarco Colandrea, Alessia d'Arma, Eugenio Ventimiglia, Rayan Matloob, Federico Dehò, Francesco Montorsi, and Andrea Salonia Luca BoeriLuca Boeri More articles by this author , Paolo CapogrossoPaolo Capogrosso More articles by this author , Giuseppe FallaraGiuseppe Fallara More articles by this author , Walter CazzanigaWalter Cazzaniga More articles by this author , Luigi CandelaLuigi Candela More articles by this author , Federico BelladelliFederico Belladelli More articles by this author , Edoardo PozziEdoardo Pozzi More articles by this author , Massimiliano RaffoMassimiliano Raffo More articles by this author , Antonio CostaAntonio Costa More articles by this author , Christian CorsiniChristian Corsini More articles by this author , Daniele CignoliDaniele Cignoli More articles by this author , Nicolò SchifanoNicolò Schifano More articles by this author , Gianmarco ColandreaGianmarco Colandrea More articles by this author , Alessia d'ArmaAlessia d'Arma More articles by this author , Eugenio VentimigliaEugenio Ventimiglia More articles by this author , Rayan MatloobRayan Matloob More articles by this author , Federico DehòFederico Dehò More articles by this author , Francesco MontorsiFrancesco Montorsi More articles by this author , and Andrea SaloniaAndrea Salonia More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002535.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: High serum estrogens levels have been associated with higher rates of heart attacks, strokes, and prostate cancer. Moreover, hyperestrogenism is believed to be harmful to male sexuality. We aimed to investigate the prevalence of and the impact of hyperestrogenism on sexual functioning in a cohort of men seeking medical attention for new onset erectile dysfunction (ED) in the real-life setting. METHODS: Data from 547 men seeking first medical help for new-onset ED at a single andrology centre were analyzed. Patients were assessed with a thorough medical and sexual history. Comorbidities were scored with the Charlson Comorbidity Index (CCI). All patients completed the International Index of Erectile Function (IIEF); the IIEF-Erectile function (IIEF-EF) domain was categorized according to Cappelleri’s criteria. Circulating hormones were measured in every patient. Hyperestrogenism was defined as estradiol (E2) levels >42.6 pg/mL (Tan RS et al. 2015). Descriptive statistics and logistic/linear regression models tested the association between hyperestrogenism and IIEF scores. RESULTS: Overall, 96 (17.6%) patients had serum estrogen levels suggestive for hyperestrogenism. Men with hyperestrogenism were older [median (IQR) 46 (35-59) vs. 44 (31-56) years; p <0.001], had more comorbidities [CCI≥1: 26.0% vs. 7.4%; p <0.001] and higher serum testosterone (TT) levels [5.4 (5.2-8.0) vs. 4.3 (4.1-5.7); p=0.01] than those with normal E2 values. A higher rate of severe ED was found in men with elevated E2 levels (49.0% vs. 29.9%; p=0.01). Moreover, the IIEF-orgasmic function (IIEF-OF) domain was lower in ED men with hyperestrogenism than those with normal E2 values [6 (3-10) vs. 9 (5-10), p=0.03]. Serum E2 levels were positively correlated with TT levels (rho 0.26, p <0.001), but negatively correlated with IIEF-OF (rho -0.2, p<0.01) and IIEF-EF scores (rho -0.33, p <0.001). At multivariable logistic regression analysis, hyperestrogenism (OR 2.44, p=0.02) was associated with severe ED after accounting for age, BMI, CCI and serum TT values. CONCLUSIONS: One out of five men seeking first medical help for ED showed elevated serum E2 values in the real-life setting. Hyperestrogenism was associated with health significant comorbidities, orgasmic function impairment and higher severity of ED. Source of Funding: none © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e179 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Luca Boeri More articles by this author Paolo Capogrosso More articles by this author Giuseppe Fallara More articles by this author Walter Cazzaniga More articles by this author Luigi Candela More articles by this author Federico Belladelli More articles by this author Edoardo Pozzi More articles by this author Massimiliano Raffo More articles by this author Antonio Costa More articles by this author Christian Corsini More articles by this author Daniele Cignoli More articles by this author Nicolò Schifano More articles by this author Gianmarco Colandrea More articles by this author Alessia d'Arma More articles by this author Eugenio Ventimiglia More articles by this author Rayan Matloob More articles by this author Federico Dehò More articles by this author Francesco Montorsi More articles by this author Andrea Salonia More articles by this author Expand All Advertisement PDF DownloadLoading ...

Hyperestrogenism is associated with sexual function impairment in men – findings from a cross-sectional, real-life study

ABSTRACT Introduction High serum estrogens levels have been associated with higher rates of heart attacks, strokes, and prostate cancer. Moreover, hyperestrogenism is believed to be harmful to male sexuality. Objectives We aimed to investigate the prevalence of and the impact of hyperestrogenism on sexual functioning in a cohort of men seeking medical attention for new onset erectile dysfunction (ED) in the real-life setting. Methods Data from 481 men seeking first medical help for new-onset ED at a single andrology centre were analyzed. Patients were assessed with a thorough medical and sexual history. Comorbidities were scored with the Charlson Comorbidity Index (CCI). All patients completed the International Index of Erectile Function (IIEF) and the IIEF-Erectile function (IIEF-EF) domain was categorized according to Cappelleri's criteria. Circulating hormones were measured in every patient. Hyperestrogenism was defined as estrogen (E2) levels &amp;gt;42.6 pg/mL (Tan RS et al. 2015). Descriptive statistics and logistic/linear regression models tested the association between hyperestrogenism and IIEF scores. Results Overall, 88 (18.3%) patients had serum estrogen levels suggestive for hyperestrogenism. Men with hyperestrogenism were older [median (IQR) 46 (34-58) vs. 44 (32-55) years; p&amp;lt;0.001], had more comorbidities [CCI≥2: 18 (20.5%) vs. 28 (7.1%); p&amp;lt;0.001] and higher serum testosterone (TT) levels [5.4 (4.2-7.3) vs. 4.3 (3.1-5.7); p=0.02] than those with normal E2 values. A higher rate of severe ED was found in men with elevated E2 levels (48.9% vs. 30%; p=0.02). Moreover, the IIEF-orgasmic function (IIEF-OF) domain was lower in ED men with hyperestrogenism than those with normal E2 values [6 (3-10) vs. 9 (6-10), p=0.03]. Serum E2 levels were positively correlated with TT levels (rho 0.25, p&amp;lt;0.001), but negatively correlated with IIEF-OF scores (rho -0.17, p=0.005) and IIEF-EF scores (rho -0.32, p&amp;lt;0.001) (Figure 1). At multivariable logistic regression analysis, hyperestrogenism (OR 2.37, p=0.03) was associated with severe ED after accounting for age, BMI, CCI and serum T values. Conclusions One out of five men seeking first medical help for ED showed elevated serum E2 values in the real-life setting. Hyperestrogenism was associated with health significant comorbidities, orgasmic function impairment and higher severity of ED. Disclosure Work supported by industry: no.

Prevalence and predictors of unrecognized low sexual desire in men with new onset erectile dysfunction – findings from a cross-sectional, real-life study

ABSTRACT Introduction The interrelationship between male sexual desire and erectile dysfunction (ED) has been variously investigated. Objectives We aimed to investigate the prevalence of and the predictors of unrecognized low sexual desire (LSD) in a cohort of men seeking medical help for new onset ED in the real-life setting. Methods Data from 1509 men seeking first medical help for new-onset ED at a single andrology centre between 01/2010 and 01/2020 were analyzed. Patients were assessed with a thorough medical and sexual history. Comorbidities were scored with the Charlson Comorbidity Index (CCI). All participants were asked to self-report the presence of LSD. Moreover, patients completed the International Index of Erectile Function (IIEF) and the Beck Depression Inventory (BDI). Depressive symptoms were defined as BDI ≥11. The median value of the IIEF-Sexual desire domain (IIEF-SD) was used to categorize the cohort in low SD (IIEF-SD &amp;lt;7) vs. normal SD (IIEF-SD ≥7). The IIEF-Erectile function (IIEF-EF) domain was categorized according to Cappelleri's criteria. Circulating hormones were measured in every patient. Hypogonadism was defined as total testosterone (tT) &amp;lt; 3.0 ng/mL. Descriptive statistics and logistic regression models tested the association between clinical variables and unrecognized LSD. Results Overall, 312 (20.7%) patients self-reported LSD and were excluded from further analyses. Of 1197 patients not self-reporting LSD, 369 (30.8%) had IIEF-SD &amp;lt;7 (arbitrarily defined as unrecognized LSD). Patients with unrecognized LSD were older [median (IQR) 54 yrs (41-63) vs. 49 yrs (36-59), p&amp;lt;0.001], had lower IIEF-EF [10 (5-20) vs. 22 (11-28)] but higher BDI [6 (3-12) vs. 4 (1-8)] and lower tT [4.3 (3.2-5.7) vs. 4.7 (3.2-7.3) ng/ml] (all p&amp;lt;0.001) than men without LSD. Overall, men with unrecognized LSD presented a higher rate of severe ED (50% vs. 24%, p&amp;lt;0.001), and of BDI suggestive for depressive symptoms (30.6% vs. 18.3%) and of hypogonadism (19.9% vs. 10%) (all p&amp;lt;0.001). At multivariable logistic regression analysis, lower tT, despite not suggestive for hypogonadism (OR 0.91, p=0.03), lower IIEF-EF (OR 0.94, p&amp;lt;0.001) and BDI suggestive for depressive symptoms (OR 1.83, p&amp;lt;0.001) were found to be independent predictors of unrecognized LSD, after accounting for age. Conclusions One out of three men seeking first medical help for ED showed unrecognized LSD according to the IIEF-SD domain scores. Men with unrecognized LSD were older, had higher rates of severe ED and depressive symptoms and lower tT values despite not suggestive for hypogonadism than men with normal SD. A detailed investigation of sexual desire should be always included in the diagnostic work-up of men with ED, in order to better tailoring patient therapeutic management. Disclosure Work supported by industry: no.

MP27-13 PREVALENCE AND PREDICTORS OF UNRECOGNIZED LOW SEXUAL DESIRE IN MEN WITH NEW ONSET ERECTILE DYSFUNCTION—FINDINGS FROM A CROSS-SECTIONAL, REAL-LIFE STUDY

You have accessJournal of UrologySexual Function/Dysfunction: Evaluation I (MP27)1 Sep 2021MP27-13 PREVALENCE AND PREDICTORS OF UNRECOGNIZED LOW SEXUAL DESIRE IN MEN WITH NEW ONSET ERECTILE DYSFUNCTION—FINDINGS FROM A CROSS-SECTIONAL, REAL-LIFE STUDY Luca Boeri, Paolo Capogrosso, Walter Cazzaniga, Luigi Candela, Giuseppe Fallara, Edoardo Pozzi, Federico Belladelli, Nicolò Schifano, Daniele Cignoli, Gianmarco Colandrea, Massimiliano Raffo, Costantino Abbate, Francesco Montorsi, and Andrea Salonia Luca BoeriLuca Boeri More articles by this author , Paolo CapogrossoPaolo Capogrosso More articles by this author , Walter CazzanigaWalter Cazzaniga More articles by this author , Luigi CandelaLuigi Candela More articles by this author , Giuseppe FallaraGiuseppe Fallara More articles by this author , Edoardo PozziEdoardo Pozzi More articles by this author , Federico BelladelliFederico Belladelli More articles by this author , Nicolò SchifanoNicolò Schifano More articles by this author , Daniele CignoliDaniele Cignoli More articles by this author , Gianmarco ColandreaGianmarco Colandrea More articles by this author , Massimiliano RaffoMassimiliano Raffo More articles by this author , Costantino AbbateCostantino Abbate More articles by this author , Francesco MontorsiFrancesco Montorsi More articles by this author , and Andrea SaloniaAndrea Salonia More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002024.13AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The interrelationship between male sexual desire and erectile dysfunction (ED) has been variously investigated. We aimed to investigate the prevalence and the predictors of unrecognized low sexual desire (LSD) in a cohort of men seeking medical help for new onset ED in the real-life setting. METHODS: Data from 1509 men seeking first medical help for new-onset ED at a single andrology centre in 2010-2020 were analyzed. Patients were assessed with a thorough medical and sexual history. Comorbidities were scored with the Charlson Comorbidity Index (CCI). All participants were asked to self-report the presence of LSD and to complete the International Index of Erectile Function (IIEF) and the Beck Depression Inventory (BDI). Depressive symptoms were defined as BDI≥11. The median value of the IIEF-Sexual desire domain (IIEF-SD) was used to categorize the cohort in low SD (IIEF-SD<7, defined as unrecognized LSD) vs. normal SD (IIEF-SD≥7). The IIEF-Erectile function (IIEF-EF) domain was categorized according to Cappelleri’s criteria. Serum hormones were measured in every patient. Hypogonadism was defined as total testosterone (tT)<3.0 ng/mL. Descriptive statistics and logistic regression models tested the association between clinical variables and unrecognized LSD. RESULTS: Overall, 312 (20.7%) patients self-reported LSD and were excluded from further analyses. Of 1197 patients not self-reporting LSD, 369 (30.8%) had IIEF-SD<7. Patients with unrecognized LSD were older [median (IQR) 54 yrs (41-63) vs. 49 (36-59)], had lower IIEF-EF [10 (5-20) vs. 22 (11-28)], higher BDI [6 (3-12) vs. 4 (1-8)] and lower tT [4.3 (3.2-5.7) vs. 4.7 (3.2-7.3) ng/ml] (all p<0.001) than men without LSD. Men with unrecognized LSD presented a higher rate of severe ED (50% vs. 24%, p<0.001), of BDI≥11 (30.6% vs. 18.3%) and tT<3.0ng/mL (19.9% vs. 10%) (all p<0.001). At multivariable logistic regression analysis, lower tT (OR 0.91, p=0.03), lower IIEF-EF (OR 0.94, p<0.001) and BDI≥11 (OR 1.83, p<0.001) were found to be independent predictors of unrecognized LSD, after accounting for age. CONCLUSIONS: One out of three men seeking first medical help for ED showed unrecognized LSD. Men with unrecognized LSD were older, had more severe ED and depressive symptoms and lower tT values despite not suggestive for hypogonadism than men with normal SD. Thus, a detailed investigation of sexual desire should be always included in the diagnostic work-up of men with ED. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e476-e476 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Luca Boeri More articles by this author Paolo Capogrosso More articles by this author Walter Cazzaniga More articles by this author Luigi Candela More articles by this author Giuseppe Fallara More articles by this author Edoardo Pozzi More articles by this author Federico Belladelli More articles by this author Nicolò Schifano More articles by this author Daniele Cignoli More articles by this author Gianmarco Colandrea More articles by this author Massimiliano Raffo More articles by this author Costantino Abbate More articles by this author Francesco Montorsi More articles by this author Andrea Salonia More articles by this author Expand All Advertisement Loading ...

Does prior surgical interventional therapy for BPH affect the oncological or functional outcomes after primary whole-gland prostate cryoablation for localized prostate cancer?

To assess whether prior interventional treatment for benign prostatic hyperplasia (BPH) influences oncologic or functional outcomes following primary whole-gland prostate cryoablation. Among 3831 men with prostate cancer who underwent primary whole-gland prostate cryoablation, we identified 160 with a history of prior BPH interventional therapy including transurethral needle ablation (n = 6), transurethral microwave thermotherapy (n = 9), or transurethral resection of the prostate (n = 145). Patients with a history of medically treated or unspecified BPH therapy were excluded from the study. Oncological and functional outcomes were compared between men with and without prior BPH interventional therapy. In unadjusted analyses, prior interventional BPH therapy was associated with higher risks of postoperative urinary retention (17.5% vs. 9.6%, p = 0.001) and new-onset urinary incontinence (39.9% vs. 19.4%, p > 0.001) compared with no prior therapy. Interventional BPH therapy was not correlated with the risk of developing a rectourethral fistula (p = 0.84) or new-onset erectile dysfunction (ED) at 12 months (p = 0.08) following surgery. On multivariable regression, prior interventional BPH therapy was associated with increased risk of urinary retention (OR 1.9, 95%, p = 0.015) and new-onset urinary incontinence (OR 2.13, p < 0.001). The estimated 5 years Kaplan-Meier survival analysis showed no statistically significant difference (p = 0.3) in biochemical progression free survival between those who underwent interventional BPH therapy compared with those who did not. Local disease recurrence assessed by post cryoablation positive for-cause prostate biopsy showed no significant difference between the two groups (25.4% vs. 28.7%, p = 0.59). Prior interventional BPH therapy did not affect the oncologic outcomes nor did it increase the risk of rectourethral fistula or ED in sexually performing patients prior to cryosurgery. Prior interventional BPH therapy was associated with increased risk of urinary retention and incontinence after primary whole-gland prostate cryoablation for prostate cancer.

Functional and oncological outcomes of salvage cryosurgery for radiorecurrent prostate cancer.

To evaluate the oncological and functional outcomes of salvage cryosurgery (SCS) for radiorecurrent prostate cancer (rrPCa). A total of 169 consecutive patients with biopsy confirmed rrPCa were retrospectively analysed. All patients underwent SCS in a single referral centre between 2006 and 2018. The primary outcome was biochemical recurrence-free survival (BRFS) according to the Phoenix definition (prostate-specific antigen [PSA] nadir +2ng/mL). The secondary outcomes were overall survival, BRFS defined as a PSA level of >0.5ng/mL, metastasis-free survival, androgen-deprivation therapy (ADT)-free survival, and functional outcomes. Complications were classified according to the Clavien-Dindo system. PSA was measured every 3-6months postoperatively. Functional outcomes were scored as reported by patients at outpatient visits. Kaplan-Meier survival analysis and uni- and multivariable Cox regression were performed. The median (interquartile range) follow-up was 36(18-66)months. The BRFS after 5 and 8years was 52% (95% confidence interval [CI] 43-62%) and 45% (95% CI 35-57%), respectively. At multivariable analysis PSA level at initial diagnosis, initial treatment, interval between primary treatment and SCS, age at SCS, and post-SCS PSA nadir were significant factors for BRFS. The 5-year ADT-free survival was 70% (95% CI 62-79%). Clavien-Dindo Grade ≥III complications occurred in 1.2% (two/169) of patients. In all, 19% (29/156) of patients had new-onset urinary incontinence defined as >1pad/24h and 92% (57/62) of patients had new-onset erectile dysfunction. Persistent urinary fistula occurred in 6.5% (11/169) of patients. The present study shows acceptable oncological outcomes of SCS considering the salvage character of the treatment. The occurrence of serious complications such as urinary incontinence and fistula should not be underestimated.

MP70-12 SALVAGE FOCAL CRYOTHERAPY OFFERS SIMILAR SHORT-TERM ONCOLOGICAL CONTROL AND IMPROVED URINARY FUNCTION COMPARED TO SALVAGE WHOLE GLAND CRYOTHERAPY FOR RADIATION RESISTANT/RECURRENT PROSTATE CANCER

You have accessJournal of UrologyProstate Cancer: Localized: Ablative Therapy II (MP70)1 Apr 2020MP70-12 SALVAGE FOCAL CRYOTHERAPY OFFERS SIMILAR SHORT-TERM ONCOLOGICAL CONTROL AND IMPROVED URINARY FUNCTION COMPARED TO SALVAGE WHOLE GLAND CRYOTHERAPY FOR RADIATION RESISTANT/RECURRENT PROSTATE CANCER Wei Phin Tan*, Ahmed Elshafei, Alireza Aminsharifi, and Thomas Polascik Wei Phin Tan*Wei Phin Tan* More articles by this author , Ahmed ElshafeiAhmed Elshafei More articles by this author , Alireza AminsharifiAlireza Aminsharifi More articles by this author , and Thomas PolascikThomas Polascik More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000950.012AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The treatment of radiation-persistent prostate cancer remains a challenge and should be tailored to the individual patient. We aim to compare short-term oncological and functional outcomes of salvage focal cryotherapy (SFC) to salvage total cryotherapy (STC) for radiation persistent/recurrent prostate cancer. METHODS: We queried the COLD registry for men who underwent SFC and STC of the prostate for radiation persistent/recurrent disease. Propensity score weighting was used to match age at time of treatment, pre-salvage therapy PSA, Gleason sum, and pre-salvage cryotherapy androgen deprivation therapy status. Primary outcome was progression-free survival (PFS). RESULTS: A total of 385 men with biopsy-proven persistent/recurrent prostate cancer after primary radiotherapy were included in the study. Median follow-up, age, PSA and Gleason sum pre-salvage cryotherapy was 24.4 months (1st/3rd quartile: 9.8/60.3), 70 years (1st/3rd quartile: 66/74), 4 ng/dl (1st/3rd quartile: 2.7/5.6) and 7 (1st/3rd quartile: 6/8), respectively. After propensity score weighting, patients who were treated with STC did not have a significant difference test in PFS compared to patients treated with SFC on weighted log-rank test (79.8% vs. 76.98%, p= 0.11). SFC was associated with a lower probability of post-treatment transient urinary retention (5.6% vs 22.4%. p<0.001). There were no significant differences in rectal fistula (1.4% vs 3.8, p=0.30), new onset urinary incontinence within 12 months (9.3% vs 15.1%, p=0.19) or new-onset erectile dysfunction within 12 months (52.6% vs 59.6, p=0.47) in the SFC vs STC group, respectively. CONCLUSIONS: STC has similar 2-year oncological outcome compared to SFC in the radiation- persistent/recurrent disease population, but patients who underwent SFC have a lower urinary retention rate compared to STC. Source of Funding: WPT is supported by the Ruth L. Kirschstein NRSA Institutional Research Training Grant (T32-CA093245). © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e1059-e1060 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Wei Phin Tan* More articles by this author Ahmed Elshafei More articles by this author Alireza Aminsharifi More articles by this author Thomas Polascik More articles by this author Expand All Advertisement PDF downloadLoading ...

Unrecognized Prediabetes Is Highly Prevalent in Men With Erectile Dysfunction–Results From a Cross-Sectional Study

IntroductionThe association between prediabetes (PreDM) and erectile dysfunction (ED) has been analyzed scantly. AimTo assess the association between PreDM and erectile function (EF) in a cohort of white European men with ED. MethodsDemographic, clinical, and laboratory data from 372 consecutive men were analyzed. Health-significant comorbidities were scored with the Charlson Comorbidity Index (CCI). Patients were invited to complete the International Index of Erectile Function (IIEF)-EF domain questionnaire. The EF domain was categorized according to Cappelleri’s criteria. Men were defined as having PreDM according to the criteria defined by the American Diabetes Association (2015). Descriptive statistics and logistic regression models tested the association between clinical variables and PreDM status and severe ED. Main Outcome MeasuresWe assessed the prevalence of PreDM in our cohort of men with ED and the potential association of PreDM and sexual health within the same cohort. ResultsOf 372 men, +PreDM was found in 86 (23.1%) patients. Men with +PreDM had lower total testosterone (tT), higher triglycerides, and higher total cholesterol values (all P < .03) than those without PreDM. Likewise, +PreDM patients had a higher rate of CCI ≥1 (P = .03) and more frequently had severe ED (P = .013) compared with –PreDM. Age (OR 1.03; P = .01); lower tT (OR 0.81; P = .02); and severe ED (OR 3.37; P = .004) were associated with +PreDM status, after accounting for BMI, CCI, alcohol consumption, and cigarette smoking. Similarly, age (OR 1.02; P = .02) and +PreDM (OR 2.02; P = .02) were associated with severe ED, after accounting for other clinical variables. Clinical ImplicationsIdentifying +PreDM status in ED men is clinically relevant in order to adopt preventive strategies to attempt and reduce risk of developing DM and subsequent cardiovascular diseases. Strengths & LimitationsTo our knowledge, this is the first study evaluating the prevalence of unrecognized PreDM and the association of PreDM and ED severity in a real-life setting. Limitations are the retrospective nature of the cross-sectional study and the lack of haemodynamic parameters for every patient. Conclusions1 in 5 men seeking medical help for new-onset ED showed glucose values suggestive for unrecognized PreDM and +PreDM status was associated with worse hormonal and metabolic profiles, along with a higher risk of severe ED than −PreDM. Boeri L, Capogrosso P, Perderzoli F, et al. Unrecognized prediabetes is highly prevalent in men with erectile dysfunction–results from a cross-sectional study. J Sex Med 2018;15:1117–1124.

328 Ultrasonographic Changes to Cavernosal Tissue in Men with New-Onset Erectile Dysfunction following Penile Plication Surgery

328 Ultrasonographic Changes to Cavernosal Tissue in Men with New-Onset Erectile Dysfunction following Penile Plication Surgery

Statin Use in Men and New Onset of Erectile Dysfunction: A Systematic Review and Meta-Analysis

BackgroundErectile dysfunction has been reported as an adverse effect of statin therapy. MethodsWe performed a meta-analysis of randomized trials and observational studies that compared statin users versus non-statin users and reported data regarding new onset of erectile dysfunction in men with established cardiovascular disease or cardiovascular disease risk factors. We used DerSimonian-Laird and Peto models to construct the summary estimates risk ratio. We used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) to assess the overall quality of evidence for new-onset erectile dysfunction. ResultsThree randomized trials and 3 observational studies were identified, with 69,448 men, of whom 24,661 were statin users. Statin use was not associated with an increased risk of new onset of erectile dysfunction by random effects model or fixed effect model (risk ratio 0.96; 95% confidence interval, 0.84-1.10; P = .58; and odds ratio 0.95; 95% confidence interval, 0.88-1.02; P = .20, respectively). This effect was similar in randomized trials and observational studies (Pinteraction = .86). Randomized trials provided a moderate quality of evidence, and observational studies provided a very low quality of evidence by the GRADE assessment. Random effects meta-regression analyses revealed no difference in treatment effect according to age or diabetes mellitus (P = .83 and P = .74, respectively). ConclusionsAmong men with established cardiovascular disease or cardiovascular disease risk factors, statin use does not seem to be associated with a new onset of erectile dysfunction. Adequately powered and high-quality randomized trials are recommended to confirm these findings.

Prospective Outcome Analysis of the Safety and Efficacy of Partial and Complete Cryoablation in Organ-confined Prostate Cancer

To determine the rate of complications and change in International Prostate Symptom Score and Sexual Health Inventory for Men scores following cryotherapy treatment of low- and intermediate-risk prostate cancer. The secondary end points were the change in prostate-specific antigen post cryotherapy and biopsy-proven recurrence. Enrollment occurred from 2007 to 2015 to assess long-term complications of cryotherapy. A prostate biopsy was performed at 1 year or in the event of biochemical failure. Subjects were staged and graded by standard 12- to 14-core transrectal ultrasound (TRUS) biopsy. A subset of subjects underwent additional 3-dimensional mapping biopsy if the cancer was suspected to be downgraded. Analyses of functional outcomes were stratified into focal and nonfocal treatments. The study consisted of 393 men with low- and intermediate-risk prostate cancer, aged 44-89 years. Patient IPSS scores improved significantly in the nonfocal treatment strata at all time points and after 1 year in the focal strata with a median drop at 1 year of 4 points (P <.001). No significant difference was detected for a change in preprocedural SHIM score in either treatment strata after 2 years (P >.7). Eighty-two patients (20.9%) had a rise in prostate-specific antigen resulting in biochemical failure. Seventy patients had detected recurrence for an overall recurrence rate of 20.4% in 343 patients. A total of 109 patients (27.7%) reported urinary retention and urgency post cryotherapy, with 15.3% requiring catheterization for up to 3 weeks. Thirty-seven patients (9.4%) experienced urethral meatal stricture, and 36 patients (9.2%) reported unresolved new-onset erectile dysfunction. Complication rates, most significantly erectile dysfunction, are decreased in this study compared with those previously reported in the literature for cryotherapy for prostate cancer.

MP79-20 RISK STRATIFICATION FOR ERECTILE DYSFUNCTION AFTER PELVIC FRACTURE URETHRAL INJURIES: A PILOT STUDY

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: External Genitalia Reconstruction and Urotrauma (including transgender surgery) I1 Apr 2017MP79-20 RISK STRATIFICATION FOR ERECTILE DYSFUNCTION AFTER PELVIC FRACTURE URETHRAL INJURIES: A PILOT STUDY Paul H Chung, Cody Gehring, Reza Firoozabadi, and Bryan B Voelzke Paul H ChungPaul H Chung More articles by this author , Cody GehringCody Gehring More articles by this author , Reza FiroozabadiReza Firoozabadi More articles by this author , and Bryan B VoelzkeBryan B Voelzke More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2504AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Pelvic fractures with associated urethral injuries are associated with a high risk of erectile dysfunction (ED) perhaps due to the proximity of the cavernosal nerve to the bulbomembranous junction. We sought to compare the frequency and severity of new onset ED in pelvic fracture patients with and without urethral injuries and to identify potential risk factors for ED in the setting of pelvic injury. METHODS A retrospective analysis was conducted evaluating male patients treated for pelvic fractures with and without urethral injury at a level 1 trauma center between 2005 and 2016. The International Index of Erectile Function (IIEF) questionnaire was administered by telephone to assess post-injury ED. Additional questions regarding pre-injury sexual function, glans vascular symptoms, glans sensitivity, and an updated past medical history were also administered. A diagnosis of new onset ED was defined as the patient having no recollection of ED prior to injury and subsequently having an IIEF score of <22 after injury. Glans vascular symptoms were defined as having a cold glans during an erection. Penile sensitivity was described as either decreased or increased sensitivity of the glans penis. RESULTS Of the 118 patients, 42% (50/118) patients responded to the questionnaire: 21 (42%) with pelvic fracture urethral injuries (PFUI) and 29 (58%) with pelvic fractures alone. We observed a numerical increase in new-onset ED in the PFUI group (n=12, 57%) when compared to the pelvic fracture alone group (n=11, 38%, p=0.29). The mean post-injury IIEF score was higher for the PFUI group (18 ± 7.6) than the pelvic fracture alone group (13 ± 8.7, p=0.05), with the PFUI patients more frequently developing severe ED (IIEF <7) (p<0.05). There were no significant differences in glans vascular symptoms (p=0.33) or penile sensitivity (p=0.17) between the two groups. Age, comorbidities, concomitant injuries, pelvic fracture pattern, and need for pelvic angioembolization were not risk factors for developing ED in either cohort. CONCLUSIONS ED was more severe in patients with PFUI compared to patients with pelvic fractures alone. Based on our results, a larger prospective analysis is warranted to better characterize ED in pelvic fracture patients. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e1080 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Paul H Chung More articles by this author Cody Gehring More articles by this author Reza Firoozabadi More articles by this author Bryan B Voelzke More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...