Organic ED Research Articles

(115) Utility of Thermography as a Screening Tool for Erectile Disorder

Abstract Introduction Ultrasonography remains the gold standard for the evaluation of penile vasculature in men with erectile disorder. Despite its value, ultrasound assessment can be costly for patients, and requires an intracavernosal injection prior to imaging. With estimates of psychogenic ED being up to 40% or more in clinical populations, a less invasive method of quantifying penile vascular response would be beneficial in directing patients for further assessment and treatment. One such method that has potential is thermography as it requires no genital contact, can indirectly measure blood flow through temperature change, and has been validated in self-reported clinical non-clinical populations for the measurement of sexual response. Objective To determine whether thermography could be used to differentiate psychogenic from organic erectile disorder by comparing thermography to penile doppler ultrasound in men being assessed for erectile disorder. Methods 81 patients (m age = 43 years) recruited through a hospital Urology clinic completed penile vascular assessment across two different sessions: 1) thermographic measurement during a 15-minute baseline neutral and 15-minute sexually explicit film; 2) standard penile ultrasound assessment with an ICI of Prostaglandin E1. Demographic and sexual functioning questionnaires were completed, and urologist diagnosis following ultrasound assessment was used to classify patients as having psychogenic or organic ED. Results 45 patients had PSV values consistent with organic ED, while 36 patients were classified into the psychogenic ED group. Men with organic ED were significantly older than those in the psychogenic ED group (p < .05), and more likely to have concurrent health conditions (p < .05). A Repeated Measures ANOVA on temperature change measured through thermal imaging demonstrated that men with psychogenic ED had significantly greater penile temperature (m = 32.45°C, SD = 1.34) during sexual arousal than those with organic ED (m = 31.73°C, SD = 1.34; p <. 05), and also had a significantly (p < .01) stronger correlation between their self-reported and physical sexual response during thermographic assessment (psychogenic ED mean r =.49; organic ED mean r = .27). Furthermore, a hierarchical cluster analysis of thermography measures grouped patients into three distinct categories (high, medium and low temperature change), with significantly more of the psychogenic ED group being classified into the highest temperature cluster (82%). The medium and low temperature clusters were less sensitive at differentiating organic and psychogenic ED. Conclusions Thermography could provide a less costly and less invasive way to screen out patients presenting with ED who have a high degree of temperature change during sexual response. While thermography has been shown to differentiate between self-reported and clinical populations, this is the first evaluation of this instrument as a tool to differentiate within ED diagnostic groups. Although men with psychogenic ED were more likely to be classified in the highest temperature change cluster, thermography was less sensitive at differentiating organic and psychogenic ED in the middle and lower temperature groupings. Further research with larger samples would be beneficial in exploring potential clinical cutoffs for penile temperature change. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Dare Biosciences, Initiator Pharma.

(012) Sexual Dysfunction in Men After Failed Hypospadias Repair

Abstract Introduction Hypospadias is commonly treated in childhood, and future sexual function of such patients is sometimes overlooked. Some published reports reveal excellent sexual function following hypospadias repair at long term, while other authors state high prevalence of sexual dysfunction which depends on original position of urethral meatus. Patients with complications of primary hypospadias repair are one of the most difficult subpopulations to evaluate. This is a unique subset of patients who should be described separately from men who underwent successful hypospadias repair. Objective To describe the spectrum of sexual dysfunction in patients with sequelae of failed hypospadias repair and our experience in its management. Methods We evaluated 112 patients with a history of failed hypospadias repair, defined as presence of voiding symptoms or cosmetic problems remaining despite previous surgery or caused by it. Patients’ median age was 29.5 years (range: 18–62). There were no intersex cases. Only 9.8% (11/112) underwent single attempt at surgical reconstruction, the median number of attempts was 3.5 (range: 1–9). Patients with IIEF-EF score ≤ 25 were considered to have erectile dysfunction; those with IIEF-EF ≤ 16 underwent penile doppler ultrasound, penile electromyography and endocrine assessment. Results 64.2% of patients (72/112) were dissatisfied with penile appearance, 40.2% (45/112) had ED, 71.4% (80/112) had ejaculation disorders. Psychogenic ED was diagnosed in 21 patients with preserved non-coital erections and no evidence of organic ED. Median IIEF-EF in ED patients was 20 (range: 8–25). Asthenic ejaculation, delayed ejaculation and anejaculation were present in 63.4% (71/112), 7.1% (8/112) and 3.5% (4/112) patients, respectively. Premature ejaculation was present in 28.6% (32/112) patients, but its association with hypospadias or previous surgery is unlikely. On univariate analysis only the number of previous attempts at surgical repair was a significant predictor of sexual dysfunction following definitive surgery (p = 0.033). Rate of normal sexual function was 37.5%, 23.5% and 9.1% among patients with history of ≤ 3, 4–6 and ≥ 7 procedures, respectively. Conclusions Failed hypospadias repair may lead to a wide spectrum of sexual dysfunction, involving sexual desire, erection and ejaculation. Repeated surgery leads to increased risk of sexual dysfunction which may be devastating for patient’s quality of life. Disclosure No.

(157) Primary Erectile Dysfunction Caused by Cavernovenous Leakage: Clinical Presentation and New Surgical Treatment in 81 Consecutive Patients with Severe Erectile Dysfunction

Abstract Introduction Introduction. Primary erectile dysfunction (PED) due to cavernovenous leakage (CVL), a disease in which blood entering corpora cavernosa escapes too early because of abnormal venous network, may affect as many as 1 to 2% of men under 30 with failure of erections to develop or maintain. When resistant to PDE5Is, it is a devastating condition leaving men with no possibility of sexual intercourse with penetration, and usually absence of diagnosis and specific treatment. Objective Evaluate symptoms and results of a new method of treatment combining open surgery and embolization simultaneously during the same procedure, in patients with PED and CVL resistant to PDE5Is. Methods 81 consecutive patients with severe PED with CVL diagnosed by pharmacologically-challenge penile duplex sonography (PC-PDS) were operated-on. Leaks were imaged by caverno-computed tomography. Patients with other cause of ED were excluded, all had refused a penile implant, signed an informed consent, had a control PC-PDS three months after surgery, and were clinically evaluated during follow-up. A retrospective analysis was performed on prospectively collected data. Comparisons of variables before and after surgery used a paired t-test. Results Mean age at PED onset reported by patients was 19.0±4.6 years, range 13–30. Mean age at surgery was 34.5±9.2 years, range 18–70. Mean ED duration before surgery was 15.4±10.1 years (range 1–40). All patients had clinical signs of organic ED (no phase of erection improvement in the past six months, erectile dysfunction during masturbation (Erection Hardness Score (EHS)<3 and/or erection instability). CVL could be suspected in all patients based on reported erection instability during masturbation, and in 86.4%, based on variation of EHS according to body position during masturbations. At three-month evaluation, mean pharmacologic EHS had increased from 2.59±.77 before surgery, to 3.45±.63 (p<.0001). The mean pharmacologic EHS increase was 0.83±.92. All CVL hemodynamic parameters at PC-PDS had decreased compared to pre-surgery: mean End Diastolic Velocity (from 9.9±9.22 to 6.77±7.34 cm/s, p<.023), mean leakage speed on Deep Dorsal Vein (from 10.87±12.48 to .69±2.77 cm/s, p<.0001), mean speed on any superficial vein (from 10.96±10.08 to 4.77±6.90 cm/s, p<.0001). Patients unable to perform penetrations despite intracavernous injection of Prostaglandin E1 20 micg plus Papaverine 40 mg (pharmacological EHS<3) decreased from 64.2 to 13.5% (Chi-square test: p<.001). At the end of the 26.0±21.9-month follow-up, IIEF-5 score had increased from 8.9±5.3 to 16.1±5.8 (p<.013), clinical EHS during sexual intercourse from 1.97±.67 to 3.31±.71 (p<.0001), penetration success rate from 18.3±28.2 to 64.2±40.1%, morning EHSfrom 1.11±1.40 to 2.12±1.49 (p<.0002), masturbation EHS from 2.14±.84 to 3.07±.77 (p<.002) before and after surgery, respectively. 38.3% did not take any medication for erection. Conclusions Simultaneous open surgery and embolization is a conservative treatment that should be discussed for patients with PED and CVL. PED can be suspected during consultation. Detection of CVL in all patients under 30 with ED should be evaluated in sexual medicine practice. Disclosure No.

(347) Prediction of Post-operative Sexual Satisfaction after Penile Prosthesis Implantation (With and Without Penile Lengthening Procedures) Using Preoperative Penile Length Measurements

Abstract Introduction `- Penile prosthetic devices are the gold standard treatment of medication-resistant erectile dysfunction, however penile length reduction was reported as one of the main post operative disturbing complaints - Many lengthening procedures during penile prosthesis implantation (PPI) were described to increase postoperative sexual satisfaction. Objective `- To predict post-operative sexual satisfaction after PPI (with or without penile lengthening procedure) using preoperative penile length measurements. Methods `- This study was conducted in our urology department as prospective RCT, in the period between August 2018 till April 2020 - It included 61 male patients with organic ED who are candidates for PPI. - Patients were randomized to 2 groups; group A included 31 patients who underwent suspensory ligament release via penopubic Z-plasty, dorsal phalloplasty, suprapubic lipectomy, +/− ventral phalloplasty (in case of high scrotal insertion); group B included control patients who underwent PPI only via penoscrotal incision. - Measurement of preoperative and postoperative (after 3 months) penile lengths were done, including; the flaccid, visible stretched and functional stretched penile lengths. - Assessment of patients’ sexual satisfaction was done using the Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) score adapted to penile prosthetic implant. - Patients with EDITS scores of 60-80 were considered satisfied, and those with EDITS scores of 80-100 were considered very satisfied. - Receiver operating curve (ROC) analysis was done to detect cutoff value for the preoperative stretched penile lengths (functional & visible) that are predicted to aid the patient to reach a postoperative satisfaction of EDITS ≥90 in each group. Results `- The mean preoperative measurements showed no statistically significant difference between the two groups. - However, the mean postoperative measurements after 3 months demonstrated a statistically significant difference between the two groups. - The mean values of both overall EDITS and the EDITS resting state and malleability scores were higher in group A (91.92 ± 7.22 and 7.38 ± 0.78) Vs. (79.55 ± 15.55 and 5.32 ± 1.12) in group B (p < 0.001) - For EDITS satisfaction level, the percentage of the very satisfied patients [≥ 80] in group A (89.7%) was significantly higher than in group B (64.3%) (p= 0.045) - Also, for the EDITS resting state and malleability satisfaction level, the percentage of the very satisfied patients in group A (55.2%) was significantly higher than in group B (0.0%) (p < 0.001) - ROC curve was done for both groups In group A: - Functional stretched penile length: AUC 0.815 with a cutoff value of 12.75 cm yielding a 81.8% sensitivity and 71.4% specificity (p value = 0.013) - Visible stretched penile length: AUC 0.795 with a cutoff value of 10.75 cm yielding a 81.8% sensitivity and 71.4% specificity (p value =0.020) In group B: - Functional stretched penile length: AUC 0.927 with a cutoff value of 14.50 cm yielding a 77.8% sensitivity and 94.7% specificity (p value < 0.001) - Visible stretched penile length: AUC 0.892 with a cutoff value of 12.50 cm yielding a 66.7% sensitivity and 94.7% specificity (p value <0.001). Conclusions `- Preoperative measurement of functional and visible penile lengths can be of value in predicting post-operative sexual satisfaction after PPI (with or without concurrent penile lengthening procedures). Disclosure No

Primary organic vs. primary psychogenic erectile dysfunction: a cross-sectional study on patient's characteristics and sexual function from a tertiary referral center

ABSTRACT Introduction Erectile dysfunction (ED) is defined according to three different aetiological groups: organic, psychogenic and mixed. As most cases have mixed aetiology, EAU guidelines suggests using the terms "primary organic" or "primary psychogenic". Objectives We aimed to stratify a homogenous cohort of patients seeking medical help for ED for the first time according to the newly suggested classification, and to compare sexual function in the two groups. Methods Complete sociodemographic and clinical data from 2009 consecutive patients were analysed. All patients completed the International Index of Erectile Function (IIEF) at baseline. According to the presence of risk factors for ED (e.g., age≥ 40 yr, obesity, history of hypogonadism, hypertriglyceridemia and/or hypercholesterolemia, hypertension, cardio-vascular, peripheral vascular, neurological, chronic kidney and hepatic disease, diabetes type 1/2, COPD, hyperthyroidism, low D vitamin, use of recreational drugs, thiazides, b-blockers, antipsychotics, SSRIs and depression or anxiety under medical therapy), patients were categorised into primary organic (≥1 risk factor) or primary psychogenic (0 risk factors) ED. Linear regression analysis assessed the association between the number of risk factors and IIEF severity. Lastly, locally scatterplot smoothing (LOESS) method graphically explored the relationship between number of risk factors and IIEF. Results 1836 (91.4%) were identified with primary organic ED whereas 173 (8.6%) with primary psychogenic ED. Median (IQR) age was 52 (42-61) vs. 30 (25-36) yr, respectively (p<0.001). The most frequently reported risk factors were smoking (53%), high blood pressure (36%), BMI > 30 (15%) and total testosterone <3ng/mL (14%). Overall, 1387 patients (9.3%) had 1 risk factor, 480 (23.9%) 2, 384 (19.1%) 3 and 577 (28.72%) ≥4 risk factors. Overall, patients with primary organic ED had lower IIEF-SD (7 [6-9] vs. 7 [5-8]; p=0.0012) and -OF scores (9 [6-10] vs. 8 [5-10]; p=0.02). Conversely, IIEF-EF, -IS and -OS domain scores were similar between the two groups. At linear regression analysis, the increasing number of ED risk factors was associated with worse IIEF-tot score (coef. -0.593 p=0.039), -EF (coef. -0.409; p=0.003), -SD (coef. -0.0.85, p=0.017) and -OF (coef. -0.203, p=0.001). Conclusions One out of ten patients suffer from primary psychogenic ED in the real-life settings. The increasing number of risk factors was linearly associated with lower IIEF scores at presentation.

Sexual dysfunction in patients with late complications of hypospadias surgery.

Most hypospadias cases are successfully treated in childhood. Still, patients with sequelae of failed hypospadias repair and sexual dysfunction may be encountered. We evaluated 112 patients with a history of failed hypospadias repair, defined as the presence of voiding symptoms or cosmetic problems remaining despite previous surgery or caused by it. Patients' median age was 29.5years (range: 18-62). There were no intersex cases. Only 9.8% (11/112) underwent single attempt at surgical reconstruction, the median number of attempts was 3.5 (range: 1-9). Patients with IIEF-EF score ≤25 were considered to have erectile dysfunction; those with IIEF-EF ≤16 underwent penile doppler ultrasound, penile electromyography and endocrine assessment. About 64.2% of patients (72/112) were dissatisfied with penile appearance, 40.2% (45/112) had ED, 71.4% (80/112) had ejaculation disorders. Psychogenic ED was diagnosed in 21 patients with preserved non-coital erections and no evidence of organic ED. Median IIEF-EF in ED patients was 20 (range: 8-25). Asthenic ejaculation, delayed ejaculation and anejaculation were present in 63.4% (71/112), 7.1% (8/112) and 3.5% (4/112) patients respectively. Premature ejaculation was present in 28.6% (32/112) patients, but its association with hypospadias or previous surgery is unlikely.

Erectile Dysfunction: Epidemiology, Physiology, and Etiologies

ED is defined as the consistent inability to achieve or maintain an erection adequate for sexual activity. It is a widely prevalent disease, affecting approximately 20 million men in the United States alone. ED rates increase as men get older; however, ED is not necessarily a normal part of aging. Early-onset ED has been a predictor of underlying cardiovascular diseases, and most clinicians now advocate for a cardiology evaluation in men with new-onset organic ED. The most common etiology of ED is a vascular disease; however, ED can be caused by diabetes, endocrinopathies, medications, chronic illness, and trauma. Psychogenic causes of ED are also common. Physiology of the penile erection is complicated; however, its comprehensive understanding is imperative to enable a proper etiologic diagnosis of ED. Blood supply to the penis originates from the hypogastric arterial system, and nitric oxide is the primary neurotransmitter involved in penile erections. The epidemiology, physiology, and etiologies of erectile dysfunction are discussed in detail in this chapter. This review contains 1 figure, 2 tables, and 50 references. Key Words: causes of erectile dysfunction, epidemiology of erectile dysfunction, erectile dysfunction, nitric oxide, phosphodiesterase-5 inhibitors, physiology of the penile erection, psychogenic erectile dysfunction, sexual dysfunction, cyclic guanosine monophosphate, detumescence.

The Role of Nocturnal Penile Tumescence and Rigidity (NPTR) Monitoring in the Diagnosis of Psychogenic Erectile Dysfunction: A Review.

Nocturnal penile tumescence and rigidity (NPTR) monitoring with RigiScan was considered one of the most reliable methods to differentiate psychogenic erectile dysfunction (pED) from organic ED. However, its reliability has been questioned because of some limitations in the practice. To present contemporary views on the role of NPTR monitoring in the diagnosis of pED. We performed a comprehensive review of English-language literature on NPTR and pED by a PubMed search. Studies were included if the mechanisms of pED and nocturnal erection and the practice of NPTR monitoring in ED were the main research contents. The pED results from not only psychosocial factors but also physiological changes containing central nervous abnormality. NPTR monitoring with RigiScan is still considered a useful method for the diagnosis of pED. A normal NPTR recording in a man with ED complaints probably suggests pED, whereas an abnormal recording may represent organic ED. Radial rigidity of no more than 60% is correlated well with axial rigidity, but, when it is more than 60%, the correlation between them is questioned. The consistency between NPTR and sex-stimulated erection is questionable, and the correlation of NPTR with different patient-reported outcome scoring systems is different. A normal NPTR recording in patients with ED does not necessarily mean pED, especially in patients with spinal cord injury. NPTR recordings can be influenced by depression, smoking, aging, negative dream content, and sleep disorders. NPTR monitoring with the RigiScan is still considered a useful diagnostic tool for pED at the present stage. However, there are some disputes regarding the correlation between penile radial rigidity and axial rigidity and between NPTR and sex-related erection, as well as normative evaluation criteria for ED and the possibility of a false NPTR result, that need to be further studied. Zou Z, Lin H, Zhang Y, etal. The Role of Nocturnal Penile Tumescence and Rigidity (NPTR) Monitoring in the Diagnosis of Psychogenic Erectile Dysfunction: A Review. Sex Med Rev 2019;7:442-454.

313 Improving Diagnostic Capture of Organic ED on Ultrasound: Corporal Heterogeneity Grading to Assess Penile Fibrosis

313 Improving Diagnostic Capture of Organic ED on Ultrasound: Corporal Heterogeneity Grading to Assess Penile Fibrosis

P172 Enjoy yourself, its later than you think!

IntroductionErectile Dysfunction (ED) affects 10% of men and those affected may present at Genitourinary Medicine clinics. It may indicate significant underlying pathology and is often the first presenting symptom of...

AB017. Basic research progress in microenergy medicine

In the last decade, the convergence of life sciences, physical sciences, and engineering has brought a host of opportunities and innovations for biomedical informatics and health care in microenergy medicine, and it is called the third revolution in the field of life science research. Low-energy shock wave therapy (LESWT), a form of physical therapy in energy medicine, was shown to markedly improve erectile function in patients with organic ED, as well as in diabetic rats. In addition, LESWT has been demonstrated to facilitate elongation of myelinated axons, with consequent neurologic functional recovery in a rat model. Low-intensity pulsed ultrasound (LIPUS) is a form of ultrasound that delivered at a much lower intensity than traditional ultrasound energy and output in the mode of pulse wave. LIPUS have been demonstrated to have a rage of biological effects on tissues, including promoting bone-fracture healing, accelerating soft-tissue regeneration, inhibiting inflammatory responses and so on. Recent studies showed that biological effects of LIPUS in healing morbid body tissues may be mainly associated with the upregulation of cell proliferation and promoting multilineage differentiation of mesenchyme stem/progenitor cell lines. Therapeutic magnetic field, a good paradigm of convergence medicine, has been demonstrated to have beneficial results in benign prostatic hyperplasia (BPH), human breast carcinoma, peripheral nerve regeneration, hand osteoarthritis, osteonecrosis, and nucleic acid delivery. Magnetic field has been proven to be a safe, non-invasive method for numerous cell and tissue modifications, especially in musculoskeletal system.

MP47-10 THE COMPARISON OF ERECTILE FUNCTION BETWEEN RADICAL NEPHRECTOMY GROUP AND PARTIAL NEPHRECTOMY GROUP.

vasoactive agent. The primary aim of the study was to construct agespecific CDDU parameters for patients without organic erectile dysfunction. METHODS: A retrospective review was conducted to identify patients without organic ED who underwent in-office testing with intracavernous pharmacologic erection augmented by visual sexual stimulation and CDDU over a 5 year period. Patients were further characterized by demographic and Doppler data. Specifically, CDDU characteristics including pre and post-visual stimulation peak systolic velocity (PSV) and resistive index (RI) were identified. Patients with post-visual stimulation PSV > 35cm/s and RI > 0.9 were included in the analysis. Pearson correlation test was used to evaluate the association between ordinal age groups with PSV and RI measurements. RESULTS: 259 patients with a mean age 53.7 and a mean BMI of 27.2 were found to have normal Doppler parameters (PSV>35cm/s, RI>.90). For the entire cohort, average post-visual stimulation PSV was 59.8 (35.0-115.5) and average RI was 0.99 (.9-1.0). A majority of patients had limited medical co-morbidities, with only 29%, 7%, and 10% reporting hypertension, Diabetes, and heart disease, respectively. Priapism, as defined by needing an injectable reversible agent, occurred in 93% of patients. Doppler parameters were then analyzed across sequential decades and when age was categorized to 70, a negative correlation coefficient was obtained for pre-visual stimulation PSV (-0.09, P1⁄40.164), post-visual stimulation PSV (-0.23, P1⁄40.005) and RI (-0.005, P1⁄4.937). Pre-visual stimulation, post-visual stimulation and RI were also stratified using age as continuous variable and with a cutoff of age 1⁄4 60 (Table 1). CONCLUSIONS: No patients were diagnosed with arterial insufficiency or cavernous venous occlusive disease. There appears to be an age-related decline in post-visual stimulation PSV. Characterization of Doppler parameters in patients without organic ED can be used to construct cutoffs to further define age-specific normalcy.

Increased risk of organic erectile dysfunction in patients with chronic fatigue syndrome: a nationwide population-based cohort study.

Chronic fatigue syndrome (CFS) is a complex disorder characterized by profound and persistent fatigue and several comorbidities. CFS was previously reported to be associated with female sexual dysfunction. We propose that CFS might also be associated with organic erectile dysfunction (organic ED). We conducted a retrospective cohort study by using data from the National Health Insurance (NHI) Research Database. We identified 2156 male patients who were newly diagnosed with CFS between January 1, 2003 and December 31, 2006. After excluding those younger than 20years and prevalent cases, 1976 patients were subjected to analysis, and 7904 people served as healthy controls. All study subjects were followed up from the index date to the date of organic ED diagnosis, withdrawal from the NHI program, or the end of 2011. Compared with the non-CFS cohort, the incidence density rate of organic ED was 1.88-fold higher than that in the CFS cohort (3.23 vs. 1.73 per 1000 person-years) with an adjusted hazard ratio (HR) of 1.88 (95% CI=1.26-2.81) when adjusting for sex and comorbidities. The combined impacts of patients with CFS and cardiovascular disease (CVD), diabetes mellitus (DM), chronic kidney disease (CKD), depression, and anxiety showed a significant by joint association with organic ED risk compared with patients with no CFS and no counterpart comorbidity. The greatest magnitude of adjusted HR of ED for CFS was observed in individuals without any comorbidity (3.87, 1.95-7.66). The incidence of organic ED is higher among males aged 40years and over for both CFS and non-CFS cohorts. As the number of comorbidity increases, the incidence of organic ED increases in males without CFS. Higher incidence of organic ED was observed in males with CVD, DM, CKD, depression, or anxiety for both CFS and non-CFS cohorts.

AB163. Which the specific pathophysiologies is higher in simplified international index of erectile function (IIEF-5) among ED patients?

ObjectivesTo compare the IIEF-5 score among ED patients with specific pathophysiologies.MethodsWe studied the IIEF-5 score of 3,327 ED patients (median age 39 years) whose primary pathophysiological causes were established by comprehensive diagnostic procedures in the urology/andrology clinics of five training hospitals in China.ResultsOne hundred and seventy-six patients were excluded, other patients (n=3,151) with duration of ED between 0.5 year and 20 years were enrolled. The causes of ED was found be psychogenic (59.2%), vasculogenic (21.3%), neurogenic (4.1%), anatomical/structural (2.8%), hormonal (7.1%) or drug-induced (5.5%). A significant difference was detected in the median IIEF-5 score between the subjects with psychogenic and organic ED [15 (IQR: 13, 17) vs. 12 (IQR: 9.5, 14.5), P<0.001]. There was no significant difference among the organic groups (P=0.073), and no significant difference was found between arteriogenic and venogenic cause [13 (IQR: 10.5, 15.5) vs. 13 (IQR: 11, 15), P=0.912 (adjusted α =0.017)].ConclusionsAlthough the IIEF-5 score of men with psychological ED is greater than those with organic causes, there is no difference among patients with different organic pathophysiologies. The IIEF-5 is suitable to be a screening tool; however, our data indicate that IIEF-5 is not a definitive diagnostic tool to discriminate the pathophysiological causes of ED.

MP48-16 EMPIRICAL VS. RISK-BASED APPROACH TO INTRACAVERNOSAL INJECTION THERAPY: A PROSPECTIVE STUDY

You have accessJournal of UrologySexual Function/Dysfunction/Andrology: Medical and Non-surgical1 Apr 2014MP48-16 EMPIRICAL VS. RISK-BASED APPROACH TO INTRACAVERNOSAL INJECTION THERAPY: A PROSPECTIVE STUDY Robert Segal, Brian Le, Kristen Burns, Arthur L. Burnett, and Trinity Bivalacqua Robert SegalRobert Segal More articles by this author , Brian LeBrian Le More articles by this author , Kristen BurnsKristen Burns More articles by this author , Arthur L. BurnettArthur L. Burnett More articles by this author , and Trinity BivalacquaTrinity Bivalacqua More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.1490AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail Introduction and Objectives Intracavernosal injection (ICI) therapy is widely used for ED. Employing it in practice is largely empirical and has not been validated with evidence-based approaches. This study compares two strategies for ICI to determine whether a risk-based approach is more efficacious, increases satisfaction and/or results in fewer treatment complications. Methods After obtaining IRB approval, a prospective database of patients enrolled in the ICI program at the Johns Hopkins Hospital from May 2012-present was amassed. Demographic information, treatment outcomes and subjective patient evaluations of sexual function (IIEF, QEQ, SQoL and EDITS questionnaires) were obtained at baseline, 3 and 6 months. Two approaches were compared. Group 1 consisted of empiric ICI treatment. Patients were treated with Prostaglandin E1 10mcg, irrespective of ED etiology or severity, and only if poor response noted at test injection, then initiated on bimix or trimix. Group 2 was a risk-based approach, where using an algorithm that factored in: organic vs. neurogenic ED, number of ED risk factors, prostatectomy, nerve-sparing status, time from surgery and radiation status, patients were treated with either bimix, low- or high-dose trimix. Dose titration was permitted in both groups. Statistical analysis was carried out using t-test and chi-squared analysis. Results 156 patients were enrolled (55 in Group 1, 101 in Group 2) with 3 and 6 month f/u at 57% and 35% respectively, and similar between groups. Baseline patient characteristics and sexual function questionnaire responses were similar between groups 1 and 2, (mean age 62 vs. 61.3 p=0.73, IIEF-EF 8.25 vs. 7.30 p=0.20, and SQoL 37.8 vs. 39.8 p=0.27), though Group 1 reported higher quality erections at baseline (QEQ 14.59 vs. 7.36 p=0.02) and had a lower proportion of post-prostatectomy patients 56% vs. 72% (p=0.02). In both groups, quality of erections (QEQ) improved with treatment (mean 10.98 vs. 60.24, p<0.05), SQoL improved (38.77 vs. 50.60, p<0.05), and IIEF-EF improved (7.78 vs. 18.85, p<0.05). However, between groups at 3 and 6 months, there were no statistically significant differences in responses for IIEF, QEQ, SQoL or EDITS, and no difference in failure or medication switch rates. There were no significant differences in complication rates, though at 3 months group 2 reported a higher incidence of priapism and pain (23% vs. 7.4% p=0.08). Conclusions Both approaches resulted in significant improvements across multiple domains of sexual function. Complications rates, satisfaction and efficacy overall were similar between both approaches. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e533 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Robert Segal More articles by this author Brian Le More articles by this author Kristen Burns More articles by this author Arthur L. Burnett More articles by this author Trinity Bivalacqua More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Abnormal endothelial function in ED patients with normal nocturnal penile tumescence and rigidity: is it the role of psychogenic factors?

Underlying endothelial dysfunction (EnD) may present in the early stage of ED or psychogenic ED. We retrospectively evaluated 191 ED patients with effective nocturnal penile tumescence and rigidity (NPTR) recording, including detailed medical and psychosexual history, International Index of Erectile Function-5 and vascular parameter. All patients were allocated into psychogenic and organic groups according to the NPTR test. Brachial artery flow-mediated dilation (FMD) was used to diagnose EnD, and ED patients were classified into two groups: non-EnD (FMD10) and EnD (FMD<10). General and vascular parameters were compared between psychogenic and organic groups, and non-EnD and EnD groups with ED were compared in terms of NPTR parameters. In all, 48.7% and 51.3% patients were diagnosed as psychogenic and organic ED, respectively. 73.1% of the psychogenic patients had EnD and 39.8% organic patients had normal endothelial function. In all parameters, only the FMD value showed significant difference between psychogenic and organic ED groups (8.26±2.57 vs 9.16±2.76, P=0.020). No statistical difference was founded in NPTR parameters between non-EnD and EnD groups (P>0.05). In conclusion, NPTR cannot effectively identify the underlying vasculogenic ED from psychogenic ED. Psychogenic causes may cause or aggravate EnD in these ED patients with normal NPTR.

INCREASED ANDROGEN RECEPTOR DENSITY IN PATIENTS WITH POST PROSTATECTOMY ERECTILE DYSFUNCTION VERSUS ORGANIC ED

You have accessJournal of Urology1 Apr 2008INCREASED ANDROGEN RECEPTOR DENSITY IN PATIENTS WITH POST PROSTATECTOMY ERECTILE DYSFUNCTION VERSUS ORGANIC ED Wesley Ekeruo, Osama Mohamed, Lianqing Yang, Steven King, Larry I Lipshultz, and Mohit Khera Wesley EkeruoWesley Ekeruo More articles by this author , Osama MohamedOsama Mohamed More articles by this author , Lianqing YangLianqing Yang More articles by this author , Steven KingSteven King More articles by this author , Larry I LipshultzLarry I Lipshultz More articles by this author , and Mohit KheraMohit Khera More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(08)60981-7AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "INCREASED ANDROGEN RECEPTOR DENSITY IN PATIENTS WITH POST PROSTATECTOMY ERECTILE DYSFUNCTION VERSUS ORGANIC ED." The Journal of Urology, 179(4S), p. 335 © 2008 by American Urological AssociationFiguresReferencesRelatedDetails Volume 179Issue 4SApril 2008Page: 335 Advertisement Copyright & Permissions© 2008 by American Urological AssociationMetricsAuthor Information Wesley Ekeruo More articles by this author Osama Mohamed More articles by this author Lianqing Yang More articles by this author Steven King More articles by this author Larry I Lipshultz More articles by this author Mohit Khera More articles by this author Expand All Advertisement PDF downloadLoading ...

Review: Risk factor assessment of erectile dysfunction

Erectile dysfunction is a distressing condition that may result from organic or psychological causes. Organic ED results from neurological, hormonal or vascular pathologies, and may also have drug-related causes. Cardiovascular disease and diabetes are the most common vascular risk factors. Due to a reluctance of patients to mention ED, healthcare professionals should discuss sexual dysfunction with patients who have increased risk of ED. This article considers underlying aetiologies and outlines treatment options.

Melanotan II has erectogenic properties in organic ED

Melanotan II has erectogenic properties in organic ED