Penile Duplex Doppler Ultrasonography Research Articles

Safety and potential effectiveness of platelet-rich plasma and extracorporeal shock wave therapy in the treatment of erectile dysfunction after nerve-sparing radical prostatectomy in patients: pilot study

Background. Prostate cancer is the most common type of cancer in men. Radical prostatectomy (RPE), including nerve-sparing, often leads to erectile dysfunction and a significant decrease in the quality of life. The available treatments are limited in effectiveness and/or are not suitable for patients.Aim. The aim of the study was to evaluate the safety and effectiveness of platelet-rich plasma (PRP) and extracorporeal shock wave therapy (ESWT) in the treatment of erectile dysfunction in patients after nerve-sparing RPE.Materials and methods. 14 men were included in the study after unilateral or bilateral nerve-sparing RPE more than 3 months ago. The total prostate-specific antigen in all patients was less than 0.2 ng/ml 3 months or more after surgery. Age – 57.8 ± 6.2 (49–72) years, duration of erectile dysfunction – 7.6 ± 3.9 (3–16) months. Two visits per week were out for 6 weeks: in visit 1, the ESWT (Dornier Aries) was performed on penis and injections of PRP into the penis, the muscles involved in the erection were activated at the end of the session by ESWT, in visit 2, ESWT on penis. The examinations were performed on the 0 and 60 days of the study: International Index of Erectile Function (IIEF-5), Sexual Encounter Profile (SEP), Erection Hardness Score (EHS), Global Assessment Questionnaire (GAQ), International Prostate Symptom Score (IPSS), Quality of Life (QoL), total blood testosterone, to penile duplex Doppler ultrasonography (PDDU) with prostaglandin E1 analog. Inclusion criteria were absence of metastases to distant organs and lymph nodes; stage no more than T3b; IIEF-5 less than 21 points after RPE; PSV less than 30 cm/s and/or RI less than 0.8 according to the PDDU after RPE; the presence of erections before RPE.Results. Treatment was tolerated satisfactorily for all patients. Significant improvement of erectile function was noted according to IIEF-5 (p <0.05), SEP (p = 0.002), EHS (p = 0.002). According to GAQ, 11 patients (78.5 %) noted a positive effect of treatment. PSV and RI in both cavernous arteries increased significantly (p <0.05) according PDDU. All patients noted a dysuria decrease based on IPSS (p = 0.007) and QoL (p = 0.58). The concentration of total testosterone in the blood without significant dynamics (p = 0.192).Conclusion. There are positive effects in relation to a significant improvement in erectile function in all patients according to validated questionnaires and PDDU. The proposed treatment is a promising method of restoring patient data. The study continues on a larger sample of patients.

(493) Utilization of Intracavernosal Injection and Penile Ultrasound in the Evaluation of Erectile Dysfunction and Peyronie’s Disease

Abstract Introduction Intracavernosal injections (ICI) and penile duplex Doppler ultrasound (DDUS) play a diagnostic role for patients with erectile dysfunction (ED) and Peyronie’s disease (PD). They can help to identify vascular and anatomical changes that may guide medical and surgical management; however, contemporary utilization rates of ICI and penile DDUS have not recently been described. Here we use a multicenter database to determine utilization of ICI and penile DDUS in patients with ED and PD. Objective To evaluate the rates of ICI and penile DDUS in patients with ED and PD using a global database. Methods TriNetX is a research network of real-time data from 58 Healthcare Organizations globally. Using the International Classification of Diseases Tenth Edition (ICD-10) codes, we queried the network for adult men with ED (N52) being medically treated with phosphodiesterase (PDE)-5 inhibitors from 2002 - 2022. This included sildenafil, tadalafil, vardenafil, and avanafil. Current Procedural Technology (CPT) codes were utilized to identify patients who received penile DDUS (93980, 93981) and penile prosthesis (54400, 54401, 54405). ICD-10 codes were utilized to query the network for those with PD (N48.6) from 2002 – 2022. We then used CPT codes to search within this cohort for those who had ICI (54235) excluding patients that also had penile DDUS (93980, 93981). We separately queried for patients that had penile DDUS (93980, 93981). Finally, we queried for patient who received either evaluation method and had injection therapy (54200), penile plication (54360), or plaque excision +/− grafting (PEG) (54110, 54111, 54112). The analysis was run on June 30, 2022. Results The cohort with ED on a PDE-5 inhibitor in the TriNetX database included 613,323 patients. The cohort had a mean age of 63 +/− 13 years and racial demographics of 18% black and 70% white. 8,540 patients (1.4%) had a penile DDUS and 868 (0.1%) went on to penile prosthesis (Figure 1A). A second study cohort included 46,743 patients with Peyronie’s disease with a mean age of 62 +/− 13 years and racial demographics of 8% black and 73% white. ICI was performed in 2,960 (6.3%) PD patients: 568 (1.2%) then underwent injection therapy, 1,128 (2.4%) penile plication, and 142 (0.3%) PEG (Figure 1B). Penile DDUS was performed in 4,972 (10.7%) patients with PD: 955 (2.0%) then underwent injection treatment, 474 (1.0%) penile plication, and 255 (0.5%) PEG (Figure 1B). Conclusions For ED, penile DDUS is used in a low percentage of evaluations. For PD, penile DDUS is used more commonly than ICI only. After evaluation with penile DDUS, the most common therapy is injection. After an evaluation with ICI only, the most common therapy is penile plication. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific and Coloplast.

(202) Exploring Erectile Hemodynamics in Men Complaining of Hard-Flaccid Syndrome (HFS)

Abstract Introduction There is increasing awareness of a condition, vernacularly termed HFS, in which men complain of subjective and palpable abnormalities in the flaccid penis (hardness, heaviness) often associated with erectile dysfunction (ED). Objective We attempted to define erectile hemodynamic profiles in this population. Methods The study population consisted of (i) males ≥18 years of age (ii) who presented with self-diagnosed HFS (iii) who underwent comprehensive history and examination (including genital and lower extremity neurological) and (iv) penile duplex Doppler ultrasound (PDDU). PDDU was performed using redosing of vasodilators. PSV ≥35 cm/s and EDV ≤3 were considered normal. Patients with Peyronie’s disease or a history of intracavernosal injection therapy were excluded. Results 88 men were analyzed. Mean age was 28 ± 12 years. Median number of vascular comorbidities was zero (0, 1). 66 (75%) had a history of depression or anxiety, 60 of whom had used pharmacotherapy for such at some time and 40 were actively using anxiolytics or anti-depressants at time of evaluation. No patient had a history of neurological conditions and neurological exam was normal in all. Mean duration of symptoms was 14 ± 20 months. Median number of prior physician consultations was 1 (1,4). All complained of impaired erectile function, 50% being incapable of having penetrative sexual relations. 91% had or were using PDE5 inhibitors. On examination all patients had a hypertonic flaccid penis with excellent stretch on traction. At PDDU, median number of penile injections was 2 (1, 3). 50% of men required phenylephrine reversal. All patients had normal PSV with 2/88 having abnormal EDV values, both of whom required reversal. Mean PSV was 45 ± 35 cm/s, mean EDV was 2 ± 11 cm/s. No patient had elevated echogenicity on B-mode scanning. Conclusions In this analysis, all men presenting with self-reported HFS had normal hemodynamics and an absence of fibrosis, suggesting the absence of vascular or gross cavernosal smooth muscle structural changes. Disclosure No

(160) An Analysis of the Mis-Diagnosis of Peyronie’s Disease (PD) In Men Referred for the Assessment of Penile Deformity

Abstract Introduction PD is diagnosed in the presence of penile deformity combined with a tunical plaque. Clinical experience shows us that some men who believe they have PD actually have congenital penile curvature (CPC), whilst others, especially those with a history of penile trauma, have anxiety about having PD but, in fact, do not. Objective This analysis aimed to define the mis-diagnosis rate of men referred for PD evaluation. Methods Study population consisted of men who (i) presented to a sexual medicine clinic for the evaluation of penile deformity (ii) and/or the presence of a tunical nodule (iii) underwent comprehensive penile examination by a sexual medicine physician with extensive experience in PD and (iv) underwent penile deformity assessment at the time of penile duplex Doppler ultrasound (PDDU). Demographic and comorbidity data were recorded. Multivariable analysis (MVA) was conducted to define predictors of the absence of PD. Results 1942 patients met the inclusion criteria. 79% were MD referred (MDR), the remainder were self-referred (SR). Mean age of the entire cohort was 58±28 years (MDR 64±22y, SR 41±11y, p<0.01). Comorbidities: hypertension 24%, diabetes 11%, dyslipidemia 27%, chronic pelvic pain syndrome (CPPS) 6%, history of radical pelvic surgery (RPS) 24%, history of penile trauma 8%. Overall 14% of patients had no PD plaque identified on examination (MDR 12%, SR 21%). For MDR without PD, majority had CPC (9%), 3% had no deformity, while for SR only 6% had CPC, the remaining 15% had no deformity at PDDU. Results of MVA is presented in the Table. Conclusions Men referred to a tertiary referral center for the evaluation of PD commonly have no PD. Predictors of no PD include: diagnosis of CPPS, history of penile trauma, young age and absence of RPS. Disclosure No

A Review on Penile Doppler and Ultrasonography for Erectile Dysfunction.

Herein, we seek to review the clinical applications of penile duplex Doppler ultrasound (PDDU) in sexual medicine practices and discuss the indications, protocols, advantages, and limitations of this diagnostic modality. Other more outdated diagnostic tests, such as cavernosometry, are briefly discussed to provide the reader a background of understanding on the evolution of diagnostic testing within the realm of sexual medicine. PDDU has become a key diagnostic tool in the clinical evaluation of both erectile dysfunction (ED) and Peyronie's disease (PD). With the assistance of intracavernosal injections such as alprostadil, clinicians can utilize ultrasound technology to produce a detailed description of the hemodynamics of the patient's erection cycle. This information plays a pivotal role in establishing an accurate diagnosis and creating a sensible management plan for the patient. This review aims to provide a better understanding regarding the technique and interpretation of PDDU as it pertains to male sexual function.

MP21-20 EXPLORING ERECTILE HEMODYNAMICS IN MEN COMPLAINING OF HARD-FLACCID SYNDROME (HFS)

You have accessJournal of UrologyCME1 May 2022MP21-20 EXPLORING ERECTILE HEMODYNAMICS IN MEN COMPLAINING OF HARD-FLACCID SYNDROME (HFS) John Sullivan, Carolyn Salter, Jose Flores, Pat Guhring, Marilyn Parker, and John Mulhall John SullivanJohn Sullivan More articles by this author , Carolyn SalterCarolyn Salter More articles by this author , Jose FloresJose Flores More articles by this author , Pat GuhringPat Guhring More articles by this author , Marilyn ParkerMarilyn Parker More articles by this author , and John MulhallJohn Mulhall More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002554.20AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: There is increasing awareness of a condition, vernacularly termed HFS, in which men complain of subjective and palpable abnormalities in the flaccid penis (hardness, heaviness) often associated with erectile dysfunction (ED). We attempted to define erectile hemodynamic profiles in this population. METHODS: The study population consisted of (i) males ≥18 years of age (ii) who presented with self-diagnosed HFS (iii) who underwent comprehensive history and examination (including genital and lower extremity neurological) and (iv) penile duplex Doppler ultrasound (PDDU). PDDU was performed using redosing of vasodilators. PSV ≥35 cm/s and EDV ≤3 were considered normal. Patients with Peyronie’s disease or a history of intracavernosal injection therapy were excluded. RESULTS: 88 men were analyzed. Mean age was 28±12 years. Median number of vascular comorbidities was zero (0, 1). 66 (75%) had a history of depression or anxiety, 60 of whom had used pharmacotherapy for such at some time and 40 were actively using anxiolytics or anti-depressants at time of evaluation. No patient had a history of neurological conditions and neurological exam was normal in all. Mean duration of symptoms was 14 ± 20 months. Median number of prior physician consultations was 1 (1,4). All complained of impaired erectile function, 50% being incapable of having penetrative sexual relations. 91% had or were using PDE5 inhibitors. On examination all patients had a hypertonic flaccid penis with excellent stretch on traction. At PDDU, median number of penile injections was 2 (1, 3). 50% of men required phenylephrine reversal. All patients had normal PSV with 2/88 having abnormal EDV values, both of whom required reversal. Mean PSV was 45±35 cm/s, mean EDV was 2±11 cm/s. No patient had elevated echogenicity on B-mode scanning. CONCLUSIONS: In this analysis, all men presenting with self-reported HFS had normal hemodynamics and an absence of fibrosis, suggesting the absence of vascular or gross cavernosal smooth muscle structural changes. Source of Funding: none © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e334 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information John Sullivan More articles by this author Carolyn Salter More articles by this author Jose Flores More articles by this author Pat Guhring More articles by this author Marilyn Parker More articles by this author John Mulhall More articles by this author Expand All Advertisement PDF DownloadLoading ...

An analysis of the mis-diagnosis of Peyronie's Disease (PD) in men referred for the assessment of penile deformity

ABSTRACT Introduction PD is diagnosed in the presence of penile deformity combined with a tunical plaque. Clinical experience shows us that some men who believe they have PD actually have congenital penile curvature (CPC), whilst others, especially those with a history of penile trauma, have anxiety about having PD but, in fact, do not. This analysis aimed to define the mis-diagnosis rate of men referred for PD evaluation. Methods Study population consisted of men who (i) presented to a sexual medicine clinic for the evaluation of penile deformity (ii) and/or the presence of a tunical nodule (iii) underwent comprehensive penile examination by a sexual medicine physician with extensive experience in PD and (iv) underwent penile deformity assessment at the time of penile duplex Doppler ultrasound (PDDU). Demographic and comorbidity data were recorded. Multivariable analysis (MVA) was conducted to define predictors of the absence of PD. Results 1942 patients met the inclusion criteria. 79% were MD referred (MDR), the remainder were self-referred (SR). Mean age of the entire cohort was 58±28 years (MDR 64±22y, SR 41±11y, p<0.01). Comorbidities: hypertension 24%, diabetes 11%, dyslipidemia 27%, chronic pelvic pain syndrome (CPPS) 6%, history of radical pelvic surgery (RPS) 24%, history of penile trauma 8%. Overall 14% of patients had no PD plaque identified on examination (MDR 12%, SR 21%). For MDR without PD, majority had CPC (9%), 3% had no deformity, while for SR only 6% had CPC, the remaining 15% had no deformity at PDDU. Results of MVA is presented in the Table. Conclusion Men referred to a tertiary referral center for the evaluation of PD commonly have no PD. Predictors of no PD include: diagnosis of CPPS, history of penile trauma, young age and absence of RPS. Disclosure Work supported by industry: no.

Does Treating a Penile Plaque with Collagenase Clostridium Histolyticum Lead to Changes in Vascular Characteristics?

ABSTRACT Introduction Peyronie's Disease (PD) is a localized disease of the Tunica albuginea (TA) characterized by the formation of fibrotic plaque. Patients with PD present with erectile dysfunction (ED) up to 32% of the time. We have presented in previous studies that the most common etiology of ED in this population is vascular leak characterized by elevated end-diastolic velocity (EDV) on penile duplex doppler ultrasound (PDDU). It is postulated that the change in the architecture of the TA could be the cause of this venous leak; however, this is not definitive. XIAFLEX, which is a collagenase clostridium histolyticum, has been used in clinical practice since 2013 to dissolve the abnormal deposition of collagen type I and III, which is the predominant type in the fibrotic plaque. Objective In this study, we explore if there is a change in mean EDV and rate of vascular leak measured on PDDU before and after receiving four cycles of XIAFLEX in patients treated for Peyronie's disease. Methods All patients presenting to our institution with chief complaints suggestive of PD undergo PDDU as part of the initial evaluation. Patients who are eligible and choose to get Xiaflex underwent four cycles of treatment, each consisting of two injections 24-72 hours apart. They then undergo another PDDU 8 weeks after completing the last cycle to assess response to treatment. Peak systolic velocity, EDV, resistive index, curve degree, and direction are usually recorded during the test at 0, 5, 10, 15, and 20 min after injection of a vasoactive agent. The lowest value recorded of EDV at times 10, 15 or 20 min at the time of maximal tumescence/rigidity was chosen for the analysis. Results We identified 223 patients with PD who underwent XIAFLEX treatment with 148 completing all 4 cycles at our center between 2016 and 2020. All patients had complete data available for analysis. 87% of patients showing improvement of equal to or more than 15 degrees after four cycles of treatment. The mean EDV at the initial PDDU was 26.7, while the mean EDV at the follow-up study was 13.9 (image 1). The rate of the non-vascular PDDU findings increased after XIAFLEX treatment with initial study containing 38% as compared to 48% on follow up (p-value: 0.044). Conclusions The mean EDV and the rate of the venous leak seem to decrease with the treatment of XIALFEX for Peyronies disease. Whether this is related to change in the architecture of the plaque or improved erectile function in general due to psychological and various factors in the patient who experience improvement in the curve is to be further explored. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Endo Pharmaceuticals

The Value of the International Index of Erectile Function (IIEF) in Characterizing the Erectile Function in Patients with Peyronie's Disease

ABSTRACT Introduction Peyronie's Disease (PD) is characterized by physical deformity in the penis that often has a negative impact on the sexual relationship of the patient and his partner. The International Index of Erectile Function (IIEF) is a standardized patient questionnaire used to measure various aspects of erectile performance and the severity of erectile dysfunction. IIEF accuracy in patients with Peyronie's disease has been criticized as the questions that compromise this tool inquire about sexual activity and intercourse in the patient over the past 30 days, not considering the fact that those patients are able to achieve adequate erection for intercourse but do not engage either due to physical difficulty due to curvature or psychological stress, hence misrepresenting the degree of erectile dysfunction. Objective In this study, we correlate the IIEF score domain with the presence of vascular abnormalities on penile duplex doppler ultrasound (PDDU) during the evaluation of patients for PD. Methods We evaluate all patients presenting with symptoms suggestive of PD with a PDDU for better counseling on different treatment options. The IIEF questionnaire is filled at the beginning of each study. Arterial insufficiency is characterized by peak systolic velocity (PSV) less than 30 ml/sec, while venous leak is characterized by end-diastolic velocity (EDV) more than 5 ml/sec. Those measurements are obtained at 10, 15 and 20 min after injecting intracevrnosal vasoactive agent, while recording the tumescence and rigidity at each time point. In addition, we correlate the severity of IIEF score with the prevalence of vascular abnormalities detected in the PDDU study. Results 540 consecutive patients between January 2016 and December 2020 were included in this study. The mean age of the cohort was 55.1 years. The average curvature was 53.3 degrees, with mean tumescence and rigidity achieved 90% and 70.6%, respectively. Graph 1 shows the distribution of the different vascular abnormalities detected on the PDDU in each category of IIEF abnormality. There is a clear decreasing trend of finding non-vascular abnormalities as the IIEF value decrease from None to Severe (Figure 1). Additionally, there is concomitant rise in the amount of arterial insufficiency and venous leak (counting venous leak and mixed etiology) as the severity measured on IIED questionnaire increases. Conclusions While IIEF questionnaire has been criticized in patients with PD as being an inaccurate assessment of erectile function, it seems to still be of a value and roughly correlates with PDDU findings. After analyzing data from our cohort, IIEF has the potential assist in treatment decision making as a screening tool for need of additional tests with higher specificity. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Endo Pharma

Acute Ischemic Priapism: An AUA/SMSNA Guideline.

Priapism is a persistent penile erection that continues hours beyond, or is unrelated to, sexual stimulation and results in a prolonged and uncontrolled erection. Given its time-dependent and progressive nature, priapism is a situation that both urologists and emergency medicine practitioners must be familiar with and comfortable managing. Acute ischemic priapism, characterized by little or no cavernous blood flow and abnormal cavernous blood gases (ie, hypoxic, hypercarbic, acidotic) represents a medical emergency and may lead to cavernosal fibrosis and subsequent erectile dysfunction. A comprehensive search of the literature was performed by Emergency Care Research Institute for articles published between January 1, 1960 and May 1, 2020. Searches identified 2948 potentially relevant articles, and 2516 of these were excluded at the title or abstract level for not meeting inclusion criteria for any key question. Full texts for the remaining 432 articles were reviewed, and ultimately 137 unique articles were included in the report. This Guideline was developed to inform clinicians on the proper diagnosis and surgical and non-surgical treatment of patients with acute ischemic priapism. This Guideline addresses the role of imaging, adjunctive laboratory testing, early involvement of urologists when presenting to the emergency room, discussion of conservative therapies, enhanced data for patient counseling on risks of erectile dysfunction and surgical complications, specific recommendations on intracavernosal phenylephrine with or without irrigation, the inclusion of novel surgical techniques (eg, tunneling), and early penile prosthesis placement. All patients with priapism should be evaluated emergently to identify the sub-type of priapism (acute ischemic versus non-ischemic) and those with an acute ischemic event should be provided early intervention. Treatment of the acute ischemic patient must be based on patient objectives, available resources, and clinician experience. As such, a single pathway for managing the condition is oversimplified and no longer appropriate. Using a diversified approach, some men may be treated with intracavernosal injections of phenylephrine alone, others with aspiration/irrigation or distal shunting, and some may undergo non-emergent placement of a penile prosthesis.

096 Recent Institutional Experience with Penile Duplex Doppler Ultrasound in Patients with Erectile Dysfunction

096 Recent Institutional Experience with Penile Duplex Doppler Ultrasound in Patients with Erectile Dysfunction

Evaluation of the sensitivity of different doses of vasoactive drugs in diagnosing erectile dysfunction in impotent patients: a prospective case-control study.

IntroductionErectile dysfunction (ED) is one of the most common sexual disorders worldwide affecting about 30 million men in the United States, and an estimated 100 million men worldwide. Penile duplex doppler ultrasound (PDDU) is performed using an intracavernosal injection (ICI) of a vasoactive agent to demonstrate both arterial insufficiency and veno-occlusive dysfunction. This article aims to evaluate the sensitivity of different doses of different vasoactive agents used to diagnose ED in impotent patients.Material and methodsThis study recruited 90 subjects with ED and 100 healthy subjects as controls. All of the subjects were assessed using the International Index of Erectile Function score (IIEF-5) while degree of erection was assessed by the Erection Hardness Score (EHS). Two penile duplex tests were done for each candidate two weeks apart.ResultsNone of the sample population achieved a normal clinical response (EHS >2) to 10 ug PGE1. In contrast, 60 controls (60%) had a normal response (EHS >2) to 10 ug PGE1. This difference in response between the sample and control populations to 10 ug PGE1 was of high statistical significance 11 (p <0.001). In contrast, 54 (60%) out of the 90 cases had normal clinical response (EHS >2) to 0.25cc Trimix (everywhere). Interestingly, 96 controls (96%) demonstrated normal response (EHS >2) to 0.25cc Trimix. This difference in response between the sample and control populations to 0.25 cc Trimix was also of high statistical significance (p <0.001).ConclusionsOur study demonstrated a statistically significant association between the response to Trimix over PGE1 and peak systolic velocity (PSV) and end diastolic velocity (EDV). Thus, we conclude that 0.25 cc Trimix is more sensitive than 20 ug PGE1 in diagnosing ED for impotent patients and also provides a more potent response.

Penile vascular abnormalities in young men with persistent side effects after finasteride use for the treatment of androgenic alopecia.

BackgroundThe constellation of persistent sexual, neurological, and physical adverse effects in patients who discontinue 5α-reductase inhibitors (5ARIs) has garnered recent concern. The objective of this study was to evaluate potential penile vascular changes and persistent adverse effects of 5ARIs in men treated for androgenic alopecia (AGA).MethodsThis was a prospective case-control study with 25 subjects with a history of 5ARI use for AGA and 28 controls. Patient self-reported questionnaires including the International Index of Erectile Function (IIEF), International Prostate Symptom Score (IPSS), Patient Health Questionnaire-9 (PHQ-9), the Epworth Sleepiness Scale (ESS) and the Androgen Deficiency in the Aging Male (ADAM) were used. Penile duplex Doppler ultrasound (PDDU) results were evaluated in men with a history of 5ARI use.ResultsA significant difference in total IIEF score between the 5ARI (median: 35; IQR: 29–43) and control group (median: 29; IQR: 27–32) (P=0.035) was observed. Seventeen 5ARI subjects (68%) had a vascular abnormality on PDDU. The median (IQR) for total IPSS score for the 5ARI group was 10 [5–16] compared to 3 [2–8] for the controls (P<0.01). The 5ARI group had a higher median total PHQ-9 score than controls [10 (6.5–16) vs. 1 (0–2) (P<0.001)]. Two subjects (8%) committed suicide during or after the study.ConclusionsWhile the sexual side effects of 5ARIs are well known, there may be persistent genitourinary, physical, psycho-cognitive, anti-androgenic and penile vascular changes after 5ARI discontinuation. Use of 5ARIs for treatment of AGA may lead to persistent sexual, genitourinary, physical, psycho-cognitive, and anti-androgenic sequelae even after cessation of 5ARI therapy.

MP33-14 CLINICAL OUTCOMES OF PATIENTS WITH ATYPICAL PEYRONIE’S DISEASE UNDERGOING INTRALESIONAL XIAFLEX INJECTIONS

You have accessJournal of UrologySexual Function/Dysfunction: Peyronie's Disease (MP33)1 Apr 2020MP33-14 CLINICAL OUTCOMES OF PATIENTS WITH ATYPICAL PEYRONIE’S DISEASE UNDERGOING INTRALESIONAL XIAFLEX INJECTIONS Farouk M. El-Khatib*, Mohamad M. Osman, Linda M. Huynh, Maxwell Towe, and Faysal A. Yafi Farouk M. El-Khatib*Farouk M. El-Khatib* More articles by this author , Mohamad M. OsmanMohamad M. Osman More articles by this author , Linda M. HuynhLinda M. Huynh More articles by this author , Maxwell ToweMaxwell Towe More articles by this author , and Faysal A. YafiFaysal A. Yafi More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000877.014AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Peyronie’s disease (PD) is an acquired condition typically characterized by plaque formation and dorsal/lateral penile curvature. Atypical PD is a term used to describe less common PD presentations such as ventral curvature, multiplanar curvature, penile indentation and hourglass deformity. We sought to assess the outcomes of patients presenting atypical PD presenting to a men’s health clinic and treated with Xiaflex. METHODS: We conducted a retrospective review of charts of men who presented to one clinic with atypical PD between October 2016 and June 2019. Patients were included if they were considered to be in the stable phase of the disease and had completed a Penile Duplex Doppler Ultrasound (PDDU) prior to any intervention. Gathered data included patient demographics and treatment details, outcomes and complications. Patients presenting with indentation or hourglass deformity were asked to answer the symptom bother domain of the Peyronie’s Disease Questionnaire (PDQ) and were scored on a scale of 0-16 before and after treatment. Offered treatments included intralesional injection of Xiaflex, tunical plication, partial excision and grafting and insertion of inflatable penile prosthesis. Men who received Xiaflex injections as a treatment were only included in this study. RESULTS: During this period, 93 men with stable PD underwent PDDU, 61/93 (65.6%) were found to have atypical PD. Overall, 37/61 (60.7%) opted for treatment 21/37 (58.3%) chose Xiaflex: 5, 6, 17 and 5 had ventral curvature, multiplanar curvature, indentations and hourglass deformity respectively. The mean number of Xiaflex injections used was 8.4±3.3. 80.0% of responders said they would pursue this treatment again. There was 1 penile fracture which required surgical repair. Full results can be seen below in table 1. CONCLUSIONS: Patients with atypical PD represent a significant proportion of men with PD and Xiaflex demonstrates favorable improvements in penile curvature and bother score in such cases. Outcomes with Xiaflex in patients with atypical PD are comparable to those reported in the IMPRESS trials. Source of Funding: none © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e499-e500 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Farouk M. El-Khatib* More articles by this author Mohamad M. Osman More articles by this author Linda M. Huynh More articles by this author Maxwell Towe More articles by this author Faysal A. Yafi More articles by this author Expand All Advertisement PDF downloadLoading ...

112 Vibro-elastography: A Novel, Non-invasive Tool for Evaluating Penile Fibrosis

Penile duplex Doppler ultrasonography (PDDU) is an objective, non-invasive exam that allows characterization of the vascular status of the penis. However, this method has notable limitations and is relatively limited in its ability to identify smooth cavernosal fibrosis with commonly underlies organic erectile dysfunction (ED). Penile ultrasound vibro-elastography (PUVE) is a novel technology utilizing ultrasound and fluid mechanics that allows for non-invasive evaluation of corporal viscoelasticity, which is hypothesized to correlate with the severity of penile fibrosis. Herein, we aim to describe the principles underlying PUVE and its application in the evaluation of penile fibrosis as it pertains to erectile dysfunction. A device known as a handheld shake (Model: FD-142, Labworks Inc. Costa Mesa, Ca, USA) is used to create a 0.1-second harmonic vibration which is applied to the penile shaft using various frequencies (100, 150, and 200 Hz). An ultrasound probe positioned on the contralateral side is used to measure the resultant shear-wave velocity as it propagates through the corporal tissue. With this data, the corporal tissue viscosity and elasticity can be calculated. We performed a pilot study of 10 men with ED and/or Peyronie’s Disease to evaluate the clinical utility of PUVE. PUVE was performed on subjects in the flaccid penile state to obtain baseline measurements of the corporal tissue. Patients subsequently underwent intracavernosal injection until a fully rigid erection was achieved (or maximum of 1 mL administered). Repeat PUVE assessments were performed in the same manner on the erect penis. PDDU was also performed to measure peak systolic velocity (PSV), end-diastolic velocity, and resistive index. Corporal viscosity and elasticity were compared between the flaccid and erect penis. Penile viscosity and elasticity were also compared to PSV and Framingham risk scores which serve as a correlate for cardiovascular risk stratification.

124 The Persistent Effects of 5α-reductase Inhibitors Used in the Treatment of Androgenic Alopecia on Men's Health

The constellation of persistent sexual, neurological, and physical adverse effects in patients who discontinue 5α-reductase inhibitors (5ARIs) – collectively termed Post-Finasteride Syndrome (PFS) – has garnered recent attention with the Food and Drug Administration (FDA) and French National Agency for Drug Safety (ANSM), resulting in amendment of finasteride’s label to include a warning of the risk of persistent side effects. The purpose of this study is to further elucidate the persistent sexual, genitourinary, physical, psychiatric, cognitive, and androgenic effects of 5ARIs in men treated for androgenic alopecia (AGA). This was a retrospective case-control study that evaluated the sexual, genitourinary, physical, psychiatric, cognitive, and androgenic effects of 5ARIs in 25 subjects with a history of 5ARI use for AGA and 25 controls. Patient self-reported symptoms and validated questionnaires including the International Index of Erectile Function (IIEF), International Prostate Symptom Score (IPSS), Patient Health Questionnaire-9 (PHQ-9), the Epworth Sleepiness Scale (ESS) and the Androgen Deficiency in the Aging Male (ADAM) were used to evaluate outcomes in a standardized manner. Penile Duplex Doppler Ultrasound (PDDU) results were used to evaluate penile vascular parameters.

HP-09-006 First results of platelet-rich plasma and low intensity extracorporeal shockwave combined therapy for erectile dysfunction

Platelet-rich plasma (PRP) demonstrated its safety and effectiveness as monotherapy for erectile dysfunction (ED), as well as low-intensity extracorporeal shockwave therapy (LI-ESWT). The purpose of the present study was to evaluate safety and effectiveness of their combined use for treating ED. We hypothesized that angiogenic, neuroprotective and neurogenic effects of PRP could be enhanced by the LI-ESWT. 10 men, mean age of 44.25 (22-69), experiencing ED symptoms for 2.95 years, were included into the study for 60 days. Patients were treated with 6 rounds of intracavernous PRP injections activated with 10% CaCl2 solution and 12 LI-ESWT procedures during 6 weeks. Each PRP injection was performed in middle and distal corpus cavernosum parts bilaterally. 2000 waves were applied at every LI-ESWT procedure to each cavernous body. Effects of combined therapy were assessed by validated questionnaires (IIEF-5, SEP, GAQ) and penile duplex Doppler ultrasound (PDDU) with intracavernous PgE1 injection.

The influence of metabolic profile of obese men on the severity of erectile dysfunction: are metabolically healthy obese individuals protected?

To determine the prevalence of erectile dysfunction (ED) in metabolically healthy obese (MHO) individuals, and to compare ED severity and hypogonadism prevalence in MHO, metabolically unhealthy obese (MUO) and metabolically healthy non-obese individuals. ED patients (n=460) were evaluated by standardized protocol, that included clinical evaluation, abridged 5-item version of the International Index of Erectile Function (IIEF-5) questionnaire survey, and Penile Duplex Doppler Ultrasound (PDDU) exam. Patients were classified as obese [body mass index (BMI) ≥30.0 kg/m2] and non-obese (BMI <30.0 kg/m2), and metabolic health status was defined by National Cholesterol Education Program Adult Treatment Panel III (NCEP ATPIII) criteria. Statistical analysis was performed and statistical significance was considered at p-level <0.05. The mean age of the subjects was 56.2±10.5 years. MHO was present in 40% of obese individuals (n=37). MUO had lower mean peak systolic velocity (mPSV) compared to MHO (28.1 cm/s vs. 36.9 cm/s; p=0.005), and IIEF-5 scores were also lower in MUO compared to MHO patients (10.2 vs. 13.1; p=0.018). No statistical differences in IIEF-5 score, mPSV and hypogonadism prevalence between MHO and metabolically healthy non-obese (MHNO) patients were observed. Our results lead us to conclude that healthy metabolic profile protects obese individuals from severity of ED. The strong association between obesity and ED may be otherwise attributed to metabolic abnormalities present in the obese.

Grower or shower? Predictors of change in penile length from the flaccid to erect state.

In colloquial English, a "grower" is a man whose phallus expandssignificantly in length from the flaccid to the erect state; a "shower" is a man whose phallus does not demonstrate such expansion. We sought to investigate various factors that might predict a man being either a grower or a shower. A retrospective review of 274 patients who underwent penile duplex Doppler ultrasound (PDDU) for erectile dysfunction between 2011 and 2013 was performed. Penile length was measured, both in the flaccid state prior to intracavernosal injection (ICI) of a vasodilating agent (prostaglandin E1), and at peak erection during PDDU. The collected data included patient demographics, vascular, and anatomic parameters. The median change in penile length from flaccid to erect state was 4.0 cm (1.0-7.0), and was used as a cut-off value defining a grower (≥4.0 cm) or a shower (4.0 cm). A total of 73 men (26%) fit the definition of a grower (mean change in length of 5.3 cm [SD 0.5]) and 205 (74%) were showers (mean change in length of 3.1 cm [SD 0.9]). There were no differences between the groups with regards to race, smoking history, co-morbidities, erectile function, flaccid penile length, degree of penile rigidity after ICI, or PDDU findings. Growers were significantly younger (mean age 47.5 vs. 55.9 years, p < 0.001), single (37% vs. 23%, p = 0.031), received less vasodilator dose (10.3 mcg vs. 11.0 mcg, p = 0.038) and had a larger erect phallus (15.5 cm vs. 13.1 cm, p < 0.001). On multivariate analysis, only younger age was significantly predictive of being a grower (p < 0.001). These results suggest that younger age and single status could be predictors of a man being a grower, rather than a shower. Larger, multicultural and multinational studies are needed to confirm these results.

546 Assessment of predictors of abnormal peak systolic velocity and end diastolic velocity in penile doppler ultrasound

Penile duplex Doppler ultrasound (PDDU) is used to assess the etiology of erectile dysfunction(ED). Peak systolic velocity (PSV), and end-diastolic velocity (EDV), are the main PDDU parameters. To evaluate the impact of different cardiovascular risk factors, Peyroni disease(PD), and penile size on PSV and EDV. A retrospective review of all men presenting with erectile dysfunction (ED) who did PDDU between January 2011 and January 2012 has been carried out, including patients diagnosed as psychogenic ED. A total of 362 patients with complete data were included in this analysis. Collected data included patient demographics, vascular, and anatomic parameters. The patients’ data included known cardiovascular risk factors (age, tobacco consumption, body mass index (BMI), testosterone levels(T), diabetes mellitus(DM), hypertension(HTN), dyslipidemia and PD. Penile size was measured at the time of full erection on the dorsal aspect of the penis, from the pubic bone to tip of the glans(BTT),from skin to tip(STT) and circumference of base of penis. PDDU was done for all patients after intracavernosal injection(ICI) with Trimix. PSV and EDV were measured after 15 minutes.