Self-Esteem And Relationship Research Articles

Functional outcomes after supra-pubic phalloplasty

BACKGROUNDA thorough evaluation of the functional outcomes resulting from supra-pubic phalloplasty (SPP) assessing different aspects of the phalloplasty has not been reported. PURPOSE OF THE STUDYTo report the outcomes on sexuality, urinary function, satisfaction, and regrets following an SPP performed at our centre. SUBJECTS STUDIEDAll consecutive patients who underwent the 3-steps technique of pre-expanded SPP between 2007 and 2018 and who had at least 1 year of follow-up. METHODSQuestionnaires were sent to analyse several domains of penile reconstruction: sexuality, urinary function, perceived sensitivity, and satisfaction. Sexuality was evaluated using the Self Esteem and Relationship (SEAR) questionnaire. Urinary function was analysed based on the urethral stricture surgery PROM (USS-PROM) questionnaire. MAIN FINDINGSA total of 77 patients were included, 92.2% were transmen, and 33 (42.9%) responded to the questionnaire. Urethral lengthening (UL) was performed in 28 (36.4%) procedures and erectile prosthesis was implanted in 42 patients (54.5%). The mean length of the neophallus was 15.3cm (SD 2.6) and the mean girth was 11.8cm (SD 2.1). The mean total SEAR score (/100) was 73.8 (SD 26.7). The mean six-item LUTS score (/24) was 8.4 (SD 4.6). The standing position was the usual voiding position reported by 11 patients (73.3%). CONCLUSIONPre-expanded SPP is a robust technique that can achieve substantial flap dimensions, leading to high satisfaction with neophallus appearance and the choice of the phalloplasty technique. Overall sexual outcomes are mostly favourable. UL is feasible and effective in terms of voiding in a standing position.

A psychoeducational intervention to improve sexual functioning in male rectal and anal cancer patients: A pilot randomized controlled trial study.

Male rectal and anal cancer patients demonstrate high rates of sexual dysfunction. This pilot randomized controlled trial tested a psychoeducational intervention designed to improve psychosexual adjustment. Rectal or anal cancer patients were randomized to a Sexual Health Intervention for Men (intervention) or to a referral and information control (control). The intervention included control activities plus 4 sexual health intervention sessions every 4-6 weeks and 3 brief telephone calls timed between these sessions. Assessments were completed pre-intervention (baseline) and 3 months (follow-up 1) and 8 months (follow-up 2) post-intervention. Differences were assessed with statistical significance and Cohen's d effect sizes (d = 0.2, small effect; d = 0.5, moderate effect; d = 0.8, large effect). Ninety subjects enrolled. Forty-three participants completed at least 1 follow-up assessment (intervention, n = 14; control n = 29). At follow-up 1, men in intervention, compared to control, improved on all domains of the International Index of Erectile Function (IIEF) (p < 0.001 to p < 0.05) and demonstrated large effects (d = 0.8 to d = 1.5). Similarly, at follow-up 2, changes in all domains of the IIEF except the orgasm domain were either statistically significant or marginally statistically significant (p = 0.01 to p = 0.08) and demonstrated moderate to large treatment effects for intervention versus control (d = 0.5 to d = 0.8). Men in the intervention, compared to control, demonstrated decreased sexual bother at follow-up 1 (p = 0.009, d = 1.1), while Self-Esteem and Relationship (SEAR) total scores and the SEAR sexual relationship subscale demonstrated moderate increases for intervention versus control (d = 0.4 to d = 0.6). This study provides initial evidence for combining a psychoeducational intervention with medical interventions to address sexual dysfunction following rectal and anal cancer. Trials register number: NCT00712751 (date of registration: 7/10/2008).

MP36-01 AN ANALYSIS OF THE PSYCHOLOGICAL BOTHER IN MEN WITH PEYRONIE'S DISEASE

You have accessJournal of UrologyCME1 Apr 2023MP36-01 AN ANALYSIS OF THE PSYCHOLOGICAL BOTHER IN MEN WITH PEYRONIE'S DISEASE Luis F. Novaes, Lawrence C. Jenkins, Jean E. Terrier, Hisanori Taniguchi, Bruno Nascimento, Sigrid Carlsson, Christian Nelson, Jose M. Flores, and John P. Mulhall Luis F. NovaesLuis F. Novaes More articles by this author , Lawrence C. JenkinsLawrence C. Jenkins More articles by this author , Jean E. TerrierJean E. Terrier More articles by this author , Hisanori TaniguchiHisanori Taniguchi More articles by this author , Bruno NascimentoBruno Nascimento More articles by this author , Sigrid CarlssonSigrid Carlsson More articles by this author , Christian NelsonChristian Nelson More articles by this author , Jose M. FloresJose M. Flores More articles by this author , and John P. MulhallJohn P. Mulhall More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003270.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: There is an association between Peyronie's disease (PD) and psychological bother, depression and relationship dissatisfaction. We aimed to describe the prevalence of these psychosocial issues using validated instruments. METHODS: On presentation, all patients with PD who responded to 3 validated questionnaires were included in this study. The inventories included: the Peyronie’s Disease Questionnaire (PDQ), the Center for Epidemiologic Studies Depression Scale (CES-D), and the Self-Esteem and Relationship (SEAR) questionnaire. The PDQ has 3 subdomains, psychological and physical symptoms, penile pain, and bother signs. With worsening negative impact, PDQ scores are higher; a bother domain score ≥9 indicates clinically meaningful bother. A CES-D score, ≥16/60 suggests clinical depression. The SEAR contains 14 questions, divided into the domains of sexual relationship and confidence (self-esteem; overall relationship), with a normalized score of 0-100, (higher scores better QOL). Demographics and PD characteristics are reported. We evaluated potential predictors of psychological bother. Parameters included in univariable (UVA) and multivariable (MVA) analysis models: age, sexual orientation, PD duration, multiplanar curvature, pain, intercourse, curvature, penile instability. RESULTS: 720 patients were analyzed. Median age 58 [52, 64] years, 20% had ≥2 comorbidities, 7% were current smokers. Median PD duration was 10 [4, 24] months, 28% multiplanar curvature, median degree of the primary was 32° [21, 46]. Curvature location: mid-shaft 64%, distal 25%, proximal 11%. 49% had dorsal, 37% lateral, and 14% ventral curvature. Median PDQ scores: psychological and physical (0-24) was 9 [4, 14]; pain (0-30) was 3 [0, 8]; bother (0-16) was 4 [3, 6]; 5% had clinically significant bother. Median CES-D scores 8 [3, 15], 23% had scores ≥16, indicating clinical depression. Median SEAR scores: sexual relationship 28 [16, 41]; confidence 32 [23, 41]. On UVA, pain (OR: 4.67; 95% CI: 1.4, 14.8; p: 0.009) curvature magnitude (OR: 1.47; 95% CI: 1.1, 1.9; p: 0.007) were predictors of bother. Median PDQ pain scores in bothered patients was 14.5 [8.5, 21.2], vs 2 [0, 7] in non-bothered. On MVA (Table 1), pain was the only predictor of bother. CONCLUSIONS: Pain and curvature is associated with bother, and 1 in 4 PD patients have clinical depression. Source of Funding: SMSNA © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e479 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Luis F. Novaes More articles by this author Lawrence C. Jenkins More articles by this author Jean E. Terrier More articles by this author Hisanori Taniguchi More articles by this author Bruno Nascimento More articles by this author Sigrid Carlsson More articles by this author Christian Nelson More articles by this author Jose M. Flores More articles by this author John P. Mulhall More articles by this author Expand All Advertisement PDF downloadLoading ...

Efficacy and safety of low-intensity extracorporeal shock wave therapy versus on-demand tadalafil for erectile dysfunction

ABSTRACT Objective To compare outcomes of low-intensity extracorporeal shock wave therapy (LIESWT) versus 20 mg of Tadalafil in Erectile dysfunction (ED) patients. Materials and Methods We performed a prospective study of 51 men with ED. Twenty-five were in the LIESWT group and 26 in the Tadalafil group. Patients in the LIESWT group received 6 sessions (2 per week) with an average of 6,000 shocks per session with the PiezoWave2 unit. Other patients self-administered Tadalafil on demand. The outcomes were assessed using the International Index of Erectile Function (IIEF-5) score, Erection Hardness Score (EHS) and Self-Esteem And Relationship (SEAR) questionnaire before, at 6 and 12 weeks after treatment. Treatment-related side effects and costs were recorded too. Results The mean age in the LIESWT group was 43.7 years old, and in the Tadalafil group was 47 years old. After the 6 and 12-week follow-ups, both groups showed significant improvement when comparing the baseline values to the follow-up variables for all IIEF-5, EHS, and SEAR (P < 0.05). There was a notable statistical difference between the two groups regarding the side effects, as the shockwave group was with mild side effects (8%), while the Tadalafil group (44%) of patients had side effects (p < 0.05). This cost difference is statistically significant (p < 0.001). LIESWT is more costly compared to Tadalafil. Conclusion LIESWT has a comparable short-term therapeutic efficacy with higher safety outcomes than on-demand 20 mg of Tadalafil for ED patients.

Penis Enlargement by Penile Suspensory Ligament Division with Cross-Plasty of the Skin.

To demonstrate modified technique of penile lengthening. We have reviewed 30 patients who underwent surgery with the use of the proposed "cross-method" and also compared with 35 patients who had surgery with the division of the suspensory ligament performed with the use of V-Y plasty method. We have achieved better enlargement and SEAR (self-esteem and relationship) scores with the "cross-method" compared to V-Y plasty. The cross-method is a simple alternative technique for penile lengthening that can be performed safely in order to treat small penis syndrome and obtain better results.

A Comparison of the Psychosocial Impact of Penile Prosthesis and Intracavernosal Injection Therapy for Erectile Dysfunction Using the Self-Esteem and Relationship (SEAR) Questionnaire

ABSTRACT Introduction The few studies that do compare penile prostheses (PP) and intracavernosal injections (ICI) focus predominantly on sexual function leaving self-esteem and relationships understudied. The Self-Esteem and Relationship (SEAR) questionnaire was developed to provide a reliable tool to assess psychosocial variables of ED treatments. We hypothesized that patients with PP would have higher SEAR scores compared to patients treated with ICI. Objective To compare psychosocial variables of PP and ICI treatments using the SEAR questionnaire. Methods IRB-approval was obtained to interview patients by phone who underwent ED treatment by a single surgeon. SEAR questionnaire results were calculated according to the previously described formula and individual questions and domains were compared using T-test statistics. Results Fifty patients (25 PP, 25 ICI) agreed to be interviewed for this study. Prostate cancer (n=21, 45%) and vascular disease (n=7, 14%) were the leading cause of ED in our cohort. PI patients on average suffered from ED for a longer period than patients on ICI (5.6 vs 2.7 years, p=0.005). There were no differences in age or marital status. PP patients reported numerically higher total SEAR scores than PP patients (63 vs 53, p=0.12). PI patients reported higher sexual relationships domain scores than ICI patients (64 vs 46, p=0.04), especially in “I felt confident that during sex my erection would last long enough” (p=0.004), “I was satisfied with my sexual performance” (p=0.05), and “I felt confident about performing sexually” (p=0.02). There were no statistical differences in the confidence domain (p=0.89) or self-esteem (p=0.68) and overall relationship (p=0.80) sub-domains. Conclusions PP patients reported higher sexual relationship domain scores than ICI patients, while confidence, self-esteem, and overall relationships were similar. Regular use of the SEAR questionnaire may help to identify areas of post-treatment psychosocial needs in ED patients that may benefit from support groups or discussion with a counselor. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific

Development and Validation of the Satisfaction Survey for Inflatable Penile Implant (SSIPI)

No validated English language patient-reported outcome (PRO) currently exists that assesses satisfaction with inflatable penile prosthesis (IPP). Satisfaction data have been largely based primarily on surgeon assessment of patients or using questionnaires that have not been designed for this purpose. To develop an English-language validated PRO that assesses patient satisfaction after IPP surgery. Initially, a literature review and discussions with experts defined domains important to IPP satisfaction (pain, appearance, function, overall satisfaction). The initial 35-item Satisfaction Survey for Inflatable Penile Implant (SSIPI) was developed. Cognitive interviews were then performed with IPP patients (n = 12) to gain feedback on the SSIPI domains and items. These data were used to modify SSIPI with the addition of 2 questions for a final item number of 37. Patients from 4 centers, who were between 6 months and 5 years after IPP, were administered the questionnaire through RedCap. Reliability statistics and content analysis were used to winnow questions to yield the final 16-item version of the SSIPI. Internal consistency was assessed via Cronbach's alpha and item-total correlation. Test-retest reliability was assessed via intraclass correlation coefficients using baseline and 2-week data. For convergent validity, the Erectile Dysfunction Inventory of Treatment Satisfaction and the Self-Esteem and Relationship (SEAR) questionnaire were used. For discriminant validity, the International Prostate Symptom Score (IPSS) was used. Confirmatory factor analysis was used to assess the factor structure of the SSIPI. Internal consistency, test-retest reliability, convergent and discriminant validity, and confirmatory factor analysis were assessed. 118 men were surveyed. Mean age was 66.8 ± 9.5 years. The 16-item SSIPI showed high internal consistency with an overall Cronbach's Alpha of 0.97 (domains 0.85-0.89). Item-total correlations for individual items to subscales ranged from 0.60 to 0.91. The overall test-retest reliability was 0.94 (domains 0.87-0.93). Erectile Dysfunction Inventory of Treatment Satisfaction and Self-Esteem and Relationship had correlations of 0.84 overall (domains 0.57-0.79) and 0.47 overall (domains 0.34-0.44), respectively. International Prostate Symptom Score (discriminant validity) had correlations of -0.29 overall (domains -0.17 to -0.31). SSIPI is the first English-language validated IPP satisfaction PRO. This will enable clinicians to collect satisfaction data in a standardized way. As strengths we have used a rigorous psychometric process and have no industry sponsorship. Limitations include small numbers of specific subpopulations. The SSIPI has demonstrated robust psychometric properties.

Predictors of Pursuing Intralesional Xiaflex in Peyronie's Disease Patients

Intralesional collagenase such as Xiaflex (ILX) has become a standard treatment for Peyronie's disease (PD). Many robust studies have demonstrated its clear efficacy in the treatment algorithm. To examine predictors of the patient decision to pursue ILX in PD patients. The study included PD patients (i) with stable disease (ii) who had doppler duplex ultrasonography (DUS) at least 6 months prior to analysis date and (iii) did not choose an operation. All patients received a standard discussion regarding treatment options, specifically, observation, ILX and penile reconstructive surgery (plication, plaque incision and grafting, implant surgery). Patients who opted to use ILX were compared to those who opted against it. Comorbidity, demographic and PD characteristics were recorded at the initial PD visit. All patients completed three validated questionnaires including the PD questionnaire (PDQ), Self-Esteem and Relationship (SEAR) questionnaire and a depression questionnaire (CES-D). Logistic regression was used to determine predictors of ILX use. Predictors of ILX utilization. Four hundred and fifty stable PD men had DUS completed 6 months before to allow sufficient time for treatment decision. Of these, 111 (24.7%) patients had ILX treatment and 339 (75.3%) did not. Mean age, relationship status and pain occurrence were similar between groups, but ILX patients had less bother defined as PDQ ≥ 9 (46.8% vs 53.7%, P=.02). ILX patients had more complex curves (79.3% vs 47.8%, P < .01) and more severe instability (32.4% vs 15.3%, P=.01). ILX patients also had higher PDQ domain scores (Psychological 11.5 ± 6.4 vs 7.5 ± 6.2, P < .01; Pain 6.2 ± 6.0 vs 4.3 ± 5.6, P=.02; and Bother 9.8 ± 4.7 vs 6.6 ± 4.8, P < .01). On univariable statistics, significant bother (OR 2.41, 95% CI 1.36-4.28, P<0.01), complex curvature (OR 4.18, 95%CI 2.52-6.93, P < .01), moderate and/or severe instability (OR 1.98, 95%CI 1.18-3.30, P < .01) and PDQ-Bother scores (OR 1.15, 95%CI 1.08-1.22 P < .01) predicted ILX use. On multivariable analysis, instability (OR 2.58, 95%CI 1.02-6.57, P=.05) and significant bother (OR 1.23, 95%CI 1.04-1.45, P=.01) predicted ILX use. Educates providers as to which patients are more likely to choose ILX. Our study has a large sample size and all patients received the same standardized treatment discussion. Our study is limited by the absence of insurance data on all patients, and its retrospective single center design. ILX was chosen by the minority of stable PD patients. While moderate to severe instability and significant bother is predictive of ILX use, other demographic factors including relationship status, sexual orientation or pain were not. Punjani N, Nascimento B, Salter C, etal. Predictors of Pursuing Intralesional Xiaflex in Peyronie's Disease Patients. J Sex Med 2021;18:1258-1264.

Effect of Low-Energy Shockwave Therapy Versus Platelets Rich Plasma Therapy in Patients with Erectile Dysfunction

Phosphodiesterase 5 inhibitors (PDE5Is) and low-energy shock wave therapy (LESWT) have created a revolution in the treatment of erectile dysfunction (ED). However, they are not able to restore the actual changes in the penis. An emerging new therapy called platelet-rich plasma (PRP) is believed to be more beneficial in treating ED. The objective of this study is to evaluate and compare the efficacy of LESWT and PRP in treating ED. A total of sixty participants of pathological ED was included in the study and divided into two groups. Group A received the LESWT, whereas Group B received the PRP. The benefits were measured by the International Index of Erectile Function (IIEF), an erection hardness score (EHS) and Self-Esteem And Relationship (SEAR) questionnaires. The results of this analysis demonstrated a larger effect in treatment group B in percentage terms, but there were no statistical differences in the two groups. In the near future, PCP may be a new modality for treating ED, especially PDE5I non-respondents with organic ED. However, more extensive preclinical and applied research needs to be conducted.

In Vitro Fertilization Entails a High Prevalence of Erectile and Male Sexual Dysfunction: A Prospective Case-Control Study.

We evaluated the effect of in vitro fertilization (IVF) on sexual function in men, particularly for erectile dysfunction. A prospective case-control study at a tertiary medical center. The study group comprised men of infertile couples that required IVF to conceive. The control group comprised men of couples who conceived spontaneously. The effects of IVF on sexual and erectile function were assessed based on the International Index of Erectile Function (IIEF-15) and the Self-Esteem and Relationship (SEAR) questionnaires. Participants were followed up to 1 year postpartum. Compared to the control group (378), for the IVF group (356), mean IIEF-15 scores were significantly lower: prior to pregnancy (31.7±4.5 vs 64.4±7.2, p <0.0001), at mid-pregnancy (37.3±5.1 vs 66.4±5.5, p <0.0001) and up to one year postpartum (42.3±4.9 vs 68.6±4.3, p <0.0001). Compared to the control group, in the IVF group, mean SEAR scores were significantly lower at these 3 respective time points (29.9±6.3 vs 66.5±8.3; 34.1±5.8 vs 66.9±7.2; and 40.9±6.7 vs 67.3±5.6; p <0.0001). At the 3 time points, for the IVF compared to the control group, the median monthly sexual intercourse rate was lower; and both the use of phosphodiesterase-5 inhibitor and psychologist/sexologist care were higher. The prevalence of erectile dysfunction among men participating in IVF in order to conceive is significantly higher compared to couples that conceived spontaneously, thus leading to an extremely high rate of phosphodiesterase-5 inhibitor use.

Predictors of Depression in Men With Peyronie's Disease Seeking Evaluation

BackgroundPeyronie's disease (PD) has negative impacts on the psychosocial status of men including depression warranting clinical evaluation in up to 50% of men. AimTo examine predictors of depression in patients with early PD seeking evaluation. MethodsAll PD patients at a high-volume PD practice underwent screening and curvature assessment after intracavernosal injection. Complex deformity was defined as any degree of multiplanar curvature, curvature >60 degrees, or presence of hourglass deformity. Men completed the PD questionnaire (PDQ), a validated depression questionnaire (CES-D) as well as the Self-Esteem and Relationship (SEAR) questionnaire. Scores of ≥16 on CES-D were considered indicative of moderate/severe depression. Predictors of the presence of depression were defined using univariable and multivariable logistic regression. OutcomesDemographic, bother and curve related predictors of depression in men with PD. Results408 men completed all questionnaires. Mean age was similar between depressed and nondepressed groups (57 ± 10 years overall, P = .60 between groups). Proportions of erectile dysfunction were similar between groups (P = .96). Mean PD duration was similar between groups (19 ± 35 months overall, P = .46 between groups). Mean degree of curvature was 38 ± 2 degrees in the depressed vs 33 ± 1 degrees in the nondepressed groups (P = .03). A complex deformity was seen in 64.5% in the depressed vs 61.5% in the nondepressed (P = .56). A total of 110 (27%) patients had CESD scores ≥16. 74% depressed men were in relationships compared to 84% nondepressed men (P < .01). Other characteristics including bother, pain, duration of disease, curve complexity and instability were similar between the two groups. On univariable analysis, factors protective against depression included being partnered (OR 0.42, 95%CI 0.24–0.75, P < .01) and higher total SEAR scores (OR 0.95, 95%CI 0.94–0.97, P < .01). Elevated PDQ domain scores were associated with depression (Psychologic Symptoms 1.05, 95%CI 1.02–1.10, P < .01; Pain 1.08, 95%CI 1.03–1.12, P < .01; Bother 1.11, 95% CI 1.05–1.68, P < .01) as well as baseline history of depression (OR 2.93, 95%CI 1.67–5.14, P < .001). On multivariable analysis, only total SEAR score remained protective against depression (OR 0.96, 95%CI 0.94–0.97, P < .001). Clinical ImplicationsProviders must recognize that men with PD seeking evaluation have meaningful rates of depression for which early recognition is necessary. Strengths and LimitationsRetrospective review of a large prospectively collected dataset from a single center of men with PD utilizing a validated screening tool for depression. ConclusionWhile no significant demographic, bother or curve related factors predicted depression in early PD men seeking evaluation, it remains a significant problem warranting further prospective evaluation.P. Nahid, N. Bruno, S. Carolyn, et al. Predictors of Depression in Men With Peyronie's Disease Seeking Evaluation. J Sex Med 2021;18:783–788.

Comparison of the efficacy and safety of low-intensity extracorporeal shock wave therapy versus on-demand sildenafil for erectile dysfunction.

BackgroundLow-intensity extracorporeal shock wave therapy (Li-ESWT) is an effective therapy for erectile dysfunction (ED) but is not widely recognized and applied. This prospective nonrandomized study aimed to investigate the efficacy and safety of Li-ESWT.MethodsAfter a 4-week washout period of past ED treatment, patients entered one of 2 active treatment groups, either 9-week Li-ESWT or 100 mg on-demand sildenafil. Patients were evaluated in the first- and third-month following initiation of treatment. The Li-ESWT protocol comprised 2 sessions per week for 3 weeks, which were repeated after a 3-week interval. Patients in the drug group took self-administered sildenafil at a dose of 100 mg before intercourse. The primary outcome was the effectiveness of Li-ESWT measured by the International Index of Erectile Function-5 (IIEF-5) scores. Other measurements included erection hardness score (EHS) and Self-Esteem And Relationship (SEAR).ResultsA total of 78 participants completed the study (46 in the Li-ESWT group and 32 in the sildenafil group). Overall, 26.9% of the participants (21/78) included were psychogenic. In the third month, the outcome measured by IIEF-5 was 21.52 in the Li-ESWT group and 21.26 in the sildenafil group (P>0.05). Proportion of improvement defined by minimal clinically important difference (MCID) criteria was 52.2% in the Li-ESWT group and 59.4% in the sildenafil group (P>0.05). The EHS and SEAR improvement was similar in the 2 groups (P>0.05 at baseline and third month). Transient and mild adverse events were observed in both groups.ConclusionsIn our study, a similar treatment efficacy and safety was shown by the application of Li-ESWT as on demand sildenafil.

Defining the impact of Peyronie's disease on the psychosocial status of gay men.

Little sexual health research has been conducted in gay men. Anecdotally, this population seems to experience more bother related to Peyronie's disease (PD). To examine the impact of PD on psychosocial factors in gay vs straight men. All PD patients who were seen in the sexual medicine clinic were included. They completed three instruments: the PD questionnaire (PDQ), Self-Esteem and Relationship (SEAR) questionnaire, and a depression questionnaire (CES-D). We described demographics and sexual variables by sexual orientation. We then compared PDQ items and summary scores by sexual orientation, using a series of independent samples t tests. 34 consecutive gay and 464 straight men were included. Age and baseline characteristics were similar between the two cohorts, with the exception that fewer gay men were partnered (56% vs 87%, P<.01), and those with a partner had a shorter relationship duration: 109±9months vs 262±175months, P<.01. For the SEAR questionnaire, gay men demonstrated a more significant psychosocial impact of PD overall with lower SEAR sums (41 vs 57, P=.01) and a lower sexual relationship subdomain score (28 vs 47, P<.01). 41% of gay men vs 26% of straight men had CES-D scores consistent with depression as defined by a score of ≥16 (P=.09). In the PDQ domains, gay men scored less favorably with regard to bother scores (7 vs 5, P=.03) and pain scores (8 vs 4, P=.04). Gay men with PD experience significantly more psychosocial impact as evidenced by less favorable SEAR sum and sexual relationship scores, CES-D scores, and PDQ pain and bother domain scores. The psychosocial impact of PD is significant in all men, but it appears to be greater in gay men.

Evaluating the Impact of Penile Girth Discrepancy on Patient Bother in Men With Peyronie's Disease: An Observational Study

BackgroundMen with Peyronie's disease (PD) may experience penile narrowing. Little data on penile girth changes and their psychosocial impact exist. AimTo assess girth discrepancy in men with PD and its association with patient bother. MethodsThis was a retrospective observational study. All patients with PD at our institution who were seen in the sexual medicine clinic and who completed 3 validated instruments the PD questionnaire (PDQ), Self-Esteem and Relationship (SEAR) questionnaire, and a depression questionnaire, the Center for Epidemiologic Studies Depression Scale (CES-D), and a curvature assessment were included. Patient and PD characteristics are described. Associations of instability and bother to girth differences are assessed. 2 outcomes for girth differences are classified as (i) girth difference of ≥ 1 cm vs less and (ii) girth differences of ≥10% vs less. Unadjusted and adjusted effects of PD and patient characteristics are assessed on the outcome of high bother using logistic regression models. OutcomesThe main outcomes of this study were penile girth changes, instability, and questionnaire scores. High bother was defined as a PDQ bother score of ≥9. ResultsA total of131 men had midshaft curvature and were the focus of the study. Their mean age was 59 ± 9 (range 31–78) years. PD duration was 16 ± 25 (range 1–180) months, with a mean degree of primary curvature of 37 ± 20o. Mean girth difference between base and point of maximum curvature was 0.78 ± 0.53 cm equating to a mean girth difference at point of maximum curvature of 6 ± 4%. Instability was present in 53% of men. There were 54 men with a girth difference of ≥ 1 cm and 23 men with a ≥10% change in girth. There was no difference in CES-D, SEAR, or PDQ domain scores or high bother in men with significant girth changes. Univariable analysis of predictors of high bother included the degree of curvature (odds ratio [OR]: 1.06; P < .001), instability (OR 6.62; P < .001), CES-D sum (OR 1.09; P = .002), and SEAR score (OR 0.96; P = .001). On multivariate analysis, only the degree of primary curvature was predictive of high bother (OR 1.06; P < .001). Clinical ImplicationsPenile girth changes have little impact on overall psychosocial well-being. The degree of penile curvature is the primary predictor of patient bother. Strengths and LimitationsStrengths include a large patient population and use of validated questionnaires. Limitations include single-center, retrospective study and subjective instability grading. ConclusionsPenile girth discrepancy in men with PD has limited psychosocial impact. Clinically significant bother was associated with the degree of primary curvature.Salter CA, Nascimento B, Terrier, JE, et al. Evaluating the Impact of Penile Girth Discrepancy on Patient Bother in Men With Peyronie's Disease: An Observational Study. J Sex Med 2020;17:1560–1565.

The Relationship and Psychosocial Impact of Arousal Incontinence After Radical Prostatectomy

IntroductionArousal incontinence (AI) is a lesser known complication of radical prostatectomy (RP), and few data are available on its impact on self-esteem and sexual relationships. AimThe goal of this study was to assess the impact of AI on patient self-esteem, confidence, and sexual relationships. MethodsThis was a retrospective study. The validated Self-Esteem and Relationship (SEAR) questionnaire, as well as questions regarding AI, stress urinary incontinence (SUI), climacturia, International Prostate Symptom Score, and the International Index of Erectile Function erectile function domain, were sent to men who had undergone an RP within the past 24 months at a single institution. The data were de-identified and analyzed using descriptive statistics. OutcomesThe outcomes of this study include prevalence of AI, SEAR domain scores, patient and partner bother, management strategies employed by the patients, and the presence of concurrent climacturia or SUI. ResultsFifty-three percent of men experienced post-operative AI; of these, 41% were currently experiencing AI, and 12% reported having prior AI that had resolved. Bother of any severity was reported by 87% of men, and perceived partner bother was reported by 64% of men. Forty-one percent of men with current AI avoided sexual activity due to the presence of AI, and 14% of men with prior AI still avoided intercourse. There was no difference in total SEAR score or in the subdomains of self-esteem, sexual relationship, or confidence between men with current AI compared to those with no AI. Clinical ImplicationsAI leads to patient bother and avoidance of sexual situations. Strengths & LimitationsThis is the largest study specifically evaluating AI and the only study assessing its impact on self-esteem, sexual relationships, and self-confidence. Limitations include lack of a validated AI questionnaire, poor survey response rate, being a single-center study, and the potential for recall bias. ConclusionAlthough AI is a common occurrence post-RP and is associated with patient bother in the majority of men, it does not impact overall self-esteem, confidence, or sexual relationships compared to post-RP men who have not experienced AI.Salter CA, Bach PV, Katz D, et al. The Relationship and Psychosocial Impact of Arousal Incontinence After Radical Prostatectomy. J Sex Med 2020;17:94–98.

PD20-07 PREDICTORS OF FEMALE SEXUAL DYSFUNCTION IN INTERSTITIAL CYSTITIS/BLADDER PAIN SYNDROME, OTHER CHRONIC PAIN CONDITIONS AND HEALTHY CONTROLS IN THE MAPP RESEARCH NETWORK

INTRODUCTION AND OBJECTIVES:Female sexual dysfunction (FSD) is associated with lower quality of life (QoL) in interstitial cystitis/bladder pain syndrome (IC/BPS). Our objectives were to: 1) compare the prevalence of FSD among IC/BPS, other non-urologic chronic pain conditions (positive controls, PCs) and healthy controls (HCs); 2) evaluate the role of psychosocial and urologic factors in FSD in all three cohorts; 3) correlate longitudinal changes in FSD with changes in IC/BPS symptoms.METHODS:Cross sectional analysis was performed on female participants in the Multidisciplinary Approach to the Study of Chronic Pelvic Pain (MAPP) Research Network. FSD was defined as a score <26 on the Female Sexual Function Index (FSFI). Baseline data were compared by ANOVA and chi-squared tests. Multivariate logistic regression was used to assess associations between psychosocial variables [Self Esteem and Relationship (SEAR); Perceived Stress Scale (PSS); Hospital Depression and Anxiety Scale (HADS), International Perso...

159 Preliminary study of a specific penile prosthesis conceived for phalloplasty, the ZSI® 475 FtM

Assessing security, feasibility and patient satisfaction of a new type of penile prosthesis specifically designed for phalloplasty. Patients were included from June 2016 to September 2017 at a single institution by a single surgeon. Medical data were collected from the patients’ hospital files. Patients were then proposed to answer a satisfaction questionnaire that included IIEF (International Index of Erectile Function) questionnaire, EDITS (Erectile Dysfunction Inventory of Treatment Satisfaction) questionnaire, SEAR (Self-Esteem and Relationship) questionnaire, and specific items. Twenty patients were included, mean age 37.9 years, and 21 prostheses were implanted. All had gender dysphoria and phalloplasty type were forearm flap (n=15, 75%), suprapubic (n=4, 20%) and pedicled inguinal (n=1, 5%). 17 patients (85%) had functional urethroplasty. Complications were 2 (10%) infections medically treated, 1 (5%) infection treated by explantation, 2 (10%) mechanical failures and 1 (5%) malposition. Mean operating time was 102.6 min (SD 13.2) and mean duration of hospitalization was 2.7 days (SD 0.5%). Fourteen patients (70%) answered the satisfaction questionnaire. Twelve (85.7%) patients had sexual relationship regularly. Mean IIEF was 20.2 over 25 (SD 7.9), mean SEAR was 84.5 over 100 (SD 9.9) and mean EDITS was 82 over 100 (SD 17.5). Thirteen patients (92.8%) were satisfied or very satisfied with the prosthesis.

A Comparative study of two types of organ-sparing surgeries for early stage penile cancer: Wide local excision vs partial penectomy

IntroductionTill date, there have been few reports of comparative studies on the outcomes of these different treatment modalities. In this study, we have aimed to comparatively evaluate the quality-of-life parameters, including sexual function, urinary function, and health-related quality of life (HRQOL), in patients with early stage penile cancers who underwent two different organ-sparing surgeries. Material and MethodsFrom March 2012 to March 2015, we enrolled 15 patients with early stage penile cancers who underwent either wide local excision or partial penectomy as organ-sparing surgical treatments. We assessed their sexual and urinary functions and their HRQOL, using the International Index of Erectile Function (IIEF-15), Self-Esteem and Relationship (SEAR), and Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) questionnaires and urodynamic determinations, and comparatively analyzed the outcomes of these patients who underwent either type of surgery. ResultsAll patients who underwent these two types of surgeries experienced satisfactory outcomes. The patients who underwent wide local excision performed relatively better, in terms of their sexual functions, urinary functions, and HRQOL, but no statistically significant differences were observed in the data collected via the IIEF-15, SEAR, EDITS, and EORTC-QLQ-C30 questionnaires and urodynamic determinations (p > 0.05), except in the data corresponding to the orgasmic function (p = 0.033). ConclusionBoth types of organ-sparing surgeries assessed in this study achieved good outcomes, in terms of the aesthetics, sexual functions, urinary functions, and HRQOL in patients, without compromising the therapeutic effects of these surgeries. However, the observed decreases in orgasmic function will need to be addressed further.

PD31-05 THE DEPRESSION AND RELATIONSHIP IMPACT IN PEYRONIE'S DISEASE STUDY (DRIPD): BASELINE POPULATION CHARACTERISTICS AND PREDICTORS

You have accessJournal of UrologySexual Function/Dysfunction: Peyronie’s Disease I1 Apr 2017PD31-05 THE DEPRESSION AND RELATIONSHIP IMPACT IN PEYRONIE'S DISEASE STUDY (DRIPD): BASELINE POPULATION CHARACTERISTICS AND PREDICTORS Jean-Etienne Terrier, Lawrence C Jenkins, Christian J Nelson, and John P Mulhall Jean-Etienne TerrierJean-Etienne Terrier More articles by this author , Lawrence C JenkinsLawrence C Jenkins More articles by this author , Christian J NelsonChristian J Nelson More articles by this author , and John P MulhallJohn P Mulhall More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1383AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES There is a growing body of literature focusing on the impact PD on men's mental health and relationships. Aim: to assess the impact of PD on men's psychological and relationship health. METHODS Patients were administered 3 validated questionnaires at presentation: the Self-Esteem and Relationship (SEAR) questionnaire includes 5 components, scores standardized by transforming onto a scale of 0-100, higher scores being more favorable; the Center for Epidemiologic Studies Depression Scale (CES-D), with moderate and severe depressive symptoms were defined as >14 and >21, respectively; the Peyronie's Disease Questionnaire (PDQ) 3 domains, psychological & physical symptoms, pain, symptom bother. Multivariable analysis (MVA) was used to explore predictors of baseline scores. Factors entered into the model included: age, sexual orientation, degree of curvature; duration of PD at presentation, the presence of non-curvature deformity, patient reported loss of length, stretched flaccid penile length, pain, penile instability, and ability to penetrate. RESULTS Data from 204 men have been analyzed. Mean age = 56±12 years. Median PD duration = 9 months, mean curvature = 39±21 degrees, ED in 39%. 82% of patients were partnered with mean relationship duration=20 years. The mean penile length was 11 cms. 25% of the sample met the CES-D cut-off for depression: 13% moderate, 12% severe. Mean SEAR scores: total 54±24; sexual relationship 44±28 ; confidence 68±24; self esteem 68±25; overall relationship 70±30. These scores are similar to SEAR scores reported by men with moderate to severe ED. Mean PDQ scores: psychological & physical 11±6; pain 5±6; bother 7±4. Theses trends are similar to PDQ scores reported in the phase 3 Xiaflex studies (IMPRESS I & II). On MVA, higher CES-D scores were related to the inability to penetrate (β=0.18, p=0.04). Lower SEAR total scores were related to inability to penetrate (β=-0.30 p=0.01) and greater curvature (β=0.25, p=0.04). Higher PDQ Bother scores were related to greater curvature (β=0.33, p=0.02), and marginally related to perceived loss of penile length (β=0.24, p=0.06) and inability to penetrate (β=0.22 p=0.09). CONCLUSIONS The data reinforce the significant prevalence of depression as well as psychosexual and relationship health in degree to men with ED. Common predictors of psychological and relationship variables were inability to penetrate, greater curvature, and perceived loss of penile length. Quality of life questionnaires into clinical practice might benefit some patients. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e584-e585 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Jean-Etienne Terrier More articles by this author Lawrence C Jenkins More articles by this author Christian J Nelson More articles by this author John P Mulhall More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Sexual outcomes after partial penectomy for penile cancer: results from a multi-institutional study

Penile cancer is an uncommon malignancy. Surgical treatment is inevitably mutilating. Considering the strong impact on patients’ sexual life we want to evaluate sexual function and satisfaction after partial penectomy. The patients in this study (n = 25) represented all those who attended our institutions and were diagnosed and treated for penile cancer from October 2011 to November 2013. All patients underwent partial penectomy and followed-up (mean: 14 months; range: 12–25). Sexual presurgical baseline was estimated using the International Index of Erectile Dysfunction 15 (IIEF-15). Sexual outcomes of each patient were estimated considering four standardized and validated questionnaires. We analyzed the means and ranges of IIEF-15 including erectile function (IIEF-1–5 and -15), orgasmic function (IIEF-9 and -10), sexual desire (IIEF-11 and -12), intercourse satisfaction (IIEF-6–8), and overall satisfaction (IIEF-13 and -14). Then, we also used Quality of Erection Questionnaire (QEQ), Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) and Self-Esteem and Relationship (SEAR) to evaluate the sexual function and satisfaction of our patients. The final results showed that penile cancer leads to several sexual and psychosexual dysfunctions. Nevertheless, patients who undergo partial penectomy for penile cancer can maintain the sexual outcomes at levels slightly lower to those that existed in the period before surgery.