Sexual Health Inventory For Men Score Research Articles

Two Year Functional Outcomes Stratified According to Baseline Erectile Function Following Partial Gland Cryo-Ablation

OBJECTIVETo critically evaluate time dependent sexual function following primary partial gland cryo-ablation (PGCA) stratified according to baseline erectile function. METHODSBetween March 2017 and March 2022, all men undergoing primary PGCA by 2 surgeons were enrolled in an IRB approved outcomes registry. All subjects with PIRADS 2-5 lesion concordant with unilateral GGG 1-3 disease, no gross extra-prostatic extension on mpMRI, GGG >1 contralateral to the ROI, or distal apical disease on mpMRI were enrolled. Patients completed the Sexual Health Inventory for Men (SHIM) scale at baseline, 6, and 24 months. Men were stratified by baseline erectile function. Men with SHIM Score < 8 were excluded. Ability to sustain erection (aka “potency”) was defined as a score of 3 or greater on question 2 of the SHIM index. Median SHIM scores and the proportion of men reporting “potency” at baseline, 6, and 24 months was recorded with comparisons between each timepoint. A univariate analysis was used to determine if clinical factors were associated with loss of “potency” at 24 months. RESULTS106 men met the inclusion criteria. There was a statistically significant decrease in the mean SHIM scores for the entire cohort between baseline to 6 months and baseline to 24 months. SHIM scores increased significantly for the total cohort between 6 and 24 months. “Potency” was preserved in 70% at 24 months. CONCLUSIONThose patients most likely to exhibit a decrease in sexual function have moderate ED at baseline. Only baseline ED was shown to predict preservation of “potency”.

The correlation between erectile function and adiponectin levels in men with late-onset hypogonadism

Aim: This study investigated the relationship between erectile dysfunction (ED) and adiponectin levels in hypogonadal men. Methods: In this study, 218 patients with hypogonadism (mean age: 65.1 ± 8.3 years) were enrolled. All patients underwent physical examinations, with measurement of body mass index, body fat ratio, and waist circumference. The erectile function was assessed using the sexual health inventory for men (SHIM) scoring system. Blood biochemical profiles such as free testosterone, fasting blood glucose, and lipid profile including adiponectin levels were measured. All patients were divided into two groups based on their SHIM score: normal to moderate ED (SHIM score ≥ 12) and severe ED (SHIM score < 12), and the factors associated with severe ED were determined. Patients with severe ED were divided into two groups based on adiponectin levels (cutoff value of 7.0 μg/mL), and their basic characteristics were compared between these two groups. Results: The severe ED group was older and had higher adiponectin levels. In patients with severe ED, various metabolic parameters were significantly worse in the low adiponectin groups than in the non-low adiponectin group. Conclusions: The risk of developing cardiovascular diseases is extremely high in hypogonadal men with severe ED who had lower serum adiponectin levels.

Relationships of low-grade systemic inflammation and nutritional status with erectile dysfunction severity in men on dialysis.

Low-grade systemic inflammation and malnutrition are frequently observed in patients on dialysis and contribute to the development of endothelial dysfunction; however, the role of these conditions in erectile dysfunction (ED) severity remains to be elucidated. To investigate the relationships of low-grade systemic inflammation and nutritional status with ED severity in men on dialysis. The present study included 71 men on dialysis. The sexual health inventory for men (SHIM) was used to assess ED. Men were classified as the mild/moderate (SHIM score ≥ 8) and severe ED (SHIM score ≤ 7) groups. C-reactive protein/albumin ratio (CAR) and Geriatric Nutritional Risk Index (GNRI) were used to evaluate low-grade systemic inflammation and nutritional status, respectively. We performed multivariate analysis to assess the relationships of CAR and GNRI with severe ED. The median age of the included men was 64 years old. All men had any degree of ED with 65% having severe ED. In the univariate analyses, a significant association was observed between elevated CAR (≥0.09) and severe ED (odds ratio [OR]: 4.038, p=0.025), whereas no significant association was observed between lower GNRI(&lt;92) and severe ED (OR: 2.357, p=0.109). In the multivariate analysis, an association between elevated CAR and severe ED was still significant (OR: 5.985, p=0.010). Low-grade systemic inflammation was significantly associated with ED severity, whereas lower GNRI was not. These results may be helpful for further research to identify the optimal treatment for men suffering from severe ED.

Effect of 3-Dimensional, Virtual Reality Models for Surgical Planning of Robotic Prostatectomy on Trifecta Outcomes: A Randomized Clinical Trial.

Planning complex operations such as robotic-assisted radical prostatectomy requires surgeons to review 2-dimensional magnetic resonance imaging (MRI) cross-sectional images to understand 3-dimensional (3D), patient-specific anatomy. We sought to determine surgical outcomes for robotic-assisted radical prostatectomy when surgeons reviewed 3D, virtual reality (VR) models for operative planning. A multicenter, randomized, single-blind clinical trial was conducted from January 2019 to December 2020. Patients undergoing robotic-assisted laparoscopic radical prostatectomy were prospectively enrolled and randomized to either a control group undergoing usual preoperative planning with prostate biopsy results and MRI only or to an intervention group where MRI and biopsy results were supplemented with a 3D VR model. The primary outcome measure was margin status, and secondary outcomes were oncologic control, sexual function and urinary function. Ninety-two patients were analyzed, with trends toward lower positive margin rates (33% vs 25%) in the intervention group, no significant difference in functional outcomes and no difference in traditional operative metrics (p >0.05). Detectable postoperative prostate specific antigen was significantly lower in the intervention group (31% vs 9%, p=0.036). In 32% of intervention cases, the surgeons modified their operative plan based on the model. When this subset was compared to the control group, there was a strong trend toward increased bilateral nerve sparing (78% vs 92%), and a significantly lower rate of postoperative detectable prostate specific antigen in the intervention subset (31% vs 0%, p=0.038). This randomized clinical trial demonstrated patients whose surgical planning involved 3D VR models have better oncologic outcomes while maintaining functional outcomes.

Testosterone level in seminal vesicle fluid is a better indicator of erectile function than serum testosterone in patients with prostate cancer.

Semen comprises prostatic fluid and seminal vesicle fluid, and seminal vesicle fluid contains various factors such as prostaglandin E2 (PGE2), zinc, and testosterone, which play important roles in sperm motility. It is not known whether these factors affect erectile function. In this study, we investigated factors in seminal vesicle fluid that may affect erectile function. After receiving institutional review board approval, we collected seminal vesicle fluid samples from 134 Japanese patients with localized prostate cancer who underwent robot-assisted radical prostatectomy. We examined the relationship between the results of the Sexual Health Inventory for Men (SHIM), erection hardness score, an original questionnaire on the presence or absence of sexual desire, and concentrations of several factors in seminal vesicle fluid (testosterone, PGE2, transforming growth factor β1, and 8-hydroxy-2-deoxyguanosine), as well as the serum testosterone level. Median participant age was 67 (range 51-77) years. Median concentrations were as follows: seminal vesicle testosterone 1.85 (range 0.17-4.32) ng/ml and serum testosterone 4.60 (range 1.75-10.82) ng/ml. When the SHIM score was divided into two groups, seminal vesicle testosterone concentration was significantly increased (p = 0.002) in participants with a SHIM score ≥17, and no significant difference was observed in serum testosterone levels (p = 0.661). Multivariate analysis revealed that seminal vesicle testosterone was significantly correlated with the SHIM score (≥17 vs. <17; odds ratio 2.137, 95% confidence interval 1.148-3.978, p = 0.016). Testosterone levels in seminal vesicle fluid can reflect erectile function in patients with prostate cancer, suggesting that seminal vesicle testosterone is very important for male erectile function.

The brachial-ankle pulse wave velocity is a predictive factor for erectile dysfunction in patients with benign prostate hyperplasia

ABSTRACT Introduction Phosphodiesterase (PDE) 5 inhibitors induce relaxation of endothelial cells. Tadalafil, one of PDE 5 inhibitors, has been applied for the treatments of erectile dysfunction (ED) and benign prostate hyperplasia (BPH). Under continuous treatments with PDE 5 inhibitor for BPH, it is significant to investigate the relationship between endothelial and sexual functions by comparing the brachial-ankle pulse wave velocity (baPWV).and the sexual health inventory for men (SHIM) score. Objectives Total 89 BPH patients who consulted our clinic with a complaint of urinary symptoms were enrolled in this prospective study. They were treated with a daily dose of 5mg tadalafil. Methods The Institutional Review Board (IRB) approved this clinical study and informed consents had been obtained from 89 BPH patients. Their vessels endothelial function was assessed by baPWV and erectile function was evaluated by SHIM score. International prostate symptom score (IPSS) was obtained as male lower urinary symptoms (LUTS) parameters. However, we focused on the relationship between vessels endothelial and erectile function in this sub-analysis report. Therefore, the SHIM scores were compared with baPWV and IPSS at 0, 3, 6, 12, 24, 36, 48, 60, 72 and 84 months after PDE5 inhibitor treatment. Results The mean age of 89 patients was 66.7 +/- 11.1 years old. Their prostate size was 29.8 +/- 21.2 ml. Initial SHIM, baPWV and IPSS score were 7.4 +/- 5.6, 1742.5 +/- 393.0 cm/sec and 17.5+/- 7.5, respectively. Before tadalafil treatment, baPWV and SHIM were significantly correlated (p=0.0025) which indicated patients with low vessels endothelial function vessels endothelial function suffered from erectile dysfunction. F4rthere06re, all the data of baPWV and SHIM including after tadalafil treatment from 3 to 84 months (n=472) were significantly co-related each other (p&amp;lt;0.0001). On the other hand, baPWV were significantly improved from 3 to12 months after tadalafil administration, however baPWV levels returned to the baseline levels after 24 to 84 months. SHIM score was significantly improved from 3 to24 months after tadalafil administration, however SHIM levels returned to the baseline levels after 36 to 84 months. Conclusions Our previous paper (Aging Male 21, 2018) reported that PDE5 inhibitors improved ED, male LUTS and baPWV from 3 to 12 months. The present data also suggested that endothelial function and male LUTS strongly related to ED in BPH patients. However, baPWV and SHM score levels returned to the baseline levels after 24 and 36 months, respectively. Thus, tadalafil can delay vessels endothelial and erectile dysfunction in BPH patients. In addition, erectile dysfunction seems to be occurred after vessels endothelial dysfunction. Hence, baPWV might be a predictive factor for ED in BPH patients with tadalafil treatments. Disclosure Work supported by industry: no.

Relationship between sexual function improvement and treatment satisfaction by TRT in LOH patients

ABSTRACT Introduction In the treatment of LOH (late-onset hypogonadism) syndrome, TRT (testosterone replacement therapy) is effective for various LOH related symptoms including sexual function. However, among Japanese population, sexual desire is not always strong in elderly men. Even if the patients do not have opportunities of sexual intercourse, TRT may still be beneficial for other symptoms derived from LOH syndrome. Objectives To examine patients’ satisfaction by TRT, we examined the relationship between TRT effect on sexual function and whole treatment satisfaction in our patient cohort. Methods Patients who have LOH symptoms and low serum free-testosterone (FT) levels were diagnosed as LOH syndrome. FT was diagnosed as “low” when &amp;lt;8.5pg/ml, while diagnosed as “borderline” when 8.5-11.8pg/ml. For TRT, testosterone enanthate 250mg/2-4weeks was given for more than 6 months. SHIM (Sexual Health Inventory for Men) score and our original questionnaire asking whether they are satisfied with the treatment were examined. Results Median patients’ age was 54 years (n=95). Before treatment, total testosterone was 4.5±1.8ng/ml and free testosterone was 6.2±2.3pg/ml. The majority of chief complaint before treatment were psychological or somatic symptoms. After treatment, SHIM score showed significant improvement in all questions of 1 to 5, and total SHIM score increased from 6.4 to 9.4. The number of patients who have few opportunities for sexual intercourse (0 point for SHIM Q3.4.5) decreased from 66% to 48% after treatment. Using the questionnaire for patients’ satisfaction, 71% were classified into the effective group. The number of patients who still had few opportunities of sexual intercourse after treatment was 39% in the effective group and 71% in the ineffective group. Conclusions From the point of patient satisfaction, TRT for LOH syndrome was effective in 71% of patients. Almost 40 percent of the patients who were satisfied with the treatment answered that there were few opportunities of sexual intercourse even after treatment. The improvement in sexual function may not be always required in a cohort of our patient population. Disclosure Work supported by industry: no.

Testosterone level in seminal vesicle fluid is a better indicator of sexual function than serum testosterone in patients with prostate cancer

ABSTRACT Objective Semen comprises prostatic fluid and seminal vesicle fluid, which makes up the largest proportion. Seminal vesicle fluid contains various factors such as prostaglandin E2 (PGE2), zinc, and testosterone, which play important roles in sperm motility. Although serum testosterone is important in sexual function, many points are unclear regarding correlations between serum testosterone level and erectile function. We hypothesized that testosterone in seminal vesicle fluid may affect sexual function. Methods After receiving institutional review board approval, we collected seminal vesicle fluid samples from 132 Japanese patients with localized prostate cancer who underwent robot-assisted prostatectomy at Kyushu University Hospital from May 2017 to August 2020. We examined the relationship between results of the Sexual Health Inventory for Men (SHIM), Erection Hardness Score (EHS), an original questionnaire (presence or absence of sexual desire), and concentrations of testosterone in seminal vesicle fluid as well as serum testosterone level. Results Median participant age was 68 (range 51–77) years. Median concentrations were as follows: seminal vesicle testosterone 1.85 (range 0.17–4.32) ng/mL, serum testosterone 4.59 (range 1.75–10.82) ng/mL. When SHIM score was divided into two groups, seminal vesicle testosterone concentration was significantly increased (P=0.001) in participants with SHIM score ≥17; no significant difference was observed in serum testosterone (P=0.716). EHS score was also correlated with seminal vesicle testosterone (P=0.031) but not serum testosterone (P=0.380). Multivariate analysis revealed that seminal vesicle testosterone was significantly correlated with SHIM score (≥17 vs. &amp;lt;17, odds ratio: 2.374, 95% confidence interval: 1.244–4.529, P=0.008). Seminal vesicle testosterone was not correlated with age (R2=0.032) or serum testosterone (R2=0.014). Conclusions Testosterone levels in seminal vesicle fluid can reflect sexual function in patients with prostate cancer, suggesting that seminal vesicle testosterone may affect male sexual function. Disclosure Work supported by industry: no.

Relationship between self- image of penile size and erectile function in Japanese men

ABSTRACT Background Many studies on penile size have been conducted in other countries, but very few in Japan. Furthermore, there are no reports about men's self-image of penile size or the effect of self-image on erectile function. Objectives We investigated penile size in male urology outpatients and examined the difference between subjective and objective penile size and the relationship between self-image and erectile function. Materials and Methods 186 patients who visited our clinic between April 2007 and March 2015 with the chief complaint of late-onset hypogonadism symptoms were enrolled. Patients were asked to complete a questionnaire that included their self-assessed flaccid and erect penile length, self-image of their penile size, SHIM (Sexual Health Inventory for Men) score, and time to ejaculation. All objective penile measurements including stretched length and circumference were performed by the same physician (s). Results The mean self-assessed flaccid and erect penile lengths were 6.8 cm and 12.5 cm, respectively. The mean objectively measured flaccid and stretched penile lengths were 8.3 cm and 12.6 cm, respectively. Most of the patients (71.0%) rated their penis as normal, 27.9% as small, and only 1.1% as large. 28.5% of the patients described their penis as short, and 17.2% as thin. The mean SHIM score of patients who rated their penis as small (7.9) was significantly lower than that of patients who rated their penis as normal (10.5) (p&amp;lt;0.05). The mean time to ejaculation of all patients was 8.7 minutes, and that of the patients with premature ejaculation was 4.6 minutes. Fewer cases (8.6%) desired treatment for penile length, compared to those desiring treatment for ED (31.7%) or premature ejaculation (18.3%). Conclusion Compared with reports from other countries, a high percentage of Japanese patients are dissatisfied with their penile size, and these patients may have a lower self-esteem with respect to their erectile function. Disclosure Work supported by industry: no.

Novel 3D MRI fusion penile imaging modality for Peyronie's disease: A pilot study

ABSTRACT Introduction Penile imaging for Peyronie's disease (PD) can be challenging. Traditional cross-sectional imaging modalities such as computerized tomography (CT) or magnetic resonance imaging (MRI) can delineate and characterize pathological penile anomalies; however, limitation in imaging interpretations do exist. Optimal imaging of the penis aids in surgical planning and patient counseling. Objective In this study, we aim to utilize a novel three-dimensional (3D) MRI fusion penile imaging modality for men undergoing surgical reconstruction for PD. Methods Men with PD, palpable plaques, and deformed corpora were included in this study. We obtained preoperative cross-sectional MRI penile images and Sexual Health Inventory for Men (SHIM) Questionnaire (SHIM) scores on all included patients. We fused MRI images with Ceevra (Ceevra, Inc., San Francisco, CA, USA) 3D imaging software to develop detailed imaging aiding surgical reconstruction. 3D models were used for preoperative patient counseling and surgical planning as well as intraoperatively. Results A total of six patients were included, 3 African American men and 3 White men. The mean age was 65 and mean BMI was 35. There was no difference in preoperative SHIM scores (4 severe and 2 mild erectile dysfunction). Preoperative MRI images were fused with Ceevra software to develop detailed 3D models of corporal plaques and its related structures. The 3D models were easily accessible to surgeons during preoperative clinic visits and at time of reconstruction (Figure 1). Conclusions In this study, 3D MRI fusion penile imaging for PD has emerged as a potential preoperative advanced imaging modality useful for preoperative counseling and planning, especially in complex PD cases. Further evaluation is prerequisite to evaluate its potential role in aiding intraoperative decision making. Disclosure Work supported by industry: no.

Lipid abnormality, current diabetes and age affect erectile hardness ∼ An analysis of data from complete medical checkups performed at a single hospital in Japan

ABSTRACT Objectives The Erection Hardness Score (EHS) can assess erectile hardness with a single question and is readily used in routine clinical practice. We investigated the correlation between EHS and both erectile function and metabolic risk, lifestyle, and other factors. Methods This study included 548 men who underwent a complete standard medical checkup at our hospital between July 1, 2016, and August 31, 2018, and answered the question about erectile hardness. The following variables were evaluated: age, erectile hardness on the EHS, erectile function on the Sexual Health Inventory for Men (SHIM), current medical history (diabetes, hypertension, dyslipidemia, heart disease, stroke), metabolic risk factors (abdominal circumference, hyperglycemia, high blood pressure, lipid abnormality), and lifestyle factors. First, to examine the correlation between erectile hardness and erectile function, the mean SHIM score by EHS grade was determined for each age group. Then, an analyses was performed to examine the association between erectile hardness and age, current medical history, metabolic risk factors, and lifestyle factors. Results In each age group, a lower EHS grade was associated with a lower mean SHIM score. Lipid abnormality, diabetes, and age were independent risk factors for decreased erectile hardness. Conclusion The EHS as a measure of erectile hardness was correlated with erectile functional as assessed using the SHIM, and current diabetes and lipid abnormality were independent risk factors for decreased erectile hardness. However, neither dyslipidemia nor lipid abnormality is listed as a risk factor in the ED guidelines. Traditionally, lipid abnormality was assessed based mainly on the presence or absence of current hyper-lipidemia and serum total cholesterol level. Today, the diagnostic criteria for metabolic syndrome proposed by the World Health Organization, International Diabetes Federation, and Japanese Society of Internal Medicine also recommend the use of serum triglyceride and HDL cholesterol levels, instead of total cholesterol level, for evaluating lipid abnormality. I think the assessment of lipid abnormality should be used triglyceride and HDL cholesterol levels, instead of total cholesterol level. Disclosure Work supported by industry: no.

Patient Perception, Rather Than Magnitude of Objective Improvement, Predicts Desire for Treatment Amongst Men Undergoing Penile Shockwave Therapy

ABSTRACT Introduction Novel treatments options for refractory erectile dysfunction, including penile shockwave therapy, have recently been introduced. Despite uncertain clinical efficacy, direct-to-consumer marketing has resulted in increased patient interest in these treatments, often associated with high out-of-pocket costs. Objective In the current study, we sought to assess outcomes in men with refractory erectile dysfunction undergoing penile shockwave therapy, as well as patient's perception of treatment outcomes. Methods Community-dwelling men receiving care at a local county hospital were prospectively recruited to undergo penile shockwave therapy for treatment of refractory erectile dysfunction. Men underwent a total of six treatment sessions free of charge. Response to therapy was tracked utilizing the Sexual Health Inventory for Men (SHIM), with successful response defined as an increase in average SHIM score following treatment, as compared to baseline scores. Upon completion of treatment, defined as 4 out of 6 sessions or more, men were asked about their subjective perception of treatment benefit, including whether they would repeat treatment and recommend treatment to others. Logistic regression and Pearson's chi-squared test were used to determine whether objective treatment effect predicted men's attitudes towards penile shockwave therapy. Results A total of 23 men were prospectively recruited to our study. Of these, 19 patients (83%) completed 4 out 6 shockwave treatments. Based on increase in SHIM score, 13 men (68%) were deemed responders to therapy, while 6 men (32%) were deemed non-responders. Amongst all-comers, the median change in SHIM score before and after treatment was 0.7 points (interquartile range: 3 points). Amongst responders, the median increase was 1.3 points, while non-responders experienced a median decrease in SHIM score of 2 points after completion of treatment. No statistically significant differences were noted between responders and non-responders with regard to important patient characteristics such as age, BMI, and smoking status, as well as comorbidities including diabetes, peripheral arterial disease, and history of myocardial infarction. Amongst patients completing treatment, 50% noted subjective improvements, while 93% stated they would repeat treatment and recommend treatment to others. On univariate logistic regression, objective response to therapy, based on increase in SHIM score, failed to predict patient's subjective sense of improvement (OR=5, 95% CI 0.3-72.8, p=0.24) and the frequency subjective improvement was not statistically different amongst responders and non-responders (Pearson's chi-squared; p=0.22). Conclusions Objective, clinically significant improvement in SHIM scores was not seen amongst men undergoing penile shockwave therapy for erectile dysfunction. Despite this, men experienced subjective improvement and a high rate of desire to continue treatment and recommend treatment to others, which could not be predicted by objective response to treatment. Increased patient education is required in order to set treatment expectations for costly novel therapies. Disclosure No

Expedited algorithm for IPP following Radical Prostatectomy

ABSTRACT Introduction Erectile dysfunction (ED) following radical prostatectomy (RP) is a postoperative result that negatively impacts patient quality of life. The recovery of potency following radical prostatectomy varies depending on a multitude of factors including but not limited to surgical technique, surgeon experience and patient comorbidities. There are several factors that contribute to this decline in erectile function as a result of oncologic control after RP which may be classified as vasculogenic, neurogenic, and psychological. Current guidelines recommend patients wait up to 24 months before IPP surgery. However, no definitive algorithm or guideline has been established for the expedited management of ED in the postoperative setting following radical prostatectomy. Objective We are proposing an expedited algorithm for patients who fail PDE-5 inhibitors at the three-month follow-up following RP. Methods Patients who underwent inflatable penile prosthesis (IPP) surgery for the treatment of ED over a 36-month period following RP were identified from our IRB approved database. All patients completed an IIEF-5 questionnaire and had a penile doppler ultrasound (PDUS) performed preoperatively. Validated scoring for erectile function was performed with the International Index of Erectile Function (IIEF-5), and the Sexual Health Inventory for Men (SHIM) was defined. The relationships, according to Doppler diagnosis, IIEF-5 score, SHIM scale, and erection score were evaluated as well as surgical outcomes and patient comorbidities. Logistic regression and Wilcoxon rank sum tests were performed. Results 1,158 patients were evaluated in this series, of whom 121 met inclusion criteria. PDUS determined that 88 (72.8%) suffered from veno-occlusive disease, while 19 (15.7%) had arterial insufficiency. 101 (83.4%) had a RALP vs 20 (16.6%) who received an open RP. The mean time between RP and IPP was 20 months, with the mean ages of RP and IPP being 58 and 64 years respectively. Ages of patients ranged from 40 to 82 years old. Increased time between RP and subsequent IPP was correlated with lower SHIM scores. Additionally, each month that passed caused a decrease of 1.8% in SHIM scores (p&amp;lt; 0.05), as well as a greater likelihood of developing worsening vasculogenic ED (p= 0.042). Increased patient age during RP and subsequent IPP was also correlated with lower SHIM scores (p= 0.049), while RALP was found to be a predictor of higher patient satisfaction (p= 0.02). Conclusions As a result of the overwhelming diminishing SHIM scores over the 20 month postoperative course following RP as well as the significant prevalence of veno-ccclusive disease in this common patient population, we are strongly recommending a baseline PDUS at the 3 month followup. Furthermore, if veno-occlusive disease is identified upon the 3 month baseline PDUS, we encourage frank discussion of IPP placement with the patient. Equally important is it to consider discussing the degree of veno-occlusive disease and resultant ED will worsen as the postoperative period lengthens. Those patients found to have veno-occlusive etiology should have early surgical intervention mitigating further severity of the subsequent veno-occlusive disease. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast and Boston Scientific

Characteristics of Patients with Erectile Complaints Referred to a Center of Excellence – Defining Complex Erectile Dysfunction

ABSTRACT Introduction The prevalence of erectile complaints in the US is estimated to be more than 50%. Most of the time ED complaints are evaluated and treated in the primary care setting. However, when first line measures are not efficient, patients are referred to general Urologists or to a specialized center. Objective The primary aim of this study is to describe the characteristics of patients referred to a tertiary center for evaluation of erectile complaints not responding to traditional first line therapies and, or patients with an associated complaint of penile deformity (rule out Peyronie's Disease/PD). Methods We retrospectively analyzed a cohort of patients between 2005 and 2019, detailing primary complaints, sexual histories, self-assessment scores, medical history and results of in office intracavernous injection followed by Color Doppler Duplex Ultrasound (CDDU). CDDU findings were recorded following injection of low dose alprostadil (10-20 mcg) and again after a period of privacy and visual sexual stimulation. CDDU findings including peak systolic velocities (PSV), and resistive indices (RIs) were recorded. Arterial insufficiency (AI) was defined as either a post-stimulation PSV &amp;lt; 25 (severe) or a PSV 25-34.9 with RI ≥ 0.9 (moderate). Cavernous venous occlusion disease (CVOD) was defined as post-stimulation PSV ≥35 with RI &amp;lt; 0.9. Vascular normal was defined as post-stim PSV ≥ 35 with RI ≥ 0.9. Results A total of 1490 patients with a median age of 60 (range, 18 – 88), median BMI of 28.4 (range, 15.9 – 56.8) and median Sexual Health Inventory for Men (SHIM) score of 10 (range, 0-25). In our cohort, 257/1489 (17.3%) patients had heart disease, 656/1489 (44.1%) patients had hypertension, 520/1489 (34.9%) patients had diabetes, and 203/1488 (13.6%) patients had a past medical history of hypertriglyceridemia. Smoking history was present in 853/1478 (57.7%) of patients and complaint of PDE-5 failure was made by 945/1201 (78.7%) patients who reported using it. 900 patients (60.4%) had a complaint of penile deformities and ED, 461 (30.9%) had a complaint of ED only, and 129 (8.7%) had a complaint of PD only. Prostate surgery history was noted in 316 men: radical retropubic prostatectomy 108, robotic assisted prostatectomy 134 and endoscopic resection or enucleation 74. Following CDDU we confirmed 767 (51.5%) patients with both ED and PD, 351 (23.6%) with ED only, and 310 (20.8%) PD only. We found 62 men (4.2%) had normal vascular erectile response to low dosage PGE1 (diagnosed as psychogenic ED vs. post-prostatectomy neurogenic ED). Among the 351 patients with ED only on Doppler, 132 (37.6%) had AI, 124 (35.3%) had CVOD, and 95 (27.1%) had a mixed vascular diagnosis. Among patients with vascular ED on diagnoses by CDDU, 73/351 (20.8%) had heart disease, 192/349 (55.0%) had smoking history, 273/311 (87.8%) complained of PDE5-inhibitor failure, 130/351 (37.0%) had diabetes, and median SHIM score was 7 (range 1-25). Conclusions This summary describes the characteristics in 1490 men who presented for evaluation of erectile complaints and or complaints of penile deformity to a tertiary care center. Patients referred to Urologists have complex ED, defined as refractory to PDE5-Inhibitors, associated with penile deformities, and multiple medical / surgical risk factors. Disclosure No

Lidocaine Incorporated Alprostadil-phentolamine Urethral Gel for Erectile Dysfunction: Patient Tolerability and Satisfaction

ABSTRACT Introduction Localized therapy remains an important tool in the armamentarium against ED in patients who decline surgical intervention. Options include intracavernosal injections (ICI) and intraurethral (IU) therapies. For patients averse to injections, IU can be an option. Discomfort is a common side effect of IU therapies. Objective Herein, we assess the use, tolerability and satisfaction of a lidocaine incorporated IU gel treatment including phentolamine and alprostadil. Methods In this single-center study, 75 patients were telephonically surveyed following the prescription of IU lidocaine-alprostadil-phentolamine gel for ED. Prior to IU therapy, all patients had ICI incorporated penile Doppler exams as part of their routine ED workup. Each survey consisted of 5 questions from the validated Sexual Health Inventory for Men (SHIM) questionnaire and 4 questions regarding satisfaction with IU therapy. Patients were excluded if they did not fill their IU prescription, did not answer after 3 attempted calls, declined participation, or were non-English speaking. Clinico-demographic factors were analyzed using chi-square, t-tests, and logistic regression to determine associations of treatment satisfaction. Results Out of 75 patients, 39 had treatment data available for analysis. Median age of the cohort was 61 years (IQR 56-66). Hypertension and hyperlipidemia were the most common comorbidities within the group at 21 (53.8%) patients and 13 (33.3%) patients, respectively. Surveys were conducted a median 128 days after initial prescription. In total, 15 (38.4%) patients were satisfied with IU treatment. Thirty-seven (94.9%) patients did not report pain with IU gel usage. Prior success with &amp;lt;10 units of ICI alprostadil-papaverine-phentolamine (during penile Doppler or as a previous therapy) was associated with increased treatment satisfaction (p=0.039). Post-treatment SHIM scores were also associated with increased treatment satisfaction (p=0.047). Factors such as age, time since initial insult, hypertension, or hyperlipidemia were not found to influence treatment satisfaction. Conclusions IU therapy is an acceptable alternative in patients interested in localized ED therapy who are averse to ICI. Patients who responded to &amp;lt;10 units of ICI was associated with IU treatment satisfaction. IU therapy has a success rate of ∼33%, with the most common adverse event being discomfort. In this study, lidocaine incorporated IU gel offered similar efficacy (38.4%) and is well-tolerated with 94.9% reporting no discomfort. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientic, Coloplast, Neotract

Efficacy of Intracavernosal Injections of 50-Unit Versus 100-Unit Doses of AbobotulinumtoxinA (Masport®) in Vasculogenic Erectile Dysfunction with Phosphodiesterase Type 5 Inhibitors Resistant

Background: We aimed to evaluate the safety and efficacy of 50-unit dose against 100-unit dose of intracavernosal injection (ICI) of AbobotulinumtoxinA (BTX-A) (Masport®) in patients with vascular erectile dysfunction (ED) resistant to first-line therapies, including phosphodiesterase type 5 inhibitors (PDE5I). Methods: In this double-blind randomized controlled trial (RCT), 40 patients with ED resistant to PDE5I were randomly divided into two groups: ICI of a single dose of Masport® 50 units and single dose of 100 units. Peak systolic velocity (PSV) confirmed arterial insufficiency vascular disorder. For all patients, International Index of Erectile Function (IIEF), Sexual Health Inventory for Men (SHIM), and Erection Hardness Score (EHS) questionnaires were completed. Six weeks after the treatment, the subjects were re-examined. Results: Our results showed an acceptable clinical efficacy and safety of ICI of Masport® six weeks after injection. No systemic complications in patients were seen. Three patients complained of brief penile pain shortly after injection, but there were no other local complications. The increase in mean PSV in the 100-unit group due to treatment was significant (P-value &lt; 0.0001). Also, there was a significant difference between the two groups of 50- and 100-unit (P-value &lt; 0.0001). In addition, the increase in mean IIEF-EF, SHIM score, and EHS due to treatment was significant between the two groups. For the 100-unit group, P-value &lt; 0.0001 and the difference between the two groups was also significant (P-value &lt; 0.0001), which indicated a better response to treatment in the 100-unit group. The mean increase of IIEF score (EF domain) was 4.3 (mean IIEF: 9.4 and 13.7 after and before, respectively) in the 100-unit group and (mean IIEF: 8.1 and 9.1 after and before, respectively) in the 50-unit group. Conclusions: The results of this study showed that ICI of AbobotulinumtoxinA, especially at a dose of 100 units, in patients with refractory vasculogenic ED is safe and effective in improving sexual function and ultrasound indices.

Initial experience of single-port robot-assisted radical prostatectomy: A single surgeon's experience with technique description.

BackgroundWith the implementation of da Vinci SP robot platform (Intuitive Surgical, Inc., Sunnyvale, CA, USA), we described our initial experience with the da Vinci SP robot platform (Intuitive Surgical, Inc., Sunnyvale, CA, USA) for single-port robotic-assisted radical prostatectomy (SP-RARP).MethodsThis retrospective review included 30 consecutive patients with prostate biopsy-confirmed prostate cancer who underwent SP-RARP by a single surgeon between June and November 2020. SP-RARP was performed with a single-incision plus one method, in which the multichannel guide port was inserted directly with an additional assist port. We report our initial experience of perioperative and early functional outcomes.ResultsThe mean operative time (SD), console time (SD), and blood loss were 142.8 (15.1) min, 109.9 (15.7) min, and 133.0 (72.9) mL, respectively. No intraoperative complications or blood transfusions were reported. Of the 30 patients, 21 (70.0%), 7 (23.3%) and 2 (6.7%) had stage pT2, pT3a and pT3b disease, respectively. Positive surgical margins were reported in 5 of the 30 (16.7%) patients in the final pathology report, including 2 of 21 (9.5%) with stage pT2 and 3 of 9 (33.3%) with ≥ pT3. At 12 weeks after SP-RARP, 80.0% of patients had achieved continence and the potency was 46.7%; 8 of 11 (72.7%) had sexual health inventory for men (SHIM) scores ≥ 17 and 6 of 19 (31.6%) had SHIM scores < 17.ConclusionsThe SP platform for radical prostatectomy was technically safe and feasible. After overcoming the technical learning curve, this platform may provide high-quality outcomes comparable to those of multi-port platforms.

Association between Aortic Calcification Burden and the Severity of Erectile Dysfunction in Men Undergoing Dialysis: A Cross-Sectional Study.

Accelerated atherosclerosis is a major complication in patients with end-stage renal disease and it plays an important role in the pathogenesis of erectile dysfunction (ED). However, the association between aortic calcification burden and the severity of ED remains unclear. The aim of the present study was to investigate this association in men undergoing dialysis. This cross-sectional study included 71 men undergoing peritoneal dialysis and/or hemodialysis between July 2016 and May 2018 at Mutsu General Hospital. ED was assessed with the Sexual Health Inventory for Men (SHIM). Patients were divided into the mild/moderate (SHIM score ≥8) and severe ED groups (SHIM score ≤7). Aortic calcification index (ACI) was examined as a clinical indicator of abdominal aortic calcification. Multivariable logistic regression analysis was performed to identify the significant factors associated with severe ED. The median age of the study participants was 64 years; all had ED, with 64.8% having severe ED. In the multivariable analyses, a slight association was observed between ankle-brachial index and severe ED (odds ratio [OR], 0.058; p=0.072), whereas ACI was significantly associated with severe ED (OR, 1.022; p=0.022). Aortic calcification burden was independently associated with severe ED.

Toggling Technique Allows Retrograde Early Release to Facilitate Neurovascular Bundle Sparing During Robot-Assisted Radical Prostatectomy: A Propensity Score-Matching Study.

BackgroundThis study aimed to present the surgical facilitation of neurovascular bundle (NVB) sparing using the toggling technique (30° lens down/up switching) and to evaluate erectile dysfunction (ED) recovery after robot-assisted radical prostatectomy (RARP).MethodsWe assessed 144 patients (group with toggling, n = 72; group without toggling, n = 72) who underwent RARP with bilateral NVB sparing using propensity score matching. Inclusion criteria were ≥ 1 year follow-up and preoperative potency as per the Sexual Health Inventory for Men (SHIM) questionnaire (≥ 17 points). Recovery of ED after RARP was defined as return to baseline sexual function or self-assessment regarding successful intercourse. The subjective surgeon’s nerve sparing (SNS) score and tunneling success rates were used to evaluate surgical facilitation. The recovery rate of ED between the groups was analyzed using Kaplan-Meier analysis.ResultsA better ED recovery trend was confirmed according to the SNS score (R2 = 0.142, P = 0.004). In the analysis of NVB sparing ease, the toggling group showed higher SNS scores (on right/left side: P = 0.011 and < 0.001, respectively) and overall tunneling success rates (87% vs. 74%, P = 0.001) than the group without toggling. Overall, ED recovery rates were 82% (59/72) and 75% (54/72) in the groups with and without toggling, respectively, at the 1-year follow-up (P = 0.047), and the toggling group showed a faster ED recovery rate at 3 months (47% vs. 35%, P = 0.013). In a specific analysis of the potent cohort (< 60 years, bilateral full NVB spared, SHIM score ≥ 22), the ED recovery rate reached 87% (14/16) in the toggling group.ConclusionThe retrograde early release with the toggling technique improves the facilitation of NVB sparing, leading to improved ED recovery.

Comparative study of tamsulosin versus tadalafil in benign prostatic hyperplasia patients with lower urinary tract symptoms. A prospective randomized study.

Introduction:Benign prostatic hyperplasia (BPH) is one of the common causes of lower urinary tract symptoms (LUTS) in aging men. Men with LUTS have a higher incidence of erectile dysfunction (ED), and LUTS themselves represent an independent risk factor for ED, triggering a significant negative impact on quality of life.Materials and Methods:A total of 92 patients were randomly assigned to two groups. Groups I and II had 45 and 47 patients, two patients from Group I and three patients from Group II did not follow and were excluded from the study. Patients in Group I received 0.4 mg of tamsulosin and Group II patients received 5 mg tadalafil. Patients were assessed at baseline, 3 months, and at 6 months after receiving treatment. Treatment efficacy was measured by a change in Qmax, post void residual urine (PVR), International Prostate Symptom Score (IPSS), and Sexual Health Inventory for Men (SHIM) score at 3 months and 6 months.Results:Baseline parameters between the two groups were similar. Mean Qmax improved by 7 ml/s at 3 months to 9.44 ml/s at 6 months in Group I versus 4.73 ml/s at 3 months to 6.46 ml/s at 6 months in Group II (P = 0.739). Mean PVRU decreased by 35.53 ml at 3 months to 47.23 ml at 6 months in Group I versus 44.98 at 3 months to 58.28 ml at 6 months in Group II (P = 0.102). IPSS score improved by 4.24 points at 3 months to 7.22 points at 6 months in Group I versus 4 points at 3 months to 5.02 points at 6 months in Group II (P = 0.336). SHIM score improved by 0.7 points 16.2 at 3 months to 0.8 points at 6 months in Group I versus 6.12 points at 3 months to 6.3 points at 6 months (P < 0.001).Conclusion:When both groups were compared, tadalafil showed statistically similar improvements in Qmax, PVRU, and IPSS score, but statistically significant improvement was observed with tadalafil in SHIM score compared with tamsulosin in treating LUTS secondary to BPH. Our study provides evidence that once daily tadalafil 5 mg is well tolerated and can be considered for the treatment of LUTS secondary to BPH especially in patient with ED.