SHIM Score Research Articles

Long term outcomes from uncorrected hypospadias: a scoping review

IntroductionThe goal of hypospadias repair is to optimize urinary and sexual function, improve cosmesis and minimise the psychosocial effects associated with a penile anomaly. However, a lack of clarity exists regarding the role of surgery in milder hypospadias where the anomaly is inconspicuous and there is no anticipated impact on function. The aim of this study was to review the long term functional, cosmetic and psychosocial outcomes in men with uncorrected hypospadias. This information may be helpful for parents who are burdened with deciding the correct treatment for their child's hypospadias. MethodsA scoping review of PubMed, EMBASE, and CINAHL + databases was performed in adherence with PRISMA guidelines. Eight studies were identified for inclusion in the review. ResultsMen with mild uncorrected hypospadias have similar functional outcomes to those without hypospadias, preferring to void standing and reporting similar IPSS scores. However, those with severe untreated hypospadias experience significant urinary difficulties, higher IPSS scores, and are more likely to sit when voiding. They reported worse SHIM scores, more ventral curvature, and greater difficulty with intercourse. Most men with incidentally identified hypospadias are unaware of their condition and are satisfied with their penile appearance. There was no difference in the attainment of psychosocial milestones between men with uncorrected hypospadias versus no hypospadias. ConclusionThere is a lack of research regarding the experiences of adult men with uncorrected hypospadias. However, there is some evidence to support the non-operative management of mild hypospadias. Therefore, the decision to defer surgery in infancy should balance parental wishes and physician guidance, particularly in cases where the risk of functional impairment is low.

Resultados a largo plazo de hipospadias no intervenidos: una revisión exploratoria

Introduction: The goal of hypospadias repair is to optimize urinary and sexual function, improve cosmesis and minimise the psychosocial effects associated with a penile anomaly. However, a lack of clarity exists regarding the role of surgery in milder hypospadias where the anomaly is inconspicuous and there is no anticipated impact on function. The aim of this study was to review the long term functional, cosmetic and psychosocial outcomes in men with uncorrected hypospadias. This information may be helpful for parents who are burdened with deciding the correct treatment for their child's hypospadias.Methods: A scoping review of PubMed, EMBASE, and CINAHL+ databases was performed in adherence with PRISMA guidelines. Eight studies were identified for inclusion in the review.Results: Men with mild uncorrected hypospadias have similar functional outcomes to those without hypospadias, preferring to void standing and reporting similar IPSS scores. However, those with severe untreated hypospadias experience significant urinary difficulties, higher IPSS scores, and are more likely to sit when voiding. They reported worse SHIM scores, more ventral curvature, and greater difficulty with intercourse. Most men with incidentally identified hypospadias are unaware of their condition and are satisfied with their penile appearance. There was no difference in the attainment of psychosocial milestones between men with uncorrected hypospadias versus no hypospadias.Conclusion: There is a lack of research regarding the experiences of adult men with uncorrected hypospadias. However, there is some evidence to support the non-operative management of mild hypospadias. Therefore, the decision to defer surgery in infancy should balance parental wishes and physician guidance, particularly in cases where the risk of functional impairment is low.

Acute Toxicity and Early Prostate Specific Antigen Response After Two-Fraction Stereotactic Radiation Therapy for Localized Prostate Cancer Using Peri-Rectal Spacing – Initial Report of the SABR-Dual Trial

Purpose: SABR-Dual is a phase III trial with an initial phase-I safety cohort, of two-fraction stereotactic radiotherapy (SABR) with optional MRI-based focal boost, using peri-rectal spacing, for localized prostate cancer. This represents the initial report from the phase-I non-randomized cohort. Materials and methods: Subjects had favorable intermediate risk (FIR) or low risk (LR) prostate adenocarcinoma, and gland volume <80cc. All underwent radiopaque hydrogel spacer and fiducial marker placement prior to simulation (CT and 3-tesla T2 MRI). The clinical target volume included the entire prostate, and in FIR patients, 1-2cm of seminal vesicle (SV). A 2mm expansion was applied for planning target volume (PTV), and a dose of 27 Gy was prescribed to the PTV-prostate, 23 Gy to the PTV-SV, with an optional 30 Gy simultaneous boost (SIB) to an MRI-defined dominant lesion. Primary endpoint was 3-month patient-reported changes in quality of life based on the EPIC-26, IPSS, and SHIM questionnaires. Secondary endpoints were 6-month quality of life, acute toxicity (using CTCAEv5) and early PSA response. Results: Among the 20 patients in the phase-I cohort, 95% had FIR disease, and 50% received an SIB. At median follow-up of 8 months, a 3-month minimally clinically important change occurred in 1/20 (5%), 6/20 (30%), 2/20 (10%), 4/20 (20%), and 5/20 (25%) in urinary incontinence, urinary obstructive, bowel, sexual, and hormonal domains. There was a mean increase of 1±5.4 in IPSS and decrease of 1.8±6.5 in SHIM scores. Rates of grade 2 urinary and bowel toxicity 10% and 0%, respectively, with no grade ≥3 toxicities. Mean PSA decrease at last follow-up was 70.4%±17.7%. Conclusion: This generalizable protocol of two-fraction prostate SABR using peri-rectal spacing is a safe approach for ultra-hypofractionated dose-escalation, with minimal acute toxicity. Longer-term outcomes and direct comparison with standard 5-fraction SABR are being studied in the phase-III randomized portion of SABR-Dual.

Psychological Impact of Sexual Disorders Related to Benign Prostatic Hypertrophy

Objectives: Lower urinary tract disorders related to BPH are today among the most frequent symptoms in urology. The aim of our study is to determine the prevalence of erectile dysfunction in patients with BPH-related lower urinary tract symptoms and the related psychological impact. Methods: We conducted a study to assess the psychological impact of BPH-related sexual dysfunction. We used two scores to assess anxiety-depressive symptoms. The Patient Health Questionnaire-9 (PHQ-9), which gives an indication of the severity of depression, and the Generalized Anxiety Disorder - 7 (GAD-7) 1 for screening patients for generalized anxiety disorder. The severity of erectile dysfunction was specified using the SHIM score (Sexual Health Inventory for Men). Results: A total of 290 participants. The mean age was 58 years, 175 (60%) patients had erectile dysfunction, 120 (60%) of these patients with ED were treated with alpha blockers (OR=2.38, RR = 1.43, p = 0.04). The most represented age group was 60-69 years, 50 (28%) patients were treated with alpha blockers (OR=1.67, RR = 1.15, p = 0.01) while only 10 (5.7%) patients were treated with herbal extracts (phytotherapy). 65% of participants with erectile dysfunction showed varying degrees of depression and 53% of participants with erectile dysfunction showed varying degrees of anxiety. Conclusion: Micturition disorders caused by benign prostatic hyperplasia (BPH) and erectile dysfunction are frequent and often coexist. BPH-related erectile dysfunction has a significant psychological impact.

(156) Morphometrix Tissue Segmentation Technology as a Diagnostic Aid in the Evaluation of Vasculogenic Causes of Erectile Dysfunction

Abstract Introduction Morphometrix Imaging Technologies Inc. (MPX) Tissue Segmentation Technology (TST) isolates and processes the component of ultrasound reflective signals associated with coherent specular reflection at the liquid spaces in living tissue. The software identifies and quantifies the hypoechoic structures in B-Mode Ultrasound Scans produced by these reflections and thereby profiles liquid spaces in the tissue created by blood and lymphatic vessels as a proxy for vascular intensity. It then derives tissue segment counts (TSC) as a final quantification step. Unlike SHIM Scores, TST provides a quantitative assessment of the vascular health of the erectile tissue. Objective The goal of the study was to determine whether TSC can predict a response to regenerative treatments for ED. We retrospectively studied the efficacy of MPX TST in assessing the vascularity of the corpus cavernosa (CC) and compared the findings to SHIM scores before and after Shockwave therapy (SWT). MPX can assess penile vascularity in the flaccid state using TSC and can calculate cross-sectional area and volume. Methods Retrospective study of 57 men, average age 54.9 with ED. B-mode Ultrasound video scans were performed on the penis in the flaccid state before and after treatment completion and processed through MPX to obtain the TSC which were compared to IIEF-5 SHIM scores. A typical treatment involved multiple sessions of SWT and PRP penile injection. Subjects were divided into three groups based on response to treatment and correlation with SHIM Scores: Group 1 – Good Responders &amp; Good Correlation with SHIMs, Group 2 – Poor &amp; Non-Responders &amp; Good Correlation with SHIMs, Group 3 – Good &amp; Poor Responders &amp; Non-Correlation with SHIMs. Results Overall we had an 80.7% correlation between TSC and the SHIM Score results. The average SHIM score increased to 15.9 from 10.6, (p&amp;lt;0.006). The average TSC in the left CC increased to 25 from 17.3, (p&amp;lt;0.002). The average TSC in the right CC increased to 24.7 from 17.9, (p&amp;lt;0.002). 54.9% (34 patients) were good responders and the SHIM scores correlated well with TSC. The average SHIM score increased to 17.5 from 10.8, (p&amp;lt;0.001). The average TSC in the left CC increased to 28.1 from 15.3, (p&amp;lt;0.001). The average TSC in the right CC increased to 31.2 from 17.1, (p&amp;lt;0.003). 21.1% (12 patients) were poor responders and the SHIM scores correlated well with TSC. The average SHIM score increased 10.3 from 9.4, (p&amp;lt;0.554). The average TSC in the left CC declined to 13.5 from 15.5, (p&amp;lt;0.559). The average TSC in the right CC declined slightly to 14.9 from 12.5, (p&amp;lt;0.268). 19.3% (11 patients) were a mixture of good and poor responders and the SHIM scores did not correlate well with TSC. The average SHIM score increased to 15.1 from 11.3, (p&amp;lt;0.103). The average TSC in the left CC declined to 25.5 from 26.8, (p&amp;lt;0.919). The average TSC in the right CC declined to 25.5 from 25.7, (p&amp;lt;0.975). Conclusions MPX tissue segmentation software can provide quantitative information about the vascularity of the corpus cavernosa and can differentiate responders to treatment from non-responders. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Morphometrix.

(016) Sexual Health Toxicity Following MRI-Guided versus CT-guided Prostate SBRT

Abstract Introduction Sexual health toxicities remain an under-reported but important health outcome for patients undergoing radiotherapy for localized prostate cancer. With the increasing adoption of higher daily doses of radiation over shorter timeframes delivered using stereotactic body radiotherapy (SBRT), the precision of radiation delivery remains an important factor that can reduce patient toxicity. MRI-guided SBRT (MRgRT) allows for improved image quality, treatment gating, and planning target volume margin reduction, offering improved radiation precision, which may translate to reduced treatment-related toxicity as compared to traditional CT-guided SBRT (CTgRT). Objective We sought to evaluate the effect of MRI-guidance on sexual health toxicity in patients following prostate SBRT for the treatment of localized prostate cancer. Methods We conducted a post-hoc analysis of patients enrolled on a phase III single-center randomized trial (MIRAGE: NCT04384770). The trial overall seeks to study the relative benefit of MRI vs CT guided SBRT (40 Gy/5 fractions) in patients with localized prostate cancer. Right and left neurovascular bundles (NVBs) and internal pudendal arteries (IPAs) were contoured on treatment planning images. Dosimetric parameters for these structures (Dmax, Dmin, Dmean, and V20Gy) were collected. Patient-reported sexual function outcomes (SHIM and EPIC-26 surveys) were also collected prior to treatment and at 1, 3, and 12 months following treatment. A clinically relevant decrement was defined as a ≥24 point decrease in the EPIC-26 sexual domain scores and a ≥9 point decrease on SHIM surveys. Unpaired t-tests and chi-square tests were used to evaluate for statistical significance. Results 152 patients received either MRgRT (n = 77) or CTgRT (n = 75). MRgRT resulted in a significant improvement in the volume receiving 20 Gy or less of radiation (V20Gy) in the left NVB (7.3cc vs 10.9cc, p = 4.4x10-8), right NVB (7.0cc vs 10.7cc, p = 2.8x10-7), and right IPA (0.42cc vs 1.35cc, p = 0.049), and trended towards significance for the left IPA (0.3cc vs 1.1cc, p = 0.066). Only 48 patients were not given hormonal therapy with radiotherapy. No statistically significant differences in clinically relevant decrements in patient-reported SHIM or EPIC scores were seen between MRgRT and CTgRT in these patients. No clear association between acute or chronic (12-months post-RT) sexual health toxicity and radiation exposure to the NVBs or IPAs was identified. Conclusions Patients treated with MRgRT had decreased radiation exposure to the bilateral NVBs and IPAs compared to patients treated with CTgRT. These data highlight the dosimetric benefits of MRgRT with regard to sexually relevant organs at risk. Power to detect associations between dosimetry and patient-reported sexual health outcomes will increase as the data matures and more patients have recovered testosterone after use of hormonal therapy. Future work will assess the impact on MRI-guided vs CT-guided radiation on sexual health outcomes at later time points. Disclosure No.

P252 Male Genitourinary Dysfunction after Minimally Invasive and Open Ileoanal Pouch

Abstract Background Restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) is the preferred surgical treatment for IBD or FAP. As these diseases often manifest during adolescence or early adulthood, treatment effects on genitourinary function (GU), sexual function, and fertility are of paramount importance. However, the difference in male GU function and sexual function after minimally invasive IPAA (MIS-IPAA) compared to open-IPAA are unclear. We conducted an observational survey to compare long-term GU functionality in male patients’ post MIS-IPAA or open-IPAA. Methods All adult male patients who underwent IPAA at a single tertiary hospital between 1983 and 2023 were identified, and demographics and clinical data were obtained from our prospectively maintained pouch registry. Patients were surveyed using validated questionnaires (Table 1). The primary outcome was the composite survey scores. Patients were stratified into MIS-IPAA (laparoscopic, robotic, single-incision surgery) or open-IPAA groups based on the mode of pelvic/rectal dissection. Reoperative IPAA procedures (revisions, redo, and excisions), incomplete surveys, patients with permanent ileostomy, and status post prostatectomy were excluded. Results A total of 1,836 patients were surveyed, and 457 (24.9%) submitted a response. After exclusion criteria, 296 responses were analyzed: 236 (79.7%) open-IPAA and 60 (20.3%) MIS-IPAA. In both groups, most patients had ulcerative colitis (88 vs. 89%). Compared to open-IPAA, MIS-IPAA had a similar age at surgery (40.6 vs. 40.9, p=0.88), younger age at survey (48.2 vs 58.2, p&amp;lt;0.001), and shorter interval between surgery and survey (7.7 vs. 17.4, p&amp;lt;0.001). Male MIS-IPAA patients were able to achieve orgasm more successfully than those with open-IPAA (5 vs. 4, p=0.001). No significant difference was observed between MIS- and open-IPAA in erectile function (SHIM score 22.5 vs 21, p=0.22), IBD-specific male sexual dysfunction (IBD-MSDS, 3 vs. 2, p=0.19), lower urinary tract symptoms (LUTS) (CLLS, 4 vs. 6, p=0.16), or use of therapeutic aids for sexual activity (6 vs. 6, p=0.7). There was no difference in global quality of life (CGQoL, 0.83 vs 0.80, p=0.6). There were no differences between the patients who had difficulty conceiving a child (4 vs. 7, p=0.46) and those who experienced infertility (1 vs. 2, p=0.54). Patients experiencing infertility showed no difference in quality of life between the MIS- and open-IPAA groups (FertiQoL, 84.9 vs 85.9, p=0.64). Conclusion Minimally invasive IPAA had a higher preservation of orgasm ability than did open IPAA. There was no difference in erectile function, LUTS, need for therapeutic aids for sexual function, or fertility between MIS and open approach to pelvic dissection in IPAA.

P270 Male Genitourinary Dysfunction after Primary and Reoperative Ileoanal Pouch Surgery

Abstract Background Restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) is the preferred surgical treatment for patients with IBD or FAP. As these diseases often manifest during adolescence or early adulthood, treatment effects on genitourinary function (GU) and sexual function are of paramount importance. However, the reoperative IPAA (R-IPAA) effects on male GU function and sexual function compared to primary IPAA (P-IPAA) are not known. Therefore, we conducted an observational survey to compare the long-term GU functionality of P-IPAA and R-IPAA long-term GU functionality male patients. We hypothesized that R-IPAA is associated with higher GU-dysfunction compared to R-IPAA. Methods All adult male patients who underwent IPAA at a single tertiary hospital between 1983 and 2022 were identified and demographics and clinical data were obtained from our prospectively maintained pouch registry. Patients were surveyed using validated questionnaires (Table 1). The primary outcome was composite survey scores. Patients were stratified into P-IPAA or R-IPAA groups; R-IPAA was defined as IPAA excision, reconstruction, or revision. Patients status-post prostatectomy were excluded. Results A total of 1,836 male patients were surveyed, and 457 (24.9%) submitted a response. After exclusion criteria, 339 responses were analyzed:296 (87.3%) P-IPAA and 38 (11.2%) R-IPAA, which included 22 redo IPAA, 9 excisions, and 7 revisions. In both groups, most patients had ulcerative colitis (89 vs. 90%). P-IPAA compared to R-IPAA had a similar age at surgery (40.8 vs. 42, p=0.59), similar age at survey (56.2 vs. 56.4, p=0.94), and a similar interval between surgery and survey (15.4 vs. 14.4, p=0.51). The P-IPAA group had less severe sexual dysfunction than the R-IPAA group (IBD-MSDS, 2.0 vs. 7.0, p=0.002). No significant difference was observed between P-IPAA and R-IPAA in erectile dysfunction (SHIM score 21 vs. 18.5, p=0.24), urinary tract symptoms (CLLS, 5.5 vs. 8.0, p=0.06), use of therapeutic aids for sexual activity (6 vs. 7, p=0.29), or orgasm ability (4 vs. 4, p=0.3). Patients with P-IPAA had a higher CGQoL (0.83 vs. 0.7, p=0.02). There were no differences between patients who had difficulty conceiving a child (4 vs. 7, p=0.5) and those who experienced infertility (3 vs. 1, p=0.43). In patients with fertility problems, no quality-of-life differences were observed between the groups (FertiQoL, 85.9 vs. 88.5, p=0.62). Conclusion Primary-IPAA was associated with increased sexual function and overall higher global quality of life compared to R-IPAA. No difference in erectile function, LUTS, and the need for therapeutic aids for sexual function, orgasm ability, or fertility were observed.

Predictors of mid-term functional outcomes for robot-assisted Madigan simple prostatectomy: results of a multicentric series according to the BPH-6 achievement.

BPH-6 achievement remains an objective far to be evaluated for every technique currently available for the surgical management of bladder outlet obstruction (BOO) with the goal of preserving ejaculatory function. The aim of this study was to evaluate predictors of BPH-6 achievement of urethral-sparing robot assisted simple prostatectomy (us-RASP) on a large series performed at two tertiary-care centers. Two institutional us-RASP datasets were merged, considering eligible all patients with a follow-up >12 months. Baseline, perioperative and functional data according to BPH-6 endpoint were assessed. Descriptive analysis was used. Frequencies and proportions were reported for categorical variables while medians and interquartile ranges (IQRs) were reported for continuously coded variables. A logistic regression model was built to identify predictors of BPH-6 achievement. For all statistical analyses, a two-sided P<0.05 was considered significant. Study cohort consisted of 94 eligible patients. The median follow-up was 40.7 months (IQR 31.3-54.2). Overall BPH-6 achievement was 54.7%. Compared to baseline, reduction of ≥30% in IPSS was observed in 93.6% of patients, reduction of <6 points for SHIM in 95.7% and response to MSHQ-EjD question 3 indicating emission of semen in 72.6%, respectively. On multivariable analysis, prostate volume between 110-180 mL (OR 0.09; 95% CI 0.01-0.92; P=0.043) and higher preoperative SHIM score (OR 1.18; 95% CI 1.05-1.32; P<0.01) were independent predictors of BPH-6 metric achievement. us-RASP may provide a complete resolution of BOO and preservation of ejaculatory function in sexually active men with a prostate volume ranging 110-180 mL.

(395) Our Experience with Subcutaneous Injection of Non-Proprietary Testosterone Cypionate as a Novel Approach for Hypogonadism

Abstract Introduction Subcutaneous injection of testosterone has been investigated as a method of testosterone replacement therapy (TRT) in hypogonadal men. We have been investigating the use of a non-proprietary subcutaneous (SubQ) injection of testosterone cypionate using a ½ inch 27g needle for replacement to treat hypogonadism. This is an update on our work which includes a larger sample size and longer follow up. Objective To assess the use of non-proprietary SubQ TRT as treatment in hypogonadal men and its effect on HCT, PSA, and patient satisfaction. Methods This study is a retrospective chart review of patients receiving SubQ TRT with a mean follow up length of 9.8 months (range 0-24 months). Patient data was collected prior to initiation of therapy and at subsequent visits. Testosterone, HCT, and PSA were determined through regular blood draws and a patient satisfaction survey was performed over the phone. Univariate analysis and paired t-tests were used to analyze study variables. Results 41 total patients received SubQ TRT. Mean changes in total testosterone level (increased 281.3 + 81.1, p-value=0.0008), hematocrit (increased 1.5 + 1.0), PSA (increased 0.4 + 0.4), SHIM score (increased 3.8 + 1.4, p-value=0.0088) and AUA symptom score (decreased 0.9 + 1.6) were calculated at the patients’ initial visit and most recent follow up while still on SubQ TRT (Table 1). A total of 30 patients had been on various combinations of TRT before switching to SubQ including IM (13), CC (13) Testopel (8), HCG (2) SubQ (2), T gel (1) and Anastrozole (1). Data on the most frequent TRTs is demonstrated in Table 2. Patient satisfaction surveys were completed by 32 patients (78%), with 26 (81.2%) patients reporting overall satisfaction with SubQ TRT versus 45% (9/20) with past forms of TRT. 93.7% (15/16) reported SubQ TRT was both easier and less painful, and 73.6% (14/19) preferred SubQ injections over their previous form of TRT. Reasons for stopping SubQ TRT included unrelated stroke (1), prostate cancer (1), development of scar tissue (1) or bruising (1), ineffective therapy (1), difficulty drawing up the syringe (1), cost (1), and trouble obtaining medication from the pharmacy (1). Conclusions The use of non-proprietary testosterone cypionate SubQ as treatment for hypogonadism results in an elevation in serum total testosterone and improvement on both SHIM and AUA symptom scores at follow up. PSA and HCT rose over the span of treatment, but the rises were not statistically significant, and no patient developed erythrocytosis. Our data demonstrate SubQ TRT is easier and less painful to use and scores higher on overall patient satisfaction compared to other forms of TRT. Disclosure No

(360) Low-Intensity Shockwave Therapy (LiSWT) Appears to Show Improvement in Erectile Function at 1 Month Compared to SHAM in Men with Erectile Dysfunction

Abstract Introduction Restorative therapies such as Low-intensity Shockwave Lithotripsy (LiSWT) for erectile dysfunction (ED) have generated substantial interest. Despite growing popularity, a paucity of data exists to confirm efficacy in reversing underlying pathophysiologies of ED. Objective We evaluated the efficacy of the Storz® Duolith™ to determine whether active versus sham treatment is superior for treatment of ED. Methods We performed a two-arm stratified, single-blinded, randomized controlled clinical trial. Inclusion/exclusion criteria are listed in table 1. A total of 31 patients were enrolled, with 15 randomized to the sham group and 16 to the treatment group. Patients underwent LiSWT with the Duolith™ device delivered twice weekly for 3 weeks, comprising 3000 shockwaves at 0.1 mJ/mm2 delivered to the distal penis, base of penis, and crura. Outcomes included absolute change in IIEF/SHIM score and change in EHS score. Changes in SHIM scores were compared between the treatment arms using Student’s t-test, while changes in EHS scores were compared using Wilcoxon rank-sum test. Results Demographic and baseline clinical characteristics were similar between arms. At one-month post-treatment, SHIM scores improved by 3.4 points in the LiSWT arm while no improvement was seen in the sham arm (-3.4 vs. 0.7, p=0.014). This corresponded to a 42.1% improvement in the LiSWT arm and a 0.1% decline in the sham arm. No significant differences were observed in EHS change scores between treatment arms. No adverse outcomes were reported. Conclusions The present interim analysis shows improvement in SHIM scores in men undergoing LiSWT for ED. Additional recruitment and follow-up is in ongoing to further demonstrate efficacy and sustainability of LiSWT in the treatment of ED. Disclosure No

(020) Implementing a Virtual Mindfulness-based Group Therapy to Improve Male Sexual Dysfunction

Abstract Introduction Erectile dysfunction (ED) is almost always multi-factorial. Simultaneous performance anxiety and psychogenic inhibition can impair erectile function even when underlying organic aetiologies are present. Sex therapy should be considered first-line treatment for ED. Mindfulness is a technique to focus on being aware of what you're sensing and feeling in the moment, without interpretation or judgment. Mindfulness-based therapy programs have been successful at improving female sexual dysfunction and prostate cancer survivors quality of life (QOL). Objective To design and evaluate the feasibility of a virtual, mindfulness-based group therapy (vMBGT) program for patients experiencing mild-to-moderate ED. We secondarily assess relationship satisfaction, QOL, and changes in erectile function after intervention. Methods A mixed-methods approach was taken for this feasibility pilot study. A total of 18 participants (mean age: 42; range 22-69 years) with ED were recruited to participate in a 4-week virtual mindfulness-based group therapy program. Three groups were led by trained facilitators on a weekly basis via Webex platform and ran 1.5-2 hours in length, followed by daily home-practice and sex education between sessions. Participants completed questionnaires (International Index of Erectile Functioning, Erection hardness scale, Relationship Assessment Scale, Five Facets of Mindfulness Questionnaire) as a baseline and 3 months after treatment. Qualitative exit interviews and program feedback was requested from all participants. Results The dropout rate for this study was 11%. Two of the eighteen men missed 2 of the 4 sessions; one participant dropped out and one had unanticipated work commitments. There was a statistically significant improvement in the mean IIEF scores from baseline 41 to 49 after vMBGT intervention (p &amp;lt; 0.05). There was a clinically significant improvement in SHIM score by 4 points. There was an improvement in EHS at 3 months compared to baseline (p=0.08) Overall, feedback was positive, and all participants responded that they would recommend this program to others. Some participants felt that the material could be lengthened to 6 weeks and/or that an in-person setting would have been more interactive, whereas others appreciate the convenience and comfort of the virtual platform. Conclusions This is the first published vMGBT program for patients experiencing mild to moderate ED. This program is feasible, the content was well received, and patients had improvement in their erectile function and QOL. Our pilot study has provoked a change to the treatments we can offer patients with ED and we have modified the program based on feedback. Further studies are needed to compare this to medical management and other psychotherapy interventions. Disclosure No

(309) Risk Factors Associated with the Utilization of Xiaflex Injections for Peyronie’s Disease

Abstract Introduction Collagenase clostridium histolyticum (CCH), known as Xiaflex (Endo Pharmaceuticals Dublin, Ireland) is the only FDA approved medication for Peyronie’s Disease (PD) in the United States. While Xiaflex has shown efficacy with improvement of curvature by &amp;gt;20% in over half of recipients, patients are hesitant to pursue treatment due to the monetary costs, length of treatment, and perception of injectable therapy. Objective The aim of this study is to determine if demographic and clinical factors are associated with clinical decision making to pursue Xiaflex injections for treatment of PD. Methods We retrospectively reviewed patients who presented to our institute from 2009 to present with PD. Demographic and clinical parameters were extracted. Independent T-test and Wilcoxon rank sum tests were used to determine correlation between continuous variables and whether Xiaflex was selected. Odds ratios with 95% confidence interval were used to determine association between categorical variables and whether Xiaflex was pursued. Results 143 patients presented with PD. Of these cases, 24.5% (35) received Xiaflex and 75.5% (108) declined Xiaflex. There was no significant difference in age, months since curvature was first noted, history of erectile dysfunction (ED), ED response to PDE5 inhibitors, history of hypogonadism, lowest total and free testosterone levels documented, history of GU trauma, history of depression or anxiety, hourglass deformity, past urethral instrumentation, SHIM score, plaque volume, maximum plaque diameter on ultrasound, distance of curve apex from coronal sulcus, or history of Dupuytren’s contracture between the treatment and nontreatment group (P&amp;gt;0.05). Subjects who chose treatment had significantly greater predicted curvature and degree of curvature on initial ultrasound at the time therapy was offered compared to those who did not select treatment. Patients who received Xiaflex had an average predicted curvature at presentation of 49.5 degrees (sd = 28.1) and degree of curvature on initial ultrasound of 50.02 degrees (sd=20.0) respectively. Patients who did not receive Xiaflex had an average predicted degree of curvature at presentation of 37 degrees (sd=23.8) and degree of curvature on initial ultrasound of 37.6 (sd=23.0). Conclusions Our data suggests that PD patients who chose treatment with Xiaflex had greater penile average curvature compared to those who did not choose treatment. Despite erectile function, comorbidities, and radiographic findings, degree of penile curvature remains a key risk factor for selecting injectable therapy for PD. Disclosure No

(462) Penile Implant Cancellations During the COVID-19 Pandemic- A Retrospective Cohort Study

Abstract Introduction During the early stages of the COVID-19 pandemic, hospitals prioritized the availability of ventilators, anesthesia personnel, hospital beds, and personal protective equipment; consequently, widespread recommendations were made to postpone or cancel all elective procedures [1,2]. Determination of what was considered “elective” in urology was ill-defined, though there was consensus by international and European urologic societies that the “lowest priority” tier of procedures included those for functional and reconstructive urology, urogynecology, infertility, and prosthetic surgery [3,4]. Though these are indicated for benign conditions, the long-term impact of remaining under-treated is unknown. No data in the existing literature describe the effect of prosthetic surgery cancelations on patient outcomes during the COVID-19 pandemic. Objective To determine the primary reasons for cancelation of penile prosthetic implantation during the COVID-19 pandemic and to assess subsequent patient outcomes. Methods In this retrospective cohort study, all male patients ≥18 years old scheduled for implantation of a penile prosthesis at our institutions during a 2-year span (1/1/20 to 1/1/22) were eligible for inclusion. Data were abstracted from Epic with ICD-10 and CPT codes for erectile dysfunction and penile prostheses, respectively. Information collected about patients included age, ethnicity, marital status, SHIM score, prior penile implant status, prostate cancer history and therapy, initial date of surgery, cardiac/medical clearance status, cancelation status and cause, whether surgery was rescheduled, and if the surgery ultimately occurred. Crude and adjusted associations between factors related to cancellations were assessed using binary logistic regression and summarized as odds ratio (OR) along with 95% confidence intervals (CI). All statistical analyses were performed using SPSS 28.0.1. Results Of the 284 patients that met inclusion criteria, 77 (27.1%) had their surgeries canceled; of those, 33 (42.9%) were later rescheduled, with 31 (93.9%) ultimately undergoing the procedure. There was no significant difference in the average age or SHIM score of those who were and were not canceled. Only 9 (11.7%) of the cancelations were ordered by the hospital, with 4 (5.2%) canceled because of the restriction on elective procedures and 4 (5.2%) due to patients testing positive for COVID. 68 (88.3%) of the cancelations were at the behest of patients; 3 (3.9%) elected not to undergo surgery during the pandemic. The remaining 65 (84.4%) canceled for a variety of reasons, including not getting a pre-procedure UA or COVID test. Patients who did not receive cardiac/medical clearance were three times more likely to cancel (OR 3.04; 95% CI = 1.72-5.37; P&amp;lt;0.001). This association remained statistically significant after adjusting for insurance status (OR 2.32; 95% CI = 1.24-4.34; P=0.009). Conclusions Our data revealed that most cancelations of penile prosthetic implantations during COVID-19 were patient-instigated, with few cancelations due to COVID-19 infection or reluctance to have surgery during the pandemic. Most cancelations appeared secondary to difficulties with pre-procedure labs/testing, likely to have been an indirect consequence of the COVID-19 pandemic. Severely limited availability of PCP or lab appointments caused patients increased difficulty obtaining the necessary testing before surgery. Nevertheless, many of the canceled patients were able to reschedule, with nearly all ultimately undergoing the procedure. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific, Rigicon, Coloplast, Baxter.

O046 Reduction of surgical complications via 3D printed/virtual models available during (robotic-assisted) radical prostatectomy

Abstract Introduction Prostate cancer is the leading cancer in males in the UK and mostly treated via robotic-assisted radical prostatectomy (RARP). The prognosis of prostate cancer is promising especially if detected early. Studies have shown that the use of 3D patient-specific models has positive effects on surgical outcomes in other fields. This systematic review aims to assess whether 3D printed and virtual models reduce surgical complications for patients undergoing RARP. Methods This study was a systematic review conducted using PRISMA guidelines from comprehensive databases - PubMed and Medline. These were then screened using an inclusion and exclusion criteria, to remove papers that were not relevant to the research question. Last, each abstract was screened for relevancy and duplicates were removed. Results A total of 201 patients had the use of 3D patient-specific modelling of the prostate to aid in surgery. Across all studies, a decrease in positive surgical margin rates was reported, indicating better outcomes for patients. However, no statistically significant difference was found between intervention and control groups, in nerve sparing, bladder neck sparing and postoperative SHIM score. A decrease in detectable PSA was found in intervention groups. Furthermore, the use of 3D models did lead to more surgeons changing the pre-operative plan, suggesting that 3D modelling enhances surgical planning – leading to potentially improved outcomes. Conclusion The use of 3D modelling has positive outcomes for patients undergoing RARP, however, the extent is still unclear as research in this area remains limited.

Long COVID and risk of erectile dysfunction in recovered patients from mild to moderate COVID-19

Patients with coronavirus disease 2019 (COVID-19) were shown to have reduced serum testosterone levels compared to healthy individuals. Low testosterone levels are linked with the development of erectile dysfunction (ED). In this case-controlled study, 20 healthy controls and 39 patients with ED 3 months after recovering from mild-to-moderate COVID-19 pneumonia were studied. The patients ranged in age from 31 to 47 years. To identify early and late COVID-19 infections, real-time polymerase-chain reaction (RT-PCR) and COVID-19 antibody testing were done. The levels of luteinizing hormone (LH), follicular stimulating hormone (FSH), total testosterone (TT), free testosterone (FT), free androgenic index (FAI), and sex hormone-binding globulin (SHBG) were measured. The sexual health inventory for patients (SHIM) score was used to measure the erectile function of the patients and controls. When compared to the controls, the TT serum level in long COVID-19 (LC) patients with ED was low (p = 0.01). In contrast to controls, FT and FAI were both lower in LC patients with ED. (p = 0.001). FSH serum levels did not significantly differ (p = 0.07), but in ED patients, LH serum levels were elevated. SHIM scores were associated with low TT (p = 0.30), FT (p = 0.09), and high LH (p = 0.76) in LC patients with ED. Male patients with decreased serum levels of LH and testosterone may have hypothalamic-pituitary–gonadal axis dysfunction, which could lead to the development of LC-induced ED. Therefore, an in-depth research is necessary to confirm the causal link between COVID-19 and ED in LC patients.

MP79-20 LOW-INTENSITY SHOCKWAVE THERAPY: SUSTAINED IMPROVEMENT IN THE TREATMENT OF ERECTILE DYSFUNCTION

You have accessJournal of UrologyCME1 Apr 2023MP79-20 LOW-INTENSITY SHOCKWAVE THERAPY: SUSTAINED IMPROVEMENT IN THE TREATMENT OF ERECTILE DYSFUNCTION Jeunice Owens-Walton, Emmett Kennady, Christopher Ballantyne, Darren Bryk, Marwan Ali, Sarah Ratcliffe, Indika Mallawaarachchi, Bahrom Ostad, Hamza Beano, Matthew Clements, Mikel Gray, David Rapp, Nicolas Ortiz, and Ryan Smith Jeunice Owens-WaltonJeunice Owens-Walton More articles by this author , Emmett KennadyEmmett Kennady More articles by this author , Christopher BallantyneChristopher Ballantyne More articles by this author , Darren BrykDarren Bryk More articles by this author , Marwan AliMarwan Ali More articles by this author , Sarah RatcliffeSarah Ratcliffe More articles by this author , Indika MallawaarachchiIndika Mallawaarachchi More articles by this author , Bahrom OstadBahrom Ostad More articles by this author , Hamza BeanoHamza Beano More articles by this author , Matthew ClementsMatthew Clements More articles by this author , Mikel GrayMikel Gray More articles by this author , David RappDavid Rapp More articles by this author , Nicolas OrtizNicolas Ortiz More articles by this author , and Ryan SmithRyan Smith More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003356.20AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Restorative therapies for erectile dysfunction (ED), such as Low-intensity Shockwave Lithotripsy (LiSWT) have generated substantial interest. Despite growing popularity, there are mixed data as to the efficacy of LiSWT and unanswered questions regarding the appropriate patient population for use. This study is a 2-arm stratified, randomized controlled clinical trial to determine whether LiSWT is superior to a sham control for treatment of ED. METHODS: A total of 32 patients with mild to moderate ED (SHIM ≥8 and ≤21) were randomized to LiSWT or sham. In this single-blinded study, patients on the sham arm were allowed to cross over at one month of treatment. Patients underwent twice weekly LiSWT treatments for 3 weeks (6 total) with the Storz® Duolith™ device each delivering 3000 shockwaves at 0.1 mJ/mm2 to the distal penis, base of penis, and crura. Primary outcomes included absolute and relative changes in SHIM score and EHS from baseline to 1, 3, and 6 months post-treatment. Changes in SHIM scores were evaluated with Student’s t-test, while changes in EHS were evaluated using Wilcoxon rank-sum test. RESULTS: Of the subjects randomized to sham, all elected to cross over to LiSWT at 1 month. At 1, 3, and 6 months post-treatment, the mean absolute changes in SHIM scores were 4.2, 4.7, and 5.4, respectively, in the LiSWT group compared to -0.7 in the sham group at 1 month (p<0.001) (Figure 1A). The percentage improvement in SHIM scores were 51.7%, 54.6%, and 60% at 1, 3, and 6 months post-treatment, respectively (p<0.001). EHS improved in the LiSWT group with median absolute improvements of 0.6, 0.9, and 1.0 (p<0.001) (Figure 1B) and percentage improvements 41.1%, 61.1%, and 68.8% over the same time course (p<0.001). The mean EHS improved from baseline of 2 to 2.9 over the treatment course. No adverse outcomes were reported. CONCLUSIONS: Our analysis demonstrates an absolute and durable improvement in SHIM scores and EHS in men undergoing LiSWT for ED at 1, 3, and 6 months post-treatment compared to sham. SHIM score improvements met criteria for previously established minimal clinically significant differences in the erectile function domain of the SHIM (≥4). While limited by population size, the current study is promising for minimally invasive management of ED symptoms. Source of Funding: No funding to disclose © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1149 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jeunice Owens-Walton More articles by this author Emmett Kennady More articles by this author Christopher Ballantyne More articles by this author Darren Bryk More articles by this author Marwan Ali More articles by this author Sarah Ratcliffe More articles by this author Indika Mallawaarachchi More articles by this author Bahrom Ostad More articles by this author Hamza Beano More articles by this author Matthew Clements More articles by this author Mikel Gray More articles by this author David Rapp More articles by this author Nicolas Ortiz More articles by this author Ryan Smith More articles by this author Expand All Advertisement PDF downloadLoading ...

MP68-16 INTRAOPERATIVE ANGIOGRAPHY OF THE NEUROVASCULAR BUNDLE IMPROVES ANATOMICAL DISSECTION DURING ROBOT-ASSISTED RADICAL PROSTATECTOMY: INITIAL CLINICAL EXPERIENCE

You have accessJournal of UrologyCME1 Apr 2023MP68-16 INTRAOPERATIVE ANGIOGRAPHY OF THE NEUROVASCULAR BUNDLE IMPROVES ANATOMICAL DISSECTION DURING ROBOT-ASSISTED RADICAL PROSTATECTOMY: INITIAL CLINICAL EXPERIENCE Nordine Amara, Tarek A. L. Youssef, Jordan Massa, Elias Elkhouri, Adel Ait Kaki, Aouad Fidjel, and Belur Patel Nordine AmaraNordine Amara More articles by this author , Tarek A. L. YoussefTarek A. L. Youssef More articles by this author , Jordan MassaJordan Massa More articles by this author , Elias ElkhouriElias Elkhouri More articles by this author , Adel Ait KakiAdel Ait Kaki More articles by this author , Aouad FidjelAouad Fidjel More articles by this author , and Belur PatelBelur Patel More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003331.16AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Based on current knowledge of the surgical anatomy of the prostate we investigated the value of intraoperative angiography of the neurovascular bundle (NVB) using indocyanine green (ICG) and near-infrared fluorescence (ICG-NIRF) during robot-assisted radical prostatectomy (RARP) to provide a better dissection and preservation of the NVB. METHODS: Retrospective, unicentric study of 91 consecutive patients from 2016 to 2021. In patients who met the inclusion criteria (stage T1 and T2 (stage T3 excluded), mild-moderate ED (assessed using the Sexual Health Inventory for Men scores or SHIM Score), prostate specific antigen <10 ng/ml), we used intraoperative ICG-NIRF angiography (using the built-in Firefly fluorescence imaging system). All patients provided signed informed consent for inclusion in our study. We evaluated the proportion (%) of bilateral NVB identified to optimise and facilitate the dissection, as well as any ICG-related complications that occurred (assessed using the Clavien-Dindo classification). All patients were followed up at 3, 6, 9, and 12 months after surgery to evaluate their erectile function using the SHIM score. RESULTS: Ninety-one patients received intraoperative angiography. The NVB was identified in all cases, without difficulties. No ICG-related complications or allergies were observed.There was no significant difference in the SHIM score at 9 months compared with baseline(p=0.331), and erectile dysfunction returned to baseline levels in almost all patients. CONCLUSIONS: Intraoperative, real-time ICG-NIRF angiography is simple, non-invasive, and improves identification of key anatomical landmarks to optimise micropreservation of the NVB during RARP and preserve erectile function. Larger clinical studies should confirm preliminary results. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e959 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nordine Amara More articles by this author Tarek A. L. Youssef More articles by this author Jordan Massa More articles by this author Elias Elkhouri More articles by this author Adel Ait Kaki More articles by this author Aouad Fidjel More articles by this author Belur Patel More articles by this author Expand All Advertisement PDF downloadLoading ...

MP13-18 LARGE PROSTATE SIZE AND ITS EFFECT ON LUTS IMPROVEMENT AND SEXUAL PRESERVATION FOLLOWING CONVECTIVE WATER VAPOR THERMAL THERAPY

You have accessJournal of UrologyCME1 Apr 2023MP13-18 LARGE PROSTATE SIZE AND ITS EFFECT ON LUTS IMPROVEMENT AND SEXUAL PRESERVATION FOLLOWING CONVECTIVE WATER VAPOR THERMAL THERAPY Owen Lewer, Michael Felice, Gaurav Pahouja, Amy Wozniak, and Kevin McVary Owen LewerOwen Lewer More articles by this author , Michael FeliceMichael Felice More articles by this author , Gaurav PahoujaGaurav Pahouja More articles by this author , Amy WozniakAmy Wozniak More articles by this author , and Kevin McVaryKevin McVary More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003233.18AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: LUTS/BPH can affect quality of life in men. Convective water vapor thermal therapy (CWVTT - Rezum) is a minimally invasive surgical treatment (MIST) for LUTS/BPH which produces significant, 5-year improvement of LUTS in men with prostates between 30 and 80 cc with minimal de-novo sexual dysfunction. However, CWVTT outcomes based on variable prostate volume (PV) are incompletely described thus is an unmet need. We aim to elucidate the relationship between PV and outcomes post-CWVTT in men with LUTS/BPH. METHODS: In this retrospective study of men undergoing CWVTT from 1/2018 to 3/2022, PV was categorized by tertiles. The primary outcome measured was mean change in I-PSS post-CWVTT between tertiles over 24 months, and analyzed using general linear mixed models. Secondary outcomes include SHIM and IPSS-QOL. Results were adjusted for relevant patient characteristics. RESULTS: 232 patients were included and broken into PV tertiles: small (≤38.5 cc, N=78), medium (38.5-≤55.6 cc, N=76), and large (>55.6 cc, N=78). For IPSS, the change from baseline to 3-months post-op was -7.6 (p=<0.01), -10.4 (p=<0.01) and -11.6 (p=<0.01), small, medium, and large PV, respectively. Post-operatively, small and medium PV had decreasing IPSS scores while large PV IPSS scores were relatively stable. Large PV tended to have the lowest IPSS scores, regardless of time. These trends were similar for IPSS-QOL. For SHIM scores, all PV tertiles decreased from baseline to 3-months post-op. All 3 tertiles had improved SHIM scores over time. Large PV had significant increases in SHIM scores when unadjusted for other patient factors [0.18 per month (95% CI: 0.03 - 0.33, p=0.02)]. Small PV tended to have the lowest SHIM scores, regardless of time. In all three outcomes, when adjusted for other patient characteristics, the trends were not statistically significant. CONCLUSIONS: Interestingly, patients with larger PV may exhibit a more dramatic improvement in sexual function as measured by SHIM than those with smaller PV. In contrast, larger prostates may have a less dramatic improvement in LUTS as measured by I-PSS and I-PSS QoL than smaller ones. However, adjusted analyses show no significant improvement or decline in any of our outcomes by PV after the first post-operative appointment. Source of Funding: NIAID T35 AI125220 © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e180 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Owen Lewer More articles by this author Michael Felice More articles by this author Gaurav Pahouja More articles by this author Amy Wozniak More articles by this author Kevin McVary More articles by this author Expand All Advertisement PDF downloadLoading ...

PD26-11 ERECTILE DYSFUNCTION IN PEYRONIE’S DISEASE: PREVALENCE AND ETIOLOGY AS DEMONSTRATED BY COLOR DUPLEX DOPPLER ULTRASOUND

You have accessJournal of UrologyCME1 Apr 2023PD26-11 ERECTILE DYSFUNCTION IN PEYRONIE’S DISEASE: PREVALENCE AND ETIOLOGY AS DEMONSTRATED BY COLOR DUPLEX DOPPLER ULTRASOUND Laura Geldmaker, Daniela Haehn, Sarah Hampton, Christopher Walker, Colleen Ball, and Gregory Broderick Laura GeldmakerLaura Geldmaker More articles by this author , Daniela HaehnDaniela Haehn More articles by this author , Sarah HamptonSarah Hampton More articles by this author , Christopher WalkerChristopher Walker More articles by this author , Colleen BallColleen Ball More articles by this author , and Gregory BroderickGregory Broderick More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003304.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Peyronie’s Disease (PD) can coexist with erectile dysfunction (ED). International guidelines recommend that PD management includes an assessment of each patient’s ability to initiate and sustain erection, by intracavernosal injection (ICI) test with or without duplex Doppler ultrasound. Distress caused by PD may limit a patient’s ability to assess adequacy of penile rigidity. Our objective was to assess vascular erectile integrity non-invasively in the setting of PD. METHODS: Consecutive patients who underwent ICI followed by Color Doppler Duplex Ultrasound (CDDU) at our institution were retrospectively reviewed. CDDU findings were recorded following injection of alprostadil and again after a period of privacy and visual sexual stimulation (VSS). Erectile re-observations were made with patient standing after VSS. Erectile rigidity was assessed by one physician and all patients were asked to compare to their best quality home erection. CDDU findings including peak systolic velocities, end diastolic velocities, and resistive indices were recorded. Among patients diagnosed with PD, comparisons of patient characteristics between those with and without a diagnosis of ED were made using a Wilcoxon rank sum test (continuous characteristics) or Fisher’s exact test (categorical characteristics). RESULTS: Our assessment of 1853 men using CDDU found 1239 were diagnosed with PD by CDDU. Among those with PD, 353 (28.5%) were diagnosed with PD only (vascular normal) and 886 (71.5%) were diagnosed with PD+ED. Patients with a CDDU diagnosis of PD only were younger [median: 57 (49, 62) vs. 61 (55, 67) years, p<0.001], less likely to have hypertension [119/349 (34.1%) vs. 424/885 (47.9%), p<0.001], less likely to have used PDE-5 inhibitor [243/348 (69.8%) vs. 692/882 (78.5%), p=0.002], and less likely to have failed to a PDE-5 inhibitor [150/243 (61.7%) vs. 531/691 (76.8%), p<0.001] compared to men with PD+ED. Mean SHIM scores were not normal in either group. SHIM scores were higher among those with PD only [median (interquartile range): 14 (8–20) vs. 10 (6–18), p<0.001]. CDDU diagnoses for men with PD+ED were AI 284/886 (32.1%), CVOD 371/886 (41.9%), mixed vascular ED 231/886 (26.1%). CONCLUSIONS: In our practice more than 90% of men undergo history and physical examination with same day CDDU for the evaluation of PD. In this series, Doppler analysis found that 71.5% of PD patients have some form of vascular ED. We recommend an evidence-based assessment of vascular erectile integrity before any patient is triaged to medical or surgical intervention. Source of Funding: N/A © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e739 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Laura Geldmaker More articles by this author Daniela Haehn More articles by this author Sarah Hampton More articles by this author Christopher Walker More articles by this author Colleen Ball More articles by this author Gregory Broderick More articles by this author Expand All Advertisement PDF downloadLoading ...