1205 TESTOSTERONE PROFILES IN MEN WITH SECONDARY RETARDED ORGASM

Vol. 183, No. 4, Supplement, Monday, May 31, 2010

THE JOURNAL OF UROLOGY姞

AGE ⬎65Y at time of RT

OR 2.8

CI 1.8-4.2

P value ⬍0.01

Prostate Size ⬍40 grams

1.8

1.3-6.1

⬍0.01

BT ⫹ EBRT

1.5

1.2-3.8

⬍0.05

IMRT

0.7

0.2-0.8

⬍0.05

Source of Funding: None

1205 TESTOSTERONE PROFILES IN MEN WITH SECONDARY RETARDED ORGASM Doron S. Stember*, Nina Logmanieh, Matthias Heck, John P. Mulhall, New York, NY INTRODUCTION AND OBJECTIVES: Besides the use of SSRI medications, penile hypothesia, chronic penile hyperstimulation and idiosyncratic masturbation, there is some evidence that low serum testosterone (T) levels may contribute to the development of retarded orgasm. This analysis was conducted to evaluate the serum androgen profiles of men presenting with secondary retarded orgasm (SRE). METHODS: We compared androgen profiles of two groups of men: those with SRE without ED, and a contemporaneous group of age/comorbidity matched men with ED but no SRE. Excluded from this analysis were men with primary RE, diabetes, history of androgen deprivation therapy, chemotherapy, abnormal biothesiometry, prior diagnosis of hypogonadism or treatment with T supplementation. Men who were not partnered or had a partner for ⱕ12 months were also excluded. All men had 2 early morning blood draws analyzing total and free T, SHBG, estradiol and LH levels. RESULTS: 172 men had SRE and 154 ED. Mean ages were 59⫾22 and 60⫾19 years respectively. There were no significant differences in comorbidity profiles. In the SRE group, 20% indicated that they currently experienced no orgasm during sexual encounters, 10% had an orgasm less than half the time, and 70% had an orgasm more than half the time. Total T levels were ⬍300 ng/dl (p⬍0.01) for 26% of the SRE patients and 16% of ED patients. In all age groups, except men ⱕ50 years, the proportion of men with total T levels ⬍300 ng/dl was higher in the SRE group compared to the ED group: ⱕ50 years (n⫽36, 10% vs 8%, p⫽ns), 51-65 years (n⫽60, 22 vs 17%, p⫽0.03) and ⱖ65 years (n⫽76, 37% vs 24%, p⬍0.01). Predictors of low T in SRE patients on multivariable analysis are presented in the Table. CONCLUSIONS: These data indicate that one quarter of men with SRE have hypogonadism. They also have a higher prevalence of hypogonadism compared to men with ED and this is most likely in older men and those men who currently are completely unable to have an orgasm with intercourse. SRE Patients Patient age⬎65 years

OR 3.6

CI 1.8-5.9

Never have an orgasm with intercourse

1.3

1.1-2.3

P value ⬍0.01 0.02

Source of Funding: None

1206 PRE-OPERATIVE URINARY AND ERECTILE FUNCTION REPRESENT SIGNIFICANT PREDICTORS OF POST-OPERATIVE URINARY CONTINENCE RECOVERY IN PATIENTS TREATED WITH NERVE SPARING RADICAL PROSTATECTOMY Andrea Gallina*, Alberto Briganti, Luigi Barbieri, Andrea Salonia, Renzo Colombo, Francesco Sozzi, Zanni Giuseppe, Federico Pellucchi, Valerio Di Girolamo, Patrizio Rigatti, Francesco Montorsi, Milan, Italy INTRODUCTION AND OBJECTIVES: Pre-op erectile function (EF) represents an important determinant of EF recovery after bilateral nerve sparing radical prostatectomy (BNSRP). However, poor data is available on the association between baseline EF or urinary function

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and urinary continence (UC) recovery after BNSRP. The aim of this study was to address the association between pre-op functional data and post-operative UC recovery in patients treated with BNSRP METHODS: The study included 752 patients treated with BNSRP at a single tertiary referral center between June 2003 and June 2009. All patients had complete pre-op data including pre-op EF assessed by the International Index of Erectile Function (IIEF-EF) and urinary function evaluated with the International Prostatic Symptoms score (IPSS). All patients post-op completed the International Consultation on Incontinence questionnaire (ICIQ) every 3 months during the first year after surgery and every 6 months thereafter. UC recovery was defined as an ICIQ score ⱕ6 (no pads). Univariable and multivariable Cox regression models addressed the rates of UC. Covariates consisted of pre-op EF and urinary function, age, body mass index (BMI), pathological stage and pre-op PSA RESULTS: Mean and median age at surgery was 62.4 and 62.5 yrs, respectively. Pre-op IIEF-EF showed severe, moderate, mild to moderate, mild and no ED in 23.6, 6.2, 6.2, 17.4 and 46.6% of patients, respectively. IPSS scores were 0-7 (no/mild symptoms), 8-19 (moderate), ⱖ 20 (severe) in 49.4, 39.8 and 10.8%, respectively. Mean and median BMI was 25.8 and 25.6 kg/m2, respectively. At univariable Cox regression analyses, patient age, pre-op IIEF-EF and IPSS scores were significantly associated with UC after surgery (all p’0.002). These data were confirmed at multivariable analyses, where age and pre-op IPSS scores maintained their significant inverse association with UC recovery while IIEF-EF domain showed a significant direct association with UC after BNSRP (all pⱕ0.04). Patients with full EF prior to surgery (ⱖ26) had a 1.5 higher probability of UC recovery as compared to patients with severe ED, even after accounting for the effects of the other predictors (p⫽0.02) CONCLUSIONS: We demonstrated that pre-op EF and urinary functions represent significant predictors of UC after surgery. We speculate that pre-op ED might be a marker of pelvic vascular disease which may affect the external urinary sphincter. Pre-op functional parameters should be also considered for UC prediction after BNSRP Source of Funding: None

1207 GOOD CLINICAL OUTCOME AFTER URETHROPLASTY AT THE EXPENSE OF ERECTILE FUNCTION LOSS? Kathy Vander Eeckt*, Steven Joniau, Leuven, Belgium INTRODUCTION AND OBJECTIVES: It is common knowledge that urethral reconstruction can cause erectile dysfunction. However, only few studies have evaluated this. We aimed to assess erectile function after urethral reconstructive surgery in a single-center, singlesurgeon series. METHODS: 184 patients underwent urethral reconstruction between 2003 and 2009 at our institution. All patients received a questionnaire assessing remembered preoperative IIEF-5 score (rIIEF-5) and IIEF-5 at the time of completing the questionnaire (p-IIEF5). Any urethral instrumentation after surgery was considered a treatment failure. One-way ANOVA, Kaplan-Meier with log-rank test and Wilcoxon paired sample test were used for statistical analysis. RESULTS: Mean follow up of the total group was 31 months (SD ⫹/- 20.5). Overall 5-year failure-free rate was 89.2%. A total of 113 questionnaires were returned. 27 patients were excluded because they had no sexual partner during the full period of evaluation, in 3 patients data on IIEF-5 were incomplete. The remaining 83 were included in the analysis. Of those, 28 underwent end-to-end urethroplasty, 10 had a fasciocutaneous flap and 41 a buccal mucosa graft (BMG) reconstruction, and 4 had a urethrocutaneous fistula excision. There was a significant difference between the median r-IEFF-5 and p-IEFF-5 for the whole group: 23 (IQR 20-24) versus 18.5 (IQR 6-24) (p⬍0.0001). In end-to end urethroplasty group, median r-IEFF-5 and p-IEFF-5 were 23.5 (IQR 20-25) and 21 (IQR 8-24) (p⫽0.03). For the BMG reconstruction group, median r-IEFF-5 and p-IEFF-5 were 23 (IQR 20-25) and 22 (IQR 8-24) (p⫽0.002). Finally, for the fasciocutaneous flap