UNMODERATED POSTER PRESENTATIONS

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PODIUM SESSIONS Thursday, 1 December 2011 14.00–15.30 Blue Room 2 PS-01 Male sexual health Chairs: I. Eardley, UK A. Martín-Morales, Spain PS-01-001

THYROID HORMONES AND SEXUAL FUNCTION Corona, G.1; Wu, F. C. W.2; Forti, G.3; Lee, D.4; O’Connor, D. B.5; O’Neill, T. W.4; Pendleton, N.6; Bartfai, G.7; Boonen, S.8; Maggi, M.9 1 Sexual Medicine and Andrology, University of Florence, Italy; 2Department of Endocrinology, University of Manchester, UK; 3Endocrinology Unit, University of Florence, Italy; 4Epidemiology Unit, University of Manchester, UK; 5 Psychological Science Institute, University of Leeds, UK; 6Clinical Gerontology, University of Manchester, UK; 7Department of Andrology, Albert Szent-Gyorgy Medical, Szeged, Hungary; 8Geriatric Unit, Katholieke Universiteit Leuven, Belgium; 9Andrology Unit, University of Florence, Italy Objective: The role of thyroid hormones in the control of erectile functioning has been only marginally investigated. The aim of this study is to investigate the association between thyroid and erectile function in a general population sample (European Male Aging study [EMAS]) and in patients seeking medical care for sexual dysfunction (University of Florence Study, UNIFI study). Methods: Two different cohorts of subjects were evaluated. The first one derives from EMAS study, a multicenter survey performed on a sample of 3,370 community dwelling men aged 40–79 years (mean 60 ± 11 years). The second cohort is a consecutive series of 3,203 heterosexual male patients (mean age 51.8 ± 13.0 years) attending our Andrology and Sexual Medicine Outpatient Clinic for sexual dysfunction at the University of Florence (UNIFI study). In the EMAS study, all subjects were tested for thyroid-stimulating hormone (TSH) and free thyroxin (FT4). Similarly, TSH levels were checked in all patients in the UNIFI study, while FT4 only when TSH resulted outside the reference range. Results: Overt hyperthyroidism (reduced TSH and elevated FT4, according to the reference range) was found in 0.3 and 0.2% of EMAS and UNIFI study, respectively. In the EMAS and UNIFI samples, TSH levels were inversely related with erectile dysfunction (ED). Overt hyperthyroidism was associated with an increased risk of severe erectile dysfunction (ED, hazard ratio = 14 and 16 in the EMAS and UNIFI study, respectively; both P < 0.05), after adjusting for confounding factors. These associations were conformed in nested casecontrol analyses, comparing subjects with overt hyperthyroidism to age, BMI, smoking status, and testosterone-matched controls. Conversely, no association between hypothyroidism and ED was observed. Conclusion: Erectile function should be evaluated in all individuals with hyperthyroidism. Conversely, assessment of thyroid function cannot be recommended as routine practice in all ED patients. Policy of full disclosure: None.

PS-01-002

UPON NORMALIZATION OF SERUM TESTOSTERONE IMPROVEMENTS OF FEATURES OF THE METABOLIC SYNDROME ARE CONTINUOUS OVER 48 MONTHS: A STUDY IN THREE COHORTS, IN TOTAL 410 MEN Saad, F.1; Haider, A.2; Yassin, A.3; Zitzmann, M.4; Gooren, L.5; Nieschlag, E.4 1 Bayer Pharma AG, Scientific Affairs Men’s Health, Berlin, Germany; 2 Private Urology Practice, Bremerhaven, Germany; 3Institute for Andrology and Urology, Norderstedt, Germany; 4Centre for Reproductive Medicine and Andrology, Münster, Germany; 5VUMC Amsterdam, Department of Endocrinology, The Netherlands Objective: Hypogonadal men often have the metabolic syndrome. We studied the effects of normalization of testosterone over 48 months in three cohorts of men, following the same treatment protocol. Methods: Cohort MZ: 281 men (134 primary, 88 secondary hypogonadism) and 59 with late-onset hypogonadism (LOH) (aged 40 ± 13 years). One hundred thirty-seven had received testosterone for 4 years. Cohort AH: 230 men, aged 62 ± 8 years, 209 had LOH. One hundred forty-three had received testosterone for 4 years. Cohort AY: 130 men, aged 61 ± 9 years), 127 had LOH. Cut-off point was serum testosterone <12 nmol/L. Treatment with parenteral testosterone undecanoate for 48 months was the sole intervention. Results: Plasma levels of testosterone rose from a range of 5.6–9.7 to a range of 15.4–19.0 nmol/L. A remarkable progressive and sustained decline of body weight and waist circumference occurred over the full study period, most outspoken over the first 24 months. Plasma cholesterol, triglyceride, and LDL-cholesterol decreased significantly over the study period. Plasma glucose declined over the first 12–18 months and then stabilized. In cohort MZ at baseline 240/281, men fulfilled the harmonized criteria of the metabolic syndrome, falling to 114/281 after 2 years. At baseline 88/143, men in cohort AH and 93/130 men in cohort AY met the criteria of the metabolic syndrome by the harmonized definition. After 48 months of testosterone treatment, this number had declined to 48/143 in cohort AH and to 62/130 in cohort AY. Conclusion: In men with hypogonadism, testosterone treatment over 48 months led to an improvement of metabolic syndrome components with sustained declines of body weight and waist circumference and improvements of cholesterol, LDL, and triglycerides. Improvements in younger men with “classical” primary or secondary hypogonadism (cohort MZ) were of a similar magnitude as in men with LOH (cohorts AH and AY). Policy of full disclosure: F. Saad is an employee of Bayer Pharma AG. A. Haider and L. Gooren have received travel compensation from Bayer. A. Yassin and M. Zitzmann have received lecture honoraria from Bayer and Ferring. E. Nieschlag has received lecture honoraria from Bayer.

PS-01-003

TESTOSTERONE IN HYPERTENSIVE MEN WITH ERECTILE DYSFUNCTION: A SECRET PLAYER? Ioakeimidis, N.; Vlachopoulos, C.; Rokkas, K.; Terentes-Printzios, D.; Samentzas, A.; Askitis, T.; Aznaouridis, K.; Stefanadis, C. Athens Medical School, 1st Department of Cardiology, Greece Objective: Testosterone deficiency has been associated with a higher mortality due to cardiovascular (CV) disease in men with erectile dysfunction (ED); however, whether a low plasma testosterone level

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370 could predict cardiovascular events in ED patients with hypertension has not been investigated. Methods: Two hundred seventy-five non-obese treated hypertensive ED patients (30–69 years old, mean ± SD = 52 ± 8 years) without a previous history of CV disease were followed up. At baseline, the subjects underwent examination of coronary risk factors and assays of plasma total testosterone (TT) and C-reactive protein. Results: During the mean follow-up period of 43 months, a total of 29 CV events occurred. The difference in hypogonadism (TT < 3.4 ng/mL) prevalence between patients with and those without CV was significant (35% vs. 19%; P < 0.01). Kaplan–Meier survival analysis by tertile of TT levels revealed that the subjects with the lowest testosterone tertile were more likely to develop CV events than those with the highest tertile (P = 0.012 by log-rank test, see figure below). Cox proportional hazards models showed that the subjects with the lowest tertile of plasma testosterone (<4.0 ng/mL) had an approximately 2.5-fold higher CV event risk compared to those with the higher testosterone tertiles after adjustment for age, risk factors, antihypertensive therapy, and statins (multivariate-adjusted hazard ratio, 2.6; 95% CI, 1.01–8.38). Multivariate analysis did not show any significant association of C-reactive protein with CV events. Conclusion: A low plasma testosterone level is associated with CV events in middle-aged hypertensive patients with ED, independent of risk factors and low-grade inflammation. Policy of full disclosure: None.

PS-01-004

LONG-ACTING TESTOSTERONE UNDECANOATE IMPROVED AGING MALE SYMPTOM SCORES BUT NOT DEPRESSION VS. PLACEBO IN A HYPOGONADAL POPULATION WITH TYPE 2 DIABETES Hackett, G. Good Hope Hospital, Sutton Coldfield, UK Objective: Testosterone replacement has been shown in several studies to improve sexual function aging male symptom (AMSS) and depression (HADS). This is the first double-blind, placebo-controlled study of testosterone in an exclusively type 2 diabetic population. Methods: The male type 2 diabetic population 7 UK general practices were screened to identify 211 eligible patients with clinical hypogonadism. Two hundred patients entered the 30-week, double-blind, placebo-controlled phase of testosterone undecanoate 1,000 mg with 187 (93%) completing and 106 entering a 12-month, open-label follow-on. Patients were assessed for IIEF, AMSS HADS, and a Global Efficacy score (GEQ). Results: The TT rose from 9.6 to 13.06 (plateau level) in the TU group, and fell from 8.4 to 7.3 in the placebo group. AMSS fell from 41.0 to 36.7 with TU (40.7–37.6 with placebo). HADS rose from 12.8 to 13.9 with TU (13.4–13.6 with placebo). The prevalence of ED overall was 77% with the mean EF score increasing from 17.8 to 18.9

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Podium Sessions with TU (18.3–20.2 with placebo). Only 10% of the patients were taking treatment for ED. There was one treatment emergent prostate cancer in the placebo arm. The most striking findings were on the open-label continuation study, AMSS fell from a further 3.3 points overall equating to an 8-point drop from baseline. The EF score fell by 2 points, but was not significantly changed from baseline. There were no further safety concerns with a mean PSA increase from 1.91 to 2.11, and mean hematocrit was unchanged from baseline. Conclusion: TU therapy produced significant improvement in AMSS up to 18 months. Trials of testosterone therapy may need to be given for substantially longer than the current practice of 3 months. There was no improvement in depression scores and minor improvement in ED. Policy of full disclosure: This was an investigator-initiated and sponsored study supported by an unrestricted grant from Bayer plc.

PS-01-005

BODY MASS INDEX REGULATES HYPOGONADISM-ASSOCIATED CV RISK: RESULTS FROM A COHORT OF SUBJECTS WITH ERECTILE DYSFUNCTION Corona, G.1; Rastrelli, G.1; Monami, M.2; Forti, G.3; Mannucci, E.2; Maggi, M.1 1 Sexual Medicine and Andrology, University of Florence, Italy; 2Geriatric Unit, University of Florence, Italy; 3Endocrinology Unit, University of Florence, Italy Objective: Obesity is an independent cardiovascular (CV) risk factor. Testosterone (T) is inversely related to body mass index (BMI) in males. There is substantial evidence suggesting that low T could play a role as a moderator of CV mortality in men. This study is designed to assess the possible interaction between T and obesity in predicting major cardiovascular events (MACE) in a sample of subjects with erectile dysfunction. Methods: A consecutive series of 1,687 patients was studied. Different clinical, biochemical, and instrumental parameters were evaluated. According to BMI, subjects were divided into normal weight (BMI = 18.5–24.9 kg/m2), overweight (BMI = 25.0–29.9 kg/m2), and obese (BMI ≥ 30.0 kg/m2). Hypogonadism was defined as total T below 10.4 nmol/L. Information on MACE was obtained through the City of Florence Registry Office. Results: Among the patients studied, 39.8% had normal weight, whereas 44.1% and 16.1% were overweight or obese, respectively. Unadjusted analysis in the whole sample showed that while hypogonadism and obesity were significantly associated with an increased risk of MACE, their interaction term was associated with a protective effect. In a Cox regression model, adjusting for confounders, hypogonadism showed a significant increased risk of MACE in normal weight subjects, whereas it was associated with a reduced risk in obese patients. Conclusion: Hypogonadism-associated CV risk depends on the characteristics of subjects, being more evident in normal weight than in obese patients. Further studies are advisable to clarify if low T in obese patients is a (positive) consequence of a comorbid condition (i.e., to save energy) or if it represents a pathogenetic issue of the same illness. Hence, possible misuse/abuse of testosterone treatment in obese subjects must be avoided. Policy of full disclosure: None.

PS-01-006

DIABETES MELLITUS IS ASSOCIATED WITH PENILE SHORTENING Kadihasanoglu, M.1; Aydin, M.1; Sariogullari, U.1; Miroglu, C.1; Kendirci, M.2 1 Şişli Etfal Hospital, Department of Urology, Istanbul, Turkey; 2Istanbul Surgery Hospital, Department of Urology, Turkey Objective: To investigate whether the presence of diabetes mellitus might be a risk factor for penile shortening in men with erectile dysfunction (ED).

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Podium Sessions Methods: A total of 1,169 men were included into this study and were divided into three groups: group 1, men with diabetic ED (N = 233); group 2, non-diabetic ED patients (N = 733); and group 3, infertile men without ED and diabetes (N = 203). Patients were excluded from the study if they had had a history of pelvic surgery, Peyronie’s disease, hormonal abnormalities, and congenital/acquired penile abnormalities. All the groups were statistically compared for age, body mass index (BMI), rate of comorbid conditions other than diabetes, measured penile girth, flask and stretch penile size. Calculated values were provided as mean ± SD. Kruskal–Wallis test was used for statistical analyses and P < 0.05 was considered as significant. Results: Men in group 3 were younger than the others, while groups 1 and 2 were statistically comparable. No significant difference was found among the groups for BMI values. Similarly, penile girth measurements were also found to be comparable (P = 0.092). However, flask and stretch penile measurements in diabetic ED men were significantly lower than those in non-diabetic ED men and infertile men without ED and diabetes (P < 0.001). Measured flask and stretch penile size were as follows: group 1, 7.61 ± 1.52 and 12.86 ± 1.08 cm; group 2, 8.12 ± 1.45 and 13.55 ± 1.81 cm; and group 3, 8.56 ± 1.53 and 14.28 ± 1.77 cm. In addition, non-diabetic ED men exhibited significantly lower flask and stretch penile lengths compared to non-ED and nondiabetic infertile men (P < 0.05). Conclusion: This comparative clinical study suggests that the presence of diabetes in men with ED might be a risk factor for penile shortening. These findings might also be taken into account in clinical decision-making for diabetic ED patients, such as for penile rehabilitation or implantation of penile prosthesis. Policy of full disclosure: None.

PS-01-007

INCREMENTAL VALUE OF POOR PENILE ARTERIAL INFLOW FOR THE PREDICTION OF SIGNIFICANT CORONARY ARTERY STENOSIS IN ASYMPTOMATIC HYPERTENSIVE PATIENTS WITH INCREASED CAROTID INTIMA MEDIA THICKNESS: A PROSPECTIVE ANGIOGRAPHIC STUDY Vlachopoulos, C.; Ioakeimidis, N.; Terentes-Printzios, D.; Synodinos, A.; Aznaouridis, K.; Aggelis, A.; Fassoulakis, C.; Rokkas, K.; Askitis, T.; Stefanadis, C. Athens Medical School, 1st Department of Cardiology, Greece Objective: Aortic stiffness and carotid intima media thickness (IMT) are markers of subclinical vascular damage in patients with essential hypertension. Reduced penile peak systolic velocity (PPSV) is associated with increased risk for cardiovascular events as well as the degree and distribution of atherosclerotic lesions. This study was undertaken to ascertain whether poor penile inflow adds incremental value beyond aortic stiffness and IMT evaluation for predicting coronary artery disease (CAD) in hypertensive ED patients. Methods: One hundred eighty-one consecutive asymptomatic ED patients with hypertension were prospectively evaluated for CAD. All patients underwent dynamic (after prostaglandin E1 stimulation) penile Doppler ultrasonography, carotid-femoral pulse wave velocity (PWV), and carotid IMT evaluation. Mean PPSV values below 25 cm/ second are considered to indicate severe arterial insufficiency (SAI). Results: Coronary angiography revealed significant stenosis in 43 (24%) patients with a positive stress test. SAI was found in 23 of 43 (53.5%) CAD patients and in 30 of 138 (22%) non-CAD subjects (P = 0.005). The prevalence of high PWV and IMT values (≥75th percentile, 9.6 m/s and 0.94 mm, respectively) was significantly higher among CAD patients than among non-CAD subjects (39.5% vs. 19.4%, P = 0.004 and 55.2% vs. 26.7%, P < 0.001, respectively). By conditional logistic regression analysis, SAI conveyed no additional predictive information beyond high PWV values. On the contrary, SAI confers an incremental value over high IMT values in predicting CAD (OR: 4.62, CI: 2.34–9.57, P < 0.001, see figure below).

Conclusion: Adjunctive assessment of PPSV with carotid wall thickness enhances the detection of silent CAD among hypertensive ED patients. Policy of full disclosure: None.

PS-01-008

EFFICACY AND SAFETY OF TOPICAL APROSTADIL CREAM (VITAROS®) IN HYPERTENSIVE, DIABETIC, AND CARDIAC PATIENTS WITH MALE ERECTILE DYSFUNCTION (ED) Buvat, J.1; Schupp, J.2; Goldstein, I.3; Damaj, B.4; Frank, D.5; Hachicha, M.5 1 Centre d’Etude et de Traitement, de la Pathologie de L’appareil, Lille, France; 2San Diego, CA, USA; 3San Diego Sexual Medicine, San Diego, CA, USA; 4Apricus Biosciences, San Diego, CA, USA; 5NexMed USA, San Diego, CA, USA Objective: Topical alprostadil cream with the skin penetration enhancer DDAIP was approved as Vitaros® for first-line treatment of ED in Canada and is under regulatory review in Europe and the United States. Two identical multicenter, randomized, placebocontrolled, parallel-group, double-blind, phase 3 trials evaluated the efficacy and the safety of 100, 200, and 300 mcg topical alprostadilDDAIP in men, and demonstrated significant improvement of mildto-severe ED. Methods: A combined dataset of 1,732 randomized patients was analyzed to provide data in subpopulations of patients with and hypertensive (N = 745), diabetic (N = 350), and/or cardiac (N = 479) comorbidity. Cardiac patients were identified based on predefined conditions or procedures reported in their medical history. The primary efficacy end point was the International Index of Erectile Function (IIEF) with the erectile function (EF) domain as co-primary efficacy end point. Secondary end points included Sexual Encounter Profile (SEP) and Global Assessment Questionnaire (GAQ). Results: Least square mean changes (SE) in the IIEF-EF domain scores from baseline were statistically significantly (P < 0.003) in favor of the recommended 200 mcg and 300 mcg doses, i.e., 2.9 (0.53) and 2.0 (0.50) vs. −0.6 (0.52) for placebo in the hypertensive population, 3.5 (0.77), 2.1 (0.81) vs. −1.2 (0.82) for diabetic patients, and 1.5 (0.68) and 1.9 (0.64) vs. −1.7 (0.71) points for cardiac patients, respectively. Also, secondary end points such as the percentage of patients reporting improvement in their erections in the GAQ were statistically significant for the two recommended doses (P < 0.001). No treatment-related serious adverse events were reported. Most of the mild-to-moderate local reactions resolved within 2 hours. Conclusion: Topical alprostadil-DDAIP cream significantly improves symptoms of ED in a broad range of patients including more-difficultto-treat patients who may not be candidates for phosphodiesterase type 5 (PDE5) inhibitors. Policy of full disclosure: None.

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372 PS-01-009

SEXUAL FUNCTION IN MAJOR DEPRESSION AND THE EFFECT OF TREATMENT WITH GEPIRONE-ER Fabre, L. F.; Smith, L. C. Fabre Kramer Pharmaceuticals, Houston, TX, USA Objective: To describe the effect of major depression on sexual function and to contrast the effect of gepirone-ER on sexual function in men and women. Major depressive disorder (MDD) affects sexual function of men and women differently as measured by the Derogatis Inventory of Sexual Function (DISF). Overall, MDD causes worse sexual dysfunction in women than in men. MDD affects desire and arousal in women more than in men, and orgasm in men more than in women. Gepirone-ER is a 5-HT1A antidepressant which has shown efficacy in relieving both depression and sexual dysfunction. Methods: Four hundred twenty patients with MDD were evaluated with Hamilton Rating Scale for Depression (HAMD-17) and DISF prior to and after treatment with gepirone-ER (40–80 mg/day). Results: These severely depressed patients (80% had been previously hospitalized and 12% had made a previous suicide attempt) had an average HAMD-17 of 25.8 at baseline and improved to 10.8 (mildly ill) after 8–12 weeks of gepirone-ER. Before treatment, the sexual function of the female group was −2 standard deviations (SD) from normal on total DISF score, with the domains of desire in the normal range, and all other domains −2 SD below normal. At baseline, the male sexual function for all domains except orgasm (−3 SD) and drive (−2 SD) was in the normal range. Treatment with gepirone-ER statistically significantly improved sexual function in men and women. For women after treatment, desire, arousal, and behavior are normal, but orgasm, drive, and total score are still −2 SD below normal. For men after treatment, total score and all domains except orgasm are in the normal range. Conclusion: Major depression is more devastating to sexual function in women than in men, and women respond less to medication than men. Policy of full disclosure: Dr. Fabre is a full-time employee of and a shareholder in Fabre Kramer Pharmaceuticals, Inc. Dr. Smith is a paid consultant to Fabre Kramer Pharmaceuticals, Inc.

PS-01-010

POOR RESPONSE TO INTRACAVERNOUS ALPROSTADIL INJECTION TEST IS ASSOCIATED WITH ARTERIOGENIC ERECTILE DYSFUNCTION AND HIGHER RISK OF MAJOR ADVERSE CARDIOVASCULAR EVENTS Rastrelli, G.1; Corona, G.1; Morelli, A.1; Vignozzi, L.1; Mannucci, E.2; Maggi, M.1 1 University of Florence, Clinical Physiopathology, Italy; 2University of Florence, Critical Care, Italy Objective: Intracavernous alprostadil injection (ICI) test has been considered useless in assessing the vascular status of subjects with erectile dysfunction (ED). The aim of the study was to analyze the clinical correlates of ICI test in patients with ED and to verify the value of this test in predicting major adverse cardiovascular events (MACE). Methods: A consecutive series of 2,396 men (mean age 55.9 ± 11.9 years) attending our Andrology Outpatient Clinic for sexual dysfunction were retrospectively studied. A subset of this sample (N = 1,687) was enrolled in a longitudinal study. Clinical and biochemical factors and penile color Doppler ultrasound (PCDU) were evaluated. All patients underwent an ICI test and the responses were recorded on a four-point scale ranging from 1 = no response to 4 = full erection. Results: Among the patients studied 16.4%, 41.2%, 40.2%, and 2.2% showed grades 4, 3, 2, and 1 ICI test response, respectively. After adjusting for confounders, subjects with grade 1 ICI test response

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Podium Sessions showed reduced perceived sleep-related, masturbation-related, and sexual-related erections when compared to the rest of the sample. In addition, a worse response to ICI test was associated with a higher prevalence of hypogonadism-related symptoms and signs along with lower testosterone levels. The prevalence of both diabetes mellitus and metabolic syndrome was inversely related to ICI test response. Accordingly, dynamic and basal peak systolic velocity (PSV), as well as acceleration at PCDU, decreased as a function of ICI test response. In the longitudinal study, after adjusting for confounders, grade 1 response was independently associated with a higher incidence of MACE (HR = 2.745 [1.200–6.277]; P < 0.05). These data were confirmed when only subjects with normal PSV (>25 cm/second) were considered. Conclusion: Our results demonstrate that poor ICI test response is associated with several metabolic disturbances and higher incidence of MACE. We strongly recommend performing ICI test with alprostadil in all ED subjects. Policy of full disclosure: None.

PS-01-011

VERY LONG-TERM OUTCOME OF A COHORT OF 542 ED PATIENTS UNDER SELFINTRACAVERNOUS INJECTIONS Virag, R.; Sussman, H.; Costa, C. CETI, Paris, France Objective: Intracavernous injections (ICI) were introduced as selfadministered treatment in 1983. We present a cohort of 542 patients treated during 10–25 years. Our main purpose was to evaluate ICI efficacy, tolerance, and safety after long-term usage. Secondary items were different drugs used, attitude toward the partner, additional treatments, and medical events along the survey. Methods: The cohort represents 24.2% of the 2,237 patients having started ICI between 1983 and 1999. Inclusion criterion was 10-year minimal follow-up. Information on the use of treatment rate, dose, changes, complications, additional treatments, diseases, and partner’s issues was obtained from our database through visit/telephone within the 2 years of the study (2009–2010). Statistics were made with Statistica®. Results: At treatment initiation, median age was 51 years, mean follow-up 14 ± 5.4 years, 41% had started 20 years ahead. Thirty-four percent presented organic, 28% psychogenic, and 38% mixed etiology. At the most recent control, 2/3 was still using ICI and 1/3 of those who had stopped intended to restart. According to ED severity/progression, various medications were used mono-, bi-, tri-, or polytherapy. Reasons to stop the treatment were improvement (13%), oral therapy (27.5%), inefficacy (23%), abstinence (11%), health problems, and/or death (6%). Of 163 patients who tried PDE5I, only 40% decided to keep it as sole treatment. Seventy-nine percent used ICI once to twice a week, 11% less and 10% are frequent users. Seventyfour percent depended totally on ICI. Complications affected less than 10%: Peyronie’s and corporal nodules (2.8% each) and priapism (1%). Fifty-two percent concealed the treatment from their partners; 3.3% enjoyed “papaverine babies.” Testosterone replacement was issued in 36%. PK occurred in 4.3% and CHD in 6%. Conclusion: Seventy-five percent of patients are still using ICI after 10–27 years, with satisfaction and very few complications. Treatment efficacy needed changes of regimen in half of the cases and only 13% were definitely cured. Policy of full disclosure: None.

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Podium Sessions PS-01-012

TIME TO ONSET OF ACTION OF VARDENAFIL ORODISPERSIBLE AND FILMCOATED TABLETS: A RETROSPECTIVE ANALYSIS OF THE PIVOTAL TRIALS Debruyne, F.1; Gittelman, M.2; Sperling, H.3; Börner, M.4; Beneke, M.5 Andros Mens Health Institutes, Arnhem, The Netherlands; 2South Florida Medical Research, Biscayne Boulevard, Aventura, FL, USA; 3Kliniken Maria Hilf GmbH, Mönchengladbach, Germany; 4Bayer Pharma AG, Berlin, Germany; 5Bayer Pharma AG, Elberfeld, Germany

1

Objective: Patients and physicians consider rapid onset of action an important attribute of oral pharmacotherapy for erectile dysfunction. The time to onset of action of an orodispersible tablet (ODT) formulation of vardenafil was investigated. Methods: A post hoc integrated analysis was performed on data from two 12-week, double-blind, multicenter, randomized, parallel-group, placebo-controlled phase III trials of 10 mg vardenafil ODT. Vardenafil film-coated tablet data were generated from a retrospective integrated analysis at week 12 of four double-blind, multicenter, randomized, parallel-group, fixed-dose, placebo-controlled phase III trials. Time intervals (15-, 30-, and 60-minute increments, up to ≥6 h after study medication intake) were determined for the period between dosing and start of sexual activity (with the intention of intercourse). The total number of intercourse attempts and Sexual Encounter Profile question 3 (SEP3) success rates were calculated per time interval. Results: Within 15 minutes post-dosing, mean-per-patient SEP3 success rates were 62.5% (vardenafil ODT) vs. 29.4% (placebo), with corresponding overall SEP3 success rates of 59.8% and 38.2%. In this time interval, 5.3% vs. 2.8% of all sexual activity attempts were initiated by subjects taking vardenafil ODT (N = 89; 25.3%) or placebo (N = 62; 18.6%), respectively. At 16–30 minutes post-dosing, SEP3 success rates were 65.3% and 32.6% (mean per patient), and 70.2% and 51.0% (overall), for vardenafil ODT vs. placebo, respectively, with a corresponding 10.4% and 8.7% of all sexual activity attempts being made by subjects taking vardenafil ODT (N = 170; 48.3%) or placebo (N = 118; 35.3%). Comparable results were observed for vardenafil 10 and 20 mg film-coated tablet at corresponding time intervals. Conclusion: Vardenafil ODT shows a rapid onset of action, comparable with that of vardenafil film-coated tablet. In those men who begin sexual activity within 30 minutes after dosing, the majority of sexual attempts lead to successful intercourse. Policy of full disclosure: F. M. J. Debruyne has acted as a speaker for Bayer Pharma AG and a consultant for Dendreon and Ferring Pharmaceuticals. M. Gittelman has acted as a clinical trial investigator and speaker for Bayer Pharma AG. H. Sperling has served as a speaker, consultant, and investigator for AMS, Bayer Pharma AG, Eli Lilly/ ICOS, Ferring Pharmaceuticals, and Pfizer. M. Börner and M. Beneke are employees of Bayer Pharma AG. This study was funded by Bayer Pharma AG. Editorial assistance in the writing of this abstract was provided by Sarah Stowell, PhD and James Reed, PhD of Fishawack Communications Ltd, and was funded by Bayer Pharma AG.

Methods: Data were pooled from17 randomized, double-blind, parallel-group clinical trials of tadalafil vs. placebo for 12 weeks. The current analysis included only men receiving tadalafil 10 mg (N = 512) or 20 mg (N = 1,767). End-point values for efficacy measures (see table below) were summarized for incomplete responders (ICR) and complete responders (CR). Last-observation-carried-forward was used to analyze end-point data. Continuous variables were assessed by two-way anova adjusted for treatment, ICR status, and their interaction. For discrete variables, statistical significance was assessed using the Mantel–Haenszel test (association) and Breslow–Day test (homogeneity across doses). The association of IIEF-EF domain <26 with other potential measures of incomplete response was assessed based on kappa coefficient stratified by dose. Results: Incomplete response (IIEF-EF < 26) was seen with tadalafil 10 mg and 20 mg for 298/512 (58.2%) and 787/1,767 (44.5%) patients, respectively. At end point, response was significantly better for CR vs. ICR for all measures (P < 0.001). The classification of ICR based on IIEF-EF <26 showed fair (0.21–0.40)-to-moderate (0.41–0.60) agreement (Landis and Koch, Biometrics 1977;33:159–174) with GAQ and IIEF-EF change <4 and moderate agreement with SEP3 <80% based on kappa coefficients. Conclusion: The IIEF-EF domain defines normal as IIEF-EF ≥26. Incomplete response (IIEF < 26) showed fair-to-moderate correlation with other potential definitions of incomplete response including SEP3 <80%, IIEF-EF change <4, and GAQ “no.” Policy of full disclosure: Dr. A. Seftel serves as a consultant for Eli Lilly and Company. X. Ni and L. McKay are full-time employees of Eli Lilly and Company.

PS-01-014

12 WEEKS OF TREATMENT WITH TADALAFIL AS NEEDED SIGNIFICANTLY IMPROVES EJACULATORY AND ORGASMIC DYSFUNCTIONS IN MEN ENROLLED IN 17 PLACEBO-CONTROLLED STUDIES OF ERECTILE DYSFUNCTION Paduch, D.1; Bolyakov, A.2; Polzer, P.3; Watts, S.3 Weill Medical College, Brady Urological Health Center, New York, NY, USA; 2Weill Medical College, Urology and Reproductive Medicine, New York, NY, USA; 3Lilly Research Laboratories, Eli Lilly, Indianapolis, IN, USA

1

PS-01-013

OVERALL TREATMENT RESPONSE AMONG PATIENTS WITH INCOMPLETE RESPONSE TO TADALAFIL ON-DEMAND: ANALYSIS OF POOLED DATA FROM 17 RANDOMIZED CLINICAL STUDIES Seftel, A.1; Ni, X.2; McKay, L.2 Cooper University Hospital, Surgery/Urology, Camden, NJ, USA; 2Eli Lilly and Company, Lilly Research Laboratories, Indianapolis, IN, USA

1

Objective: To characterize various measures of efficacy in patients with complete vs. incomplete response to tadalafil based on a cutoff of IIEF-EF domain score = 26 for normal erectile function (Porst et al. J Sex Med 2010;7:414–444).

Objective: To evaluate whether treatment with tadalafil improves ejaculatory function (EjF) or orgasmic function (OF) compared to placebo in men with ejaculatory dysfunction (EjD) or orgasmic dysfunction (OD) and a broad spectrum of EjD and OD severities. Methods: Baseline and 12-week (end point) data from 17 placebocontrolled trials of tadalafil were integrated. Study designs have been published; subjects (men with a history of erectile dysfunction) were randomized to placebo, or one of three doses of tadalafil, taken as needed. EjF was assessed via Question 9, and OF via Q10, of the International Index of Erectile Function Questionnaire (IIEF). Based on responses to IIEF-Q9 and IIEF-Q10, subjects were categorized into one of three response groups: (i) responses of 1 (“almost never/ never”) or 2 (“a few times”) were taken as evidence of severe EjD or

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Podium Sessions

OD; (ii) a response of 3 (“sometimes”) was evidence of mild EjD or OD; and (iii) responses of 4 (“most times”) or 5 (“almost always/ always”) were evidence of minimal or no EjD or OD. (Responses of 0 [“no sexual stimulation/intercourse”] were excluded.) Analyses of covariance compared mean values in the tadalafil and placebo groups. Results: More than 3,400 subjects were randomized. At baseline, 46% had severe EjD and 54% had severe OD, with balance across treatment groups. A tadalafil dose–response relationship was observed for subjects with severe EjD or OD. With tadalafil treatment, significant improvements in EjF and OF were observed in the severe and mild EjD and OD groups; in the minimal-severity group, tadalafil significantly prevented loss of EjF and OF relative to placebo. Conclusion: Ejaculatory and orgasmic dysfunctions are common male sexual disorders. Across most EjD and OD severities, significant improvements in the quality of orgasm and ejaculation were observed after 12 weeks of tadalafil (vs. placebo). Policy of full disclosure: The original placebo-controlled studies of as-needed tadalafil, the present analysis, and this communication were supported by Eli Lilly and Company (Indianapolis, IN, USA). Financial disclosures: D. Paduch, paid investigator and/or consultant/ advisor/speaker for the study sponsor; A. Bolyakov, paid investigator and/or consultant/advisor/speaker for the study sponsor; P.K. Polzer and S. Watts, employees of and minor shareholders in the study sponsor. Writing/editorial support: Stephen W. Gutkin, Rete Biomedical Communications Corp. (Wyckoff, NJ, USA), with support from the study sponsor. Mean Changes in Ejaculatory- and Orgasmic-Function Parameters

Variable

Baseline degree of dysfunction (IIEF response)

Mean difference (baseline to 12 weeks) Placebo

IIEF-Q9 Ejaculation*

Severe EjD (1 or 2) 0.8 Mild EjD (3) 0.3 Minimal or no EjD −0.6 (4 or 5)

IIEF-Q10 Orgasm†

Severe OD (1 or 2) Mild OD (3) Minimal or no OD (4 or 5)

0.8 −0.1 −0.8

Tadalafil 5 mg

Tadalafil 10 mg

Tadalafil 20 mg

1.5‡ 0.9 −0.3‡

1.8‡ 0.8‡ −0.3‡

2.0‡ 1.1‡ −0.2‡

1.2‡ 1.0‡ 0.0‡

1.7‡ 0.9‡ −0.4‡

1.9‡ 1.0‡ −0.3‡

*IIEF-Q9: “When you had sexual stimulation or intercourse, how often did you ejaculate?” † IIEF-Q10: “When you had sexual stimulation or intercourse, how often did you have the feeling of orgasm or climax?” ‡ Mean difference is statistically significant vs. placebo (p < 0.05) EjD = ejaculatory dysfunction; OD = orgasmic dysfunction

PS-01-015

EARLIER RESUMPTION OF PENILE FUNCTION AFTER BILATERAL NERVE SPARING ROBOTIC PROSTATECTOMY: A RANDOMIZED CONTROLLED PILOT STUDY OF VACUUM ERECTION THERAPY + TADALAFIL VS. TADALAFIL ALONE Engel, J. George Washington University, Urology, Washington, DC, USA Objective: To determine if daily vacuum therapy (VED) combined with tadalafil can induce an earlier or higher rate of return of penile function compared to tadalafil alone after bilateral nerve sparing robotic prostatectomy (BNSNP). Methods: Men were randomized 1 month post-BNSRP to receive tadalafil, 20 mg, three times weekly (DRUG), or tadalafil at the same dosage in conjunction with the VED used 10 minutes unbanded per day at least five times weekly (COMBO). Treatment started 1 month after surgery; follow-up visits were conducted at 1, 3, 6, 9, and 12 months. Patients were to attempt intercourse at least twice before each visit. Assessments were the International Index of Erectile Function (IIEF-5), the erectile hardness scale (EHS), and the patients were

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questioned as to their ability to have vaginal penetration (SEP2) and intercourse to orgasm (SEP3). Results: Thirteen men were randomized to the COMBO group, none dropped out. Ten patients started the DRUG treatment, three dropped out. As early as 3 months after treatment initiation, men in the COMBO group demonstrated statistically greater improvement in SEP2 (20% DRUG vs. 69% COMBO P > 0.05). At 6 months, all four measures of penile function demonstrated statistically superior results in the COMBO group vs. the DRUG group (P > 0.05). By 12 months, penile function in the COMBO group was statistically superior only in IIEF-5 and SEP3. Ninety-two percent and 29% of men in the COMBO group and DRUG group, respectively, responded that they had an erection that lasted long enough to reach orgasm. Mean IIEF at 12 months was 18.9 vs. 11.1 (P > 0.05) in the COMBO and DRUG groups, respectively. Compliance to the VED usage was superior to that of tadalafil. Conclusion: Men with ED subsequent to BNSRP had a more rapid and complete return of sexual function when treated with tadalafil plus VED vs. tadalafil alone. Policy of full disclosure: The study was supported by an educational grant from Timm Medical Technologies (Eden Prairie, MN, USA).

PS-01-016

PREMATURE EJACULATION: A PROSPECTIVE RANDOMIZED STUDY TO COMPARE PELVIC FLOOR REHABILITATION AND DAPOXETINE, A NOVEL SELECTIVE SEROTONIN REUPTAKE INHIBITOR Pastore, A. L.1; Palleschi, G.2; Silvestri, L.2; Ripoli, A.2; Autieri, D.2; Leto, A.2; Carbone, A.2 1 Rome, Italy; 2Sapienza University of Rome, Faculty Pharmacy and Medicine, Latina, Italy Objective: Premature ejaculation (PE) is the most common male sexual disorder. PE may present as a lifelong or acquired condition characterized by ejaculation that always or almost always occurs prior to or within 1 minute of vaginal penetration, as well as an inability to delay ejaculation. The intra-vaginal ejaculatory latency time (IELT) is defined as the time from vaginal intromission to ejaculation. We compared pelvic floor muscle (PFM) rehabilitation to “on-demand” treatment with the selective serotonine reuptake inhibitor (SSRI) dapoxetine in 40 healthy men with premature ejaculation (baseline IELT ≤ 2 minutes). Methods: From July 2010 to January 2011, 40 healthy male patients with PE were enrolled. Patients were randomized into two treatment groups: (i) PFM rehabilitation or (ii) 30 or 60 mg of “on-demand” dapoxetine. IELT mean values were compared to measure the effectiveness of the two different therapeutic approaches after 12 weeks of treatment. PFM rehabilitation comprised physiokinesitherapy electrostimulation and biofeedback. Results: At the end of treatment, 11 of the 19 patients (57%) treated with PFM rehabilitation were able to control the ejaculation reflex, with a mean IELT of 2.11 minutes (range: 2.06–2.54 minutes). In the SSRI group, the 21 patients were randomly divided into two subgroups, the first group received 30 mg of “on-demand” dapoxetine and the second received 60 mg of dapoxetine. After 3 months of therapy, 5 of 8 (62.5%) patients in the 30-mg subgroup and 5 of 7 (72%) in the 60-mg subgroup had an IELT > 3 minutes (mean IELT 3.07 minutes and 3.68 minutes, respectively). Conclusion: All of the patients in dapoxetine group reported a significant improvement in their IELT compared to baseline IELT and the IELTs of patients in the PFM rehabilitation study group. Policy of full disclosure: None.

375

Podium Sessions PS-01-018

IS THERE A CORRELATION BETWEEN PREMATURE EJACULATION AND THE FEMALE PARTNER’S SEXUAL FUNCTION? Bronner, G.; Kitry, N.; Raviv, G.; Ramon, J.; Elran, E. Sheba Medical Center, Sexual Medicine Center-Urology, Ramat-Gan, Israel

PS-01-017

PERCEIVED EJACULATE VOLUME REDUCTION IN PATIENTS WITH ERECTILE DYSFUNCTION: PSYCHOBIOLOGICAL CORRELATES Rastrelli, G.1; Corona, G.1; Boddi, V.1; Paggi, F.2; Balercia, G.2; Forti, G.1; Mannucci, E.3; Maggi, M.1 1 University of Florence, Clinical Physiopathology, Italy; 2University of Marche, Endocrinology, Ancona, Italy; 3University of Florence, Critical Care, Italy Objective: The disorders of ejaculation encompass a heterogeneous group of dysfunctions including premature ejaculation, delayed ejaculation, and perceived ejaculate volume reduction (PEVR). The aim of this study was to explore the psychobiological correlates of PEVR in patients with erectile dysfunction (ED). Methods: A consecutive series of 3,141 patients (mean age 51.6 ± 13.1) attending our Andrology Outpatient Clinic for ED were retrospectively studied. Among these, 71 were excluded because they underwent prostate surgery. Different clinical and biochemical factors were assessed along with parameters derived from the Structured Interview on Erectile Dysfunction (SIEDY) evaluating the organic, relational, and intrapsychic components of ED. PEVR was investigated using validated question #15 of the SIEDY, which showed an accuracy of 69% (52–86%), P = 0.041, in predicting objectively measured ejaculate volume in a consecutive series of 106 subjects (mean age 32.9 ± 7.6) consulting for infertility. Results: After adjustment for confounders, PEVR was specifically associated with the use of androgen deprivation therapy and other medications including a-blockers, serotonergic reuptake inhibitor antidepressants, and angiotensin-converting enzyme inhibitors/angiotensin receptor blockers. A higher prevalence of diabetes mellitus and hypogonadism was observed in patients with PEVR compared with the rest of the sample (23.0% vs. 14.1% and 9.1% vs. 5.3%, respectively; both P = 0.05). Sexual parameters such as severe ED (HR = 1.25 [1.11–1.41]; P = 0.0001) and patient’s (HR = 1.53 [1.38–1.70]; P = 0.0001) and partner’s (HR = 1.21 [1.07–1.36]; P = 0.005) hypoactive sexual desire (HSD) were also significantly related to PEVR. Furthermore, PEVR was associated with an impairment of both the relational and intrapsychic components of ED. In a multivariate model, after adjusting for confounders, hypogonadism, diabetes mellitus, severe ED, and patient’s and partner’s HSD were all independently associated with PEVR. Conclusion: Our results indicate that PEVR is important not only for couple reproductive purposes but also appears to have a distinct role in the couple’s sexual performance. Policy of full disclosure: None.

Introduction: Male and female sexual dysfunctions comprise of biological, psychological, and interpersonal aspects. Premature ejaculation (PE) and female vaginal penetration difficulties (VPD) are problems that may concurrently impair the couple’s ability to reach a satisfying sexual relationship. Objectives: To investigate the association between male PE and their female partner’s sexual function, looking specifically into VPD (including tampon use, gynecological examination, inserting self-finger or spouse-finger, and penile penetration). Methods: A cross-sectional study of 125 heterosexual couples using the Female Sexual Function Index (FSFI) and a VPD questionnaire to evaluate the female sexual function and PE-Q for the male (a subscale in the Israeli Sexual Behavior Inventory [ISBI]). Intensity of pain during each of the VPD was reported by women on a 1–100 mm visual analogue scale (VAS). Main Outcome Measures: The correlation between PE, female sexual function, and VPD. Results: Women partners of men with severe PE (before penetration) had significantly experienced more VPD, especially difficulties in penile penetration and tampon use. The intensity of pain in VPD (total score and penile penetration score) was higher in partners of males with severe PE. No correlation was found with intensity of pain during tampon use, gynecological examination, and inserting self-finger or spouse-finger. No significant correlation was found between total score of PE and total FSFI score or the separate domains of the female sexual function. Conclusion: Severe female penetration difficulties and male PE (antes-portas) are interrelated. Couples with these sexual problems may face unconsummated marriage and fertility difficulties. The optimal therapeutic outcome for male and female with these sexual dysfunctions should be addressed in parallel. Further research is required to study the connection and the causation of PE and VPD. Policy of full disclosure: None.

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376 Thursday, 1 December 2011 15.30–16.30 Blue Room 2 PS-02 Basic science—preclinical research chairs: S. Cellek, UK P. Hedlund, Sweden PS-02-001

TESTOSTERONE PROTECTS FROM METABOLIC SYNDROME-ASSOCIATED PROSTATITIS: AN EXPERIMENTAL STUDY IN RABBIT Vignozzi, L.1; Morelli, A.1; Comeglio, P.1; Cellai, I.1; Filippi, S.1; Gacci, M.2; Saad, F.3; Adorini, L.4; Vannelli, G.5; Maggi, M.1 1 Sexual Medicine and Andrology, Clinical Physiopathology, Florence, Italy; 2 Department of Urology, University of Florence, Italy; 3Scientific Affairs, Men’s Healthcare, Berlin, Germany; 4Intercept Pharmaceuticals, Italia Srl, Perugia, Italy; 5Department of Anatomy, Histology and Forensic Medicine, Florence, Italy Objective: Metabolic syndrome (MetS) and BPH/LUTS are often associated. One of their common denominators is hypogonadism. However, testosterone (T) supplementation is limited by concerns for potential prostatic side effects. This study was aimed at determining whether MetS-associated prostate alterations are prevented by T supplementation. Methods: We used a previously described animal model of MetS, obtained by feeding male rabbits a high-fat diet (HFD) for 12 weeks. Subsets of HFD rabbits were treated with T or with the farnesoid-X receptor agonist INT-747. Rabbits fed a standard diet were used as controls. The in vitro effect of dihydrotestosterone (DHT) was studied in human prostatic stromal cells (hBPH). Results: HFD animals develop hypogonadism and all the MetS features: hyperglycemia, glucose intolerance, dyslipidemia, hypertension, and visceral obesity. In addition, HFD animals show a prostatitis-like syndrome. Immunohistochemical analysis demonstrated that HFD induced prostate fibrosis, hypoxia, and inflammation. The mRNA expression of several proinflammatory (IL-8, IL-6, IL-1β, TNFα), T-lymphocyte (CD4, CD8, Tbet, Gata3, ROR γt), macrophage (TLR2, TLR4, STAMP2), neutrophil (lactoferrin), inflammation (COX2, RAGE), and fibrosis/myofibroblast activation (TGFβ, SM22-α, α-SMA, RhoA, ROCK1/ROCK2) markers was significantly increased in HFD prostate. T, as well as INT-747, treatment prevented some MetS features, although only T normalized all the HFD-induced prostate alterations. In hBPH, DHT inhibited TNFα-induced secretion of cytokines/chemokines (IL-8, IL-6, MCP1, IL-9, IL-12) and growth factor (bFGF). Conclusion: These data highlight that T protects rabbit prostate from MetS-induced prostatic hypoxia, fibrosis, and inflammation, which can play a role toward the development/progression of BPH/LUTS. Policy of full disclosure: None.

PS-02-002

EFFECTS OF CHANGES IN THE SEX HORMONE MILIEU ON MALE’S ERECTILE FUNCTION IN RATS Kataoka, T.; Hotta, Y.; Shiota, A.; Ohno, M.; Maeda, Y.; Kimura, K. Nagoya City University, Hospital Pharmacy, Japan Objective: Late-onset hypogonadism (LOH) is associated with erectile dysfunction (ED). Recent clinical studies have suggested that not only androgen, but also estrogen, affect erectile function. Sex hormone imbalance might cause ED; however, the underlying mechanisms causing endocrine ED remain unclear. Methods: Male rats were divided into the following groups: high estrogen (High-E), high estrogen and low testosterone (HighE&Low-T), high estrogen and high testosterone (High-E&High-T) and Control group. The rats were treated some hormone milieu

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Podium Sessions changing. At 4 weeks, the rats underwent erectile function testing by intracavernosal pressure (ICP) measurements (N = 6), and strips of the rats’ corpora cavernosa were analyzed in an isometric tension study (N = 5). Results: The ICP/MAP was significantly decreased in the treated groups (Control: 0.70 ± 0.03, High-E: 0.44 ± 0.03, High-E&Low-T: 0.49 ± 0.03, High-E&High-T: 0.44 ± 0.02). The relaxant response of rat corpora cavernosa strips to SNP was significantly decreased in the treated groups (Control: Emax = 83.2 ± 10.3%, High-E: Emax = 44.8 ± 6.8%, High-E&Low-T: Emax = 46.6 ± 5.0%, High-E&High-T: Emax = 38.9 ± 1.5%). The contractile response to NA was increased in the treated groups (Control: 167.9 ± 14.4%, High-E: 202.3 ± 18.8%, High-E&Low-T: 201.7 ± 20.8%, High-E&High-T: 251.2 ± 13.3%). The relaxant response to Rho kinase inhibitor was enhanced in the treated groups (Control: IC50 = 1.22 × 10-6M, High-E: IC50 = 2.26 × 10-7M, High-E&Low-T: IC50 = 1.31 × 10-7M, HighE&High-T: IC50 = 1.25 × 10-7M). Conclusion: Our hypothesis that sex hormone imbalance is associated with ED is supported by both in vivo and in vitro experiments using pharmacological tools. The present findings suggested that sex hormone imbalance, not only low levels of testosterone, but also high levels of estrogen, should be considered a risk factor for ED. Policy of full disclosure: None.

PS-02-003

ANDROGEN DEPLETION LEADS TO UPREGULATION OF SIRT1-ENOS AXIS IN HUMAN CAVERNOUS TISSUE Tomada, I.1; Tomada, N.2; Almeida, H.1; Neves, D.1 Faculty of Medicine of Porto, Experimental Biology, Portugal; 2S. João Central Hospital, Porto, Portugal

1

Objective: Hypogonadism and aging lead to equivalent structural changes in corpus cavernosum (CC) that associate with erectile function impairment. These conditions also compromise cavernous nitric oxide (NO) bioavailability, a gaseous vasodilator mainly produced by endothelial NO synthase (eNOS). Its activity is, in part, regulated by the NAD+-dependent protein deacetylase Sirtuin-1 (Sirt1) that plays a critical role in endothelial homeostasis and is considered a longevity factor in vascular tissue. Thus, we aimed to characterize human CC of androgen-deprived, young and aged individuals, postulating that androgen deprivation induces molecular modifications in Sirt1/eNOS axis similar to those observed in aging. Methods: Human penile fragments were collected from young individuals submitted to male-to-female sex reassignment procedure (N = 3, 19–28 years), who undergone an anti-androgen chemical regimen, healthy young organ donors (N = 6, 17–34 years), and aged patients submitted to penile deviation surgery (N = 7, 61–74 years). The study design was authorized and approved by the local hospital and university ethics committees. Cavernous tissue samples were processed for dual-immunofluorescence (IF) of alpha-actin/Sirt1 and endothelin1(ET1)/eNOS. Estrogen receptors were analyzed by immunohistochemistry and semi-quantification of Sirt1, eNOS, and phospho-Akt was assayed by Western blot. Statistical significance was assumed at P < 0.05. Results: IF study demonstrated that Sirt-1 was expressed in cavernous smooth muscle cells in all groups studied, with a higher intensity in young and aged individuals. ET1 expression was apparently raised in androgen-deprived and aged human CC, and eNOS was hardly observed in young cavernous tissue. Androgen withdrawal led to a significant increase in penile Sirt1 expression accompanied by a raise in total eNOS levels. No differences in these proteins expression were observed between young and aged tissues, neither in phospho-Akt system among groups. Estrogen receptors were undetectable in all analyzed CC samples. Conclusion: These findings indicate that Sirt1 regulates expression of eNOS in human CC, employing mechanisms influenced by androgen depletion. Policy of full disclosure: None.

377

Podium Sessions PS-02-004

WHY ERECTILE DYSFUNCTION IS HIGHLY PREVALENT AND PRECEDES OTHER VASCULAR DISEASES IS ATTRIBUTABLE TO INCOMPETENT CAVERNOUS ENDOTHELIAL CELL–CELL JUNCTION Suh, J.-K.1; Jin, H.-R.1; Ryu, J.-K.2; Yin, G. N.1; Kwon, M.-H.1; Song, K.-M.1; Choi, M. J.1; Lee, J. S.3; Kim, W. J.1; Chung, W.-S.4 1 Inha University, Urology, Incheon, Korea; 2Inha University School of Medicine, Urology, Incheon, Korea; 3Kwandong University, Urology, Seoul, Korea; 4Ewha Womans University, Urology, Seoul, Korea Objective: Exact mechanism by which erectile dysfunction (ED) occurs prior to systemic vascular diseases remains to be elucidated, although artery size hypothesis has been suggested. We, herein, performed a comprehensive study to answer this question. Methods: Either hypercholesterolemia or diabetes was induced by feeding a high-cholesterol diet or by intraperitoneal injection of streptozotocin in 8-week-old C57BL/6J mice. We determined cavernous expression of endothelial cell–cell (EC-EC) junction proteins and vascular endothelial permeability in penis, heart, hindlimb, brain, and testis after injection of a variety of vascular space markers (350– 2,000 kDa) into the jugular vein. We also investigated the effect of recombinant angiopoietin-1 (Ang1) and histone deacetylase 2 (HDAC2) on the endothelial permeability. Cavernous expression of EC-EC junction was determined in patient with diabetes or hypercholesterolemia. Results: The cavernous expression of EC-EC junctions in both human and mice, including VE-cadherin, claudin-5, and PECAM-1, was significantly lower in hypercholesterolemic or diabetic groups than in controls. These EC-EC junction proteins were more sparsely distributed in endothelium of cavernous sinusoids than in endothelium of cavernous artery and dorsal blood vessels. We observed a significant leakage of fluorescent tracer across the cavernous endothelium, whereas minimal leakage in heart and hindlimb or no leakage in brain and testis was noted in normal mice. Moreover, endothelium of cavernous sinusoids was much more permeable to vascular tracers in hypercholesterolemic and diabetic condition than in normal condition. Intracavernous injection of Ang1 protein induced recovery of erectile function and decreased cavernous endothelial permeability by restoring EC-EC junction proteins in diabetic mice. siRNA for HDAC2 significantly increased EC-EC junction proteins and decreased endothelial permeability in cultured cavernous endothelial cells. Conclusion: Incompetent cavernous endothelial cell–cell junction gives us an important clue to understanding why ED is highly prevalent and often precedes the occurrence of other systemic vascular diseases. Policy of full disclosure: None.

PS-02-005

RELAXANT CAPACITY OF PDE5 INHIBITORS IS POTENTIATED BY NEBIVOLOL IN HUMAN CORPUS CAVERNOSUM AND PENILE ARTERIES FROM DIABETIC PATIENTS WITH ERECTILE DYSFUNCTION Angulo, J.1; Martínez-Salamanca, J. I.2; Fernández, A.3; Cuevas, P.3; Cardoso, P.4; Wright, H. M.5; La Fuente, J. M.6 1 Hospital Ramón y Cajal, Histología-Investigación, Madrid, Spain; 2Servicio de Urología, Hospìtal Puerta de Hierro, Madrid, Spain; 3Hospital Ramón y Cajal, Madrid, Spain; 4Serviço de Urología, Hospital Amadora-Sintra, Lisboa, Portugal; 5Forest Research Institute, Jersey City, NJ, USA; 6Hospital Santo Antonio, Porto, Portugal Objective: Diabetes is associated with increased prevalence of erectile dysfunction (ED) and a poorer therapeutic response to conventional therapy for ED, i.e., type 5 phosphodiesterase inhibitors (PDE5-Is), due to impaired NO/cGMP signaling in erectile tissue. Nebivolol is a cardioselective ß1-adrenoceptor antagonist with NO-dependent vaso-

dilatory capacity that has been shown to improve erectile function in diabetic rats with ED. The aim of the study was to evaluate the effects of nebivolol on relaxant responses and cGMP accumulation induced by PDE5-Is, sildenafil, tadalafil, and vardenafil in human corpus cavernosum (HCC) and penile resistance arteries (HPRA) from diabetic ED patients. Methods: HCC and HPRA were obtained from cavernosal specimens from 15 non-ED, non-diabetic (NEND) organ donors and 17 diabetic patients with ED undergoing penile prosthesis implantation. HCC and HPRA were mounted in organ chambers and wire myographs, respectively, for evaluating PDE5-I-induced relaxation with or without nebivolol. cGMP content in HCC was determined by ELISA. Results: PDE5-I-induced relaxations of HCC (0.001–10 μM) and HPRA (0.001–100 μM) from diabetic ED patients were reduced vs. NEND. Nebivolol (1 μM) potentiated the efficacy of all three PDE5-Is to relax HCC and HPRA in diabetic ED patients. Nebivolol + PDE5I-induced relaxations in diabetic ED patient tissues were equivalent to that observed in PDE5-I-treated NEND. Furthermore, nebivolol enhanced cGMP accumulation induced by PDE5-Is (10 μM) in diabetic HCC, comparable to levels observed in NEND HCC (see table below). Conclusion: Nebivolol improves the efficacy of PDE5-Is to relax HCC and HPRA in diabetic patients with ED likely by enhancing NO/cGMP signaling. Further clinical research is warranted. Policy of full disclosure: This work was supported by a grant from Forest Research Institute (Forest Laboratories, USA).

PS-02-006

ORAL L-CITRULLINE SUPPLEMENTATION IMPROVES ERECTILE FUNCTION IN RATS WITH ACUTE ARTERIOGENIC ERECTILE DYSFUNCTION Shiota, A.1; Hotta, Y.1; Takahata, Y.1; Kataoka, T.1; Ohno, M.1; Maeda, Y.1; Morita, M.2; Hara, T.2; Kimura, K.1 1 Nagoya City University, Nagoya City Mizuho Word, Japan; 2Kyowa Hakko Bio Co. Ltd., Tukuba City, Japan Objective: Recently, the number of acute arteriogenic ED patients following traffic accidents has increased. Penile revascularization surgery is one of the most popular therapies for arteriogenic ED. To find a useful therapy substituted for such an invasive surgery, we investigated whether oral L-citrulline supplementation improved erectile function on rats with acute arteriogenic ED. Methods: Eight-week-old male Wistar-ST rats were divided into three groups: sham-operated rats (Control group), arteriogenic ED rats by ligating bilateral internal iliac arteries (Ligation group), and oral 2% water L-citrulline supplementation (L-citrulline group). L-citrulline group was given to ligated rats for 21 days from 1 week after operation. Erectile function was evaluated by maximum intracavernous pressure/mean arterial pressure (max ICP/MAP) ratios under the stimulation of cavernous nerve at 4 weeks after operation. Then penile corpus cavernosum were obtained from all rats, stained by a Masson trichrome stain, and observed under microscope. Serum NOx levels were measured by HPLC. Bonferroni’s multiple t-test was used as statistical analysis. Results: Max ICP/MAP of Ligation group was significantly lower than that of Control group (P < 0.05), and that of L-citrulline group was significantly higher than that of Ligation group (P < 0.05). Smooth muscle (SM)/collagen ratios in Ligation group were reduced compared

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378 with Control group. However, SM/collagen ratios in L-citrulline group were increased compared with Ligation group. NOx levels of Ligation group were significantly lower than that of Control group (P < 0.05), and that of L-citrulline group were significantly higher than that of Ligation group (P < 0.01). Conclusion: Max ICP/MAP ratios were restored by oral L-citrulline supplementation. Thus, we suggest that oral L-citrulline supplementation in early ischemic period may be a new novel therapy for acute arteriogenic ED. Policy of full disclosure: None.

PS-02-007

PROTEIN STRUCTURAL ALTERATIONS IN DIABETIC CAVERNOSAL TISSUE—THEIR ROLE IN ERECTILE DYSFUNCTION PROGRESSION Castela, A.1; Soares, R.2; Gomes, P.2; Coelho, P.3; Fernandes, R.4; Costa, R.2; Vendeira, P.1; Costa, C.2 1 University of Porto, Institute for Molecular and Cell, Portugal; 2University of Porto, Department of Biochemistry (U38-FCT), Portugal; 3Instituto Politécnico do Porto, Ciências Químicas e das, Vila Nova de Gaia, Portugal; 4 Instituto Politécnico do Porto, Ciências Químicas e das, Portugal Objective: Erectile dysfunction (ED) is one of the most prevalent complications in diabetic men. Hyperglicemia contributes to increased oxidative stress (OS) in diabetic corpus cavernosum (CC), promoting alterations in cavernosal cellular components. However, it remains unclear the mechanisms by which OS induces modifications in diabetic penile tissue with the progression of diabetes and its role in the development of ED. We intended to evaluate/quantify CC protein structural modification caused by OS in an early and late stage of diabetes. Methods: Male Wistar rats were divided into groups (N = 5/group): 2- and 8-week-streptozotocin-induced type 1 diabetes and agematched controls. Systemic OS was evaluated in blood samples by chromatographic detection of oxidized glutathione (GSSG)/reduced glutathione (GSH). Penile OS-induced protein damage was assessed by oxidative structural changes detected by western blotting of 3nitrotyrosine (3-NT) and protein carbonylation. Results: Our results revealed a significant increase in blood GSSG/ GSH ratio at 8 weeks of diabetes (diabetic rats 1.619 ± 0.216 vs. controls 0.779 ± 0.238, P < 0.05), suggesting a systemic OS increment. Consistently, a significant augmentation in protein nitration (diabetic group: 3.398 ± 0.332 vs. controls 2.284 ± 0.092; P < 0.05) and carbonylation (diabetic animals: 12.620 ± 0.224 vs. controls 11.240 ± 0.398; P < 0.05) was observed only in 8-week diabetic CC, indicating more severe protein oxidative modifications at a late stage of the disease. Conclusion: We demonstrated that systemic and penile OS effects are detected mainly in established diabetes. OS-induced penile protein modifications seem to occur only in the advanced stage of the disease and may be responsible for promoting structural/functional deregulations in cellular/molecular mechanisms essential for normal erectile process, contributing to the development and progression of diabeticassociated ED. Policy of full disclosure: None.

PS-02-008

EXPRESSION AND DISTRIBUTION OF THE TRANSIENT RECEPTOR POTENTIAL ION CHANNEL A1 (TRPA1) IN HUMAN PENILE ERECTILE TISSUE Ückert, S.1; Waldkirch, E.1; Sonnenberg, J.2; Boeck, N.2; Kuczyk, M.1; Hedlund, P.3 1 Hannover Medical School, Department of Urology, Germany; 2IBFA, Sexual Function Research Unit, Barsinghausen, Germany; 3University Vita Salute, Department of Urology, Milano, Italy Objective: The transient receptor potential ion channel A1 (TRPA1) has been suggested to be involved in mechano-afferent/efferent signal-

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Podium Sessions ing in the bladder, prostate, and urethra. Up until today, no study has addressed the expression of this receptor in male genital and reproductive tissues. Thus, it was the aim of the present study to evaluate in human penile erectile tissue by means of molecular biology and immunohistochemistry the expression and localization of TRPA/TRPA1. Methods: Human penile erectile tissue (corpus cavernosum penis) was obtained from five subjects who had undergone gender reassignment surgery. The expression of messenger ribonucleic acid (mRNA) encoding sequences specific for the TRPA receptor protein (hTRPA01FWD [985-1003], hTRPA02REV [1641–1623]) was elucidated by means of reverse transcriptase polymerase chain reaction (RT-PCR). Using immunohistochemical methods (double-labeling technique, laser fluorescence microscopy), the distribution of TRPA1 in relation to neuronal nitric oxide synthase (nNOS), the neuropeptide vasoactive intestinal polypeptide (VIP), and vesicular acetylcholine transporter protein (VAChT) was examined. Results: RT-PCR revealed a faint but distinct signal related to the expected molecular size of 656 bp. Immunoreactivity for TRPA1 was registered in nerves transversing the cavernous sinusoidal space. These nerves also displayed the expression of VAChT. Signals specific for TRPA1 were also observed in meshworks of nerve fibers running alongside the walls of cavernous arteries. Varicose nerves containing nNOS or VIP were not immunoreactive for TRPA1. Cavernous vascular and non-vascular smooth muscle did not present immunosignals related to TRPA1. Conclusion: The distribution of TRPA1 and VAChT receptors in penile erectile tissue suggests a role for TRPA1 in the mechanism of cholinergic signaling in the human penis. Policy of full disclosure: None.

PS-02-009

NEURO-INFLAMMATION FOLLOWING CAVERNOUS NERVE INJURY IS ACCOMPANIED BY SIGNIFICANT CHEMOKINE-GENE UPREGULATION IN VIVO AND IN VITRO Albersen, M.1; Berkers, J.1; Dekoninck, P.2; Deprest, J.2; De Ridder, D.1; Van der Aa, F.1 1 University Hospitals Leuven, Experimental Urology, Belgium; 2University Hospitals Leuven, Experimental Gynecology, Belgium Objective: We have recently demonstrated the essential role of adipose tissue-derived stem cell (ADSC) recruitment toward the major pelvic ganglion (MPG) in rats following cavernous nerve injury (CNI). The interaction between chemokines and their receptors plays a major role in this process. The objectives of this study were to examine chemokine subtype expression in neuro-inflammation of the rat MPG following cavernous nerve injury (CNI), and to evaluate the usefulness of tumor necrosis factor alpha (TNFA)-stimulated rat Schwann cells as an in vitro model for neuronal chemokine production. Methods: Six male 12-week-old Sprague Dawley rats underwent laparotomy and bilateral crush injury of the cavernous nerves. Six rats served as sham controls (laparotomy and periprostatic dissection only). Twenty-four hours after CNI, the MPGs were harvested, RNA was isolated and subjected to qPCR analysis in triplicate. A rat peripheral nerve schwannoma derived Schwann cell line was acquired (RT4D6P2T) and cultured in the presence of TNFA in dosages of 0, 1, 10, and 100 nM for 24 hours in triplicate. Cells were then harvested and RNA was isolated and subjected to qPCR analysis. Results: Twenty-four hours following CNI, neuro-inflammation was present in the rat MPG as illustrated by significant upregulation of TNFA and transforming growth factor beta (TGFB) 1 and 2. Crush injury further resulted in significant upregulation of the chemokines CCL2-22-28, CXCL12, CX3CL1, and XCL1. The in vitro stimulation of Schwann cells with TNFA mimicked this neuro-inflammatory condition at 24 hours as illustrated by a similar TGFB and chemokine RNA expression profile. Conclusion: CNI-related neuro-inflammation in vivo and in vitro is accompanied by the expression of various chemokines. These chemokines may be responsible for the recruitment of ADSC toward the

379

Podium Sessions MPG following CNI in rats. In addition, we developed a Schwann cell culture model that can be employed to further study this recruitment in vitro. Policy of full disclosure: None.

PS-02-010

DELAYED EJACULATION IN RAPID EJACULATOR RATS BY DAPOXETINE IS ASSOCIATED WITH ALTERATION IN C-FOS EXPRESSION IN BRAIN NUCLEI Clement, P.1; Laurin, M.2; Compagnie, S.2; Bernabé, J.2; Giuliano, F.3 University of Versailles, Orsay, France; 2Pelvipharm Laboratories, Orsay, France; 3Raymond Poincaré Hospital, Garches, France

1

Objective: Assessment of the effects of acute administration of the short-acting selective serotonin reuptake inhibitor dapoxetine on ejaculatory performance and activity in brain nuclei of the ejaculation circuit in rapid ejaculator rats taken as a model of premature ejaculation. Methods: Standard copulatory test was used to select rapid ejaculator rats on the basis of their ejaculatory performance. Parameters of sexual, including ejaculatory, behavior and c-Fos level of expression in discrete brain areas were determined in rapid ejaculator rats following acute oral treatment with dapoxetine. Results: Dapoxetine acute oral administration to rapid ejaculator rats (N = 8) resulted in significant diminution of ejaculatory performance (lengthened ejaculation latency and decreased ejaculation frequency) together with significantly reduced c-Fos level of expression in thalamic and hypothalamic nuclei of the brain ejaculation circuit. Conclusion: Acute treatment with dapoxetine increased ejaculation latency and decreased neuronal activity in brain nuclei of the ejaculation circuit in rapid ejaculator rats. Hence, a neuroanatomical support is provided for the pharmacological treatment of premature ejaculation. Policy of full disclosure: Study sponsored by Janssen-Cilag.

PS-02-011

GENITAL BLOOD FLOW AND BLADDER FUNCTION IN A FEMALE RAT MODEL FOR NERVE-SPARING HYSTERECTOMY Castiglione, F.1; Bergamni, A.1; Benigni, F.1; Bivalacqua, T.2; Rigatti, P.1; Montorsi, F.1; Hedlund, P.1 1 URI-Ospedale San Raffaele, Urology, Milano, Italy; 2Johns Hopkins University, Urology, Baltimore, MD, USA Objective: Radical hysterectomy (RH) causes bladder and sexual dysfunctions. Nerve-sparing RH (NSRH) may improve this morbidity but long-term studies are scarce and preclinical models in this field are not available. The aim of the current study was to establish and evaluate models for NSRH in female rats. Methods: After ethical permission, female Sprague Dawley rats (250 g) were subjected to unilateral pelvic nerve (PN) crush (PNC; forceps; 3 × 30 seconds; N = 10) or crush of the PN and nerves from the major pelvic ganglion supplying the vagina and bladder (clocknerve crush [CNC]; N = 10). During anesthesia, mean arterial blood pressure (MAP) was monitored and clitoral and vaginal blood flows (Doppler; tissue perfusion units [TPU]) were registered during stimulation (5 V; 20 Hz) of the PN at 3 and 10 days after crush. Bladder function was studied by cystometry in conscious rats with bilateral PNC or CNC (each N = 10) in comparison to sham operated rats (N = 10). Values are mean ± SEM. Results: Control stimulations of the intact PN at 3 and 10 days caused vaginal peak flows of all rats, which were 0.22 ± 0.06 and 0.13 ± 0.02 TPU/MAP for PNC and 0.24 ± 0.08 and 0.12 ± 0.03 TPU/MAP for CNC. Stimulation of the PNC or CNC side yielded lower vaginal peak flows (P < 0.05), which were 0.10 ± 0.03 and 0.04 ± 0.002 TPU/ MAP for PNC and 0.10 ± 0.04 and 0.04 ± 0.02 TPU/MAP for CNC. A similar reduction (P < 0.05) occurred at 3 and 10 days for the clitoral

flow. Whereas sham rats exhibited regular voiding patterns, rats with bilateral PNC or CNC did not exhibit regular micturitions but detrusor overactivity with non-voiding contractions and dribbling incontinence. Conclusion: PNC and CNC procedures cause similar effects on genital blood flow and bladder function in female rats. The described models are proposed as relevant for the study of NSRH and will forward understanding of etiologies and novel therapeutic strategies for associated urogenital dysfunctions. Policy of full disclosure: None.

PS-02-012

PERIOPERATIVE SYSTEMIC BETAMETHASONE TREATMENT IN A RAT MODEL FOR NERVE-SPARING HYSTERECTOMY Castiglione, F.1; Bergamini, A.1; Benigni, F.1; Bivalacqua, T.2; Rigatti, P.1; Montorsi, F.1; Hedlund, P.1 1 URI-Ospedale San Raffaele, Urology, Milano, Italy; 2Johns Hopkins University, Urology, Baltimore, MD, USA Objective: Radical hysterectomy (RH) causes bladder and sexual dysfunctions. The aim of the current study was to examine the effect of perioperative betamethasone treatment on genital blood flow and bladder function in a rat model for nerve-sparing RH. Methods: After ethical permission, female Sprague Dawley rats (250 g) were subjected to unilateral (N = 20) or bilateral (N = 20) pelvic nerve (PN) crush (PNC; N = 10). Half of each group was given subcutaneous betamethasone (0.6–0.2 mg/kg/day; 5 days perioperatively). During anesthesia, mean arterial blood pressure (MAP), and clitoral and vaginal blood flows (Doppler; tissue perfusion units [TPU]) were registered during PN stimulation 10 days after unilateral crush. Cystometries were performed in conscious rats with bilateral PNC at 10 days. Results: Voltage-dependent (2.5, 5, and 7.5 V) blood flow responses to PN activation were obtained in all rats. However, genital blood flows upon activation of the intact PN (control) of bethamethasonetreated rats appeared lower than in vehicle-treated rats. Control peak clitoral and vaginal blood flows (7.5 V) were 0.17 ± 0.03 and 0.30 ± 0.04 TPU/MAP (vehicle) and 0.11 ± 0.02 (ns) and 0.14 ± 0.03 (P < 0.05) TPU/MAP (betamethasone). Peak clitoral and vaginal blood flow (5 V) of the crush-side were 0.05 ± 0.005 (P < 0.001 vs. control) and 0.08 ± 0.02 TPU/MAP (P < 0.01 vs. control) in vehicle rats. In betamethasone group, clitoral and vaginal blood flow responses were 0.08 ± 0.01 and 0.09 ± 0.02 TPU/MAP (crush-side; P < 0.05 vs. control). During cystometries, the incidences of dribbling incontinence were 73% for vehicle-treated rats compared to 12.5% in betamethasone-treated rats (P < 0.05). The mean amplitude of NVC was 4.3 ± 2.4 (P < 0.05) and 11.3 ± 3.6 cmH2O in betamethasone- and vehicle-treated rats, respectively. Conclusion: Perioperative administration of betamethasone seems to preserve micturition function but not genital blood flow in rats with PN injury. Policy of full disclosure: None.

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380 Friday, 2 December 2011 15.30–16.00 Red Room PS-03 Women’s sexual health Chairs: A. Giraldi, Denmark A. Burri, UK PS-03-001

CLINICAL APPROACH TO ANORGASMIA IN WOMEN WITH SPINAL CORD INJURY Courtois, F.1; Charvier, K.2; Bélanger, D.3; Vézina, J.-G.3; Coté, I.3; Boulet, M.3; Carrier, S.4; Jacquemin, G.4 1 Montréal, Canada; 2Hospices Civils de Lyon, Saint Genis Laval, France; 3 IRDPQ, Québec, Canada; 4IRGLM, Montréal, Canada Objective: Spinal cord injury (SCI) impairs sexual function. Yet studies show that up to 53% of women with SCI are capable of orgasm and more than 85% of men with SCI are capable of ejaculation. In order to reduce the discrepancy between men and women with SCI, we adapted the clinical protocol used in men to women, thus providing better guidance and increasing stimulation modalities. Clinically guide women with SCI in achieving orgasm through better mental representation of their genitals and better guidance with stimulation procedures. Methods: Thirty women with lesions from C4 to L4 and aged from 18 to 69 years were assessed for perineal sensitivity (light touch, pressure, vibration, pain), followed by guided stimulation with Ferticare vibrostimulation associated when negative with gradual doses of midodrine (5–20 mg). Results: The results show that assessing perineal sensitivity is helful to gain better perception of the vulva in 85% of women with SCI and that using various guided sources of stimulation help 79% in reaching orgasm. Systolic blood pressure at orgasm increased from an average of 91–145 mm Hg, diastolic from 49 to 82 mm Hg at orgasm, and heart rate from 68 to 75 beats/minute. The sensations described at orgasm include an average of 6.4 cardiovascular responses compared to 2.6 during sexual stimulation without orgasm, 11.4 muscular contractions compared to 7 without orgasm, 10 autonomic responses compared to 2.6 without orgasm, and 1.4 dysreflexic responses compared to 0.6 without orgasm. Conclusion: The results confirm that women with SCI are capable of orgasm, and that almost 80% can achieve it when clinically guided. The success rate is more comparable to that of SCI men treated for anejaculation. The discrepency better sexes appears not so much to be a function of ejaculation vs. orgasm than similar guidance during clinical treatment. Policy of full disclosure: None.

PS-03-002

AUTOIMMUNE THYROIDITIS—IMPACT ON SEXUAL WELL-BEING IN PREMENOPAUSAL WOMEN Stoian, D.; Anastasiu, D.; Craina, M. University of Medicine, Clinic Obstetrics-Ginecology I, Timisoara, Romania Objective: In Banat region, the autoimmune thyroid disease has an incidence of up to 10% in premenopausal women. Are they are difference in sexual life, between TCA categories of disease, in premenopausal women? Methods: Recruitment: January 2010–July 2011, inclusion criteria: premenopausal women, with no ovarian failure/DM/neurological or psychiatric disease, diagnosed with autoimmune thyroiditis (high TPO antibodies), typical aspect on ultrasound, ± dysthyroidism, stable relationship. Algorithm: sexual anamnesis, FSFI, and Beck depression II Questionnaire. Results: Study group: 251 cases, mean age 37.56 ± 4.5 years, with A: asymptomatic thyroid disease (normal TSH) 145 cases, S: subclinical hypothyroidism (TSH > 4 mUI/L, normal FT3 + FT4) 49 females, and C: 56 cases with clinical disease (↑ TSH + ↓ FT3 and/or FT4).

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Podium Sessions Optimum TSH threshold is 3, we subdivided subgroup A, in A (TSH < 3 mUI/L and B TSH > 3–4 mUI/L). Control group: premenopausal apparent healthy women without thyroid disease. We observed higher incidence of secondary depression, in total group (22.7%) the more severe thyroid disease, the higher incidence of depression: 11.86% (A), 18.51% (B), 30.61% (S), and 41.06% (C) as compared with controls (8.7%) P < 0.005. A correlation between BDII and FSFI domain score: r = −0.43 to −0.62 (P < 0.05) for arousal, −0.49 to −0.57 (P < 0.01) for desire, respectively, −0.68 to −0.84 (P < 0.01) for sexual satisfaction (P, 0.04). Also, there is a secondary hyperprolactinemia: 2/118 (A), 3/27 (B), 22/49 (S), and 37/56 (C). There are significant differences in FSFI domain scores between A, B, S, and C subgroups and controls. Conclusion: Even “euthyroid disease” patients have lower desire, lubrication, orgasm, and satisfaction score as compared with controls. Hypothyroidism, subclinical or clinical ones associates increased levels of depression, but also significant lower FSFI domain scores: desire, arousal, orgasm, and satisfaction. Policy of full disclosure: None.

PS-03-003

AUTOMATIC SEXUAL ASSOCIATIONS “PREDICT” HYPOTHALAMUS ACTIVITY IN HEALTHY WOMEN EXPOSED TO EXPLICIT PORNOGRAPHY Borg, C.; de Jong, P.; Georgiadis, J. University of Groningen, The Netherlands Objective: To explore how relative sex-nice vs. sex-disgust automatic associations in memory affect brain responses to explicit images of vaginal penetration. Methods: Twenty-one women participated in an fMRI study. They viewed a set of 36 colored photographs representing six emotional categories, including neutral male–female bodily interaction (NB), core disgust (DIS), and images depicting explicit vaginal penetration (PEN). Models were kept faceless or with minimal focus on the face. Stimuli were presented in multiple 23s-blocks of 10 pictures of the same category. Post-scanning, participants conducted a single-target implicit association task (st-IAT) to measure the relative automatic associations of penetration pictures with sex-nice vs. sex-disgust. Subjects rated their subjective evaluation of all stimuli on a Visual Analogue Scale. Results: DIS and PEN main effects showed remarkable overlap, as indicated by analysis of the conjugated activity between them. This overlap not only included large areas of posterior cortex implicated in visual emotion processing (occipital, occipitotemporal, occipitoparietal), but also primordial areas like midbrain, ventral pallidumamygdala, and hypothalamus-nucleus accumbens. Joint DIS/PEN activity in subcortical areas previously assigned a strong pro-sexual function adds to growing evidence that these areas signal general emotional salience, and further questions if erotic specificity is established in the brain. Still, hypothalamus-nucleus accumbens activity varied as a function of individual automatic sexual associations only during PEN, but this correlation was counterintuitive, insofar that PEN-related activity in this area was negatively coupled to sex-nice associations. This might indicate differential emotional capture, possibly related to differential appraisal of these explicit male-directed pornographic images. Conclusion: The present findings reveal neural correlates of automatic sexual associations and shed new light on the relationship between hypothalamus-ventral striatum activity and human sexuality, showing that this link may be more complex than previously thought. Policy of full disclosure: None.

381

Podium Sessions PS-03-004

EFFECTS OF HORMONAL CONTRACEPTION ON WOMEN’S SEXUAL FUNCTION: A CROSSSECTIONAL STUDY IN A COHORT OF DANISH WOMEN Læssøe, N.1; Wåhlin, S.1; Kristensen, E.1; Giraldi, A.1; Pedersen, A. T.2 Psychiatric Center Copenhagen, Department of Sexological Research, København V, Denmark; 2Department of Sexological Research, Psychiatric Center Copenhagen, København Ø, Denmark

1

Objective: To investigate the relationship between the use of combined hormonal contraceptives (HC) and women’s sexual function, with special emphasis on type of progestin. Methods: A questionnaire including Female Sexual Function Index (FSFI) and Female Sexual Distress Scale (FSDS) with additional questions on use of contraception was completed by a community sample of healthy women aged 18–35 years. The participants were divided into two groups: 152 users of HC (61.6%) and 107 non-HC users (38.4%). The HC group was further divided into two subgroups: 28 participants using combined HC containing anti-androgenic progestin (AP-HC) and 124 participants using combined HC containing other types of progestin (O-HC). Main outcome measures were FSFI, cutoff at 26.55 indicating Female Sexual Dysfunction (FSD) and FSDS, cutoff at 15 indicating Female Sexual Distress. Manifest FSD (MFSD) defined as FSFI score < 26.55 and FSDS > 15. Kruskal–Wallis test was performed comparing FSFI and FSDS scores. Chi-squared test was performed comparing the distribution around cutoff. Results: Stastically significant differences were found between users of HC and non-HC users in mean FSDS score (P = 0.032), as non-HC users had the highest mean FSDS score (12.4). No differences were found in FSFI score or MFSD. In subgroup analysis statistically significant differences were found between the users of AP-HC, O-HC, and non-HC users in both FSFI score (P = 0.013), FSDS score (P = 0.010), and MFSD (P = 0.005). Users of AP-HC had the lowest mean FSFI score (26.5), the highest mean FSDS score (14.5), and the highest rate of MFSD (40.7%). Conclusion: In a cross-sectional setting, we found a significant negative influence of combined HC containing anti-androgenic progestin on women’s sexual function. HC users in general had less sexual distress than non-HC users. Policy of full disclosure: None.

PS-03-005

SEXUAL FUNCTION IN BULGARIAN PATIENTS WITH PCOS AND/OR OBESITY BEFORE AND AFTER METFORMIN TREATMENT

in FSFI score. It is interesting to note that LH but not FSH shows moderate positive correlation to all domains of FSFI. FSFI scores do not show correlation to the indices of carbohydrate metabolism (blood glucose and IRI during OGTT), lipid profile, and arterial pressure. After metformin treatment, there was an increase in all FSFI domain scores although statistical significance was noted only for the total FSFI score and the domains lubrication and pain, probably because of the small number of patients. Conclusion: Lean PCOS patients have lower scores on FSFI than obese patients with or without PCOS. The hyperandrogenemia is not a determinant for sexual dysfunction in PCOS women. Metformin treatment has a favorable effect on sexual function. Policy of full disclosure: None.

PS-03-006

WHAT ROLE PLAYS FEMALE SEXUAL DYSFUNCTION IN THE GYNECOLOGIST DAILY ROUTINE? Kottmel, A.1; Rüther, K.2; Bitzer, J.3 Kantonsspital Nidwalden, Stans, Switzerland; 2Hopital du Jura, Delemont, Switzerland; 3University Hospitals Basel, Dept. Ob/Gyn, Switzerland

1

Objective: Female sexual dysfunctions, e.g., sexual desire disorder, have a high prevalence. The aim of this study is to evaluate the approach of Swiss gynecologists toward patients with sexual problems in their outpatient service. Methods: After a pilot study at the Department of Gynaecology of the University Hospital of Basel, Switzerland, an adapted selfadministered 19-item questionnaire was sent to 856 Swiss gynecologists to evaluate their current care for patients with sexual issues and their attitude toward this topic. Results: While 40.4% of the 341 responding gynecologists (39.8% response rate) quoted to have at least 1–2 days of training in sexual medicine, 7.9% of the respondents routinely explore sexual issues in more than 80% of their patients. 28.2% of the respondents offer specific appointments for sexual issues, 85% propose a referral. Lacking therapy motivation was mentioned as the most common cause for persisting symptoms (63.3%). Dyspareunia was quoted as the most or second most prevalent diagnosis of female sexual dysfunction in 77.1% of the questionnaires. Conclusion: Swiss gynecologists rarely report to be uncomfortable to address sexual problems and 40.4% have at least a basic additional training in sexual medicine. Nevertheless, this issue is seldom part of the routine in the gynecological outpatient care. This could be partly due to their assumption that many patients have only scarce therapy motivation. Another finding is the high subjective prevalence of dyspareunia compared to sexual desire or arousal disorders, which is not consistent with results of epidemiologic studies. Policy of full disclosure: None.

Gateva, A.; Kamenov, Z. Alexandrovska Hospital Sofia, Clinic of Endocrinology, Bulgaria Objective: The clinical signs of hyperandrogenemia, commonly seen in polycystic ovarian syndrome (PCOS) patients combined with obesity and infertility can cause emotional distress. There are however few data about the psychosocial and sexual function of patients with PCOS. The aim of the study was to investigate the sexual function in patients with obesity and/or PCOS using female sexual function inventory (FSFI) before and after metformin treatment. Methods: In the present study were included 79 patients divided into three groups—group 1 obese (N = 22), group 2 lean PCOS (N = 41), and group 3 obese PCOS (N = 16). All of the subjects completed FSFI questionnaire. In patients who had insulin resistance (OGTT + IRI) metformin treatment was started in dose 1,700–3,000 mg/day. Results: Obese women without PCOS showed significantly higher scores on total FSFI and all domains except from desire compared to lean PCOS subjects. Although the differences do not reach statistical significance, lean PCOS patients have the lowest scores on all domains. FSFI score correlates negatively only with androstendione levels. Women with and without hyperandrogenemia do not show differences

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382 Friday, 2 December 2011 15.30–16.00 Blue Room PS-04 Surgery Chairs: L. C. Cormio, Italy D. Ralph, UK PS-04-001

ORGASMIC FUNCTION AND LUBRICATION OF THE NEO-VAGINA: COMPARISON BETWEEN TWO TECHNIQUES OF VAGINOPLASTY IN MALE TO FEMALE SEX REASSIGNMENT SURGERY Colombo, F.1; Pultrone, C. V.2; Barbieri, B.2; Gentile, G.2; Brunocilla, E.2; Franceschelli, A.1 1 Policlinico S. Orsola-Malpighi, Andrology, Bologna, Italy; 2Policlinico S. Orsola-Malpighi, Urology, University of Bologna, Italy Objective: To compare sensitivity and lubrication of neovagina, during sexual intercourse, obtained with two different surgical techniques of vaginoplasty: (i) double-skin flap, penile and perineal-scrotal flap; and (ii) penile skin tube incise dorsally and widened with opened urethral flap, described by Perovic that we used since May 2010. The neovagina is lined, in this way, in the upper portion, with mucosa with functional (sensitivity) and aesthetic advantages. The neoclitoris is obtained by reducing the glans, and the neurovascular bundle (NVB) is preserved with the underlying strip of tunica albuginea. The labia minora are realized through the reconfiguration of the inner surface of the foreskin preserved at the time of penile degloving. Methods: From May 2010, 10 patients (pts), group A, underwent surgery in accordance with described technical modifications. Followup consisted of outpatient visits at first, second, and third months and of an interview at 6 months after surgery, in order to estimate the erotico-orgasmic function and the vaginal lubrication. The results have been compared with those obtained interviewing 10 pts who underwent male-to-female surgery with double-skin flap, penile and perineal-scrotal (group B). Results: Comparing group A and group B in order to evaluate the orgasmic function, we obtained similar results with 100% in reported orgasmic achievement. In the analysis of the subjective perception of “vaginal ejaculation/secretion” during excitation/orgasm, we observed better results in group A than in group B: 80% of pts vs. 50%. Conclusion: Currently there is no “gold standard” technique for male-to-female sex reassignment surgery, both in terms of functional and aesthetic results. In our preliminary experience, the use of urethral flap seems to provide better lubrication of the neo-vagina during sexual intercourse. Policy of full disclosure: None.

PS-04-002

MULTICENTRIC STUDY OF RECONSTRUCTIVE TECHNIQUE OF THE GLANS AFTER PARTIAL PENECTOMY FOR SQUAMOUS CELL CARCINOMA Leonardi, R.1; Pecoraro, S.2; Sansalone, S.3; Silvani, M.4; Zucchi, A.5 Casa di Cura Musumeci GECAS, Gravina di Catania, Italy; 2Clinica Malzoni Avellino, Nefro Uro Andrologia, Italy; 3University “Tor Vergata”, Urology Department, Roma, Italy; 4S.C. Urologia, Ospedale degli Infermi, Biella, Italy; 5University of Perugia, Urology and Andrology, Italy

1

Objective: Squamous cell carcinoma of the penis represents 1% of all malignant tumors of the male and it is more frequent in the sixth and seventh decade of life. The technique we propose provides the removal of the tumor glans with the simultaneous reconstruction of neo-glans using the distal part of the urethra, in order to minimize the destructive results of this mutilating surgery. Methods: Surgical techniques: Sub-coronal incision and degloving of the penis. Disassembly of the penis, isolating neurovascular bundles

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Podium Sessions and urethra; the glans is entirely removed. Biopsy of the tip of corpora cavernosa and urethra to exclude positive margins. The reconstructive step starts performing a ventral incision of distal part of the urethra in order to overturn it to cover the tip of corpora cavernosa. Urethra is then fixed on the tip of corpora cavernosa. Penile skin is then sutured to the edge of neo-glans. Results: From March 2006 to May 2011, we underwent to this operation 34 patients, age 60 (r. 36–73), with a histological diagnosis of carcinoma of the glans. Staging with PET-CT scan, MRI, bone scan showed no metastasis in all cases. We performed limphoadenectomy of sentinel lymph nodes in 12 pts with palpatory evidence of increased inguinal lymph nodes that resulted free of tumor. The histological examination of glans specimens confirmed preoperative diagnosis. The mean follow-up was 27 months (r. 3 months to 5 years). All the patients had no local recurrence and no evidence of metastases. All the patients were satisfied about aesthetical and functional results. Conclusion: The use of the reconstruction technique using the distal part of the urethra produces a neo-glans with proper sensitivity, able to increase in volume during tumescence and during sexual intercourse, and not so dry as using buccal mucosa graft. This reconstructive technique may ensure to the patient not only a good oncological result, but above all, a normal sexual activity. Policy of full disclosure: None.

PS-04-003

VACUUM THERAPY FOR PEYRONIE’S DEFORMITY: AN EFFECTIVE AND VIABLE ALTERNATIVE TO SURGERY Chitale, S.; Sethia, K. Norfolk & Norwich University H, Urology, UK Objective: Surgery is an established therapeutic option for most stable Peyronie’s deformities. A number of patients are unable to accept the concept of corrective penile surgery and would prefer a nonsurgical option if available. In this prospective study, we present a single center experience in treating Peyronie’s curvature using an external vacuum device. Methods: Twenty-six patients with treatment naïve Peyronie’s deformity were recruited. Twenty-two out of 26 (85%) were ≥50 years of age (mean 60 years). Twenty-four out of 26 (92%) patients had stable Peyronie’s deformity for ≥12 months (mean duration 24.75 months). Baseline IIEF scores, VAS for pain, sexual encounter profile (SEP) question 2, angles of deformity, lengths, and girths of erect and flaccid penis were recorded and reassessed after 6 months. Fourteen out of 26 (59%) patients had dual angle of deformity. Seventeen out of 26 (65%) used their device as per recommendations, 5/26 (19%) used it at lesser frequency, and 5 never used it. Twenty-one out of 26 (80%) patients were followed up at 6 months intervals. Results: Follow-up data at 6 months were available for 21 patients. Fourteen out of 26 (54 %) noticed improvement in their IIEF scores and 17/26 (65%) recorded positive response to SEP Q 2. Twenty-four out of 40 (60%) angles of deformity showed recordable improvement. Ten out of 26 (38%) and 13/26 (50%) had a measurable improvement in their erect and flaccid penile lengths, respectively, and 12/26 (46%) and 13/26 (50%) had an objective improvement in their erect and flaccid penile girths, respectively. One patient (3.8%) had a treatmentrelated minor complication. One patient discontinued using the device after a trial of 6 months and opted for surgery. Conclusion: External vacuum therapy is a perfectly reasonable and viable option for correcting Peyronie’s deformity and after appropriate counseling, should be offered as a first line nonsurgical option for most patients including those unfit or hesitant toward surgery. Policy of full disclosure: None.

383

Podium Sessions PS-04-004

EXCISION OF ELLIPTIC FRAGMENT OF EXTERNAL LAYER OF TUNICA ALBUGINEA AS A NEW, LITTLE-INVASIVE METHOD OF OPERATIVE TREATMENT OF CONGENITAL PENILE CURVATURE—LATE RESULTS Perdzynski, W.; Adamek, M. Damian’s Hospital, Reconstr. Male Urogenital Tract, Warsaw, Poland Objective: After operations by Essed-Schroeder method, many recurrencies appear (10–15%). After Nesbit or Yachia methods, recurrence rate is lower but corpora cavernosa are opened. Authors proposed less invasive procedure. Methods: From 2006 to 2011, authors operated on 85 adult men with congenital penile curvature. Downward curvature was detected in 52 patients, lateral in 33, upward in 10. In 10 patients, curvatures occurred at least in two planes. Skin and tunica dartos were incised longitudinally on convex surface of curvature. In downward curvature, dorsal neurovascular bundles were separated from tunica albuginea and elliptic fragments of external layer of tunica were excised. Tunica was sutured with single absorbable sutures which went through both layers of tunica invaginating internal layer. In all patients, straightening of penis was always checked by artificial erection. If curvature was still present next excisions were done. In upward curvatures, excisions were done on both sides of urethra. In lateral penile curvatures, convex penile surface was shortened. Antiandrogens were given orally 3 days before and 14 days after operation. Results: In all patients, penis was straightened during operation. Follow-up examinations, which were done 6 months to 4.5 years after operation, showed that in 83 patients penis was straight, and in two recurrence (2.3%) of 15–20 degrees curvature was detected, in one of them reoperation was done. Disorders of superficial sensation on glans, erectile dysfunction, or disturbances of micturicion were not detected in any patient. Conclusion: (i) Excision of elliptic fragment of external layer of tunica albuginea with subsequent invagination of internal layer by sutures passing through both layers of tunica is an effective method in the treatment of congenital penile curvature. (ii) Operation is little invasive because there is no need for opening of cavernous bodies, which diminish potential risk of complications. (iii) For performing proposed operation, knowledge of stratified structure of tunica albuginea is necessary as well as delicate and precise operative technique. Policy of full disclosure: None.

PS-04-005

THE OUTCOMES OF THE T SHUNT PROCEDURE AND INTRACAVERNOUS TUNNELING (SNAKE MANEUVER) FOR THE MANAGEMENT OF THE ISCHEMIC PRIAPISM Zacharakis, E.1; Muneer, A.2; Skolarikos, A.3; Minhas, S.2; Papatsoris, A.3; Deliveliotis, C.3; Ralph, D.2 1 University College Hospital, Urology, London, UK; 2University College Hospital, St Peter’s Andrology, London, UK; 3Sismanogleio’ General Hospital, 2nd Department of Urology, Athens, Greece Objective: Ischemic priapism, which is refractory to conventional medical and surgical intervention, results in necrosis of the corpus cavernosum smooth muscle with resultant erectile dysfunction and penile shortening. The aim of this study was to assess the outcome of the T-shunt procedure and intracavernous tunneling for the management of the ischemic priapism. Methods: Over a 24-month period, 15 patients presented with prolonged ischemic priapism. The mean age was 40.2 years (range 31–69) and the median duration of priapism was 96 hours (range 24–168). The etiology was sickle cell disease (four patients), idiopathic (five patients),

and antipsychotic agents (six patients). All cases had an unsuccessful aspiration and intracorporal administration of sympathomimetics and underwent “T-shunt” procedure and intracavernous tunneling with a size 8 Hegar dilator each side. All patients completed an IIEF-5 questionnaire pre- and 3 months postoperatively, and all had cavernosal muscle biopsies at the time of shunting. Results: Of the 15 patients, T shunting and snake maneuver failed to treat the priapism in eight cases and they had an early penile prosthesis implantation. In the remaining seven cases, the “T shunt” was successful; however, the patients developed delayed erectile dysfunction secondary to extensive corporal fibrosis. All patients had histological evidence of cavernosal smooth muscle necrosis. The average IIEF-5 score in all of the patients preoperatively was 24. After a median follow-up of 3 months, the patients with early penile implantation had already resumed successful sexual intercourse, and the overall satisfaction rate was 96% according the IIEF-5 score. By contrast, the average IIEF-5 score in the group of patients with T-shunt procedure was 4. Conclusion: In ischemic priapism of more than 24 hours duration, the T-shunt technique may result in immediate resolution of ischemic penile pain and rigidity, but the patients usually develop delayed erectile dysfunction secondary to extensive corporal fibrosis. Policy of full disclosure: None.

PS-04-006

COATED IMPLANTS AND “NO TOUCH” SURGICAL TECHNIQUE DECREASE THE RISK OF INFECTION IN INFLATABLE PENILE PROSTHESIS IMPLANTATION TO 0.46% Eid, J. F.1; Wilson, S.2 Institute for Advanced Urological Care, New York City, NY, USA; 2Indio, CA, USA

1

Objective: The inflatable penile prosthesis (IPP) is a well-established treatment for erectile dysfunction. Infection is the most dreaded complication. Infection retardant coatings on modern implants have lowered the infection rate approximately 50%. This study explores whether a “no touch” enhancement to the surgical technique of IPP will further decrease infection rates. The “no touch” technique ensures that neither the surgeon, the instruments nor the implant touches the patient’s skin. Methods: A single surgeon performed 2,347 IPP between January 2002 and June 2011. In 2002, noninfection-retardant coated implants were used and the remaining years infection retardant-coated IPPs were implanted. During the years 2003–2006 coated devices underwent penoscrotal implantation. Since 2006, the “no touch” enhancement was added to the surgical procedure. Patients in the various groups were stratified for age, diabetes, and type of implant. Infection rates in the non-coated IPP, coated IPP with standard technique, and coated IPP implanted with “no touch” enhancement were calculated and subjected to statistical analysis. The two company’s implants were scrutinized for their individual infection rates in each group. Results: Patients were similar for age and diabetes. One hundred thirty-two non-coated implants had an infection rate of 5.3%. In the years 2003–2005, 704 coated devices had improvement in incidence of infection to 2% (P ≤ 0.05) In the years 2006–2010, the “no touch” technique enhanced the standard surgical procedure in 1,511 patients. Only seven infections were seen yielding an infection incidence of 0.46%. There was no difference in the two manufacturer’s infection rates in any of the groupings. Differentiation between virgin and revision operation displayed no bias in the infection rate. Conclusion: Infection retardant coatings lower the risk of infection from 5.3% to 2%. The “no touch” enhancement to the surgical procedure further decreases the rate of infection to 0.46%. Neither manufacturer showed statistical superiority in survival from revision for infection. Policy of full disclosure: J. Francoise Eid is a consultant for AMS and Coloplast. S. K. Wilson is a consultant for AMS and Coloplast.

J Sex Med 2011;8(suppl 5):369–383

384

HIGHLIGHTED POSTER SESSIONS

Friday, 2 December 2011 11.00–11.30 Exhibition Hall B Area 1 HP-01 Basic science—preclinical research Chairs: J. Angulo, Spain M. Albersen, Belgium HP-01-001

EFFECT OF MESCENCHYMAL DERIVED STEM CELLS USING MATRIXEN ON THE ERECTILE FUNCTION IN THE RAT MODEL WITH BILATERAL CAVERNOUS NERVECRUSHING INJURY Kim, S. J.1; Ahn, T. Y.2; Bae, W. J.3; Choi, Y. S.3; Cho, H. J.3; Hong, S. H.3; Lee, J. Y.3; Hwang, T.-K.3; Kim, S. W.3 1 Seoul St. Mary’s Hospital, Urology, Korea; 2Asan Medical Center, University of Ulsan College of, Seoul, Korea; 3Department of Urology The Catholic University of Korea, Seoul, Korea Objective: To evaluate the effect of mesenchymal derived stem cell (MSC) and MSCs mixed with Matrixen which is a collagen-based biocompatible polymer on the erectile dysfunction by bilateral cavernous nerve crushing injury. Methods: Rats were divided into four groups: control group (N = 3), bilateral cavernous nerve crushing group (BCNC group, N = 3), BCNC administered with MSCs group (N = 7.1 × 106 in 20 μL), and BCNC administered with MSCs/Matrixen group (N = 7, 1 × 106 in 20 μL). After functional assessment at 4 weeks, major pelvic ganglion (MPG) and penile tissue were collected. Intracavernosal pressure (ICP)/mean arterial pressure (MAP) ratio was measured by cavernous nerve electrical stimulation. Immunofluorescent staining of MPG was performed with PKH26 and Tuj1. Masson’s trichrome staining and western blot analysis of endothelial nitric oxide synthase (eNOS) and neuronal nitric oxide synthase (nNOS) were done in corpus cavernosum. Results: ICP/MAP ratios of BCNC with MSCs and MSCs/Matrixen groups were significantly increased compared with BCNC group. Moreover, ICP/MAP ratios of MSCs/Matrixen group were significantly increased compared with BCNC with MSCs group. In MPG, the more implantation of MSCs and increased expression of nerve cells were observed in MSCs/Matrixen group. More restoration of smooth muscle was also observed in BCNC with MSCs/Matrixen group. Significant increase expression of nNOS was noted in BCNC with MSCs/ Matrixen group. Conclusion: MSCs/Matrixen group showed more functional and histological restoration compared with the single injection with MSCs in the rats of bilateral cavernous nerve crushing injury. Therefore, we considered that the use of transplant cell carrier such as Matrixen may help the implantation of MSCs and improve the therapeutic effect of MSCs. Policy of full disclosure: None.

J Sex Med 2011;8(suppl 5):384–405

HP-01-002

VISFATIN IMPAIRS ENDOTHELIUMDEPENDENT RELAXATION IN HUMAN PENILE RESISTANCE ARTERIES THROUGH NICOTINAMIDE PHOPHORIBOSYL TRANSFERASE (NAMPT) ACTIVITY Angulo, J.1; La Fuente, J. M.2; Sánchez-Ferrer, C. F.3; Fernández, A.4; Romacho, T.3; Cuevas, P.4; Carraro, R.5; Peiró, C.3 1 Hospital Ramón y Cajal, Histología-Investigación, Madrid, Spain; 2Serviço de Urologia, Hospital Santo Antonio, Porto, Portugal; 3Departamento de Farmacología y, Terapéutica. UAM, Madrid, Spain; 4Hospital Ramón y Cajal, Madrid, Spain; 5Servicio de Endocrinología, Hospital La Princesa, Madrid, Spain Objective: Visfatin, also known as extracellular pre-B-cell colonyenhancing factor (PBEF) is an adipocytokine whose circulating levels are enhanced in metabolic disorders, such as type 2 diabetes mellitus and obesity. In contrast to conventional cytokines, visfatin also intrinsically possesses the enzymatic activity nicotinamide phosphoribosyltransferase (NAMPT). Circulating visfatin levels have been positively associated with vascular damage and endothelial dysfunction, which are, in turn, closely related to the development of erectile dysfunction (ED). The aim of this work was to evaluate the influence of visfatin on endothelial function in human corpus cavernosum (HCC) and penile resistance arteries (HPRA). Methods: HCC and HPRA were obtained from cavernosal specimens from subjects without ED or with ED of nonvascular etiology and mounted in organ chambers and wire myographs, respectively. Acetylcholine (Ach)-induced endothelium-dependent relaxation was evaluated in the absence or the presence of exogenous visfatin. Results: Visfatin (50 ng/mL) did not influence Ach-induced relaxation of HCC (pD2 6.98 ± 0.40 vs. 7.01 ± 0.43, n.s.; Emax 79.5 ± 5.9% vs. 80.5 ± 6.2% relaxation, n.s., in control and treated conditions, respectively; N = 6). In contrast, endothelial vasodilation was significantly impaired by the treatment with visfatin (50 ng/mL) in HPRA (pD2 7.07 ± 0.21 vs. 6.06 ± 0.32, P < 0.05; Emax 88.8 ± 3.1% vs. 58.9 ±

385

Highlighted Poster Sessions 9.5% relaxation, P < 0.01, in control and treated conditions, respectively; N = 10) while it did not modify endothelium-independent relaxation to sodium nitroprusside. The impairment caused by visfatin on endothelial vasodilation in HPRA was prevented by co-treating with the inhibitor of NAMPT activity, APO866 (10 μM) (pD2 6.75 ± 0.14 vs. 6.75 ± 0.47, n.s.; Emax 83.3 ± 5.1% vs. 78.4 ± 7.1% relaxation, n.s., in control and treated conditions, respectively; N = 5). Conclusion: Visfatin impairs endothelial vasodilation of HPRA through a mechanism involving NAMPT activity. Elevated concentrations of this adipocytokine could contribute to the pathogenesis of ED in metabolic disorders. Policy of full disclosure: None.

HP-01-003

HYPERSALINE SODIUM-RICH CARBONATED NATURAL MINERAL WATER CONSUMPTION MODIFIES STRUCTURE AND EXPRESSION OF ANGIOGENIC FACTORS IN CORPUS CAVERNOSUM OF FRUCTOSE-TREATED RATS Neves, D.1; Tomada, I.1; Pereira, C.2; Monteiro, R.2; Martins, M. J.2 Faculty of Medicine of Porto, Experimental Biology, Portugal; 2Faculty of Medicine of Porto, Department of Biochemistry, Portugal

1

Objective: Increased fructose consumption induces metabolic syndrome (MS), which conversely, seems to be prevented by calcium, magnesium. and potassium intake. Erectile dysfunction (ED) is highly prevalent in MS patients, due to cavernous structural changes and imbalance of angiogenic factors fundamental to maintain endothelium integrity. Vascular endothelial growth factor (VEGF) engages VEGFR1 and VEGFR2 and crosstalk with other angiogenic factors as angiopoietins, which compete for binding to the endothelial-specific Tie2 receptor. Thus, we aimed to characterize the effects of hypersaline sodium-rich carbonated natural mineral water ingestion on smooth muscle cells (SMC) content and expression of vascular growth factors and receptors in the corpus cavernosum (CC) of fructose-rich diet treated rats. Methods: Twenty-one male Sprague-Dawley rats were divided into three groups (N = 7) and maintained during 8 weeks with free access to tap water (C), 10% fructose in tap water (FRUCT), or 10% fructose in Água das Pedras® (FRUCTMIN). The penises were excised to perform immunodetection of alpha-actin, a specific marker of the SMC, followed by computer-assisted color histomorphometry (ImageJ® software). Immunofluorescence detection of alpha-actin/ PECAM-1, VEGF/VEGFR1, VEGF/VEGFR2, Ang1/Tie2 and Ang2/Tie2 and semi-quantification of VEGF, VEGFR1, VEGFR2, Ang1, Ang2 and Tie2 by Western blotting (WB) were also performed. WB bands were quantified by densitometry using the ScionImage software. Results: FRUCTMIN rats presented higher proportion of SMC in CC (15.6 ± 0.9) than C or FRUCT groups (10.5 ± 1.1 with P = 0.003 and 9.3 ± 1.2 with P = 0.001, respectively). Immunofluorescent study revealed endothelial expression of VEGF, VEGFR2, and Tie2, while VEGFR1, Ang1, Ang2 were detected in SMC. VEGF also co-localized with VEGFR1 in SMC in all experimental groups. No differences were observed by WB. Conclusion: The characterization of the CC of fructose-fed rats treated with a mineral-rich water is presented for the first time; however, further molecular analysis will be necessary to clarify its exact contribution for vascular function. Policy of full disclosure: C. Pereira has a PhD grant partially supported by Unicer Bebidas, SA. The other authors have nothing to declare.

HP-01-004

INVESTIGATION OF THE EFFECTS OF THE LEVEL OF GLYCEMIC CONTROL ON ERECTILE FUNCTION AND PATHOPHYSIOLOGICAL MECHANISMS OF ERECTILE DYSFUNCTION IN DIABETIC RATS Jae-Seung, P.; Kim, S. W. Seoul National University Hospital, Urology, Korea Objective: To investigate the effects of the level of glycemic control on erectile function and related penile structural and functional changes in diabetic rats. Methods: Fifty-five 8-week-old Sprague-Dawley rats were classified into four subgroups: normal control (group 1, N = 10), well-controlled diabetes (group 2, N = 15), poorly-controlled diabetes (group 3, N = 15), and untreated diabetes (group 4, N = 15). Diabetes was induced by injection of streptozotocin and multiple daily insulin injections in group 2 and once daily injection in group 3 were performed for 4 weeks after 10 weeks of diabetic induction. The ratio of intracavernosal pressure over mean arterial pressure (ICP/MAP), HbA1c, and total testosterone levels was measured. Apoptotic index and smooth muscle cell component (SMC) were calculated. Protein expression of nNOS and eNOS, MYPT1, and Akt was analyzed. Results: Different levels of HbA1c were confirmed in each group. Group 4 showed significantly decreased ICP/MAP, which was increased according to the level of glycemic control, and group 2 showed near normal ICP/MAP. Group 4 showed the highest apoptotic index, which was decreased according to the level of glycemic control, and group 1 showed the lowest index. The SMC was significantly decreased in group 4. nNOS expression was significantly decreased in diabetic groups compared to group 1. The ratio of phosphorylated/ total MYPT1 expression was the highest in group 4, and group 3 showed higher ratio than groups 1 and 2. The ratios of phosphorylated/total eNOS and Akt were the lowest in group 4, and group 3 showed lower ratios than groups 1 and 2. No differences in testosterone levels were identified among groups. Conclusion: Decrease in erectile function was confirmed according to the level of glycemic control and tight glycemic control can attain recovery of erectile function to a near normal status, which was associated with strutural and functional changes in corpus cavernosum. Policy of full disclosure: None.

HP-01-005

THE CYCLIC AMP-BINDING PROTEIN KINASE A (CAK) IS CO-LOCALIZED WITH VASOACTIVE INTESTINAL POLYPEPTIDE IN THE HUMAN VAGINA Ückert, S.1; Kauffels, W.2; Kuczyk, M.3; Hedlund, P.4 Hannover Medical School, Department of Urology, Germany; 2Klinikum Hildesheim GmbH, Department of Gynecology, Germany; 3Hannover Medical School, Division of Surgery, Germany; 4University Vita Salute, Department of Urology, Milano, Italy

1

Objective: The vagina has been assumed to contribute mainly to the normal female sexual response cycle. There are hints from experimental studies that this mechanism is under the control of the nitric oxide (NO)/cyclic GMP pathway and related proteins. Up until today, only a few studies have investigated the significance of the cyclic AMP signaling in maintaining the function of vascular and non-vascular female genital smooth muscle. The aim of the present study was to evaluate in the human vagina by means of immunohistochemistry the expression and distribution of the protein kinase A (cAK), known a major intracellular target for cyclic AMP, the vasoactive intestinal polypeptide (VIP), and protein gene product 9.5 (PGP 9.5). Methods: Immunohistochemical methods (double-labeling technique, laser fluorescence microscopy) were applied to sections of the

J Sex Med 2011;8(suppl 5):384–405

386 human vaginal wall (full wall specimens) in order to evaluate the expression and distribution of cAK, VIP, and PGP 9.5. Results: A dense meshwork of varicose nerve fibers, characterized by the expression of the neuronal marker protein PGP 9.5, was identified in the subepithelial layer of the vagina. Some of these nerves also presented staining for VIP. Immunoreactivity specific for cAK was observed in non-vascular smooth muscle and in the entire wall of small arteries interspersing the sections. The blood vessels were found innervated by numerous VIP-positive, slender varicose nerve fibers. Conclusion: Our results indicate that the cyclic AMP signaling is involved in the perception of sensory signals and the control of local vascular events in the human vagina. Policy of full disclosure: None.

HP-01-006

DOPAMINE MODULATES REWARD SYSTEM ACTIVITY DURING SUBCONSCIOUS PROCESSING OF SEXUAL STIMULI Both, S.1; Oei, N.2; Rombouts, S.2; Soeter, R.2; van Gerven, J.3 Leiden University Medical Cent, Psychosomatic Gynecology and S, The Netherlands; 2LUMC, Department of Radiology, Leiden, The Netherlands; 3 CHDR, Centre for Human Drug Research, Leiden, The Netherlands

1

Objective: Dopaminergic medication is associated with hypersexuality, however, how exactly dopamine affects sexual motivation is unclear. As a major neurotransmitter in the reward system, dopamine may act on the processing of sexual stimuli. Here we investigated the effect of dopamine on neural activity in the reward system during subconscious processing of sexual stimuli. We hypothesized that increasing dopamine levels by a dopamine agonist (levodopa) would enhance brain activation in the reward system elicited by subconsciously processed sexual pictures, whereas this would be attenuated by decreasing dopamine activity with a dopamine antagonist (haloperidol). Methods: Fifty-five healthy male volunteers were assigned to one of three groups (levodopa, haloperidol, or placebo) in a randomized double-blind experimental design. FMRI scans were obtained during a backward masking task containing target pictures shown very briefly (26 ms), immediately followed by masks (474 ms). Under these conditions, participants see the masks, but the targets escape visual recognition and remain “subconscious.” Four target categories were presented, consisting of human pictures with a sexual, emotional negative and neutral content, and as a fourth target a fixation cross. To determine whole-brain main task effects, Z statistic images were thresholded using clusters determined by Z > 2.3 and a cluster significance threshold of P < 0.05. The linear contrast (haloperidol < placebo < levodopa) was analyzed with independent ROI-analyses. Results: An identification task to evaluate subliminal presentation indicated that participants did not recognize the targets. The whole brain analyses showed that the sexual stimuli were specific in inducing activation in reward-related brain areas, including the nucleus accumbens (Nacc). Haloperidol–placebo–levodopa showed parametrically increasing activation in the Nacc and dorsal anterior cingulated cortex (dACC). Conclusion: In healthy males, reward-related brain areas respond to sexual stimuli, even when these are presented outside awareness. As expected, these activations were modulated by dopamine. Policy of full disclosure: This study was supported by an ESSM research grant (2009) awarded to S. Both.

J Sex Med 2011;8(suppl 5):384–405

Highlighted Poster Sessions HP-01-007

GENDER-RELATED DIFFERENCES IN RAT BLADDER PDE5 BIOLOGICAL AND CATALYTIC ACTIVITY Vignozzi, L.1; Filippi, S.1; Morelli, A.1; Comeglio, P.1; Mancina, R.1; Gacci, M.2; Carini, M.2; Maggi, M.1 1 Sexual Medicine and Andrology, Clinical Physiopathology, Florence, Italy; 2 Department of Urology, University of Florence, Italy Objective: To investigate and directly compare PDE5 expression and biological activity in female and male bladder, as evidences have been accumulating that PDE5 inhibitors show a definitive improvement of lower urinary tract symptoms in the male. On the contrary a lack of efficacy has been reported in the female. Methods: We studied PDE5 gene (real-time RT-PCR) and protein (western blot) expression, as well as its enzymatic activity in bladder homogenates of adult male and female Sprangue-Dawley rats. As a readout of biological activity of PDE5, we studied the ability of vardenafil to potentiate the relaxant effects of the NO donor sodium nitroprusside (SNP) in female and male bladder strips that were compared with those obtained with the PDE-insensitive cGMP analog Sp-8-Br-PET-cGMPS. Results: In carbachol-precontracted bladder strips, SP-8-Br-PETcGMPS induced a dose-dependent relaxation that was identical in male and female preparations. After blocking PDE5 with 100 nM vardenafil, in both genders SNP induced a maximal relaxation that was not different from that one obtained with SP-8-Br-PET-cGMPS and comparable among genders. In the absence of vardenafil, SNP was less potent in relaxing male bladder than the female one. PDE5 catalytic activity is more pronounced in male as compared to female bladder. Conclusion: This study demonstrates that PDE5 biological and catalytic activity is more pronounced in male as compared to female bladder, suggesting that male bladder could be regarded as a more suitable target for PDE5i than female counterpart in the treatment of LUTS Policy of full disclosure: None.

HP-01-008

PHOSPHODIESTERASE TYPE 5 IS EXPRESSED IN HUMAN AND RAT LOWER URINARY TRACT TISSUES AND ITS INHIBITION WITH TADALAFIL IMPROVES PROSTATE GLAND OXYGENATION IN SPONTANEOUSLY HYPERTENSIVE RATS Morelli, A.; Sarchielli, E.; Comeglio, P.; Filippi, S. Mancina, R.; Gacci, M.; Vignozzi, L.; Carini, M.; Vannelli, G. B.; Maggi, M. University of Florence, Italy Objective: In human prostate PDE5 expression was prominently localized in the endothelial and smooth muscle cells of the vascular bed, suggesting a possible action of PDE5 inhibitors (PDE5i) on prostate blood flow. This study was aimed to investige PDE5 expression in human and rat lower urinary tract (LUT) tissues, including vasculature, and to determine the effects of PDE5 inhibition with tadalafil on prostatic blood perfusion. Methods: Human vesicular-deferential arteries (which originate from the inferior vesical artery, the main arterial source of blood supply to the bladder and prostate) were analyzed for PDE5 expression (quantitative RT-PCR and immunohistochemistry) and activity. The effects of tadalafil on prostate oxygenation were studied in spontaneously hypertensive rats (SHR), characterized by ischemia/hypoxia of the genitourinary tract. SHR were treated with tadalafil (2 mg/kg/daily) for 1, 7, or 28 days and compared with untreated SHR and the unaffected counterpart Wistar Kyoto rats (WKY). Prostate oxygenation was detected by Hypoxyprobe-1™ and hypoxia markers (HIF1α and ETB) immunostaining. Results: Human vesicular-deferential artery expressed high levels of PDE5, similar to corpora cavernosa, immunolocalized in the endothe-

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Highlighted Poster Sessions lial and smooth muscle layer. In these arteries, tadalafil inhibited cGMP breakdown (IC50 in the low nanomolar range, as in corpora cavernosa) and increased the relaxant response to sodium nitroprusside. SHR prostate resulted markedly hypoxic (hypoxyprobe immunopositivity) and positive for HIF1α and ETB, while tadalafil treatment restored oxygenation to WKY level at each time point. The mRNA expression of the HIF-1α target gene, BNIP3, was significantly increased in SHR prostate and partially restored to WKY level by tadalafil. Conclusion: Human vesicular-deferential artery is characterized by a high expression and activity of PDE5 which was inhibited by tadalafil in vitro. In SHR, tadalafil increases prostate tissue oxygenation, thus suggesting a possible mechanism through which PDE5i exert beneficial effects on LUT symptoms. Policy of full disclosure: None.

Friday, 2 December 2011 11.00–11.30 Exhibition Hall B Area 2 HP-02 Psychosexual issues Chairs: S. Brody, UK L. Athanasiadis, Greece HP-02-001

TIRESIAS (TYPES OF SEXUAL RESPONSE AND SUBSTANCE ADDICTION) Del Río Olvera, F. J.1; Cabello Santamaría, F.2 IASP, Jerez de La Frontera, Spain; 2Instituto Andaluz de Sexología, Málaga, Spain

1

Objective: There are just a few studies to assess the sexual response of subtances consumers. Despite it’s poor scientific evidence, it seems that is sexuality affected in different ways by drugs. The present research tries to analyze the sexual response of people depending on the type of substance consumption, and comparing with non-consumers. Methods: The sample was recruited from 28 treatment centers, distributed in 27 Spanish provinces, that is, sampling for conglomerates with two groups, experimental (1.054 people) and control (211 people). The questionnaires Golombok Rust Inventory Sexual of Satisfaction (GRISS), Questionnaire of Anxiety State-feature (STAI) and Sexual Opinion Survey (SOS) have been used. We performed the Levene test and contrasted with the statistic T. Results: The experimental group showed according to the scales of GRISS the following dysfunctions: premature ejaculation 70.6%, erectile dysfunction 49.4%, vaginismus 70.8%, orgasm disorder 43.1%. The control group showed the following dysfunctions: premature ejaculation 40.2%, erectile dysfunction 31.7%, vaginismus 47.3%, orgasm disorder 10.9%. Likewise, the experimental group, presented statistical differences against control group in anxiety and SOS (average group control: STAI-A = 13.521, STAI-R = 15.246, SOS = 96.389; experimental average group: STAI-A = 20.349, STAI-R = 26.341, SOS = 86.7). To end up the consumers of substances suffer more from sexual dysfunction, anxiety and negative attitudes about sex. Conclusion: The results confirm the initial hypothesis. Drug consumers present a bigger number of sexual dysfunctions than non-consumer people. It was also confirmed those with a higher rate in anxiety and lower in SOS suffered from more frequent sexual dysfunctions. Policy of full disclosure: None.

HP-02-002

SEXUAL AND REPRODUCTIVE HEALTH AND CONDOM DISCOMFORT AMONG STUDENTS: AN EXPLORATORY STUDY Papaharitou, S.1; Giaglis, G.1; Moraitou, M.2; Hatzichristou, D.1 Aristotle University, Center for Sex & Reproductive Health, Thessaloniki, Greece; 2Alexandreio TEI, Midwifery Dpt., Thessaloniki, Greece

1

Objective: Consistent and correct use of condom remains the best strategy to prevent transmission and acquisition of sexually transmitted diseases (STDs), since its use is not only a birth control method. Like any health protective device however, condoms may be less effective when used incorrectly. Condom-associated discomfort may lead to breakage or low motivation to use condoms. Our study aimed to identify prevalence and types of male condom-associated discomfort among students, the outcomes of this discomfort, and discomfort’s role in condom breakage. Methods: The study included a convenient sample of sexually active college students (120 male, 140 female). Subjects completed voluntarily a questionnaire that assessed demographics, their 3-month recall sexual behavior (i.e., frequency of condom use), and a range of potential condom-use errors and problems. Three aspects of condom use were measured: breakage, not using condoms throughout penetration, and low condom-use motivation. Data were analyzed using Fisher’s x-squared and Pearson’s r coefficient.

J Sex Med 2011;8(suppl 5):384–405

388 Results: Discomfort was reported by almost 35% of subjects, including tightly fitting condoms, erectile dysfunction, vaginal irritation, and sensation’s loss. Discomfort was associated with breakage (P = 0.01), incomplete use (P = 0.01), and less motivation to use condoms (P = 0.018). Gender moderated the latter two findings. Adjusted findings indicate that students reporting discomfort were 3.6-times more likely to report breakage also (P = 0.038). Conclusion: Findings from this exploratory study suggest the possibility that a substantial proportion of young people may experience discomfort and sexual problems when using condoms. The associations observed suggest that discomfort could be a potential antecedent of condom breakage, incomplete use, and less motivation to use condoms putting in risk young’s reproductive health. Education may improve understanding of contraceptive use benefits, risk reduction strategies, and communication techniques. Policy of full disclosure: None.

HP-02-003

IS CURRENT PUBLIC AWARENESS OF HUMAN PAPILLOMA VIRUS SUFFICIENT IN THE WEB-NETWORKING GENERATION? Sacca, A.1; Salonia, A.1; Abdollah, F.1; Matloob, R.1; Moretti, D.2; Ferrari, M.1; Castiglione, F.1; Castagna, G.1; Clementi, M. C.1; Rigatti, P.1; Montorsi, F.1 1 University Vita-Salute San Raffaele, Dept. Urology, Milano, Italy; 2Urological Research Institute, Milan, Italy Objective: To assess the level of awareness on human papilloma virus (HPV) infection among patients attending an academic sexual and reproductive medicine center. Methods: A cohort of 924 patients (mean age 39.83 years, range 18–77) were (267 [28.9%] women and 657 [71.1%] men) anonymously completed a brief self-administered structured questionnaire including general demographic data and questions about subject’s awareness of risks and prevention aspects related to HPV infection. Descriptive statistics and regression models tested the association between HPV’s awareness and predictors. Results: Overall, 474 (51.3%) patients were aware of HPV’s existence. Women were more frequently HPV-aware than men (P < 0.001); similarly, highly educated patients reported the highest awareness on HPV (chi2: 31.907; P < 0.001). At multivariate analysis, age at survey (B = 1.021, P = 0.007), female sex (B = 0.268, P < 0.001), high school (B = 0.374; P < 0.001) and university degree (B = 0.443, P < 0.001) educational levels emerged as independent predictors of HPV awareness. Among the 474 HVP-aware patients, 404 (85%) had consciousness of HPV’s sexual transmissibility (women vs. men; chi2: 7.66; P = 0.02). Moreover, 386/474 (81.4%) patients had awareness of HPVmediated genital carcinogenesis in women, 115 (24.3%) of penile carcinogenesis, and only 79 (16.7%) of oral cavity carcinogenesis. Women had higher awareness about HPV-related female genital cancer (chi2: 14.95; P < 0.001) and HPV-mediated condylomatosis (chi2: 6.38; P = 0.007). Conversely, women and men did not differ in terms of awareness about HPV-related penile and oral cavity cancer (all P > 0.05). Two hundred forty-two out of 474 (51.1%) patients were aware of the availability of a HPV vaccine. Conclusion: This exploratory analysis showed that public awareness of HPV-related risks is still dramatically low in the worldwide webnetworking era. Male gender’s awareness is even lower. Policy of full disclosure: None.

J Sex Med 2011;8(suppl 5):384–405

Highlighted Poster Sessions HP-02-004

SEXUAL AND REPRODUCTIVE HEALTH AND MEDIA USE: AN EXPLORATION OF FEMALE YOUNG STUDENTS’ HIV/STDS KNOWLEDGE Papaharitou, S.1; Nakopoulou, E.1; Moraitou, M.2; Hatzichristou, D.1 Aristotle University, Center for Sex & Reproductive Health, Thessaloniki, Greece; 2Alexandreio TEI, Midwifery Department, Thessaloniki, Greece

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Objective: Young people are at high risk of sexually transmitted infections, lack knowledge about sexually transmitted diseases (STDs) and are more aware of the risks of unwanted pregnancy than their risk of acquiring a STD. Exposure to mass media related to HIV/AIDS has been linked to attitudinal and behavioral changes. This study aims to identify the source(s) of HIV/STD information of female students and their behavior in order to help establish control and education programs. Methods: The study included a convenient sample of 200 sexually active female college students. All students who volunteered to participate completed a questionnaire assessing sociodemographic and knowledge factors about STDs, sexual beliefs and source of information. Results: The rate of students having had sexual experience was 80%. Mean age of sexual life initiation was 17.5 years with a mean number of sexual partners was 3.68. The most widely known STD was HIV although one fourth of participants could not recognize other STDs as so. Main sources of knowledge were mass media (36%) and friends (31%). Most of them (90%) have watched an advertisement on HIV prevention on TV, 80% have read about it in a lifestyle magazine, almost 50% were informed about HIV from campaigns on radio or newspapers, while less than 20% have ever received an informative email about HIV/STD prevention. Mass media were for one third, the first source of information for protection against STD. Conclusion: Studies have shown that young people are sexually active and tend to engage in high-risk behavior. However, their knowledge on sexual health and STDs relies on non-scientific sources of information. Our results suggest a need for implementation of STDs control programs and provision of education through comprehensive mass media programs. Policy of full disclosure: None.

HP-02-005

HETEROSEXUAL ANAL INTERCOURSE IS INCREASING IN PREVALENCE, AND IS ASSOCIATED WITH BISEXUAL BEHAVIOR AND HISTORY OF VENEREAL DISEASE, AND FEMALE SEXUAL DYSFUNCTION Weiss, P.1; Brody, S.2 Charles University, Prague, Czech Republic; 2Uni of the West of Scotland, Paisley, UK

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Objective: Examining changes in lifetime prevalence of heterosexual anal intercourse from 1993 to 2008 in the Czech Republic, and associations with other aspects of sexual behavior, health and function. Methods: Representative samples of the Czech population (aged 15–96) were surveyed in 1993, 1998, 2003, and 2008 (total N = 7,720), providing information on lifetime number of sex partners, current masturbation, and histories of heterosexual anal intercourse, homosexual sex, prostitution, venereal disease, any sexual dysfunction, and childhood sexual abuse. Results: Lifetime prevalence of heterosexual anal intercourse increased from 1993 to 2008 (women: 16.6–19.7%, men: 15.7–25.3%). Anal intercourse was associated with lifetime number of sex partners (odds ratio [OR] per partner for men: 1.007, P = 0.006, OR women: 1.048, P < 0.001), current masturbation (OR men: 1.852, P = 0.002, OR women: 1.985, P < 0.001), and histories (which increased between 1993–2008) of homosexual sex (OR men: 2.602, P < 0.001, OR women: 2.845, P < 0.001), prostitution (OR men customer: 2.702, P < 0.001,

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Highlighted Poster Sessions OR women prostitute: 2.657, P < 0.001), venereal disease (adjusted for number of sex partners; OR men: 1.813, P < 0.001), and sexual dysfunction (OR women: 1.372, P < 0.02). Conclusion: Heterosexual anal intercourse is associated with sexual dysfunction, bisexual behavior, and venereal disease histories. There are several possible reasons for the increasing prevalence, including pornography modeling the behavior. The observed associations might be due to factors including psychosexual impairments. The results are consistent with the health differences between various sexual behaviors. Policy of full disclosure: Funding for the underlying survey was provided by The AIDS Commission of the Czech Health Ministry and by Pfizer.

HP-02-006

MALE CANCERS AND SPECIFIC REQUESTS FOR SEXUAL CARE: LESSONS FOR DAILY PRACTICE BASED ON THREE PROSPECTIVE SURVEYS IN AN OUTPATIENT UROLOGY CLINIC IN A PUBLIC HOSPITAL Bondil, P.1; Habold, D.1; Damiano, T.2 Centre Hospitalier, Urology-Andrology, Chambery, France; 2ROSA, Chambery, France

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Objective: In order to specify our needs in oncosexology, prospective investigations were made among successive cancer male outpatients, all cancers (AC) then prostate cancer (PC) consulting in urology whatever the stage, treatment or follow-up. Methods: All cancer: investigation of exclusive sexual patient requests among 615 successive cancer male outpatients. Five analyzed parameters: age, sexual problems, concerned cancers, sexual treatments, and referral physician. PC: proactive analysis of erectile capacity (Hardness Erectile Score: HES), treatment demand and survey well-founded in 246 all ages patients (mean age 70.6) then in 122 aging (>74 years) ones. Results: All cancer: sexual treatment: for 126 patients (20.5%) i.e., 114 erectile dysfunction (ED), 5 lowering of desire and 7 miscellaneous; concerned cancers: 8% non-urological; specific treatment: mainly pharmacological using oral PDE5i (N = 50) and PGE1 intracavernous injections (ICI) (N = 48); referral physicians: only 10% patients specifically sent by other physicians. PC: (i) all age: 18% no ED (mean HES 3.7) vs. 82% ED (HES score < 3); treatment demand = 48%; survey approval = 95%; (ii) aging: 93% ED; treatment demand (9%) or already treated (19%); survey approval (99%). In our 368 unselected PC outpatients, 20% have no ED problem, 40% ask for or are treated. If 40% are not interested in a treatment, 95% agree to be questioned and informed. Conclusion: These observational investigations show five facts: (i) a minority (20.5%) of our all cancers patients benefits from specific care concerning mainly ED (90%), PC (79%) and pharmacological treatments (89%); (ii) the low number of non-urological cancers (8%) reflects an inequality of access to oncosexological care; (iii) 82% of our all ages PC patients have ED but only half is treated; (iv) when proactively asked, 95% wanted specific information or treatment even the older ones; (v) a paradoxical situation in CP group: overestimation of ED negative impact in youngest population vs. underestimation of sexual interest in oldest one. Policy of full disclosure: None.

HP-02-007

SEXUAL DYSFUNCTION AND DEPRESSION Hakobyan, S. YSMU, Sexology, Yerevan, Armenia Objective: The connection between sexual dysfunction and depressive disorders has been noted for centuries; Freud, for example, wrote that “melancholia consists in mourning over loss of libido.” More recently, the acceptance of decreased libido as a symptom of major depressive disorder (MDD) is reflected in various standardized depression rating

forms that contain an item assessing loss of sexual interest. However, there has been little empirical research that evaluates the prevalence, clinical subtypes, and natural course of sexual changes in medicationfree patients with depressive disorders. The goals of this article are to review research on the prevalence of sexual dysfunction in people with depressive disorders and to make recommendations for future research. Methods: Investigate physical symptoms in 132 patients with depressive disorders and reported that 72% of patients with unipolar depression and 77% of patients with bipolar depression acknowledged loss of libido, compared with 5% of age-matched controls. Two similar studies including only patients with unipolar depression found a greater prevalence of decreased libido in patients with depression compared with age-matched controls. Results: Depression occurs in 10–25% of all women after childbirth, and women with a history of MDD or bipolar disorder are at a significantly increased risk for recurrence of depression during this time. Decreased libido is a common complaint in nondepressed postpartum women, and to our knowledge, no study has compared sexual dysfunction in women with and without depression during the postpartum period. Conclusion: The reported evidence suggests a relatively high prevalence of sexual dysfunction in patients with MDD before treatment with medication or psychotherapy compared with nondepressed patients or community sample controls. To date, reduced libido appears to be the most common problem, occurring frequently in both men and women with depression. Policy of full disclosure: None.

HP-02-008

THE RE-ESTABLISHMENT OF ORGANIC AND EROTIC FUNCTIONS IN PENILE PROSTHESIS IMPLANTATION: WHICH RELATION? Abbona, A.1; Peraldo, F.2; Pisano, F.1; Soria, F.1; Fiorito, C.1; Gontero, P.1 Molinette Hospital, Turin, Italy; 2Turin, Italy

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Objective: Many studies about prosthetic penile implants working have been reported in the literature but only a few of them take account of psychosexual problems as patient and couple’s satisfaction and erotic function. The aim of our study is to evaluate the correlation between organic and erotic function and to underline the importance of a multidisciplinary management of these patients, involving the urologist and sexuologist. Methods: The study was designed as a two-arm controlled study. We enrolled patients with erectile disfunction who were scheduled for a tri-component inflatable penile prosthesis implantation. In the first arm (control group) were enrolled patients before 2009, who only underwent to surgery, without any psycosexuological counseling. From January 2009, we enrolled patients who were treated at Molinette Hospital (case group). They underwent a treatment course divided into four steps: (i) preoperatively patients underwent to couple psychosexuological counseling and, when behavioral or systemic problems emerged, couple therapy; (ii) surgical treatment; (iii) posttreatment psychosexuological evaluation; and (iv) follow-up. Sexual and andrological questionnaires (IIEF, Sexual Daydreaming Questionnaire) were administered preoperatively and at 3, 6, and 12 months. Patients are comparable for age, type of surgery, and prosthesis implanted. Results: Since today, 15 patients were enrolled in arm 1 and 15 patients in arm 2. Questionnaires analysis reports a better positive correlation between surgical outcomes and individual and couple erotic function re-establishment in case group. Moreover, during the preoperative couple psychosexuological counseling came out important cultural resistances, hard to win, especially in partners over 55 years. Conclusion: After prosthetic implantation, sexuality and erotic function have been improved in patients in which surgical treatment has been preceded and accompanied from a psychosexuological counseling in comparison with patients who underwent only surgical treatment. Policy of full disclosure: None.

J Sex Med 2011;8(suppl 5):384–405

390 Friday, 2 December 2011 15.00–15.30 Exhibition Hall B Area 1 HP-03 Women’s sexual health Chairs: R. E. Nappi, Italy S. Both, The Netherlands HP-03-001

ALEXITHYMIA AND VAGINISMUS: A CORRELATION PERSPECTIVE Ciocca, G.1; Limoncin, E.1; Gravina, G. L.1; Carosa, E.1; Di Sante, S.1; Di Tommaso, S.1; Lenzi, A.2; Gandini, L.1; Isidori, A. M.3; Jannini, E. A.1 1 University Of L’Aquila, Experimental Medicine, Italy; 2University of Rome La Sapienza, Experimental Medicine, L’aquila, Italy; 3University of Rome La Sapienza, Department of Patophysiology, Roma, Italy Objective: This study aims at investigating the presence of alexithymia in women affected by vaginismus. Alexithymia is referred to as the inability to express feelings with relevant words. Vaginismus is a typically female sexual dysfunction that occurs with involuntary tightness that is actually caused by involuntary contractions of the muscles surrounding the vagina, preventing penetration. It is believed that in women affected by vaginismus, alexithymia is more frequently present. Methods: Forty-one women who were diagnosed with vaginismus not associated to organic causes or psychopathologies have been selected. Those women were administered TAS-20, a self-report questionnaire which is used to assess the levels of alexithymia. The clinical case study group composed of women affected by vaginismus was compared to a control group composed of 34 women having a normal sexual function that was assessed using FSFI. Women showing dysfunctional scores to FSFI have been excluded from follow-up. The statistically significant difference between the two groups was evaluated with the t-test, through SPSS 17. Results: The comparison of means of the scores obtained from the two groups that were administered TAS-20 revealed a statistically significant difference with index below 0.05. Among the subfactors resulting from TAS-20, it was observed that women affected by vaginismus find it harder to identify feelings and their thoughts seem to be oriented to the outer world. Finally, in women who have been diagnosed with vaginismus compared to healthy women there is a four times greater risk of being also affected by alexithymia. Conclusion: The general trend of this study and the statistical analysis performed show that in women affected by vaginismus the presence of alexithymia is significantly greater compared to healthy women. Therefore it is likely that female patients who avail themselves of medical-psychological counseling and that have been diagnosed with vaginismus, also tend to show a deficit in the cognitive response to emotions (alexithymia). Policy of full disclosure: None.

HP-03-002

SEXUALITY OF WOMEN WITH POLYCYSTIC OVARY SYNDROME Skrzypulec-Plinta, V.1; Kowalczyk, R.2; Skrzypulec, A.2 Medical University of Silesia, Women’s Health Chair, Katowice, Poland; 2 Medical University of Silesia, Katowice, Poland

1

Objective: The basis of the work was laid on the fact that polycystic ovary syndrome (PCOS) modifies sexuality. The aim of the study was to investigate how PCOS influences changes of sexuality like sexual interactions, sexual functioning, or sexual self-assessment. Methods: The examined group consisted of 100 women aged 17–42 with PCOS. Control group consisted of 50 healthy women. In the study, the following questionnaires were used: The Bem Sex Role Inventory, Mell-Krat scale, The Sexuality Scale, The Sexual Awareness Scale, The Multidimensional Sexuality Questionnaire, The Multidimensional Sexual Self-Concept Questionnaire and Feriman-Gallwey scale. Questionnaires were supplemented by questions related to socialeconomic status, medical history, and elements of sexual interviews.

J Sex Med 2011;8(suppl 5):384–405

Highlighted Poster Sessions Results: No differences in libido level, frequency of sexual contact, number of partners, type of sexual behaviors, the role which sex played in life, motivation for sex level, measurement of orgasm, and sexual disorders between groups of women with PCOS and control group were detected. Women with PCOS under the age of 30 showed strong feeling that their sexuality is controlled by outside factors. They also had lower motivation for avoiding risky sexual behavior and were considerably more often found to have higher sexual assertiveness. Conclusion: Women with PCOS have many problems in the sexual sphere, it considerably lowers their quality of life. They should be quickly diagnosed and should have wide access to psychological-sexual therapy as well as the possibility to participate in support women groups with PCOS. Policy of full disclosure: None.

HP-03-003

SEXUAL FUNCTION IMPACT OF STRESS URINARY INCONTINENCE SURGICAL TREATMENT: COMPARISON BETWEEN MIDURETHRAL AND SINGLE-INCISION SLINGS Lopes, T.1; Resende, A.1; Oliveira, R.2; Pinto, R.1; Botelho, F.1; Tomada, N.1; Francisco, C.1; Vendeira, P.1 1 Hospital de São João, Department of Urology, Porto, Portugal; 2Faculty of Medicine of Porto, Portugal Objective: Few studies on surgical treatment of female stress urinary incontinence (SUI) assess the impact on sexual function. The goal of our study was to evaluate the impact on sexual function of conventional mid-urethral slings (CMUS) and single-incision slings (SIS), at 24 months of follow-up. Methods: Ninety patients with urodynamically confirmed SUI were randomized for different surgical treatment techniques of SUI: 30 to TVT-O™, 30 to TVT-Secur™ (hammock) and 30 to Mini-Arc™. Outcomes concerning continence status and complications have already been presented elsewhere. Patients answered the Portuguese translation of the Female Sexual Function Index (FSFI) questionnaire, at baseline and 24 months. Data were revised and comparison analysis was made between groups. Results: At 24-month evaluation, 16 patients (5 in each SIS group and 6 in the CMUS group) could not be contacted, so a carry-forward last observation was performed. Seventy-four patients (82%) were contacted and of these, only 39 (43%) were sexually active and willing to answer FSFI questionnaire. Globally, no significant changes were found between preoperative and postoperative (at 24-month followup) total or domain (desire, arousal, lubrification, orgasm, satisfaction, and pain) scores on the FSFI questionnaire. In addition, comparison between surgical treatment groups (using different types of slings) showed no statistically significant differences. Conclusion: Surgical treatment of female stress urinary incontinence, using CMUS and SIS, did not significantly affect sexual function. Nevertheless, further randomized clinical trials with larger populations are warranted to confirm these data. Policy of full disclosure: None.

HP-03-004

SEXUAL FUNCTION IN PREMENOPAUSAL MORBID OBESE WOMEN WITH OBSTRUCTIVE SLEEP APNEA SYNDROME Camera, A.2; Fanfulla, F.3; Chiovato, L.4; Nappi, R. E.1 University of Pavia, Research Centre f.Reproductive, Italy; 2Pavia, Italy; 3 Fondazione Maugeri, Pavia, Italy; 4University of Pavia, Italy

1

Objective: To assess sexual function in premenopausal morbid obese women evaluated for a suspect of obstructive sleep apnea syndrome (OSAS). Methods: We enrolled 35 women (age 41.4 ± 7.7 years; BMI 42.8 ± 5 kg/m², waist circumference 130.6 ± 10.3 cm) who were evaluated by means of Female Sexual Function Index (FSFI), Female Sexual Dis-

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Highlighted Poster Sessions tress Scale (FSDS), General Health Questionnaire (GHQ), Perceived Stress Scale (PSS), as well as hormonal and metabolic assessment. The presence of OSAS was assessed by a full standard polysomnography and by Epworth sleepiness scale (EPS). Results: The FSFI total score was 24.2 ± 11.1 with 10 women scoring <20 (Italian lower limit of normality), while FSDS was 15.5 ± 13.4 with 16 women scoring >15. Mean GHQ score was 4.3 ± 3.7 and PSS median score 21.3 ± 8.4, suggesting psychological distress. Mean LH, FSH, and estradiol values were in the normal range for the age. Twenty-two women meet the criteria for OSAS diagnosis and 15 showed excessive daytime sleepiness. A statistically significant difference between women with abnormal or normal FSDS score was found for Apnea-Hypopnea Index (AHI: 39.4 ± 38 vs. 18.8 ± 15, P = 0.03), GHQ (5.9 ± 3.5 vs. 2.9 ± 3.3, P < 0.01) and PSS (25.1 ± 8.4 vs. 18.1 ± 7, P < 0.01), respectively. Statistically significant correlations were found between AHI and FSDS (r = 0.48, P = 0.003), GHQ (r = 0.42, P = 0.01), and PSS score (0.39, P = 0.02) but not with FSFI score that was only correlated to BMI (r = 0.4, P = 0.01). Conclusion: We conclude that premenopausal morbid obese women with OSAS showed a high prevalence of sexual dysfunction. Sexual function seems to be related to obesity itself while the sexual distress to the severity of OSAS. Policy of full disclosure: None.

HP-03-005

THE IMPACT OF PARENTAL BONDING ON FSD IN WOMEN WITH TYPE 1 DIABETES: PRELIMINARY RESULTS FROM A PILOT STUDY Dimitropoulos, K.1; Bargiota, A.2; Mouzas, O.3; Tzortzis, V.1; Koukoulis, G.2 1 University Hospital of Larissa, Department of Urology, Greece; 2University Hospital of Larissa, Department of Endocrinology, Greece; 3University Hospital of Larissa, Department of Psychiatry, Greece Objective: It has been suggested that parenting behavior may have an impact on female sexuality. The aim of the study was to assess the role of parental bonding in the pathogenesis of FSD in a group of women with type 1 diabetes (T1DM). Methods: Thirty-six premenopausal women with uncomplicated T1DM and 36 age-matched healthy controls took part in a semistructured interview. The Parental Bonding Instrument (PBI) that assesses two dimensions of parenting behavior, care and overprotection, was used to evaluate the perception of being parented to the age of 16 years. The FSFI and the FSDS were used to assess sexual function and sexual distress respectively. According to the current definitions, FSD was the combination of impaired sexual function and sexual distress. Mann–Whitney test was used for between-groups comparisons. Results: Diabetic women had significantly higher maternal care scores (P = 0.000) and lower maternal overprotection scores (P = 0.006) comparing with the controls. However, no difference was found between the two groups in the paternal PBI scores (P > 0.05). Women with diabetes had significantly worse FSFI (P = 0.004) and FSDS scores (P = 0.022) compared with the healthy ones. According to the FSFI and FSDS results, diabetic women were divided into women with and without FSD (16.67% and 83.33%, respectively). No significant difference was found in the maternal and paternal PBI scores between the two groups (P > 0.05). Moreover, diabetic women with impaired sexual function but no sexual distress (11.11%) had no difference in the PBI scores comparing with the diabetics with FSD (16.67%) (P > 0.05). Conclusion: The study results indicate that parental bonding does not seem to have an impact on female sexuality in premenopausal, uncomplicated women with T1DM. Further research is required to confirm our results. Policy of full disclosure: None.

HP-03-006

WEIGHT LOSS IMPACT ON YOUNG ADULT ACTIVE FEMALE SEXUAL LIFE Stoian, D.; Craina, M.; Anastasiu, D. University of Medicine, Clinic Obstetrics-Gynecology I, Timisoara, Romania Objective: The present paper is trying to evaluate the impact of sustained and important weight loss on sexual function of young women, as compared with age-matched control group, without weight loss approach. Methods: Six hundred two overweight females, recruitment January 2010–February 2011, 575 were included in the study: 20–40 years; sexually active, involved in a stable relationship (out: 27 cases); compliance with the recommended lifestyle changes: restrictive diets three times weekly recommended exercise; compliance to administration of FSFI and BESAQ questionnaire; without DM (10 cases), RD (1 case), thyroid diseases (61 cases), PCOS (48 cases), Cushing syndrome (1 case). Followed up: 6 months with anamnesis, metabolic and sexual inventory at 0, 1, 3, and 6 months. Control group: from the initial 454 cases:—the noncompliant persons with the weight loss program (89 cases), at level 0 and 1,—apparent healthy overweight females. Results: Compliance to program: 80.4%/70.9%/66.29% at 1/3/6 months: mean weight loss 11.45 ± 4.7 kg. We observed an increase of self confidence—sexual initiative: mean 5.5 ± 2.7 attempts/month vs. 2.4 ± 0.2—total FSFI score: 20.15/23.4/24.2 vs. 19.5 control group, P < 0.002—desire: 4.3/4.4/4.5 vs. 4.25, P < 0.002—satisfaction: 3.9/4.2/4.55 vs. 3.8, P < 0.001—orgasm: 4.3/4.5/4.7 vs. 4.3, P < 0.002—a correlation betweenFSFI score change and absolute weight loss (kg) (0.76, P < 0.02) in the 301 cases with completed 6-month program. Pain disorders did not change significantly, intra- and intergroup. Conclusion: Weight loss has beneficial effect on sexual satisfaction, desire, orgasm but no effect on pain disorders. Policy of full disclosure: None.

HP-03-007

BODY IMAGE AND SEXUAL FUNCTION IN TURKISH WOMEN COMPARED TO TURKISH MEN: INTERNET SURVEY RESULTS Hattat, H.1; HATTAT, E.1; HATTAT, I.2 Hattat Uro-Andrology Hospital, Uro-Andrology, Istanbul, Turkey; 2Family Health Research Association, Istanbul, Turkey

1

Objective: Recent reports suggested that negative body image is related to lower sexual self-confidence, sexual avoidance, lower sexual efficacy, and lower sexual assertiveness. The aim of this study was to assess the effects of body image on the sexual lives of Turkish women compared to Turkish men. Methods: ESHA Turkey Office sent 2000 questionnaires to its Internet members between February 2011 and July 2011. 326 men (25–59 years old) and 412 women (32–56 years old) accepted to participate to the study. Main outcome measures were IIEF, FSFI, and Body Esteem Scale (Franzoi & Shields, 1984). Results: Sixty-one percent of men and 79% of women had moderate to extreme negative scores for physical and sexual attractiveness. Half of the men expressed extreme concerns on upper body strength whereas 80% of the women had extreme negative feelings about their weight. In terms of physical/sexual attractiveness subscale, 72% of men had worries about their sex organs whereas 52% of women had concerns about sex organs, sex activities and sex drive, 16% had concerns about breasts, 13% about facial structures. Out of 199 men with moderate to extremely negative physical attractiveness scores, 63% had moderate to severe intercourse dissatisfaction, 72% had moderate to severe overall dissatisfaction, 47% had moderate to severe erectile dysfunction. Out of 326 women with moderate to extremely negative sexual attractiveness scores, 67% had less than 3 points in the sexual desire domain of FSFI, 78% in the arousal domain, 58% in the orgasm domain, 63% in the satisfaction domain. Out of 330 women with moderate to extremely negative weight concern scores, 72% had less

J Sex Med 2011;8(suppl 5):384–405

392 than 3 points in the sexual desire domain of FSFI, 69% in the arousal domain, 63% in the orgasm domain, 74% in the satisfaction domain. Conclusion: Body image effects sexual satisfaction and sexual functions both in men and women. However, this effect is higher in the case of women where the weight concern is an additional determinant. Policy of full disclosure: None.

Highlighted Poster Sessions Friday, 2 December 2011 15.00–15.30 Exhibition Hall B Area 2 HP-04 Surgery and sexual dysfunction Chairs: W. Hellstrom S. Minhas, UK HP-04-001

HP-03-008

AGE GROUP ANALYSIS OF A RANDOMIZED, DOUBLE-BLIND, PHASE 3 STUDY OF FEMPROX®, A TOPICAL ALPROSTADIL CREAM WITH A NOVEL TRANSDERMAL DELIVERY TECHNOLOGY (NEXACT®) FOR THE TREATMENT OF FEMALE SEXUAL AROUSAL DISORDER (FSAD) Moncada, I.1; Fernando, Y.2; Goldstein, I.3; Damaj, B.4; Frank, D.5; Hachicha, M.5; Fernando, Y.5; Schupp, J.5 1 Jefe de Servicio Urologia, Madrid, Spain; 2San Diego, USA; 3San Diego Sexual Medicine, USA; 4Apricus Biosciences, San Diego, USA; 5NexMed USA, San Diego, USA Objective: FSAD is characterized by the inability to attain sexual arousal or to maintain arousal until the completion of a sexual activity leading to personal distress in adult women. There is no approved treatment available for this condition. Femprox®, a topical alprostadil cream formulated with an ester of N,N-dimethylalanine and dodecanol (DDAIP) is being developed for FSAD. Methods: A randomized, double-blind, placebo-controlled phase 3 trial was performed in pre- and postmenopausal women with FSAD as defined according to the AFUD Consensus Panel. Women received a total of 10 identical premeasured doses (i.e., five doses for each treatment period of 4 weeks with the same alprostadil dose) of either placebo (N = 97), 500 mcg (N = 91), 700 mcg (N = 91), or 900 mcg (N = 95) alprostadil cream during 8 weeks of active treatment after a 4-week nontreatment baseline period. The primary efficacy end point was the arousal success rate (yes responses to Question 3 of the Female Sexual Encounter Profile (FSEP)/number of the sexual encounters). Secondary end points included the Female Sexual Function Index (FSFI) and other validated assessments. Results: Mean age was 45 years (range 22–62 years). The primary efficacy end point was met for all dose groups tested. In the age group analysis the 900 mcg dose group showed a statistically significantly improved arousal success rate when compared to placebo in patients aged 45 and younger (50% vs. 23%; P < 0.002) as well as in the older age group (38% vs. 22%; P < 0.02). Total FSFI and domains including arousal and orgasm were highly statistically significant (P < 0.001) in the younger age subset. Topical alprostadil-DDAIP cream was well tolerated with no serious adverse events reported. Conclusion: These data provide further evidence of the efficacy and safety of topical alprostadil-DDAIP cream for the treatment of FSAD in pre- and postmenopausal women. Policy of full disclosure: None.

EFFECTIVE ANTIBIOTIC DIPS FOR THE COLOPLAST TITAN PENILE IMPLANT Rojas-Cruz, C.1; Wilson, S.2 Fundacio Puigvert, Barcelona, Spain; 2Indio, CA, USA

1

Objective: Infection is the worst complication seen with inflatable penile prosthesis (IPP). The Coloplast Titan IPP has a hydrophilic coating that absorbs an aqueous solution giving increased surface lubricity to decrease bacterial adherence. If antibiotics are added, surface absorption permits short-term elution of antibiotics after implantation. The ideal antibiotic dip would be inexpensive, available without mixing and effective against gram-positive skin organisms like Staphylococcus epidermidis and Staphylococcus lugdunensis that cause 75% of infections. Ideally, it also should have effectiveness against other more toxic bacteria that occasionally infect. We tested several antibiotic dips comparing zones of inhibition (ZOI) against five bacteria known to infect IPP. Results were compared to those ZOI created with strips of an AMS IPP pre coated with Rifampin/minocycline (InhibiZone). Methods: Pieces of sterile Coloplast Titan IPP were dipped in (i) Trimethoprim/polymixin B ophthalmic solution (Polytrim); (ii) Trimethoprim/sulfmethoxazole (Bactrim) infusion vial diluted 1:1 with saline; (iii) Bacitracin; (iv) Rifampin/minocycline; (v) Rifampin/ Bactrim. ZOI for the Titan strips and for strips of AMS InhibiZone coated device were tested against S. epidermidis, S. lugdunensis, Staphylococcus aureus, pseudomonas and enterococcus. Results: All dips except Bacitracin showed ZOI ≥ InhibiZone (P ≥ 0.005) for most organisms. Because of broad-spectrum effectiveness, ease of handling, and cost, 1:1 dilution of IV Bactrim with saline seemed ideal. 30 cc undiluted Polytrim ophthalmic solution was as easy to use and almost as effective. Conclusion: The Coloplast IPP strips when dipped in several solutions showed equal or significantly larger ZOI against commonly infecting organisms than AMS InhibiZone coated device. We believe Bactrim diluted with a small amount of saline give the easiest to prepare and most effective dip for the Coloplast IPP. Policy of full disclosure: Study funded by Coloplast. S. Wilson is an investigator for Coloplast and consultant for AMS and Coloplast. C. Rojas-Cruz is an investigator for Coloplast and consultant for AMS and Coloplast.

HP-04-002

CLINICAL RESULT OF VENOUS LIGATION SURGERY IN ERECTILE DYSFUNTION PATIENT Kim, J. Y. Pilip & Paul Medical Institut, Urology, Jeongjadong, Boondanggu, Korea Objective: According to the American Urological Association clinical guidelines panel penile venous surgery is not justified for routine use. However, in most nonsurgical cases these treatment modalities are insufficient to produce adequate erection. Although penile venous surgery has almost been abandoned and the venous factor eliminated as a contributing factor to erectile dysfunction, new concepts of erection related veins has recently been described and reported in literature. We are to report clinical result of venous ligation surgery. Methods: They were evaluated using the International Index of Erectile Function (IIEF-F) scoring system. In the dorsal area of penis, 1–2 cm from the subglans was incised at a length of 3–5 cm in a transverse direction with depth sufficient to expose the Buck’s fascia and was then bluntly dissected up to the prepubic area. The incised

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Highlighted Poster Sessions area was widened with a retractor, so that the prepubic area could be seen. We ligated deep deep dorsal vein, cavernosal veins and paraarterial veins. Results: Retrospective investigation was done for this study with 13 cases from January 2007 to September 2010. Median patient age at surgery was 45.2 years (range 22–54) and mean follow-up was 13 months (range 2–39). Preoperation average IIEF-5 score was 11 and postoperation average IIEF-5 score was 17. One case of infection was reported. Conclusion: Though the patients group was small in number, this venous drainage reduction surgery as the modified venous ligation surgery appears to deliver reasonable positive results with low morbidity. Patients showed improvement of IIEF-5 score by this surgery. The results obtained in this limited number of patients are promising and justify trials in larger groups. Policy of full disclosure: None.

HP-04-003

PATIENT SATISFACTION AND COMPLICATIONS WITH THE TITAN® ONE TOUCH RELEASE (OTR) PENIS PROSTHESIS Lindeborg, L.1; Fode, M.2; Fahrenkrug, L.2; Sønksen, J.2 Roskilde Hospital, Denmark; 2Herlev Hospital, Denmark

1

Objective: In recent years significant improvements in design and antibacterial measures of penile prosthesis have reduced the incidence of complications and patient satisfaction is reported to be high. The purpose of this study is to assess complication rates and patient satisfaction with the Coloplast Titan® OTR inflatable penile prosthesis. Methods: Thirty-three patients (median age 61 years, range 32–71 years) with organic erectile dysfunction underwent implantation from November 2008 to April 2011. All patients had failed previous treatment with oral as well as injection therapy. Patient satisfaction was assessed by the “Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) Questionnaire” and complications were assessed by a retrospective chart review. Results: At follow-up, one patient had died from unrelated causes and updated contact information could not be found for one patient. One prosthesis had been removed due to infection and two patients had undergone revision surgery due to autoinflation and problems with deflation respectively. Further significant complications (Clavien score > 2) included sustained scrotal pain in one patient and the development of a scrotal hernia in another. Thirty EDITS questionnaires were administered and 26 (87%) were completed. Notably 22 patients (85%) reported to be either “very satisfied or “somewhat satisfied” with the prosthesis and only 2 patient were dissatisfied. Twenty four patients (92%) would recommend a penile prosthesis to someone with a similar medical condition. Conclusion: Patient satisfaction with the Titan® OTR inflatable penile prosthesis was high in our series and the complication rate was acceptable. It is however important to inform patients about potential problems such as infection and mechanical failure. Overall the Titan® prosthesis is a good option in the management of erectile dysfunction when other treatments have failed. Policy of full disclosure: J. Sønksen is a consultant for Coloplast.

HP-04-004

THE STATUS OF SEXUAL FUNCTION IN PATIENTS WITH PEYRONIE’S DISEASE

the largest number suffers from decreased libido: 134 patients (16.4%) and erectile dysfunction—121 patients (14.2%) of 815 patients. It was connected with the fact that some patients had been in the involutional period of sexual activity. After the onset of PD the picture had changed. Just 137 patients (16.81%) still had normal sexual function. Impaired sexual function (678 patients [83.19%]) included difficulty or inability of the coitus as a result of erectile deformation and/or pain in 58 men (7.12%), erectile dysfunction and pain during erection in 693 patients (85.03%), abnormal ejaculation in 77 men (9.45%) and impairment of libido in 149 men (18.28%). Conclusion: Number of patients with impaired sexual function increased significantly owing to those patients whose sexual intercourse was difficult or impossible because of erectile deformation and/ or weak erections. Decreased libido in patients with PD can be explained as a consequence of the termination of sexual activity or reducing its intensity. The changes of ejaculation and orgasm are usually caused by psychological problems or chronic inflammation in the genitourinary system and are not correlated with the PD. Policy of full disclosure: None.

HP-04-005

DURATION OF DISEASE HAS SIGNIFICANT IMPACT ON ED OCCURRENCE IN PATIENTS WITH INDURATIO PENIS PLASTICA Nale, D.1; Bojanic, N.2; Nikic, P.2; Tulic, C.2 Clinical Center of Serbia, Urology Clinic, Belgrade, Serbia; 2Clinic of urology, intensive care, Belgrade, Serbia

1

Objective: Sexual and erectile function can be affected by psychogenic and/or organic basis, or secondary factors due to the presence of plaque in t. albuginea, influencing the erectile physiology. The aim was to estimate the incidence of sexual and erectile dysfunction in patients with induratio penis plastica (I.P.P.), during inflammatory and degenerative stage of disease, and relation to organic erectile dysfunction (ED). Methods: We have investigated 250 pts with I.P.P. Mean age 50.7 ± 11.3 (range 19–72). Diagnostic criterion for I.P.P. was evidence of palpabile plaque on penis. Anamnestic protocol was comprised of structured questions investigating disease onset, penile pain, penetration and sexual issues. Clinical assessment included number, size and location of plaque and angle of penile curvature. Results: Out of 250 patients with I.P.P., sexual dysfunction was found in 95 (38%) during inflammatory stage of disease, with ED in 78 (31,2%) among them. In degenerative (surgical) stage of disease, 114 (45.6%) patients were found with sexual dysfunction, with significantly higher rate of ED observed between them (´² = 3.72; DF = 2; P < 0.05). In inflammatory stage of disease, significantly higher occurrence of sexual dysfunction due to the presence of penile pain was found (´² = 11.1; DF = 1; P < 0.01). No significant difference was found comparing two groups of patients with different stage of disease with sexual dysfunction due to impossible vaginal penetration (´² = 2.6; DF = 1; P > 0.05). Conclusion: There is a significant relation between I.P.P. and organic ED (41.6% pts). Duration of disease has significant impact on ED occurrence in patients with I.P.P. which implicates that I.P.P. is rather initiation feature than result (sequel) of ED. Duration of I.P.P. does not affect significantly improvement or deterioration of penile curvature (deformation) and consecutive sexual dysfunction development. Policy of full disclosure: None.

Gorpynchenko, I.; Gurzhenko, Y.; Maksym, R. Institute of Urology, Department of Sexology and Andrology, Kiev, Ukraine Objective: An important clinical characteristic is the study of male sexual function. To clarify the role of Peyronie’s disease (PD) as a factor that leads to possible impairments of sexual function, we have included comparison of clinical characteristics before and after the onset of PD in 815 patients. Results: In this study, 512 patients (62.8%) had normal sexual function before the onset of PD. Among patients with impaired sexual function,

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394 HP-04-006

SEXUAL OUTCOMES AFTER ORGAN POTENCY-SPARING SURGERY AND GLANS RECONSTRUCTION IN PATIENTS WITH PENILE CARCINOMA Gulino, G.; Sasso, F.; Palermo, G.; Pinto, F.; D´Onofrio, A.; Sacco, E.; Racioppi, M.; Bassi, P. Catholic University, Urology, Roma, Italy Objective: Radical surgery like penile amputation is still considered the “gold standard” for treatment of invasive penile carcinoma T2-T3. However, despite good local control of disease, have been reported very poor anatomical, aesthetic, functional and psychological outcomes. The purpose of this study was to assess the impact of organ potency-sparing surgery in patients with locally confined carcinoma of the penis. Methods: We evaluated retrospectively 42 patients (mean age 56) with penile cancer clinically confined, treated with diathermocoagulation in six cases with superficial lesions, glandulectomy and glanduloplasty with urethral mucosa and sparing of cavernosal apexes in 25 cases, glandulectomy and limited apical resection in 11 cases of stage T2. Sexual function, were evaluated with IIEF-15 questionnaire related to the period preceding the macroscopic evidence of malignancy and 6 months after surgery. Quality of life was assessed by Bigelow-Young questionnaire. The scores related to the period of macroscopic evidence of the tumor have been compared to those obtained 6 months after surgery. Results: Six months after surgery, 73% of patients reported spontaneous rigid erections, 60% coital activity while 76% of the group treated with glans reconstruction (urethral glanduloplasty) reported normal ejaculation and orgasm, regained an average of 35 days after surgery. The average IIEF-15 scores of the pre-cancer period were not statistically different (P > 0.05) than those recorded 6 months after surgery. In the group treated with glandular reconstruction, pre- and postoperative IIEF-15 mean scores related to ejaculation and orgasm domains were not significantly different. Mean scores of Bigelow and Young questionnaires showed significant (P < 0.01) improvement after surgery. Conclusion: The sexual-sparing surgical treatments have a positive impact on a wide spectrum of patient’s life. These treatments allow to obtain both oncological radicality and anatomo-psychological integrity, to preserve the body image and to restore some complex such as erection and ejaculation. Policy of full disclosure: None.

HP-04-007

TOTAL PHALLOPLASTY COMBINED WITH METOIDIOPLASTY AS A ONE-STAGE PROCEDURE IN FEMALE TRANSSEXUALS: IS IT POSSIBLE? Djordjevic, M.; Stanojevic, D.; Kojovic, V.; Bizic, M.; Majstorovic, M. School of Medicine, Belgrade, Urology, Serbia Objective: Metoidioplasty presents creation of small phallus from hormonally enlarged clitoris, without possibility for sexual intercourse. Total phalloplasty includes creation of neophallus from an extragenital tissue, large enough to enable insertion of penile prosthesis and penetration during sexual intercourse.Usually, phalloplasty is performed as a procedure after metoidioplasty due to complexity of procedure. We evaluated advantages of combined phalloplasty and metoidioplasty as one stage procedure. Methods: Between May 2007 and March 2011, 23 female transsexuals, aged 20–53 years (mean 29 years) underwent one stage phalloplasty combined with metoidioplasty. Surgery included: removal of internal/ external female genitalia, creation of neophallus using microvascular latissimus dorsi free flap, clitoral lengthening and incorporation into the neophallus, urethral lengthening as well as insertion of testicle prosthesis into the scrotum created from joined labia majora. Results: Follow-up was from 6 to 52 months (mean 22 months). Mean duration of surgery was 612 minutes (ranged from 492 to 769 minutes).

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Highlighted Poster Sessions The length of neophallus was ranged from 13 to 17 cm. There was no partial or total necrosis of the phallus. Urethral fistula occured in two and stricture in three cases and were repaired 3–6 months postoperatively. In 17 cases, penile prostheses (10 maleable and 7 inflatible) were inserted during the first year after phalloplasty. Conclusion: Combined metoidioplasty and total phalloplasty is feasible and safe surgical procedure. The main advantage is complete reconstruction of neophallus that avoids multistaged gender reassignment surgery in female transsexuals. Our preliminary results confirmed successful outcome. Policy of full disclosure: None.

HP-04-008

MINIMALLY INVASIVE SURGERY FOR PENILE AUGMENTATION USING TYPE I COLLAGEN Yun, T. K.1; Jeon, H. S.1; Sohn, D. W.2 Manomedi Urologic Clinic, Urology, Seoul, Korea; 2The Catholic University, Urology, Seoul, Korea 1

Objective: Many penile augmentation has been performed with various materials and methods. Fat injection for penile augmentation has complications like contour irregularities, fat migration and absorption. Recently, type I collagen implant has been used and the safety has been improved with surgical technique development. The aim of this study is to report clinical safety and surgical techniques in complex phalloplasty using type I collagen. Methods: Type I collagen derived from bovine pericardium (Lyoplant®) was used for phalloplasty. It has micro porous fibrous structure for rapid and regular ingrowth of autologous connective tissue. We operated penile augmentation in 286 patients with type I collagen. In the penile dorsal area, 1∼2 cm from the subglans was incised at a length of 3–5 cm and was dissected from glans to the prepubic junction. Then, a fundiform ligament was incised for lengthening. Implant was designed according to the size of the penis and we incised multiple horizontal and vertical slits in collagen tissue using knife for improving of graft survival. Thereafter, enhancement tissue was placed between the dartos fascia and Buck’s fascia. The dartos fascis and skin were closed by two layers and whole body of penis except glans was wrapped up by elasctic bandage evenly. To reduce nocturnal erectile pain and discomfort, we prescribed oral ketoconazole which can reduce nocturnal erection. Results: The mean operation time was about 40 minutes and most patients had sexual intercourse successfully after 1 month. The average augmented effect in circumference was 34% and mean penile length gain (flaccid penis) was 2.3 cm. Complications like graft failure was occurred in three patients (1%) and the graft was removed partially or entirely. Other complications like inflammation or wound dehiscence were treated through conservative treatment. Conclusion: This complex phalloplasty using type I collagen implant with minimal incision showed positive results in safety and effectiveness. In our experience, this technique may be a good choice in penile augmentation surgery in the future. Policy of full disclosure: None.

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Highlighted Poster Sessions Saturday, 3 December 2011 11.00–11.30 Exhibition Hall B Area 1 HP-05 Male sexual health Chairs: K. Hatzimouratidis, Greece A. Shechter, Israel HP-05-001

THE GAY MEN SEX STUDIES: ERECTILE DYSFUNCTION AMONG BELGIAN GAY MEN Vansintejan, J.; Devroey, D.; Vandevoorde, J. Vrije Universiteit Brussel, Family Medicine, Brussels, Belgium Objective: To determine the prevalence of erectile dysfunction (ED) in a sample of the Belgian men who have sex with men (MSM) population, and to assess the relevance of major predictors such as age, relationship and education. Finally, we investigated the use of PDE5 inhibitors among Belgian MSM. Methods: An Internet-based survey on sexual behavior and sexual dysfunctions, called GAy MEn Sex StudieS (GAMESSS), was administered to MSM, aged 18 years or older, between the months of April and December 2008. The questionnaire used was a compilation of the Kinsey scale for sexual orientation, Erection Quality Scale (EQS) and the shortened version of the International Index of Erectile Function (IIEF-5). The analytic sample comprised 1,752 Belgian MSM aged 18 years or older. Results: Of the 1,752 participants, 45% indicated having some problems getting an erection. In these group of MSM, 71% reported mild ED; 22% reported mild to moderate ED; 6% reported moderate ED and 2% had severe ED. Independent predictors for the presence of ED were: age (OR = 1.04, 95% CI 1.03–1.05, P < 0.0001), having a stable relationship (OR = 0.59, 95% CI 0.48–0.73, P < 0.0001), frequency of sex with their partner (OR = 1.22, 95% CI 1.12–1.32, P < 0.0001), and a more passive sex role (OR = 3.12, 95% CI 1.89–5.16, P < 0.0001). Only 10% of the Belgian MSM used a PDE5 inhibitor (mean age 43 years ± 11 SD) and 83% of them was satisfied with the effects. Remarkable is the amount of street drugs used by MSM to improve ED. Conclusion: Forty-five percent of participating Belgian MSM reported some degree of ED. ED may have a negative impact on the self image and can cause frustration and anxiety for future sexual relationships. Keywords: Homosexuality, Internet, sexual behavior, erectile dysfunction. Policy of full disclosure: None.

HP-05-002

PERCEIVED REDUCED SLEEP-RELATED ERECTIONS IN SUBJECTS WITH ERECTILE DYSFUNCTION: PSYCHOBIOLOGICAL CORRELATES Corona, G.1; Rastrelli, G.1; Balercia, G.2; Forti, G.3; mannucci, E.4; Maggi, M.1 1 Sexual Medicine and Andrology, University of Florence, Italy; 2Endocrinology Unit, University of Marche, Ancona, Italy; 3Endocrinology Unit, University of Florence, Italy; 4Geriatric Unit, University of Florence, Italy Objective: Perceived reduced sleep-related erections (PR-SREs), along with erectile dysfunction (ED) and hypoactive sexual desire, have been recently recognized as the most important symptoms characterizing late-onset hypogonadism in community-dwelling European men. However, the clinical correlates of PR-SREs have not been thoroughly investigated. The aim of this study is to evaluate the psychobiological correlates of PR-SREs in a large series of subjects consulting for ED. Methods: A consecutive series of 3,888 (mean age 51.6 ± 13.0 years) ED patients attending an Outpatient ED clinic was retrospectively analyzed.PR-SREs were investigated using validated question #13 of SIEDY structured interview, which showed an accuracy of about 70% in predicting RigiscanTM parameters in a consecutive subset of 199 subjects. Clinical, biochemical, hormonal, instrumental (penile color Doppler ultrasound; PCDU) and intrapsychic (MHQ-questionnaire) correlates were also evaluated. Results: 63.6% of patients reported PR-SREs. After adjustment for age, total, analog free, calculated free and calculated bioavailable testosterone (T) were significantly lower in subjects reporting more severe PR-SREs. After adjusting for T levels and other confounders, PR-SREs were still associated with higher BMI, glucose and triglyceride levels, as well as with an increased 10 year-cardiovascular risk score. Accordingly, PR-SREs were more prevalent in subjects showing a reduced dynamic peak systolic velocity at PCDU or reporting severe ED. Among intrapsychic parameters, depressive and histrionic traits were significantly higher and lower, respectively, in subjects with any degree of PR-SREs. Conclusion: Our study indicates that investigating PR-SREs represents an important step during the andrological consultation. In fact, reduced SREs might indicate an endocrine, organic and/or psychiatric ED background that might help in directing further investigation. Policy of full disclosure: None.

HP-05-003

ANDROGEN DEFICIENCY: A CRITICAL DETERMINANT OF AORTIC STIFFNESS IN MEN WITH ERECTILE DYSFUNCTION Ioakeimidis, N.; Vlachopoulos, C.; Samentzas, A.; Terentes-Printzios, D.; Xaplanteris, P.; Rokkas, K.; Fassoulakis, C.; Askitis, T.; Rempelakos, A.; Stefanadis, C. Athens Medical School, 1st Department of Cardiology, Greece Objective: Low total testosterone (TT) and increased aortic stiffness are predictive markers for those at high risk of CV disease. The influence of low TT on the age/aortic stiffness relationship in men with erectile dysfunction (ED) is unknown. Methods: TT was measured in 382 ED patients with no evidence of clinical atherosclerosis. Carotid-femoral Pulse Wave Velocity (PWVcf) was measured as an index of aortic stiffness. Results: In univariate analysis, TT concentration was associated with PWVc-f (r = −0.435, P < 0.001). The fit with an exponential equation provides better values of R2 than linear fit by 6%. Figure 1 shows the exponential increase in PWVc-f with decreasing TT. The inverse correlation between PWVc-f and TT remained significant in multivariate analysis (β = −0.170, P < 0.001). Subjects were then categorized by age decade and further subdivided according to presence/absence of hypogonadism (HypG), (TT < 3.4 ng/mL). PWVc-f values of each age/ testosterone category after adjustment for confounders are shown in Figure 2. In the first two age categories, patients with HypG had

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396 significantly higher adjusted PWVc-f (by 0.80 m/s, P < 0.01 and 0.45 m/s, P < 0.05, respectively) compared to subjects with TT above the cut off level for biochemical definition of HypG. However, in older age categories, PWVc-f between hypG patients and men with normal TT did not differ. It can be noted also that young HypG men (<50 years and 50–59 years old) had already elevated PWVc-f compared to older men (50–59 and 60–69 years old, respectively) with normal TT. Conclusion: TT is independently associated with aortic stiffening. The effect of low TT on aortic elastic properties is emphasized in young men. This finding underlines the important role of testosterone as a marker of arterial damage, and imply a contribution of this compound to the pathophysiology of CV disease. Policy of full disclosure: None.

Highlighted Poster Sessions Policy of full disclosure: Primary author, Dr. L. Belkoff, has no conflict of interest. Co-author and submitter, K. DiDonato, is an employee of VIVUS.

HP-05-005

THE REAL-LIFE PERCEPTION OF EFFICACY, ATTITUDE, SATISFACTION, AND SAFETY OF VARDENAFIL THERAPY (REPEAT): A PROSPECTIVE, INTERNATIONAL, MULTICENTER, NON-INTERVENTIONAL STUDY Hartmann, U.1; Hanisch, J. U.2; Mattern, A.3 Hannover Medical School, Clinical Psychology, Germany; 2Bayer Vital GmbH, Leverkusen, Germany; 3Bayer Pharma AG, Berlin, Germany

1

HP-05-004

AN OPEN-LABEL, LONG-TERM EVALUATION OF THE SAFETY AND TOLERABILITY OF AVANAFIL IN MEN WITH ERECTILE DYSFUNCTION Belkoff, L.1; McCullough, A.2; Goldstein, I.3; Didonato, K.4; Trask, B.5; Bowden, C.5 1 Urologic Consultants of SE PA, Bala Cynwyd, USA; 2Albany Medical Center, USA; 3Alvarado Hospital, San Diego, USA; 4Redwood City, USA; 5 VIVUS Inc., Mountain View, USA Objective: Avanafil is a rapidly absorbed, highly specific PDE5 inhibitor under investigation for the treatment of erectile dysfunction (ED). The objective of this phase 3 study was to evaluate the long-term safety and tolerability of avanafil in men with ED. Methods: Seven hundred twelve men with mild to severe ED (mean age 56) were enrolled across 40 U.S. centers. A key inclusion criterion was successful completion of a qualifying randomized study (TA-301 or TA-302). All subjects were initially assigned to treatment with avanafil 100 mg. Subjects could undergo dose reduction to 50 mg for improved tolerability or a dose increase to 200 mg for increased efficacy. Sexual function was assessed at baseline and all follow-up exams using patient diaries and the IIEF). Primary efficacy end points included vaginal penetration (SEP 2), successful intercourse (SEP 3), and the IIEF EF-Domain score. Results: Four hundred ninety-three subjects completed at least 26 weeks on active treatment and 153 subjects completed 52 weeks or more. The majority of subjects (75%) escalated their dose to 200 mg. Sixty-seven percent of sexual attempts across all doses resulted in successful intercourse, and the overall mean IIEF-EF domain score during treatment was 22.6, an improvement of more than 10 points from baseline. The most frequently reported adverse events were headache, flushing, and nasopharyngitis. There were no drug-related SAEs, no deaths, no reports of hearing loss or priapism, and only one subject reported experiencing cyanopsia, which was mild in severity. Eighty-four percent of study-wide sexual attempts were made within 60 minutes of dosing, with successful intercourse reported as early as 15 minutes and in some subjects, beyond 6 hours. Conclusion: Avanafil was studied without restriction on food, alcohol or alpha-blockers and was found to be well tolerated and effective for treatment of erectile dysfunction. Results suggest a rapid onset of action and sustained duration of effect.

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Objective: To assess the safety, effectiveness and patient acceptance of vardenafil therapy under daily life conditions in men aged ≥18 years with erectile dysfunction, and to investigate the change in relationship quality over the course of treatment. Methods: REPEAT was a prospective, non-interventional, post-marketing surveillance study of vardenafil patients. It was conducted in 1,433 centers across 21 countries in Asia, Europe, and South Africa, and comprised an initial patient visit and 1–4 follow-up visits during an observation period of up to 12 months. Data were acquired by physician interviews and questionnaires, and recorded in case report forms. Outcome variables included patient satisfaction with vardenafil treatment, and improvement in relationship quality, as independently assessed by patients and optionally, their partners (using the “Partnerschaftsfragebogen” [PFB]). All adverse events were reported. Results: Of the 7,496 patients enrolled in the study, 7,430 and 6,470 were included in the safety and effectiveness analyses, respectively. In total, 94.6% of patients reported being “very satisfied” or “satisfied” with overall treatment effectiveness. At last documented visit, 84.6% of patients reported that they would continue use of vardenafil. Relationship quality at last visit was improved compared with initial visit, in both patients (mean PFB score 56.3 ± 12.7 vs. 51.1 ± 13.3) and partners (mean PFB score 57.1 ± 12.8 vs. 51.5 ± 13.1). The most frequently reported adverse events were headache, flushing and nasal congestion, consistent with the known safety profile of phosphodiesterase type 5 inhibitors. Conclusion: These results confirm the established effectiveness and safety profile of vardenafil under real-life conditions. In addition, an improvement in mean relationship quality over the course of vardenafil therapy was noted, demonstrating the benefits conferred by vardenafil treatment on both members of the couple, and mirroring the improvement seen in sexual quality of life, for both patients and their female partners, in other vardenafil clinical trials. Policy of full disclosure: U. Hartmann has been a clinical trial investigator for Bayer Pharma AG, and a consultant to Astellas, Boehringer Ingelheim, Eli Lilly and Company, Pfizer, and Procter & Gamble. J. Hanisch and A. Mattern are employed by Bayer Vital GmbH and Bayer Pharma AG, respectively. Editorial support in developing this abstract was provided by Sarah Stowell, PhD and James Reed, PhD of Fishawack Communications Ltd, and funded by Bayer Pharma AG.

HP-05-006

BASELINE FACTORS ASSOCIATED WITH INCOMPLETE RESPONSE TO TADALAFIL ON-DEMAND: ANALYSIS OF POOLED DATA FROM 17 RANDOMIZED CLINICAL STUDIES Seftel, A.1; Ni, X.2; McKay, L.2 Cooper University Hospital, Surgery/Urology, Camden, USA; 2Eli Lilly and Company, Lilly Research Laboratories, Indianapolis, IN, USA

1

Objective: To identify baseline factors associated with incomplete response (IIEF-EF < 26, Porst et al. J Sex Med 2010;7:414–444) to tadalafil.

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Highlighted Poster Sessions Methods: Data were pooled from 17 double-blind, placebo-controlled, parallel-group clinical trials of men with ED ≥3 months randomized to tadalafil or placebo for 12 weeks. The current analysis assessed only men receiving tadalafil 10 mg (N = 512) or 20 mg (N = 1,767). Last-observation-carried-forward was used to analyze end point data. Baseline characteristics were compared using anova or Cochran– Mantel–Haenszel tests adjusting for tadalafil dose. Dichotomized baseline risk factors were assessed using the Mantel–Haenszel odds ratio (OR) and CMH test statistic. Multivariate logistic regression modeling used significant baseline factors as explanatory variables. Results: Incomplete response (IIEF-EF < 26) was seen with tadalafil 10 and 20 mg for 298/512 (58.2%) and 787/1767 (44.5%) of patients, respectively. For incomplete responders, mean baseline IIEF-EF Domain score was 12.8 vs. 16.1 for complete responders; scores at end point were 17.0 and 28.5 for incomplete and complete responders, respectively. In univariate analysis, factors associated with incomplete response included insulin use, cerebrovascular disease, more severe ED, diabetes, Asian origin, tadalafil dose, age > 65 years, alcohol use, ED of organic etiology, CYP3a4 inhibitor use, or hypertension (all P < 0.05). In multivariate analysis, significant associations with incomplete response (P < 0.05) were seen for severe ED (OR 2.8), moderate ED (OR 2.1), tadalafil 10 (vs. 20) mg dose (OR 1.8), insulin use (OR 1.6), diabetes (OR 1.4), and age >65 (OR 1.4). Conclusion: Incomplete response to tadalafil on-demand treatment is an important consideration when treating men with ED. Some of the most significant risk factors for incomplete response were more severe ED at baseline, insulin use, diabetes, and age >65 years. Policy of full disclosure: Dr. A. Seftel serves as a consultant to Eli Lilly and Company. X. Ni and L. McKay are full-time employees of Eli Lilly and Company.

change score ± SEM) vs. 3.0 ± 1.4, P = 0.0322. Similar improvements were observed in penile endothelial function, expressed by FMD maximum (FMD): mean change 8.2 mL/minute/dL for the treatment group vs. −0.1 mL/minute/dL for the sham group, P < 0.0001. Combining the objective and subjective parameters, we found that 22 patients in the treatment group (56%) showed significant improvement in both IIEF and FMD whereas only 1 patient in the sham group (5%) showed an improvement in both. Importantly, the treatment group experienced a greater increase in the IIEF Overall Satisfaction category, 1.9 ± 0.5, vs. sham, 0.1 ± 0.4, P = 0.0054. None of the patients experienced adverse effects from the treatment. Conclusion: This is the first randomized, double-blind, placebocontrolled study demonstrating that ESWT has a positive physiologic effect on cavernosal hemodynamics. As such, ESWT represents a new, effective, and well tolerated treatment for men with erectile dysfunction who previously responded to pharmacotherapy. Policy of full disclosure: E. Sprecher is a consultant for Medispec Ltd. Medispec Ltd. Israel provided a partial unrestricted grant including use of the electrohydraulic unit (Omnispec ED1000).

HP-05-007

Objective: The incidence of erectile dysfunction (ED) increases with age, however ED in young men is a powerful predictor of coronary artery disease (CAD). Aim of this study was to examine the profile of young asymptomatic men with ED. Methods: One hundred twenty-nine consecutive asymptomatic men <50 years of age with ED were comprehensively evaluated using medical history and exercise treadmill test (ETT). Patients who had positive ETT were referred for coronary arteriography in order to document CAD. Aortic stiffness was evaluated with carotid femoral pulse wave velocity (PWVc-f) and wave reflections with augmentation index (AIx) and augmented pressure (AP) of the aortic pressure waveform. Results: A considerable proportion (16/129 or 12.4%) of men had angiographically documented CAD. CAD patients compared to men without CAD had a higher prevalence of smoking (75 vs. 48%, P < 0.05) whereas the prevalence of hypertension, dyslipidemia and diabetes was similar between the two groups. Furthermore, CAD patients had significantly higher PWVc-f (9.1 vs. 7.9 m/s), AIx (26.4 vs. 21.7%) and AP (11.5 vs. 8.4 mm Hg) compared to patients without CAD (all P < 0.05). Interestingly, men who smoke more than 40 pack-years of cigarettes had significantly higher PWVc-f, AIx and AP values compared to men who smoke less than 40 pack-years and never smokers (see figure below). Conclusion: Cigarette smoking is an important modifiable cardiovascular risk factor for occult CAD in ED patients <50 years of age and pathophysiological mechanisms may include a stiff vascular tree and enhanced wave reflections. Policy of full disclosure: None.

LOW-INTENSITY EXTRACORPOREAL SHOCK WAVE THERAPY FOR ERECTILE DYSFUNCTION IN PHOSPHODIESTERASE TYPE 5 INHIBITOR RESPONDERS: A RANDOMIZED, DOUBLE-BLIND, PLACEBOCONTROLLED STUDY Massarwi, O.; Vardi, Y.; Appel, B.; Gerber, E.; Sprecher, E.; Kilchevsky, A.; Gruenwald, I. Rambam Healthcare Campus, Neurourology, Haifa, Israel Objective: To evaluate the impact of Low Intensity Extracorporeal Shockwave Therapy (ESWT) on men with ED in a prospective randomized controlled trial. Methods: We enrolled 60 men with vasculogenic ED who were responders to PDE5is. Their mean baseline International Index of Erectile Function ED domain score (IIEF-ED) was 12.2 after a 1-month PDE5i washout period. The men were then randomized to 12 sessions of ESWT or sham treatment. ESWT was applied to the penile shaft and crura at five sites. Assessment of erectile function was performed prior to the first treatment (V1) and 1 month after the final treatment (FU1) using validated sexual function questionnaires and flow-mediated dilatation (FMD) testing. Results: The ESWT group (treatment) evidenced a greater increase in IIEF-ED from V1 to FU1 vs. the sham group: 6.7 ± 0.9 (mean

HP-05-008

DETERMINANTS OF INCREASED CARDIOVASCULAR RISK IN MEN <60;50 YEARS OF AGE WITH ERECTILE DYSFUNCTION Aggelis, A.; Vlachopoulos, C.; Ioakeimidis, N.; Terentes-Printzios, D.; Synodinos, A.; Rokkas, K.; Askitis, T.; Stefanadis, C. Athens Medical School, 1st Department of Cardiology, Greece

J Sex Med 2011;8(suppl 5):384–405

398 Saturday, 3 December 2011 11.00–11.30 Exhibition Hall B Area 2 HP-06 Men’s sexual health and ejaculatory disorders Chairs: J. Sonksen, Denmark B. Giammusso, Italy HP-06-001

EJACULATORY DUCT OBSTRUCTION, AN IMPORTANT CAUSE OF EJACULATORY DISORDERS Raheem, A.1; Zacharakis, E.1; De Luca, F.1; Walkden, M.2; Allen, C.2; Ralph, D.1 1 University College London Hospital, Urology, UK; 2University College London Hospital, Radiology, UK Objective: Ejaculatory duct obstruction (EDO) is a recognized and correctable cause of male infertility. However, EDO is also associated with ejaculatory dysfunction that may be the presenting symptom. This study looks in the prevalence of ejaculatory disorders in patients with EDO. Methods: Evaluation of the ejaculatory disorders in 23 male patients with EDO diagnosed by trans-rectal ultrasonography (TRUS) and confirmed by TRUS guided seminal vesicle aspiration and seminal vesiculography. Results: Out of the 23 patients with confirmed EDO, 11 (48%) had disorders of ejaculation. The presenting symptoms included: painful ejaculation in 7 patients (30%), low volume ejaculate in 5 (22%), weak force of ejaculation in 3 (13%), watery ejaculate in 1 (4%), and hemospermia in 1 patient (4%). Eight of the 11 patients with ejaculatory dysfunction (73%) had more than one ejaculatory symptom. Ejaculatory dysfunction was the reason for referral in 5 patients (45%), while the other 6 (55%) were mainly referred for infertility, however, these patients also complained of ejaculatory symptoms. Conclusion: Ejaculatory disorders are common in patients with EDO. Thus patients with ejaculatory symptoms should be investigated for the presence of EDO which is a correctable condition. Policy of full disclosure: None.

HP-06-002

THERAPY FOR PULMONARY TUBERCULOSIS AS A REASON FOR EJACULATORY DISORDERS Kulchavenya, E.1; Medvedev, S.2 Novosibirsk, Russia; 2Research TB Institute, Novosibirsk, Russia

1

Objective: The sexual life is an integral part full and happy life. Patient with pulmonary tuberculosis (TB) suffers from his disease itself as well as from different complications. It is known that 42–67.3% of patients with diabetes and high blood pressure have sexual dysfunction. In Siberia there is an epidemic of tuberculosis, and the majority of TB patients are young men for whom sexual viability is very important. The aim was to estimate the frequency of ejaculatory disorders in men suffering from tuberculosis and to determine the effect of TB treatment on the ejaculation. Methods: Ninety-eight pulmonary TB patients were enrolled in study. The intravaginal latency time before onset of TB was estimated retrospectively and in 3 months of anti-TB therapy. Results: Before anti-TB therapy 14.3% of pulmonary TB patients had ejaculatory disorders: 10.2% had premature ejaculation, and 4.1% delayed ejaculation. The rest 85.7% of patients had normal ejaculation. After 3 months of the therapy with 4 anti-TB drugs (isonazid, rifampicin, pyrazinamid, and streptomycin) the proportion was changed significantly. The share of patients with normal ejaculation decreased to 61.2%. On contrary, frequency of premature ejaculation increased twice (20.4%), and delayed ejaculation—in 4.5 times (18.4%).

J Sex Med 2011;8(suppl 5):384–405

Highlighted Poster Sessions Conclusion: Proportion of ejaculatory disorders in patients with pulmonary TB before a start of anti-TB therapy was the same as in population as whole. So, tuberculosis as a disease does not damage an ejaculatory function. Three months of standard anti-TB therapy with four drugs significantly worsened the ejaculatory function of patients. The high growth of delayed ejaculation may be explained by neurotoxicity of anti-TB drugs. So, tuberculosis as a disease does not damage an ejaculatory function, but the treatment of tuberculosis does it. There is necessary a special pathogenetic therapy to prevent this complication. Policy of full disclosure: None.

HP-06-003

ALEXITHYMIA AND DELAYED EJACULATION: A CONTRIBUTE TO UNDERSTAND A NEGLECTED SEXUAL DYSFUNCTION Michetti, P. M.1; Eleuteri, S.2; Giuliani, M.3; Pinto, R.3; Rossi, R.4; Leonardo, C.1; Franco, G.1; De Dominicis, C.1; Simonelli, C.4 1 La Sapienza University, Urology, Rome, Italy; 2Sapienza University of Rome, Medicine and Psychology, Italy; 3Institute of Clinical Sexology, Rome, Italy; 4La Sapienza University, Medicine and Psychology, Rome, Italy Objective: Alexithymia construct describes a set of personality features as difficulty in identifying and communicating emotions to others, reduced imaginal and fantasy activity, externally oriented cognitive style. High or moderate alexithymia levels have yet been documented in men with Erectile Dysfunction (ED) and Premature Ejaculation (PE). The aim of this study was to investigate the presence of alexithymia in men with Delayed Ejaculation (DE), comparing such results with data found from other Male Sexual Dysfunctions (MSD). Methods: To 44 patients with DE diagnosed by DSM-IV-TR criteria, range age 20–63, was administered Toronto Alexithymia Scale (TAS20), a validated tool used to evaluate alexithymia levels. Results: Only 9.1% of the patients could be categorized as alexithymic (TAS20 > 61), 4.5% of them were placed in the grey area (52–60) while 86.4 % of the sample were found to be non-alexithymic (<51). The overall average score of the TAS-20 was 44.70. The preliminary results show that alexithymia construct does not seem to be correlated with DE, differently from other MSD, where presence of such condition was found in about 63% of patients. Despite the well-known hypercontrol configuration, patients with DE present no difficulty in identifying and communicating emotions to others. This datum is probably connected to the greater social acceptance of DE than PE and ED: the symptom does not affect the core male identity. In a somatopsychic point of view, the consequent fewer individual and relational distress could represent an important protective factor from creating or exacerbating high levels of alexithymia. Conclusion: The preliminary data seem to suggest that DE, not being correlated to alexithymia construct, is maybe based on other individual psychogenic features. On a clinical level, these results suggest to carry out more researches on this aspect, in order to validate the various etiological theorizations yet existent to select the better therapeutic approach for this dysfunction. Policy of full disclosure: None.

HP-06-004

POLYMORPHISMS IN THE SEROTONIN 1B RECEPTOR GENE ARE ASSOCIATED WITH SELF-REPORTED EJACULATION LATENCY TIME Jern, P.1; Westberg, L.2; Johansson, A.1; Gunst, A.1; Eriksson, E.2; Sandnabba, N. K.1; Santtila, P.1 1 Abo Akademi University, Department of Psychology, Turku, Finland; 2University of Gothenburg, Sahlgrenska Academy, Sweden Objective: Previous research has indicated that serotonergic genes may influence ejaculatory function. Attempts to investigate effects of polymorphisms in serotonergic genes have been carried out, but so far,

399

Highlighted Poster Sessions no study has conducted exploratory genotype analyses regarding the serotonin receptor 1A, 1B and 2C subtypes, that have been hypothesized to mediate the inhibitory effects of serotonin on ejaculation in rodents. The aim of the present study was to investigate effects of a total of 6 single nucleotide polymorphisms (SNPs) located in genes encoding serotonin receptor subtypes 1A, 1B and 2C on self-reported ejaculation latency time. Methods: A retrospective self-report measure of ejaculation latency time was used to investigate ejaculatory function in a population-based sample of 1,399 male twins. DNA was collected using self-administered saliva sampling. Calculations of allelic effects were conducted using the Generalized Estimating Equations module of PASW 18.0, which appropriately controls for between-subjects dependence. Results: Out of six investigated polymorphisms, two SNPs (both serotonin receptor 5-HT1B linked) had a significant main effect on ejaculation latency time. Of these, one (rs11568817) remained significant after Bonferroni correction for multiple testing, indicating that individuals homozygous for the G allele had significantly shorter ejaculation latencies. Conclusion: This study supports the long-standing hypothesis that serotonergic genes play a role in the etiology of premature ejaculation. Replication of the results of the present study is warranted. Policy of full disclosure: None.

HP-06-005

EIACULATIO PRAECOX WORSES THE SEXUAL DISTRESS PERCEIVED BY FEMALE PARTNER Limoncin, E.1; Tommassetti, M.1; Gravina, G. L.1; Ciocca, G.1; Carosa, E.1; Isidori, A. M.2; Lenzi, A.2; Jannini, E. A.1 1 University of L’Aquila, Experimental Medicine, L’Aquila, Italy; 2University of L’Aquila, Experimental Medicine, Italy Objective: To compare the levels of sexual-distress perceived by females who defined their partners as affected by PE with what perceived by an age-matched group of partners who did not define their partners as affected by PE. Additionally, a correlational analysis was performed to investigate if and which demographic features borne on sexual distress. Methods: The study population was composed of (i) 984 partners of men affected by PE (PE group) and (ii) 374 partners of men not affected by PE (control group). The empirical data were collected through a website dedicated to PE. To the compilers were initially asked to report if their partners suffered from PE. All compilers who answered affirmatively to this question were categorized in the PE group whereas everyone else was included in the control group. To all compilers were asked to brief on age, educational qualification, provenance and duration of relationship and to complete the Female Sexual Distress Scale-Revised. Results: the groups were balanced respect to age (P = 0.45), educational level (P = 0.21) and duration of relationship (P = 0.09). A significant difference was found respect to provenance with the majority of control group coming from northern-central Italian regions whereas in the PE group the majority coming from northern Italian regions (P = 0.012). The PE group perceived higher levels of sexual distress (median value 18 [95% CI 17–20]) than the control group (median value 6 [95% CI 5–7]) P < 0.0001. In the stepwise multivariate linear regression analysis the variables which influenced the levels of sexual distress were age (R2 = 0.37, P = 0.002) and duration of relationship (R2 = 0.46, P = 0.011). Conclusion: This survey suggests that female of PE group perceive higher levels of sexual distress than partners of men without PE. Interestingly, age and duration of relationship are the powerful variables able to worsen the perception of female sexual distress. Policy of full disclosure: None.

HP-06-006

THE RELATIONSHIP BETWEEN LOWER URINARY TRACT SYMPTOMS (LUTS) AND PREMATURE EJACULATION (PE) IN KOREAN MEN Min, K.-S.1; Um, J.1; Yoon, J.1; Kang, D.1; Cho, K.-S.2 Busan Paik Hospital, Urology, Korea; 2Yonsei University Severance Ho, Seoul, Korea

1

Objective: To evaluate the correlation between lower urinary tract symptoms (LUTS), erectile dysfunction (ED) and premature ejaculation (PE) in Korean men aged more than 40 years old. Methods: A total of 258 men aged more than 40 years old were enrolled by questionnaires which were composed of International Prostate Symptom Score (IPSS: storage symptoms (ST), voiding symptoms [VD]), five-item version of the International Index of Erectile Function (IIEF-5) and Premature Ejaculation Diagnostic Tools (PEDT). Comparative analysis was done to examine the relationship between LUTS and PE. Results: A total of 258 male ranging in age from 40 to 79 years completed the questionnaires and were included in the assessment. 40–49 years old men were 8, 50–59 years old men were 47, 60–69 years old men were 191, 70–79 years old men were 12. Prevalence of PE by criteria of PEDT was 29.1%, and PE to be judged by them was 49.5%. There were no significant correlation of the scores of the IPSS and PEDT with age but were significant relationship between IIEF-5 score and age. PEDT score was positive coefficient correlation to IPSS-SD (r = 0.326, P < 0.001), IPSS-VD (r = 0.183, P = 0.005) and IPSS-Total (r = 0.310, P < 0.001). PEDT score was correlated to IPSS-SD more than IPSS-VD. In particularly, PEDT score was significantly negative coefficient correlation to IIEF-5 total score (r = −0.248, P = 0.004). IIEF-5 total score was not shown significant coefficient correlation to IPPS-SD (r = −0.199, P = 0.068), IPSS-VD (r = −0.158, P = 0.372) and IPSS-Total (r = −0.221, P = 0.149). However, IIFF-5 total score had tendency to be negatively correlated to IPSS-SD more than IPSS-VD. Conclusion: LUTS, especially storage symptoms may have negative impact on men with PE. In elderly men, control of both ED and LUTS play an important role in management of PE. Policy of full disclosure: None.

HP-06-007

THE CLINICAL SIGNIFICANCE OF STOPWATCH INTRAVAGINAL EJACULATION DELAY TIME (IELT) AND CORRELATION WITH SELF REPORTED IELT: RESULTS FROM NATIONAL REPRESENTATIVE SAMPLING Lee, S. W.1; Lee, J. H.1; Park, H. J.2; Park, J. K.3; Park, K.4; Choi, S.5; Kam, S. C.6 1 Samsung Medical Center, Urology, Seoul, Korea; 2Pusan National University, Urology, Busan, Korea; 3Jeonbuk National University, Urology, Jeonju, Korea; 4Chonnam National University, Urology, Seoul, Korea; 5Jassen Korea, Urology, Seoul, Korea; 6Gyeongsang National Universit, Urology, Jinju, Korea Objective: The definition of premature ejaculation (PE) is still evolving, but the classic triad in the definition includes short intravaginal ejaculatory latency time (IELT), lack of control, and distress of patients. The stopwatch IELT is the only objective parameter among these triad and essential in international society of sexual medicine definition. The objective of this study is to investigate the clinical significance of stopwatch IELT and correlation with self-report IELT. Methods: Random samples of 1,035 men aged 20–64 years based on a demographically representative of Korean population were involved in this study. The validated Korean version of premature ejaculation diagnostic tool (PEDT) was used for diagnosis of PE. The stopwatch IELT and self-reported IELT were checked. Comparison of intergroup was performed using χ2 test or one-way anova.

J Sex Med 2011;8(suppl 5):384–405

400 Results: The mean stopwatch IELT was 377 ± 339 seconds and the IELT was decreased with age (479 ± 413 seconds in twenties, 385 ± 319 in thirties, 371 ± 340 in forties, 321 ± 274 in fifties and 268 ± 307 in sixties). Among 1,035 men, 3.0% was less than 1 minute in stopwatch IELT and 13.6% was between 1 and 2 minutes. The selfreported IELT matched stopwatch IELT in 48.2% of responders. The self-reported IELT was longer than stopwatch IELT in 37.6% of responders and shorter in 14.2%. The PEDT total score and IELT by stopwatch showed a negative correlation (ρ = −0.313, P < 0.0001). The stopwatch IELT showed a significant correlation with health status, stress, libido, sexual life satisfaction and partner relationship but did not with drinking, smoking, exercise and masturbation. Conclusion: The stopwatch IELT was well correlated with PEDT score and many parameters of PE. The self-reported IELT did not match the stopwatch IELT in 51.8% of responders. The stopwatch IELT is essential parameter in diagnosis of PE and can be used for evaluating the severity of PE. Policy of full disclosure: Supported by Jassen Korea.

HP-06-008

EJACULATION DYSFUNCTION IN MEN WITH SPINAL CORD INJURY: IMPACT OF LESION LEVEL OR COMPLETENESS? Courtois, F.1; Charvier, K.2; Morel Journel, N.2; Vézina, J. G.3; Côté, I.3; Jacquemin, G.4; Carrier, S.4 1 Montréal, Canada; 2Hospices Civils de Lyon, Saint Genis Laval, France; 3 IRDPQ, Québec, Canada; 4IRGLM, Montréal, Canada Objective: Spinal cord injury (SCI) impairs ejaculation. While the completeness of the lesion affects remaining function, lesion level appears to be crucial in determining the type of ejaculation dysfunction and its response to treatment. Objective: Assess the type of ejaculation dysfunction and treatment success in men with SCI as a function of lesion level and completeness. Methods: One hundred twenty men with lesions varying from C2 to S4, subdivided into complete and incomplete lesions, and into higher (C2-T6), intermediate (T7-T10 or T11-L2) and lower lesions (L5S4), and tested for ejaculation with masturbation-erotica, vibrostimulation and/or midodrine treatment. Results: Overall only 6% of SCI men could never achieve ejaculation, while 94% could achieve ejaculation (21% natural stimulation, up to 73% when adding vibrostimulation, up to 94% when adding midodrine). Complete lesions achieved similar success (95%) than incomplete lesions (93%), but men with higher lesions responded best to treatment (80%), while those with intermediate lesions required more midodrine or showed negative results (50%), and those with lower lesions responded more to natural stimulation (90%) but with premature ejaculations. Upon ejaculation, men with complete lesions showed similar cardiovascular changes ( SBP = 36 mm Hg) than incomplete lesions ( SBP = 33 mm Hg), but patients with higher lesions showed significantly larger increases in blood pressure ( SBP = 42 mm Hg) than intermediate ( SBP = 9 mm Hg) or lower ( SBP = 10 mm Hg) lesions. Men with complete lesions also reported similar sensations (M = 24 descriptors) than incomplete lesions (M = 22 descriptors), but patients with higher lesions reported significantly more sensations (M = 25 descriptors) than intermediate (M = 19 descriptors) or lower (M = 10 descriptors) lesions. Conclusion: Despite a relatively poor natural capacity, most men with SCI can achieve ejaculation. Completeness of the lesion seems less affecting treatment than lesion levels, even though it contributes to the initial maintenance of natural ejaculations. The results are discussed in terms of their important clinical implications for treatment strategies and the underlying neurophysiology of ejaculation. Policy of full disclosure: None.

J Sex Med 2011;8(suppl 5):384–405

Highlighted Poster Sessions Saturday, 3 December 2011 15.00–15.30 Exhibition Hall B Area 1 HP-07 Surgical potpourri Chairs: N. Cruz Navarro, Spain D. Schultheiss, Germany HP-07-001

THE EFFECTS OF OZONE THERAPY ON CAVERNOSAL DEMAGE DUE TO ISCHEMIA/ REPERFUSION INJURY INDUCED PRIAPISM IN RAT MODELS Basar, M.1; Aydos, T.2; Kul, O.3; Atmaca, T.3; Uzunalioglu, T.3; Kisa, U.4 Ankara, Turkey; 2Baskent University, Faculty of Medicine, Ankara, Turkey; 3University of Kirikkale, Faculty of Veterinary Medicine, Turkey; 4 University of Kirikkale, Faculty of Medicine, Turkey

1

Objective: The aim of the present study was to investigate the effect of ozone therapy applied before reperfusion in experimental priapism model on possible perfusion injury. Methods: A total of 42 adult male Wistar rats weighing 230.6+7– 12.71 g were used in the study. All subjects were divided into seven working groups including equal number of subjects in each group. Groups were considered as follows: P1: control group; P2: priapism; P3: priapism + taurine; P4: priapizm + ozone treatment; P5: taurine; P6: ozone treatment; P7: priapism + taurine + ozone therapy. Priapism was produced by vacuum method under ketamine (50 mg/kg, i.p.)/ xylazine (7 mg/kg, i.p.) anesthesia. After having waited for 4 hours in priapism status, reperfusion was elicited. Taurine and/or ozone therapy application was performed in P3, P4 and P7 groups 15 minutes before reperfusion. Cavernous tissue was isolated after sacrifization, and apoptosis was evaluated by TUNEL technique. Statistical analysis was performed by using Kruskal–Wallis test. Results: While apoptotic index was 9.3 ± 4.07 in P1, it was determined as 17.8 ± 10.24 in P2. This value was stated as 11.6 ± 5.41 and 11.2 ± 5.26 in P5 and P6, respectively. Additionally, this index was confirmed as 29.7 ± 20.50 in P3, 13.7 ± 20.59 in P4 and 8.3 ± 6.70 in P7. Conclusion: Apoptotic index raised in priapism created rats after reperfusion as expected. Intraperitoneal ozone therapy performed before reperfusion reduced apoptotic index values near to control group’s values. Moreover, combined application of taurine and ozone therapy before reperfusion reduced these values even below the control cases. As a result, ozone therapy plays a protective role in the prevention of cavernous tissue damage due to reperfusion in priapism. Policy of full disclosure: This study was supported by The Scientific and Technological Research Council of Turkiye (110S273).

HP-07-002

DISTAL CORPUS CAVERNOSUM SMOOTH MUSCLE FIBROSIS DUE TO NON-ISCHEMIC PRIAPISM—SHOULD EMBOLIZATION BE PERFORMED EARLIER? Zacharakis, E.1; Shabbir, M.1; Walkden, M.2; Minhas, S.1; Ralph, D.1; Muneer, A.1 1 University College Hospital, Urology, London, UK; 2University College Hospital, Department of Radiology, London, UK Objective: Non-ischemic priapism is due to unregulated cavernous arterial inflow. Since the venous outflow mechanism is unaffected, the corpus cavernosum is perfused with oxygenated blood and therefore these patients can be managed conservatively. We report on our series of patients with non-ischemic priapism who have developed fibrosis of the distal corpus cavernosum following a period of conservative treatment. Methods: Over a 5-year period, eight patients with non-ischemic priapism presented to our unit. The mean age was 37.4 years (range 20–56). The etiology in seven cases was secondary to a perineal injury and in one case due to conversion of an ischemic priapism to a non ischemic priapism following surgical intervention.

401

Highlighted Poster Sessions Results: On follow-up penile MRI and Doppler studies showed the development of distal corpus cavernosum fibrosis. Pudendal artery super selective embolization was eventually performed in all of the patients. Clinically these patients reported the development of erectile dysfunction due to poor distal penile tumescence. Four patients eventually underwent insertion of a penile implant and further four patients are using PDE5 inhibitors. The conditions were reproduced in an in vitro model using precontracted strips of rabbit corpus cavernosum superfused at high pO2 levels. This showed that the smooth muscle tone reduced by 43% of the initial tone (N = 4) after superfusion for 12 hours indicating irreversible smooth muscle dysfunction. Conclusion: The risk of ischemic damage in non-ischemic priapism is expected to be minimal due to the oxygenation of the corpus cavernosum being maintained. However, corpus cavernosum smooth muscle perfusion with higher than normal pO2 levels may result in oxidative stress due to the formation of reactive oxygen species. Irreversible damage to the smooth muscle is followed by the development of fibrosis. Based on these findings we suggest that superselective embolization of high flow priapism should not be delayed. Policy of full disclosure: None.

Methods: Between October 2003 and February 2011, 167 patients (aged from 18 to 62 years) underwent single stage metoidioplasty. Urethra was reconstructed using three different methods: (i) tubularization of the longitudinal dorsal clitoral skin flap (21 case); (ii) combination of longitudinal skin flap and buccal mucosa graft (41 cases); and (iii) combination of labia minora flap and buccal mucosa graft (105 cases). Results: The median follow-up was 39 months (ranged 7–94 months). The total length of neourethra ranged from 9.4 to 14.2 cm (median 10.8 cm). Voiding while standing was reported in 152 patients (91%). Fistula was noted in 21 cases (12.57%), 5 (23.81%) in group (i), 7 (17.07%) in (ii), and 9 (8.57%) in group (iii). Stricture occurred in 8 patients (4.79%), 4 (19.04%) in (i), 2 (4.87%) in (ii), and 1 (0.95%) in group (iii). The best success rate was achieved in (iii) group (90.47%), while in group (ii) and (i) was 79.05% and 57.15%, respectively. Total success rate in all patients was 82.64%. Conclusion: Comparison of three methods for urethral lengthening confirmed combined buccal mucosa graft and labia minora flap as a method of choice for urethroplasty in metoidioplasty minimizing postoperative complications. Policy of full disclosure: None.

HP-07-003

RE-DO VAGINOPLASTY WITH SIGMOID COLON IN MALE TRANSSEXUALS Bizic, M.1; Stanojevic, D.1; Vujovic, S.1; Djordjevic, M.2 1 School of Medicine, University of Belgrade, Serbia; 2School of Medicine, Belgrade, Urology, Serbia

HP-07-005

TWO-YEAR FOLLOW-UP OF PLAQUE INCISION AND PLICATION TO CORRECT PEYRONIE’S DISEASE Claes, H.; Van Poppel, H. Univ. Clin. Gasthuisberg, Urology, Leuven, Belgium

Objective: Postoperative vaginal absence or schrinkage present the most difficult complications after failed vaginoplasty in male transsexuals. We evaluated our results in re-do vaginoplasty using sigmoid colon. Methods: Between April 2000 and February 2011, 29 female transsexuals, aged 26–59 years (mean 32) underwent rectosigmoid vaginoplasty due to failed vaginal reconstruction. Isolated segment of rectosigmoid was from 8 to 11 cm length to avoid excessive mucous production. Rectosigmoid is harvested with blood supply originating on sigmoidal arteries or/and superior haemorrhoidal vessels. Stapling devices is used for the colorectal anastomosis as a safest procedure. Creation of perineal cavity for vaginal replacement is done using simultaneous approach through abdomen and perineum. Very precise dissection must be done to avoid injury of rectum, bladder and urethra. Introital remnants or perineal skin flaps were used for anastomosis with rectosigmoid vagina. Postoperative dilation was recommended to prevent purse string scarring with subsequent vaginal stenosis in 6 months after surgery. Results: Follow-up ranged from 7–138 months (mean 43). Good aesthetic result with satisfactory psychosexual functioning was achieved in 20 cases. Complications were neovaginal prolapse (5), introital stenosis (4), excesive mucous production (4), and diversion colitis (2). Conclusion: Rectosigmoid colon presents a good choice for creation of neovagina in male transgenders after failed vaginoplasty. Described refinements significantly decrease the number of complications that usually occur in this type of vaginoplasty. Policy of full disclosure: None.

Objective: We assessed the 2-year follow-up outcome of a combination of plaque vertical incision and longitudinal plication of the tunica albuginea in selected patients with Peyronie’s disease by extensive preoperative and postoperative subjective and objective analysis. Methods: From 2000 to 2009, 178 patients (mean age 48 years) with Peyronie’s disease more than 18 months and stable disease for at least 12 months underwent surgery. To assess preoperative erectile function and long-term outcome: IIEF questionnaire and several general assessment questionnaires completed by the patient and the patients’ partner were used. Results: A significant curvature recurred or persisted in 12 patients. Sixteen patients reported a significant decrease in penile rigidity following surgery. We noticed a reduced penile length during maximal rigidity in all patients postoperatively. A diminution of the mean values of the orgasmic and erectile function domains of IIEF was found in 31.3% and 32.8% of patients, respectively. Sexual desire and intercourse satisfaction domains were unchanged in most patients. According to several general assessment questions, 136 (76.4%) men and 122 (68.5%) partners were satisfied with the procedure. Conclusion: Although our results indicate that this procedure is efficient for the treatment of penile curvatures and has minimal complications, we should be aware that there is a significant patient and partners dissatisfaction rate. So patients and especially their partners have to be counseled about this. Policy of full disclosure: None.

HP-07-004

HP-07-006

URETHRAL RECONSTRUCTION IN METOIDIOPLASTY (FEMALE TO MALE TRANSSEXUAL SURGERY): COMPARISON OF THREE DIFFERENT METHODS

SURGICAL MANAGEMENT OF PENILE FRACTURE AND LONG-TERM OUTCOME— RESULTS OF A PROSPECTIVE STUDY

Kojovic, V.1; Stanojevic, D.1; Bizic, M.1; Majstorovic, M.1; Djordjevic, M.2 1 School of Medicine, University of Belgrade, Serbia; 2School of Medicine, Belgrade, Urology, Serbia Objective: Urethral lengthening is the most difficult part in female transsexuals and it poses many challenges. We evaluated outcome of three different methods for urethral lengthening in metoidioplasty as a type of phalloplasty in female transsexuals.

Hatzichristodoulou, G.; Dorstewitz, A.; Gschwend, J.; Herkommer, K.; Zantl, N. TU Munich, Klinikum r. d. Isar, Department of Urology, Germany Objective: Penile fracture is a rare emergency. Surgical therapy with defect closure is accepted as treatment of choice. However, little is known about postoperative long-term effects, especially erectile function (EF). In this prospective study we present results of surgery and long-term results in affected patients.

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402 Methods: From 1995 to 2008 N = 35 patients presented at our department with suspicion of penile fracture. Mean patient age was 38.5 years (range 17–60 years). A magnetic resonance imaging was performed in 15 patients (42.9%) to confirm the diagnosis, a cavernosogram in 13 patients (37.1%). In seven patients (20.0%) penile fracture was diagnosed without further imaging because of clear findings. EF was assesed by the International Index of Erectile Function (IIEF)-5 questionnaire. Results: Penile fracture was detected in 28/35 patients (80.0%); 26/28 patients (92.9%) underwent surgery; 2 patients (7.1%) refused surgery. Access to the tunica was obtained in 22 patients (84.6%) by circumcision, in 4 patients (15.4%) by longitudinal incision. The tunica defect was closed with PDS suture. Urethral lesions were found in 7/26 patients (26.9%) and repaired simultaneously; 14/26 patients (53.8%) were available for follow-up 3.8 years (range 0.3–10.7 years) after surgery; 11/14 patients (78.6%) were potent before surgery; 3 patients (21.4%) had mild erectile dysfunction (ED) without requiring treatment. At follow-up 7/14 patients (50.0%) had impaired EF, with 3 patients (21.4%) needing treatment for ED. Mean IIEF-5-Score decrease was 5.6 points (range 2–11 points). Seven patients (50.0%) had no impairment of EF. Penile deviation occured in four patients (28.6%). Conclusion: Surgical therapy of penile fracture is easy and should be offered to patients. Urethral lesions can be repaired. However, in the long-term ED can occur and may need treatment. Follow-up of patients is required for detecting complications. Policy of full disclosure: None.

HP-07-007

PENILE PROSTHESIS INSERTION IN GENDER DYSPHORIA—LONG-TERM RESULTS Dente, D.1; Garaffa, G.2; Kayes, A.2; Christopher, N.2; Ralph, D.2 Policlinico Umberto Primo, Urology, Rome, Italy; 2St. Peter’s Andrology Center, Andrology, London, UK

1

Objective: The aim of this study is to report the results of penile prosthesis implantion in patients with gender dysphoria who have had a previous phalloplasty. Methods: Between 2000 and 2010, 154 patients (age 22–59 years, mean 38.5 years) with Gender Dysphoria had a penile prosthesis inserted into their phalloplasty. The types of phalloplasty included the forearm free flap (N = 93), an abdominal phalloplasty (N = 52) and a combination of the above in 12 patients. The prostheses used were the AMS 700CX in 143 pts, AMS Ambicor in 10 pts, Coloplast Titan in 1 pt. The resevoir component and a single testicular prosthesis had been inserted 3 months earlier. A single cylinder was used in 111 patients and 2 cylinders, when the phallus was bulky, in 43 patients. A vascular graft, impregnated with silver to reduce infection, was used to form a cap and sock around the cylinder to aid with anchorage to the pubis and to reduce the chance of distal erosion. The surgical results and complications were recorded. Results: A prosthesis was inserted in all patients without intraoperative complications. After a mean follow-up of 20 months (range 7–123 months), a successful surgical result was declared with the prosthesis in a good position and the patient being able to cycle the device in 137 patients, although only 69 patients (50%) were having sexual intercourse. The revision rate was 31% to include: infection in 23 patients (16%), erosion 9 pts (6%), mechanical failure 33 pts (24%) and elective readjustment of components in 28 patients. Some patients had multiple revisions. Conclusion: The insertion of a penile prosthesis into a phalloplasty technically allows enough rigidity to have penetrative sexual intercourse. However, the patients must be informed of the shorter device life expectancy and the high complication and revision rate. Policy of full disclosure: None.

J Sex Med 2011;8(suppl 5):384–405

Highlighted Poster Sessions HP-07-008

PENILE LENGTHENING FOR ADULT CONTRACTILE PENIS PRESERVING SUSPENSORY LIGAMENT Yun, T. K.1; Jeon, H. S.1; Sohn, D. W.2 Manomedi Urologic Clinic, Urology, Seoul, Korea; 2The Catholic University, Urology, Seoul, Korea 1

Objective: The resection of suspensory ligament has drawbacks such as the possibility of reattachment of the penis to the pubis, a hump that forms at the base of the penis, in addition to alteration in the angle of erection. The aim of this study is to report a simple and minimally invasive surgical technique for penile lengthening without cutting of suspensory ligament. Methods: Dysgenetic dartos fascial band and hypermobility of penis are the common cause of contractile penis. So it is important to collect these two points for correction of contractile penis. We performed penile surgery in 78 patients. All of them were underwent minimally partial circumcision. Through the partial circumcision, dysgenetic dartos fascia was dissected from glans to the prepubic junction. The repair is performed combination of tacking penile base to prepubic fascia and anchoring subcutaneous penile skin to base of penile shaft for correction of hypermobility. The penis was wrapped up by elastic bandage evenly for 2 weeks. The outcome of the operation is evaluated by measurement of penile length before and after operation. Results: The postoperative course was uneventful with no serious complications. The angle of erection (as reported by patient) was similar to that prior to the procedure. The mean penile length gain (flaccid penis) was 2.5 cm. There were 74 patients (95.5%) satisfied with the result and retraction occurred in two cases after 6 months. Conclusion: The described technique is simple and minimally invasive. In our experience, this technique may be good choice in adult contractile penis and there were no additional procedures required. Policy of full disclosure: None.

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Highlighted Poster Sessions Saturday, 3 December 2011 15.00–15.30 Exhibition Hall B Area 2 HP-08 Sexual potpourri Chairs: A. Aversa, Italy S. Arver, Sweden HP-08-001

EFFECTS OF LONG-ACTING TESTOSTERONE UNDECANOATE ON BONE MINERAL DENSITY IN MIDDLE-AGED MEN WITH LATE-ONSET HYPOGONADISM AND METABOLIC SYNDROME: RESULTS FROM A 36-MONTH CONTROLLED STUDY Aversa, A.1; Bruzziches, R.1; Francomano, D.1; Greco, E.1; Fornari, R.1; DiLuigi, L.2; Lenzi, A.1; Migliaccio, S.1 1 Sapienza University of Rome, Dept Experimental Medicine, Italy; 2Foro Italico University of Rome, Dept of Health Sciences, Italy Objective: We evaluated the effects of long-term testosterone replacement therapy (TRT) on the bone mineral density in obese patients with metabolic syndrome (MS) and late-onset hypogonadism (LOH). Methods: Sixty men (mean age 57 ± 10) with low serum testosterone (T < 320 ng/dL) and MS regardless the presence of osteoporosis were enrolled. Forty men received intramuscular T-undecanoate (TU) four times/year for 36 months and 20 age-matched hypogonadal men with MS in whom T treatment was contraindicated were used as controls. Hormonal, biochemical markers, vertebral and femoral bone mineral density (BMD) by DEXA were measured. Results: At baseline, overall patients had mild osteopenia (lumbar BMD = 0.891 ± 0.097 g/cm2; femoral BMD = 0.847 ± 0.117 g/cm2). TU induced a significant improvement of bone mass after 36 months (lumbar BMD = 1.053 ± 0.145 g/cm2; P < 0.002; femoral BMD = 0.989 ± 0.109; P < 0.003 g/cm2) with a 5%-per-year increase and a significant reduction in hs-CRP without changes in BMI. A direct relationship between serum T and BMD increments at the lumbar (r2 = 0.66, P < 0.0001) and femoral (r2 = 0.52, P < 0.0001) sites was demonstrated. Study adherence was 50% without serious side effects. Conclusion: Long-term TRT in middle-aged men with LOH and MS determines a significant increase in both vertebral and femoral BMD related to achieved serum T levels, probably independently from estradiol modifications. Policy of full disclosure: A. Aversa and S. Migliaccio received speaker’s honoraria from Eli Lilly; A. Aversa received honoraria from Bayer Schering Pharma.

HP-08-002

ASSESSING QUALITY OF LIFE VIA AGING MALE SYMPTOMS (AMS) SCALE AFTER TREATMENT WITH INTRAMUSCULAR LONG-ACTING TESTOSTERONE Ho, C. C. K.1; Tong, S. F.2; Low, W. Y.3; Ng, C. J.3; Khoo, E. M.3; Lee, V. K. M.4; Md Zainuddin, Z.1; Tan, H. M.3 1 Universiti Kebangsaan Malaysia, Dept of Surgery, Kuala Lumpur, Malaysia; 2Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia; 3Universiti Malaya, Kuala Lumpur, Malaysia; 4International Medical University, Kuala Lumpur, Malaysia

tosterone undecanoate 1,000 mg was given at week 0, 6, 18, 30, and 48. Self-administered AMS questionnaire were completed at week 0, week 30, and week 48. Results: Fifty-six participants in the treatment arm and 58 in the placebo arm completed the study. The improvement in the total AMS score was significantly more in the treatment arm compared to the placebo (F: 4.576, P = 0.017) over the 48-week period. The mean for total AMS was 38.46 ± 11.85 at baseline and 33.59 ± 1.69 at 48 weeks for placebo and 41.73 ± 12.73 at baseline and 32.61 ± 9.67 at 48 weeks for the treatment group. The change in the total AMS score was −12.6% in placebo group and −21.9% in the treatment group. The psychological and somatovegetative subscale decreased significantly more in the treatment arm compared to placebo (−2.8 compared to −1.2, P = 0.03; and −3.2 compared to −1.8, P = 0.016). The difference in change among the randomized groups for the sexual subscale scores followed the same trend, though not statistically significant. Conclusion: Intramuscular long acting testosterone is effective in improving quality of life as assessed by the AMS scale in men with TDS. Policy of full disclosure: This study was supported by Bayer Schering Pharma.

HP-08-003

SHORT STATURE IS ASSOCIATED WITH SEVERITY OF ERECTILE DYSFUNCTION Rokkas, K.; Vlachopoulos, C.; Ioakeimidis, N.; Terentes-Printzios, D.; Synodinos, A.; Samentzas, A.; Aggelis, A.; Xaplanteris, P.; Askitis, T.; Stefanadis, C. Athens Medical School, 1st Department of Cardiology, Greece Objective: Severe erectile dysfunction (ED) may carry an incremental predictive value for future cardiovascular events. Height may be considered as a possible independent factor to be used in cardiovascular risk calculations. The aim of this study was to assess the relationship between severity of ED and anthropometric characteristics of men with erectile dysfunction (ED). Methods: A total of 424 men (mean age 56 years old) were included in the study. ED was diagnosed according to history and score of the 5-item Sexual Health Inventory for Men (SHIM, cutoff value <21). Lower scores indicate poorer erectile function and vice versa. Results: Weight, height and body mass index were divided into tertiles. SHIM score was not different among tertiles of BMI and weight, meanwhile erectile function decreased across tertiles of height (P < 0.001). The short ones were below 169 cm and tall ones over 178 cm on average. Among the shortest height category, the relative risk was 2.07 (95% CI 1.18–3.56) for severe and moderate-severe ED (SHIM score <8 and 8–10, respectively) when compared with those within the highest height category (see table below). Conclusion: Men short stature poses ∼2.0 times higher risk for moderate-severe and severe ED than being a tall individual. The results of this study suggest that height may be considered as a possible independent factor to be used in evaluation of men with ED.The possible pathophysiological, environmental, and genetic background of this peculiar association is not known. Policy of full disclosure: None.

Objective: To investigate the effect of intramuscular injection of testosterone undecanoate 1,000 mg over 12 months on the Aging Male Symptoms (AMS) scores in men with testosterone deficiency syndrome (TDS). Methods: This randomized, double-blind, placebo-contolled study was carried out in a tertiary hospital. One hundred twenty men above 40 years old with TDS were randomized into intramuscular injection of either placebo or testosterone undecanoate 1,000 mg. Fifty-six and 58 participants from active treatment and placebo group, respectively, completed the study. Intramuscular injection of either placebo or tes-

J Sex Med 2011;8(suppl 5):384–405

404 HP-08-004

PRIAPUS IS HAPPIER WITH VENUS THAN WITH BACCHUS Boddi, V.1; Corona, G.2; Monami, M.3; Fisher, A.2; Bandini, E.2; Melani, C.4; Balzi, D.2; Patussi, V.5; Forti, G.2; Mannucci, E.2; Maggi, M.2 1 Università di Firenze, Fisiopatologia Clinica, Italy; 2Università di Firenze, Fisiopatologia Clinica, Italy; 3Università di Firenze, Diabetes Section Geriatric Uni, Italy; 4Università di Firenze, Epidemiological Unit, Italy; 5 Regional Unit for Alcoholism, Firenze, Italy Objective: The relationship between alcohol consumption and erectile function is still not completely clarified. Aims of the present study are to explore a number of biological and clinical correlates of alcohol consumption in a sample of men consulting for sexual dysfunction, and to verify possible associations with the incidence of major adverse cardiovascular events (MACE). Methods: A consecutive series of 1,956 (mean age 55 ± 11.9 years old) attending our Outpatient Clinic for sexual dysfunction was retrospectively studied. A subset of the previous sample (N = 1,687) was enrolled in a longitudinal study.Different clinical, biochemical, instrumental (penile Doppler ultrasound: PCDU) and intrapsychic (Middlesex Hospital Questionnaire, MHQ) were evaluated. We considered alcohol abuse more than 3 drinks per day. Results: Among the patients studied 81% reported no or mild (<4 drinks/day) alcohol consumption while 14.3% and 3.9% declared a moderate (4–6 drinks/day) or severe (>6 drinks/day) alcohol abuse, respectively. After adjustment for confounders, both moderate or severe alcohol abuse was associated with low perceived partner’s sexual desire, worse couple relationship, and smoking abuse. Furthermore, moderate and severe alcohol abuse was associated with low PRL and TSH levels, as well as an increase in triglycerides and total cholesterol levels. Penile blood flow was reduced in moderate and severe alcohol drinkers even after adjustment for confounders. In the longitudinal study, after adjusting for confounding factors, any kind of alcohol abuse was independently associated with a higher incidence of MACE (HR = 2.043 [1.059-3.943]; P < 0.0001). Conclusion: Our findings demonstrate that, in subjects consulting for erectile dysfunction (ED), severe alcohol consumption is associated with a worse sexual function and a higher incidence of MACE. Policy of full disclosure: None.

HP-08-005

THE HhlpED STUDY: IMPACT OF ERECTION HARDNESS ON ERECTION MAINTENANCE AND SEXUAL QUALITY OF LIFE IN MEN WITH ERECTILE DYSFUNCTION AND ESPECIALLY THEIR PARTNERS Claes, H.1; Albert, A.2; Opsomer, R.3; Andrianne, R.4; Patel, S.5; Commers, K.6 1 Univ. Clin. Gasthuisberg, Urology, Leuven, Belgium; 2CHU Liege, Biostatics, Belgium; 3Univ. Clin. St Luc, Urology, Bruxelles, Belgium; 4CHU Liege, Urology, Belgium; 5Pfizer, Walton Oaks, Tadworth, Brussels, Belgium; 6 Pfizer Belgium, Brussels, Belgium Objective: This work evaluated the impact of improvements in the patient-reported Erection Hardness Score (EHS) on patient reports of confidence and quality of sexual relationships assessed by the SelfEsteem And Relationship (SEAR) questionnaire total score; ability to maintain an erection based on components of the International Index of Erectile Function (IIEF); and measures of satisfaction with duration of lovemaking, ability to achieve vaginal insertion, and overall experience of lovemaking based on components of the modified Quality of Life domain of the Sexual Life Quality Questionnaire (mSLQQQOL). The impact of patient-reported improvements in EHS on partner-reported measures of orgasm and satisfaction based on the Female Sexual Functioning Index (FSFI) and on components of the mSLQQ-QOL are also reported. Methods: HelpED, an observational, multicenter study in Belgium, enrolled men with newly diagnosed or untreated erectile dysfunction

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Highlighted Poster Sessions (ED) who were in a stable heterosexual relationship. Of the 447 men recruited, only those whose erections improved from EHS < 3 at baseline to EHS3 (hard enough for penetration but not completely hard) at follow-up and from EHS < 4 to EHS4 (completely hard and fully rigid) were included in this post hoc analysis. EHS3 and EHS4 groups were compared using the unpaired Student t-test (two-sided and 5% critical level). Results: Compared with EHS3 (N = 63), EHS4 (N = 128) patients scored significantly higher on measures of confidence and quality of sexual relationships, ability to maintain an erection, and sexual quality of life (P < 0.05). EHS4 partners also scored significantly higher on partner-reported measures of orgasm, satisfaction, and duration of lovemaking than did EHS3 partners (P < 0.05). However, partner reports of ease of achieving vaginal insertion and overall patient or partner experience did not differ between groups. Conclusion: These data illustrate the importance of achieving EHS4 to sexual quality of life of both patient and partner. Policy of full disclosure: Dr. H. Claes is a consultant and a speaker for Pfizer Inc, Bayer, and Eli Lilly and Company.

HP-08-006

A 6-MONTH PROSPECTIVE OBSERVATIONAL STUDY OF PDE5 INHIBITOR TREATMENT PERSISTENCE AND ADHERENCE IN LATIN AMERICAN MEN WITH ERECTILE DYSFUNCTION: THE PROACT STUDY Rubio-Aurioles, E.1; Reyes Vallejo, L. A.2; Lei, Y.3; Sorsaburu, S.4 Universidad Nacional Autónoma, de Mexico, Ciudad de Mexico, Mexico; 2 Eli Lilly de México S.A. de C., Lilly Research Laboratories, Ciudad de Mexico, Mexico; 3Eli Lilly and Company, Lilly Research Laboratories, Toronto, Canada; 4Eli Lilly and Company, Indianapolis, IN, USA

1

Objective: To investigate persistence and adherence to on-demand phosphodiesterase type 5 (PDE5) inhibitors sildenafil, tadalafil, and vardenafil among Latin American men with erectile dysfunction (ED). Methods: Men with mild to severe ED of various etiologies, who were PDE5 inhibitor–naïve, were enrolled in this observational study in Brazil, Mexico, and Venezuela. Men received on-demand PDE5 inhibitors and provided treatment information at baseline and at 1, 3, and 6 months post-enrollment at a physician visit or by telephone/postal questionnaire. Patients were defined as persistent at a follow-up visit if they used ≥1 dose of their originally prescribed PDE5 inhibitor within 4 weeks of the visit. Persistence at 6 months was defined as persistence at all follow-up visits. Patients were adherent if they utilized correctly their most recent dose of the originally prescribed PDE5 inhibitor. Patients responded to questions about reasons for non-persistence. Multivariate logistic regression models were used to identify factors associated with persistence and adherence. Results: Five hundred eleven patients (116, sildenafil; 317, tadalafil; 75, vardenafil; 3, lodenafil) enrolled. Mean age was 53 years, and 23%, 54%, and 23% had mild, moderate, and severe ED, respectively. Three hundred forty patients (67%) were persistent and 320 (63%) were adherent to treatment at 6 months. Average time to becoming non-persistent was 2.4 months. The most common reason for nonpersistence at 6 months was cost of medication (sildenafil, 23%; tadalafil, 37%; vardenafil, 25%) and lack of efficacy (sildenafil, 15%; tadalafil, 19%; vardenafil, 17%). Persistence and adherence at 6 months were associated with education level (P = 0.05 for both) and ED severity (P = 0.08 and P = 0.04, respectively). Conclusion: In this study, education level and ED severity were patient factors associated with persistence and adherence to PDE5 inhibitors in Latin American men. These results will help physicians identify patients at risk for becoming non-persistent or non-adherent with their on-demand PDE5 inhibitors. Policy of full disclosure: This study was funded by Eli Lilly and Company.

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Highlighted Poster Sessions HP-08-007

HP-08-008

ASSOCIATION OF SEXUAL DYSFUNCTION WITH GLOBAL HEALTH-RELATED QUALITY OF LIFE IN FEMALE PATIENTS WITH RHEUMATIC DISEASES

INCORPORATING MINDFULNESS INTO AN INTERNET-BASED INTERVENTION FOR FEMALE SEXUAL DYSFUNCTIONS

Anyfanti, P.1; Triantafyllou, A.2; Triantafyllou, G.2; Gavriilaki, E.2; Pyrpasopoulou, A.2; Chatzimichailidou, S.2; Christaki, E.2; Glystra, A.2; Douma, S.2; Aslanidis, S.2; Doumas, M.2 1 Thessaloniki, Greece; 22nd Propedeutic Department of, Internal Medicine, Aristotle, Thessaloniki, Greece Objective: Rheumatic disorders may severely impair global healthrelated quality of life, but whether impairment of physical functions like sexual functioning has accumulating negative effects on patients’ quality of life remains unclarified. We therefore aimed at investigating the impact of sexual dysfunction on global health-related quality of life in female patients suffering from rheumatic diseases. Methods: Consecutive female patients attending the Rheumatology Department of Hippokration General Hospital, Thessaloniki, Greece, comprised the study population. Assessment of female sexual dysfunction was based on the Female Sexual Function Index (FSFI) questionnaire, the total score of which ranges between 2 and 36, with a cutoff score ≤26.55 considered representative of female sexual dysfunction. Global health-related quality of life was evaluated using the EuroQolVAS (Euro-Quality of life, Visual Analogue Scale). Results: In total, 220 female patients 55.3 ± 14.0 years old participated in the study. The most prevalent rheumatic disorders in our sample were rheumatoid arthritis in 36.6%, osteoarthritis in 16.2%, systemic lupus erythematosus in 14%, psoriatic arthritis in 6.9%, and ankylosing spondylitis in 6.0%. Female sexual dysfunction was met by 68.3% in our population. The mean VAS score was 60.0 ± 21.1. Sexual dysfunction was strongly and reversely correlated with patients’ quality of life (r = 0.178, P = 0.008). Conclusion: While normal sexual functioning is mainly considered as a privilege of the healthy, our findings clearly demonstrate that perceived good quality of life in female patients with rheumatic diseases is strongly associated with satisfactory sexual functioning. Efforts should be made to identify presence of sexual dysfunction and efficiently resolve the problem when dealing with the female rheumatologic patient. Policy of full disclosure: None.

Mccabe, M.; Hucker, A. Deakin University, Psychology, Burwood, Australia Objective: Female sexual dysfunctions (FSDs) can have a negative impact on women’s lives and the lives of their partners. Because of the embarrassment and shame that can surround FSDs, it has been suggested that Internet-based interventions can offer the anonymity needed to make women feel more comfortable undergoing treatment for their sexual difficulties. To extend past research and address the limitations of our previous Internet program for FSDs, PursuingPleasure, an online treatment program for mixed FSDs, was evaluated. Methods: Thirty heterosexual women in stable relationships completed the PursuingPleasure program, and 30 women were enrolled in the wait-list control condition. The program comprised six online modules which incorporated psychoeducation, communication exercises, sensate focus exercises, partner engagement and CBT exercises. PursuingPleasure also included mindful-meditation, as well as email contact and fortnightly online chat groups. Both groups of women completed a pre- and posttreatment questionnaire and a 3-month follow-up questionnaire. Information was also included for partners to ensure that they were involved in the treatment process. Results: A comparison of the treatment and control group at pretest and posttest was conducted to investigate changes in sexual functioning and relationship variables. Maintenance of treatment gains at a 3-month follow-up was also explored. The results indicated that the intervention group demonstrated significant improvements in the measures of relationship and sexual functioning compared to the control group. Specific results will be outlined in the presentation. Conclusion: By implementing a program that builds on previous research and evaluates a more comprehensive Internet-based intervention for FSDs, increased treatment gains and lower attrition rates were observed compared to past programs of this format. This study demonstrates the efficacy of Internet-based treatment options for FSDs and further elucidates the role of mindfulness and partner engagement in FSD interventions. Policy of full disclosure: No financial support was provided for the research or the presentation for either author.

J Sex Med 2011;8(suppl 5):384–405

406

UNMODERATED POSTER PRESENTATIONS

PO-01

Basic science

PO-01-001

CLITORAL AND VAGINAL BLOOD FLOWS ARE SIMILARLY REDUCED IN OLD SPONTANEOUSLY HYPERTENSIVE RATS AND OLD WISTAR-KYOTO RATS Castiglione, F.1; Salonia, A.1; Montorsi, F.2; Rigatti, P.3; Hedlund, P.4 University Vita-Salute San Raffaele, Urology, Milan, Italy; 2IRCCS San Raffaele, Milano, Italy; 3Milano, Italy; 4 Lund University, Sweden

1

Objective: Cardiovascular disease is a risk factor for urogenital dysfunctions. In the current investigation, we aimed to study blood flow of the vagina and clitoris in 12-month-old spontaneously hypertensive rats (SHR) and aged-matched Wistar-Kyoto rats (WKY) in comparison to young (3-month-old) WKY rats. Methods: After ethical permission, 12-month-old female SHR (N = 5), WKY (N = 5) and 3-month-old WKY (N = 6–7) were used for recordings of vaginal and clitoral blood flows by Doppler (tissue perfusion units; TPU) during activation of the dorsal clitoral nerve (DCN). Simultaneously, direct mean arterial blood pressure (MAP) was recorded via the carotid artery. Values were analyzed in an anova and are given as mean ± SEM. Results: MAP amounted to 190 ± 12, 166 ± 16, and 122 ± 11 cmH2O in old SHR, old WKY, and young WKY (P < 0.05), respectively. Voltage-dependent (2.5, 5, 7.5 V) blood flow responses to DCNactivation were obtained in all rats. Peak clitoral blood flows were 0.03 ± 0.01 (2.5 V), 0.07 ± 0.02 (5 V) and 0.09 ± 0.03 TPU/MAP (7.5 V) in SHR. Corresponding values in old WKY (ns vs. old SHR) were 0.04 ± 0.01 (2.5 V), 0.08 ± 0.03 (5 V), and 0.10 ± 0.03 TPU/MAP (7.5 V). In young WKY, clitoral flow amounted to 0.08 ± 0.01 (2.5 V; P < 0.05 vs. SHR and old WKY), 0.15 ± 0.03 (5 V; P = 0.07 vs. old SHR and old WKY) and 0.17 ± 0.04 TPU/MAP (7.5 V; ns). Vaginal peak flows amounted to 0.05 ± 0.02 (2.5 V), 0.11 ± 0.03 (5 V), and 0.11 ± 0.03 TPU/MAP (7.5 V) for old SHR. In old WKY (ns vs. old SHR), vaginal peak flows were 0.03 ± 0.01 (2.5 V), 0.03 ± 0.01 (5 V), and 0.04 ± 0.01 TPU/MAP (7.5 V). Corresponding values in young WKY (P < 0.05 old SHR and old WKY) were 0.11 ± 0.02 (2.5 V), 0.22 ± 0.02 (5 V), and 0.28 ± 0.03 TPU/MAP (7.5 V). Conclusion: In comparison to young control rats, old WKY controls and SHR develop similar reductions in genital blood flow. This needs to be considered when evaluating autonomic functions in cohorts with more than one health risk factor. Policy of full disclosure: Swedish Medical Research Council, the Urological Research Institute.

PO-01-002

VAGINAL EPITHELIUM STRUCTURE OF YOUNG WOMEN TREATED WITH TESTOSTERONE COMPARED TO MENOPAUSAL AND PREMENOPAUSAL WOMEN Baldassarre, M.1; Perrone, A. M.2; Giannone, F. A.1; Foschini, M. P.2; Valisella, S.2; De Luca, M. E.2; Alvisi, S.2; Latorre, R.1; Venturoli, S.2; Meriggiola, M. C.2 1 CRBA, S. Orsola-Malpighi Hospital, Bologna, Italy; 2C.I.S.S., S. OrsolaMalpighi Hospital, Bologna, Italy Objective: To date the effects of long-term testosterone (T) administration on the human vagina are poorly understood. The aim of this study was to investigate the effects of long-term T treatment on vaginal histology, proliferation and innervation in female to male

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transsexual subjects (FtM). We compared vaginal samples from FtM subjects with those of pre-menopausal women (PrM) and post menopausal women (M). Methods: Vaginal samples from 9 FtM subjects treated with T (intramuscular injections of 100 mg Testoviron Depot/10 days for at least 1 year), undergoing sex reassignment surgery, and 16 PrM and 9 M subjects undergoing vaginal hysterectomy for prolapse were collected. For each sample, morphology, glycogen content, proliferation (ki-67), Estrogen Receptor α (ERα) expression and innervation as detected by the Protein Gene Product 9.5 (PGP 9.5), were evaluated. Both M and PrM women had not received any hormonal treatment for at least one year. Results: Vaginal samples from FtM showed a loss of normal architecture of the epithelium, intermediate and superficial layers were completely lost and glycogen content was depleted. Testosterone administration resulted in a strong proliferation reduction when compared to both M and PrM subjects. Moreover, stromal and epithelial ERα and stromal PGP 9.5 expression was significantly decreased when compared to PrM subjects. Conclusion: In conclusion our data suggests that exogenous T administration at supraphysiological dosage determines profound changes in histomorphology and reduced proliferation of vaginal epithelium. Policy of full disclosure: None.

PO-01-003

THE EFFECT OF OXYTOCIN ON THE RELAXATION RESPONSE IN ISOLATED RAT VAGINAL TISSUE Lee, H.-S.1; Li, Z.1; Kim, S.-O.1; Lee, M.1; Jung, S. I.1; Park, K.1; Park, J. K.2 1 Chonnam National University, Urology, Gwangju, Korea; 2Chonbuk National University, Urology, Gwangju, Korea Objective: Oxytocin is involved in human reproduction and serves an important role in sexual arousal. Several studies have well documented that serum oxytocin increases during sexual stimulation and arousal in women. The purpose of this study was to investigate the effect of oxytocin on the relaxation response in normal and castrated rat vaginal tissue. Methods: Female Sprague-Dawley rats (230–240 g, N = 30) were divided into three groups: control group (N = 10), bilateral ovariectomy group (Ovx, N = 10), and bilateral ovariectomy followed by subcutaneous injections of 17β-estradiol (Ovx + Est, 50 ug/kg/day, N = 10). After 4 weeks, strips of rat vagina were mounted in organ chambers to measure isometric tension. After the strips were precontracted with phenylephrine (5 × 10-6M), the contractile responses to oxytocin (10-11∼10-5 M), in the presence and absence of nitric oxide inhibitor (N[omega]-nitro-L-arginine methyl ester [L-NAME]) were examined. Results: Oxytocin showed a relaxing effect at low concentrations (1011∼10-9 M), but induced contractile response at high concentrations (10-8∼10-5 M). In the presence of L-NAME (30 uM), the relaxation effects of oxytocin was significantly abolished. In the Ovx groups, the relaxation effects of oxytocin were significantly decreased compared to control and Ovx + Est groups (P < 0.05). Conclusion: These results suggest that oxytocin in a low dose (up to 10-9 M) has a relaxing effect on rat vaginal smooth muscle tissue. These effects might be partly mediated through the NO pathway. Policy of full disclosure: None.

407

Unmoderated Poster Presentations PO-01-004

EFFECT OF TESTOSTERONE ADMINISTRATION ON ANDROGEN RECEPTOR EXPRESSION IN THE HUMAN VAGINA Baldassarre, M.1; Perrone, A. M.2; Giannone, F. A.1; Valisella, S.2; Costantino, A.2; Alvisi, S.2; De Luca, M. E.2; Venturoli, S.2; Meriggiola, M. C.2 1 CRBA, S. Orsola-Malpighi Hospital, Bologna, Italy; 2C.I.S.S., S. OrsolaMalpighi Hospital, Bologna, Italy Objective: Recent data report an important role of testosterone (T) in modulating female sexual responses, but little is known about the expression and distribution of androgen receptor (AR) in the human vagina. The aims of our study were to evaluate the expression of AR in the human vagina in premenopausal (PrM) and menopausal (M) women and in young T treated women. Methods: Vaginal biopsies were obtained from pre- (PrM) and postmenopause (M) women and from women with Gender Identity Disorder (FtM) receiving exogenous T. AR gene and protein expression in vaginal tissues were determined by real-time PCR and Western blot respectively, while the localization of AR in vaginal mucosa and stroma was performed by immunohistochemistry. Results: ARs were detected by immunostaining both in mucosa and stroma. In vaginal mucosa AR density score decreases with age but does not change with T administration. In stromal tissue, AR density score does not change with age but significantly increases with T administration (P < 0.01). AR protein expression was significantly reduced in M compared to PrM subjects (P < 0.05) and increased with T administration (P < 0.001). The expression of AR mRNA evaluated by Real-time PCR showed a significantly higher mRNA expression in FtM vs. M patients (P < 0.01) and in PrM vs. M subjects (P < 0.05). Conclusion: We found AR protein and mRNA expression both in the epithelium and stroma of the human vagina in all groups of women. A negative correlation exists between age and AR expression in vaginal mucosa. T administration increases AR expression in both mucosa and stroma. Policy of full disclosure: None.

PO-01-005

GENOMIC, STRUCTURAL AND FUNCTIONAL EXPRESSION OF A DISTINCT SET OF CHEMOKINE-RECEPTORS MAY BE RESPONSIBLE FOR HOMING OF ADIPOSE TISSUE-DERIVED STEM CELLS TOWARDS THE MAJOR PELVIC GANGLION FOLLOWING CAVERNOUS NERVE INJURY Albersen, M.1; Dekoninck, P.2; Berkers, J.1; Van Haute, C.1; Zia, S.2; Deprest, J.2; De Ridder, D.1; Van der Aa, F.1 1 University Hospitals Leuven, Experimental Urology, Belgium; 2University Hospitals Leuven, Experimental Gynecology, Belgium Objective: We have recently demonstrated the essential role of adipose tissue-derived stem cell (ADSC) recruitment towards the major pelvic ganglion (MPG) in rats following cavernous nerve injury (CNI). We showed upregulation of the chemokines CCL2,22,28, CXCL12, CX3CL1 and XCL1 in the MPG following CNI. The objective of this study was to examine chemokine receptor (CR) expression in human ADSC to identify chemokines and their receptors responsible for this migratory process. Methods: Human ADSC were isolated from subcutaneous adipose tissue of five consenting donors. ADSC were cultured up till passage 5 (p5) and characterized by FACS and differentiation potential toward adipogenic and osteogenic lineages. Cells were subjected to qPCR for all 21 known CRs. These results were validated by FACS and intracellular FACS. Functional activation of CR in ADSC was tested with CCL2,11,19,28; CX3CL1, XCXL12 and XCL1 by calcium-imaging and controlled by actin polymerization assay.

Results: RNA for CRs CCR1,3,4,10; CX3CR1; CXCR4,6,7; XCR1; CCRL1,2 was detected by qPCR at p5. Validation by FACS at p5 showed very low membranous CR expression, however, intracellular FACS indicated high expression of CCR4,10, CX3CR1; CXCR6,7 and XCR1 at p5, and of all qPCR-detected CRs except CCRL1 and 2. Functional activation by calcium imaging was present for CCL2 (binds to CCR4), CCL28 (CCR10), CX3CL1 (CX3CR1) and XCL1 (XCR1). Responses were more pronounced at p0 than at p5. CCL11 (CCR3) evoked insignificant responses, and CCL19 (CCR7) did not induce calcium influx. These results were corroborated by an actin polymerization assay under fluorescence microscopy. Conclusion: We identified the ligand-CR pairs CCL2-CCR4, CCL28-CCR10, CX3CL1-CX3CR1 and XCL1-XCR1 as potentially responsible for ADSC homing towards the MPG following CNI. Surprisingly, CXCR4-SDF1 (CXCL12), is not likely a major homing factor for ADSC, as previously proposed. Modification of expression of these receptors in ADSC could improve homing and thus treatment efficacy. Policy of full disclosure: None.

PO-01-006

NITRERGIC INNERVATION OF VASA NERVORUM SUPPLYING THE MAJOR PELVIC GANGLION Cellek, S.1; Smith, S.2; Cameron, N.3; Cotter, M.3; Muneer, A.4 Cranfield University, Cranfield Health, UK; 2University of Cambridge, UK; 3University of Aberdeen, UK; 4Institute of Urology, London, UK

1

Objective: Vasa nervorum are small diameter blood vessels that supply blood to main nerve trunks and ganglia. Although vasa nervorum have been known to be innervated by autonomic nerves, the expression of neuronal nitric oxide (nNOS), a key enzyme in vasodilation and erectile function, has not been studied. Dysfunctional vasa nervorum has been suggested to cause microvascular deficit and neurodegeneration in the major pelvic ganglia (MPG) of diabetic rats. Our aim was therefore to investigate the expression of nNOS in the nerve fibers innervating the vasa nervorum of MPG in control and diabetic rats. Methods: The MPG were obtained from 12-week streptozotocininduced diabetic rats and non-diabetic rats, fixed in paraformaldehyde, frozen and processed for immunohistochemistry. The expression of nNOS, nerve fiber markers such as PGP9.5 and blood vessel markers such as collagen-IV were investigated using immunofluorescence. Results: The results show that small diameter blood vessels (20–100 um) are innervated by a rich network of nerve fibers, most of which are nNOS positive. The difference in the innervation pattern between non-diabetic and diabetic animals has also been investigated. Conclusion: To our knowledge this is the first demonstration of nitrergic innervation of vasa nervorum. Policy of full disclosure: None.

PO-01-007

THE EFFECTS OF CHARD EXTRACT ON ACCUMULATION OF PENILE FREE OXYGEN RADICALS IN STREPTOZOTOCIN-INDUCED DIABETES Aydin, M.1; Kadihasanoglu, M.2; Kabasakal, L.3; Ipci, Y.3; Saçan, Ö.4; Yanardag, R.4; Sener, G.3; Kendirci, M.5 1 Etfal Hospital, Department of Urology, Istanbul, Turkey; 2Şişli Etfal Hospital, Department of Urology, Istanbul, Turkey; 3Marmara U. Faculty of Pharmacy, Department of Pharmacology, Istanbul, Turkey; 4Istanbul University, Faculty of Engineering, Turkey; 5Istanbul Surgery Hospital, Department of Urology, Turkey Objective: Accumulation of free oxygen radicals (SOR) in the penis plays a pivotal role in diabetes-related erectile dysfunction (ED) by cavernosal endothelial damage, cavernosal neuropathy and reduced bioavailability of nitric oxide. The goal of this study was to elucidate

J Sex Med 2011;8(suppl 5):406–469

408 the effects of normoglicemic chard extract (Beta vulgaris L. var. cicla) on oxidative damage in the penis in an animal model of stretptozotocin-induced diabetic ED Methods: Adult male Spraque-Dawley rats were divided into four groups: control, diabetic, diabetes + chard, and diabetes + insulin. Rats were subjected to intraperitoneal streptozotocin (60 mg/kg) to induce diabetes. Chard extract (2 g/kg) was given orally for 28 days beginning on the 14th day of the study. At 2 months, erectile functions were evaluated by cavernosal nerve stimulation. Penile tissues were studied for cavernosal glutathione (GSH), a key antioxidant and malondialdehyde (MDA), an end-product of lipid peroxidation, levels. P < 0.05 was considered as significant. Results: Diabetes caused significant decreases in GSH levels (P < 0.01), while MDA levels were significantly increased (P < 0.01), demonstrating oxidative damage in the penis. Chard extract treatment significantly reversed the elevations in the MDA levels (P < 0.01), while reduced GSH levels were reversed back to the control levels (P < 0.01). In addition, cavernosal nerve-mediated measurements of erectile function were significantly reduced in diabetes (P < 0.05). However, treatment with chard extract did not improve erectile functions in vivo in diabetic animals. Conclusion: These data demonstrated that oxidative damage in diabetes resulted in diminished erectile function. Treatment with chard extract may prevent corpora cavernosa from oxidative damage by reducing SOR accumulation and increasing antioxidant capacity Policy of full disclosure: None.

PO-01-008

OXIDATIVE STRESS-INDUCED ALTERATIONS IN HUMAN DIABETIC CAVERNOSAL TISSUE Castela, A.1; Soares, R.2; Van Antwerpen, P.3; Zouaoui Boudjeltia, K.4; Roumeguere, T.5; Gomes, P.2; Vendeira, P.6; Virag, R.7; Costa, C.2 1 University of Porto, Institute for Molecular and Cell, Portugal; 2University of Porto, Dep of Biochemistry (U38-FCT), Portugal; 3Faculty of Pharmacy, Universite Libre de Bruxelles, Brussels, Belgium; 4Lab de Médecine Expérimentale, ULB 222 Unit, Montigny-le-Tilleul, Belgium; 5Department of Urology, Erasme Hospital, ULB, Brussels, Belgium; 6University of Porto, IBMC, Portugal; 7Centre d’Exploration et, Traitement de l’impuissance, Paris, France Objective: Erectile Dysfunction (ED) is a prevalent complication of diabetes. Increased oxidative stress (OS) exerts deleterious actions in diabetic penile tissue leading to the progression and development of diabetic-ED. However, it is still under investigation the effects of OS in human diabetic corpus cavernosum (CC). We aimed to evaluate/ quantify the OS markers 3-nitrotirosine (3-NT) and myeloperoxidase (MPO) in cavernosal tissue of diabetic patients with ED. Methods: Fragments of CC were collected during surgery from 18 diabetic patients with ED and 10 non-diabetic non-ED individuals. Generation of oxidative lesions in CC samples was evaluated by the detection of 3-NT and MPO, using double immunofluorescence for 3-NT/α-smooth muscle actin (α-SMA) and MPO/α-SMA. Quantitative analysis of immunostaining intensity of these oxidative biomarkers was performed by ImageJ color deconvolution. Results: Our results revealed that the expression of 3-NT and MPO was predominantly localized perivascularly in cavernosal tissue of diabetic ED and non-diabetic non-ED samples. Immunohistochemical quantification showed a significant increase of 3-NT (diabetic group: 109.6 ± 4.13 vs. non-diabetic controls: 89.9 ± 1.31; P < 0.01) and MPO (diabetic group: 128.9 ± 2.32 vs. non-diabetic controls: 112.6 ± 2.45; P < 0.001) expression levels in diabetic erectile tissue, indicating prominent OS effects in diabetic penile tissue. Conclusion: These preliminary data suggest that OS-induces modifications in proteins in penile smooth muscle and endothelial components. In addition, increased MPO may hamper nitric oxide bioactivity in perivascular cells. Both alterations may be responsible for altering cavernosal smooth muscle and endothelial cellular processes contributing to diabetic-ED. Policy of full disclosure: None.

J Sex Med 2011;8(suppl 5):406–469

Unmoderated Poster Presentations PO-01-009

PROTECTIVE EFFECT OF CYANIDIN-3-O-βD-GLUCOPYRANOSIDE CONCENTRATION MATERIALS FROM MULBERRY FRUIT PIGMENT AGAINST OXIDATIVE DAMAGE IN STREPTOZOTOCIN-INDUCED DIABETIC RAT BLADDER Choi, Y. S.1; Kim, S. J.2; Ahn, T. Y.3; Bae, W. J.1; Cho, H. J.1; Hong, S. H.1; Lee, J. Y.1; Hwang, T.-K.1; Kim, S. W.1 1 Department of Urology, The Catholic University of Korea, Col, Seoul, Korea; 2Seoul St. Marys Hospital, Urology, Korea; 3Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea Objective: To determine whether C3G (Cyanidin-3-O-β-dglucopyranoside) concentration materials from mulberry fruit pigment has protective effects or not on streptozotocin-induced diabetic rats in bladder dysfunction, with interrelationships between oxidative stress and apoptosis. Methods: Sprague-Dawley rats (12 weeks old) were divided into three groups (N = 12 in each): normal control, diabetes (DM), and diabetes with C3G concentration materials treatment (DM + C3G). DM and DM + C3G group received a single injection of streptozotocin (50 mg/ kg), and 4 weeks after induction of diabetes, DM + C3G group were treated with daily C3G (10 mg/kg) dissolved in water for 8 weeks. After 12 weeks of streptozotocin injections, rats in each group underwent cystometrograms (CMG) and then the bladder tissues were sampled. Results: DM group showed markedly lower maximal intravesical pressure than that in the control group, whereas rats in the DM + C3G group showed improved maximum intravesical pressure by minimizing apoptosis based on TUNEL assay and increased level of Akt and Bad phosphorylation, implying inhibition of pro-apoptotic stimuli (see figure below). A significant increase in 8-hydroxy-2-deoxyguanosine (8-OHdG), the predominant marker of oxidative damage, was shown in the DM group compared with the normal group. In DM + C3G group; however, 8-OHdG was statistically significantly reduced compared with DM group. With respect to Superoxide dismutase protein, western blot analysis revealed a significant decrease in DM group compared with the control group; however, it was expressed more in DM + C3G group than in the control group (see figure below). Conclusion: The current study is the first to suggest that C3G concentration materials may have a potency to protect bladder under conditions of diabetes-induced oxidative stress. Policy of full disclosure: None.

409

Unmoderated Poster Presentations PO-01-010

THE EFFECTS OF NEW HERBAL FORMULA (KBMSI-2) ON PENILE ERECTION AND EXPRESSION OF NITRIC OXIDE SYNTHASE ISOFORMS IN STREPTOZOTOCIN-INDUCED DIABETIC RAT MODEL Yoon, B. I.; Bae, W. J.; Kim, S. J.; Kim, S. W.; Ha, U. S. The Catholic University, Urology, Seoul, Korea Objective: The aim of this study was designed to investigate the effects of new herbal formula (KBMSI-2) on erectile dysfunction in streptozotocin-induced diabetic rat model. Methods: Twenty-four Sprague-Dawley male rats were randomly divided into three groups; control (N = 8), diabetes (DM) (N = 8), DM + KBMSI-2 200 mg/kg treatment (N = 8) groups. The DM induced groups received a single intraperitoneal injection of streptozotocin (STZ). Distilled water was administered in the control and DM group. To investigate the penile erection, intracavernosal pressure (ICP) and intracavernosal pressure/mean arterial pressure (ICP/MAP) were recorded in all groups. Serial sections of the penis were used to perform Masson’s trichrome stain. We analyzed the expression of nitric oxide synthase (nNOS, eNOS) and cGMP concentration in the isolated corpus cavernosum by western blotting. Results: Peak ICP/MAP ratio was increased in KBMSI-2 treatment group compared with DM group (P < 0.05). Masson’s trichrome staining confirmed that the smooth muscle component was increased in KBMSI-2 treatment group compared with DM group. The nNOS, eNOS and cGMP expression of KBMSI-2 200 mg/kg treatment group was increased compared with DM group by western blotting. Conclusion: This study showed that herbal formula of KBMSI-2 improved the erectile function by preserving the smooth muscle content and inhibiting the fibrosis of the corpus cavernosum in streptozotocin-induced diabetic rat model. Policy of full disclosure: None.

PO-01-011

NATURAL PIGMENT EXTRACTED FROM MULBERRY FRUIT CONTAINING CYANIDIN3-O-ß-D-GLUCOPYRANOSIDE HAS A POTENCY TO PROTECT ERECTILE FUNCTION BY MINIMIZING OXIDATIVE STRESS IN A RAT MODEL OF DIABETIC ERECTILE DYSFUNCTION Bae, W. J.1; Kim, S. J.2; Ahn, T. Y.3; Choi, Y. S.1; Cho, H. J.1; Hong, S. H.1; Lee, J. Y.1; Hwang, T.-K.1; Kim, S. W.1 1 Department of Urology, The Catholic University of Korea, Col, Seoul, Korea; 2Seoul St. Marys Hospital, Urology, Korea; 3Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea Objective: The aim of the present study was to determine the effects of the natural pigment with mulberry fruit containing mainly C3G on erectile responses in diabetic rats, evaluating its protective effects on erectile function and its ability to reverse an established case of ED. Methods: Sprague-Dawley rats (12 weeks old) were divided into three groups (N = 12 in each): normal control, diabetes mellitus (DM), and diabetes treated with natural pigment containing C3G (DM + C3G). The rats in the diabetic groups received a single injection of streptozotocin (50 mg/kg), and from 4 weeks after establishment of diabetes, DM and DM + C3G were treated with vehicle and natural pigment (10 mg/kg), respectively, for 8 weeks. After 12 weeks of DM induction, intracavernosometry was performed in all rats and corpora tissues were harvested to perform a TUNEL assay for apoptotic index, ELISA for quantifying the levels of 8-hydroxy-2-deoxyguanosine (8-OHdG), and western blot for for eNOS, nNOS and SOD protein expression. Results: In comparison with the DM group, rats in the DM + C3G group showed significant improvement in parameters for erection (peak ICP, ICP/MAP), apoptotic index, and NO bioactivity (eNOS and nNOS). Decrement for 8-OHDG and increment for SOD in DM

+ C3G meant natural pigment treatment may protect erectile function, probably by minimizing oxidative damage to endothelial and neuronal function for erection in a rat model of diabetic ED. Conclusion: The current study is the first to suggest that natural pigment containing C3G treatment might have a potency to protect erectile function in condition of diabetic oxidative stress. Policy of full disclosure: None.

PO-01-012

THE EFFECTS OF ORAL TREATMENT OF L-CITRULLINE ON ERECTILE FUNCTION IN CASTRATED RATS Hotta, Y.1; Kataoka, T.1; Shiota, A.1; Ohno, M.1; Maeda, Y.1; Morita, M.2; Hara, T.2; Kimura, K.1 1 Nagoya City University, Japan; 2Kyowa Hakko Bio Co. Ltd., Tsukuba, Japan Objective: L-Citrulline is converted into arginine and increases the production of nitric oxide. We investigated whether oral administration of L-Citrulline was effective on erectile dysfunction followed by hypogonadism using castrated rats. Methods: Fifteen-week-old male rats were divided into three groups: (i) Control; (ii) Castration (Cast); and (iii) Cast + L-Citrulline (Cast + Cit). Rats in the Cast and Cast + Cit groups underwent surgical castration. Rats in Cast + Cit groups were treated with 2% L-Citrulline in drinking water for 4 weeks after surgery. Rats in Control group were underwent sham surgery. After 4 weeks after surgery, we evaluated bioavailable-testosterone (Bio-T), erectile function, and serum NOx levels. Bio-T was measured with LC-MS/MS. Erectile function was assessed based on changes in intracavernous pressure (ICP) by electrical stimulation of cavernous nerve and calculated maximum ICP/mean arterial pressure (MAP). Serum NOx levels were measured by HPLC. Bonferroni’s multiple t-test was used as statistical analysis. Results: In both Cast and Cast + Cit groups, Bio-T was decreased compared with Control group at 4 weeks after surgery. ICP/MAP in Cast group was significantly decreased compared with Control group. ICP/MAP in Cast + Cit group was not significantly but increased compared with Cast group. Serum NOx levels were decreased in Cast group compared with in Control group. The levels in Cast + Cit group were increased compared with in Cast group. Conclusion: The oral treatment of L-Citrulline might be useful for erectile dysfunction in castrated rats, and is expected to become a novel therapy for erectile dysfunction with hypogonadism. Policy of full disclosure: None.

PO-01-013

HYPOGONADISM AND PENILE ARTERIAL DISEASE ARE ADDITIVELY ASSOCIATED WITH INCREASED AORTIC STIFFNESS AND CAROTID INTIMA MEDIA THICKNESS Ioakeimidis, N.; Vlachopoulos, C.; Rokkas, K.; Terentes-Printzios, D.; Samentzas, A.; Synodinos, A.; Abdelrasoul, M.; Aznaouridis, K.; Askitis, T.; Stefanadis, C. Athens Medical School, 1st Department of Cardiology, Greece Objective: Aortic stiffness and carotid intima media thickness (IMT) are markers of CV risk. Hypogonadism (HypG) and penile arterial insufficiency (AI) are reliable measures for predicting CV disease in erectile dysfunction (ED) patients. We examined whether there is an additive association among these parameters and early changes in arterial structure and function. Methods: Carotid–femoral pulse wave velocity (c-f PWV), IMT and penile peak systolic velocity (PSV) were measured in 205 consecutive ED patients without manifest CV disease. PSV below 35 cm/second was considered to indicate AI. Total testosterone (TT) levels were measured in all patients. HypG was defined when TT levels were below 3.4 ng/mL.

J Sex Med 2011;8(suppl 5):406–469

410 Results: Patients with AI compared to subjects without AI had higher age and risk factors adjusted c-f PWV and IMT (by 0.36 m/s and 0.07 mm, respectively, all P < 0.01). Patients with HypG had increased c-f PWV and IMT compared to men with normal TT (by 0.95 m/s, P < 0.001 and 0.05 mm, P < 0.05, respectively). ED patients were categorized by PSV (normal PSV, AI) and further subdivided according to TT (normal TT and HypG) (see figure below). In patients with normal TT, AI compared with normal penile arterial function was accompanied by increased c-f PWV and IMT (by 0.40 m/s and 0.06 mm, respectively, all P < 0.05). Similarly in men with HypG, AI compared with normal penile arterial function was related to heightened c–f PWV and IMT (by 0.82 m/s, P < 0.01 and 0.10 mm, P < 0.05, respectively). Patients with both HypG and AI had the highest c–f PWV and IMT compared to all the other groups. Conclusion: Severely impaired penile vascular circulation in conjunction with low TT is additively associated with increased aortic stiffness and carotid IMT. Policy of full disclosure: None.

PO-01-014

THE PROSTATE AFTER ANABOLIC ANDROGENIC STEROIDS: A MORPHOMETRICAL STUDY IN RATS Sampaio, F.1; Vargas, R.1; Oliveira, L.2; Frankenfeld, S.2; De Souza, D.3; Costa, W.1; Favorito, L.1 1 Urogenital Research Unit, UERJ, Rio de Janeiro, Brazil; 2UFRJ, Rio de Janeiro, Brazil; 3Rio de Janeiro, Brazil Objective: This study aims to assess the morphological modifications in the prostate ventral lobe of rats chronically treated with supraphysiological doses of anabolic androgenic steroids using morphometric methods. Methods: Eight male Wistar rats with 105 days of age were used in this experimental study. Animals were assigned as control rats (N = 4) injected with peanut oil or treated rats (N = 4) injected with nandrolone decanoate (10 mg/kg). Both the steroid hormone and the vehicle were administered by intramuscular injection once a week for eight weeks. With 161 days of age, the rats were killed and ventral lobe of the prostate was dissected and processed for histology. The height of the acinar epithelium was measured in micrometers in photomicrographs of 400× magnification. The surface density of lumen, epithelium and stroma were calculate by the pointing intercepts method, with a grid of 100 points superimposed to 200× magnified images. All analyses were performed with the ImageJ software. Student’s t-test was used for mean comparisons. In all cases, significance was set at 0.05. Results: The height of the epithelium increased by 7.6% in treated animals when compared to controls (P < 0.0001). Corroborating to this finding, the surface density of epithelium was raised by 20% (P < 0.001). Concerning both lumen and stroma surface density, treated groups presented a reduction of 9% (P = 0.009) and 16% (P = 0.02), respectively. Conclusion: The use of anabolic androgenic steroids in rats promotes structural changes in the prostate. Policy of full disclosure: None.

J Sex Med 2011;8(suppl 5):406–469

Unmoderated Poster Presentations PO-01-015

EFFECT OF THE ETHANOL ON THE ERECTILE FUNCTION IN THE RAT Hyun, J. S.1; Kam, S.1; Moon, K. H.2 College of Medicine, Gyeongsan, Urology, Jinju, Korea; 2Yeungnam University, College of Medicine, Daegu, Korea

1

Objective: Alcohol consumption is associated with the erectile function. However, the effect of ethanol (ETOH) on penile tissue is not fully understood. We investigated the acute and chronic effects of ETOH on corporal tissue in the rat. Methods: To examine the acute effect of ETOH, the rats were divided into a control group and four experimental groups (1 hour, 2 hours, 4 hours, and 6 hours after injected the ETOH). To examine the chronic effect of ETOH, the rats were divided into a control group (oral intake normal saline, 3 g/Kg, 4 weeks) and experimental groups (oral intake 15% ETOH, 3 g/kg, 4 weeks). The ICP/BP response to cavernosal nerve stimulation was assessed. And the concentration of released cGMP and cAMP were measured. Results: In acute ETOH study, the percentage of ICP/BP of the normal control group was 71.6 ± 4.8 (N = 7), the four experimental groups (1 hour, 2 hours, 4 hours, and 6 hours after injected the ETOH) were 79.3 ± 8.3 (N = 7), 86.6 ± 7.6 (N = 7), 74.6 ± 7.3 (N = 7), and 75.1 ± 5.2 (N = 7). The percentage of ICP/BP of experimental group (2 hours) only was statistically higher than the control group (P < 0.05). The concentration of cAMP of experimental group (2 hours) was statistically higher than the control group (control group N = 6, 4.56 ± 1.14 pmol/mL vs. 2 hours 13.30 ± 4.92 pmol/mL) (P < 0.05). In chronic ETOH study, the percentage of ICP/BP of the normal control group was 84.0 ± 4.0 (N = 6), the experimental group was 88.5 ± 6.5 (N = 6) (P > 0.05). The concentration of cAMP and cGMP were not statistically higher than the control group (P > 0.05). Conclusion: Acute effect of ETOH was improved the percentage of ICP/BP, and increased cAMP concentration in the corpus cavernosum of the rat. It can be one of the mechanisms for erectile function after alcohol drinking. Policy of full disclosure: None.

PO-01-016

A COMPARISON BETWEEN RADIOTELEMETRIC ASSESSMENT OF INTRACAVERNOSAL PRESSURE AND INTRASPONGIOSAL PRESSURE FOR EVALUATING APOMORPHINE-INDUCED ERECTION IN RATS Lee, J. H.1; Lee, S. W.1; Ko, M.1; Chae, M. R.1; Kam, S. C.2; Park, J. K.3; Jeon, J. H.4; So, I.4 1 Samsung Medical Center, Urology, Seoul, Korea; 2Gyeongsang National University, Jinju, Korea; 3Jeonbuk National University, Jeonju, Korea; 4 Seoul National University, Korea Objective: A recording the intracavernosal pressure (ICP) in conscious rats using telemetry has the advantage of being able to evaluate erection under physiological conditions. Recently, intraspongiosal pressure (ISP) recording has been introduced and has some advantages over ICP recording. The Aim of this study was comparing ICP and ISP monitoring and determining the appropriate method for assessing erectile function. Methods: Eight rats were assigned to the normal group (4 for ICP and 4 for ISP monitoring), and another eight were assigned to the hypercholesterolemia group (4 for ICP and 4 for ISP monitoring). A telemetric pressure sensor was implanted in the corpus cavernosum and spongiosum. Pressure was recorded in freely moving animals during apomorphine-induced erection tests. Only the pressure increase occurring during sexual behavior was analyzed. Results: In ICP recording, mean latency, mean duration of each episode, mean ICPMax, mean AUC, and mean summed AUC were 326.8 ± 62.7 seconds, 61.6 ± 8.5 seconds, 119.2 ± 22.7 mm Hg, 2010.1 ± 491 mm Hg·s, and 3741.7 ± 1035.4 mm Hg·s, respectively, for the

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Unmoderated Poster Presentations normal group vs. 602.9 ± 147.2 seconds, 43.8 ± 9.0 seconds, 84.0 ± 10.0 mm Hg, 635.2 ± 159.1 mm Hg·s, and 701.4.7 ± 168.6 mm Hg·s, respectively, for the hypercholesterolemia group. There was a significant difference in mean latency, mean AUC, and mean summed AUC. In ISP recording, the pressure change in erection behavior included simple peaks without a baseline pressure increase. Therefore, it is impossible to calculate duration, AUC, and summed AUC. In addition, a similar pressure change appeared even before apomorphine injection, and this change did not correspond with sexual behavior. Conclusion: ICP recording provided consistent and accurate data, whereas ISP recording was difficult to identify changes of pressure during erection due to its artifact. We conclude that ICP recording is more accurate than ISP recording for assessing erectile function. Policy of full disclosure: This study was supported by a grant from the Korean Health Technology R&D Project, the Ministry for Health, Welfare & Family Affairs, Republic of Korea (A090583).

PO-01-017

THE EFFECTS OF THE COMBINED USE OF A PHOSPHODIESTERASE TYPE 5 INHIBITOR AND MEDICATIONS FOR HYPERTENSION, LOWER URINARY TRACT SYMPTOMS, AND DYSLIPIDEMIA ON CORPORAL TISSUE TONE Lee, J. H.1; Chae, M. R.1; Park, J. K.2; Jeon, J. H.3; Lee, S. W.1 Samsung Medical Center, Urology, Seoul, Korea; 2Jeonbuk National University, Urology, Jeonju, Korea; 3Seoul National University, Korea

1

Objective: Erectile dysfunction (ED) is closely associated with its comorbidities (hypertension, dyslipidemia, and lower urinary tract symptoms (LUTS)). To establish theoretical basis of choosing an appropriate medication for ED and concomitant disease, we examined the effects combining a PDE5I with representative drugs for hypertension, dyslipidemia, and LUTS in organ baths using rabbit corpus cavernosal (CC). Methods: Concentration-response-curves (CRC) of mirodenafil were generated on 10-5 M phenylephrine-precontracted strips before and after preincubation of losartan, amlodipine, nifedipine, enalapril, doxazosin, tamsulosin, or simvastatin. CRC of sodium nitroprusside before and after preincubation of losartan were conducted to determine the losartan/nitric oxide interaction on CC. We also generated CRC of mirodenafil and alpha adrenergic blocksers before and after preincubation of 1 mM tetraethylammonium to determine role of potassium channel opening in synergistic effect. Results: The relaxing effect of mirodenafil was significantly enhanced by the presence of 10-4 losartan, 10-6 nifedipine, 10-6 amlodipine, 10-7 doxazosin, and 10-9 M tamsulosin (P < 0.05). The maximum relaxation effects were 47.2 ± 3.8%, 57.6 ± 2.6%, 64.0 ± 3.7%, 76.1 ± 5.7%, and 71.7 ± 5.4%, respectively. Enalapril and simvastatin had no enhancing effects. The relaxation by sodium nitroprusside alone (39.0 ± 4.0%) was significantly enhanced in the presence of the 10-4M losartan (66.0 ± 6.0%, P < 0.05). Tetraethylammonium significantly inhibited the enhancement effects of tamsulosin and doxazosin on mirodenafil-induced relaxation (doxazosin: 76.1 ± 5.7% vs. 45.3 ± 2.3%; tamsulosin: 71.7 ± 5.4% vs. 48.1 ± 3.5%). Conclusion: Amlodipine, nifedipine, losartan, doxazosin, and tamsulosin enhanced relaxation effect of mirodenafil. Losartan seems to exert synergistic effect by interaction with nitric oxide. And potassium channel opening effect of PDE5I and alpha adrenergic blocker could be one of mechanism for their synergistic effect. We believe that the combination of a PDE5I with aforementioned drugs could be a pharmacologic strategy for simultaneously treating ED and its comorbidities and increasing response rates to PDE5I. Policy of full disclosure: This study was supported by a grant from the Korean Health Technology R & D Project, Ministry for Health &Welfare, Republic of Korea (A090583).

PO-01-018

HIGH BLOOD PRESSURE ACCELERATES PENILE ARTERIAL INSUFFICIENCY IN YOUNG ERECTILE DYSFUNCTION PATIENTS: A WINDOW OF OPPORTUNITY FOR PREVENTING VASCULAR DISEASE Rokkas, K.; Vlachopoulos, C.; Ioakeimidis, N.; Samentzas, A.; Terentes-Printzios, D.; Synodinos, A.; Aggelis, A.; Aznaouridis, K.; Askitis, T.; Stefanadis, C. Athens Medical School, 1st Department of Cardiology, Greece Objective: The incidence of erectile dysfunction (ED) increases with age. Hypertension is a common risk factor for ED. Reduced penile peak systolic velocity (PSV), an established index of ED severity, is associated with increased risk for cardiovascular events as well as the degree and distribution of atherosclerotic lesions. Aim of this study is to evaluate the influence of high blood pressure (BP) on the association between age and penile blood flow. Methods: A total of 235 consecutive non-diabetic ED patients without manifest cardiovascular/atherosclerotic disease underwent penile Doppler ultrasonography during the dynamic phase (10 μg prostaglandin E1). Results: ED patients were categorized by BP (normal, Grade I and Grade II/III hypertension) and further subdivided according to age (<60 years and ≥60 years). Left figure below shows a graphical representation of PSV according to age and BP categories. PSV decreased with age and BP category; the decrease with age being more pronounced for higher BP categories and the decrease with BP being more important for older subjects. Interestingly, subjects younger than 60 years with hypertension had already decreased PSV, compared with older men with normal BP. Penile PSV was inversely correlated with age (P < 0.001). In the right figure below, regression lines denote the results of linear regression on age for different BP categories. The decrease in PSV with age was more pronounced when the levels of BP increased and the accelerate effect of high BP on age was visible among patients with Grade II/III hypertension (R square = 0.196, P < 0.001). Conclusion: This study provides data regarding the effect of both age and BP on penile blood flow. Our data presented here allow identification of young hypertensive men in whom PSV is low and who might warrant more intensive follow-up. Policy of full disclosure: None.

PO-01-019

EFFECTS OF CHRONIC STRESS ON PENILE CORPUS CAVERNOSUM OF RATS Sampaio, F.1; De Souza, D.2; Silva, D.3; Cortez, C.3; Costa, W.1 Urogenital Research Unit, UERJ, Rio de Janeiro, Brazil; 2Rio de Janeiro, Brazil; 3UERJ, Rio de Janeiro, Brazil

1

Objective: To investigate if prepubertal chronic stress may promote structural changes in the penile corpus of rats. Methods: For this experimental basic study, eight Wistar rats were assigned into the stress group (SG) and were submitted to 2 hours of tube restraint daily, from the 4th to the 9th week of life. Other 7 rats were used as the control group (CG). All animals were weighed weekly. At day 64, animals were sacrificed by anesthetic overdose, blood was collected for testosterone dosage by radioimmunoassay, and penis and

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412 adrenal were collected. Adrenal mass index and testosterone serum levels were used to assess the efficacy of the stress stimulus. The surface density of connective tissue and smooth muscle fibers of corpus cavernosum were measured on Masson’s trichromic stained slices. Picrosirius red stained slices were assessed under polarized light for differentiate types of collagen. Student’s t-test was applied for mean comparisons, considering P < 0.05 significant. Results: Testosterone serum concentration decreased and adrenal mass index increased, confirming the effectiveness of the stress protocol. Smooth muscle fibers of corpus cavernosum decreased from 14.07% (CG) to 8.98% (SG) (P = 0.02) and connective tissue increased from 53.66% (CG) to 64.47% (SG) (P = 0.01). Also, in SG there was a higher predominance of type I collagen compared to CG. These results indicate that the corpus cavernosum morphology is altered in the chronically stressed individuals. Conclusion: Stress stimuli induced structural changes in the corpus cavernosum of rats, suggestive of penile fibrosis, which may play a role in erection dysfunction of stressed idividuals. Policy of full disclosure: None.

PO-01-020

AVANAFIL, A HIGHLY SELECTIVE PHOSPHODIESTERASE TYPE 5 INHIBITOR FOR THE TREATMENT OF ERECTILE DYSFUNCTION: SELECTIVITY FOR ELEVEN PDE ISOZYMES, IN COMPARISON WITH SILDENAFIL, TADALAFIL, AND VARDENAFIL Wang, R.1; Burnett, A.2; Omori, K.3; Kotera, J.4; Kikkawa, K.4; Yee, S.5; Didonato, K.6; Day, W.5 1 University of Texas Med School, MD Andersen Cancer Center, Houston, USA; 2The Johns Hopkins Hospital, Baltimore, USA; 3Mitsubishi Tanabe Pharma Corpo, Kanagawa, Japan; 4Mitsubishi Tanabe Pharma Corpo, Saitama, Japan; 5VIVUS, Inc., Mountain View, USA; 6Redwood City, USA Objective: Phosphodiesterase type 5 (PDE5) inhibitors are indicated for treatment of erectile dysfunction (ED); however, they can also inhibit other PDE isozymes and affect their target tissues (eg, PDE1: heart; PDE6: retina; PDE11: skeletal muscle and testis). Avanafil, a novel PDE5 inhibitor under investigation for treatment of ED, is rapidly absorbed from the gastrointestinal tract (Tmax 30–40 minutes) and has a relatively short (3–5 hours) half-life. An in vitro study was conducted to compare the inhibitory effects of avanafil with that of sildenafil, tadalafil, and vardenafil. Methods: PDE isozymes were isolated from animal tissue (PDE1– PDE6 and PDE10) or produced in transfected COS-7 cells as recombinant proteins (PDE7–9 and PDE11). The inhibitory effects (IC50) and selectivity (fold difference, vs. PDE5) of avanafil, vardenafil, sildenafil and tadalafil for 11 PDE isozymes were determined. Results: Avanafil strongly inhibited PDE5 (IC50 = 5.2 nM) in a competitive manner (IC50: for sildenafil, vardenafil, and tadalafil = 1.6 nM, 0.084 nM, and 4.0 nM, respectively) and had high selectivity against all other PDE isozymes (see table below). Avanafil showed higher selectivity (120-fold) against PDE6 than sildenafil (15-fold) and vardenafil (20-fold), and higher selectivity (>10,000-fold) against PDE1 compared with sildenafil (375-fold) and vardenafil (1,000-fold). Avanafil also had higher selectivity against PDE 11 (>19,231-fold) compared with sildenafil, vardenafil, and tadalafil. Conclusion: Avanafil exhibited strong specificity towards PDE5, and selectivity against all other PDE isozymes. Higher selectivity against PDE6 is consistent with observations from clinical studies, including a randomized phase 3 trial in which avanafil (50, 100, or 200 mg) treatment was effective for all primary end points with no reports of impairment of color discrimination. These data indicate that the high overall selectivity of avanafil may confer a safety benefit by virtue of its high specificity to PDE5 and selectivity against other PDE isozymes. Policy of full disclosure: There is no financial conflict of interest for Dr. R. Wang, the presenting author. K. DiDonato and W. Day are employees of VIVUS, Inc. and own a stock in the company.

J Sex Med 2011;8(suppl 5):406–469

Unmoderated Poster Presentations

PO-01-021

THE NEUROBIOLOGY OF SEXUAL ORIENTATION—THE GAY BRAIN Goldstein, J. SF Clinical Research Center, San Francisco, CA, USA Objective: Homosexuality is a constantly debated issue as to whether it is determined at birth or a choice (nature vs. nuture). The works of the Kinsey Reports and Dr. Evelyn Hooker published in the 1950s resulted in the removal of homosexuality from the DSM4 in 1973. Since then, it has been mentioned as an illness only in the context of being a putative exacerbating factor in anxiety states. Recent studies reveal a clear cut neurobiological origin to sexual orientation. Methods: Neurobiologist Simon LeVay conducted a study of brain tissue samples from 41 human autopsies performed at several hospitals in New York and California. Dr. Ivanka Savic- Berglund and Dr. Per Lindstrom of the Karolinska Institute, Stockholm, performed fMRI and PET measurements of cerebral blood flow. Results: LeVay found a significant size difference of the interstitial nuclei of the anterior hypothalamus between homosexual and heterosexual men. Dr. Savic-Berglund and Dr. Lindstrom, using volumetric studies, found significant cerebral size differences between homosexual and heterosexual subjects; the brains of homosexual men resembled heterosexual women and homosexual women resembles heterosexual men. Pheromonal studies also have added to the scientific knowledge of sexuality. Sex-atypical connections were found among homosexual participants. Amygdala connectivity differences were found to be statistically significant and provided evidence toward sexual dimorphism between heterosexual and homosexual subjects. Extensive controls were performed during testing to exclude analytical variability. Conclusion: A totally evidence-based medicine presentation will provide current data regarding homosexuality showing differences, or similarities, between the brains of homosexuals and heterosexuals as well as providing insight to further research on bisexual, transsexual, and asexual orientations and their implications to appropriate medical care, counseling, and research. Policy of full disclosure: None.

PO-01-022

REPRODUCTIVE FUNCTION IN ADULT RATS SUBMITTED TO TESTICULAR TORSION BEFORE AND DURING PUBERTY Sampaio, F.1; Milhomem, R.1; Ribeiro, C.1; Medeiros JR., J.1; De Souza, D.2; Pereira-Sampaio, M.3 1 Urogenital Research Unit, UERJ, Rio de Janeiro, Brazil; 2Rio de Janeiro, Brazil; 3Urogenital Research Unit, UERJ, Department of Morphology, UFF, Rio de Janeiro, Brazil Objective: The aim of this work was to assess the reproductive function of 4- or 6-week-old rats that underwent testicular torsion (TT). Methods: Nineteen prepubertal (4 weeks old, TT4, N = 10) or pubertal rats (6 weeks old, TT6, N = 9) were submitted to TT. Under anesthesia, the right testicle was accessed and spermatic cord twisted by 720 degrees clockwise. The testicle was fixed in this position during

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Unmoderated Poster Presentations 4 hours, after what it was untwisted and the skin wound was closed. Other 20 rats of same ages were used as sham groups (SH4, N = 10 and SH6, N = 10). When animals completed 12 weeks, they were mated with females. These females were euthanized at the 20th day of gestation and the number of fetuses, absorptions, corpora lutea and implantation sites were recorded. The sperm analysis was performed at 14 weeks old. Rats were killed and semen was collected separately from the right and left epididymal cauda. Sperm concentration and motility was performed using a Neubauer counting chamber and the sperm viability was evaluated by the hyposmotic test. anova with Bonferroni posttest or Kruskal–Wallis with Dunns posttest were applied according to normality test. Graphpad Prism software were used for all analyses and differences were considered significant when P < 0.05. Results: The results of sperm analysis revealed a significant difference from samples of right testicles submitted to torsion in relation to the other testis. The differences were noted in all spermatic parameters and in both groups (TT4 and TT6). However, there was no significant difference in the fertility parameters between groups. Conclusion: Both prepubertal and pubertal rats submitted to a 4 hours TT had a great quantitative and qualitative loss of germinative function of the twisted testicle. Despite the difference on sperm analysis, the reproductive function in adulthood was not affected. Policy of full disclosure: None.

PO-02

Psychosexual issues and management

PO-02-001

OUR WAY TO APPROACH SEXUAL PATIENTS Bianchessi, I.1; Orlando, E.2 Retired IRCCS S.Matteonow, Urology, Pavia, Italy; 2Communication Consultant, Roma, Italy

1

Objective: The aim is to describe our contemporaneous diagnostic and therapeutic way in the treatment of sexual diseases in the couple, not separating body from mind, sparing meetings with different specialists. Methods: Our approach is based on meetings where diagnosis and therapy are complementary and where it is not possible to distinguish one from the other. In the first meeting we do an examination, an individual talk to objectify the symptoms before a talk with the couple, we make a planning together, prescribe laboratory and instrumental tests and a first level behavior couple therapy, respecting always privacy but avoiding taboos. During the second meeting we make an interview on the experience of the prescription and give second level prescriptions. Results: Usually literature tends to give a precise definition of a disease while a sexual patient has a complex disease with many different facets. This happens because sexuality involves two persons, two bodies and two minds with reciprocal effects. It is a kind of mirroring play. This aspect must be highly considered when approaching a couple with a sexual problem. Initially this approach requires more time but later the solution will be faster and more lasting compared to an approach with a diagnostic phase followed by pharmacological and psychological therapy. Conclusion: Partner’s alliance is essential for a successful therapy, complicity between the partners becomes the key factor in this integrated approach. We exploit Hellstrom’s pyramid inside a continuous supporting “embrace” of couple behavior therapy. Often you can spare invasive exams and pharmacological therapies. In this way the patient trusts you as single specialist to rely on for his/her problem. Our 30 years old experience of use of this approach led us to standardize it as our “gold standard” to approach sexual patients. Policy of full disclosure: None.

PO-02-002

MANAGEMENT OF SEXUALITY OF PATIENTS WITH CANCER AND STOMA Bianchessi, I.1; Orlando, E.2 Retired IRCCS S. Matteonow, Urology, Pavia, Italy; 2Communication Consultant, Roma, Italy

1

Objective: Offer patients with cancer and stoma a better quality of life including sexuality through the cooperation of the sexologist and the nursing staff helping the patient taking care of his/her new body image. Methods: It is essential that the sexologist has an interview before surgery (even before cancer diagnosis) to get to know the couple, their sexuality and to discuss possible arising problems after surgery and their therapeutic solutions, involving the partner since the beginning. The nursing staff helping the patient taking care of the stoma must take advantage of his/her role, must be a kind of “container” for doubts, anxiety and fears of the patient and his/her partner. Useful for the nursing staff is the PLISSIT model modified by Master and Johnson. The sexologist acts on two parallel ways: investigate on organic diseases pre and post surgery with laboratory and instrumental tests and at the same time start a brief therapy to help the couple find their intimacy again and reinvent a new sexuality with stoma. Results: In our experience if a couple has a good complicity before surgery it reacts positively also to the new situation using all the tricks that we offer. Love is accepting the partner and the stomized patient must be sure to be accepted also with his/her new image. Conclusion: We agree with literature that for sexuality and quality of life a good stoma is better than a problematic anastomosis. Males have

J Sex Med 2011;8(suppl 5):406–469

414 more often than females depression caused by sexual problems. Surely more studies on the sexuality of these patients are required. Obviously nerve-sparing techniques with less invasive cut surely help a better sexuality. Policy of full disclosure: None.

Unmoderated Poster Presentations and related behavioral changes; (iii) reviewing the possible effect of medications; and (iv) evaluating both patient and spouse for comorbid sexual, marital and social problems. This comprehensive approach will prevent overdiagnosis of HS, enable adequate management of the problem and lead to the suitable treatment for each couple. Policy of full disclosure: None.

PO-02-003

SEXUALITY IN MEN OPERATED FOR PROSTATE CANCER Laursen, B. S. Aalborg Hospital, Clinical Nursing Research Unit, Denmark Objective: A growing number of men is diagnosed with prostate cancer and a growing number of these men are treated with surgery; radical prostatectomy. A well-know complication following radical prostatectomy is erectile dysfunction. There is only limited focus on this complication in the phase of rehabilitation. In the few cases where erectile dysfunction is on the agenda the focus is on the physical ability to gain an erection and perform a sexual intercourse not on sexuality in a broader perspective. The purpose of this study is to investigate how erectile dysfunction influence male sexuality in a broad perspective. Methods: The study is a descriptive explorative qualitative study with a phenomenological/hermeneutic frame of understanding. Qualitative interviews are used as data collection. Results: Through the analysis of the interviews, four themes appeared: lack of spontaneous intercourse, identity and masculinity, the opposite sex, and redefinition of gender. Conclusion: The patients experience great influence on their sexuality in respect to their physical sex life, their body, their personal experience and their relations. This demonstrates that sexuality has many different expressions and that sexuality is close connected to human identity. The many aspects of sexuality give the individual variations of possibilities to express his sexuality in other ways than through sexual intercourse. Policy of full disclosure: None.

PO-02-004

HYPERSEXUALITY IN PARKINSON’S DISEASE: IS THE PATENT REALLY HYPERSEXUAL Bronner, G.1; Hassin-Baer, S.2 Sheba Medical Center, Sexual Medicine Center, Ramat-Gan, Israel; 2Sheba Medical Center, Parkinson & Mov. Dis. Clinic, Ramat-Gan, Israel 1

Objective: To present cases of suspected male hypersexuality (HS) within couples, where the male has Parkinson’s disease (PD), to differentiate betweeen disguised and true HS and to explore the different backgrounds and etiologies. Background: A range of impulse control disorders (ICD) have been described in PD, including compulsive shopping, pathological gambling, binge eating and hypersexuality. In the movement disorders clinic, spouses may complain that they find it hard to cope with excessive sexual demands of their parkinsonian partners. This can lead to considerable tension within a family that is already dealing with the variable consequences of PD. Thorough sexual interview often reveals that these cases may reflect various types of sexual dysfunctions that present as HS. It is important to diagnose correctly these disorders and to counsel and treat them accordingly. Methods: We describe four male patients with PD from the movement disorders clinic that were referred by the neurologist as suspected HS. Results: The sexual assessment revealed that only one of the four cases was of suspected hypersexual behavior. In the other three cases, a different sexual dysfunction was diagnosed: erectile dysfunction, delayed ejaculation and a case of a sexual desire gap within the couple. Conclusion: Complaints on hypersexual behavior of patients with PD must be carefully addressed and evaluated in a setting of a multidisciplinary team including a specialist in sex therapy. The diagnostic procedure includes (i) obtaining a detailed description of the problematic sexual behavior; (ii) exploring existence of other components of ICD

J Sex Med 2011;8(suppl 5):406–469

PO-02-005

CLINICAL MANAGEMENT OF COMPULSIVE SEXUAL BEHAVIOR Hughes, B. Trinity College Dublin, Social Work and Social Policy, Ireland Objective: This research investigates the supports used by patients/ clients to self-manage their compulsive sexual behavior. Methods: A qualitative approach was used. Data collection includes pilot study, focus groups, questionnaires, and interviews involving 87 adult participants consisting of 43 treatment providers who work with this phenomenon in clinical practice and 44 individual who selfidentified with compulsive sexual behavior. Interpretative phenomenological analysis (IPA) and thematic analysis (TA) are used for data analysis. Results: The primary supports used by participants to manage their compulsive sexual behavior are psychological, medical and educational. Psychological supports include psychotherapy, residential treatment, and 12-step fellowship movements. Seventeen (39%) of the “addicts” sought psychotherapy and 6 (13%) attended group therapy. Four (9%) “addicts” specifically sought residential treatment for their sexual compulsion and 7 (16%) spoke about their sexual compulsion while in residential treatment for substance addictions. Twenty-four (54%) participants sought help from 12-step fellowships. Medical support is sought by 28 (48%) participants which included the medical doctor, sexual health clinician, psychiatrist and psychologist. Medical support is typically used by patients/clients with comorbid disorders, sexual disease or concurrent substance addictions. Education is the third source of support used by patients/clients. This typically involves the patient/client reading, and completing “homework” given by treatment provider. Personal development exercises were often given by treatment providers, and these take the form of reflective journaling on sexuality and related topics. Additional educational components mainly available in residential treatment programs include art, music, and sand therapy. Conclusion: Participants require specific support to manage their sexually compulsive behavior. Supports can be delivered in a variety of settings, used in different ways as well as concurrently. The supports are most effective when used to meet the specific needs of the individual. Increased awareness and training among patients/clients and professionals will develop successful strategies for the management of compulsion sexual behavior. Policy of full disclosure: B. Hughes is a Government of Ireland Scholar. This Research is supported by the Irish Research Council for the Humanities and Social Sciences (IRCHSS).

PO-02-006

GEPIRONE-ER: A POTENTIAL TREATMENT FOR DEPRESSION AND SEXUAL DYSFUNCTION Fabre, L. F.; Smith, L. C. Fabre Kramer Pharmaceuticals, Houston, TX, USA Objective: To study the effect of Gepirone-ER compared to placebo in a population of subjects with major depression and sexual dysfunction. Depressive illnesses cause sexual dysfunction and conversely sexual dysfunction can lead to depression. Unfortunately, in either case treatment is usually with Selective Serotonin Reuptake Inhibitors (SSRIs). SSRIs further reduce sexual function and this negative effect may last long after SSRI discontinuation. Gepirone-ER is a novel drug candidate which has a mechanism of action different from the SSRIs. Previous studies have shown gepirone-ER effective in improving sexual function independent of its antidepressant and anxiolytic effect.

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Unmoderated Poster Presentations Methods: Subjects (383) with major depressed were entered into an 8-week, double-blind, randomized study of gepirone-ER and placebo. The Hamilton Depression Rating Scale (HAMD-17) measured depressive symptoms and the Derogatis Inventory of Sexual Function (DISF) measured sexual function at baseline and every following visit. The DISF is a comprehensive sexual scale which has subscales (domains) including sexual cognition and fantasy (desire), sexual arousal, sexual behaviors and experience, orgasm and sexual drive and relationships. Results: Gepirone-ER was found to be an effective antidepressant, HAMD-17 effect size (ES) 2.07, P = 0.003. Secondary efficacy parameters were also significant: e.g., HAMD-17 responders P = 0.02. Similarly, DISF results indicate increased sexual function for the combined data base, men and women, total score ES 6.1, P = 0.017 and domain score: desire ES 2.03, P = 0.043 and separately men total score ES 9.1, P = 0.046 and domain scores: desire ES 3.57, P = 0.07 (trend) and drive ES 1.0, P = 0.048. Women’s scores were higher for the gepirone-ER treated group but missed statistical significance, e.g., total score ES 4.6 NS. Conclusion: Gepirone-ER represents a new class of antidepressants (5-HT1A agonists) that are effective as antidepressants and effective in increasing sexual function. Thus, gepirone-ER if approved would satisfy a current medical need. Policy of full disclosure: Dr. L. F. Fabre is a full-time employee of and a shareholder in Fabre Kramer Pharmaceuticals. Dr. L. C. Smith is a paid consultant to Fabre Kramer Pharmaceuticals.

PO-02-007

SHARED PSYCHOTIC DISORDER WITH SEXUAL DELUSIONS—CLINICAL CHALLENGE FOR SEXUAL MEDICINE PRACTITIONER Lew-Starowicz, M. Institute of Psychiatry & Neurology, III Department of Psychiatry, Warszawa, Poland Objective: The aim of this presentation is to discuss clinical issues of couples looking for sexual treatment of an alleged pathology that is related to shared psychotic disorder (SPD). Methods: The author reviews recent state of knowledge and PubMed publications on SPD and discuss diagnostic and treatment difficulties referring to cases of SPD with sexual delusions from his own practice. Results: The literature on SPD remains limited and lacks in descriptions of non-consanguineous patients sharing sexual delusions as core symptoms. The definite prevalence is unknown but such patients may refer to sexologists and cause diagnostic and managing difficulties. Diagnosis may be challenging, especially for non-mental health professionals. The prognosis is often unfavorable due to patients resistance when appropriate treatment is offered. Conclusion: This is the first presentation of partners sharing sexual delusions that meet diagnostic criteria for SPD. More attention to this topic in the field of sexual medicine is needed in order to avoid false diagnosis and to validate therapeutic settings that could improve treatment outcomes in the future. Policy of full disclosure: None.

PO-02-008

COMPREHENSIVE SEXOLOGICAL CARE AFTER SPINAL CORD INJURY Sramkova, T.; Fajtová, R. Traumatological Hospital, Traumatology, Brno, Czech Republic Objective: In the Czech Republic 200 individuals incur spinal cord injury (SCI) every year. Complete spinal lesions constitute 40%. They lead to loss of motor and sensory modalities below the level of spinal injury and loss of autonomic functions including erection and ejaculation. Males under 39 years predominate (55%). The objective is to

inform SCI patients of the possible sexual dysfunction and then effectively treat them in order to help maintain quality of life (QOL). Methods: The first step is sexological counseling for paraplegics (and their partners) during hospitalization at the spinal unit. We developed and provided patients with an educational brochure and two educational DVDs focused on partner relationships, erectile dysfunction and infertility. We used the generic measure of quality of life WHOQOLBREF and the depression scale GDS. Treatment for erectile dysfunction (ED) constituted oral PDE5 inhibitors or intracavernous injection of PGE1 (prostaglandin E1). Program of assisted reproduction for paraplegic couples included sperm retrieval using electroejaculation (EEJ) or testicular sperm extraction (TESE). In case of pathospermia we performed ICSI (Intracytoplasmic Sperm Injection) to achieve pregnancy. Results: We found that 53 patients (58%) out of 92 had sexual life. One third (32%) reported decreased sexual desire, 57% mentioned erectile dysfunction and 93% reported anejaculation. Sexually active patients had higher score in all WHOQOL-BREF domains—physical (P = 0.002), psychological (P = 0.000), social (P = 0.001) and environmental (P = 0.007)—and had lower depression scores (P = 0.000) and they were more satisfied with life (SWLS score, P = 0.014). With ED treatment using I-PDE5 we achieved 69% effect (tadalafil), with intracavernous injections 94% effect (Sramkova et al. 2008). EEJ in combination with ICSI resulted in 30.4% pregnancy rate in our paraplegic couples. Conclusion: SCI mainly affects young men and requires comprehensive sexological-andrological care, which helps increase QOL of paraplegics and their partners. Policy of full disclosure: None.

PO-02-009

RECLASSIFYING THE RESTLESS GENITAL DISORDER AS A SUBTYPE OF VULVODYNIA Markos, A.1; Markos, A. R.2 GU Medicine Dept., MID Straggardshire NHS Trust, Stafford, UK; 2Mid Staffordshire Gen Hosp FT, G U M & Sex Health, Stafford, UK

1

Objective: The “Persistent Sexual Arousal Syndrome” was reported first in 2001, later reclassified as “Persistent Genital Arousal Disorder” and now “Restless Genital Disorder.” The condition shares common features with the ISSVD classification for vulvodynia; namely: distressing, intrusive, unwelcomed vulval sensation that may be localized, generalized; provoked, unprovoked or both. The main difference, with other subtypes of vulvodynia, is the patient’s sensation of being on the verge of orgasm. Methods: Literature review of case reports, under the separate titles of Persistent sexual, genital arousal and restless genital disorders; with cross reference to publications referring to male genital pain, of unknown etiology (i.e., Dysaesthetic Penoscrotodynia). Results: (i) Despite 10 years of media, public interest, web-based surveys and questionnaires, there are scarce publications of single or series of case reports. (ii) Focus had shifted from the description of sexual to genital arousal, then to restless genital, and from a syndrome into a disorder. (iii) The recorded cases overlooked similarities with male patients presenting with genital pain conditions in otherwise normally looking skin, under the different titles of pain or burning. (iv) There could be two underlying separate micropathological processes, namely neuropathy and/or dysfunctional arterio-venus shunting (Erythromelalgia). (v) The clinical community, after three decades of analyzing vulvodynia, appreciated the advantages of simplifying nomenclatures and classifications (e.g., rebranding vestibulodynia or burning vulva syndromes as vulvodynia). (vi) The most effective lines of treatment for ReGD are similar to those for vulvodynia (eg SSRIs & SNRIs & TENS). Conclusion: The ISSVD new classification of vulvodynia would fit well with ReGD; the genital sensation being spontaneous, intrusive, distressing and unwelcomed; localized, generalized, provoked, unprovoked or combined. ReGD would benefit from a similar simplified reclassification as a subtype of vulvodynia. Policy of full disclosure: None.

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CRIMINAL CONSEQUENCES OF EXTREME SEXUAL PRACTICES BETWEEN CONSENTING ADULTS IN EUROPE Kamnerdsiri, W. Paris, France Objective: Extreme sexual behaviors related to Paraphilias: the recent decisions by European Courts that condemned these practices, even among consenting adults; and the role forensic psychiatrists might play in preserving individual freedoms in light of the ongoing legal debate about such issues. Methods: Literature review. As the fields of psychiatry and psychology continue to develop, they tend to excise the most common deviant sexual behaviors from medicine; however, an opposite trend appears to be taking place in law. Recent court decisions illustrate a growing contradiction between protection of individual freedoms and preservation of human dignity. The criteria used to support these verdicts deserves consideration by forensic practitioners since future criminal cases will likely necessitate an analysis of sexual behaviors previously relegated to private life. From the comic case of a Scottish man castigated for copulating with his bicycle in his hotel room, via an innocuous case of sadomasochistic relations in England, to the horrific case of cannibalism recently adjudicated in Germany, a significant number of situations exist wherein the mutual consent of those involved—even in the absence of a violation of public order—has been ignored in court decisions. Also significant is the confirmation of some of these sentences by the European Court of Justice, setting forth the inhumane treatment involved and its morally demeaning characteristics. Ipso facto, the court surpasses its objective mission of protecting “public order” by prescribing a “moral order”. Results: Forensic sexologists must play their role in the ongoing legal debate about such issues, supporting the notion that legal action should be confined to cases where others are harmed against their will. Conclusion: If some people need degrading scenarios to reach orgasmic pleasure, this unfortunate condition should not automatically lead to the loss of their human status or human rights. Policy of full disclosure: None.

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THE EFFECTS OF ARMY FABOO ON SOLDIERS’ SEXUALITY: FACTS AND CONSEQUENCES

Unmoderated Poster Presentations Conclusion: The proposed means of achieving balance may represent a new ethic concerning the management of sexuality in the armed forces that would preserve mental health inside the organization and social health outside it. Policy of full disclosure: None.

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WHICH LEVEL OF SEXUAL SCRIPTS AFFECT ON SEXUAL HEALTH IN COUPLES? Ziaei, T.1; Ziaei, F.2 1 Isfahan University, Midwifery, Islamic Republic of Iran; 2Gorgan Educational Organization, Educational Management, Islamic Republic of Iran Objective: Much of how one thinks about sexual relationships is affected by sexual scripts. Who are the initiators of sexual activity, wide differences of opinion about talking during sex, overt sexual behaviors (oral-genital stimulation, and anal sexual intercourse) reflect cultural, interpersonal, and intrapsychic scripts. The present study was done to assess which level of sexual scripts affect on some sexual behavior of couples in Gorgan. Methods: Descriptive study was done by questionnaire in GorganIran on 129 married women. Analysis was done with the use of descriptive analysis test. Results: The findings show that 38% of women sometimes and 27.3% rarely were the initiators in the sexual activity. 74.4% of these initiators claimed that this increased desire in their husbands. Who were not the initiators, said the reason was that they were too proud. About talking during sex only 14% never spoke among sex. couples who had anal intercourse 74.16% of women claimed that it was a request from their husband and about 22% said request was from themselves. Also, between couples who had oral sex, 66.7% said the request was from their husbands. Conclusion: By looking the result of the research, one can see interpersonal and intrapsychic level of sexual scripts is affected on initiating of sexual activity. At intrapsychic level women were not initiator but at interpersonal level they modify their belief and try to be initiator because of controlling the boundaries of sexual intimacy within their relationships. Oral and anal sex, reflect cultural, and interpersonal scripts. In this study we concluded that as Simon and Gagnon (1986) suggested that sexual scripting takes place at three levels: cultural, interpersonal, and intrapsychic. Therefore, paying attention to this subject can help couples to coordinate their relationship, especially sexual relationship to have sexual health. Policy of full disclosure: None.

Kamnerdsiri, W. Paris, France Objective: Prevalence of sexual misconducts among military personnel at war. Solutions used in the past to cope with the problem. Methods: Literature review. The Army adopted official “don’t do, don’t ask, don’t say” policy regarding sexual activity in order to abide by moral standards. This type of policy influences mental health of soldiers of both genders and on the surrounding society, as the soldiers who cannot restrain their sexual impulses will satisfy them at the expense of any sexual object available. If a financially deprived social environment welcomed sexually deprived soldiers, to achieve an exchange of subsistence, equilibrium between the needs and the services offered can eventually be achieved without inflicting damage on society. However, if the social environment is hostile, soldiers will resort to illegal actions, possibly raping civilians or their comrades, both of which are equally disruptive, individually and socially. Such a situation is observed in Iraq because of a growing concern regarding the instances of Post-Traumatic Stress Disorder (PTSD) diagnosed among both male and female soldiers who have endured what is now officially referred to as “Military Sexual Trauma,” or MST. The dire effects that these rogue actions may have on the local society and ultimately on the efficiency of any military intervention are of great concern are. Results: This review addresses the consequences of this sexual taboo and discusses possible means of achieving a balance between morality and efficiency that could be addressed in future studies.

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WHEN THE SPICE OF SEX LIFE IS MISSING—A QUALITATIVE STUDY OF COUPLES EXPERIENCE OF SEX LIFE CHANGE IN ERECTILE DYSFUNCTION AS A RESULT OF OPERATION Mikkelsen, A. H. Aalborg Hospital, Department of Urology, Denmark Objective: Prostate cancer is common and is being diagnosed in younger men now compared with two decades ago. The treatment options for prostate cancer depend in part on the patients’ age, his overall health and whether the tumor has spread. For tumors that are still inside the prostate, radical prostatectomy is the common treatment. Common to that treatment is, that it often results in varying degrees of erectile dysfunction and this is one of the major concerns of patients undergoing treatment for prostate cancer, because it often affects the masculinity, relationship and the quality of life. The purpose of this study is, on the basis of the patients and the partners’ perspective, to contribute to a better understanding among how erectile dysfunction affects the sex life and what impact it can have on the individual and the relationship.

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Unmoderated Poster Presentations Methods: The study is based on a phenomenological-hermeneutic framework, and the empiric material is collected through qualitative interviews. Results: The study shows, that the man experiencing loss, because it is not possible to implement spontaneous sex, which affects his identity, masculinity and it affects his possibility to show loving feelings to his partner. His pleasure and interest for sex declines, because erection is not possible. The females’ pleasure and interest do not change. Even if the man enjoys touching, and growing intimacy between the partners, the man miss the enjoyment of intercourse and orgasm with ejaculation. The women’s miss of the enjoyment of orgasm is greatest in women, who have vaginal orgasm, while women, who achieve orgasm by stimulation of the clitoris, do not miss intercourse significantly. Conclusion: It may be perceived as a rewarding challenge to create new ways in sex life, because it means that the intimacy grows, but the man is still missing the quality of the intercourse. Policy of full disclosure: None.

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AN INTERNET-BASED STUDY DESCRIBING THE PSYCHOSEXUAL CHARACTERISTICS OF SUBJECTS SPECIFICALLY AROUSED BY PEOPLE WITH DISABILITIES Limoncin, E.1; Carta, R.2; Gravina, G. L.2; Carosa, E.2; Ciocca, G.2; Isidori, A. M.3; Lenzi, A.3; Jannini, E. A.2 1 University of L’Aquila, Experimental Medicine, L’Aquila, Italy; 2University of L’Aquila, Experimental Medicine, Italy; 31st University “La Sapienza”, Experimental Medicine, Roma, Italy Objective: It is not necessarily the case that sexual attraction towards disability, a poorly studied condition known as devotism, is a sexual perversion. Aim of this Internet-based survey is to perform a complete descriptive analysis of the socio-demographic and psycho-sexual characteristics of devotees. Methods: The target population, studied using a multilingual semistructured questionnaire, was selected from online devotee-communities. The questionnaire explored sociodemographic profile, sexual orientation, social discomfort, quality of sentimental relationships, attraction towards people with mental disability and the precipitating factors for this condition. Results: The average devotee selected on Internet communities was a heterosexual middle-aged European or North-American man with a high educational level. The great majority of interviewees (70.8%) became aware of their attraction for people with disabilities before the age of 14, and 46.8% felt no significant social discomfort for their condition. The development of this sexual interest showed no correlation with exposure to relatives, friends or acquaintances with a disability during early childhood, or with poor parent-child attachment. Although most devotees (62.6%) were attracted by particular physical disabilities, a subpopulation (25.1%) was specifically attracted by human characteristics such as adaptability, fortitude, and ability to overcome the obstacles experienced by people with disabilities. Finally, only 8.7% of interviewees felt sexual attraction for people with mental disabilities. Conclusion: Devotism is an understudied dimension of sexual deviancy that covers a wide array of clinical conditions ranging from an unambiguous pathological mindset to more blurred clinical pictures. The criteria necessary to include this condition in the large family of paraphilias need to be identified carefully. Policy of full disclosure: None.

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ADOLESCENTS’ SEXUAL BEHAVIOR IN HUNGARY—DO WE MAKE ENOUGH FOR THEM? Eros, E. OGYEI, Family Plan. and Adolescence, Budapest, Hungary Objective: Sexual education is the effective protection of future generations from unintended pregnancies and sexually transmitted infections. In Hungary sex education at secondary schools is mandatory from 1975. Official age at initial sex education is 10 years. Methods: The target population of the HBSC 2010 study is young people attending school, aged 11, 13, and 15 years old. These age groups represent the onset of adolescence, the challenge of physical and emotional changes, and the middle years when important life and career decisions are beginning to be made. The survey is carried out on a representative sample consisting of 4,552 teenagers. Results: Age of onset of sexual activity in Hungary 50.7% of sexually active 9th graders was 14 years or younger when starting sexual life. 20.8% of 11th graders reported to initiate sexual life at the age of 14 or before. Higher rate of boys reported to start sexual life early (14 yrs or earlier) than girls. From all contraception methods condom is the most popular, 56.2% of sexually active youth used condom as a protection, 12.3% chose other methods as well. The rate of those that are sexually active but use no protection is 10.2%. Conclusion: Formal sex and relationship education is effective in reducing the rate of unwanted pregnancies, but the satisfaction with the highlight and quality of sex education of the youth is low. Wider access, better training for the providers and multidisciplinary collaborations may help address this discrepancy. Multidisciplinary outpatient clinic for adolescents gives a possible optimal solution and new perspective for the sexual education. The most basic needs of adolescents are for accurate and complete information about their body functions, sex, safer sex, reproduction, and sexual negotiation and refusal skills. Without information, adolescents are forced to make poorly informed decisions that may have profound negative effects on their lives. Policy of full disclosure: None.

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ASSOCIATION OF SEXUAL DYSFUNCTION WITH MENTAL HEALTH DISORDERS IN A SAMPLE OF GREEK MEDICAL STUDENTS Anyfanti, P.1; Gavriilaki, E.2; Triantafyllou, A.2; Avagianou, P.-A.2; Triantafyllou, G.2; Nikolaidou, B.2; Sachpekidis, C.2; Lazaridis, N.2; Papadopoulos, N.2; Panagos, C.2; Doumas, M.2 1 Thessaloniki, Greece; 22nd Propedeutic Department of, Internal Medicine, Aristotle, Thessaloniki, Greece Objective: The interplay of sexual dysfunction and mental health disorders is commonly encountered in the physically ill, but their association in healthy population subgroups has not been adequately studied. The aim of this study was to investigate the relationship between sexual dysfunction and mental health disorders in a young, healthy sample of Greek medical students. Methods: Students of the Medical School of Aristotle University of Thessaloniki, Greece, comprised the study population. Participants were asked to complete the Hamilton Anxiety Scale (HAM-A), in order to measure anxiety severity, the Zung self-rating depression scale, to provide a subjective estimation of depressive symptoms, as well as the International Index of Erectile Function (IIEF) and Female Sexual Functioning Index (FSFI) questionnaires, to detect cases of male and female sexual dysfunction, respectively. Results: Of the 78 participants, 46 were female aged 22 (19–24) years, and 32 male aged 21 (18–32) years. Sexual dysfunction was found in 24.3%, anxiety in 18.9%, and depressive symptomatology in 9.5%. Prevalence of anxiety was significantly higher among students with sexual dysfunction compared to students with normal sexual function, 34.4% vs. 13.6%, respectively (P = 0.035). Depressive symptomatology

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Unmoderated Poster Presentations

was present in 22.2% of students with sexual dysfunction, compared to 5.4% of students with normal sexual function (P = 0.055). Conclusion: In young and healthy individuals, sexual dysfunction is associated with a heavier burden of anxiety and depression. The exact impact of mental distress on sexual dysfunction, and vice versa, and the underlying pathophysiological links, require further investigation. Policy of full disclosure: None.

Results: Patient was given a follow-up appointement 1 week later.He reported that his issue was resolved and he is able to ejaculate intravaginally at all attempts of intercourse. Conclusion: Sexual Medicine physicians concentrate more on the physicak aspects of the sexual dysfunctions.They should take their time in exploring the psychological aspect which can yield a satisfactory result. Policy of full disclosure: None.

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EFFECTS OF MEDICATIONS ON SEXUAL FUNCTIONING IN PATIENTS TREATED IN A DAY HOSPITAL SETTING

DISORDERS OF SEXUAL DESIRE IMPACT YOUR OWN QUALITY OF LIFE: WHAT ABOUT YOUR PARTNER’S?

Arbanas, G.1; Ivezic, E.2; Maroevic, S.3; Muzinic, L.3 1 General Hospital Karlovac, Psychiatry, Croatia; 3 Psychiatric hospital Vrapce, Zagreb, Croatia

2

Zagreb, Croatia;

Objective: The aim of this study was to find out how different categories of psychotropic medications effect different aspects of sexual functioning (e.g., drive, arousal, and orgasm). Methods: One hundred ninety-two patients from three day hospitals were asked about their sexual functioning. The questionnaire with six questions (sexual desire, easiness of getting aroused, erection or vaginal lubrication, easiness of getting an orgasm, satisfaction with the orgasm and retarded ejaculation/anorgasmia). There were six possible answers to each of the questions. Dana on patient’s diagnoses and medications were collected from their medical records. Results: Of 192 patients, 72% were men. The mean age was 48.1 (range 19–72). Approximately one fourth of the patients were diagnosed with alcohol dependence, one fourth with depression, one fourth with anxiety disorders and one fourth with posttraumatic stress disorder (PTSD). 71.9% of patients were treated with antidepressants, 68.8% with anxiolytics, 32.8% with antipsychotics, 22.9% with hypnotics and 21.4% with mood stabilizers. Antidepressants had negative effect on sexual desire and the satisfaction of orgasm, but did not have effect (surprisingly) on retarded ejaculation. Anxiolytics had negative effect on sexual desire and easiness of arousal. Antipsychotics had negative effect on the item orgasm satisfaction. Hypnotics had negative effect on erection/vaginal lubrication. Mood stabilizers had negative effect on sexual arousal. Conclusion: Patients suffering from depression, anxiety disorders and PTSD are usually treated with different psychotropic medications. As the results show, these drugs can have deleterious effect on different aspects of sexual functioning. Policy of full disclosure: None.

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THE POWER OF ONE SESSION IN THE TREATMENT OF INTRAVAGINAL ANEJACULATION Assalian, P. McGill University Health Cente, Psychiatry Human Sexuality, Montreal, Canada Objective: (i) To illustrate the power of interpretation of the unconscious and how that simple intervention to a key issue of the patient’s life had a major positive impact. (ii) To illustrate the importance of taking a full history including the psychological aspect of the dysfunction and not to rush to a physical cause. Methods: this is not a research paper.This presentation is about a 22-year-old male who was unable to ejaculate intravaginally with his girl friend.He has no difficulties ejaculating on masturbation nor with oral sex. No ED. What became evident from the interview that his father impregnated his first wife,and felt he was rushed into marrying his wife,and this message was repeated to the patient.At the end of the interview the author suggested to the patient that his inability to ejaculate intravaginally has to do with his fear of impregnating his girl friend and this may lead to rushed relation like his father.

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Bolmont, M.1; Lorenz, G.2; Bianchi-Demicheli, f.3; Ortigue, S.2 University of Geneva, Psychology FPSE, Switzerland; 2University of Geneva, psychology FPSE, Switzerland; 3University Hospital of Geneva, Psychosomatic Gynecology, Switzerland

1

Objective: According to the WHO, sexual health is characterized by the integration of somatic, emotional, intellectual and social aspects of human sexuality. Although a growing body of evidence demonstrates negative consequences of sexual disorders at the personal level, little remains known about their impact on the partner’s mental and sexual health overall. Methods: To address this question, we conducted a review of the clinical literature investigating the possible consequences of sexual disorders (i.e., hypoactive sexual desire (HSDD) and erectile dysfunction (ED)) on both the personal and the partner’s lives. Studies, including standard scales such as profile of female sexual function, life satisfaction index, self-esteem and relationship questionnaires and medical outcome survey, were considered for the present review. Results: Preliminary results showed that men with ED reported having a lower sexual satisfaction (P < 0.001) and a lower self-esteem (P < 0.0001) than men without ED. Men with ED, however, reported having a greater satisfaction with their financial status and hobbies (P < 0.001). At the interpersonal level, ED had a significant negative impact on the sexual satisfaction, desires and pleasure of the man’s partner (P < 0.01). For women, results showed that individuals with HSDD reported more negative emotional psychological states compared to women without HSDD (P < 0.001). For example, 88.5% of women with HSDD declared they were unhappy compared to 7.5% of women without HSDD. Surprisingly no information was found in the current clinical literature regarding the impact of a woman’s sexual disorder on their partner’s well-being. Conclusion: Based on this shocking lack of consideration of one’s partner in the interactive cycle of human sexual response, here we propose an integrative model of the human sexual response in which every phase integrates not only one’s own desires and mental states, but also the partner’s desires and mental states, and their dynamic interaction. Policy of full disclosure: None.

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ED epidemiology and risk factors

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HELP-SEEKING INTERVAL IN ERECTILE DYSFUNCTION: ANALYSIS OF ATTITUDES, BELIEFS, AND FACTORS AFFECTING TREATMENT-SEEKING INTERVAL IN TURKISH MEN WITH PREVIOUSLY UNTREATED ERECTILE DYSFUNCTION Gülpinar, Ö.1; Haliloglu, A. H.2; Abdulmajed, M. I.1; Boga, M. S.2; Yaman, O.1 1 University of Ankara, Department of Urology, Turkey; 2University of Ufuk, Department of Urology, Ankara, Turkey Objective: In this study, we report data on attitudes, beliefs and factors affecting help-seeking interval among Turkish men with erectile dysfunction to determine whether they are different from those previously published in literature. Methods: 202 out of 279 Turkish men complaining of erectile dysfunction attending our clinic between December 2006 and March 2008 without the need for referral were interviewed based on standardized questionnaire covering demographic details, relationships, helpseeking interval and attitudes and beliefs. Eleven patients interrupted the questionnaire and only 191 individuals who had never sought medical help for their erectile dysfunction completed the study. Results: The mean age of study population was 50.1 (20–80) years. Overall, 93.7% of subjects had engaged in sexual intercourse during the year preceding the interview. The mean help-seeking interval and the mean estimated time elapsed since last satisfactory sexual intercourse were 24.5 (1–360) and 10.5 (1–180) months, respectively. Patients with low household income and education level had relatively longer help-seeking interval than the remaining sample. No statistical correlation was seen between treatment-seeking interval and patient age, duration of marriage or continued relationship and presence of premature ejaculation. Main reasons for delayed consultation included embarrassment (N = 63, 33%) and thinking of erectile dysfunction as a natural process of aging (N = 51, 26.7%). Conclusion: To enable earlier diagnosis and management of erectile dysfunction, emphasis should be put into the provision of affordable health care and wide public education about erectile dysfunction as an entity requiring prompt medical consultation. Policy of full disclosure: None.

blood pressure (SBP/DBP), body mass index (BMI), smoking and alcohol consumption were recorded. Results: In total, 132 male students 23 ± 2.36 years old participated in the study. Erectile dysfunction was present in 20.5% of the students; of them, 70.4% exhibited mild, 3.7% moderate, and 25.9% severe erectile dysfunction. Mean SBP/DBP in our sample were 129.9 ± 1.3/80.3 ± 0.9 mm Hg, and mean BMI was 24.3 (18.9–35.5). Smoking and alcohol consumption were recorded by 34.4% and 70.2% of the students, respectively. Erectile dysfunction was not significantly associated with SBP/DBP levels, BMI, smoking, or alcohol consumption. Conclusion: A significant portion of medical students exhibits erectile dysfunction. Since traditional cardiovascular risk factors do not appear to contribute to erectile dysfunction in young students, further investigation is needed to identify potential risk factors in this specific population subgroup with special focus on psychological factors. Policy of full disclosure: None.

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ERECTILE DYSFUNCTION AND DIABETES: RESULTS IN A PROSPECTIVE STUDY IN ORAN (ALGERIA) Arrar, M.; Gorine, M. Centre Hospitalo-Universitaire, Oran, Algeria Objective: To estimate the aspects of Erectile Dysfunction in Diabetic patients and test the questionnaire adapted to our local particular social context. Methods: 128 diabetic patients were screened in an open study. Erectile function was assessed using adapted questionnaire. Morning erections (ME), premature ejaculation (PE), sociodemographic data was obtained using adapted questionnaire etablished by a multidisciplinary medical team. The five item version of the IIEF scale was also used Results: Organic origin found in 23.4%. A likely sole “psychogenic” is found in16.4%. In 62.2% ED was both “organic”and “psychogenic.” There was a significative difference between both groups psychogenic and organic ME, PE and macroangiopathy. The study explore a specific questionnaire related to our population: it shows particulars aspects of sexual perception in our patients. Conclusion: E D approach is now more easy since “Viagra effect” but it stay an important worring subject in our population. An algorithm is suggested in ED outcome of our local diabetic population. Policy of full disclosure: None.

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PREVALENCE AND POTENTIAL CONTRIBUTORS OF ERECTILE DYSFUNCTION AMONG MEDICAL STUDENTS Gavriilaki, E.1; Anyfanti, P.2; Triantafyllou, A.1; Triantafyllou, G.1; Petidis, K.1; Papadopoulos, N.1; Lazaridis, N.1; Panagos, C.1; Nikolaidou, B.1; Sachpekidis, C.1; Doumas, M.1 1 2nd Propedeutic Department of, Internal Medicine, Aristotle, Thessaloniki, Greece; 2Thessaloniki, Greece Objective: Erectile dysfunction is commonly encountered in the general population, among which younger individuals are expected to exhibit lower prevalence given the age-dependent relationship of this particular clinical entity. In this study, we aimed at estimating the prevalence of erectile dysfunction in a young age group comprising of medical students, and investigate the impact of well-known contributing factors. Methods: Consecutive male medical students of the Aristotle University of Thessaloniki, Greece, comprised the study population. Assessment of erectile dysfunction was based on the International Index of Erectile Dysfunction (IIEF) questionnaire, with a total score ranging between 0–30, and a cutoff score ≤25 considered representative of erectile dysfunction. In addition, office systolic and diastolic

OPTIMIZATION OF POST-PROSTATECTOMY ERECTILE FUNCTION IN GERMANY: A PATIENT-FOCUSED APPROACH Balangas, A.1; Kohler, T.2; Schattka, S.1; Wilson, S.3 Institute for Urologic Excelle, Westerstedte, Germany; 2Southern Illinois University, Springfield, IL, USA; 3Indio, CA, USA

1

Objective: In Germany, post-prostatectomy (RRP) erectile dysfunction (ED) treatment is confounded by division of urologic service into general urologists (GU) and surgical urologists (SU). The initial visit with the SU who ultimately performs the RRP occurs after GU referral. After RRP, 30 days are spent in Rehabilitation Center. Rehab staff and GU perform subsequent assessment and treatment for ED. We report our experience utilizing letters of invitation to patients for educational seminars by the SU for post RRP ED. Methods: Between 2007 and 2009, 217 patients received invitations to participate in optional, after hours seminars to discuss their postRRP experiences. Goals of the seminars were to obtain information on cancer status, erectile function, continence and quality of life. We also assessed if penile rehab regimens or therapies had been done. Results: Of 217 invitations, 132 patients attended (104 non-nerve sparing RRP/28 nerve sparing RRP). Prior to the seminar 36% abstained from sex because of “no options” or incontinence. Just prior to the seminar, actual use of PDE5is and VEDs was 5 and 16% respec-

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420 tively. After the seminar, 78% tried PDE5is and 58% VED. Use of injections increased from 21 to 30% and penile implants from 0% to 21% after the seminar. Patients indicated there was no prior mention of penile rehabilitation and complete minimization of the impact of post RRP ED. In addition, they had received misinformation regarding cost (none) and complication rates with prosthetics. Conclusion: Opportunities for improvement in the German medical system for treatment of post RRP ED include an emphasis on ED rehabilitation and appropriate counseling by the rehabilitation center and GU physicians. Direct patient contact by the SU proved to be an effective way to improve the quality of ED treatment of post prostatectomy patients in Germany. Policy of full disclosure: T. Kohler, Consultant AMS & Coloplast; S. Wilson, Consultant AMS & Coloplast.

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PREVALENCE AND RISK FACTORS OF ERECTILE DYSFUNCTION IN A RURAL POPULATION IN UGANDA Claramonte, M.1; García-Cruz, E.2; Alcaraz, A.2 Hospital Saint Francis, Buluba, Uganda; 2Hospital Clínic de Barcelona, Urology, Spain

1

Objective: the aim of the study was to determine the prevalence and risk factors of erectile dysfunction (ED) in Buluba, a rural population in Uganda. Methods: From September 2010 to December 2010, a prospective, consecutive, cross-sectional study was conducted. A total of 902 men attending the outpatient clinic of Saint Francis Hospital in Buluba, Uganda, were enrolled. From those 902 men, a subgroup of 204 patients were previously diagnosed as HIV+ and were followed in a specific VIH outpatient clinic in the same center. No blood sample determination was performed for testosterone determination. Variables age, weight, height, tobacco use and drinking habits, Erection Hardness Score and AMSS, as well as Hypertension, Diabetes, Dyslipidemia, VIH and other relevant clinical variables were prospectively recorded. A multivariate analysis was used to analyze the variables related to erectile function and AMSS. Results: Mean age was 39 ± 11.8 years. The rate of erectile dysfunction was 47.8% (Mild ED 28.8%; Moderate ED 14% and Severe ED 5%). In the multivariate analysis, variables age, HIV positive and high AMSS scoring were related with the diagnosis of ED. When excluding HIV+ population, 36.8% of men suffered ED (Mild ED 23%; Moderate ED 10.2% and Severe ED 3.6%). In this population, variables age and high AMSS scoring were related to ED in the multivariate analysis. A total of 5.7% of men had severe symptoms (≥50) of hypogonadism according to AMSS. In the multivariate analysis, age and ED were related to severe hypogonadal symptoms. Conclusion: The rate of erectile dysfunction in a rural milieu in Uganda is high. Variables age and VIH+ were related to erectile dysfuntion. Policy of full disclosure: None.

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THE GLOBAL ONLINE SEXUALITY SURVEY— ARABIC VERSION Shaeer, O. Cairo University, Andrology, Egypt Objective: The Global Online Sexuality Survey (GOSS) is as a worldwide epidemiologic investigation of human sexuality. It aims at retrieving comparable data from every culture and country using harmonized, mostly validated and scored data collection systems, age adjusted to the World Health Organization World Standard Population, with special understanding for every culture’s unique characteristics. GOSS was first launched in the Middle East, a challenging region where sexuality is taboo and where population based surveys in this domain are very rare.

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Unmoderated Poster Presentations Methods: GOSS was offered to Arabic-speaking web surfers in the Middle East via paid advertising on Facebook®. Advertisement was randomly directed to web surfers older than 18 years of age independent of surfing preferences for the purpose of randomization. Data collected included the abbreviated version of the International Index of Erectile Dysfunction, ejaculatory control, comorbidities, experience with medication for ED and PE, penile size and its impact on sexuality, and contraceptive use. Results: 45.1% demonstrated various degrees of erectile dysfunction (ED). Surprisingly, prevalence of premature ejaculation (PE) surpassed that of ED: 82.6%, despite an average intravaginal ejaculatory latency time (IELT) of 9.06 minutes ± 10.2. Genital size was estimated. Aging, diabetes, hypertension under treatment and depression correlated positively with ED. New risk factors for ED emerged, including PE, penile size concerns and penile curvature. Utility of phosphodiesterase inhibitors (PDE5i’s) was compromised with wide spread impressions of extreme side effects. Conclusion: In the Arab countries, prevalence of ED and the effect of risk factors have proven similar to reports from different parts of the world. New risk factors emerged and should be considered in managing ED. PDE5i’s are stigmatized with false fixed beliefs that should be addressed by mass media and upon counseling. The prevalence of PE surpassed that of ED and influenced it to a great extent. Policy of full disclosure: None.

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IS SELF-REPORT OF ERECTILE DYSFUNCTION ASSOCIATED WITH SEVERITY, CARDIOVASCULAR RISK FACTORS, AND DEPRESSION? Park, H. J.1; Park, N. C.1; Min, K.2; Woo, S. H.3 Pusan National University, Urology, Busan, Korea; 2Inje University, Urology, Busan, Korea; 3Eulji University Hospital, Seoul, Korea

1

Objective: The aim of this study was to evaluate whether cardiovascular risk factors and depression are associated with frequency of selfreport in patients with ED. Methods: A total of 459 patients who visited the urology clinics between January 2005 and July 2008 were analyzed. All patients were at least 40 years old. The group with unreported ED was defined as men with an IIEF-5 score of ≤21 who did not self report ED. The group with self-reported ED was defined as men with an IIEF-5 score of ≤21 who self reported ED. Symptoms of depression were assessed by the Center for Epidemiological Studies-Depression Scale (CES-D). Results: Overall frequency of ED was 39.8%; 25.9% were assigned to the unreported ED group, and 13.9% were assigned to the selfreported ED group. The average age was 54.9 ± 7.6 years for the unreported group and 51.4 ± 8.1 years for the self-reported ED group (no difference). The incidence of presenting with subjective ED symptoms was higher in the younger generation; however, it was not statistically significant. The incidence of patients with hypertension, diabetes, and BMI (≥25 kg/m2) was significantly higher in the self-reported ED group. Similarly, the incidence of abnormal results for fasting glucose level, triglyceride, HDL, and total cholesterol value in the selfreported group was significantly higher. The incidence of severe ED (≤10 IIEF-5 score) was significantly higher in the self-reported group. The incidence of patients with depression (>17 points CES-D) was significantly higher in the self-reported ED group. Conclusion: Our results suggest that men with self-reported ED had a higher frequency of cardiovascular risk factors and symptoms associated with depression compared to men with unreported ED. Furthermore, ED was more severe in men with self-reported ED than in those with unreported ED. Policy of full disclosure: None.

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Unmoderated Poster Presentations PO-03-008

PREVALENCE OF METABOLIC SYNDROME AND OTHER CARDIOVASCULAR RISK FACTORS IN A POPULATION OF PATIENTS WITH ERECTILE DYSFUNCTION Pacheco-Figueiredo, L.1; Neves, E.2; Coutinho, P.2; Botelho, F.1; Tomada, I.3; Tomada, N.1 1 Hospital de São João, Serviço de Urologia, Porto, Portugal; 2Escola de Ciências da Saúde, Universidade do Minho, Braga, Portugal; 3Lab de Biologia Molecular, Faculdade Medicina, Porto, Portugal Objective: To estimate the prevalence of cardiovascular risk factors, including metabolic syndrome (MS), in a series of Portuguese patients with erectile dysfunction (ED) and quantify their role, in an individual and aggregate fashion, regarding penile hemodynamics and reported ED severity. Methods: Cross-sectional study of 408 patients followed in Urology Department of Hospital Sao João (Portugal) and Private Hospital Clipóvoa (Portugal) within the period 2008–2010. MS was defined based on the National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATP III) criteria. For this purpose, we used the dichotomized variables: hypertension (HTA), glucose intolerance (GI), hypertriglyceridemia (HTG), decreased HDL cholesterol and central obesity. The penile hemodynamics were measured using the dynamic penile color Doppler ultrasound (D-PCDU) and ED severity was assessed with the International Index of Erectile Function-5 questions (IIEF-5). Results: There was a high prevalence of HTA (46.3%), GI (36.0%), HTG (24.8%), decreased HDL (22.3%) and central obesity (41.2%). The prevalence of MS was 26.5%. The median of IIEF-5 and peak systolic velocity (PSV) was 12.0 and 34.0 cm/s, respectively. Multivariate analysis revealed HTA and GI as independent factors decreasing the value of PSV (P = 0.002) and the score IEEF-5 (P = 0.010), respectively. Conclusion: We emphasize the high prevalence of cardiovascular risk factors in a population of patients with ED, as well as the strong independent association between HTA and hemodynamic worsening of erectile function. Policy of full disclosure: None.

PO-03-009

TRADITIONAL CARDIOVASCULAR RISK FACTORS AS POTENTIAL CONTRIBUTORS TO SEXUAL DYSFUNCTION IN MALE RHEUMATOLOGIC PATIENTS Gavriilaki, E.1; Triantafyllou, A.1; Anyfanti, P.2; Avagianou, P.-A.1; Triantafyllou, G.1; Pyrpasopoulou, A.1; Chatzimichailidou, S.1; Christaki, E.1; Douma, S.1; Aslanidis, S.1; Doumas, M.1 1 2nd Propedeutic Department of, Internal Medicine, Aristotle, Thessaloniki, Greece; 2Thessaloniki, Greece Objective: Although traditional cardiovascular risk factors have been identified as predictors of sexual dysfunction in the general male population, their impact on sexual functioning in specific groups of patients remains unclarified. The purpose of this study was to investigate whether traditional cardiovascular risk factors account for sexual dysfunction in male patients suffering from rheumatic diseases. Methods: Study participants were patients of the Rheumatology Department of Hippokration General Hospital, Thessaloniki, Greece. The International Index of Erectile Function (IIEF) questionnaire was used to evaluate sexual function, with total score ranging between 0–30 and a cutoff value of ≤25 considered representative of erectile sexual dysfunction. In addition, a thorough medical history was taken with emphasis placed on presence of hypertension, diabetes mellitus, dyslipidemia, previous cardiovascular events, smoking and alcohol consumption. All patients had their demographic data, body mass index (BMI) and systolic and diastolic blood pressure (SBP/DBP) recorded.

Results: In total, 108 male patients with a mean age of 51.4 ± 13.7 years participated in the study. Erectile dysfunction affected 48.1% of them. Mean BMI was 27.2 ± 3.9, and mean SBP/DBP was 129.8 ± 17.6/81.2 ± 10.1 mm Hg. Hypertension was present in 29.6% of the participants, diabetes mellitus in 9.3%, dyslipidemia in 25.9%, a history of cardiovascular events in 12%, while smoking and alcohol consumption were reported by 50.9% and 25.9%, respectively. Age was identified as the only factor associated with significantly higher prevalence of sexual dysfunction in the logistic multiple regression model (P = 0.013). Conclusion: Although traditional cardiovascular risk factors are wellknown to predict erectile dysfunction in the general population, they do not seem apart from age responsible for the increased prevalence of erectile dysfunction among rheumatologic patients. Whether a negative impact of psychological or disease-related factors could explain this finding should be the subject of future studies. Policy of full disclosure: None.

PO-03-010

PENILE ANGINA (PA) CONCEPT: THE TRUE, THE FALSE, AND THE USEFUL Bondil, P. Centre Hospitalier, Urology-Andrology, Chambery, France Objective: ED being often but not always a clinical precursor of acute cardiovascular (CV) events, the concept of penile angina (PA) has been proposed (Prog Urol 2005). This specific ED is characterized by: occurrence in young men <60, often significant ED, significant CV risk and absence of non-CV obvious etiology. Our aim was to analyze the PA concept validity by comparing its physiopathological mechanisms and its clinical usefulness with the pectoris angina. Methods: To analyze the PA concept through three real clinical cases. Results: Case 1: 52 years old, high mountain guide consults for a penile pain and cyanosis occurring during physical stress in cold climatic conditions, disappearing when he stops and climbs down in hotter conditions. Penile and CV check-up are normal. 5 mg daily tadalafil improved by 80% this ischemic problem confirmed by a Doppler made in high altitude. Alpinist warmer underwear fully resolves the problem. Case 2: 42 years old consults for painful erections since 20 hours. He reports similar episodes spontaneously resolved. Cavernous gas analysis confirms an ischemic priapism treated by etilefrine injection without sequels. Case 3: 46 years old consults for progressive ED (EHS = 2) since 18 months. The health checkup reveals a high CV risk and a coronary insufficiency requiring stent dilation. ED was successful treated with oral PDE5i and lifestyle improvement. Conclusion: physiologically, the true PA is the rare ischemic priapism. Stricto sensu, the occurrence of penile vascular pain is only possible in case of erection excess (i.e., priapism) or of non erectile vascular spasm (as in first case induced by cold). This exceptional “Raynaud-like disease” is not related to erection but only to stress. For daily practice, the false PA (isolated vascular ED), by far the most frequent is the most useful because it can prevent or reduce the morbi-mortality of numerous men ignoring their underlying CV disease through a simple question. Policy of full disclosure: None.

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422

Unmoderated Poster Presentations

PO-03-011

PO-03-012

IS SERUM hsCRP ASSOCIATED WITH ERECTILE DYSFUNCTION IN AGING MEN? COMMUNITY-BASED STUDY

EVALUATING ERECTILE DYSFUNCTION IN PATIENTS ATTENDING A RHEUMATOLOGY DEPARTMENT: A PILOT STUDY

Lee, W. K.1; Lee, S. K.2; Kim, D. H.3; Moon, D. G.4; Kim, J. J.4; Kim, S.-C.5; Yang, D. Y.6; Yang, S.-K.7 1 Chuncheon Sacredheart Hospital, Urology, Korea; 2Chuncheon Sacredheart Hospital, Urology, Korea; 3Hallym University, Social Medicine, Chuncheon, Korea; 4Korea University Hospital, Urology, Seoul, Korea; 5Chung-Ang University Hospital, Urology, Seoul, Korea; 6Kangdong Sacredheart Hospital, Urology, Seoul, Korea; 7Konkuk University Hospital, Urology, Chungju, Korea

Triantafyllou, A.1; Gavriilaki, E.1; Anyfanti, P.2; Triantafyllou, G.1; Pyrpasopoulou, A.1; Chatzimichailidou, S.1; Gkaliagkousi, E.1; Papadopoulos, N.1; Douma, S.1; Aslanidis, S.1; Doumas, M.1 1 2nd Propedeutic Department of, Internal Medicine, Aristotle, Thessaloniki, Greece; 2Thessaloniki, Greece

Objective: The importance of endothelial dysfunction and inflammation in erectile dysfunction (ED) has been well documented and it may share its pathogenesis with atherosclerotic vascular disease. The serum C-reactive protein (CRP) is a non-specific marker of systemic inflammation, and well established risk factor in atherosclerotic vascular disease. Recently introduced high sensitive CRP (hsCRP) has more accurate value than conventional CRP. Hence, we evaluated the association between hsCRP and ED in aging men. Methods: Our study used a multistage stratified design to recruit a random sample of 1,510 men aged 45 years or older in Chuncheon, Korea. Men with the urologic (except for BPH) or neurologic diseases that could cause erectile dysfunction were excluded. Also, if men had been recently medical conditions that could cause or suppress inflammation such as infection or NSAID use, these men were excluded. The serum hsCRP levels were analyzed by continuous variable, top 10 percentile, top 20 percentile and top 25 percentile. ED was defined as an International Index of Erectile Function-5 (IIEF-5), analyzed by severe (5–7 points), moderate (8–11 points), mild (12–21 points), and normal (>21 points). Results: Finally 338 men were recruited. Mean age was 69.1 (47–93) years, and mean serum hsCRP was 0.277 (0.035–7.769) mg/L. Men with mild, moderate, and severe ED were 100 (30.1%), 16 (4.8%) and 110 (33.1%), respectively. No statistically significant association was observed between the hsCRP levels and IIEF-5 (P > 0.05). Also, in analyses including covariates such as age, body mass index, hypertension, diabetes mellitus, hyperlipidemia, alcohol, smoking and IPSS index, the serum hsCRP level was not significant risk factor. Conclusion: Age, alcohol and IPSS were associated with ED in aging men. However, the serum hsCRP levels were not associated with ED in aging men. The systemic inflammation is not a immediate risk factor of ED in aging men. Policy of full disclosure: None.

Objective: Musculoskeletal disorders include a wide spectrum of diseases characterized by pain and inflammation that are commonly encountered in the general population and affect predominantly women. As such, many physical aspects and functions in male patients suffering from rheumatic disorders remain understudied. The purpose of this study is to investigate prevalence of erectile dysfunction in a sample of male rheumatologic patients. Methods: In the present pilot study, the population consisted of consecutive patients visiting the Rheumatology Department of Hippokration General Hospital, Thessaloniki, Greece. The International Index of Erectile Function (IIEF) questionnaire, with total score ranging from 0 to 30, was distributed and completed by the participants, in order to detect cases of erectile dysfunction based on the cutoff score of ≤25, and further classify these patients as presenting mild (17–25), moderate (11–16), or severe (0–10) erectile dysfunction. Results: A total of 77 male patients with a mean age of 51.4 ± 13.0 were studied. Participants were diagnosed with serumnegative spondyloarthritis (31.2%), psoriatic arthritis (29.9%), rheumatoid arthritis (22.1%), and other rheumatic diseases (16.9%). Sexual dysfunction affected 62.3% of the participants. More specifically, 45.4% suffered from mild, 7.8% from moderate, and 9.1% from severe erectile dysfunction. Patients suffering from rheumatoid arthritis and systemic sclerosis presented the highest prevalence of sexual dysfunction (88.2% and 54.5%, respectively). Conclusion: Although this is a pilot study, prevalence of erectile dysfunction is profoundly magnified in the ground of rheumatic diseases, with the vast majority of male patients exhibiting impaired sexual functioning. The exact dimensions of the problem and the role of physical and/or psychological factors should be thoroughly investigated in future studies. Policy of full disclosure: None.

PO-03-013

MANAGEMENT OF PENIL FRACTURE, EFFECTS ON ERECTILE FUNCTION: CONSERVATIVE TREATMENT OR EARLY SURGICAL TREATMENT Ozorak, A.1; Hoscan, M. B.2; Oksay, T.1; Kosar, A.1; Guzel, A.1 Suleyman Demirel University, Urology, Isparta, Turkey; 2Baskent University, Urology, Antalya, Turkey 1

Objective: To present our experience with surgical and conservative treatment of penile fractures. Methods: Penile fracture is the traumatic rupture of the corpus cavernosum. Penile fracture usually occurs during sexual intercourse.This study was carried out in our department from 2005 to 2011, and included 29 patients presenting with penile fracture. Patients describe a popping, cracking, or snapping sound with immediate detumescence. Diagnosis is made based on history and physical examination findings. Nine patients with simple fracture and/or who refused surgical treatment were treated conservatively, and the other 20 patients with more severe injuries underwent early surgical intervention. Surgery was performed with circumferential incision and penis degloved to the base of the penis in all of the patients.Treatment results and complications were evaluated in both conservative and surgically treated patients. Results: Patients’ ages ranged from 25 to 45 years (mean 34 years). The most common cause of penile fracture is sexual intercourse (93%). In conservatively treated patients erectile dysfunction was observed in two patients. There was no serious complication in surgically treated patient.

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Unmoderated Poster Presentations Conclusion: Penile fracture can be diagnosed easily with history and physical examination and better functional results can be achieved with early surgical repair. Policy of full disclosure: None.

PO-03-014

PO-03-015

THE INVOLVEMENT OF PROSTATE CANCER THERAPY IN COUPLE LIFE: OPEN, LAPAROSCOPIC, ROBOTIC, AND HIFU APPROACH

CORONARY AND PELVIC ARTERIES CT SCAN IN PATIENTS WITH VASCULOGENIC ED FREE OF CARDIAC SYMPTOMS

Manea, C. N.; Hiriscau, I.; Maxim, R.; Crisan, N.; Dobrota, F.; Coman, I. EndoPlus Urology Clinic, Robotic Surgery and HIFU, Cluj Napoca, Romania

Virag, R.1; Paul, J. F.2 1 CETI, Paris, France; 2CMC Marie Lannelongue, Radiology Department, Le Plessis Robinson, France

Objective: The diagnosis and treatment of prostate cancer often results in significant physical side-effects and associated psycho-social stressors that can interfere with the experience of sexual intimacy for couples. Our study aims to evaluate couples’ sexual life and to determine any potential sexual dynamic dysfunctions which could occur before and after performing classic radical prostatectomy, laparoscopic, robotic radical prostatectomy and HIFU therapy in prostate cancer. Methods: One hundred three men diagnosed with localized and locally advanced prostate cancer, along with their partners, will undergo evaluation; in total 34 couples with the robotic surgery, 36 couples with HIFU, 14 couples with laparoscopic prostatectomy and 19 couples with open surgery. The initial evaluation aimed to identify sexual dynamic dysfunctions before the intervention. The couples were informed about the immediate and long term effects of the intervention and of existing therapeutic solutions. Results: Each partner of the couple was reevaluated 1, 3, and 6 months after the radical therapy. The main goal of evaluating the sexual behavior was to obtain valid information in order to make the optimal and oncological therapeutic decision. The partner’s answer frequency for both pre- and postoperatory of each item of the questionnaire was calculated. Our research team’s contribution is the individualization of the grid on the respective pathology. Conclusion: The preservation of sexual intimacy is an important issue to consider, as the majority of older adults continue to value, engage in, and enjoy sexual activity throughout their lives. Bringing into being an organized and individualized questionnaire is an important informative and predictive tool for outlining the profile of the sexual life of a couple and also for making the proper post-therapeutic decision. Policy of full disclosure: None.

Objective: To determine the presence and extent of coronary lesions in ED patients, with abnormal echo Doppler of penile deep arteries and free of known CHD. Secondary objective was the evaluation of location and extent of arterial lesions in the pelvic arteries including internal pudendal arteries and their branches. Methods: Thirty patients (median age 60 (46–73) with an IIEF-5 at 10.5 +/– 5 were included in the study when fulfilling the echo-döppler criteria PSV <25 cm/second after IC injection of 10 mcg of PGE1. Only one patient had no vascular risk factor (VRF). 33% are diabetic, 37% smokers, 43% hypertensive and 50% hyperlipidemic. In one session we perform CT scan of the heart and the pelvic area after ICI of 10 mcg of PGE1. After 3D reconstruction each vessel (coronary and pelvic) were classified for occlusion, stenosis infiltration and calcifications. Stenosis of a cardiac vessel > 50% lead to a functional test (stress test or echography after dobutamine). Results: Twenty-three patients (76.7%) have various type of coronary lesions in one (48%), two (10%) or three (42%) vessels, mainly infiltration and calcification predominant in the LAD (85%); 32% have stenosis <50%. All but one of the 13 functional tests were normal. In 97% of the cases the internal pudendal arteries are infiltrated (32%) or occluded (65%). Aorta and iliac arteries are slightly diseased or normal. Conclusion: The study shows (i) that in vasculogenic ED, there is a great probability to find already diseased coronary arteries without significant stenosis, and (ii) lesions in the pelvic area are predominant in the distal tree. Limitation of the study is the lack of a control age and VRF matched group to eliminate cofounding factors. Policy of full disclosure: None.

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424 PO-04

Unmoderated Poster Presentations ED and comorbidities

PO-04-001

SEXUAL DYSFUNCTION AND QUALITY OF LIFE IN FEMALE AND MALE PATIENTS WITH MYOCARDIAL INFARCTION Özer, Z.1; Bektas, H.2; Arıkan, F.2; Vicdan, N.2 Antalya, Turkey; 2Akdeniz University, Antalya, Turkey

1

Objective: Sexual activity and quality of life in male and female patients assessed with MI patients. Methods: The sample of the study was 70 patients with MI (26 female, 44 male) consecutive patients treated with Cardiology Unit of Akdeniz University. In this study, the data were gathered via an information form that assesses socio-demographical attributes and sexual dysfunction; international sexual dysfunction assessment forms; The Arizona Sexual Experience Scale (ASEX) was used for the assessment of the severity of sexual dysfunction for patients who resumed their sexual activity. Erection Function International Assessment Form (IIEF) for men; and The MacNew Heart Disease Health-related Quality of Life [MacNew] Questionnaire was used for quality of life. Obtained data were evaluated using statistical evaluations, univariate analysis, regression and Pearson correlation tests. Results: The patients in the sample averaged 60.03 years of age (SD 12.47 years, range 35–83), included most patients were male (62.3%), married (73.9%), and had completed primary education (30.4%) and had health insurance (95.7%). Sexual dysfunction was defined in 68% of women, and 35% of men. Reductions in the frequency of intercourse and sexual satisfaction were decreased in patients. The most important reason associated with the decreased prevalence of sexual intercourse was the fear of re-infarction, with a rate of 54.3%, fear of die (24.3%), pain (42.9%) and fatique (45.7%). ASEX score ranged from 0 to 19, with a mean of 7.32. ASEX subscore were sex drive (8.77 ± 7.68), arousal (10.58 ± 5.88), vaginal lubrication (7.31 ± 7.49), ability to reach orgasm (5.15 ± 5.43), and satisfaction from orgasm (5.19 ± 5.47). IIEF score ranged from 2 to 31, with a mean of 6.36. IIEF subscores were erectile function (16.2 ± 7.79), orgasmic function (5.84 ± 3.63), sexual desire (4.59 ± 2.57), intercourse satisfaction (7.91 ± 4.24), and overall satisfaction (4.95 ± 2.82). Quality of life score ranged from 2 to 7, with a mean of 4.18. Conclusion: MI has a negative impact on frequency of, and satisfaction with, sexual activity, and lead to sexual dysfunction within a large number of female and male patients. All these factors must be taken into account when it comes to managing this condition. Policy of full disclosure: None.

PO-04-002

HIGH SERUM URIC ACID LEVEL IS ASSOCIATED WITH PENILE VASCULAR DISEASE SEVERITY AND INCREASED AORTIC STIFFNESS IN ERECTILE DYSFUNCTION PATIENTS WITH METABOLIC SYNDROME Rokkas, K.; Vlachopoulos, C.; Ioakeimidis, N.; Aggelis, A.; Terentes-Printzios, D.; Synodinos, A.; Samentzas, A.; Christoforatou, E.; Askitis, T.; Stefanadis, C. Athens Medical School, 1st Department of Cardiology, Greece Objective: Hyperuricemia has been associated with endothelial dysfunction and increased aortic stiffness. Metabolic syndrome (MetS) is an independent risk factor for severe erectile dysfunction (ED) and cardiovascular disease. Here we first sought to investigate the association between uric acid (UA) levels and ED; second, we examined whether there is an independent association of UA with severe ED and arterial stiffness in individuals subdivided according to presence of MetS. Methods: The study included 205 ED patients (mean age 56 y) without clinical atherosclerosis. UA levels were determined from blood samples; Carotid-femoral pulse wave velocity (PWV) and penile

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peak systolic velocity (PPSV) were used to assess vascular function. Lower PPSV indicates severe penile vascular disease and increased atherosclerotic burden. Results: Results: Subjects were divided into tertiles based on the level of UA. PPSV decreased (36.2 vs. 32.8 vs. 27.6 cm/s, P < 0.001) and PWV increased (8.2 vs. 8.7 vs. 9.3 m/s, P < 0.001) with increasing tertiles of UA. The significant association between vascular function parameters and UA tertiles persisted when adjusting for traditional risk factors, C-reactive protein, testosterone and cardiovascular medication (P < 0.001, by analysis of covariance). ED patients categorized by UA levels were further subdivided according to presence of MetS (see figure below). Patients with high UA concentration (3rd tertile) and MetS had a higher prevalence of severe ED (PPSV < 25 cm/s) and increased aortic stiffness (>75th percentile, 9.6 m/s) compared to the other subgroups. Conclusion: High serum UA concentration in conjunction with MetS is associated with significant vascular changes in the aorta and the penile vasculature of ED patients suggesting a link between UA levels, MetS and increased cardiovascular risk. Policy of full disclosure: None.

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SEXUAL LIFE OF MEN AFTER CORONARY ARTERY BYPASS GRAFT SURGERY Skrzypulec-Plinta, V.1; Wanot, J.2; Skrzypulec, A.2 Medical University of Silesia, Women’s Health Chair, Katowice, Poland; 2 Medical University of Silesia, Katowice, Poland

1

Objective: Thirty-eight to seventy-eight percent of patients with cardiovascular diseases complain about erectile dysfunction. History of cardiovascular disease in patients together with its consequences and complications has a tremendous influence on the physical and emotional condition of patients. Anxiety and depression can lead to fitness and general health condition deterioration, family conflicts, the feeling of uncertainty as a sexual partner including the fear of having a sexual life. The aim of this study was to assess sexual activity, sexual satisfaction and erectile dysfunction after Coronary Artery Bypass Graft surgery (CABG), focusing on the time of resuming sexual activity after the operation, frequency of sexual intercourses, age and co-existing ailments. Methods: The study group consisted of 133 male patients after CABG surgery. The control group was 59 randomly chosen men from the area of Upper Silesia. In the study the following questionnaires were used: Beck Depression Inventory, Beck Anxiety Inventory, International Index of Erectile Function. Results: In group of patients after CABG decrease of level of sexual satisfaction after surgery was observed. They also presented increasing tendency of erectile dysfunction after CABG. The majority of patients resumes sexual activity after CABG—the age of the subjects significantly influences the time of resuming sexual activity. Conclusion: Proper sexological diagnosis and professional care for patients after CABG surgery should be a standard. Policy of full disclosure: None.

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Unmoderated Poster Presentations PO-04-004

THE EFFECT OF ERECTILE DYSFUNCTION ON GLOBAL HEALTH-RELATED QUALITY OF LIFE IN PATIENTS WITH RHEUMATIC DISEASES Triantafyllou, A.1; Anyfanti, P.2; Gavriilaki, E.1; Avagianou, P.-A.1; Triantafyllou, G.1; Pyrpasopoulou, A.1; Chatzimichailidou, S.1; Gkaliagkousi, E.1; Douma, S.1; Aslanidis, S.1; Doumas, M.1 1 2nd Propedeutic Department of, Internal Medicine, Aristotle, Thessaloniki, Greece; 2Thessaloniki, Greece Objective: Quality of life in male patients with rheumatic diseases is affected not only by the disease per se, but also as a result of various physical and psychological functions potentially impaired directly or indirectly by the disease. We intended to investigate the effect of erectile dysfunction on global health-related quality of life in patients suffering from rheumatic diseases. Methods: Consecutive male patients visiting the Rheumatology Department of Hippokration General Hospital, Thessaloniki, Greece comprised the study population. All participants completed the International Index of Erectile Dysfunction (IIEF) questionnaire for the evaluation of sexual function, with total score ranging between 0–30 and a cutoff value of ≤25 indicating erectile dysfunction. Global health-related quality of life was assessed by use of the EuroQol-VAS (Euro-Quality of life, Visual Analogue Scale). Results: A total of 56 male patients with a mean age of 53.2 ± 12.5 years were included in the study. The most prevalent rheumatic disorders in our sample were ankylosing spondylitis in 30.4%, psoriatic arthritis in 25%, rheumatoid arthritis in 23.2%, and others in the rest 21.4%. Of the study participants, 67.9% exhibited erectile dysfunction. The mean VAS score was 68.3 ± 18.0. Erectile dysfunction was strongly and reversely correlated with patients’ quality of life (r = 0.416, P = 0.001). Conclusion: Erectile dysfunction may exert deleterious effects on quality of life and this is encountered not only in healthy individuals, but also in those suffering from chronic illness like rheumatologic patients. Since improvement of global health-related quality of life is a priority for all health-care professionals, assessment of erectile dysfunction should be included in the routine clinical examination of male rheumatologic patients. Policy of full disclosure: None.

PO-04-005

THE IMPACT OF ERECTILE DYSFUNCTION ON SEXUAL-SPECIFIC QUALITY OF LIFE IN PATIENTS WITH RHEUMATIC DISORDERS Triantafyllou, G.1; Gavriilaki, E.1; Triantafyllou, A.1; Anyfanti, P.2; Avagianou, P.-A.1; Pyrpasopoulou, A.1; Chatzimichailidou, S.1; Petidis, K.1; Douma, S.1; Aslanidis, S.1; Doumas, M.1 1 2nd Propedeutic Department of, Internal Medicine, Aristotle, Thessaloniki, Greece; 2Thessaloniki, Greece Objective: Health-related quality of life is potentially impaired by a wide spectrum of mental and physiological disorders, including sexual dysfunction. In the present pilot study, we aimed at uncovering the impact of erectile dysfunction on quality of life in the specific group of rheumatologic patients. Methods: The present pilot study included consecutive patients visiting the Rheumatology Department of Hippokration General Hospital, Thessaloniki, Greece. Patients were asked to anonymously fill in the International Index of Erectile Dysfunction (IIEF) and the Erectile Dysfunction Effect on Quality of Life (ED-EQoL) questionnaires, for the disclosure of erectile dysfunction and the evaluation of erectile dysfunction-related quality of life, respectively. Data analysis included Pearson chi-square test for the comparison of frequencies, and Spearman’s Rho correlation coefficient for the correlation between the examined variables. Results: In total, 73 male patients with a mean age of 50.5 ± 13.0 years participated in the study. The most prevalent rheumatic disorders in

our sample were psoriatic arthritis in 30.6%, ankylosing spondylitis in 29.2%, rheumatoid arthritis in 22.2%, and others in the rest 18%. Of the study participants, 61.6% exhibited erectile dysfunction, who scored a mean ED-EQoL of 72.2 ± 17.7. Erectile dysfunction was strongly and reversely correlated with patients’ quality of life (r = 0.377, P = 0.001). Conclusion: Additionally to their primary disease, erectile dysfunction in patients suffering from rheumatic diseases represents yet another factor with detrimental effects on their quality of life. As such, health care professionals dealing with rheumatologic patients should routinely and drastically address this issue, in order to improve their patients’ quality of life, self-confidence and interpersonal relationships. Policy of full disclosure: None.

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TESTOSTERONE AND CARDIOVASCULAR RISK IN PATIENTS WITH ERECTILE DYSFUNCTION Corona, G.1; Rastrelli, G.1; Balercia, G.2; Forti, G.3; Mannucci, E.4; Maggi, M.1 1 Sexual Medicine and Andrology, University of Florence, Italy; 2Endocrinology Unit, University of Marche, Ancona, Italy; 3Endocrinology, University of Florence, Italy; 4Geriatric Unit, University of Florence, Italy Objective: The relationship between cardiovascular (CV) diseases (CVD) and testosterone (T) levels in men has not been completely clarified. The aim of this study is to evaluate the association between T levels and CV risk in subjects with erectile dysfunction (ED) and to verify whether their body mass index might (BMI) represents a possible confounder in testosterone-related CV stratification. Methods: A consecutive series of 2269 male patients attending the Outpatient Clinic for ED was studied. The assessment of CV risk was evaluated using the engine derived from the Progetto Cuore study. Results: After adjustment and for BMI and associated morbidities, sex hormone binding globulin bound (SHBG) and unbound T levels decreased as a function of CV risk assessed thorough Progetto Cuore risk engine. In addition, a higher prevalence of hypogonadism related symptoms and signs was associated with a higher CV risk. Among factors included in the Progetto Cuore risk engine age, total and HDL cholesterol and diabetes were all significantly associated with CV riskdependent modification of total and calculated free-T levels. When the relationship between SHBG bound and unbound testosterone and CV risk was evaluated as a function of obesity (BMI > 30 kg/m2), all the aforementioned associations were confirmed only in non obese patients. Conclusion: Hypogonadism could be associated either with an increased or reduced CV risk, depending on the characteristics of subjects. Low T observed in obese patients might represent the result of higher CV risk rather than a direct pathogenetic mechanism. Policy of full disclosure: None.

PO-04-007

CORRELATION BETWEEN NIH CATEGORY IV PROSTATITIS AND ERECTILE DYSFUNCTION Ozorak, A.1; Oksay, T.1; Capar, E.1; Kosar, A.1; Hoscan, M. B.2 Suleyman Demirel University, Urology, Isparta, Turkey; 2Baskent University, Urology, Antalya, Turkey

1

Objective: In this study we evaluated the correlation between prostatitis severity and erectile dysfunction frequency in patients with NIH category IV prostatitis. Methods: Our study includes twenty four patients with NIH category IV prostatitis, who had lower urinary tract symptoms and were diagnosed with medical history, physical examination, urine examination, expressed prostatic secretion, prostate biopsies under transrectal ultrasonography guidance. All patients filled up NIH-CPSI (National

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426 Institute of the Health Chronic Prostatitis Symptom Index) and IIEF-5 (International Index of Erectile Function-5). Results: The patients had mean age of 54.25 ± 11.34; mean PSA of 16.57 ± 20.1, mean prostate volume of 40.38 ± 29.4, mean NIH-CPSI of 17.45 ± 7.37, mean IIEF-5 of 18.83 ± 6.9. Fifteen patients (62.5%) had erectile dysfunction. There was no statistically significance between IIEF-5 and PSA or prostate volumes (P = 0.68, P = 0.24). There was no statistically significance and correlation between IIEF-5 and age (P = 0.77, r = 0.101). There was statistically significant correlation between IIEF-5 and NIH-CPSI (P = 0.022, r = 0.34). NIH-CPSI subunits (micturition, pain, and quality of life) and IIEF-5 was compared. Respectively, there was statistically significance between IIEF-5 and NIH-CPSI micturition symptoms (P = 0.0345) but there was no any between IIEF-5 and NIH-CPSI pain, quality of life symptoms (P = 0.87, P = 0.568). Conclusion: There is correlation between prostatitis severity and erectile dysfunction frequency in patients with NIH category IV prostatitis. Especially patients, who have more micturition symptoms, have more erectile dysfunction. Correlation between erectile dysfunction frequency and NIH category IV prostatitis is due to organic etiology and need more investigations. Policy of full disclosure: None.

PO-04-008

SEXUAL FUNCTION IN AZOOSPERMIC AND OLIGOSPERMIC MEN Koukos, S.1; Vappa, S.1; Baltogiannis, D.1; Giannakis, D.1; Tsounapi, P.2; Takenaka, A.2; Vlachopoulou, E.1; Kolitsas, N.1; Sofikitis, N.1; Dimitriadis, F.1 1 University of Ioannina, Urology, Greece; 2Tottori University, Urology, Yonago, Japan Objective: To investigate the erectile function in azoospermic (group A; N = 8) and oligospermic men (group B; N = 8). Methods: In the present study 16 patients participated. Group A consisted of eight men with azoospermia or cryptoazoospermia. Group B consisted of eight oligospermic men. The patients were evaluated with the International Index of Erectile Function–5, Penile Hardness Scale (IIEF-5), Penetration Rate (% successful attempts for penetration to the total number of attempts for penetration; PR), and Ejaculation Rate (%successful ejaculations to the total number of penetrations; ER). The levels of FSH, prolactin, and total testosterone were also assessed. The comparison between the two groups was carried out with the Wilcoxon test. A probability P less than 0.05 was considered to be statistically significant. Results: In oligospermic men the mean IIEF-5 score was 23. In azoospermic men the mean IIEF-5 score was equal to 21.5. Specifically, 75% of oligospermic men had no erectile dysfunction and 25% had mild erectile dysfunction. In azoospermic men 37.5% demonstrated no erectile dysfunction and 62.5% showed mild erectile dysfunction. In oligospermic men the mean value of PR and ER was 94% and 86%, respectively and in azoospermic men the above parameters were 86% and 84%, respectively. The mean value of FSH for group B was 9.53 mIU/mL and for group A was 11.29 mIU/mL. Also, the mean value of the total testosterone was 5.19 ng/mL in group B and 3.65 ng/ mL in group A. The index of the scale of penile hardness was equal to 3.6 in both groups. No statistically significant difference was found in the mean values of any parameters between the two groups. Conclusion: There were no significant differences in the PR, ER, IIEF-5 score, and the hormonal profiles between oligospermic and azoospermic men. Policy of full disclosure: None.

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Unmoderated Poster Presentations PO-04-009

A PILOT STUDY TO EVALUATE THE EFFECTS OF VARDENAFIL ON SEXUAL DISTRESS IN MEN WITH OBESITY Aversa, A.; Natali, M.; Francomano, D.; Bruzziches, R.; Guerra, A.; Latini, M.; Donini, L. M.; Lenzi, A. Sapienza University of Rome, Dept Experimental Medicine, Italy Objective: There are no interventional studies on the impact of sexual distress (SD) in men with obesity. We investigated the effects of vardenafil on sexual distress in middle-aged (mean age 49 ± 8) healthy obese men in the absence of premature ejaculation, erectile dysfunction or hypogonadism. Methods: After 4-week run-in period, twenty men with high body mass index (BMI = 40 ± 8) and SD at Sexual Distress Esteem Questionnaire-Male (mean score 65 ± 20 AU) were randomized to receive either vardenafil 10 mg on-demand (VAR, N = 10) or matched placebo (PLB, N = 10). Primary end points were variations from baseline in the intravaginal ejaculatory latency time (IELT) measured by the stopwatch technique; secondary end points were variations from baseline in Self-Esteem and Relationship (SEAR) and Male Sexual Health Questionnaire-Ejaculatory domain (MSHQ-EjD) scores. Results: VAR significantly improved IELT (P < 0.0001) as well as SEAR (P < 0.001) and MSHQ-EjD (P < 0.005) scores while no changes were observed after PLB. Interestingly, an inverse relationship between BMI and IELT was found in all men studied (r2 = 0.37, P < 0.001). Conclusion: Sexual Distress in healthy obese men seems to be correlated mainly with inadequate ejaculatory control especially in men with higher BMI. Our preliminary results suggest that treatment with vardenafil may improve ejaculatory control thus ameliorating selfesteem and sexual performance. Policy of full disclosure: A. Aversa received speaker’s honoraria from Eli Lilly and Bayer Schering Pharma.

427

Unmoderated Poster Presentations PO-05 Male sexual health (aging male, hormones, lifestyle factors) PO-05-001

STABLE EXTRAMARITAL AFFAIRS ARE BREAKING THE HEART Fisher, A. D.1; Bandini, E.1; Corona, G.1; Monami, M.2; Cameron Smith, M.1; Melani, C.3; Balzi, D.4; Forti, G.1; Mannucci, E.2; Maggi, M.1 1 Andrology Unit, Clinical Physiopathology, Florence, Italy; 2Diabetes Section,, Geriatric Unit, Florence, Italy; 3Epidemiological Unit, Azienda Sanitaria Locale, Florence, Italy; 4Epidemiological Unit,, Azienda Sanitaria Locale, Florence, Italy Objective: The relationship between extramarital affairs and cardiovascular risk is still not completely clarified. The aim of this study was to investigate whether extramarital affairs have a protective effect on cardiovascular risk or, conversely, a deleterious one. Methods: A consecutive series of 1,098 patients (mean age 54 ± 12 years old) attending our outpatient clinic for sexual dysfunction between 2000 and 2007 with available information on extramarital affairs was enrolled in a longitudinal study. At baseline, different clinical, biochemical, instrumental (penile Doppler ultrasound, PCDU) parameters were evaluated. Information on major cardiovascular events (MACE) was obtained through the City of Florence Registry Office. Results: Among patients studied, 91.8% of the whole sample reported no or occasional extramarital affairs, while 8.2% declared a stable secondary relationship. During a median follow-up of 4 (0–8) years, 95 major adverse cardiovascular events (MACE), eight of which were fatal, were observed. Cox analysis, after adjustment for confounding factors, showed that presence of stable extramarital affair was associated with a higher incidence of MACE (HR = 2.13 [1.12; 4.07], P = 0.023). The introduction in the Cox model of patient perceived partner’s hypoactive sexual desire (PPPHSD) attenuates the association (HR 1.86 [0.93; 3.70], P = 0.078). The sample was therefore divided according to PPPHSD. We observed that unadjusted incidence of MACE was significantly associated with presence of extramarital affairs only in men reporting a primal partner without PPPHSD. This association was also confirmed in a Cox regression model, after adjusting for confounders (HR = 2.87 [1.81; 6.98], P = 0.020). Conclusion: To be unfaithful represents an independent risk factor for MACE. Therefore, infidelity induces not only heart trouble in the betrayed partners, but seems to be also able to increase the betrayer’s heart-related events. Policy of full disclosure: None.

PO-05-002

VARICOCELE AND MALE AGING: RESULTS OF A CONTROLLED STUDY Maio, G. Abano Terme, Italy Objective: To verify if varicocele may decrease serum testosterone and facilitate the onset of hypogonadism in the age group 45–65 years. Methods: One hundred consecutive patients with mild-moderate ED (June 2010–March 2011) were investigated using clinical history, andrological examination (after 2 minutes in the standing position), IIEF-15 erection domain (IIEF-15ed), colordoppler-scrotal ultrasound in subjects with a palpable varicocele. Exclusion criteria included significant testicular abnormalities: testis tumor, criptorchidism, pubertal/postpubertal mumps orchitis, testicular hypo-atrophia due to other causes (cord torsion trauma etc.). Statistical analysis: variables were compared using: (i) Mann–Whitney test for noncontinuous variables; (ii) t-test independent samples for continuous variables; (iii) chi-square for categorical variables; a P < 0.05 was considered significant (software SPSS-15.0). Results: Mean age was 52.60 ± 5.79 (varicocele, group A, 52.33 ± 5.80; non-varicocele, group B, 52.80 ± 5.83; p ns). 39/100 subjects presented a palpable varicocele 2°–3° Dubin at physical examination;

colordoppler-scrotal ultrasound confirmed varicocele in 35 and showed a concomitant subclinical right varicocele in 11. IIEF-15ed: 17.17 ± 2.31 (group A: 17 ± 2.55; group B: 17.26 ± 2.18; p ns. Total testosterone: 4.32 ng/mL ± 1.13; (varicocele group 3.79 ng/mL ± 0.98; no-varicocele group: 4.61 ± 1.11 (P 0.000; IC 95%: 0.3833–1.2702). Total testosterone <3 ng/mL was present in 14/100; group A: 9/35 (25.71%), group B: 5/65 (7.69%) (P 0.013). Conclusion: This study shows a statistical significant correlation between varicocele, testosterone reduction and hypogonadism; the study can be a starting point for larger studies. The varicocele prevalence was apparently, surprisingly high in the study population. As a matter of fact studies on older populations show an increase with age of varicocele prevalence (Levinger et al., Andrologia 2007;39:1–4). Policy of full disclosure: None.

PO-05-003

THE SECRET LIVES OF PENILE FRACTURE PATIENTS Kramer, A.1; Wilson, S.2 University of Maryland, Baltimore, MD, USA; 2Indio, CA, USA

1

Objective: The unusual event of penile fracture occurs when there is a disruption of the tunica albuginea surrounding engorged erectile tissue during aggressive sexual behavior. There is often an audible crack and rapid detumescence with subcutaneous hemorrhage occurs. Medical literature has described the etiology and treatment of penile fracture. We report the remarkably unusual social situations of a series of patients who sustained this unique injury. Methods: We conducted retrospective chart review of 16 patients whose injury was severe enough to require surgical repair at the University of MD between 2007 and 2011. Particular attention was paid to the intake interview in the emergency department and the postoperative chart notes by the attending urologist to ascertain out of the ordinary social situations in which the injury was sustained. The occurrence of penile fracture is sufficiently rare that the first author was able to interact personally with most of the patients. All except 2 of the patients were remarkably forthcoming with the personal social dynamics of the sexual encounter. Results: Most of these patients were living secret lives when they sustained the penile injury. Half of these patients sustained the injury during an extramarital affair. Only 3 patients sustained the injury in a bedroom with their spouse; the remainder was in out of the ordinary locations for sexual intercourse e.g., cars, elevator, the workplace, and public restrooms. 2 patients refused to even acknowledge they had an erection. These were designated the “immaculate fracture.” Conclusion: Penile fracture patients appear to be a unique population of men who are having sexual intercourse in stressful and secret situations. Extramarital affairs and out of the ordinary locations appear common in patients sustaining this relatively rare injury. Policy of full disclosure: S. Wilson is a consultant for AMS and Coloplast; A. Kramer is a consultant for Coloplast.

PO-05-004

DYSAESTHETIC PENOSCROTODYNIA: THE MALE EQUIVALENT OF VULVODYNIA Markos, A. GU Medicine Department, MID Straggardshire NHS Trust, Stafford, UK Objective: To standardize nomenclature and classification of penoscrotodynia, in line of the ISSVD classification for vulvodynia. To promote and improve the care of male patients presenting with genital pain of unidentified etiology. Methods: Review of genital dermatology books and Pub Med English literature for: Male, Genital, Penile, Glans, Scrotal, Pain, Dysaesthesia, Hyperaesthesia, Allodynia and/or Burning. Results: There is paucity of research and literature reporting on male genital pain of unidentified etiology. Penoscrotodynia is diagnosed on patient’s history; and the finding of otherwise normally looking genital skin. The patient’s distress is usually out of proportion of physical

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428 findings, if any. Pain Diary quantify the distress. Peniscopy exclude minute lesions. A subgroup has Alcohol or Caffeine induced Penoscrotodynia. The “Red Scrotum Syndrome,” a form of Erythromelalgia; is localized, provoked and unprovoked scrotodynia. Conclusion: Male patients present with genital skin burning sensation, hyperaesthesia, allodynia and/or pain; with what otherwise is healthy looking skin and with no clear underlying etiology. Penoscrotodynia share a pattern of presentation, distress and management; similar to vulvodynia. Penoscrotodynia would benefit from a similar classification, to that of the ISSVD for “vulvodynia”; as: Localized PSD (to describe Scroto Dynia, Peno Dynia or Glanso Dynia); or Generalized; Provoked, Unprovoked or Mixed; and graded as Mild, Moderate or Severe. The underlying etiology may be Neuropathy, Arterio-venous shunting (Erythromelalgia) or both. Caffeine and alcohol induce penoscrotodynia in a subgroup of patients. Lines of managment are similar; namely, SSRIs & SNRIs. Policy of full disclosure: None.

PO-05-005

A STUDY OF THE ATTITUDES AND BEHAVIORS OF KOREAN MEN TO COMPLEMENTARY AND ALTERNATIVE MEDICINE FOR THE IMPROVEMENT OF SEXUAL FUNCTION: THE KOREAN INTERNET SEXUALITY SURVEY (KISS), PART II Song, S. H.1; Choi, W. S.1; Son, H.2; Paick, J.-S.1 Seoul National University, Urology, Korea; 2Seoul National University, Boramae Hospital, Korea

1

Objective: Little research has been performed on complementary and alternative medicine (CAM) usage for improving sexual function. To study CAM usage for sexual problems and to propose a model explaining what leads men to use CAM. Methods: Participants recruited via the Internet were asked to complete questionnaires about CAM usage and sexual function. Actual CAM users were allocated to group A, men who desired but did not actually use CAM were allocated to group B, and others were allocated to group C. It was presumed that men desired CAM when exposed to some risk factors of sexual dysfunction, and these are the men among that actually use CAM. Results: A total of 443 subjects of mean age of 39.2 ± 10.2 years were included. The prevalence of CAM use for sexual function was 11.1%, and dietary supplements were the most common type of CAM. Overall mean satisfaction for the used CAM by percent was 55.5 ± 24.2%. One hundred and ninety-two men (43.3%) were allocated to Group B. By multivariate analysis, the risk factors for desiring CAM included drinking (OR = 2.24, 95% CI = 1.28–3.91), regarding sex a very important part of life (OR = 2.16, 95% CI = 1.41–4.09), self-reported erectile dysfunction (OR = 5.08, 95% CI = 1.60–16.1), and self-reported premature ejaculation (OR = 3.34, 95% CI = 1.65–6.76). Smoking (OR = 2.49, 95% CI = 1.11–5.61) and having a strong positive attitude toward sexual activity (OR = 3.77, 95% CI = 1.42–9.99) were found to be independent risk factors of actual CAM use. On the other hand, RE (role emotion) points on the SF-36 (OR = 0.22, 95% CI = 0.06–0.73) and self-reported PE (OR = 0.22, 95% CI = 0.06–0.73) were found to be negatively related to actual use. Conclusion: Smoking, drinking, self-reported ED, self-reported PE, attitude towards sexual activity, and emotional problems play roles in decision making regarding the use of CAM. Policy of full disclosure: None.

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Unmoderated Poster Presentations PO-05-006

HYPOGONADISM AS A RISK FACTOR FOR CARDIOVASCULAR MORTALITY IN MEN: A META-ANALYTIC STUDY Rastrelli, G.1; Corona, G.1; Monami, M.2; Guay, A.3; Buvat, J.4; Sforza, A.5; Forti, G.1; Mannucci, E.2; Maggi, M.1 1 University of Florence, Clinical Physiopathology, Italy; 2University of Florence, Critical Care, Italy; 3Lahey Clinic, Endocrinology, Peabody, MA, USA; 4 CETPARP, Lille, France; 5Maggiore-Bellaria Hospital, Bologna, Italy Objective: To verify whether or not hypogonadism represents a risk factor for cardiovascular (CV) morbidity and mortality and to verify whether or not testosterone replacement therapy (TRT) improves CV parameters in subjects with known CV diseases (CVD). Methods: We performed a review and meta-analysis of available prospective and cross-sectional studies. In addition, a specific metaanalysis on the CV effects of TRT in available randomized clinical trials (RCTs) was also performed. An extensive Medline search was performed including the following words “testosterone,” “CVD,” and “males.” The search was restricted to data from January 1, 1969 up to January 1, 2011. Results: Out of 1178 retrieved articles, 70 were included in the study. Among cross-sectional studies patients with CVD has significantly lower testosterone (T) and higher 17-β-estradiol (E2) levels. Conversely, no difference was observed for dehydroepiandrosterone sulphate (DHEAS). The association between low T and high E2 with CVD was confirmed in a logistic regression model, after adjusting for age and body mass index (HR = 0.763 [0.744–0.783], P < 0.0001 and 1.015 [1.014–1.017], respectively for each increment of total T and E2; both P < 0.0001). Longitudinal studies showed that baseline T was significantly lower among patients with incident overall- and CVrelated mortality, in comparison to controls. Conversely, we did not observe any difference in baseline T and E2 levels between case and controls for incident CVD. Finally, TRT was positively associated with a significant increase of treadmill test duration and time to 1-mm ST segment depression. Conclusion: Low T and higher E2 correlate with increased risk of CVD and CV mortality. TRT in hypogonadism moderates metabolic components associated with CV risk. Whether low T is just an association with CV risk, or an actual cause and effect relationship, awaits further studies. Policy of full disclosure: None.

PO-05-007

HYPOGONADOTROPIC HYPOGONADISM: CHANGES IN TESTICULAR BLOOD FLOW AND APPEARANCE AFTER TREATMENT WITH GONADOTROPHINS Ur Rehman, K.1; Shahid, K.2; Humayun, H.3 FMH College of Medicine, Andrology & Urology, Lahore, Pakistan; 2FMH College of Medicine, Radiology Department, Lahore, Pakistan; 3FMH College of Medicine, Lahore, Pakistan

1

Objective: Hypogonadotropic Hypogonadism responds well to the treatment with gonadotropins. We aims to investigate the testicular changes that lead to this improvement in testicular function. Methods: All consecutive male patients presenting to our clinic, with the disease, were included in the study. Their hormonal status was recorded at baseline and repeated after 1–3 months. Scrotal Color Doppler Ultrasonography (CDUS) was performed before and after treatment with gonadotropins. Results: Our study included 26 patients having age range of 18–43 years and were followed for a period of 8–29 months. After treatment, serum testosterone and secondary sex characters improved in all patients and spermatogenesis developed in 16 out of 26 patients. On CDUS, testicular, intra-parenchymal blood flow was undetectable in all except three patients. Baseline Peak systolic velocity PSV was 0.39 ± 1.14 cm/second on left side and 0.44 ± 1.07 on right side. This improved significantly to 3.6 ± 2.9 and 3.5 ± 2.81 cm/second respec-

429

Unmoderated Poster Presentations tively after treatment (P < 0.01). Similarly their subcapsular arterial flow and testicular size also improved significantly (P < 0.01). Baseline transverse epididymal diameter was found to be 5.3 ± 1.8 and 5.27 ± 1.58 cm/second on right and left sides, respectively. After treatment with gonadotropins, this improved significantly to 7.2 ± 2.7 and 7.09 ± 2.22 cm/second, respectively. At baseline no patient had detectable varicocele on CDUS. After treatment varicocele (>2.5-mm diameter) was demonstrable in six patients. Conclusion: In our study, HH patients had absent detectable blood flow in most patients. After treatment their testicular blood flow improved and the flow of sub-capsular vessels of testes returned earlier whereas the intra-parenchymal blood flow became detectable later. The transverse epididymal diameter also improved after treatment. In some patients, previously undetectable varicocele became detectable after treatment. Policy of full disclosure: None.

PO-05-008

LOW TOTAL TESTOSTERONE CONCENTRATION AND INCREASED CRP LEVELS ARE ASSOCIATED WITH DECREASED EXERCISE CAPACITY IN ESSENTIAL HYPERTENSIVE MEN Vlachopoulos, C.; Ioakeimidis, N.; Terentes-Printzios, D.; Aggelis, A.; Synodinos, A.; Samentzas, A.; Christoforatou, E.; Rokkas, K.; Askitis, T.; Stefanadis, C. Athens Medical School, 1st Department of Cardiology, Greece Objective: Erectile dysfunction (ED) and maximum capacity during exercise stress test (EST) (measured in metabolic equivalents, METS) may predict late cardiovascular events. Subclinical inflammation and low androgen level are involved in the pathophysiologogy of ED. In this study, we investigated the combined effect of increased C-reactive protein (CRP) levels and low endogenous total testosterone (TT) concentration on exercise capacity in hypertensive patients undergoing EST. Methods: One hundred fifty-six asymptomatic non-diabetic hypertensive ED patients (56 ± 8 years) underwent maximal EST under the standard Bruce protocol. Blood specimens were analyzed for CRP and TT levels. Results: In univariate analysis, maximum exercise capacity during EST was negatively correlated with CRP (r = −0.225, P < 0.001) and positively correlated with TT (r = 0.325, P < 0.001). Stepwise regression analysis revealed that age, CRP (b = −0.171, P < 0.01) and TT (b = 0.207, P < 0.001) were independent predictors of exercise intensity (adjusted R square = 0.322). The distributions of CRP and TT were split by the median (1.36 mg/L and 4.45 ng/mL, respectively) and accordingly subjects were stratified into those with high and low values. ED patients were then categorized by CRP levels and further subdivided according to TT concentration. The subgroup of hypertensive ED patients with high CRP/low TT exhibited significantly lower maximum workload (see figure below) as compared with the subgroups of high CRP/high TT, low CRP /low TT and low CRP/ high TT (overall P < 0.001, after adjustment for age). Conclusion: In essential hypertensive men with ED, pronounced lowgrade inflammation in conjunction with low androgen level exert an additive unfavorable effect on maximum workload. Policy of full disclosure: None.

PO-05-009

RESULTS OF CO-SDT STUDY: PREVALENCE AND RISK FACTORS OF METABOLIC SYNDROME IN A POPULATION OF 2,508 MEN WITH TESTOSTERONE DEFICIENCY SYNDROME García-Cruz, E.1; Cardeñosa, Ó.2; Luque, P.1; Alcaraz, A.1 Hospital Clínic de Barcelona, Urology, Spain; 2Bayer España, Barcelona, Spain

1

Objective: In a population of men with Testosterone Deficiency Syndrome, we aimed to determine the prevalence and risk factors of Metabolic Syndrome and its associate comorbidity. We examined whether the symptoms of Testosterone Deficiency Syndrome, recorded by AMSS questionnaire, were related to the presence of Metabolic Syndrome. Methods: A total of 2,508 men with untreated Testosterone Deficiency Syndrome (testosterone < 8 nmol/L or testosterone 8–12 nmol/L with free testosterone < 250 pmol/L) were prospectively and consecutively recruited by 455 Spanish andrologists, endocrinologists and urologists. Variables age, waist circumference, body mass index, hypertension, diabetes mellitus, dyslipidemia, IIEF-5 and AMSS were prospectively recorded. NCEP-ATP III criteria was used to define Metabolic Syndrome. We performed a multivariate analysis of the variables included in the study, including if answers “severe” or “extremely severe” in any of the questions of AMSS questionnaire were related to Metabolic Syndrome. Results: Mean age was 61.2 ± 8.2. Rate of glucose >110 mg/dL: 29.6%, triglycerides >150 mg/dL 49.7%, HDL-cholesterol <40 mg/ dL: 37.9%, hypertension (>130/85): 42.8% and waist circumference > 102 cm: 52%. According to NCEP-ATP III criteria, a total of 50.1% of men had metabolic syndrome. The presence of hypertension (OR 1,784, CI 95% 1,363–2,335), dyslipidemia (OR 2,180, CI 95% 1,662– 2,859), glucose >110 mg/dL (OR 3,280, CI 95% 2,450–4,392), waist circumference >102 cm (OR 8,3, CI 95% 6,327–10,888) and answering “severe” or “extremely severe” to AMSS 8 question (“anxiety, feeling panicky”) (OR 2,049, CI 95% 1353–3,103) were related to Metabolic Syndrome. Conclusion: The rate of Metabolic Syndrome and its components in males with Testosterone Deficiency Syndrome is high. Hypertension, diabetes, dyslipidemia, waist circumference >102 cm and “severe” or “extremely severe” anxiety (AMSS-8 4/5) are related to Metabolic Syndrome in this population. Policy of full disclosure: This study was performed with BAYER Healthcare España funding support.

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430 PO-05-010

TESTOSTERONE DEFICIENCY IN MALES: PREVALENCE AND RELATION WITH METABOLIC PARAMETERS Becerra, A.1; Menacho, M.2; Perez-Lopez, G.1; Lucio, M. J.1; Asenjo, N.1; Rodriguez-Molina, J. M.1; Del Rey, J. M.2 1 Hospital Ramon y Cajal, Gender Unit, Dpt. Endocrinology, Madrid, Spain; 2 Hospital Ramon y Cajal, Dpt. Biochemistry, Madrid, Spain Objective: Androgen deficiency in the aging male has become an actual topic due to the aging population and finding from different studies that shown a progressive decline of serum levels of age-related testosterone. These levels have been inversely related with markers of metabolic syndrome and cardiovascular disease. The aim of this observational study was to analyze the prevalence of testosterone deficiency and the relation of endogenous testosterone with different metabolic parameters, in a Spanish middle-aged and elderly male population. Methods: We analyzed the medical records of 1,422 men, aged between 18 and 88 years, who had at least one biochemical determination made in 2010 to include serum levels of glucose, glycosilated hemoglobin, lipid profile, total testosterone (TT) and estradiol. Results: Our male population present an evident (TT < 230 ng/dL) or partial androgenic deficit (TT 230–345 ng/dL) in 4.7% and 12% (in minus 40 years and in more 60 years, respectively).We find an inversely significant correlation of values of TT with those age (r = −0.263, P < 0.001), glucose (r = −0.186, P < 0.001), and triglycerides (r = −0.142, P < 0.001), and a directly significant correlation with those HDL-cholesterol (r = 0.139, P = 0.001), LDL-cholesterol (r = 0.100, P = 0.018) and estradiol (r = 0.264, P < 0.001). Conclusion: Our findings show that testosterone deficit is relatively common in relation with aging. The decrease in testosterone concentrations is related with glucose and lipid profile, and in consequence with the development of diabetes mellitus and cardiovascular disease. Policy of full disclosure: None.

PO-05-011

PREVALENCE OF LOH IN KOREA: A NATIONWIDE STUDY Moon, D. G.1; Lee, S. W.2; Park, J. K.3; Park, K. S.4; Ahn, H. S.5; Study Group, K. A. Male6 1 Korea University, Urology, Seoul, Korea; 2Samsung Medical Center, Urology, Seoul, Korea; 3Chonbuk University, Urology, Chonju, Korea; 4 Chonnam University, Urology, Kwangju, Korea; 5Korea University, Preventive Medicine, Seoul, Korea; 6Korean Aging Male Study Group, Seoul, Korea Objective: We performed this Nationwide study to assess the prevalence of LOH defined by total testosterone <350 ng/mL and ADAM questionnaire. Additionally, the severity of LOH was also assessed by AMS scale. Methods: Using Multi-level Stratified Random Sampling methods, a random sample of 2,000 men of 40–80 years old and geographically representative of Korean population were allocated to 30 health promotion centers in nationwide cities and provinces in Korea. By trained interviewers, validated patients-reported outcomes (PROs) of ADAM questionnaire and AMS were asked. Before 11 am, serum total testosterone and SHBG were measured by radioimmunoassay through a central lab. All design of population sampling and statistics was performed by an expert statistician. Results: The study population was composed of 37.9% of 40s, 34.0% of 50s, 18.1% of 60s and 9.9% of 70s to 80s, respectively. The prevalence of LOH defined as TT < 350 ng/mL was 28.4%, and 24.1% of 40s, 28.7% of 50s, 28.1% of 60s and 44.4% of 70s to 80s, respectively. Prevalence of LOH by TT threshold was 10.5% in TT < 250 ng/dL, 18.5% in TT < 300 ng/dL and showed decade-dependent increase of prevalence. The prevalence of LOH defined by ADAM questionnaire was 88.7% and 58.3% of 40s, 77.8% of 50s, 84.2% of 60s and 88.7% of 70s to 80s, respectively. ADAM and AMS did not show significant

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Unmoderated Poster Presentations correlation with TT. Hypertension, Diabetes and allergic rhinitis showed significant correlation with TT level as comorbid diseases. Conclusion: Because of diagnostic limitations, prevalence of LOH showed a large difference between testosterone and symptom questionnaires (28.4% by TT and 88.7% by ADAM). Prevalence of LOH in Korea is expected to increase rapidly like western countries for the demographic trends toward greater longevity and increasing comorbid diseases. More accurate diagnostic tools for LOH should be developed. Policy of full disclosure: None.

PO-05-012

LONG-ACTING TESTOSTERONE UNDECANOATE IMPROVED DIABETES CONTROL VS. PLACEBO IN A HYPOGONADAL POPULATION WITH TYPE 2 DIABETES Hackett, G. Good Hope Hospital, Sutton Coldfield, UK Objective: Testosterone replacement has been shown in several small studies of men with metabolic syndrome and/or type 2 diabetes to improve insulin resistance, HbAic andvisceral adiposity. This is the first study conducted entirely in a primary care type 2 diabetic population. Methods: The male type 2 diabetic populations of 7 UK general practices were screened for morning total testosterone, SHBG and calculated free testosterone to identify 211 eligible patients with clinical hypogonadism. 200 patients entered the 30-week, double-blind, placebo-controlled phase of 30 weeks vs. matched placebo. Patients were assessed for HbA1c, HOMA-IR, CRP, glucose, PSA, FBC, BMI, waist circumference, 187 (93%) completed the study with 106 entering a 12-month open-label follow-on. Results: HbA1c fell from 7.61 to 7.52 overall in the TU group and rose from 7.57 to 7.69 in the placebo group. In the poorly controlled patients the fall was 9.2 to 9.0 in the TU group and remained unchanged at 9.2 in the placebo arm. There was one treatment emergent prostate cancer in the placebo arm, The most string findings were on the open-label continuation study, where HbA1c fell from 8.3 to 7.3 overall and from 9.4 to 8.9 in the poorly controlled group with mean final plateau testosterone levels of 15 nmol/L and FT of 0.35 nmol/L. Mean weight loss was 2 kg and BMI fell by 1.1 with 1.5-cm reduction in waist circumference. There were no further safety concerns with a mean PSA increase from 1.91 to 2.11 and mean hematocrit was unchanged from baseline. Conclusion: Therapy with testosterone undecanoate produced small changes in HbA1c at 30 weeks but marked changes after a further 52 weeks. Metabolic benefits of testosterone undecanoate in type 2 diabetes may not been seen until 12–18 months of therapy. Policy of full disclosure: This was an independent investigator initiated trial funded with the aid of an unrestricted grant from Bayer plc.

PO-05-013

ANALYZING BY DECADE, TESTOSTERONE UNDECANOAT DEPOT INJECTABLE DOES NOT INCREASE PROSTATE VOLUME: STUDY ON 140 HYPOGONADIC PATIENTS WITHOUT PROSTATIC CANCER Peretianu, D.1; Carsote, M.2; Poiana, C.2; Staicu, D. C.1 SCM Povernei, Endocrinology, Bucuresti-Bucharest, Romania; 2Institute of Endocrinology, Bucureşti-Bucharest, Romania

1

Objective: Re-analyzing the effect of injectable testosterone undecanoat depot (TUD) in hypogonadic patients. Methods: (i) Patients: 139 men with hypogonadism (median age: 65 years). (ii) Distribution: by decade. (iii) TUD (Nebido-R-BayerSchering) 1,000 mg was injected one per 3 months i.m. (iv) Prostate volume (PV) appreciated by per-abdominal ultrasound: 3.5 MHz probe, elliptical volume (cm3), Aloka 550. (v) Time of analysis: before starting testosterone (T0), after 0.5 (T1), 3 (T2), 6 months (T3), 1

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Unmoderated Poster Presentations (T4), 2 (T5) and 3 years (T6). (vi) Maximum increment from P0 was noted “delta” %. (vii) Statistical analysis: Student test. Results: I. All average PV for decade (see table below). II. “Delta” % for decade (see table below): 11,98 (T4); 6,10 (T3); 3,45 (T2); 0,60 (T1); 10,53 (T2); 1,81 (T3); 3,71 (T5); 5,88 (T1). III. Significance T0 vs. T max, p (for decade, no > 90) = 0.62; 0.37; 0.63; 0.22; 0.38; 0.76; 0.057. II. PV at T0 increases with age, from 17 (19–29 years) to 48.25 (80–89 years), P = 0.0006. III. Considering all observations, TUD did not increase PV significantly (average of “delta” % = 5,51). IV. Inside a specific decade no significant increased in PV was registered: all P > 0.05 (80–89 decade P = 0.057). V. In some patients, especially from 50 to 79 years, TUD could decrease slightly prostatic volume. Conclusion: Considering the risk for prostate, in elderly, testosterone undecanoat 1,000 mg depot injectable is a safe treatment, even after 3 years administration. Policy of full disclosure: Dr. D. Peretianu was/is guest lecturer for Bayer-Schering on testosterone pathophysiology, diabetes mellitus, and related scientific areas.

PO-05-014

TESTOSTERONE UNDECANOAT 1,000 MG AT 3 MONTHS DOES NOT INCREASE PSA LEVEL AFTER 1 YEAR: STUDY ON 70 PATIENTS Peretianu, D.1; Carsote, M.2; Poiana, C.2; Staicu, D. C.1 SCM Povernei, Endocrinology, Bucuresti-Bucharest, Romania; 2Institute of Endocrinology, Bucuresti-Bucharest, Romania

1

Objective: To find if testosterone undecanoat 1,000 mg injection (NebidoR; Bayer-Schering) has a negative effect on prostate. Methods: (i) Retrospective analysis (from files). (ii) From over 150 patients to whom testosterone undecanoat 1,000 mg, i.m. was administrated at 3 months, in the last 4 years, and to whom the prostatic volume was quantified (J Sex Med 2010;7(suppl 6):402, HP-04-005), 71 PSA analyses were done before treatment and at 1 year (after 4 administrations). (iii) None patient with prostatic cancer was included. Statistical analysis: Student test, simple correlation, multiple regression. Results: (i) Patients: 71 men, 18–96 years, average: 62.89; median: 65. (ii) Prostatic volume: average: 41.27 cm3, standard deviation (SD): 20.37. Partial prostatectomy: 9 patients. (iii) PSA before treatment: average: 1.9 ng/mL, SD: 1.57; PSA post 1 year: average: 1.92, SD: 1.62. (iv) Statistical difference of average: P = 0.95, nonsignificant. (v) Correlation between age and PSA is significant, both before (r1), and after treatment (r2): r1 = 0.33; r2 = 0.34, P < 0.01. (vi) Correlation between PSA and prostatic volume was significant, both before (r3), and after treatment (r4): r3 = 0.55, r4 = 0.53, P < 0.01. (vii) Multiple regression test (r2 = 0,83; F = 50,86; P < < 0.001) shows that PSA level post testosterone does not depend on testosterone but on age, prostatic volume (before and after treatment) and PSA initial level (before testosterone administration). Conclusions: (i) Testosterone undecanoat 1,000 mg injectable i.m. at 3 months does not increase PSA level after four administrations at 1

year. (ii) PSA level post testosterone is in fact dependent on age, prostatic volume before treatment and the level before treatment. Policy of full disclosure: Dr. D. Peretianu was/is guest lecturer for Bayer-Schering concerning testosterone pathophysiology, diabetes mellitus, and related scientifc areas.

PO-05-015

INCREASES IN BONE MINERAL DENSITY AND LEAN BODY MASS IN MEN WITH LATEONSET HYPOGONADISM UPON 12 MONTHS OF TREATMENT WITH 50 MG TESTOSTERONE GEL FOLLOWED BY 12 MONTHS TESTOSTERONE UNDECANOATE Rodriguez Tolra, J.1; Cuadrado Campaña, J. M.2; Torremadé Barreda, J.2; Llorens de Knecht, E.2; Franco Miranda, E.2 1 Badalona, Spain; 2H.Universitari de Bellvitge, L´Hospitalet de Llobregat, Spain Objective: The declining levels of testosterone encountered in aging men (LOH) are associated with decreases in bone mineral density (BMD) and lean body mass (LBM), adding to the risks of frailty with falls and fractures and increased mortality. There are also psychological factors, like depression, compounding the risks of falls. Methods: A prospective study in males 50–65 years presenting with LOH and free testosterone < 0.250 nmol/L + Aging Males Symptoms (AMS) score > 36. Fifty patients received 12 months testosterone gel 50 mg and subsequently 12 months testosterone undecanoate 1,000 mg/12 weeks. The following measurements were performed after 12 months treatment with 50 mg testosterone gel and after a further 12 months with testosterone undecanoate: 1) changes in serum testosterone 2) changes in lean body mass of trunk, arms and legs 4) changes in bone mineral density 5) changes in Aging Male Symptoms scores (AMS scores), measuring three dimensions of symptoms/complaints: psychological, somato-vegetative and sexual. Results: After 12 and more so after 24 months, there were significant 1) increases in free testosterone 2) increases in the total lean body mass more of arms and legs and less of the trunk 4) increases T-scores and Z-scores in bone mineral density of vertebral column at the level of L1-L4, at total femur and trochanter but not significant at Ward’s triangle and femur’s neck 4) improvements in AMS scores. Conclusion: Treatment of men with LOH with T results in significant improvements of lean body mass and bone mineral density of hip and lumbar spine and also psychological symptoms measured by the AMS. It contributes to the prevention of frailty in elderly men. Policy of full disclosure: None.

PO-05-016

EFFECTS ON CARDIOVASCULAR RISKS AND SAFETY OF 12 MONTHS OF TREATMENT WITH 50 MG TESTOSTERONE GEL FOLLOWED BY 12 MONTHS TESTOSTERONE UNDECANOATE IN MEN WITH LATE-ONSET HYPOGONADISM Rodriguez Tolra, J.1; Cuadrado Campaña, J. M.2; Torremadé Barreda, J.2; Llorens de Knecht, E.2; Franco Miranda, E.2 1 Badalona, Spain; 2H.Universitari de Bellvitge, L´Hospitalet de Llobregat, Spain Objective: Changes in body composition, with an increase in (total and visceral) fat in the elderly are associated with declining levels of testosterone. These changes are associated with an impairment of glucose metabolism and lipid profiles increasing the risk of development of diabetes mellitus type2, atherosclerosis and cardiovascular disease. This study analyzed the effects of normalizing serum testosterone and tested safety of testosterone administration to elderly men. Methods: A prospective study in males 50–65 years presenting with LOH and free testosterone < 0.250 nmol/L. Fifty patients received 12

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432 months testosterone gel 50 mg and subsequently 12 months parenteral testosterone undecanoate 1,000 mg/12 weeks. The following measurements were performed after 12 months treatment with 50 mg testosterone gel and after a further 12 months with parenteral testosterone undecanoate: (i) changes in serum testosterone; (ii) changes in total fat, %visceral fat and %fat on hips; (iii) changes in blood pressure; (iv) changes in lipid profiles; (v) safety parameters: international prostate symptoms score (IPSS), digital rectal examination (DRE), prostate specific antigen (PSA), hemoglobin, hematocrit. Results: After 12 and more so after 24 months: significant there were (i) increases in free testosterone, (ii) decreases of total fat, %visceral fat and specially %fat on hips, (iii) significant decreases in systolic and diastolic blood pressure; (iv) a not significant decrease of HDL and no change of total cholesterol LDL; (v) no changes in IPSS while PSA did not significantly increase. Hemoglobin and hematocrit increased significantly but stabilized after 12–18 months. Conclusion: Treatment of elderly men with low testosterone results in significant improvements of body composition (decrease of fat mass), improvement of total cholesterol without affecting HDLcholesterol, lowering of blood pressure. Risk factors were acceptable. No impact on lower urinary tract symptoms. Erythropoiesis was stimulated but hematocrit values were in the safe margin. Policy of full disclosure: None.

PO-05-017

TIME-COURSE OF EFFECTS OF TESTOSTERONE TREATMENT: FROM BEGINNING TO MAXIMUM THERAPEUTIC EFFECT Saad, F.1; Aversa, A.2; Isidori, A.2; Zitzmann, M.3; Gooren, L.4 Bayer Pharma AG, Scientific Affairs Men`s Health, Berlin, Germany; 2 Sapienza Università di Roma, Med Pathophysiol & Endocrinol, Rome, Italy; 3 University of Muenster, Center of Reproductive, Germany; 4VUMC Amsterdam, Dpt. of Endocrinology, Chiang Mai, Thailand

1

Objective: The effects of testosterone on the male organism are manifold. This review attempts to determine, from published studies, the time-course of the effects following testosterone replacement therapy from their first manifestations until maximum effects are attained. Methods: Literature data of testosterone replacement and data from a recent study in three centers of men having received testosterone for at least 48 months. Results: Effects on sexual interest appear after 3 weeks plateauing at 6 weeks, with no further increments expected beyond. Changes in erections/ejaculations may require up to 6 months probably related to restoring prostate function. Effects on quality of life manifest within 3–4 weeks, but maximum benefits take longer. Effects on depressive mood become detectable after 3–6 weeks with a maximum after 18–30 weeks. Effects on erythropoiesis are evident at 3 months, peaking at 9–12 months, with little further increase thereafter. Prostate-specific antigen and volume rise, marginally, plateauing at 12 months; but then rise further, not related to testosterone treatment but to aging itself. Insulin sensitivity may improve within few days, but effects on glycemic control become evident only after 3–12 months. Decrease in body weight and waist circumference, as evident from the 48-month study, continue at least over 48 months, paralleled by improvements of lipid profile. Changes in lean body mass, and muscle strength occur within 12–16 weeks, to stabilize at 6–12 months, but, can marginally continue over years. Effects on inflammation occur within 3–12 weeks. Effects on bone are relatively slow but are detectable already after 6 months while continuing at least for 3 years. Conclusion: The time-course of the spectrum of effects of testosterone shows considerable variation, depending on the type of action but probably also related to pharmacodynamics of the testosterone preparation. Policy of full disclosure: F. Saad is an employee of Bayer Pharma AG, manufacturers of testosterone products. A. Aversa received grants from Bayer and Lilly. M. Zitzmann received compensation for lecturing from Bayer and Ferring. L. Gooren received compensation for lecturing from Bayer.

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Unmoderated Poster Presentations PO-05-018

THE INFLUENCE OF LOWER URINARY TRACT SYMPTOMS DURING TESTOSTERONE REPLACEMENT THERAPY IN MEN WITH TESTOSTERONE DEFICIENCY SYNDROME Shin, H. S.1; Park, J. S.1; Moon, K. H.2; Song, P. H.2 Catholic University of Daegu, Urology, Korea; 2Yeungnam University, Urology, Daegu, Korea

1

Objective: There has long been a concern among clinicians that chronic testosterone replacement might have an adverse effect on the prostate. We investigated the effect of testosterone replacement therapy (TRT) on lower urinary tract symptoms (LUTS) and PSA level in patients with testosterone deficiency syndrome (TDS). Methods: This study was investigated the influence of LUTS of administration of long-acting parenteral testosterone undecanoate to testosterone deficiency (calculated total testosterone <3.2 ng/mL) with symptoms of hypogonadism. From 2008 to 2009, 72 patients, aged 54.6 ± 8.0 years (range 45–72), received TRT. At baseline and after TRT, digital rectal examination, serum testosterone, aging males’ symptoms (AMS) scores, PSA, transrectal ultrasonography, International Prostate Symptoms Scores (IPSS), maximal flow rates (Qmax) and post-voiding residual volumes (PVR) were evaluated. Results: Mean follow-up periods were 22.6 months (range 12–41). TRT significantly increased serum testosterone levels and decreased total AMS scores (P < 0.05). IPSS decreased significantly and Qmax increased significantly over the study period (P < 0.05). PSA levels, prostate volume and PVR did not change significantly (P > 0.05). A total of 5 patients with serum PSA level greater than 4 ng/mL after TRT underwent a prostate biopsy but no patients were found to have prostate carcinoma. Conclusion: A considerable improvement in serum testosterone, total AMS scores, IPSS and Qmax were found but PSA levels were not changed significantly after mean 22.6-month follow-up periods of TRT in patients with TDS. Large prospective studies are required to understand the mechanism of TRT on LUTS in patients with TDS. Policy of full disclosure: None.

PO-05-019

VARICOCELECTOMY IN MIDDLE-AGED PATIENTS WITH ERECTILE DYSFUNCTION: SERUM TESTOSTERONE AND SEXUAL FUNCTION MODIFICATIONS Maio, G.1; Maio, G.2; Saraeb, S.3 Abano Terme, Italy; 2Casa di Cura Città di Rovigo, Abano Terme, Italy; 3 ULSS 1 Belluno Hospital, Italy

1

Objective: Varicocele is a well-known source of damage to spermatogenic cells, less documented, is the damage to Leydig cells that should take place at an older age. In this study we correlated varicocelectomy in patients over 40 years of age with serum testosterone and sexual function modifications. Methods: From January 2006 to September 2010 82 pts with large varicocele, age 40–60 years, complaining scrotal pain and mild-moderate ED (IIEF-15 erection domain ≥15), underwent varicocelectomy using antegrade scleroembolization. In the 2 months before and 6–9 months after surgery, patients performed total testosterone assay and completed IIEF-15 questionnaire for erectile function (IIEF-15EF) and sexual desire (IIEF-15SD) specific domains. Statistical analysis: software SPSS-15.0; variables were compared using: (i) Wilcoxon test for noncontinuous variables; (ii) t-test paired samples for continuous variables; a P < 0.05 was considered significant. Results: Mean age was 50.6 ± 5.51 years. IIEF-15EF was 19.2 ± 2.47 before vs. 22.22 ± 3.35 after surgery (P 0.000). IIEF-15SD resulted 5.79 ± 0.90 before vs. 6.82 ± 1.04 after surgery (P 0.000). 43.9% of patients had an IIEF-15FE improvement ≥4 points (responders). Total testosterone was 3.82 ± 0.85 ng/mL before surgery vs. 4.65 ± 0.89 after

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Unmoderated Poster Presentations P 0.000) Stratifying the subjects into two groups based on IIEF-15FE score improvement, responders and non responders, the increase in total testosterone after surgery was higher in responders (3.41 ng/mL ± 0.64 vs. 4.83 ± 0.53; P 0.000) than nonresponders (4.17 ng/mL ± 0.84 vs. 4.50 ± 1.07; P 0.032). Conclusion: This study shows a significant benefit of sexual function both in terms of erectile function and sexual desire after varicocelectomy in middle-aged subjects with a large varicocele. These benefits are accompanied by by significant increase in total testosterone. Policy of full disclosure: None.

PO-05-020

SEX: THE NEW HEALTHCARE INEQUALITY Kalejaiye, O.; Pearcy, R. Derriford hospital, Urology, Devon, UK Objective: There are less penile prosthesis implanted per head of population in England than in any other European country (personal reference AMS). One of the reasons implicated is lack of funding. The objective of this study was to evaluate the Primary Care Trusts’ (PCTs) funding practice and criteria for penile prosthesis implantation in England to determine service equality. Methods: A list of all the PCTs in England was obtained from the National Health Service (NHS) choices’ website. Each PCT’s website was visited to find the e-mail address for their Freedom of Information (FOI) department. FOI requests were made to each PCT asking questions regarding their criteria for funding and the number of requests and implants funded in the previous 12 months. Results: A total of 111 PCTs were e-mailed with 88% replying. 28% of the PCTs replying fund penile prosthesis; these were mainly in the North and South East of England. 22% of the PCTs do not fund. Although 50% fund under exceptional circumstances, only 22% of these have any clinical criteria to base their decision making. 18% of these clinical criteria were based on guidelines. On reviewing those who had received requests for funding in the previous 12 months, 54% did not fund any of the requests, 15% funded 50% or less and 31% funded all the requests received. Of the PCTs funding under exceptional circumstances, only 38% actually funded any of the requests received. Conclusion: Despite guidelines on the management of erectile dysfunction, there remains variability in access to penile prosthesis surgery. Guidelines are rarely used in decision making. Funding remains an important factor in determining who receives potentially life changing treatment for erectile dysfunction refractory to all other treatment options. A patient’s address and personal wealth appears to have more of an impact than guidelines. Policy of full disclosure: None.

PO-05-021

SAFETY OF TESTOSTERONE REPLACEMENT FOR HYPOGONADISM ASSOCIATED WITH SICKLE CELL DISEASE: A PILOT REPORT Morrison, B.1; Reid, M.1; Madden, W.1; Burnett, A.2 University of the West Indies, Urology, Kingston 7, Jamaica; 2Hopkins School of Medicine, Urology, Baltimore, USA 1

Objective: We previously reported a prevalence of 29% of hypogonadism in adult males with sickle cell disease (SCD) and subsequently commenced testosterone therapy in these patients. However, the safety of testosterone therapy in sickle cell disease in relation to priapism episodes is relatively unknown. Methods: Testosterone undecanoate (Nebido®) 1 g was administered intramuscularly to seven men with hypogonadism and SCD for a total of four doses over 30 weeks. Hypogonadism was defined as a total testosterone <12.0 nmol/L with reference lab range of 12.5– 38.1 nmol/L. Baseline PSA, testosterone, hematocrit, cholesterol, renal and liver function tests and serum glucose were done. All patients had serum total and free testosterone, blood viscosity and hematocrit measured at each visit. The presence of adverse drug effects was inves-

tigated. Four patients reported prior episodes of priapism with two patients having episodes of frequency of 1 and 5 times monthly. The other two reported no priapism episodes in the past year, with lifetime episodes of 5 and >20 episodes. Results: Seven men with a mean age of 33.1 years and mean testosterone level of 10.2 nmol/L were treated. Posttreatment testosterone levels increased to a mean value of 13.4 nmol/L. All other laboratory indices remained stable. After testosterone therapy, there was no evidence of increased priapism frequency in these patients, including those with current stuttering episodes. One patient reported an episode of priapism lasting for 4 hours which resolved spontaneously. Injection site pain was the most frequently reported adverse effect. There was no increase in painful crises, hypersensitivity or edema. Conclusion: Testosterone undecanoate appears to be safe in men with SCD treated for hypogonadism. Policy of full disclosure: None.

PO-05-022

BARRIERS TO KNOWLEDGE, AWARENESS, AND DIAGNOSIS OF ERECTILE DYSFUNCTION AND LOW TESTOSTERONE IN MEN: SURVEY OF 1,019 MEN AND 222 GENERAL PRACTITIONERS IN THE UK Hackett, G.; Kember, L. E. Good Hope Hospital, Sutton Coldfield, UK Objective: Many men have undiagnosed Testosterone Deficiency Syndrome (TDS), a condition characterized by low sex drive, erectile dysfunction (ED) depression and weight gain. Symptoms of TDS may indicate underlying conditions including diabetes and heart disease. The syndrome is associated with an increased risk of heart disease and early death.1-6 Surveys of men’s and physician’s perceptions and understanding of TDS were performed in the UK to explore awareness of TDS, its presentation and health burden. Methods: In May 2011, two quantitative surveys were commissioned to explore understanding of men’s and physician’s perceptions and understanding of TDS. The on-line survey was conducted in the UK by a specialist on-line healthcare research company. All men were aged over 30 years. All physicians were general practitioners (GPs). The GP-survey sought information on whether ED and TDS are regularly encountered in practice, awareness of existing guidance/guidelines on ED and TDS treatment. The parallel survey of men investigated attitudes to and understanding of TDS in the context of sexual health. Results: 1019 men and 222 physicians representing samples from all regions in the UK were recruited. Three-quarters of men had never heard of TDS and one-third considered the symptoms to be a normal feature of aging. Only 40% of men would be comfortable discussing sexual problems with their GP compared with comfort rates > 60% for other “embarrassing” health problems. 15% told researchers they would never go to the doctor about sex drive issues. Men were aware of treatments for ED but unaware that most ED therapies would not impact ED symptoms if TDS was the underlying cause. While 85% of GPs acknowledged that TDS is not a “lifestyle” condition but a medical condition, 90% were unaware of current management guidelines and two-thirds did not appreciate the link between TDS and premature death. Conclusion: TDS is under-recognized by men and by GPs and often considered a normal sign of aging rather than a clinical condition impacting on sexual health, and patient morbidity and mortality.

References: 1 Malkin CJ et al. Heart 2010;96:1821–1825. 2 AACE. Endocrine Practice 2002;8(6):439–456. 3 Wang C et al. The Aging Male 2008;1–8. 4 Svartberg J et al. Eur J Epid 2004;(19):657–663. 5 Hackett GI et al. Br J Diab Vasc Dis 2009;9:226–31. 6 Kapoor D et al. Diabetes Care 2007;30:911–917. Policy of full disclosure: None.

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Unmoderated Poster Presentations ED diagnosis

PO-06-001

SERUM LEVELS OF ASYMMETRIC DIMETHYLARGININE AND TESTOSTERONE AMONG EGYPTIAN TYPE 2 DIABETIC MEN WITH ERECTILE DYSFUNCTION AS RISK MARKERS FOR CORONARY ARTERY DISEASE Gadalla, K.1; Abdel Fattah, A.2; Kandeel, H.3; Ali, A.4 Al-Azhar Faculty of Medicine, Urology, Cairo, Egypt; 2Al-Azhar Faculty of Medicine, Clinical Pathology, Cairo, Egypt; 3Al-Azhar Faculty of Medicine, Endocrinology, Cairo, Egypt; 4Al-Azhar Faculty of Medicine, Internal Medicine, Cairo, Egypt 1

Objective: Measure serum ADMA and testosterone levels in type II diabetic patients with ED for evaluation of their value as risk markers for Coronary artery diseases. Methods: The study was conducted on 50 participants ;thirty of them were diabetic with duration (6.97 ± 1.6 years), duration of ED was (3.03 ± 1.43 years), their mean age was (39.47 ± 4.1 years) (group1). Twenty apparently healthy age matched group as controls (group 2), their mean age was (37.65 ± 2.91 years). Clinical assessment was done for all participants regarding CAD (by Electrocardiogram and Echocardiography) and DM. Penile Doppler for ED patients. Samples were taken from both group for measuring HbA1c, fasting blood sugar, lipid profile (TC, TG, LDL, HDL), prolactin, ADMA, free and total testosterone (FT), (TT) as well as other routine investigations. Informed consent was taken from all participants. Results: Nonsignificant difference in serum prolactin level was found between group 1 and group 2. Significantly higher Serum FBS, TC, TG, LDL, ADMA levels and also HbA1c were in group 1 as compared to group 2. However serum levels of FT, TT, HDL were significantly lower in group 1 as compared to group 2. Conclusion: Serum ADMA and testosterone levels can be considered as risk markers for endothelial dysfunction and atherogenesis in diabetic men with ED. Therefore ED should alert diabetic men and healthcare givers to the future risk of developing CAD. Testosterone replacement is recommended for diabetic males diagnosed as ED with low testosterone. Policy of full disclosure: None.

PO-06-002

IS ERECTION HARDNESS SCORE QUESTIONNAIRE A VALID TOOL TO EVALUATE PENILE RIGIDITY? Gallo, L.1; Giannella, R.2; Pecoraro, S.2 1 Studio Urologico Gallo, Andrology, Naples, Italy; 2Clinica Malzoni, Department of Andrology, Avellino, Italy Objective: To establish in a direct and objective way the effectiveness of EHS (Erection Hardness Score) questionnaire as evaluation tool for penile rigidity. Methods: Patients coming to our centers affected by vascular ED were recruited in this prospective double blind study. Subjects referred their grade of penile rigidity using the single-item questionnaire EHS including four different answers: (i) penis does not enlarge; (ii) penis is larger but not hard enough for penetration; (iii) penis is hard enough for penetration but not completely hard; (iv) Penis is completely hard and fully rigid. The rigidity referred by patients was compared with one detected by a blind physician (LG) after administration of 10 micrograms of intracavernous alprostadil and video sexual stimulation. Results: Sixty-two patients presenting at least one risk factor for vascular ED were recruited. In 55 cases among 62 (88,7%) the grade of rigidity referred by the patient was exactly the same than one found by the physician. In the other seven cases, the mean difference between the two values was 1.86 (±SD 0.38). The mean time for questionnaire filling was 23.45 seconds (±SD 5.34).

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Conclusion: EHS questionnaire is a valid, easy and reliable diagnostic tool to establish the penile rigidity directly referred by patients Policy of full disclosure: None.

PO-06-003

SERUM C-REACTIVE PROTEIN LEVELS AND RESPONSE RATE TO TADALAFIL 5 MG ONCE DAILY IN ERECTILE DYSFUNCTION PATIENTS WITH DIABETES Park, H. J.1; Park, N. C.1; Min, K.2; Woo, S. H.3 Pusan National University, Urology, Busan, Korea; 2Inje University, Urology, Busan, Korea; 3Eulji University Hospital, Seoul, Korea

1

Objective: Erectile dysfunction (ED) in diabetes is related to endothelial dysfunction. We studied the relative importance of the Creactive protein (CRP) level in ED patients with diabetes and determined whether the CRP level predicts the response to tadalafil 5 mg once daily treatment. Methods: The study enrolled 102 men suffering from ED with diabetes who were between 40 and 60 years old. All patients completed the International Index of Erectile Function (IIEF) and were given tadalafil 5 mg daily. Three months later, the IIEF was repeated. A control group contained 88 healthy subjects of similar ages. The IIEF and serum CRP levels in patients and healthy controls and in patient responders and non-responders to tadalafil 5 mg once daily were compared. Results: The average age was 53.2 ± 7.5 vs. 55.6 ± 8.1 years in patients and healthy controls, respectively (P = 0.655). The mean duration of diabetes was 54.3 ± 17.2 months. The mean IIEF and CRP level was 12.1 ± 6.3 and 0.21 ± 0.17 mg/dL, respectively, in patients and 28.2 ± 2.3 and 0.09 ± 0.07 mg/dL in the controls. The two groups differed significantly based on the compared parameters (PIIEF = 0.000, PCRP = 0.031). While 71 patients (69.6%) achieved sufficient erection for sexual intercourse, 31 patients (30.4%) did not after tadalafil once daily treatment. The average age was 56.2 ± 7.7 and 51.3 ± 6.5 years, respectively, in the tadalafil non-responders and responders (P = 0.065). The mean CRP levels were 0.31 ± 0.15 and 0.14 ± 0.10 mg/dL in nonresponders and responders, respectively, and the difference was significant (P = 0.028). Conclusion: The serum CRP level may be a marker for evaluating the endothelial status in ED patients with diabetes. In addition, it can be used to predict the response to tadalafil 5 mg once daily treatment. Policy of full disclosure: None.

PO-06-004

IS BLOOD VISCOSITY RELATED WITH OTHER DIAGNOSTIC TOOLS IN PATIENTS WITH ERECTILE DYSFUNCTION? Park, K.1; Zhao, C.2; Park, J. K.2 Chonnam National University, Urology, Gwangju, Korea; National University, Urology, Jeonju, Korea

1

2

Chonbuk

Objective: Vasculogenic erectile dysfunction is more frequent in the patients with abnormal blood findings than normal men. Blood viscosity also might affect the occurrence of erectile dysfunction and depends on hematocrit (Hct), hemoglogin (Hb), and fibrinogen. We evaluated the relationship among Complete Blood Count (CBC), blood viscosity and color Doppler ultrasonography in the patients with erectile dysfunction (ED). Methods: The patients of 56 with ED were included in this study prospectively. CBC, blood chemistry, testosterone, blood viscosity (BIO-VISCO, Jeonju, Korea), color Doppler ultrasonography (B&K, Netherland), and questionnaire of the International Index of Erectile Function (IIEF) were measured after informed consent form. Correlation analysis was performed to see interrelationship between variable for Hb, Hct, cholesterol, triglyceride, HDL-cholesterol, testosterone, penile Doppler ultrasonography and blood viscosity.

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Unmoderated Poster Presentations Results: Blood viscosity is higher in the patients with ED than normal men in the USA. Hct, Hb and end diastolic peak velocity at 15 minutes after intracavernosal injection of vasoactive agents were significantly related with blood viscosity (P < 0.05). However, the plasma level of testosterone, triglyceride, and cholesterol were not correlated with blood viscosity. Conclusion: Blood viscosity has relationship with Hct, Hb and end diastolic velocity at 15 minutes of color doppler ultrasonography and could be used with another diagnostic tool for the patients with ED. Policy of full disclosure: J. K. Park (corresponding author including other authors) got grants from the Korea Healthcare Technology R&D Project, Ministry for Health, Welfare &Family Affairs, Republic of Korea (A90583). However, government only had a financial role for this research.

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ED medical treatment

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SAFETY AND EFFICACY OF TADALAFIL 5 MG ADMINISTERED ONCE DAILY IN MEN WITH ERECTILE DYSFUNCTION AND LOWER URINARY TRACT SYMPTOMS Ahn, T. Y.; Hong, S. Asan Medical Center, Urology, Seoul, Korea Objective: Increasing evidence also indicates that the clinical use of phosphodiesterase type 5 inhibitors provides relief from LUTS. The purpose of our study is to investigate the safety and effects of tadalafil 5 mg once daily in men with ED and LUTS. Methods: This study included a total of 89 patients who complained of ED and LUTS and who were given tadalafil 5mg once daily for eight weeks between September 2009 and February 2011. The International Prostate Symptom Score (IPSS) and the International Index of Erectile Function (IIEF)-5 questionnaire information were obtained prior to treatment (V1), and again following treatment with tadalafil 5 mg once a day (weeks 4 [V2] and 8 [V3] after treatment began). We also evaluated any adverse effects of tadalafil 5 mg when it was administered once daily during the follow-up period. Results: A total, of 60 patients (67.4%) completed the 8-week clinical study. Regarding subjective symptoms, there were 48 patients (80.0%) who experienced improvement of their ED and 43 patients (71.7%) who experienced the improvement of their LUTS. The IPSS values were 15.33 ± 8.32 (V1), 11.78 ± 7.69 (V2), and 9.91 ± 7.77 (V3), with significant improvement (V1 vs. V2, P = 0.042, V1 vs. V3, P = 0.006). The IIEF-5 values were 8.34 ± 5.33 (V1), 15.74 ± 8.99 (V2), and 18.72 ± 19.58 (V3), with significant improvement (V1 vs. V2, P = 0.001, V1 vs. V3, P = 0.001). A total of three patients (5.0%) reported adverse effects, i.e., two patients experienced facial flushing and one patient had mild chest discomfort. Conclusion: Treatment with tadalafil 5 mg once daily was beneficial for the treatment of both ED and LUTS. Adverse effects on the cardiovascular system were minimal in our study. Therefore, we believe that taking tadalafil 5 mg once daily is safe forD patients with ED and LUTS. Policy of full disclosure: None.

PO-07-002

EFFECTS OF DAILY PDE5 INHIBITORS ON ENDOTHELIAL FUNCTION IN MEN WITH VASCULAR ED: RESULTS FROM A PRELIMINARY RANDOMIZED, DOUBLEBLIND, PLACEBO-CONTROLLED SPONTANEOUS STUDY Aversa, A.; Francomano, D.; Bruzziches, R.; Lenzi, A. Sapienza University of Rome, Dept Experimental Medicine, Italy Objective: Although the effect of phosphodiesterase type 5 inhibitors on endothelial function in the systemic circulation has been extensively studied, no head-to-head spontaneus study comparing the systemic effect of two different daily PDE5 inhibitor molecules in patients with erectile dysfunction (ED) has never been performed. Methods: Thirty men complaining vascular ED (mean IIEF-5 = 11 ± 5 and peak systolic velocity-PSV = 22 ± 2 cm/second) were enrolled in a randomized, double-blind, placebo-controlled, parallel study (mean age 55 ± 9) and received either daily vardenafil 5 mg (VAR; N = 10), tadalafil 5 mg (TAD; N = 10) or matched placebo (PLB; N = 10). Each patient assumed the drug at 5 pm for 4 weeks, and was permitted to engage with sexual activity after a minimum of two hs. Primary end points were variation from baseline of reactive hyperemia index (RHI) and augmentation index (AI) calculated by fingertip peripheral arterial tonometry (PAT) device. Secondary end points were variations of IIEF-5 and SEP3 scores.

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436 Results: Patients who took daily vardenafil and tadalafil reported significant (P < 0.01) improvements in arterial stiffness as evaluated by AI but no improvement in average RHI compared with baseline. When corrected for heart rate (AI75), both VAR and TAD showed more powerful effect on arterial stiffness (P < 0.0001) compared with baseline. No effect was detected on both RHI and AI after PLB. Each active treatment resulted in significantly greater IIEF-5 scores (P < 0.001) and better SEP3 response rates (P < 0.001) compared with PLB. Conclusion: This is the first study that compares same dosages of tadalafil and vardenafil for daily treatment in men with ED. We demonstrate that short-term daily vardenafil has comparable efficacy and safety than tadalafil in improving arterial stiffness in men with severe vasculogenic ED. Despite different half-lives, both drugs appear to be more effective than placebo in ameliorating erectile function. Policy of full disclosure: A. Aversa received speaker’s honoraria from Eli Lilly and Bayer Schering Pharma.

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THE USE OF A COMBINATION OF A LONGAND SHORT-TERM PDE5 INHIBITOR IN PATIENTS WITH SEVERE ED: RESULTS FROM AN OPEN-LABEL UNCONTROLLED STUDY Claes, H.; Van Poppel, H. Univ. Clin. Gasthuisberg, Urology, Leuven, Belgium Objective: To study the improvement of erection in men with severe erectile dysfunction (ED), which were not satisfied with the highest dose of a short-term PDE5 Inhibitor (S-PDE5-I), by adding a longterm PDE5 Inhibitor (L-PDE5-I) in a daily dose. Methods: This observational open-label, uncontrolled study enrolled 128 men (aged 52–78 years), in whom 2 months of S-PDE5-I therapy at the maximal recommended dose with at least four attempts at intercourse during the 2-month period had failed. To assess sexual function: the Erection Hardness Score (evaluated by the patient as well as the partner and physician too), IIEF questionnaire and several questionnaires completed by the patient and the patients’ partner were used. Results: 169 men and their partners completed the baseline questionnaires after the S-PDE5-I therapy period and gave consent. The mean ± SD baseline EHS (range 1–4) was 2.3 ± 0.8 (self-assessed), 2.2 ± 0.9 (partner-assessed), and 2.2 ± 0.8 (physician-assessed). 128 patients and their partners returned within the 2- to 4-month follow-up period. The assessment follow-up showed an increase in the mean values of all the four domains of IIEF. According to several general assessment questions, satisfaction and confidence improved. Partners found that erectile capacity had greatly improved from baseline to study end. No major adverse effects were observed. Conclusion: The results of this study support the use of a combination of a S-PDE5 I and a L-PDE5-I in men in whom a S-PDE5-I alone fails. We suggest that every man, who is not totally satisfied with PDE5-I treatment, could benefit from a combination of a long- and short-term PDE5 Inhibitor. Policy of full disclosure: Dr. H. Claes is a consultant and a speaker for Pfizer Inc, Bayer, and Eli Lilly and Company.

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VARDENAFIL ON-DEMAND IMPROVES ENDOTHELIAL DYSFUNCTION AND VASCULAR INFLAMMATION MARKERS Corona, G.1; Mansani, R.1; deVita, G.1; Forti, G.2; Maggi, M.1 Sexual Medicine and Andrology, University of Florence, Italy; 2Endocrinology Unit, University of Florence, Italy 1

Objective: Current opinion in sexual medicine research suggests that the pathogenetic mechanisms underlying vascular disease in the penis (e.g., endothelial dysfunction and vascular inflammation) resemble that occurring the other location of cardiovascular system. The aim of

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Unmoderated Poster Presentations present study is to assess the possible role of Vardenafil in improving vascular inflammation markers and penile flow. Methods: This is a randomized controlled pilot study with cross over involving 38 subjects with type 2 diabetes mellitus. The study consists of a 2-week wash-out period, followed by two consecutive treatment phases. The first phase consists on a 8 weeks treatment period in which the patients will be randomized to receive Vardenafil 20 mg or Vardenafil 10 mg, washout for 2 weeks and then a new period of 8 weeks with the opposite treatment. The two groups were comparable for age, testosterone levels, and glycometabolic control at the enrolment. Results: At the end of the study a significant improvement in both basal and dynamic (after PGE1 stimulation) penile peak systolic velocity was observed (18.2 ± 4.1 vs. 20.8 ± 6.3 and 43.2 ± 14.1 vs. 48.9 ± 12.9 cm/second, respectively; both P < 0.02). The use of Vardenafil was also associated with a significant reduction of some vascular inflammation markers such as fibrinogen (336 ± 84.9 vs. 300.4 ± 87.0 mg/dL; P < 0.01), erythrosedimentation velocity (15.5 ± 8.5 vs. 13.5 ± 8.1 seconds, P < 0.02) and HOMA index (6.4 ± 1.4 vs. 5.5 ± 1.2, P < 0.005). In addition a trend toward a reduction of IL-6 was also observed (0.83 ± 0.74 vs. 0.57 ± 0.34 pg/mL, P = 0.074). Finally both total testosterone and IIEF-5 score increased after Vardenafil treatment. Conclusion: Our study demonstrate that the improvement of sexual function after Vardenafil treatment is linked to a reduction of vascular inflammatory markers, strictly associated with a better penile vascular flow and higher testosterone levels. Policy of full disclosure: None.

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EFFECT OF DAILY TADALAFIL AND MONTHLY TESTOSTERONE ENANTHATE ON PDE5 INHIBITOR NONRESPONDERS Kim, J.1; Ham, B. K.1; Yang, D. Y.2; Kim, J. J.1; Moon, D. G.1; Oh, M. M.3; Lee, C. H.4 1 Korea University, Urology, Seoul, Korea; 2Hallym University, Urology, Seoul, Korea; 3Korea University, Seoul, Korea; 4Kyunghee University, Seoul, Korea Objective: Despite the oral PDE5 inhibitors for erectile dysfunction, the overall failure of PDE5 inhibitors remains at 18–37%. The Korea University Penile Rehabilitation Program was designed to maintain adequate concentration without risk of supraphysiologic levels of testosterone with combined daily PDE5 inhibitor treatment for a long term period. The present study attempts to identify whether the effects of testosterone replacement is maintained after combined therapy with testosterone and PDE5 inhibitors. Methods: A cohort of patients diagnosed with erectile dysfunction who failed to respond to at least 3 months of treatment with PDE5 inhibitors at maximum dose, and were hypogonadal by symptoms and low serum total testosterone (<3.5 ng/mL) were enrolled. Treatment protocol consisted of monthly testosterone enanthate for 12 weeks, followed by monthly testosterone enanthate every 4 weeks with daily 5 mg tadalafil for 12 weeks. Cohorts were divided by level of testosterone deficiency (2.5 ng/mL) to observe for different effects pertaining to severity. The patients were then discontinued for testosterone and maintained with 5 mg daily tadalafil. Main outcome effect was observed for IIEF-EF domain score and patient treatment response was analyzed by a general linear model at each repeated measurement. Results: Thirty-five patients (55.5 ± 9.7 years) were enrolled in this study. 82.9% of the patients had at least one chronic disorder, and 41.2% had two or more chronic conditions. Patients with lower testosteroneshowed higher response but was not statistically significant (P = 0.051), and also showed better maintenance of function (P = 0.021) However, only 25% of patients in the lower testosterone group achieved IIEF-5 scores above 20, while all remaining patients eventually required recommencement of combination therapy to maintain effects. Conclusion: Combination therapy shows higher treatment response in patients with severely low levels of testosterone and higher mainte-

437

Unmoderated Poster Presentations nance of treatment effect after discontinuation of testosterone, demonstrating some underlying rehabilitation with treatment. Policy of full disclosure: None.

PO-07-006

IMPROVEMENT IN SEXUAL QUALITY OF LIFE OF THE FEMALE PARTNER FOLLOWING VARDENAFIL TREATMENT OF MEN WITH ERECTILE DYSFUNCTION: A RANDOMIZED, DOUBLE-BLIND, PLACEBOCONTROLLED STUDY Martín-Morales, A.1; Graziottin, A.2; Bou Jaoudé, G.3; Debruyne, F.4; Buvat, J.3; Beneke, M.5; Neuser, D.6 1 Hospital Carlos Haya, Department of Urology, Malaga, Spain; 2Gynecology & Medical Sexology, H. San Raffaele Resnati, Milan, Italy; 3CETPARP, Lille, France; 4Andros Mannenkliniek, Arnhem, The Netherlands; 5Bayer Pharma AG, Elberfeld, Germany; 6Bayer Vital GmbH, Wuppertal, Germany Objective: To assess the efficacy of vardenafil in men with erectile dysfunction (ED) and determine the effects of treatment of the man on the female partner’s sexual quality of life. Methods: Study participants comprised men aged 18–64 years with ED and their female partners. Eligible men had ED of ≥6 months’ duration, and a female partner who was motivated to support their ED treatment. Eligible female partners had a total Female Sexual Function Index (FSFI) score > 23.55, indicating an absence of marked sexual dysfunction. Following a 4-week screening period, the man was randomized to treatment with vardenafil 10 mg or placebo, which could be titrated to 20 or 5 mg after 4 weeks. Primary efficacy measures (assessed at week 12/last observation carried forward [LOCF]) were: (1) Sexual Encounter Profile Question 3 (SEP3); and (2) improvement in female partners’ sexual quality of life, assessed using the quality of life domain of the modified Sexual Life Quality Questionnaire (mSLQQ-QOL). Results: The intent-to-treat population included 343 couples, with 168 and 175 men randomized to receive vardenafil and placebo, respectively. Vardenafil treatment significantly improved rates of successful intercourse and the female partners’ sexual quality of life. Least squares (LS) mean SEP3 success rates after 12 weeks of treatment were 67.2% (9.5% baseline) vs. 24.2% (12.4% baseline) in the vardenafil and placebo groups, respectively (P < 0.0001). In female partners, LS-mean mSLQQ-QOL scores were 68.2 (28.8 baseline) for vardenafil vs. 40.5 (24.6 baseline) for placebo (P < 0.0001). Conclusion: Vardenafil treatment of men with ED improves rates of successful intercourse and the sexual quality of life of those female partners without marked sexual dysfunction. Policy of full disclosure: A. Martín-Morales has been a consultant, investigator, and/or speaker for Bayer Pharma AG, Eli Lilly and Company/ICOS, Ipsen Pharma, Johnson & Johnson, Pierre Fabre, Pfizer, and ProStrakan; A. Graziottin has been a speaker for Bayer Pharma AG, Epitech, Janssen-Cilag, Pantarhei Bioscience, Recordati, Sanofi, Théramex/Teva and Valeas, an advisory board member for Bayer Pharma AG, Janssen-Cilag, Novo Nordisk, Théramex/Teva and Valeas, and a consultant for Bayer Pharma AG, Epitech and Théramex/Teva; G. Bou Jaoudé has been an investigator and consultant for Bayer Pharma AG, investigator and speaker for Eli Lilly and Company/ ICOS, and an investigator for Boehringer Ingelheim, Johnson & Johnson and Pfizer; F. Debruyne has acted as a speaker for Bayer Pharma AG and a consultant for Dendreon and Ferring Pharmaceuticals; J. Buvat has been an investigator, speaker and/or advisor for Bayer Pharma AG, Eli Lilly and Company, Pfizer and ProStrakan; and M. Beneke and D. Neuser are employees of Bayer Pharma AG. Editorial support in developing this abstract was provided by Sarah Stowell PhD and James Reed PhD of Fishawack Communications Ltd, and funded by Bayer Pharma AG.

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EFFICACY AND SAFETY OF TADALAFIL (CIALIS) IN MEN WITH ERECTILE DYSFUNCTION SECONDARY TO RADICAL PROSTATECTOMY OR HORMONERADIOTHERAPY IN PATIENTS WITH PROSTATE CANCER Mashal, A.1; Mermershtain, W.2 ben Gurion University, Family Medicine, Beer Sheva, Israel; 2ben Gurion University, Department of Oncology, Beer Sheva, Israel

1

Objective: The purpose of this study was to estimate the tadalafil (Cialis) efficacy and safety in male patients with erectile dysfunction secondary to radical prostatectomy or hormone-radiotherapy therapy in patients with prostate cancer. Methods: Patients / Methods: The study included 30 patients with confirmed prostate adenocarcinoma. Ten patients underwent radical prostatectomy, and 20 patients treated by concomitant TAB and 3DCRT. The median age was 68 years. The treatment with tadalafil 20 mg every 72 hours was initiated at 1–3 months after prostatectomy or 3DCRT. Subsequently, tadalafil scheduling could be adjusted to a patient needs. Data were collected using the International Index of Erectile Function (IIEF) questionnaires. Results: Tadalafil significantly improved ED for 60% according to questionnaires. Improvent of ED reported in 70% of the pateints who started tadalafil at 1 month after RP or 3DCRT, compared to 30% in those whose therapy was initiated at longer interval. Conclusion: To our experience, tadalafil (20 mg) improved erectile function and was well tolerated by men with ED secondary to radical prostatectomy and concomitant hormono-radiation therapy in patient with prostate cancer. Early initiation of tadalafil may be predictive for better functional outcome. Policy of full disclosure: None.

PO-07-008

TREATMENT OF ERECTILE DYSFUNCTION WITH PHOSPHODIESTERASE TYPE 5 INHIBITOR (PDE5 INH) IN MALE PARTNER OF WOMEN WITH VAGINISMUS Ozkara, H.; Akkus, E.; Dinc, S.; Alici, B.; Tek, B. Istanbul University, Urology/Andrology, Istanbul, Turkey Objective: Vaginismus is one of the well known FSD (Female Sexual Dysfunction). Male partner of women with vaginismus can have ED problem due to unseccful attempt of sexual intercourse. Here we reviewed couples who admitted to our clinic with unconsummated marriages. Methods: Between 2003 and 2010, 50 women (mean age 27.75 ± 4.20 years) admitted with the complaint of unsuccessful intercourse. They were diagnosed having vaginismus, which is defined as DSM-IV-TR. They were married for a period of 6–39 months (21.07 ± 17.02) and did not succeed any sexual intercourse (unconsummated marriage). Fifty male partners of these women answered IIEF-5 in order to define erectile dysfunction. Male partner’s age was mean 30, 85 ± 5.57 years. Results: All male partners responded to the IIEF-5. In all 24 (%48) men denied having any sexual dysfunction (IEFF-5 score > 22). The others 13 (%26) have responded to questions as mild/moderate ED (IEFF-5 score: 17–21); 9 (%18) as mild (IEFF-5 score: 12–16) and 4 (% 8) as moderate (IEFF-5 score: 8–11). After treatment of vaginismus, female partner feel to be ready for sexual intercourse; all 26 male partners with ED (IEFF-5 score < 22) have complained performance anxiety. We all prescribe male partner tadalafil 20 mgr for the first sexual intercourse. In all, 24 patients needed the tadalafil 20 mgr for less than 1 month. Treatment failures (2 males 7.6%) were managed sucessfuly by intracavernous injection therapy, combined with psychosexual therapy. Conclusion: We conclude that ED is frequent finding in male partner (%52) whose wife has vaginismus, which should be easily managed

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438 with PDE5 INH. Non responders (7.6%) to PDE5 INH can be treated with intracavernous injection therapy. Policy of full disclosure: None.

PO-07-009

PHASE III CLINICAL TRIAL OF AVANAFIL IN THE TREATMENT OF ERECTILE DYSFUNCTION Park, J. K.1; Park, K.2; Kim, S. W.3; Kim, J. J.4; Park, N. C.5; Lee, S. W.6; Paick, J. S.7; Ahn, T. Y.8; Suh, J.-K.9; Chung, W. S.10 1 Chonbuk National University, Urology, Jeonju, Korea; 2Chonnam National University, Urology, Kwangju, Korea; 3Catholic University, Urology, Seoul, Korea; 4Korea University, Urology, Seoul, Korea; 5Pusan National University, Urology, Busan, Korea; 6Sungkyunkwan University, Urology, Seoul, Korea; 7Seoul National University, Urology, Korea; 8Ulsan University, Urology, Seoul, Korea; 9Inha University, Urology, Incheon, Korea; 10Ewha University, Urology, Seoul, Korea Objective: There are many kinds of phosphodiestease type 5inhibitor in the world. Avanafil (4-[(3-chloro-4-methoxybenzyl) amino]-2-[2(hydroxymethyl)-1-pyrrolidinyl]-N- (2-pyrimidinylmethyl)-5-pyrimidinecarboxamide) is a brand new selective PDE5 inhibitor developed by Mitsubishi Tanabe Pharma Corporation (Osaka, Japan). We evaluated the efficacy and safety of avanafil on demand in the patients with ED with phase III clinical trial. Methods: This was a multicenter, randomized, double-blind, placebocontrolled, fix-dosed phase three clinical trial involving 200 patients with ED. The subjects, who were treated with placebo or avanafil (100 mg or 200 mg) for 12 weeks, were asked to complete the International Index of Erectile Function (IIEF), the Sexual Encounter Profile (SEP) diary, and the Global Assessment Questionnaire (GAQ) during the study. The primary outcome parameter was the change from baseline for the IIEF erectile function domain (EFD) score. The secondary outcome parameters were SEP Q2 and Q3, the shift to normal rate (EFD ≥26), and the response to the GAQ. Results: Compared to placebo, patients who took 100 or 200 mg of avanafil had a significantly improved IIEF-EFD score (P < 0.001). Similar results were observed in comparing Q2 and Q3 in the SEP diary and the GAQ. Flushing was the most common treatment-related adverse event and drug related adverse were transient, and mild-tomoderate in severity. Conclusion: Avanafil is an effective and well-tolerated on demand therapy for ED of broad-spectrum etiology and severity. Policy of full disclosure: J. K. Park (corresponding author including other authors) got grants from jw Pharmaceutical Co. (Study No: TA-1790). However, jw pharmaceutical company only had a financial role for this research.

PO-07-010

EFFICACY AND SAFETY OF VARDENAFIL FOR THE TREATMENT OF ERECTILE DYSFUNCTION IN MEN WITH METABOLIC SYNDROME: RESULTS OF A RANDOMIZED, PLACEBO-CONTROLLED TRIAL Schneider, T.1; Gleißner, J.2; Merfort, F.3; Hermanns, M.4; Beneke, M.5; Ulbrich, E.6 1 PUR/R, Mülheim, Germany; 2Die Gesundheitsunion, Wuppertal, Germany; 3Diabetologic Office, Grevenbroich, Germany; 4Jenapharm GmbH & Co.KG, Jena, Germany; 5Bayer Pharma AG, Wuppertal, Germany; 6Bayer Vital GmbH, Leverkusen, Germany Objective: To evaluate the efficacy and safety of vardenafil vs. placebo in men with erectile dysfunction (ED) and metabolic syndrome. Methods: Double-blind, randomized, multicenter, parallel-group, placebo-controlled study conducted at 15 center in Germany, comprising 4-week non-medicated run-in, and 8-week treatment, periods. Participants had ED of mild-to-moderate severity or greater [erectile function domain of the International Index of Erectile Function (IIEF-

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Unmoderated Poster Presentations EF) score ≤21] and metabolic syndrome (assessed by International Diabetes Federation criteria). Vardenafil starting dose: 10 mg, titratable to 5 or 20 mg after 4 weeks. Primary efficacy measures: IIEF-EF, Sexual Encounter Profile (SEP) diary questions 2 and 3. Secondary efficacy measures included percentage of men achieving “return-tonormal” erectile function, and percentage of men titrating to the highest dose. Adverse events (AEs) were recorded throughout the study. Results: The intent-to-treat (ITT) population included 145 men (vardenafil, N = 75; placebo, N = 70). Baseline least squares (LS) mean IIEF-EF scores were 12.0 (vardenafil) and 12.7 (placebo), indicating moderate-to-severe ED. Vardenafil was statistically significantly superior to placebo for all primary efficacy measures (P < 0.0001) (LS mean IIEF-EF scores at week 8 [last observation carried forward]: 21.0 [vardenafil], 14.2 [placebo]), and showed nominally statistically significant superiority vs. placebo for percentage of subjects reporting “return-to-normal” erectile function (P = 0.0004). After 4 weeks of treatment, 41.3% and 20.0% of all ITT subjects taking vardenafil or placebo, respectively, remained on the 10 mg dose. Treatment-emergent AEs were mild-to-moderate in severity and consistent with the known AE profile of phosphodiesterase type 5 inhibitors. Conclusion: This is the first study to assess the efficacy and safety of vardenafil, taken alone, for ED therapy in men with metabolic syndrome. Despite these patients having low baseline erectile function, vardenafil treatment was associated with significant improvements in erectile function and rates of successful intercourse, and was well tolerated. Policy of full disclosure: T. Schneider has acted as a speaker, investigator and advisory board member for Astellas, Bayer Pharma AG and Pfizer. J. Gleißner has no conflicts of interest to declare. F. Merfort has acted as a speaker, investigator and advisory board member for Bayer Pharma AG, Eli Lilly and Company and Novo Nordisk. M. Hermanns is an employee of Jenapharm GmbH & Co. KG. M. Beneke and E. Ulbrich are employees of Bayer Pharma AG and Bayer Vital GmbH, respectively. Editorial support in developing this abstract was provided by Joanne Millership PhD of Fishawack Communications Ltd, and funded by Bayer Pharma AG.

PO-07-011

CAN DOSE FRAGMENTATION OF TADALAFIL 10 OR 20 MG EFFICIENTLY REDUCE THE INCIDENCE OF HEADACHE AS ADVERSE EVENT? Mitroi, G.; Dena, S.; Nedelcuta, C.; Drocas, A. Emergency County Hospital, Urology, Craiova, Romania Objective: Objectives: Although headache is the most common PDE5 inhibitors related adverse event, few studies evaluated the clinical impact during ED treatment. In an observational clinical study, the efficiency of fractionated administration of usual doses of PDE5 inhibitors (tadalafil) was evaluated as method for reducing headache incidence as adverse event. Methods: For a period of 24 months, 156 patients with erectile dysfunction, undergoing “on–demand” treatment with 10 or 20 mg tablets of tadalafil, were observed. For the 24 patients that reported headaches (15.4%) was proposed a fractionate administration of usual doses with 10 mg tablets fractionated in two doses (at 30-minute interval) and 20 mg tablets fractionated in four doses (at 30-minute interval). The results evaluation was made after 1 month. Efficacy measures for ED treatment included changes in International Index of Erectile Function–Erectile Function domain (IIEF-EF); as for efficacy of fractionated method the Visual Analogue Scale was used. Results: Among the 156 patients, 74 received doses of 10 mg and 82 used 20 mg doses, with an overall reported improved erections for 82.05% (N = 128). Among the 24 (15.4%) subjects that experienced headaches, 23 agreed for dose fragmentation. 21 patients (87.5%) reported lower intensity or disappearance of headache, with a insignificant modification in erectile function response. Conclusion: Dose fragmentations can significant reduce the incidence and intensity of headaches, probably through the delay of drug-

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Unmoderated Poster Presentations induced vasodilatation of cerebral vascular bed (by slower blood concentration buildup), but direct evidences to confirm this hypothesis are required. Policy of full disclosure: None.

PO-07-012

DOC, ARE VIAGRA AND FRIENDS RISKY? PATIENTS’ ATTITUDE ABOUT PDE5IS INFORMATION LEAFLET IN THE WEBNETWORKING GENERATION Salonia, A.1; Moretti, D.2; Saccà, A.1; Abdollah, F.1; Castiglione, F.1; Clementi, M. C.1; Castagna, G.3; Capitanio, U.1; Rigatti, P.1; Montorsi, F.1 1 University Vita-Salute San Raffaele, Urology, Milan, Italy; 2Urological Research Institute, Urology, Milan, Italy Objective: After more than 10 years since their launch on the worldwide market, patients keep having more concern about DE5Is intake than for other types of drugs. This study was aimed at assessing the patient’s attitude about patient information leaflet of PDE5is in the web-networking generation. Methods: The last 100 consecutive patients with erectile dysfunction (ED) and non naïve for PDE5Is anonymously completed a brief selfadministered structured questionnaire including general demographic data and questions about individual’s attitude about patient information leaflet of PDE5is. Descriptive statistics and regression models tested the association between patients’ attitude and predictors. Results: Complete data collection was available for 98/100 (98%) patients (mean age: 51.9 yrs; range: 23–73). Educational status was secondary school, high school and university degree in 18 (18.4%), 48 (49%), and 33 (33.7%), respectively. 76/98 (77.6%) reported a stable sexual relationship. Overall, 52 (53.1%), 30 (30.6%), and 17 (17.3%) patients reported that they had taken 1, 2 or all 3 available PDE5Is at least once, respectively. Likewise, 82 (83.7%) have read the relevant patient information leaflet first before taking the drug. Conversely, only 67 (68.4%) patients reported to read regularly the information leaflet for other types of drug (chi2: 5.49; P = 0.02). At MVA age at survey, educational status, and relationship status were not associated with patients’ attitude to read the information leaflet of PDE5is (all p > 0.05). Interestingly, 73/98 (74.5%) regularly consult the web; 68/73 (93.2%) have received at least one advertising to buy one of the PDE5Is through the web; none eventually bought a drug through the web. Conclusion: This exploratory analysis showed that patients keep having major concern about PDE5is. This leads to reading more frequently the patient information leaflet and to not buying the compound through the web. Policy of full disclosure: None.

PO-07-013

IS TRIGGER ANDROGEN THERAPY EFFECTIVE IN METABOLIC SYNDROME? Naskhletashvili, V.; Yesilevsky, Y. First Moscow Medical Institute, Urology, Russia Objective: Decreased libido and erectile dysfunction (ED) is largely associated with deficiency of testosterone (T) and metabolic syndrome. Aim: To study the possibility of stimulating androgen-therapy. Methods: Sixty patients with chronic prostatitis III (CP-III) were examined (NIH-CPSI, IIEF, Doppler ultrasound and level of T). Patients with relative androgen deficiency were treated with “Nebido” within a year. When T was achieved ≥18 nmol/L, quarterly injection was missed. Results: Forty of patients with CP-III (66,6%) showed signs of metabolic syndrome and clinical manifestation of androgen-deficiency. Levels of total T were normal-to-low (13.5 ± 1.5 nmol/L) (P ≤ 0.01). In 11 patients T rose to the normal range from a single injection (20 nmol/L), and re-introduction of the scheme was not required for 1-year follow-up. Thus, the impulse introduction of “Nebido” pos-

sessed enough stimulating effect on the reserves of hormonal selfregulation androgen-dependent functions. In 16 patients the androgen deficiency symptoms disappeared after several injections of “Nebido.” T level rose up to 16.0 ± 1.2 nmol/L after a single injection and up to 19.0 ± 1.5 nmol/L after quarterly injections. NIH-CPSI decreased in score from 13.5 ± 1.8 to 8 ± 0.8 (P ≤ 0.01), increased in IIEF score from 16.1 ± 1.1 to 20.3 ± 0.9 (P ≤ 0.01) and decreased in AMS score from 30 ± 1.5 to 20 ± 1.6 (P ≤ 0.01). Conclusion: The goal of testosterone undecanoate (“Nebido”) inclusion in the treatment of metabolic syndrome and androgen deficiency may be not a replacement therapy with quarterly injections, but an impulsed stimulation, that restores androgen-dependent body functions. Policy of full disclosure: None.

PO-07-014

THE EFFECT OF HERBAL COMBINATION FORMULA HM ON MALE SEXUAL FUNCTION AND SATISFACTION: A PLACEBOCONTROLLED, DOUBLE-BLIND CLINICAL STUDY Hattat, H.; Hattat, E.; Hattat, I. Hattat Uro-Andrology Hospital, Uro-Andrology, Istanbul, Turkey Objective: Recent reports suggested that, herbal remedies are among the first resorts for the treatment of sexual dysfunction by patients.The aim of the study was to assess whether a patented herbal combination formula, known as Formula HM would improve sexual function including erectile capacity and sexual satisfaction in men. Methods: Four hundred male patients of a private uro-andrology clinic aged 25–65 years old were invited in a placebo-controlled, double-blind, 5-month study. 382 men accepted to participate to the study. The participants were given either four capsules of Formula HM (1 g per capsule) or placebo daily. The efficacy of Formula HM was measured by using questionnaires. Main Outcome Measures: International Index of Erectile Function (IIEF) and Treatment Satisfaction Questionnaire for Medication (TSQM-Version II). Results: The participants were on average 47.1 ± 6.97 old. Formula HM improved the scores on IIEF in the erectile function domain from 14.40 ± 4.14 to 16.58 ± 4.07; in the orgasm domain from 5.72 ± 1.14 to 6.9 ± 1.25; in the sexual desire domain from 4.82 ± 0.95 to 7.39 ± 1.02, in the intercourse satisfaction domain from 5.32 ± 0.54 to 8.16 ± 0.78 and in the overall satisfaction domain from 3.47 ± 0.70 to 6.93 ± 1.42. Formula HM significantly improved erectile function scores on IIEF compared to placebo (P = 0.002). 72% of the participants were satisfied to extremely satisfied with Formula HM on the global satisfaction and effectiveness domain of TSQM. Conclusion: Oral administration of Formula HM improved sexual function in men in erection, orgasm, desire and satisfaction domains. Formula HM can be used as an alternative and complementary medical treatment in men to improve erectile function. Policy of full disclosure: None.

PO-07-015

HERBAL TREATMENT FOR ERECTILE DYSFUNCTION: A REVIEW OF CURRENT EVIDENCE Ho, C. C. K.1; Tan, H. M.2 1 Universiti Kebangsaan Malaysia, Dept of Surgery, Kuala Lumpur, Malaysia; 2Sime Darby Medical Centre, Kuala Lumpur, Malaysia Objective: To analyze the evidence for herbal treatment in erectile dysfunction. Methods: A literature search was conducted using PubMed from 1990 to 2010. The following MeSH (Medical Subject Heading) terms were used: “traditional medicine,” “erectile dysfunction,” “complementary medicine,” “herbal,” “alternative medicine,” “sexual dysfunction.” Inclusion criteria for article selection were: articles in English, studies

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440 (of any design) on sexual dysfunction in men, and publication in a peer reviewed journal. The abstracts and full text of the articles, identified from the initial search, were reviewed by two authors independently who subsequently reached a consensus on adding each included paper. The reference lists of identified articles were reviewed manually for additional relevant articles. Additional studies, recommended by expert peer reviewers, were examined and added. Results: There are studies done mainly in the laboratory on animal models. However, randomized controlled trials on human are scarce. The only herbal medications where studies on erectile dysfunction have been done were Panax ginseng, Butea superba, Epimedii herbs (icariin), Tribulus terrestris, Securidaca longepedunculata, Piper guineense and Yohimbine. Out of these, only Panax ginseng, Butea superba and Yohimbine have published studies done on humans and were proven to be effective. Unfortunately, these published trials on human subjects were also not robust. Conclusion: Many of the herbal therapies appear to have potential benefits and similarly the health risk of various phytotherapeutic compounds need to be elucidated. Properly designed human trials should be worked out and encouraged to determine the efficacy and safety of potential phytotherapies. Demand for herbal and traditional therapies will persist if not growing in popularity. Knowledge on these natural products is essential for all sexual medicine physicians. The holistic approach by herbal and traditional therapists should be emulated to ensure a more complying and satisfied patients. Policy of full disclosure: None.

PO-07-016

THE EXPERIENCE OF THE MODERN HOMEOPATHIC TREATMENT OF SEXUAL DISORDERS IN MEN Gorpynchenko, I.; Gurzhenko, I.; Maksym, R.; Boiko, A.; Kornienko, A. Institute of Urology, Department of Sexology and Andrology, Kiev, Ukraine Objective: Cefagil is the homeopathic medicine for the treatment of sexual dysfunction in men and women. The features of Cefagil are: it’s made for both partners, is not a one-time stimulant, is used only by demand and contributes to long-term harmony in intimate relationships, helps to normalize all stages of sexual intercourse: increases sexual desire, activity and satisfaction, activates the hidden reserves of the body, opening the second breathing in love, has no contraindications and well tolerated. Cefagil was studied on 34 patients with various disorders of sexual function in dynamics. The purpose of this study was to evaluate the effectiveness of the medicine Cefagil in the treatment of impairments of libido and erectile function. Methods: Clinical and laboratory examinations carried out before treatment and 1 month after therapy, which consisted of Cefagil use one tablet three times per day during 1 month. Results: In the group of patients who took Cefagil virtually all indicators of integrative index significantly increased. The indicator “erectile function” increased from 14.28 ± 0.98 to 24.86 ± 0.23 (P < 0.01), “satisfaction with sexual intercourse” increased from 7.24 ± 0.31 to 13.52 ± 0.58 (P < 0.05), “orgasm”—from 4.2 ± 0.14 to 9.31 ± 0.38 P < 0.05), “overall satisfaction”—from 4.01 ± 0.29 to 8.13 ± 0.32 (P < 0.01). Showing their dynamics in a percentage, it is seen that all integrative indices increased almost twice. Conclusion: The increase of sexual desire, according to data of study the dynamics of integrative indicators of the International Index of Erectile Function, was 58.2%. Policy of full disclosure: None.

J Sex Med 2011;8(suppl 5):406–469

Unmoderated Poster Presentations PO-07-017

NEW OPPORTUNITIES TO IMPROVE ERECTILE FUNCTION IN THE ELDERLY Startsev, V.1; Smirnova, S.2; Kiseliov, E.3 Pediatric Medical Academy, Urology, St.-Petersburg, Russia; 2Biomedical Center, St.-Petersburg, Russia; 3Medical Center “URO-PRO”, St.-Petersburg, Russia

1

Objective: We analyzed the application of Transfer factors (TF) in elderly people with erectile dysfunction (ED). TF—cytokines (10 kD) with 44 amino acids, produced by leukocytes. Lawrence (1949) first got TF from dialysis leukocyte extract. It was proven that TF stimulates the delayed-type of hypersensitivity to antigens. This type of response was called TF, meaning that it contains a molecule capable of transferring immune cells from one organism to another. Later TF were found in colostrum and chicken egg yolk (“4Life Research,” USA). TF is possible to use orally, not destroyed during digestion and safe. We used one product of the scale—TF Cardio (egg yolk, vitamins A, C, E, Niacinamide, B6, folic acid, B12, magnesium, zinc arginat, cooper glycinate, potassium, selenmetionin, Ginkgo biloba, Hawthorn, Garlic, coenzyme Q10, resveratrol, ginger oil). Methods: In 2009–2010 we observed 72 patients (57–71 years, average 64 years) with vasculogenic ED. We performed ultrasound, Doppler of penis arteries with intracavernous test injection, blood pressure measurement (trendmil). Also we studied: testosterone level, FSH, LH, prolactin, cholesterol, HDL, LDL, triglycerides, atherogenic ind., PSA. Severe metabolic complications, diabetes and age androgen deficiency were exclusion criteria. After obtaining informed consent all patients began standard therapy (averaged duration 2.5 months) with PDE5 inhibitors (or intracavernous inj.), proteolytic enzymes, vitamins A and E, adaptogens and laser to the pelvic organs. Patients were divided into two groups: 28 patients (A), in addition to the basic course, taking two capsules TF Cardio, twice a day, after eat. All those people were previously interviewed for an allergy to milk and eggs. In 44 persons (B, control) treatment was carried out only by the standard procedures. To control the outcomes we used valid questionnaires— AMS, IIEF-5. Results: Test results of patients increased by 25–30%, and generally not statistically differ in the treatment groups. In 21 patients (75%) after TF Cardio intake we marked a pronounced positive dynamics of the arterial blood amplitude in a. dorsalis penis. After receiving TF in 17 patients (60.7%) with symptoms of impaired lipid metabolism, the rate of HDL increased (14%), while lowering LDL, atherogenic index, and cholesterol were decreased to normal values. By 6–7 weeks of combination therapy with TF Cardio, 7 patients (25%) stopped complaining of headaches, they have stated a stable blood pressure at 120–130/80–85 mm Hg. In 17 persons (60.7%), who received TF Cardio, of therapy appeared adequate erection to 3 weeks of treatment, thereby reducing the amount of based prescription. We did not report indigestion, allergic reactions and other side effects in patients of group A was. In 1 case (3.6%), noted the appearance of the daily headaches that occasionally noted in his earlier, the condition improved after the abolition of TF and the headaches ceased. Within 6 months of follow-up the ability to introjection, the severity of morning erections, performance on a scale IIEF at least 21 points at AMS—16–18 points—after TF preserved in 25 people (89.3%), in contrary with patients of group B—in 21 people (47.7%). Conclusion: Transfer Factor Cardio—a multicomponent, well-balanced formula, that allows us not only to improve some metabolic processes, but also to provide meaningful improvement in erectile dysfunction in patients after 50 years. According to the testimony of many foreign and Russian scientists, this natural range of well-proven in the treatment of venous insufficiency and in the treatment of postinfarction status. Need for additional study in detail the mechanism of Transfer Factor Cardio is the state of blood vessels of patients with erectile dysfunction and to analyze the safety of this drug. After receiving credible evidence of the results of transfer factors undoubtedly take its place alongside other officinal medicines to improve quality of life in elderly men. Policy of full disclosure: None.

441

Unmoderated Poster Presentations PO-07-018

VIBERECT® DEVICE USE BY MEN WITH ERECTILE DYSFUNCTION: SAFETY, EASE OF USE, TOLERABILITY, AND SATISFACTION SURVEY Tajkarimi, K.1; Burnett, A. L.2 Summit Urology Group, Urology, Chambersburg, USA; 2Department of Urology, Johns Hopkins, Baltimore, MD, USA

1

Objective: Penile erection is a nerve generated vascular and mechanical event. Genital afferents activate spinal nuclei and higher centers responsible for sexual and urinary function. Viberect® is a new FDAcleared medical device indicated to provoke erection and to treat anejaculation in spinal cord injured men. We report a preliminary survey of Viberect® use by men with erectile dysfunction (ED). Methods: A representative sample of urology patients with ED (N = 10) were recruited (see table below). Men were instructed by a unique repetitive reflex teaching program for optimal Viberect® experience. Viberect® stimulation was performed at home for 5−10 minutes at 70–110 Hz at least three times a week for 1 month. Treatment satisfaction was assessed by Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) and Treatment Satisfaction Scale (TSS). Results: All men completed the surveys. No complaints or adverse events were reported. Viberect® was easy to use, painless, and acceptable. 90% were satisfied with the Viberect® treatment (EDITS Index > 50); mean EDITS index score was 77. Mean TSS score was increased significantly from baseline (41.8) to active (66.8) (P < 0.01). 90% would continue Viberect® treatment and recommend its use to their friends. Conclusion: This preliminary survey suggests Viberect® use by men with ED is a safe, convenient, well-tolerated, and highly satisfying modality for treatment of ED. Randomized prospective trials are necessary to authenticate these important findings. Policy of full disclosure: K. Tajkarimi: Reflexonic, LLC; A. L. Burnett: None.

PO-07-019

DISTRIBUTION OF THERAPEUTIC CONCEPTS FOR REHABILITATION OF ERECTILE FUNCTION AFTER NERVESPARING RADICAL PROSTATECTOMY IN GERMANY Bannowsky, A.1; Raileanu, A.1; Müller, A.2; Ataniyazov, R.1; van Ahlen, H.1 1 Klinikum Osnabrück GmbH, Dept. of Urology, Germany; 2University Hospital Zürich, Dept. of Urology, Switzerland Objective: Despite objective data regarding rehabilitation of erectile function (EF) after nerve-sparing radical prostatectomy (nsRP) the „gold-standard”-treatment is still under debate. The aim of this study

was to evaluate the distribution of the different treatment options in Germany. Methods: Between 10/2010 and 04/2011 we performed a questionnaire sent to all urologist (outpatient/general and university hospitals/ rehabilitation hospitals) in Germany. The survey consists of different questions, e.g., if and what kind of therapy the urologist choose to support rehabilitation of EF after nsRP. Further questions dealt with the frequency, duration and “optimal” start of the chosen therapy. Results: Until today 188 urologists completed and returned the questionnaire. The distribution was: urologists in hospitals N = 79, outpatient/ambulatory N = 106, with 24% performing surgical treatment, and urologist in rehabilitation hospitals N = 3. Overall 50% of the urologists are performing radical prostatectomy on a regular basis. The question about the “rehabilitation concept” showed 39 different treatments within this group. To increase EF after nsRP PDE5-inhibitors were mostly administered (88%): 45% “on-demand” vs. 55% on a daily or regular basis ≥3 times/week. The use of penile injection therapy, MUSE or VCD was 32%, 6%, and 30%, respectively. In 56% the treatment started within the first weeks after surgery and was performed until the patient regained potency in 46%. Only 14% of the urologists did not chose any “active” kind of rehabilitation treatment for EF recovery after nsRP. Conclusion: Lots of different therapeutic concepts are currently performed in Germany to increase EF recovery after nsRP. The use of PDE5-inhibitors is the most chosen treatment option. Despite the published data regarding effectiveness the optimal treatment seems to be still unknown. Policy of full disclosure: None.

PO-07-020

SATISFACTION EVALUATION OF PATIENTS UNDER INTRACAVERNOUS INJECTION TREATMENT FOR ERECTILE DYSFUNCTION Fotas, A.; Hintzoglou, S.; Sidiropoulos, C.; Charalambous, Papathanasiou, A.; Salpingidis, G. Ippokratio Hospital, Urological Department, Thessaloniki, Greece

S.;

Objective: The aim of the presentation is to evaluate the intracavernous injection procedure in patients who use it as treatment for erectile dysfunction. The efficacy and the disadvantages of the method were also assessed. Methods: 20 patients who used intracavernous injections of alprostadil, papaverine and phentolamine (TriMix) for erectile dysfunction answered a set of questions which included the following parameters: average dose of TriMix, period of treatment, frequency of injections, grade of satisfaction for both the outcome and the procedure and difficulties regarding the treatment. The efficacy was evaluated with the use of the International Index of Erectile Function Domain (IIEFDomain). The mean age of the patients was 67.9 years (62–78). The mean dose or TriMix was 0.46 mL (0.05–1.2) and the mean period of treatment was 84 months (11–216). Mean frequency of injection was four per month (2–8). Results: In the question whether their sexual life improved all 20 patients gave a positive answer. Regarding the sexual outcome, 8 out of 20 patients (40%) stated very satisfied, 8 out of 20 patients (40%) stated satisfied, 2 patients (10%) were neutral and 2 patients (10%) were not satisfied. Regarding the procedure, 8 out of 20 patients (40%) were comfort with the procedure, 8 out of 20 patients (40%) accepted it with minor hesitation and 4 out of 20 patients (20%) stated discomfort. The main difficulties as reported by the patients were needle insertion (66.6%), pain (33.3%), difficulty in prescribing the medicine (16.6%) and prolonged erection after the end of the sexual intercourse (16,6%). The mean IIEF-Domain was 24.9 (6–30). Conclusion: Intracavernous injection is an effective treatment for erectile dysfunction which is highly accepted by the patients. The main issues that arise from its use are minor and can be coped with patient education and information. Policy of full disclosure: None.

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442 PO-07-021

CONSERVATIVE TREATMENT OF MILD AND MODERATE VASCULOGEIC ERECTILE DYSFUNCTION Maksym, R.; Kornienko, A.; Gurzhenko, A. Institute of Urology, Department of Sexology and Andrology, Kiev, Ukraine Objective: To improve methods of conservative therapy of vasculogenic ED, aiming on the cancelation of PDE5 inhibitors. Methods: 128 patients with documented mild and moderate vasculogenic ED took part in the study. All of them used PDE5 inhibitors in the dose 50–100 mg for two to five times a week. All patients got treatment, which inluded vacuum therapy, transsrectal elecrostimulation of neurovascular bundle, intracavernous injections of special vascular compound (0.5 mL 2% pentoxifylline, 0.3 mL 1% proserini, 0.5 mL 1% adenosinthreephosphate Na, 2.5 mkg of prostaglandini E2), daily usage of 25 mg of sildenafili citrat at night. Results: In the group of mild ED (IIEF = 16–21) 58 patients decreased mean week PDE5 inhibitors dose from 138.3 to 37.5 mg. In the group of moderate ED (IIEF = 10–15) in 70 patients it decreased from 225.3 to 88.7 mg a week. 26 men from mild ED group (44,8%) canceleed PDE5 inhibitors at all at 3-month control visit after treatment; in moderate ED group—29 men (41.4%) made that. Mean IIEF score improved from 17.1 to 21.9 (P < 0.04) in mild ED group, and from 11.9 to 16.9 (P < 0.02) in moderate ED group after therapy in 3 months. Conclusion: Our method of conservative treatment of ED is effectve and could be widely used in long-term management of mild and moderate vasculogenic ED. Policy of full disclosure: None.

Unmoderated Poster Presentations Friday, 2 December 2011 09.00–17.00 Exhibition Hall B PO-08 ED surgical treatment PO-08-001

INTERCAVERNOSAL EVALUATION OF ANTIBIOTIC SOLUTIONS FOR DIPPING COLOPLAST TITAN PENILE IMPLANTS Wilson, S.1; Cruz-Rojas, C.2 Indio, CA, USA; 2Fundacio Puigvert, Barcelona, Spain

1

Objective: The inflatable penile prosthesis (IPP) is a well-established treatment for medically refractory erectile dysfunction. Infection is the most dreaded complication. Infection retardant coatings on modern implants have lowered infection rate approximately 50%. American Medical System (AMS) implants have a factory-applied coating of rifampin and minocycline (InhibiZone). The Coloplast Titan IPP has a hydrophilic coating that if dipped in an aqueous solution immediately before implantation makes the surface lubricious to inhibit bacterial attachment. This coating will also absorb antibiotics for subsequent elution off the device. We evaluate whether this coating was efficacious in inhibiting bacterial growth when dipped in antibacterial substances and compare the kill zones to the AMS IPP. Methods: Three groups of six male rats had intracavernosal implantation of Coloplast Titan strips soaked in three different antibiotic solutions. Coloplast strips (8x12mm) were dipped in: Daptomycin 10 mg/ mL, Rifampin (10 mg/mL), Gentamicin (1 mg/mL), Trimethoprim sulfamethoxazole solution (80 mg + 16 mg/mL). An additional group of 6 rats were implanted with AMS InhibiZone IPP strips. The 24 IPP strips were explanted 24 hours later and Zones of Inhibition (ZOI) were determined against the Staphylococcus aureus P1 strain on agar plates. Results: All animals tolerated the surgery and there were no complications. All of the strips produced ZOI. Coloplast dipped strips of all the antibiotics produced significantly superior ZOI against S. aureus than the AMS InhibiZone strips. Conclusion: In vivo assessment (cavernous rat model) indicated that all three antibacterial dips caused the Coloplast surfaces to create better ZOI against S. aureus than AMS InhibiZone IPP strips. Policy of full disclosure: Study funded by Coloplast. S. K. Wilson is a consultant and investigator for Coloplast, and a consultant for AMS. C. C. Rojas is a consultant and investigator for Coloplast, and a consultant for AMS.

PO-08-002

INTRAOPERATIVE PENILE MODELING FOR ACQUIRED CURVATURE BEFORE INFLATABLE PROSTHESIS INSERTION: FIRST CASE Pescatori, E.; Drei, B. Hesperia Hospital, Andrology, Modena, Italy Objective: Modeling the penis over an inflatable penile prosthesis was introduced by Wilson (J Urol 1994) to correct Peyronie’s disease curvature. This highly effective maneuver is not free from risks for prosthesis components, due to ensuing high intra-device pressures. Our aim has been to test the feasibility of intraoperative penile modeling over an artificial erection, before prosthesis placement. Methods: Clinical case. A 55-year-old man with ED s/p radical prostatectomy, after 6 months of self-injection therapy developed a left curvature with a hourglass deformity between the medium and the proximal third of the shaft, with resulting penile instability at penetration. He elected to undergo penile prosthesis placement with concomitant curvature correction. Results: Surgical procedure. An artificial (hydraulic) erection was induced (see figure below), showing a left curvature of approximatively 30°. Over such erection it was applied, similarly to the classic Wilson’ maneuver, a forceful penis bent in a direction opposite to the curva-

J Sex Med 2011;8(suppl 5):406–469

443

Unmoderated Poster Presentations ture, for 60 seconds, and repeated two times. Following, it was inserted a bicomponent inflatable prosthesis (Coloplast, Excel), with a resulting complete penile straightening (see figure below). At 5 months followup patient has upon activation a straight penis, and is fully satisfied of his sexual life. Conclusion: To the best of our knowledge this is the first case of penile modeling over an artificial erection, before the insertion of a penile prosthesis. Our case proved successful. Should our preliminary report be confirmed by adequate series, our modification of the original Wilson’ maneuver could be elected in those cases where the original maneuvre: is contraindicated (narrow-base inflatable cylinders), has limited efficacy (bi-component prostheses that upon activation develop limited device rigidity), or is not possible (non-inflatable prostheses). Furthermore, our modification could be possibly considered a first choice also in three-component prostheses due the absence of risks linked to high intra-device pressures. Policy of full disclosure: None.

(on the left corpus through the defecrt resulting from SIS patch removal, on the right corpus through mid-third corporotomy), (iv) wash all the spaces of the removed prosthesis according to Henry et al. (J Urol 2005), (v) harvest an autologous anterior rectus fascia graft through a limited suprapubic midline incision, (vi) insert a new preconnected AMS 700 CX with MS pump. At 3 months p.o. a followup MRI showed correction of left lateral bulging, and significant apical gain in both corpora (see figure below), deemed satisfactory by the patient. Conclusion: Preoperative MRI allows to clearly define details of prosthesis misplacement. Otis urethrotome is instrumental to gain the apex of a scarred corpus cavernosum. Autologous anterior rectus fascia graft appears to be a valid substitute of tunica albuginea. Policy of full disclosure: None.

PO-08-004 PO-08-003

THREE-PIECES PENILE PROSTHESIS WITH SIS PATCH PERFORATION AND SST DEFORMITY: CORRECTION BY AUTOLOGOUS RECTUS FASCIA GRAFT AND DISTAL CORPUS CAVERNOSUM INCISION BY URETHROTOME Pescatori, E.1; Drei, B.1; Pisi, P.2 Hesperia Hospital, Andrology, Modena, Italy; 2Hesperia Hospital, Diagnostica per Immagini, Modena, Italy

1

Objective: We report our management of a case where SST deformity secundary to inadequate distal dilatation was associated to perforation of corporal SIS graft. Methods: Case report. A 39 yo man presented with a penile prosthesis AMS 700CX MS pump, as secundary implant, where a SIS patch was used to cover an albugineal defect. He had two key complaints: left bulging at the medium third of the shaft upon prosthesis activation (site of SIS patch), disappearing during intercourse, and SST deformity. Our diagnostic workup comprised penile MRI and cavernosography, showing fluid collection at the bulging site, and incomplete distal corporal dilatation (see figure below). Results: Revision surgery. Incision: circumferential sub-coronal, with extrusion of degloved penis through a midline scrotal incision. In the area of left bulging a perforation of the former SIS patch was detected, with whitish fluid leaking out (negative colture outcome). It was elected to: (i) remove all the components of the implant, (ii) excise the SIS patch, (iii) gain distal cororal space by means of OTIS urethrotome

ALTERNATIVE RESERVOIR PLACEMENT OPTION IS TO UNDER-FILL NEW TITAN® CLOVERLEAF RESERVOIR ALLOWING NONPALPABLE ECTOPIC PLACEMENT Perito, P.1; Wilson, S.2; Gheiler, E.3 Perito Urology, Indio, CA, USA; 2Indio, CA, USA; 3Gheiler Urology, Indio, CA, USA

1

Objective: Increasing data suggests desire for reservoir placement outside of traditional retroperitoneal space. Flexibility in reservoir placement is imperative for implanters due to variance in patient anatomy and recent popularity of robotic prostatectomy. We studied whether the new Coloplast Titan® geometric cloverleaf shaped reservoir (CL) allows ease of alternative placement in non-traditional reservoir location and underfilling capability, maintaining abdominal surface aesthetics in patients. We compared to traditional reservoir placement. Methods: Three experienced implanters placed 30 CL during standard Coloplast inflatable penile prosthesis procedures over a 2-week period via infrapubic (66%) and penoscrotal techniques. 20 of the reservoirs were placed ectopically—anterior to transversalis fascia but posterior to abdominal wall muscles. The remainder CL were placed in traditional retroperitoneal space. Cylinder size was similar—18.6 cm penoscrotal and 19.3 cm infrapubic. All sites used nominal Rear Tip Extenders to maximize cylinder capacity. Both groups of patients were assessed at 6 weeks for auto-inflation and palpable reservoir. Results: 125 cc CL were placed. Average fill volume was 79 cc. To maximize erection, varying degrees of fluid were left in cylinders, depending on cylinder size and reservoir level. An average of 14.9 cc

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444 remained in cylinders. There were no auto-inflation or patient palpation problems in either group. Conclusion: The Cloverleaf design of the new 125 cc Titan reservoir seems to lend itself to flexibility in fill levels providing the option of ectopic placement without palpable abdominal evidence. Policy of full disclosure: Wilson: consultant for Coloplast and AMS Perito: consultant and investigator for Coloplast Gheiler: consultant and investigator for Coloplast.

PO-08-005

THE ALBUGINEA PLICATION FOR THE RECURVATUM PENIS SECONDARY IN PEYRONIE’S DISEASE (IPP): A TRADITIONAL SURGICAL PROCEDURE Passavanti, G.; Bragaglia, A.; Nucciotti, R.; Spinosa, E.; Gnech, M.; Pizzuti, V. Ospedale Misericordia, Urology, Grosseto, Italy Objective: Peyronie’s disease is a common condition and only 10% of the patients need surgical treatment. Dysfunction of penetration is the condition for surgery. Methods: We treated 37patients (51–76m67,8) with a secondary recurvatum; 29had moderate penetration difficulty and 8impossible. 31patients had hard erections and 6 mild ED. 23cases had a photography during erection and 14 had pharmacacovernosography. Recurvatum was mild (35–50°) in 30cases and severe (>50°) in7. Surgical procedure started with degloving of penis, then we dissected the vasculo-nervous plexus and in 35cases the spongiosum too, for better application of the ventral stitches. In the 14 initial cases we applied Klevmark plication stitches (prolene2/0), afterwards we performed some series of “U”-shaped plication stitches (prolene3/0). We always carried out a reconstruction of Buck Fascia and Dartos Results: We did not have any urethral complications; the patients reported a glandular hypo-aesthesia for some weeks. During the follow-up we did not have a relapse in short term and in 6cases in long-term, the plaque enlarged and the dysmorphism restarted. The shortening of penis was 1,5–2cm in accordance with severity of recurvatum. The first group reported a little nodulation corresponding with plication sites and in the other group this sensation was almost absent Conclusion: In our experience the plication does not cause ED. To obtain good results, also for high grade recurvatum, it is important to dissect carefully the dorsal plexus and spongiosum-corps to place the stitches deeply into the albuginea; the “U”-shaped stitches 3/0 and reconstruction of Buck fascia nullify the sensation of nodulation Nevertheless this procedure causes a shortening of penis and it does not correct the sand-glass deformity, we claim the albuginea plication is a good surgical procedure to treat recurvatum penis secondary to IPP. Policy of full disclosure: None.

PO-08-006

MANAGEMENT OF UNSUSPECTED PEYRONIE’S DISEASE AMONG EGYPTIAN POPULATION Gadalla, K. Al-Azhar Faculty of Medicine, Urology, Cairo, Egypt Objective: To investigate epidemiological and clinical features of Peyronie’s disease in an unselected group of patients who visit Urology Clinic for sexual problem not related to Peyronie’s disease. Methods: A series of 720 consecutive cases with sexual complaints was evaluated regarding to the age at diagnosis, the presence of general diseases, and the outcome of ultrasound sessions as a line of treatment on the improvement of the disease. The medical history which could be possibly related with the onset of the disease was investigated as well. Results: 148 patients (20.56%) had Peyronie’s disease (PD). Age of our patients ranged from 33 to 77 years old with Mean 43.97, DM presents in 147 patients (20.42%) while HTN presents in 111 patients

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Unmoderated Poster Presentations (15.42%). Penile trauma was observed in 34/148 patients (22.9%). Ultrasound sessions was scheduled for all patients, 6/148 patients (4.0%) discontinue therapy, 37/148 patients (25%) had good improvement, 69/148 patients (46.62%) had weak response, 33/148 patients (22.29%) had no response. Conclusion: The mean age of patients at diagnosis, the site of penile scars, and the outcome of ultrasound sessions could advocate that large percentage of patients were respond to ultrasound sessions. The sessions ranged from 1 to 44 sessions to reached to satisfactory response. Thus, due to the diminution of pain spontaneously or after treatment, the patients with Peyronie’s disease may have a normal life with satisfactory sexual function. Policy of full disclosure: None.

PO-08-007

EFFECT OF PDE5 INHIBITOR IN NONSURGICAL MANAGEMENT OF PEYRONIE’S DISEASE: PRELIMINARY STUDY Ham, B. K.1; Kim, J. w.1; Oh, M.1; Yang, D. y.2; Kim, J.1; Moon, D.1 Korea University Hospital, Urology, Seoul, Korea; 2Gangdong Sacred Heart Hospital, Urology, Seoul, Korea

1

Objective: This study was designed to evaluate the role of PDE5 inhibitors as combination therapy with conventional treatment of Peyronie’s disease (PD). Methods: From July 2007 to October 2010, 35 Patients were divided into two groups. Group I (N = 14) received PDE5 inhibitors in addition to conventional treatment with tamoxifen and acetyl L-carnitine, while group II (N = 21) received only conventional treatment. The follow-up duration was at least 12 weeks after the active therapy of PD. Outcomes were assessed by pain relief, successful attempts for sexual intercourse, resolution of the plaque and any occurring complications. Results: In the efficacy of overall treatment of 35 patients, 94.3% patients experienced successful sexual intercourse, while 5.7% experienced pain on erection, and 25.7% showed a decrease in plaque size. The analysis of parameters before treatment showed no significant difference between groups in terms of successful attempt at sexual intercourse (P = 0.583) and pain on erection (P = 0.445). Furthermore, there was no difference between groups after treatment in terms of successful attempts at sexual intercourse (P = 0.766), pain on erection (P = 0.766) and change in plaque size (P = 0.445). However, successful intercourse and pain relief after treatment showed significant change irrespective of groups. (P < 0.05) While the addition of a PDE5 inhibitor did not show any significant improvement in clinical outcome measures, the satisfaction of patient was higher in patients who received combination treatment (P = 0.042). Conclusion: Although the effect of PDE5 inhibitor for pain relief, successful intercourse and resolution of plaque size was not significant, patients who received PDE5 inhibitors had a more satisfaction of treatment of PD. Further prospective studies on the effect of PDE5 inhibitor in PD will be needed. Policy of full disclosure: None.

445

Unmoderated Poster Presentations PO-08-008

ULTRASONOGRAPHIC COMPARISON OF TUNICA ALBUGINEA SUBSTITUTES FOR THE TREATMENT OF PEYRONIE’S DISEASE Palmas, A.; Ferreira Coelho, M.; Cardoso, P.; Fonseca, J. Fernando Fonseca Hospital, Urology, Lisboa, Portugal Objective: Peyronie’s disease is a connective tissue disorder resulting in fibrotic plaque formation on the tunica albuginea of the penis. One approach to repair consists of plaque incision and grafting with one of many potencial grafts materials. But, the quest for the ideal graft for penile reconstruction continues. The aim of this study is to compare the postoperatively sonographic characteristics of an autologous graft (saphenous vein) with an allogenic graft material (PelvicolTM), in terms of thickening, fibroses and calcification of the graft used in the albuginea defect. Methods: Twenty-one patient with adequate erectile capacity assessed preoperatively by color Doppler underwent incision and grafting. In 10 patients were used saphenous vein grafting, and in 11 patients an acellular porcine dermal collagen matrix (PelvicolTM). The erectile function, penile deformity, and sonographic fidings of the tunica defect with the graft were assessed 12 months postoperatively. The sonographic patterns of the grafts were recorded and compared. Results: Penile curvature was completely straightened in 7 (70%) and 8 (72.7%) patients whereas 30% and 27.2% had residual curvature less than 20º. No residual curvature more than 20º and de novo erectile dysfunction was notice. The mean thickness of venous graft was 1.8 ± 0.4 mm and 1.7 ± 0.6 mm on acellular graft. No graft bulging was notice after injection of prostaglandin E1. No statistically significance on the thickening of the graft, with no calcifications our dense fibrosis around the graft, compatible with no immune or inflammatory response. Conclusion: This study shows the feasibility of PelvicolTM, as a considerable option with a high rate of functional success and sonographic patterns of well integration, similar to autologous graft. Sonography is easy to perform and has no negative side effects, we can accurately identify and measure the thickening of the tunica albuginea and the graft on the defect, with makes the sonography the perfect tool for following up patients after surgery Policy of full disclosure: None.

PO-08-009

SEXUAL FUNCTION PRESERVATION WITH THE PROSTATIC URETHRAL LIFT, A MINIMALLY INVASIVE THERAPY FOR LOWER URINARY TRACT SYMPTOMS SECONDARY TO BPH Montorsi, F.1; Laborde, E.2; Woo, H.3; Bolton, D.4; Chin, P.5; Jack, G.4; Rashid, P.6; Thavaseelan, J.7; McVary, K.8 1 IRCCS San Raffaele, Milano, Italy; 2New Orleans, USA; 3Sydney, Australia; 4Melbourne, Australia; 5Wollongong, Australia; 6Port Macquairie, Australia; 7Murdoch, Australia; 8Chicago, USA Objective: The Prostatic Urethral Lift is a novel, minimally invasive treatment that aims to offer an alternative solution to men who suffer from lower urinary tract symptoms secondary to BPH and place importance on maintaining sexual function. Through a tissue-sparing approach, the procedure mechanically opens the urethra without ablation or resection. We report on the effects of this new procedure on sexual health as it relates to erectile and ejaculatory function. Methods: During the procedure, small metallic implants are delivered transurethrally to areas of lateral lobe obstruction. The implants are positioned under endoscopic visualization such that the lobes are lifted away from the urethral lumen and towards the prostatic capsule. Between December 2005 and March 2010, 64 men over the age of 50 were treated with the Prostatic Urethral Lift in a multicenter, nonrandomized, prospective study in Australia. Subjects were followed for 12 months and evaluated with symptom and sexual function assessments.

Results: All patients were successfully treated, with relief of symptoms as early as 2 weeks post-procedure and broadly sustained to 12 months (IPSS: baseline 22.5 ± 5.4 vs. 12 months 12.1 ± 7.1, P < 0.001) for matched data. Erectile function was stable or slightly increased at all intervals in men who were sexually active, willing to answer questionnaires, and had a SHIM score > 5 at baseline (SHIM: baseline 17.7 ± 5.8 vs. 12 months 19.4 ± 5.3, P = 0.01). In addition, there were no reported adverse events of retrograde ejaculation and ejaculatory function was preserved (MSHQ-EjD function score: baseline 10.9 ± 2.4 vs. 12 months 11.1 ± 2.9, P = NS). Conclusion: Treatment with the Prostatic Urethral Lift allowed for rapid, sustained relief of symptoms and did not compromise sexual function. This procedure is potentially suited for those patients who seek relief from lower urinary tract symptoms and want to preserve their erectile and ejaculatory function. Policy of full disclosure: Disclosures The disclosures for the authors are as follows: 1) Francesco Montorsi: consultant to NeoTract, Inc. 2) Henry Woo: consultant to NeoTract, Inc. 3) Peter Chin: consultant to NeoTract, Inc. 4) Prem Rashid: consultant to NeoTract, Inc. 5) Kevin McVary: consultant to NeoTract, Inc.

PO-08-010

TREATMENT OUTCOMES OF ERECTILE DYSFUNCTION FOLLOWING RADICAL PROSTATECTOMY Brodak, M.; Navratil, P.; Kosina, J.; Louda, M.; Holub, L.; Pacovsky, J. University Hospital, Urology, Hradec Kralove, Czech Republic Objective: Prostate cancer is the most common organ cancer in male and the radical prostatectomy is the high effective treatment of a localized prostate cancer. Erectile dysfunction (ED) is the most frequent adverse event of the radical prostatectomy. Its successful treatment considerably improves the quality of life. The aim of this study is the evaluation of the efficiency of the oral therapy by sildenafil citrate and the intracavernosal injection (ICI) therapy by alprostadil. Methods: There were 489 radical prostatectomies carried out in our center in period 1998–2009. We evaluated cohort of 108 patients with ED. The first line therapy was the oral sildenafil citrate 50–100 mg. Patients without satisfactory effect was treated by ICI. There were evaluated efficacy and safety of both methods. Patients were interviewed about quality of erection and assessed by using IIEF-5 questionnaire in sildenafil cohort. Patients were questioned for adverse events. Results: The median follow-up was 42 months, median age was 63 years. The satisfactory erection for intercourse was in 51 (47 %) patients with sildenafil therapy. The 57 (53%) patients with insufficient effect were treated by ICI and 52 (91%) have experienced with good erection. Mean IIEF-5 score increased from 4.4 to 13.4 (P < 0.001) in sildenafil cohort. No serious adverse events and no priapism were recorded. The most common mild adverse events were headache in 3 (3%) patients with sildenafil and pain in the injection site was in 4 (7%) patients. Conclusion: The efficacy of sildenafil in the therapy of ED following radical prostatectomy was good, but limited. The ICI treatment after unsuccessful sildenafil therapy was high efficient. Both methods of treatment were safe with minimal adverse effects. Policy of full disclosure: None.

J Sex Med 2011;8(suppl 5):406–469

446

Unmoderated Poster Presentations PO-09

PO-08-011

DAILY ADMINISTRATION OF LOW-DOSE PDE5 INHIBITOR IN PATIENTS UNDERWENT BILATERAL NERVE SPARING RADICAL PROSTATECTOMY: EVALUATION OF ERECTILE FUNCTION Fotas, A.; Sakalis, V.; Alexandridis, D.; Triantafyllidis, Papathanasiou, A.; Salpingidis, G. Ippokratio Hospital, Urological Department, Thessaloniki, Greece

A.;

Objective: The evaluation of erectile function restoration in patients treated by bilateral nerve sparing radical prostatectomy for prostate cancer after the daily administration of low-dose PDE5-inhibitor. Methods: From September 2009 to May 2011, 52 patients with prostate cancer underwent open radical prostatectomy with bilateral preservation of the neurovascular bundles (mean age 64.63 years [58–75]). The International Index of Erectile Function (IIEF score) was used to assess pre and postoperative erectile function. The daily administration of 25 mg sildenafil, started immediately after the urethral catheter removal. Involuntary erections as reported by the patient were evaluated 1 month later. Three months after the daily use of PDE5 inhibitor the patients were reassessed by involuntary erections report and second IIEF score. Results: The mean preoperative IIEF score was 25 (12–30) and all patients were sexually active. In the first month evaluation 46 of 52 patients reported the presence of involuntary erections. At the reassessment, 3 months later 50 patients reported involuntary erections and 17 of them were able to complete sexual intercourse. The mean preoperative IIEF score for the sexual active group was 28.25 (27–30) while the postoperative was 23.75 (17–27). Conclusion: Early results lead to the conclusion that daily administration of low-dose PDE5 inhibitor after bilateral nerve sparing radical prostatectomy can help preserving involuntary erections after surgery. Despite the short observation period it seems that daily administration of low dose PDE5-inhibitor can restore sexual function. Patients with higher preoperative IIEF score are more likely to preserve their sexual function postoperatively. Of course longer time of therapy and followup of patients are needed before safe conclusions can be made. Policy of full disclosure: None.

Priapism

PO-09-001

TESTOSTERONE DEFICIENCY IS A POSSIBLE RISK FACTOR FOR PRIAPISM ASSOCIATED WITH SICKLE CELL DISEASE Morrison, B.1; Reid, M.1; Madden, W.1; Feng, Z.2; Burnett, A.2 University of the West Indies, Urology, Kingston, Jamaica; 2Johns Hopkins Sch of Medicine, Baltimore, MD, USA

1

Objective: Priapism has a high incidence in sickle cell disease (SCD). Testosterone deficiency has been recognized in adolescent and adult males with SCD. We sought to determine the association of testosterone deficiency and priapism in adult men with SCD. Methods: A cross-sectional study of 50 adult men with homozygous S SCD was performed. All patients had early morning blood taken for free and total testosterone, FSH, LH, prolactin, lipid levels, LDH and hematological indices. Patients completed an interviewer administered questionnaire regarding priapism frequency, duration and treatment. Hypogonadism was defined as serum total testosterone <12 nmol/L. The association of testosterone deficiency and priapism was determined. Results: Priapism was noted in 48% (24) of the patients and was most frequently seen in men between ages 18–25 years. Mean age of the study population was 34.2 ± 8.9 years and there was no difference in age based on history of priapism. Hypogonadism was seen in 23% (6) of patients with priapism. There was no difference in mean total testosterone levels in patients with and without a history of priapism (16.7 ± 4.9 nmol/L and 15.4 ± 5.9 nmol/L, respectively). Similarly, there was no difference in serum LH and FSH levels based on history of priapism. Of the patients who reported a history of priapism, there was no difference in frequency, number and duration of priapism episodes relative to total or free testosterone levels. There was a trend towards an association of free testosterone levels and duration of priapism episodes >30 min. Conclusion: Hypogonadism is prevalent in patients with SCD. There is a 23% risk association of hypogonadism and priapism. Prospectively gathered data is needed to define the priapism profile of SCD patients with hypogonadism. Policy of full disclosure: None.

PO-09-002

89 CASES OF PRIAPISM: WHAT CHANGES AFTER AN EXPERIENCE of 25 YEARS? Bondil, P.; Jallouli, I.; Ozone, F.; Demey, A. Centre Hospitalier, Urology-Andrology, Chambery, France Objective: The rarity of priapism (very few large published series) explains that it still remains bad known. Objective: to retrospectively analyze the evolution and the characteristics of priapisms observed in our hospital (referent andrological center) from 25 years. Methods: Comparison of main characteristics (frequency, mechanism, etiology, treatment and results) between two similar long periods (1985/1996 and 1997/2009). Results: (i) 1985/1996: 46 cases (3.8/year), mean age 39 (15–72), all from venous origin including 35 iatrogenic (29 post-ICI erectogenic drugs), 5 hematological and 6 idiopathic). 10 cases from various etiology have been operated on after failure of medical treatment after a mean delay of 43 hours. (ii) 1997/2009: 43 cases (3.4/year) mean age 48 (10–82) from different origins: (a) 24 venous including 12 iatrogenic (8 post-ICI), 1 hematological and 11 idiopathic, (b) 4 arterial posttraumatic treated by selective embolization, (c) 15 sleep-related painful erections of imprecise origin all medically treated. Several drugs (antiandrogens, alpha-stimulants, PDE5 inhibitors, 5 alpha-reductase inhibitors) have been successively used alone or associated. These pharmacological treatments resulted in a partial or complete improvement for all except 1 case requiring a selective embolization. 8 cases have been operated on (all from venous origin) after failure of medical treatment with a mean delay of 87.5 hours (24–360).

J Sex Med 2011;8(suppl 5):406–469

447

Unmoderated Poster Presentations Conclusion: This observational study shows four facts: (i) priapism is always rare (even in a referent center), (ii) venous priapism remains an emergency with none progress (surgery frequency and pretherapeutic delay), (iii) its physiopathological mechanisms have changed with an expected decrease of venous iatrogenic priapism and a surprising increase of chronic sleep-related painful erections (often difficult to treat) without clear explanations. Policy of full disclosure: None.

PO-09-003

SUPER-SELECTIVE METACHRONOUS EMBOLIZATION OF POSTTRAUMATIC BILATERAL ARTERIO-CAVERNOSAL FISTULA: CASE REPORT Gadda, F.1; Spinelli, M. G.2; Cozzi, G.3; Nicolini, A.4; Garaffa, G.5; Serrago, M. P.6; Acquati, P.6; Dell´Orto, P.7; Rocco, F.6 1 Ca Granda Ospedale Maggiore MI, Urology, Milano, Italy; 2Università Degli Studi, Milano, Italy; 3Università degli Studi, Milano, Italy; 4Fondazione IRCCS Ca´Granda, Ospedale Maggiore Policlinico, Milano, Italy; 5St Peter’s Andrology, Institute of Urology, London, UK; 6Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milano, Italy; 7Fondazione IRCCS ca’ Granda, Ospedale Maggiore Policlinico, Milano, Italy Objective: To report a case of high flow priapism due to post traumatic bilateral artero-cavernosal fistula treated with repeated super-selective arterial embolization with resorbable gelatin sponges. Methods: A 23-year-old man presented with a 1-day history of persistent penile tumescence following blunt perineal trauma. The suspicion of high flow priapism (HFP) was confirmed with Color Doppler US (ECDUSS), which showed a Peak Systolic Velocity (PSV) of 40 cm/sec and 35 cm/sec respectively for the right and left cavernosal arteries. Also bilateral turbulent, swirling flow patterns at the base of the penis suspicious of artero- cavernosal fistula were detected with the ECDUSS. MRI excluded tunica albuginea fracture. After an exhaustive discussion of possible complications with the patient, a selective arteriography of the hypogastric and internal pudendal artery was performed. This investigation confirmed the presence of pseudoaneurysm of the pudendal branches of the internal pudendal arteries bilaterally (right > left), causing artero-cavernosal communications and therefore a multistage super-selective embolization of right and left cavernous artery with absorbable sponges was performed. Results: After three procedures (first on the right penile branch, the second and the third on the left branch, 2 and 4 weeks later, respectively), both fistulas disappeared. No complication was noted. Four weeks after the last procedure, the patient had an IIEF score of 16. ECDUSS showed normal bilateral PSV. Conclusion: Arteriography with super-selective embolization proved to be an effective therapy for high flow priapism. In bilateral lesions multistage endovascular procedure with resorbable material is a good option. Policy of full disclosure: None.

PO-09-004

CORRELATION OF PROXIMAL AND DISTAL CORPUS CAVERNOSUM BIOPSY WITH COLOR DOPPLER ULTRASONOGRAPHY IN ISCHEMIC PRIAPISM Zacharakis, E.1; Skolarikos, A.2; Muneer, A.1; Freeman, A.3; Papatsoris, A.2; Minhas, S.1; Deliveliotis, C.2; Ralph, D.1 1 University College Hospital, Urology, London, UK; 2´Sismanogleio’ General Hospital, 2nd Dept of Urology, Athens, Greece; 3University College Hospital, Dept of Histopathology, London, UK Objective: Ischemic priapism is a urological emergency. Ischaemia within the corpus cavernosum results in the development of smooth muscle dysfunction followed by corporal fibrosis. The Doppler studies can show areas of perfusion within the proximal corpora despite the clinical picture being consistent with an ischemic priapism. The aim

of this study was to compare the histological changes in the corpora cavernosa with the results of the Doppler studies. Methods: Over a 24-month period 21 patients with ischemic priapism were referred to our center. The mean age was 42.7 years (range 31–69) and the median duration of priapism was 96 hours (range 24–360). The etiology was sickle cell disease (7 patients), idiopathic (6 patients), and antipsychotic agents (8 patients) All of the patients underwent a Doppler ultrasound prior to surgical intervention. Biopsies from both the distal and proximal ends of both corpora were obtained from all the patients during the “T-shunt procedure” (N = 15) and proximal open corporotomy procedure (N = 6). Results: A total of 15 patients underwent early penile prosthesis implantation, as there was recurrence of priapism after the initial surgical management. Only in 6 cases the “T shunt” was successful; however the patients developed delayed erectile dysfunction secondary to extensive corporal fibrosis. Histological analysis in all cases showed extensive or focal necrosis in both the distal and proximal segments of the corpora cavernosa. By contrast, the ultrasonography studies demonstrated a small amount of flow within the proximal corpora in 38% of cases with no indication of the degree of fibrosis. Conclusion: In ischemic priapism for more than 24 hours, significant histological changes occur in the corpus cavernosum due to the development of ischaemia. Although color penile Doppler is a useful imaging test, the presence of flow within the proximal corpora does not correlate with smooth muscle viability. Policy of full disclosure: None.

PO-09-005

PENILE PROSTHESIS IMPLANTATION IN TREATMENT OF ERECTILE DYSFUNCTION AFTER PRIAPISM IN SICKLE CELL DISEASE Souillac, I.1; Bachir, D.2; Sibaud, O.3; Virag, R.1 CETI, Paris, France; 2Centre de la Drépanocytose, Hôpital Henri Mondor, Creteil, France; 3Clinique Geoffroy Saint Hilair, Paris, France

1

Objective: Priapism acute or intermittent in sickle cell disease (SCD) leads very frequently to severe ED in young patients whose psychological distress is very high. Penile implant surgery is to date the sole solution. Heavy fibrosis renders often the procedure difficult. The aim of this study was to evaluate the technique, complications and efficiency of inflatable penile prosthesis (IPP) in such a condition. Methods: Between February 1999 and May 2011, 22 SCD patients were implanted with 25 implants. Median age was 32 years (18–68). All implantation were performed by the same surgeon. The average IIEF-5 prior to surgery was 7.8 [5–18]. Type of implants were three pieces inflatable models normal or narrow based (COLOPLAST®). They were 80% (N = 17) of primo implants five had unsatisfactory previous implants elsewhere, 4 had derivation procedure and all drainage and/or etilefrine injections. All but one had a peno-scrotal approach. Ten patients needed patch closure of the cavernotomies with various material, and their scrotum where drained. Results: Mean follow-up was 28.9 months with a satisfactory result in 64%. One subject died from acute pulmonary embolism the eighth postoperative day. Reoperation rate is 49%. The main local complication observed was material migration (9 implantations/25), responsible for a removal of material. Three of these nine patients had a second successful implantation. In addition we had two surgical site infections with final removal. Patch closures and scrotal drainage are strongly associated with the risk of migration. So does the length of the postpriapism period. Conclusion: Surgery after priapism in SCD patients is frequently difficult, mainly due to extensive post priapism fibrosis responsible for local complications and multiple interventions in fragile subjects. Results of this series are much better with a high late satisfaction rate when surgery is precocious and simple avoiding grafting and drainage. Policy of full disclosure: None.

J Sex Med 2011;8(suppl 5):406–469

448 PO-10

Unmoderated Poster Presentations Penile reconstructive surgery

PO-10-001

SEXUAL LIFE AND PATIENT SATISFACTION FOLLOWING PENIS-SPARING SURGERY FOR BENIGN, PREMALIGNANT OR MALIGNANT PENILE LESIONS Palminteri, E.1; Fusco, F.2; Berdondini, E.3; Maruccia, S.4; Salonia, A.5; Zuccati, G.6 1 Center for Urethral Surgery, Arezzo, Italy; 2University Federico II, Naples, Italy; 3Center for Urethral Surgery, Center for Urethral Surgery, Arezzo, Italy; 4Desio Hospital, Milan, Italy; 5University San Raffaele, Milan, Italy; 6 University of Florence, Italy Objective: To describe the effect of penis-sparing surgery for benign, premalignant or malignant penile lesions on sexual life and patient satisfaction. Methods: Fourteen patients (mean age 56.5 years) with penile lesions of broad-spectrum histopathology underwent organ-sparing surgery with neo-glans reconstruction using a free split-thickness skin graft harvested from the thigh. Two cases were treated by glans-skinning and glans-resurfacing, 8 by glansectomy and neo-glans reconstruction, 1 by partial penectomy and a neo-glans reconstruction, and 3 by neoglans reconstruction after a traditional partial penectomy. Sexual life and patient satisfaction after surgery were investigated using an adapted questionnaire. Results: Mean follow-up was 49 months. All patients were free of primary local disease. After surgery 13 patients (93%) reported the disappearance of preoperative disorders such as penile pain, ulcerative lesions, cosmetic alteration, impaired sensation. There were 10 patients (71%) who experienced maintaining or improving of the erectile function, 7 (50%) maintaining or improving of the penile sensitivity, 6 (43%) improving of the aesthetic aspect, 6 (43%) maintaining or improving of the sexual life. Only 1 patient (7%) reported persistent pain in the donor site. Ten patients (71%) experienced improving of the quality of life and 11 (79%) satisfaction with the outcome of surgery. All patients (100%) stated that they would repeat the surgery if they could go back. Conclusion: In benign, pre-malignant or malignant penile lesions, penis-sparing surgery combined with a cosmetic neo-glans reconstruction may assure a satisfactory aesthetic and functional result, while fully-eradicating the primary local disease. Policy of full disclosure: None.

PO-10-002

EPITHELIOID SARCOMA OF THE PENIS MIMICKING PEYRONIE’S DISEASE. A CASE REPORT Franceschelli, A.; Passaretti, G.; Barbieri, B.; Colombo, F. Policlinico S. Orsola-Malpighi, Andrology, Bologna, Italy Objective: We reported a case of epithelioid sarcoma of the penis initially diagnosed and treated as Peyronie’s disease. Methods: A 20 y-o male complained the onset of a progressive and painless dorsal and left lateral curvature during erection, making intercourse impossible, started 3 years before. An area of induration was detected at the middle part of the penis shaft. Previous ultrasound had shown some areas of thickened albuginea, with normal vascular function. An hypoechogenic area (39 × 25 × 5 mm) has been shown in the dorsal and left lateral parts of the tunica albuginea. A juvenile form of Peyronie’s disease was diagnosed and the patient was scheduled for plaque’s incision/excision and grafting. Results: The surgical approach resulted difficult with penile degloving hampered by tenacious adherence between superficial layers and albuginea; the great part of the left corpus cavernosum appeared substituted by a very tough tissue which deeply involved the erectile tissue. The intraoperative biopsy revealed mesenchymal epithelioid cancer with sarcomatoid differentiation. Because of lack of informed consent

J Sex Med 2011;8(suppl 5):406–469

for radical excision and in order to wait for the definitive pathological report, we proceed performing a wide excision of the pathological tissue and using buccal mucosa for grafting. The final histological report confirmed the diagnosis of epithelioid sarcoma; CT scan and MRI resulted negative. June 2011: after psychotherapeutic counseling, the patient has undergone a new intervention.The intraoperatory histological examination of corpora cavernosa, peri-urethral tissue and neurovascular bundle, confirmed neoplastic involvement. The cavernosal bodies, the glans, the neurovascular bundle and great part of anterior urethra were excised. A portion of proximal urethra was preserved and covered with penile skin Conclusion: In literature, few cases of epithelioid sarcoma of the penis have been reported. The low incidence, slow progression and the aspecific ultrasound aspect, can justify a late diagnosis. In young patients suffering for idiopathic acquired penile curvature, greatest attention must be placed, with possible proposal of immediate biopsy or of explorative surgical intervention Policy of full disclosure: None.

PO-10-003

PENILE AUGMENTATION SURGERY BY MICRONIZED HUMAN DERMAL TISSUES Kim, J. Y.1 Pilip & Paul Medical Institut, Urology, Jeongjadong, Boondanggu, Korea

1

Objective: Penile augmentation surgery with tissue grafts through incision so far has been performed with; however, there might be adverse effects such as a wound problem, a scar, pain, prolonged recovery time. Another augmentation method is the injection of fat but there is the disadvantage of migration and a high reabsorption rate. As a result, current penile augmentation surgery has been pursued for rapid recovery using a simple technique and natural appearance. We are to introduce new methods for penile augmentation using acellular human dermal tissue with injection. Methods: Under the local anesthesia, according to the size of the penis and the augmentation size the patient desired, about 3–6cc of dried acellular particulate dermal matrix combined with 1.5–1.8cc of lidocaine and 0.3cc of gentamicin per 1cc of the tissue were injected to the three parts at the shaft of the penis. Results: Retrospective investigation was done for this study with 121 cases from December 2007 to December 2009. 4cc of acellular micronized dermal tissues on average were used for a one-time injection. 2 cases of local skin necrosis were reported but it was treated through the conservatory treatment. There was little migrartion of the injected tissues after the graft. Conclusion: This surgical method does not require an incision and resulting in short operation and rapid recovery time. There are few side effects. Therefore, for the men who experienced difficulty with penile augmentation surgery with the preexisting techniques, for example, those who had physical health problems, or were of an older age, or were on special medications, this surgical method could be recommended. It also may be considered a new technique that can be applied for partial augmentation, correction of deformity, and reconstructive surgery as well Policy of full disclosure: None.

PO-10-004

EXTERNAL GENITALIA AVULSED PLAGUESRARE CONDITIONS DEMANDING SPECIAL MANAGEMENT Mitroi, G.1; Parvanescu, H.2; Dena, S.1; Nedelcuta, C.1; Drocas, A.1 Emergency County Hospital, Urology, Craiova, Romania; 2Emergency County Hospital, Reconstructive/ Plastic, Craiova, Romania 1

Objective: Avulsed external genitalia plagues are rarely encountered in daily routine in trauma department, but due to its particular localization and severe infectious and functional complications, it requires special multidisciplinary management involving plastic surgeons and urologists.

449

Unmoderated Poster Presentations Methods: We present our experience with 12 male patients, presented in trauma department with avulsed external genitalia plagues– 6 resulted after car accidents or other trauma and 6 after assault injuries (including domestic violence). Results: Mean age was 27 ± 3 (17–56). Six patients presented plagues involving only the penis, 3 involving penis and scrotum, 2 involving the perineum also and one with extensive injury of penile tegument, scrotum, anterior abdominal wall and pubic bone. All patients underwent immediate surgery with organ reconstruction and skin graft per prime. Mean hospitalization was 10 days (−17 days) with good postoperatory results both esthetic and functional. None reported erectile or erectile dysfunction. Conclusion: Immediate surgery with organ reconstruction, skin graft and proper postoperatory intensive care therapy assures an efficient management with excellent esthetic and functional outcome for complex avulsed external genitalia plagues. Policy of full disclosure: None.

PO-10-005

THE UTILITY OF “COLLAGEN MATRIX” IN PENILE ANDROLOGICAL SURGERY Vaccari, R.; Pezzoni, F. Centro di Andrologia, Milano, Italy Objective: “Collagen Matrix,” a soft tissue implant, is bovine pericardium, manufactured with a particular chemical process that stabilizes the tissue immunologically. This produces a strong, biocompatible material that integrates very well into the surrounding tissue. The applications regard the correction of penile curvature congenital or secondary to Peyronie’s Disease (PD) (Corporoplasty) or Phalloplasty in patients affected with Penile Ipoplasia or that refuse to accept their own penile dimensions. PD is responsible of penile pain, angulation, penile shortening and erectile dysfunction; penile curvature can provoke inability for sexual intercourse and surgical correction is indicated. Methods: For corporoplasty the technique comprehends the implantation of a “Collagen Matrix” patch, one or more,that avoids to the patients to have a shorter penis. The achievement of full erection is a fundamental step for the precise application of geometrical principles and individuation of the precise site for the tunica incision.Vasoactive drugs with saline soluction are injected to induce full erection. In the case of Peyronie’s Disease is important to remove the thickness tissue (“plaque surgery”) and sometimes penile reconstruction with graft is associated with penile prosthesis implantation, in patients affected with severe penile vascular disease. For Phalloplasty the patch implantation (more than one) is done in the sub-cutaneous penile tissue, for increasing its circumference;sometimes we associate the “suspensory ligament resection”for penile elongation. Results: We have done 62 Corporoplasties with “Collagen Matrix”implantation, 80 Phalloplasties with patch implantation in the sub-cutaneous tissue and 42 Complete Phalloplasties (with “suspensory liga- mente resection”and sometimes pubic liposuction). In all cases the results were good with poor postoperative complications. Conclusion: fondamentally was a preoperative psychosexual assessment to avoid operartions in subjects affected with psychopathology and/or unreal expectations. Policy of full disclosure: None.

PO-10-006

TOLERABILITY AND EFFICACY OF NEWLY DEVELOPED PENILE INJECTION OF CROSS-LINKED DEXTRAN AND POLYMETHYLMETHACRYLATE MIXTURE ON PENILE ENHANCEMENT: 6 MONTHS FOLLOW-UP Lee, W. K.1; Kim, J. J.2; Moon, D. G.2; Yang, D. Y.3; Kim, S.-C.4 Chuncheon Sacredheart Hospital, Urology, Korea; 2Korea University Hospital, Urology, Seoul, Korea; 3Kangdong Sacredheart Hospital, Urology, Seoul, Korea; 4Chung-Ang University Hospital, Urology, Seoul, Korea 1

Objective: Cross-linked dextran and polymethylmethacrylate (PMMA) mixture (Lipen-10®) is a newly developed tissue filler for soft tissue augmentation. The purpose of this study was to evaluate efficacy and tolerability of cross-linked dextran and PMMA mixture on penile enhancement. Methods: This was a nonrandomized, noncomparative multicenter study. Twenty adult males who wanted penile enhancement, between the ages of 20 and 70 years, were included in this study. Lipen-10® was injected into the subcutaneous tissue of the penile shaft, between Dartos fascia and Buck’s fascia, using the fanning technique. The penile girth and length were measured with a caliper in the flaccid state, before and 1, 3, and 6 months after the injection. Any adverse events were also recorded during the trial. Results: Mean injected volume of Lipen-10® was 23.73 mL (range 17–30 mL). The circumference increased by 3.7 ± 1.2 cm (50.8%, P < 0.0001) at penile base, 4.2 ± 0.9 cm (59.0%, P < 0.001) at midshaft, and 3.8 ± 1.0 cm (53.2%, P < 0.0001) at distal shaft, and the length by 2.3 ± 1.4 cm (63.2%, P < 0.001). However, in three circumferences, there was no significant difference between 3 and 6 months posttreatment (P values of 0.796, 0.498, and 0.6 for penile base, midshaft, and distal shaft, respectively). The only complications were one mild asymmetry of penile shape and one 5-mm-sized nodule in the injected surface. There were no clinically significant adverse events in all subjects. Conclusion: Penile injection of cross-linked dextran and PMMA mixture led to a significant increase in penile size, showed a good durability, and was well tolerated, without serious adverse events. These results suggest that penile injection of cross-linked dextran and PMMA mixture may be a new effective method for penile enhancement. Policy of full disclosure: None.

J Sex Med 2011;8(suppl 5):406–469

450 PO-11

Unmoderated Poster Presentations Ejaculatory disorders

PO-11-001

VALIDITY OF THE PREMATURE EJACULATION DIAGNOSTIC TOOL (PEDT) IN FOUR SUBGROUPS OF PREMATURE EJACULATION SYNDROME: DATA FROM THE KOREAN INTERNET SEXUALITY SURVEY— PART I Song, S. H.1; Choi, W. S.1; Son, H.2; Paick, J.-S.1 Seoul National University, Urology, Korea; 2Seoul National University, Boramae Hospital, Korea

1

Objective: The premature ejaculation diagnostic tool (PEDT) is a brief, multidimensional validated instrument devised for the diagnosis of PE. However, there is insufficient evidence regarding the clinical validity of this questionnaire or of its ability to differentiate subgroups of PE. The authors employed and compared PEDT scores to Waldinger’s 4 subgroups of PE (Lifelong, Acquired, Natural variable, and Premature like dysfunction) to assess the ability of PEDT scores to differentiate subgroups of PE. Methods: E-mails were sent to a population-based sample of males aged 20–59. Participants were asked to complete a questionnaire requesting detailed medical and sexual histories. The questionnaire including questions from the PEDT and from the Medical Outcome Study Short-form 36-Item Health Survey (SF-36). Self-reported PE and the 4 subgroups were defined and classified by self-assessment. PEDT-PE was defined as a cutoff score of > 11. Results: E-mails were opened by 1,206 recipients, and 443 subjects of mean age 39.3 ± 10.1 years were included (a response rate of 36.7%). PEDT-PE prevalence was 14.6%. The proportions of PE subgroups and their mean PEDT scores were: Lifelong PE (2.9%, 15.5), Acquired PE (7.0%, 11.2), Natural variable PE (7.4%, 10.4), and Premature-like dysfunction (3.2%, 9.0). PEDT scores were significantly higher in the Lifelong PE group than in other the subgroups of PE (P < 0.001). The Premature-like dysfunction group had the lowest PEDT score, and their physical and mental component scores of SF-36 were similar to those of non-PE subjects. According to ROC curve analysis, the sensitivity and specificity for a diagnosis of Lifelong PE by PEDT were 91.3% and 93.8%, respectively. Conclusion: This population-based cross-sectional survey shows the validity of the PEDT as a useful diagnostic tool for the diagnosis of self-reported PE, and especially, of Lifelong PE. Policy of full disclosure: None.

PO-11-002

PATIENTS AFFECTED BY PREMATURE EJACULATION DUE GLANS HYPERSENSITIVITY REFUSE CIRCUMCISION AS POTENTIAL DEFINITIVE TREATMENT FOR THEIR PROBLEM Gallo, L.1; Giannella, R.2; Pecoraro, S.3 Studio Urologico Gallo, Andrology, Naples, Italy; 2Clinica Malzoni, Department of Andrology, Avellino, Italy; 3Clinica Malzoni, Department of Andrology, Naples, Italy 1

Objective: Some studies showed that circumcision provides a certain benefit to male sexual health and that this procedure can increase Intravaginal Ejaculation Latency Time (IELT). This prospective study evaluates a progressive therapeutic approach for PE based on reduction of glans sensitivity. Methods: Patients coming to our centers seeking help for lifelong PE were recruited. At baseline subjects were evaluated by a physical examination, the filling of 5-item EP diagnostic tool questionnaire and IELT measurement. EP diagnosis was based on ISSM criteria. Glans local application of a lidocaine/prilocaine anesthetic cream one hour prior of intercourse was used as first line treatment. Patients whose IELT

J Sex Med 2011;8(suppl 5):406–469

increased of at least 1 minute and obtaining a normalization of EP diagnostic tool score (≤8) were considered responders to local treatment. Responders subjects were even considered affected by lifelong PE due glans hypersensitivity. We proposed to such patients to undergo circumcision as potential definitive treatment for their problem based on permanent reduction of glans sensitivity. We remarked the irreversibility and the absence of guarantees about the effectiveness of such procedure. Results: We recruited 152 patients affected by lifelong PE. At baseline, the mean questionnaire score was 15.3 (±2.34 DS) and the mean IELT was 1.42 minutes (±1.12 DS). 124 patients among 152 (81.57%) positively responded to anesthetic cream application. We proposed circumcision to such subjects. Only 4 patients among 124 (3.4%) accepted. The remaining 121 (97.6%) refused for the following reasons: 1)irreversibility of the procedure creating a permanent body alteration (90,9%); 2) absence of guarantees about the effectiveness of such procedure (53,7%); 3) costs of the procedure (38%); 4) satisfaction with anesthetic cream (28.9%). Conclusion: Patients affected by lifelong PE due glans hypersensitivity did not accept circumcision as potential definitive treatment for their problem Policy of full disclosure: None.

PO-11-003

EVALUATION OF CORRELATION BETWEEN PREMATURE EJACULATION AND FREQUENCY OF SEXUAL INTERCOURSE Jang, S.-Y. LJ Genitourinary Surgery, Seoul, Korea Objective: Premature ejaculation is the major factor that causes low satisfaction of sexual intercourse. Ejaculation time is determined by various factors including such as psychological, habitual and physical factors. This study aimed to report the importance of frequency of intercourse to regulate ejaculatory time. Methods: This study involved 81 men who have short time ejaculatory problems like within 3 minutes and have low frequency of their sexual intercourses. It was followed up in at least 3 months. The patients’ ages were from 21 to 47 (on average 33.8) and the number of married men was 38. Frequency of sexual intercourse was 0∼4 per month within the recent 1 month. We recommended more frequent sexual behaviors of at least two times per week. Results: At the 3 months’ follow-up, 58 patients answered that their ejaculatory time was delayed by only raising their frequency of sexual intercourse. Among the rest of them, 5 men answered that there was no effects despite of 2 more times a week of intercourse. And 18 men could not comply with our instruction. 58 patients who had improved had sexual intercourse 7∼12 times per month, and their ejaculatory time was delayed from 1 minute to 18 minutes (6 minutes on average). Conclusion: Premature ejaculation that accompanies a very low frequency of sexual intercourse can be improved by raising the frequency of sexual intercourse. Policy of full disclosure: None.

PO-11-004

THE PREVALENCE OF PREMATURE EJACULATION AND CLINICAL CHARACTERISTICS OF KOREAN MEN AS ACCORDING TO DIFFERENT DEFINITIONS Lee, S. W.1; Lee, J. H.1; Park, H. J.2; Park, J. K.3; Choi, S.4; Kam, S. C.5 Samsung Medical Center, Urology, Seoul, Korea; 2Pusan National University, School of Medicine, Busan, Korea; 3Chonbuk National University, Medical School, Jeonju, Korea; 4Janssen Korea, Seoul, Korea; 5Gyeongsang National University, Urology, Jinju-si, Korea

1

Objective: This study investigated and compared the prevalence of premature ejaculation (PE) diagnosed by premature ejaculation diagnostic tool (PEDT) score, self-reporting and stopwatch-recorded

451

Unmoderated Poster Presentations IELT. In addition, it examined the characteristics of males diagnosed with PE by each criterion. Methods: A questionnaire survey enrolled 2081 subjects. Stopwatchrecorded IELT was measured in 1035 of the 2081 subjects. We aimed to determine if PE has an influence on the frequency and satisfaction of sexual intercourse, the degree of libido/erectile function and the satisfaction of the sexual partner. These factors were evaluated according to different definitions of PE to assess if the definition used yielded differences in the data. For each question, symptoms were evaluated by a scale ranging from 1 to 5. Results: The prevalence of PE, based on a PEDT score of ≥11, selfreporting and stopwatch-recorded IELT of ≤1 minute was 11.3%, 19.5% and 3%, respectively. The prevalence of PE diagnoses based on PEDT score and self-reporting increased with age, but stopwatchrecorded IELT-based diagnoses did not (P < 0.05). Erectile dysfunction was commonly associated with PE. The PE negatively influenced the overall sex life of males (P < 0.05). Males experiencing PE showed lower levels of libido, erectile function and frequency and satisfaction of sexual intercourse compared to non-PE males. Moreover, PE also had a negative effect on the subjects’ relationships with their sexual partners. PE males felt that they did not satisfy their partners in terms of the partners’ sexual satisfaction and frequency of orgasm, in comparison with non-PE males (P < 0.05). Conclusion: PE is a highly prevalent sexual dysfunction in males. Regardless of whether the PE diagnosis was made on the basis of selfreporting, PEDT score or stopwatch-recorded IELT, subjective symptoms were similar among PE males. Policy of full disclosure: Supported by Jassen, Korea.

PO-11-005

PDE5 INHIBITOR AND SSRI VS. SSRI ONLY IN THE TREATMENT OF PREMATURE EJACULATION Akkus, E.; Ozkara, H.; Alici, B.; Dogan, C. I.U. Cerrahpasa Medical School, Urology-Andrology, Istanbul, Turkey Objective: To see the effectiveness of PDE5 inhibitor + SSRI vs. SSRI only treatment in the treatment of premature ejaculation (PE). Methods: Thirty-five primary (lifelong) PE cases (age 22–58) with no history of ED and stable partners. None had comorbid factors like prostatitis, thyroid disease etc. PE was defined as uncontrolled ejaculation in < 1 minute as defined by ISSM. None of the cases had previous PE treatment in the past 12 months.The cases were treated first with PDE5 inhibitor + SSRI for 6 weeks, then another 6 weeks with SSRI only.The results were evaluated upon subjective evaluation of the patients with 1—no change (non-responder), 2—mild-moderate improvement (ejaculation in 1–2 minutes), 3—significant improvement > 2 minutes) at the end of each 6 weeks periods. Results: 2 cases quit the treatment due to moderate side effects, 3 nonresponders did not continue the 2nd part of the treatment. 8/35 (22.9%) cases reported No change, 15/35 (42.9%) cases reported mild to moderate improvement, and 12/35 (34.2%) cases reported significant improvement after PDE5 inhibitor + SSRI treatment. In the second part of the study 4/30 (13.3%) reported no change, 21/30 reported mild to moderate improvement and 5/3 0(16.7%) significant improvement. Conclusion: The results demonstrate SSRI’s have some positive effect in the treatment of PE. Moreover combination treatment of PDE5 inhibitors + SSRI reveals significantly better response to PE when compared to SSRI only in the treatment of PE. Policy of full disclosure: None.

PO-11-006

CLINICAL EFFICACY OF PAROXETINE IN THE TREATMENT OF PATIENTS WITH PREMATURE EJACULATION CAUSED BY CHRONIC NONSPECIFIC PROSTATITIS Gorpynchenko, I.; Gurzhenko, Y.; Gurzhenko, A.; Maksym, R. Institute of Urology, Department of Sexology and Andrology, Kiev, Ukraine Objective: The purpose of the research is the study of clinical efficacy and safety of Paroxetine in the treatment of men with premature ejaculation caused by chronic prostatitis. Methods: Under observation there were 46 men with premature ejaculation caused by chronic inflammatory diseases of the reproductive organs in the age from 22 to 48 years old and with the disease duration from 6 months to 8 years. All patients had no symptoms of depression. Clinical picture: the duration of intercourse before treatment was: before the penis introduction into the vagina in 4 (8.6%) patients (group 1), up to 30 seconds—13 (28.3%) patients (group 2), and 60 seconds—16 (34.8%) patients (group 3) to 120 seconds—13 (28.3%) patients (group 4). Algid syndrome bothered 2 (4.3%) of 46 patients dysuric events—3 (6,5%), recurrent muco-purulent discharge from the genital tract—7 (15.2%). Treatment. Paroxetine was prescribed in a dose of 20 mg in the morning once a day during a month. Patients also received a pathogenetic therapy of the inflammatory process in the sexual sphere. Results: Changes in the clinical picture were found in 10–12 days. Patients reported varying degrees of increase in the time of sexual intercourse. In group 1 one patient have recovered (25%), 2 patients had significant improvement (50%) and one had no changes. In group 2—15.4% (2 patients) had recovery, 38.4% (5 patients) had significant improvement, 30.8% (4 patients) had improvement and 2 had no changes. In group 3—half of all patients had recovered, 5 patients (31.3%) had significant and 3 (18.7%) had not significant improvement. In group 3—nine patients (69.2%) had recovered, 2 patients (15.4%) had significant and 2 (15.4%) had not significant improvement. Conclusion: In summary, we can conclude that the clinical efficacy of treatment was 93.5%. Policy of full disclosure: None.

PO-11-007

IMPROVING EJACULATORY OR ORGASMIC DYSFUNCTION AFTER 12 WKS AS-NEEDED TADALAFIL TREATMENT SIGNIFICANTLY IMPROVES INTERCOURSE AND OVERALL SEXUAL SATISFACTION IN MEN WITH ERECTILE DYSFUNCTION: POST HOC ANALYSES OF 17 PLACEBO-CONTROLLED STUDIES Paduch, D.1; Bolyakov, A.2; Polzer, P.3; Watts, S.3 Weill Medical College, Brady Urological Health Center, New York, NY, USA; 2Weill Medical College, Urology and Reprod. Medicine, New York, NY, USA; 3Lilly Research Laboratories, Eli Lilly, Indianapolis, IN, USA

1

Objective: To evaluate whether the presence of residual ejaculatory dysfunction (EjD) or orgasmic dysfunction (OD) after 12 weeks of tadalafil treatment has a negative impact on sexual satisfaction. Methods: Data at 12 weeks (end point) from 17 placebo-controlled trials of tadalafil were integrated. The study designs have been published; in general, subjects were men with a history of erectile dysfunction not caused by other primary sexual disorders (e.g., EjD, OD). Subjects were randomized to placebo, or 1 of 3 doses of tadalafil, taken as needed. Satisfaction was assessed via the Intercourse-Satisfaction and Overall-Satisfaction domains of the International Index of Erectile Function Questionnaire (IIEF-IS, IIEF-OS), as well as Sexual Encounter Profile diary Question 5 (SEP-Q5). Ejaculatory function (EjF) was assessed via IIEF-Q9 and orgasmic function (OF) via IIEF-Q10, and subjects were categorized into 1 of 3 groups according to end point

J Sex Med 2011;8(suppl 5):406–469

452

Unmoderated Poster Presentations

(12-week) responses: 1) responses of 1 (“almost never/never”) or 2 (“a few times”) were taken as evidence of severe EjD or OD; 2) a response of 3 (“sometimes”) was evidence of mild EjD or OD; and 3) responses of 4 (“most times”) or 5 (“almost always/always”) were evidence of minimal or no EjD or OD. Analyses of covariance were used to compare mean values of tadalafil and placebo groups. Results: More than 3,400 subjects were randomized. Clinically and statistically significant mean improvements in satisfaction parameters were observed with tadalafil treatment. Subjects who reported minimal or no EjD or OD at study end point also reported superior intercourse satisfaction and overall sexual satisfaction. Improvements in satisfaction outcomes were observed across all tadalafil treatment groups. Conclusion: Ejaculatory and orgasmic dysfunction negatively affect intercourse satisfaction and overall sexual satisfaction. Treatment with tadalafil improves measures of sexual satisfaction across all EjD and OD severity categories. Policy of full disclosure: The original placebo-controlled studies of as-needed tadalafil, the present analysis, and this communication were supported by Eli Lilly and Company (Indianapolis, IN, USA). Financial Disclosures D. Paduch: Paid investigator and/or consultant/ advisor/speaker for the study sponsor. A. Bolyakov: Paid investigator and/or consultant/advisor/speaker for the study sponsor. P.K. Polzer and S. Watts: Employees of and minor shareholders in the study sponsor. Writing/editorial support: Stephen W. Gutkin, Rete Biomedical Communications Corp. (Wyckoff, NJ, USA), with support from the study sponsor.

Mean Changes From Baseline to Endpoint in Satisfaction Parameters As-needed treatment group Variable

IIEF-IS

IIEF-OS

SEP-Q5

IIEF-IS

IIEF-OS

SEP-Q5

Subgroup

Placebo

Tadalafil 5 mg

Tadalafil 10 mg

Tadalafil 20 mg

Endpoint ejaculatory dysfunction (IIEF response) Severe (1 or 2) Mild (3) Minimal or no (4 or 5) Severe (1 or 2) Mild (3) Minimal or no (4 or 5) Severe (1 or 2) Mild (3) Minimal or no (4 or 5)

0.6 1.4 2.5 −0.3 0.7 1.7 2.4 11.2 21.6

1.1 2.4 4.0* 0.0 1.2 3.1* 4.9 22.3 42.9*

1.6* 2.4* 4.5* 0.6* 1.6* 3.1* 14.8* 27.1* 51.5*

1.8* 2.6* 4.8* 0.9* 1.6* 3.4* 19.2* 28.6* 57.6*

Endpoint orgasmic dysfunction (IIEF response) Severe (1 or 2) Mild (3) Minimal or no (4 or 5) Severe (1 or 2) Mild (3) Minimal or no (4 or 5) Severe (1 or 2) Mild (3) Minimal or no (4 or 5)

0.5 2.1 2.8 −0.2 1.2 1.9 2.8 14.6 25.6

1.2* 2.4 4.3* 0.6* 1.4 3.1* 7.7 26.2 44.9*

1.7* 2.7 4.5* 0.7* 1.9* 3.2* 16.4* 31.4* 53.0*

1.9* 2.8* 4.9* 1.1* 1.9* 3.5* 20.5* 30.5* 59.6*

*Mean difference is statistically significant vs. placebo (p < 0.05). IIEF-IS = International Index of Erectile Function (IIEF) Intercourse-Satisfaction domain (mean of responses to IIEF-Q6-8; scores range from 0 [worst] to 15 [best]); IIEF-OS = IIEF-Overall-Satisfaction domain (mean of responses to IIEF-Q13-14; scores range from 2 [“very dissatisfied”] to 10 [“very satisfied”]); SEP-Q5 = Sexual Encounter Profile diary Question 5: “Were you satisfied overall with this sexual experience?” (per-patient percent “yes” response; scores range from 0 [worst] to 100% [best])

PO-11-008

66% OF MEN WITH SEVERE EJACULATORY OR ORGASMIC DYSFUNCTION REPORT IMPROVED EJACULATORY OR ORGASMIC FUNCTION AFTER 12 WKS AS-NEEDED TADALAFIL TREATMENT: POST HOC ANALYSES OF 17 PLACEBO-CONTROLLED STUDIES Paduch, D.1; Bolyakov, A.2; Polzer, P.3; Watts, S.3 Weill Medical College, Brady Urological Health Center, New York, NY, USA; 2Weill Medical College, Urology and Reprod. Medicine, New York, NY, USA; 3Lilly Research Laboratories, Eli Lilly, Indianapolis, IN, USA

1

Objective: To compare placebo and treatment effects of tadalafil in men with severe ejaculatory dysfunction (EjD) or orgasmic dysfunction (OD). Methods: Baseline and 12-week (end point) data from 17 placebocontrolled trials of tadalafil were integrated. Study designs have been published; subjects (men with a history of erectile dysfunction) were randomized to placebo, or 1 of 3 doses of tadalafil, taken as needed. The aim of this analysis was to determine the: 1) proportion of patients whose ejaculatory function (EjF) or orgasmic function (OF) improved after 12 weeks of tadalafil treatment and 2) extent of any placebo effect. EjF was assessed via Question 9, and OF via Q10, of the International Index of Erectile Function Questionnaire (IIEF). Subjects responding with 1 (“almost never/never”) or 2 (“a few times”) to IIEF-Q9 or IIEF-Q10 at baseline were categorized as having severe EjD or OD. Chi-square tests evaluated differences in distributions of men who improved at end point, to responses of 3 (“sometimes”), 4 (“most times”), or 5 (“almost always/always”) on IIEF-Q9 or IIEF-Q10. Results: More than 3,400 subjects were randomized. At baseline, 46% had severe EjD and 54%, severe OD. In the placebo group, 157 (36%) of 439 subjects reported improved EjF, as did 712 (66%) of 1,078 subjects in the tadalafil group (P < 0.001). Similarly, 35% of placebo and 65% of tadalafil recipients reported improved OF (P < 0.001). Of men taking tadalafil 20 mg, 72% reported improved EjF and 70%, improved OF. Conclusion: Ejaculatory and orgasmic dysfunctions are common male sexual disorders. The observed placebo effect of approximately 30% was similar to that in erectile dysfunction, suggesting a psychological component of improved EjF and OF. However, twice as many men improved with tadalafil vs. placebo. Robust, clinically meaningful improvements in men with severe baseline EjD or OD were demonstrated after 12 weeks of tadalafil. Policy of full disclosure: The original placebo-controlled studies of as-needed tadalafil, the present analysis, and this communication were supported by Eli Lilly and Company (Indianapolis, IN, USA). Financial Disclosures D. Paduch: Paid investigator and/or consultant/ advisor/speaker for the study sponsor. A. Bolyakov: Paid investigator and/or consultant/advisor/speaker for the study sponsor. P.K. Polzer and S. Watts: Employees of and minor shareholders in the study sponsor. Writing/editorial support: Stephen W. Gutkin, Rete Biomedical Communications Corp. (Wyckoff, NJ, USA), with support from the study sponsor. Distribution of 12-Week Responses to IIEF-Q9* and IIEF-Q10† for Those With Severe EjD or OD at Baseline Improvement (IIEF response) Variable

Treatment

No (1 or 2) n (%)

Yes (3,4, or 5) n (%)

IIEF-Q9: Ejaculation

Placebo Tadalafil 5 mg Tadalafil 10 mg Tadalafil 20 mg

280 69 93 201

(64) (56) (39) (28)

157 55 144 513

(36) (44) (61) (72)

IIEF-Q10: Orgasm

Placebo Tadalafil 5 mg Tadalafil 10 mg Tadalafil 20 mg

331 74 109 267

(65) (54) (38) (30)

176 62 179 614

(35) (46) (62) (70)

*IIEF-Q9: “When you had sexual stimulation or intercourse, how often did you ejaculate?” † IIEF-Q10: “When you had sexual stimulation or intercourse, how often did you have the feeling of orgasm or climax?” Chi-square test for distributional difference: p < 0.001 Improvement was declared if EjF or OF was no longer severe at 12 weeks

J Sex Med 2011;8(suppl 5):406–469

453

Unmoderated Poster Presentations PO-11-009

THE IMPACT OF VISUAL INTERNAL URETHROTOMY (VIU) ON SEXUAL FUNCTION 1

2

3

4

Moon, K. H. ; Song, P. H. ; Shin, H. S. ; Hyun, J. S. Yeungnam University, Urology, Daegu, Korea; 2College of Medicine, Yeungnam, Urology, Daegu, Korea; 3Catholic University of Daegu, Urology, Korea; 4Gyeongsang National University, Urology, Jinju, Korea

1

Objective: We prospectively examined the impact of VIU on sexual function. Methods: Between March 2006 and April 2010, 67 treated by VIU were enrolled in this study. Preoperative sexual function was assessed by International Index of Erectile Function-5 (IIEF-5) and Intravaginal Ejaculation latency time (IELT). Sexual function was evaluated by the Korean version of the Male Sexual Health Questionnaire (MSHQ) assessing three sexual functional domains of ejaculation, satisfaction, erection. We compared respective scores for age groups (ranges 40–49, 50–59, 60–69, 70–79 years) at preoperative, 3, 6, and 12 months after VIU and assessed the etiology of stricture, stricture site, stricture length, time of recurrence, and duration until first recurrence. Results: A total of 67 men with mean age 57.1 completed the study. There were no significant differences in erectile function and sexual satisfaction for all age groups, but it improves ejaculatory function in 40–49 (P = 0.012), 50–59 (P = 0.018) age groups. The etiology of stricture was traumatic in 23 patients, inflammatory in 14 patients, idiopathic in 25 patients, iatrogenic in 5 patients. Stricture site was bulbous in 25 patients, membranous in 36 patients and multiple in 6 patients. The mean stricture length was 1.86 ± 0.932 cm, the mean time of recurrence was 1.5 ± 0.74 times, the mean duration until first recurrence was 10.5 ± 6.72 months. In univariate analysis, there were no significant differences in satisfaction, erectile function for all various factors. But, shorter length of stricture, smaller times of recurrence and shorter duration until first recurrence improved ejaculatory function (P = 0.006, P = 0.005, P = 0.013). Conclusion: VIU does not significantly affect erectile function and sexual satisfaction, but it improves ejaculatory function in younger age group. Shorter stricture length, smaller time of recurrence and shorter duration until first recurrence improve ejaculatory function. Policy of full disclosure: None.

PO-12 Homosexuality and gender identity disorders PO-12-001

CHILDHOOD MALTREATMENT IN SUBJECTS WITH MALE TO FEMALE GENDER IDENTITY DISORDER Bandini, E.1; Fisher, A. D.2; Ricca, V.3; Meriggiola, M. C.4; Jannini, E. A.5; Manieri, C.6; Corona, G.2; Ristori, J.2; Fanni, E.5; Maggi, M.2 1 University of Florence, Sexual Medicine Andrology Unit, Italy; 2University of Florence, Psychiatric Unite, Italy; 3University of Bologna, Gynecology Unit, Italy; 4University of ‘Aquila, Course of Medical Sexology, Italy; 5University of Turin, Endocrinology and Metabolic, Italy Objective: Childhood maltreatment is quite common and constitutes a non-specific risk factor for a range of different psychiatric symptoms during lifespan. It has been demonstrated that sexual minorities are at higher risk of maltreatment and abuse, and a high proportion of transsexual subjects reports childhood maltreatment. The aim of the study is to evaluate the prevalence of reported childhood maltreatment in a clinical sample of patients with Male to Female Gender Identity Disorder, and to explore the relationship between these early life events, body image, and different psychopathological and clinical variables. Methods: A consecutive series of 162 patients with male genotype was evaluated from July 2008 to May 2010. One hundred nine subjects (mean age 36 ± 10 years) meeting the criteria for MtF GID and giving their informed consent were considered. The occurrence of childhood maltreatment experiences was evaluated through a face-to-face clinical interview. Patients were asked to complete the Body Uneasiness Test and Symptom Checklist-90 Revised. Results: More than one fourth of patients reported childhood maltreatment. Maltreated subjects reported a higher body dissatisfaction and display a worse mental health lifetime. Conclusion: The presence of reported childhood maltreatment in these patients has relevant psychopathological implications, and therefore should be carefully investigated. Policy of full disclosure: None.

PO-12-002

LONG-TIME EFFECTS ON FERRITIN AND OTHER COMPONENTS OF METABOLIC SYNDROME OF THE CROSS-SEX HORMONETREATMENT IN TRANSSEXUALS Becerra, A.; Perez-Lopez, G.; Miriam, M.; Del Rey, J. M.; Lucio, M. J.; Asenjo, N.; Rodriguez-Molina, J. M. Hospital Ramon y Cajal, Gender Unit, Dpt. Endocrinology, Madrid, Spain Objective: To analyze the effects on serum ferritin levels (Fer) and components of metabolic syndrome (MetSyn) after 2-year cross-sex hormone-treatment (CST) in transsexuals. Methods: Before starting the CST in 90 transsexuals (54 male-tofemale [MFTs] and 36 female-to-male transsexuals [FMTs]), aged 30.6+/-9.0 y, we analyzed the relations between Fer and several parameters of insulin resistance (IR) (serum insulin, HOMA-IR and QUICKI) and components of MetSyn (waist circumference [WC], systolic [SBP] and diastolic blood pressure [DBP], and serum levels of glucose [G], triglycerides [TG] and HDL-cholesterol [HDL]) by ATP III criteria. To analyze the effect of CST on Fer we compared the basal values with those after 2-year treatment with conjugated estrogen (3.75 mg/day) and cyproterone acetate (100 mg/day) in MFT and testosterone gel (50 mg/day) in FMT. Results: Baseline Fer was significantly correlationed with HOMA-IR and QUICKI (r = 0.242, P = 0.014; and r = −0.330, P = 0.016, respectively), and with those of WC, G, DBP, TG and HDL, but not with those of SBP or insulin. After treatment, in MFTs the Fer increased from 104.9+/–60.9 to 151.0+/–85.3 ng/mL (P = 0.001) and in FMTs decreased from 41.5+/–53.6 to 39.6+/–48.6 ng/mL (P = 0.001).

J Sex Med 2011;8(suppl 5):406–469

454 Conclusion: In our study the Fer is associated with IR markers and components of MetSyn. So, the transsexual patients are at risk of diabetes mellitus and cardiovascular disease. In MFTs the CST increased this risk due to the elevation in Fer, and on the contrary in FMTs the CST decreased this risk due to the fall in Fer. Policy of full disclosure: None.

PO-12-003

REPRODUCTIVE WISH IN FEMALE-TO-MALE TRANSSEXUAL PERSONS Wierckx, K.1; Van Caenegem, E.1; Elaut, E.2; De Sutter, P.3; T´Sjoen, G.1 University Hospital Ghent, Endocrinology, Gent, Belgium; 2University Hospital Ghent, Sexology and Gender Problems, Gent, Belgium; 3University Hospital Ghent, Department of Gynaecology, Gent, Belgium

1

Objective: Hormonal therapy and sex reassignment surgery (SRS) in transsexual persons lead to an irreversible loss of natural reproductive capacity. Current and future technologies could create the possibility for female-to-male transsexual persons to have genetically related children. However, little attention has been attributed to this topic. The aim of this study is to provide information on the reproductive wish of female-to-male transsexual persons after SRS. Methods: A single center study in 50 female-to-male transsexual persons. For categorical variables, differences were calculated with χ² tests if conditions were met and with Fisher Exact tests otherwise. Differences between two groups were tested with an independent Student t-test if parametrically distributed. Results: The majority (64%) of the participants were currently involved in a relationship. Eleven participants (22.0%) reported having children. In 8 participants, their female partner was inseminated with donor sperm, whereas 3 participants gave birth themselves before hormonal therapy and SRS. More than half of the participants (53.1%) mentioned the desire to have children, while an additional 8.0 % experienced this desire in the past. The wish to parent children was unrelated to the current presence of children (Fisher Exact, P = 0.48). No differences in the desire for children is observed according to age as well as time since SRS (Student t-test: P = 0.58, P = 0.88 respectively). Eighteen participants (37.5%) reported they would have considered freezing their germ cells, if this technique would have been available. Participants without children at the time of investigation expressed this desire more often than participants without (χ² test: P = 0.006). Conclusion: Our data reveal that the majority of female-to-male transsexual persons desire to have children. Therefore, during the diagnostic phase of transition more attention should be paid to this topic and to the consequences for genetic parenthood after starting sex reassignment therapy. Policy of full disclosure: None.

PO-12-004

COMPARISONS AND SYNERGIES OF THE DIFFERENT PROFESSIONAL COMPETENCES IN THE SEX REASSIGNMENT SURGERY Mutinelli, P.1; Nadalin, D. A.1; Sanfelici, A. P.1; Stella, P.1; Franceschelli, A.2; Colombo, F.2 1 Azienda USL Città of Bologna, Health GID Centre, Italy; 2Policlinico S. Orsola-Malpighi, Andrology, Bologna, Italy Objective: The interdisciplinary team of the Health GID Centre MIT introduces a synthesis of the collaboration activity with the Azienda Ospedaliera-Universitaria-Policlinico S. Orsola-Malpighi in Bologna: since 2001 with departments of Gynecology, Obstetrics and Plasticreconstructive surgery and since 2003 with the department of Urology. Scope of the work is to promote, sustain and verify the state of psychophysical health of the patients accompanied with interdisciplinary approach, from the moment of the diagnosis to the intervention of SRS, throughout follow-up as recommended by national (ONIG) and international (WPATH) guidelines.

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Unmoderated Poster Presentations Methods: 167 patients from 18 up to 62 years old have benefited of the activity of differential diagnosis, psychological support and endocrinological treatment finalized to the evaluation of the frame of eligibility to the surgical intervention of SRS, both for FtM and MtF patients. The interdisciplinary approach favors the medical compliance as guarantee both of the reading of the needs by the experts and of the adhesion to the medical prescriptions. Results: The sample demonstrates: (i) absence of psychiatric pathology, drug addiction or alimentary pathologies; (ii) no requests to restore the biological sex of birth; (iii) satisfactory management both in the couple’s relationship, also sexual, and in the inclusion in the society and working world. It is necessary to underline that the reached results are also different with relation to the characteristics of personality and to the initial resources of every single patient. Conclusion: The reached results confirm the necessity to privilege both an interdisciplinary approach to the GID issues and a networking collaboration among the Health centre and Associative MIT activity and the Azienda Ospedaliera-Universitaria-Policlinico S. Orsola-Malpighi. Policy of full disclosure: None.

PO-12-005

REVIEW OF PUBLISHED ARABIC WRITINGS ON HOMOSEXUALITY AND LESBIANISM IN ARAB SOCIETIES Mahgoub, M.1; Mahgoub, M.2 1 Alexandria University, Anthropology Department, Egypt; 2Alexandria University, Faculty of Arts, Egypt Objective: For a few years ago writing and conversation about sex was almost a taboo that approaching them is decried. The man in the village or the popular areas while he is speaking about his wife says: “No culpability time, the woman” or “the mother of my children.” He never tells his wife’s name. There is no doubt that this has changed in the time being for many reasons; all kinds of sexual relations have become acceptable for speaking about. Wedlock, extra sexual relations. Heterosexual and homosexual relations nowadays become not only acceptable topics, but it also become attractive in Arab media. In short the population conferences and the globalization are a cause of the growing talk about sexual relations, and there is a room in the Arab media for discussions of social and legal status of homosexuals in Arab societies. The aim of this working paper is to provide an outline of Arab published electronically on homosexuals and lesbians in Arab societies, in particular as it relates to the followings: The definition of homosexuality, and The possibility of scientific study of the phenomenon of homosexuals in Arab societies, Homosexuality in the Egyptian cinema, The phenomenon of homosexuality in the Arab communities, Homosexuality and the provisions of the Islamic Sharriaa, Pope Shenouda and the view homosexuality, The judiciary and the criminalization of homosexuality, Social and law look towards homosexuality, Treatment of homosexuals within Islamic countries, Lesbianism in Arab societies, and The opinion of jurists and scholars of religion in lesbianism. Methods: The ethnographic method. Conclusion: There is a need for doing anthropological field research focused on the sexual behaviors in Arab communities for the formation of sex education programs suitable to different age and cultural groups. That is in order to face the problems which are becoming urgent, such as: marital relations, the sexual deviations within the family, sexual harassment against children, and sexually transmitted diseases. Policy of full disclosure: The presenter has no funding resource.He will not be able to attend the congress without travel facilities through the orgaizing committee.

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Unmoderated Poster Presentations PO-13

Women’s sexual health

PO-13-001

ARABIC TRANSLATION OF FEMALE SEXUAL FUNCTION INDEX AND VALIDATION IN AN EGYPTIAN POPULATION

FSFI© (Rosen) is FSFI ≤ 26.55 or any of the six domains ≤3.6, for our study population, the percentage of women with sexual dysfunction is 38.7%. Conclusion: If we study the historical, cultural, political, and religious of our people we will see significant differences with respect to the American population that until now we mark the point diagnosis for female sexual dysfunction. Policy of full disclosure: None.

Anis, T.1; Aboul Gheit, S.2 Cairo University, Andrology, Egypt; 2Cairo University, Egypt

1

Objective: Female sexual dysfunction (FSD) is a prevalent health problem that has been inadequately investigated in the Arab world. A validated Arabic assessment instrument is urgently needed. The aim of the study is to validate the Arabic version of the Female Sexual Function Index (ArFSFI). Methods: This is a cross-sectional study conducted between January and April 2010. Eight hundred and fifty five women (16–60 years old) participated in the study. Validation was carried out on aspects of face, content, discriminant, and criterion (concurrent) validity. Construct validity was evaluated using principal component analysis. Reliability studies on test–retest and on internal consistency were conducted with Pearson correlation and Cronbach’s alpha respectively. The best cutoff point for the ArFSFI to differentiate cases and non-cases was determined using a Receiver Operating Characteristic (ROC) curve. Results: ArFSFI total score and scores of various domains showed high test–retest reliability (r from 0.92 to 0.98). ArFSFI domains showed high internal consistency (α from 0.85 to 0.94). Six hundred and forty-four women (75.32%) met the DSM-IV criteria for diagnosis of sexual dysfunction while 211 women (24.68%) showed normal function. The ArFSFI was found to have good discriminant validity. There were significant differences between the mean scores of women with sexual dysfunction and those of women without sexual dysfunction. A total score of 28.1 was taken as the cutoff point for the ArFSFI to distinguish between women with FSD and women with normal function (Sensitivity 96.7%, Specificity 93.2%). The ArFSFI showed an excellent overall performance (AUC = 0.985, 95% confidence interval 0.978–0.992) Conclusion: The ArFSFI is a validated, reliable, and locally accepted tool for use in the assessment of FSD in the Egyptian population. Policy of full disclosure: None.

PO-13-002

FEMALE SEXUAL FUNCTION IN SPAIN: NORMAL RANGE Castroviejo Royo, F.; Conde Redondo, C.; Martinez-Sagarra Oceja, J. M.; Rodriguez Toves, L. A.; Sanchez Garcia, J.F. Hospital Río Hortega, Urology, Valladolid, Spain Objective: There are important cultural, social and religious matters of sexuality in different populations around the world why we can not assume the results on female sexual function from other countries to our female population of Castilla y León (Spain). Methods: Between September 2008 and October and 2009 we conducted an observational, cross-sectional with 1527 women aged between 20 and 71 years of Castilla y León accounting for 33.9% of the sample to validate the study. We assessed epidemiological variables and the responses to the test FSFI© Spanish version and its six domains: desire, arousal, lubrication, orgasm, satisfaction, and pain. Results: The six domains of the FSFI© test were compared by province, age, race, sexual orientation, sexual actuvity, cultural level, the number of children and vaginal surgery before to the completion of test and type of vaginal surgery (see table below). The results of the six domains and overall test result FSFI© (1.2–36) are as follows: (i) FSFI media: 25.5 ± 8.17; Pc25:21.7; Pc75:31.4. (ii) Desire media: 3.2 ± 1.2; Pc25:2.4; Pc75:4.2. (iii) Excitation media: 3.8 ± 1.8; Pc25:2.7; Pc75:5.4. (iv) Lubrication media: 4.2 ± 2.0; Pc25:3.3; Pc75:6.0. (v) Orgasm media: 4.0 ± 2.0; Pc25:2.8; Pc75:5.6. (vi) Satisfaction media: 4.2 ± 1.7; Pc25:3.2; Pc75: 5.6. (vii) Pain media: 4.3 ± 2.0; Pc25:3.6; Pc75:6.0. Female sexual dysfunction to the original author of test

PO-13-003

FEMALE SEXUAL FUNCTION IN SPAIN: DESCRIPTIVE ANALYSIS Castroviejo Royo, F.; Conde Redondo, C.; Martinez-Sagarra Oceja, J. M.; Rodriguez Toves, L. A.; Rivero Cardenes, A. Hospital Río Hortega, Urology, Valladolid, Spain Objective: Every approach to human sexuality requires a look at its concept. Sexual response is associated with a complex interaction of psychological, interpersonal and social and physiological factors. Their disturbance causes sexual dysfunction: desire disorder, arousal, orgasm or pain. Methods: We conducted an observational, cross-sectional between September 2008 and October 2009 women between 20 and 71 years of Castilla y León (Spain). The required minimum sample was 1,045 women, so we chose a sample of 4,500 to which a questionnaire mailed FSFI© Spanish version, an explanatory letter and stamped addressed envelope for anonymous return. The population of our study was 1,527 women who returned the test anonymously answered (33.9%) (see table below). The study variables are epidemiological and FSFI© test in the Spanish version. The statistical tools used were: Kolmogorov–Smirnov, Student t-test or Mann–Whitney test and anova with Bonferroni post hoc or Kruskal–Wallis. The level of significance was considered at P ≤ 0.05. Results: Descriptive analysis by province, age, race, sexual orientation, sexual activity, number of sexual intercourse in the last 4 weeks, the cultural level, the number of children, history of previous vaginal surgery and type of vaginal surgery. Descriptive analysis for each of the six domain in which the questionnaire is divided and the overall result of the test FSFI ©. Conclusion: The sexual dysfunctions represent a deficit in the quality of life of women and are often taboo subject in the clinical evaluation. The self-administered questionnaires are very important because they help maintain anonymity, sincerity and respect the privacy of women. The number of completed questionnaires have been 1,527, obtaining similar results to other descriptive studies published in the literature. Policy of full disclosure: None.

J Sex Med 2011;8(suppl 5):406–469

456

Unmoderated Poster Presentations

PO-13-005 PO-13-004

FEMALE SEXUAL FUNCTION IN SPAIN: NEW DIAGNOSTIC POINTS FEMALE SEXUAL DYSFUNCTION IN CASTILLA Y LEON (SPAIN) Castroviejo Royo, F.; Conde Redondo, C. R.; Martinez-Sagarra Oceja, J. M.; Rodriguez Toves, L. A.; Rivero Cardenes, A. Hospital Río Hortega, Urology, Valladolid, Spain Objective: If we study the historical, cultural, political and religious in our Spanish population, we find significant differences in female sexuality in relation to the population of other countries, so that it is wrong to extrapolate on our women of Castilla y León the findings in the literature on populations other than Spanish. Methods: Women (1,527) aged between 20 and 71 years of Castilla y León accounting for 33.9% of the sample to validate the study. We assessed epidemiological variables and the responses to the test FSFI© Spanish version and its six domains: desire, arousal, lubrication, orgasm, satisfaction, and pain. Results: Results of the six domains of the FSFI © test and the overall result of the test (see table below). If we take as sexual dysfunction FSFI© values given by the original author (Rosen) to American society we must consider that sexual dysfunction is a FSFI ≤26.55 or ≤3.6 on any of the domains, for our women of Castilla y Leon would have a 38.7% of women with sexual dysfunction and even half of our population would be below that level. Due to cultural and educational conditions are not similar to the America, we give a new point of female sexual dysfunction diagnosis in conjunction with the percentile 25 of our study FSFI© ≤21.7, with statistically significant predictors: age over 51 years, primary school and have previous vaginal surgery. So then we have only 24.8% of our population that could diagnose sexual dysfunction. Conclusion: The results of our study population differ from American standards and therefore can not apply their diagnostic points when evaluating the test FSFI© and diagnose a woman with sexual dysfunction with the values used by American researchers. It has been obtained a new cutoff point for diagnosing specific to our population female sexual dysfunction, FSFI© ≤21.7. Policy of full disclosure: None.

FEMALE SEXUALITY AND POPULAR MEDIA DURING THE COMMUNIST PERIOD (1944– 1989) IN BULGARIA Georgieva, R.1; Kamenov, Z.2 Sofia, Bulgaria; 2Medical University—Sofia, Bulgaria

1

Objective: Our aim was to investigate the existing representations and discussions on female sexuality during the Communist period of 45 years (1944–1989) in Bulgaria. Methods: More than 1,500 issues of different popular media journals (periodicals on health, fashion and lifestyle) with publications were analyzed. Results: Media publications from the explored period showed a notable lack of interest in female sexuality. If it is discussed at all, it is in favor of topics like reproduction, abortion and general gynecological health. Much less attention is paid on female sexuality itself with just a few such articles being published during the whole period. In different articles a woman with low or lacking sexual desire is called “cold.” A “cold woman” is one that dispenses her husband with sexual activity. Usually no medical reason is suspected for the low female sexual desire and it is the partner’s unskillfulness that is blamed for the “coldness” of the woman or a previous experience with rape or harsh moral education. Still, female sexuality is in the realm of medicine and is discussed mostly in terms of physical illness with weak notion of the underlying psychological aspects. We did not find any publications showing the notion that the woman should experience pleasure during the sexual activity (understood mostly as intercourse). The overall impression is that sex gives pleasure only to men and a woman’s part is only in providing it. Conclusion: Female sexuality is a marginalized topic during the explored period with only reproductive sex being of moderate media interest. Policy of full disclosure: None.

PO-13-006

ESTIMATING PREVALENCE AND PREDICTORS OF SEXUAL DYSFUNCTION AMONG FEMALE MEDICAL STUDENTS Triantafyllou, G.1; Triantafyllou, A.1; Gavriilaki, E.1; Anyfanti, P.2; Petidis, K.1; Gkaliagkousi, E.1; Papadopoulos, N.1; Christaki, E.1; Lazaridis, N.1; Nikolaidou, B.1; Doumas, M.1 1 2nd Propedeutic Department of, Internal Medicine, Aristotle, Thessaloniki, Greece; 2Thessaloniki, Greece Objective: Female sexual dysfunction represents a clinical entity affecting both healthy and ill individuals in all age groups, though it remains substantially understudied both in research and in clinical practice. The aim of this study is to unveil its prevalence among young, healthy female population, and investigate the effect of well-known risk factors on sexual dysfunction in this group.

J Sex Med 2011;8(suppl 5):406–469

457

Unmoderated Poster Presentations Methods: Female students of the Medical School of Aristotle University of Thessaloniki, Greece, participated in the study. The Female Sexual Function Index (FSFI) questionnaire was completed for the evaluation of sexual functioning, with total score ranging between 2–36 and a cutoff score ≤26.55 considered representative of sexual dysfunction. All participants had their body mass index (BMI), systolic and diastolic blood pressure (SBP/DBP), smoking and alcohol habits recorded. Results: In total, 134 female students with a mean age of 22 ± 0.2 years were studied. Sexual dysfunction was found in 20.1% of our sample. Mean SBP/DBP wAS 115.9 ± 1.0/74.0 ± 0.8 mm Hg, and mean BMI was 20.9 (15.9–42.8). Smoking was reported in 25.4% and alcohol consumption in 50.7% of our population. Sexual dysfunction was not significantly associated with any of the above mentioned factors. Conclusion: Although female sexual dysfunction is most commonly considered a disease of the old and ill, it affects a significant portion of young and healthy individuals. Acknowledgement of the problem and identification of contributing factors should be addressed as a priority in the effort to preserve human’s general health and well-being. Policy of full disclosure: None.

PO-13-007

PREVALENCE OF SEXUAL DYSFUNCTION AMONG FEMALE PATIENTS ATTENDING A RHEUMATOLOGY DEPARTMENT Gavriilaki, E.1; Triantafyllou, A.1; Anyfanti, P.2; Triantafyllou, G.1; Pyrpasopoulou, A.1; Gkaliagkousi, E.1; Chatzimichailidou, S.1; Petidis, K.1; Douma, S.1; Aslanidis, S.1; Doumas, M.1 1 2nd Propedeutic Department of, Internal Medicine, Aristotle, Thessaloniki, Greece; 2Thessaloniki, Greece Objective: Although sexual dysfunction has received increasing attention in the previous years, it still represents a neglected area of research compared to other clinical entities, particularly when it comes to certain population subgroups discriminated by gender or underlying disease. The aim of the present study was to investigate the prevalence of sexual dysfunction among female patients suffering from rheumatic diseases. Methods: Consecutive female patients of the Rheumatology Department of Hippokration General Hospital of Thessaloniki, Greece, comprised the population of this pilot study. Evaluation of female sexual function was based on the self-administered Female Sexual Function Index (FSFI) questionnaire, with a total score ranging from 2 to 36, and a cutoff score ≤26.55 considered representative of sexual dysfunction. Results: In total, 282 female patients with a mean age of 54.3 ± 14.1 years were included in the study. Of them, 43.4% suffered from rheumatoid arthritis, 14% from osteoarthritis, 13.6% from systemic lupus erythematosus, 8.1% from psoriatic arthritis, 6.4% from serumnegative spondyloarthritis, 5.5% from osteoporosis, 4.3% from systemic sclerosis, and 4.7% from other rheumatic diseases. Sexual dysfunction was present in 68.7% of the participants. Women with rheumatoid arthritis and serumnegative spondyloarthritis exhibited the highest prevalence of sexual dysfunction (74.5% and 69.2%, respectively). Conclusion: Sexual dysfunction affects the vast majority of female patients with rheumatic diseases, and as such identification of contributing factors emerges as extremely important. Given the magnitude of the problem, the treating rheumatologist in the first place and the rest health care providers involved with the female rheumatologic patient should seek for and identify sexual dysfunction in time, in order to deal with this condition effectively. Policy of full disclosure: None.

PO-13-008

HOW CAN SEXUAL SELF CONCEPT PRESERVE SEXUAL HEALTH IN IRANIAN YOUNG WOMEN? Ziaei, T.1; Merghati Khoei, E.2; Salehi, M.3; Farajzadegan, Z.4 Isfahan University of medical, Midwifery, Islamic Republic of Iran; 2Tehran University of Medical S, MIDWIFERY, Islamic Republic of Iran; 3Isfahan University of Medical, Psychiatry, Islamic Republic of Iran; 4Isfahan University of Medical, Community Medicine, Islamic Republic of Iran 1

Objective: Sexual self concept indicates the view of a person to itself as a person with sexual tendencies and it is an understanding of social expectations about sexual experiences. This study was done to assess sexual self concept of young people. Methods: In the first step of this explanatory study, after translation of MSSCQ into Farsi and back translation, the final form was administered to 352 young couples in two groups (one group was who decided to marry with each other and another group was young married people).and in the second step qualitative phase of research was performed using semi structured individual interview on 12 female and 10 men, who recruited from quantitative phase, and saturation of data determined the number of them. Results: The quantitative results showed that sexual anxiety and sexual fear of women were more than men. (women 1.21, men .93, and women 1.36. men .91, P < 001, respectively) and also between tow groups these criteria were more in women in group 1 than group2. (P < 0.0001) qualitative result explored that sexual anxiety in women especially before marriage is due to lack of sexual relationship before marriage to preserve virginity but men can have sexual relationship in temporary marriage or in a hidden way because they do not worry about their virginity. Therefore lack of experience cause sexual anxiety and sexual fear for them. Although this difference between women and men save sexual health for women than men. Because there is no risk of STD and HIV for women who do not have sex but men are at risk because they have this activity. Conclusion: Despite of this fact which women are safe before marriage, but this reason is not enough to keep them safe all the time during their life. Therefore we recommend a program to educate them to know about high risk behaviors and decrease sexual anxiety to decrease unconsummated marriage. Policy of full disclosure: None.

PO-13-009

SEXUAL FUNCTION RELATES TO DIMENSIONS OF THE PERSONALITY IN A CLINICAL SAMPLE OF POSTMENOPAUSAL WOMEN Martini, E.2; Terreno, E.2; Brambilla, E.2; Albani, F.3; Santamaria, V.2; Tonani, S.2; Saletta, I.2; Nappi, R. E.1 1 University of Pavia, Research Centre f.Reproductive, Italy; 2Italy; 3Pavia, Italy Objective: Our aim was to investigate whether the domains of sexual function relate to dimensions of the personality in a clinical sample of postmenopausal women. Methods: Female Sexual Function Index (FSFI) and Tridimensional Personality Questionnaire (TPQ) were filled in by 130 postmenopausal women (mean age ± SD: 50.3 ± 3.6 years; mean BMI ± SD: 24 ± 3.7 kg/m2) suffering from hot flushes. Results: The median FSFI total score was 24.65 (1st–4th QTL: 16.5– 28.4) with 32 women being in the 1st QTL and 33 in the 4th QLT. Age, BMI and the number of hot flushes per week did not differ in women with (1st QTL) or without sexual dysfunction (FSD) (4th QTL). Higher measures of harm avoidance (HA) and reward dependence (RD) were reported by women with FSD (P < 0.01 and P < 0.05, respectively), while novelty seeking (NS) was similar in women with and without FSD. Measures of HA, RD, NS vary according to the distribution of the median domain FSFI scores. HA was significantly higher (P < 0.008) in women with low desire, arousal (P < 0.04), lubri-

J Sex Med 2011;8(suppl 5):406–469

458 cation (P < 0.02), satisfaction (P < 0.03) in comparison with women without FSD. RD did not differ between women with and without FSD with a tendency to be higher (P < 0.07) in women with orgasmic dysfunction. NS was significantly lower (P < 0.04) only in women with low arousal. Conclusion: Given the evidence that HA is correlated to high serotoninergic activity, RD to low basal noradrenergic activity and NS to low basal dopaminergic activity, the present data confirm a crucial role of the neuroendocrine balance, especially of the serotoninergic system, in the clinical expression of sexual symptoms at menopause. Policy of full disclosure: None.

PO-13-010

THE ROLE OF TRADITIONAL CARDIOVASCULAR RISK FACTORS IN SEXUAL FUNCTIONING OF FEMALE PATIENTS SUFFERING FROM MUSCULOSKELETAL DISORDERS Triantafyllou, A.1; Gavriilaki, E.1; Anyfanti, P.2; Triantafyllou, G.1; Pyrpasopoulou, A.1; Chatzimichailidou, S.1; Gkaliagkousi, E.1; Petidis, K.1; Douma, S.1; Aslanidis, S.1; Doumas, M.1 1 2nd Propedeutic Department of, Internal Medicine, Aristotle, Thessaloniki, Greece; 2Thessaloniki, Greece Objective: Sexual dysfunction in patients suffering from musculoskeletal conditions represents a substantially understudied clinical entity, and little is known about the effect on these patients of factors known to impair sexual functioning in the general population. We therefore attempted to evaluate the role of traditional cardiovascular risk factors as predictors of sexual dysfunction in a sample of female rheumatologic patients. Methods: Consecutive female patients of the Rheumatology Department of Hippokration General Hospital, Thessaloniki, Greece, participated in the study. Sexual function was evaluated with the Female Sexual Function Index (FSFI) questionnaire, with a total score ranging between 2 and 36 and a cutoff score ≤25.55 indicating female sexual dysfunction. All patients had a thorough medical history taken focused on presence of hypertension, diabetes mellitus, dyslipidemia, previous cardiovascular events, smoking and alcohol consumption. In addition, patients’ body mass index (BMI) and systolic and diastolic blood pressure (SBP/DBP) were recorded. Results: In total, 449 female patients 54.7 ± 14.2 years old were included in the study. Sexual dysfunction was exhibited by 73.5% of them. Mean BMI was 27.6 ± 5.6, and mean SBP/DBP was 130.4 ± 20.4/79.2 ± 10.6 mm Hg. Hypertension was present in 41.2% of the participants, diabetes mellitus in 10.5%, dyslipidemia in 35.4%, a history of cardiovascular events in 7.8%, while smoking and alcohol consumption were reported by 22.9% and 2.9%, respectively. Age was the only factor associated with significantly higher prevalence of sexual dysfunction in the logistic multiple regression model including all of the above-mentioned factors (P < 0.001). Conclusion: With the only exception of increasing age, traditional cardiovascular risk factors failed to predict sexual dysfunction in women suffering from rheumatic diseases. It appears, therefore, that other factors (physical and/or psychological) exert major influence on sexual functioning in women with musculoskeletal diseases, and special emphasis should be placed on their identification both in clinical practice and in research. Policy of full disclosure: None.

PO-13-011

WHAT DO YOUNG GIRLS KNOW ABOUT THEIR PELVIC FLOOR IN GENERAL AND IN RELATION TO DYSPAREUNIA? Stenz, C. Hvidovre Hospital, Physiotherapy, Denmark Objective: An increasingly number of young girls have problems with dyspareunia. The pelvic floor muscles are often a contribution factor

J Sex Med 2011;8(suppl 5):406–469

Unmoderated Poster Presentations to this pain and it has been shown that 21 % of Danish adolescents think, that they have learned to little, about the function of their body in the sex education in school. The main purpose of this study is to evaluate young girl’s knowledge of the pelvic floor in general and their knowledge about the pelvic floor in relation to dyspareunia. The study also examines what information is available for young girls about the pelvic floor and what information they get from teachers/healthcare professionals. Methods: Semi-structured qualitative interviews med six young girls and six teachers/healthcare professionals, and a quantitative survey of 50 books/materials. Results: The young girls have a very limited knowledge of the pelvic floor in general and about its relation to dyspareunia. Teachers and health care professionals rarely speak with young girls about the pelvic floor muscle in general or in relation to dyspareunia. The pelvic floor muscles are described in 9 out of 50 books/materials. In six books the pelvic floor is described as a contributing factor to dyspareunia. Conclusion: Young girls are familiar with the term “pelvic floor,” but they have limited knowledge of what it is, what it does, where it is placed in the body and that it can be a contributing factor to dyspareunia. Teachers and healthcare providers give very limited information about pelvic floor muscles in relation to dyspareunia. In the availableliterature for young people there is some information, about the pelvic floor muscle and its relation to dyspareunia, but only few places. There is a need for more information about the pelvic floor anatomy in general and its relation to dyspareunia in young girls. There is also a need for more information about this subject to teachers and healthcare professionals, who works with young girls. Policy of full disclosure: None.

PO-13-012

SEXUAL FUNCTION OF PARTNERS TO WOMEN WITH PELVIC FLOOR DYSFUNCTION Lonnee-Hoffmann, R. A.; Mørkved, S.; Salvesen, Ø.; Schei, B. St Olav Hospital, Institute for Public Health, Trondheim, Norway Objective: To assess if partners to women with pelvic floor dysfunction have impaired sexual function, compared with age matched controls. Hypothesis was that prevalence of erectile dysfunction in these men is higher than in the general population. Methods: Setting is a tertiary referral hospital in Norway. The study is part of a prospective trial examining the effect of pelvic floor surgery on sexuality of the couple and body image of women. Subjects of the study are all women, scheduled for pelvic floor surgery (urinary incontinence and vaginal prolapse). These were sent two sets of self-administered questionnaires—one for themselves and one for a possible partner. Men’s sexual function was assessed with the Brief Male Sexual Function Inventory, examining 4 domains, overall satisfaction and a total score. These scores were compared with an age matched sample of random Norwegian men (Mykletun et al. BJU International 2005;97:316–23). Means were compared with student t-test. Erectile dysfunction (ED) was assessed to be present, if men confirmed to be never or only sometimes able to maintain an errection sufficient to perform intercourse. Results: Of 300 posted questionnaires, 111 (32%) women were recruited, 78% of those had a partner of which 51 (58%) also returned completed questionnaires. 1. There was no significant difference in any of the domains in none of the age groups between partners of women with pelvic floor disorders and a normative male population in Norway. 2. A prevalence of 16% of ED was found in the study population. This is consistent with 17% prevalence of ED for example in Denmark (Christensen et al. Arch Sex Behav 2011;40:121–32). Conclusion: Partners of women who are scheduled for pelvic floor surgery in general do not have impaired sexual function or erectile dysfunction compared to an average population of the same age. Policy of full disclosure: None.

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Unmoderated Poster Presentations PO-13-013

PO-13-015

REVALUATION OF CLASSIFICATION OF FEMALE SEXUAL DYSFUNCTIONS

PRELIMINARY RESULTS ON THE EFFECT OF VAGINAL ESTROGEN ON SEXUAL FUNCTION IN WOMEN WITH INTERSTITIAL CYSTITIS / PAINFUL BLADDER SYNDROME (IC/PBS)

Gorpynchenko, I.; Romashchenko, O.; Melnykov, S.; Bilogolovskaya, V.; Koval, S. Institute of Urology, Sexology and Andrology, Kyiv, Ukraine Objective: To revalue the existing classification of female sexual dysfunctions. Methods: Evaluation of sexological, gynaecological, psychological, and somatic status of 2,111 women aged from 18 to 69. Results: In women of different age groups the frequency of sexual dysfunctions varied from 27.6% to 65.6%, and that indicates the necessity to provide most of them with the specialized sexological help. With the attempt to revalue the classification of female sexual dysfunctions the following factors were taken into account: sexual status and life quality criteria in single pattern; gender aspects; age peculiarities; gynaecological status; somatic status; hormone homeostasis. Classification of female sexual dysfunctions: I. Absence or loss of sexual desire: 1) primary; 2) secondary. II. Sexual desire disorder: 1) insufficiency of genital reaction; 2) insufficiency of psycho-emotional reaction; 3) combination of insufficiency of genital and psycho-emotional reaction. III. Orgasmic dysfunction: 1) primary; 2) secondary. IV. Sexual aversion and absence of sexual satisfaction: 1) primary; 2) secondary. V. Vaginism of non-organic genesis: 1) first degree; 2) second degree; 3) third degree. VI. Sexual pain: 1) iatrogenic dyspareunia; 2) puerperal dyspareunia; 3) age dyspareunia; 4) postcoital pain. VII. Excessive sexual attraction: 1) hyperandrogenic status; 2) nymphomania in postmenopause. VIII. Other sexual disorders, not conditioned by organic changes or diseases. IX. Non-specified sexual disorders, not conditioned by organic changes or diseases. Conclusion: The improvement of classification of female sexual dysfunctions is the key to the preservation of sexual, gynaecological health and life quality in whole. Policy of full disclosure: None.

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PERCEPTION OF BODY IMAGE AND SEXUALITY IN WOMEN WITH BREAST CANCER Laursen, B. S.1; Nielsen, H. D.2; Gregersen, A. M.2; Thorup, C. B.2 Aalborg Hospital, Clinical Nursing Research Unit, Denmark; 2Aalborg Hospital, Plastic-Reconstructive Surgery, Denmark

Gardella, B.2; Porru, D.2; Chiesa, A.2; Musacchi, V.2; Iacobone, A. D.2; Albani, F.2; Spinillo, A.2; Nappi, R. E.1 1 University of Pavia, Research Centre f.Reproductive, Italy; 2Italy Objective: Estrogen-dependent vaginal health seems to be involved in sexual pain associated with IC/PBS. We designed a pilot study to test the effect of vaginal estriol on sexual function and vaginal health index in women with recently diagnosed IC/PBS. Methods: We studied a sample of 42 IC/PBS (NIDDK criteria) range: women (mean age 40 ± 10.4 years) complaining of sexual pain disorders. FSFI Index was used to assess sexual function. A gynecological examination to assess vulvodynia (cotton swab testing), genital health [vulvoscopy, pap-smear including eosinophil index, culture and vaginal health index score (VHIS)] was performed. Each woman was treated for 12 weeks with vaginal estriol (12.5 mg/100 g) cream (three times a week) and evaluated thereafter. Results: Sexual function was highly impaired in women with IC/PBS [median total FSFI score: 5.1 (25–75%:2–19.5) at baseline. In 73.8% of the cases the VHIS was <15 suggesting the presence of vaginal atrophy and the eosinophil index was very low (15 ± 10.6 mature cells). Interestingly enough, no correlation was evident between VHIS and age in IC/PBS women, but a positive significant correlation was found between FSFI total score (r = 0.33; P < 0.03) and VHIS. Estriol vaginal cream significantly improved FSFI total score (P < 0.001) and VHIS (P < 0.001) in IC/PBS women. However, only 46.7% of women improved significantly sexual function following estriol treatment. Responders showed a tendency to be younger (36.6 ± 10.2 years) in comparison to non responders (43.0 ± 11.8 years; P < 0.07). Conclusion: Vaginal estriol cream may be useful to improve sexual function in women with IC/PBS who report sexual pain, but further studies are need to understand the determinants of the clinical response to local estrogen treatment. Policy of full disclosure: None.

PO-13-016

1

Objective: The prevalence of breast cancer in Denmark is 5,000 per year, 90% of these women are treated with surgery. Having cancer and having one breast removed can affect all aspects of a woman’s life. The literature shows that many women experience an altered body image and sexuality, loss of femininity, a feeling of less sexual attractiveness and decline in self-esteem. Furthermore mastectomy can affect women’s perception of quality of life and psychosocial state. In Denmark, no previous studies have focused on perception of body image and sexuality in this patient group. Furthermore, no study addresses the influence of perceived body image and sexuality on the decision to have breast reconstruction or not. Methods: The study was conducted within a phenomenological and hermeneutical frame of reference. Data were gathered through qualitative interviews. In all 12 women with mastectomies participated in the study Results: Through the analysis of the interviews two themes appeared: “An imperfect body” and “body ideal.” Conclusion: The knowledge of how women’s perceived body image and sexuality has been found valuable to provide better quality nursing care to women treated with mastectomy and reconstruction. Policy of full disclosure: None.

SEX, BODY AND CANCER: SEXUALITY AND BODY IMAGE OF BRAZILIAN WOMEN AFTER BREAST CANCER Barsotti Santos, D.1; dos Santos, M. A.2; Vieira, E. M.3 University of São Paulo- USP, Interunit Doctoral ProgramEERP, Ribeirão Preto, Brazil; 2University of São Paulo- USP, Dept. Psychology and Education, Ribeirão Preto, Brazil; 3University of São Paulo- USP, Dept. Social Medicine, Ribeirão Preto, Brazil 1

Objective: The objective of this qualitative study is to understand how diagnosis and treatment of breast cancer affect women’s sexuality and body image. Methods: We interviewed fifteen breast cancer survivors who were enrolled in a rehabilitation service in Ribeirão Preto, Brazil. The audio-taped material was transcribed, categorized and analyzed following the sexual scripts theory. Results: Five categories were identified. Sexual attractiveness: some interviewees related sexual attractiveness to social aesthetic models. Others associated it with specific characteristics of body and/or subjective attributes. Discourse about sexuality: some defined sexuality from traditional gender relationships which deny female sexuality while others looked favorably upon female sexual pleasure. Relationship with the partner: some women reported strengthening of the relationship during the disease while others affirmed a worsening of an already difficult relationship. Body changes: some women were bothered with their body appearance when they were naked. They reported distress based on the loss of the breast. Some interviewees expressed suffering

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460 due to body alterations that can be easily recognized by another person e.g., alopecia. Others were more concerned about body characteristics which were not related to the cancer treatment. Sexual life: all women reported alterations of the sexual function. Some of them remarked an improvement, others no changes or worsen sexual life. Conclusion: Breast cancer and its treatment bring different responses to sexuality and body image of women. It’s important to consider the interaction between cultural, interpersonal, and psychological aspects to provide integral assistance to women’s health. Policy of full disclosure: None.

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THE INFLUENCE OF DANAZOL ON ANGIOGENESIS AND INFLAMMATORY RESPONSE IN ENDOMETRIOSIS Szubert, M. Aask, Poland Objective: To evaluate Ca-125, VEGF, IL-1β, and CRP concentrations in plasma and in peritoneal fluid (PF) in patients with endometriosis and after treatment of the disease with danazol. Methods: This case-control study included 103 Caucasian women in reproductive age admitted to our hospital for diagnostic or therapeutic laparoscopy. Study group consisted of patients with confirmed endometriosis; patients without this condition—served as a comparative group. The analysis of markers was conducted before laparoscopy and only in plasma—after 3 and 6 months of treatment. Full-study protocol (two follow-up visits) completed 35 patients. Results: Endometriosis was confirmed in 68.9% women (N = 71). There were statistically significant differences between groups in pain associated with menstrual bleeding. The study group presented significantly higher plasma concentration of Ca-125 and significantly lower of VEGF. Analysis of peritoneal fluid concentration of studied markers showed, that groups varied significantly only in Ca-125 (controls: mean value: 1054.85 U/mL; SD 1135.61 vs. mean value: 2128.04; SD 2058.95 in study group; P = 0.006) and VEGF concentration (controls: mean value: 175.76, SD 116.13 vs. mean value: 354.65 SD 609; P = 0.055). Statistically significant regression of pain measured in VAS scale (P < 0.001) and fall in Ca-125 concentration (P < 0.001) was observed during and after danazol treatment. VEGF plasma concentration rose in the first period of treatment (from baseline: 73.33 pg/ mL ± 61.53 vs. 141.69 ± 94.18; P = 0.009). CRP and IL-1β concentration did not differ between groups and did not change during 6 months danazol treatment. Conclusion: Danazol treatment is highly effective in alleviating pain symptoms measured objectively in VAS scale. Ca-125 could be a useful test in follow-up since its concentration drop significantly during danazol treatment. The therapy influences VEGF plasma concentration but has no impact on inflammatory markers. Policy of full disclosure: None.

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TYPE 1 DIABETIC PREMENOPAUSAL WOMEN AFFECTED BY SEXUAL GENITAL AROUSAL DISORDER TREATED WITH TADALAFIL 5 MG DAILY Caruso, S.1; Agnello, C.2; Cicero, C.2; Malandrino, C.2; Lo Presti, L.2; Romano, M.2; Cianci, A.3 1 Universit’a degli Studi di Catania, Gruppo Ricerca Sessuologica, Italy; 2 Policlinico, Catania, Ostetricia e Ginecologia, Modica, Italy; 3Policlinico, Catania, Ostetricia e Ginecologia, Italy Objective: To determine whether daily tadalafil 5 mg is effective in type 1 premenopausal women affected by sexual genital arousal disorder (SGAD). Methods: Thirty-three volunteers were enrolled in a 12-week prospective study performed by the University Research Group for Sexology, University of Catania, Italy. Each woman underwent blood

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Unmoderated Poster Presentations samples to measure glycosylated hemoglobin (HbA1c), and testosterone (T), Free T (FT) and prolactin. The efficacy of tadalafil in quantifying the genital sexual arousal (primary end point), and desire, orgasm, enjoyment of sexual activities, frequency of sexual relationships, and genital pain (secondary end points) was assessed (a) subjectively by the Short Personal Experiences Questionnaire (SPEQ) based on the five-point Likert scale; and (b) objectively by translabial color Doppler sonography of clitoral blood flow. Results: Twenty-nine women completed the study. By SF-36 women reported QoL improvement at the 12th week follow-up (P < 0.05). By SPEQ, data indicated that tadalafil improved the experience of sexual genital arousal (P < 0.001), and of orgasm (P < 0.003), sexual enjoyment (P < 0.03), satisfaction by frequency of the sexual activity (P < 0.001), and frequency of sexual thoughts or fantasies (P < 0.04). Finally, dyspareunia decreased with respect to baseline (P < 0.001). During tadalafil administration, the mean peak systolic velocity (PSV) markedly increased (P < 0.001) and the mean diastolic velocity (EDV) significantly decreased from baseline (P < 0.001). Moreover, the mean the resistance index (RI) and the mean pulsatility index (PI) was significantly higher compared with. Conclusion: Daily tadalafil 5 mg treatment seems to improve subjective sexual aspects and could be used to treat objectively genital arousal disorder of premenopausal women with type 1 diabetes. The limit of the study is the small number of the simple. Additional studies are needed before the information should be used in usual clinical treatment. Policy of full disclosure: None.

PO-13-019

SATISFACTION IN OVERAL FEMALE SEXUAL LIFE AFTER VAGINAL SURGERY Fátima, C. R.; Consuelo, C. R.; José María, M.-S. Oceja; Luis Antonio, R. T.; Alberto, R. C. Hospital Río Hortega, Urology, Valladolid, Spain Objective: There is no consensus about if vaginal surgery produces female sexual dysfunction. Female sexual life depends on age. The Aim of this study is to determine if vaginal surgery has a harmful effect on satisfaction in sexual life after surgery to compare with average women of the same decade of age. Methods: We evaluate sexual function after surgery using the Female sexual function index (FSFI). The diagnostic point for sexual dysfunction by the FSFI author (Rosen) is < 26.55 or a domain score under 3.6. 141 women answered voluntarily 69 treated for stress urinary incontinence and 72 for pelvic organ prolapse (G1). We compare our results with standard results for FSFI for Spanish population obtained evaluating the answered of 1,527 Spanish women (G0). Satisfaction is evaluated as ability to reach orgasm, emotional closeness, sexual relationship, and satisfaction with the overall sexual. We evaluate the results in decades of age. Results: Spanish FSFI is 25.5; cutoff point for American FSFI is 26.55. If we assume this value 38.7% of Spanish women have sexual dysfunction. So, we decide to use a new cut off based on percentile 25 = 21.7 (see table below). Conclusion: Sexual satisfaction in the fifty decade does not suffer alteration after vaginal surgery. If we use the new cut off for FSFI in Spanish women P25 = 21.7, we can affirm that there is no difference between groups in women younger than 70 years old. Policy of full disclosure: None.

461

Unmoderated Poster Presentations PO-14

Sexually transmitted diseases (STD)

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SEXUAL BEHAVIOR OF PATIENTS WITH GONORRHOEA IN RELATION TO ORIENTATION Kojanova, M.1; Kuklova, I.2; Velcevsky, P.2; Belacek, J.3 Charles University Prague, First Faculty of Medicine and, Prague, Czech Republic; 2Dept. of Dermatovenereology, Charles University in Prague, Prague, Czech Republic; 3Institute of Biophysics, Charles University in Prague, Prague, Czech Republic

1

PO-13-020

MEN’S BETTER ERECTILE FUNCTION SUPPORTS WOMEN’S BETTER SEXUAL FUNCTION Brody, S.1; Weiss, P.2 University of the West of Scotland, Paisley, UK; 2Charles University, Prague, Czech Republic

1

Objective: Provide an overview of recent studies examining the association of women’s sexual function with their male partner’s erectile function. Methods: Summary of recent international studies, including those using large representative cross-sectional samples, and those involving treatment of men with erectile dysfunction. Results: In both population cross-sectional surveys and clinical treatment studies, men’s better erectile function is associated with women’s better sexual function, sexual satisfaction, and intimate relationship satisfaction. Conclusion: Better erectile function benefits women as well as men. Policy of full disclosure: Grants were provided by the Czech Ministry of Health and by Pfizer.

Objective: To evaluate the differences in sexual behavior of patients with diagnosed gonorrhoea in relation to sexual orientation Methods: Five hundred five patients with diagnosed gonorrhoea infection agreeing to fill anonymous questionnaires who stated their sexual orientation were included in this study Results: Data are compared between a group of 218 (55.6%) heterosexual men (HT); 171 (43.6%) men who have sex with men and bisexual men (MSM); and 116 (22.8%) women. By marital status 78.4% were single, 11.0% married and 10.6% divorced. Significant findings were higher proportion of married women (20.2%), single MSM (92.9%) and divorced HT (14.7%). Age at first sexual intercourse was reported by most patients at age 16–7 years (42.1%), most significantly in women (59.8%), more MSM (21.6%) dated the beginning of sexual life at the age of 20 years and over. First sexual intercourse was reported as random by 53.3% MSM and in partnership by 84.2% women. Most respondents (43.7%) reported 2 to 3 partners in the preceding year. One sexual partner was reported by 42.0% of women, 4–10 partners by MSM (33.9%). Depending on sexual practices, most HT and women reported vaginal coitus, anal sex 78.9% MSM and 20% of HT and women, oral sex 73.1% MSM, 50.5% HT and 37.1% women, non-coital practices 24.6% MSM and about 8% HT and women. 9.1% respondents reported no condom use ever (14.7% W), 40.4% reported seldom use (46.3% HT and 50.9% women), 36.4% inconsistent use (46.8% MSM). Random unprotected sex was admitted mostly by HT and MSM (48.6% and 45% resp.) in contrast to women (9.5%). Conclusion: Analysis of the data respecting key behavioral characteristics should help provide more specific precautions for patients at higher risk of gonorrhoea infection. Grant support: IGA Ministry of Health NS10292-3 Policy of full disclosure: None.

PO-14-002

WHEN IS AN STD NOT JUST AN STD? Hughes, B. Trinity College Dublin, Social Work and Social Policy, Ireland Objective: This paper examines how a sexually transmitted disease (STD) may be an indicator of an underlying compulsive sexual disorder. Methods: A qualitative approach is used. Data collection includes: pilot-study, focus-groups, questionnaires and interviews involving 87 adult participants consisting of 43 treatment providers who work with this phenomenon in clinical practice and 44 individual who self-identified with compulsive sexual behavior. Interpretative Phenomenological Analysis (IPA) and Thematic Analysis (TA) are used for data analysis. Results: Evidence suggests that a sexually transmitted disease (STD) may indicate the presence of an underlying condition namely compulsive sexual behavior. Those participants who self-identify with compulsive sexual behavior report that as a result of their compulsive behavior 17 (37%) contracted an STD and 3 (7%) became infected with HIV. 15 (33%) continue to engage in “high risk” sexual behavior and are concerned that they will infect others. 13 (29%) sought medical treatment from a sexual health clinic. During STD treatment many clinicians inquire about the patient’s pattern of sexual behavior. If compulsive sexual behavior is identified additional treatments are

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462 suggested. Patients are usually relieved when their compulsive sexual behavior is diagnosed by the physician while a small number are unresponsive or negative. Some clinicians focus primarily on the treatment of the STD and less on the patient’s behavior due to time constraints and lack of knowledge. Conclusion: Some patients seeking treatment for STD have an underlying compulsive sexual disorder. Specific clinical training is required to assist the professional to effectively diagnose the existence of this condition. Training will increase awareness, provide skills to discuss the patients concerns and equip the clinician to identify underlying issues and related comorbid disorders. Training also provides knowledge regarding the treatment options available. Accurate diagnosis of compulsive sexual behavior in a sexual health clinic will impact positively on the patient’s and the public’s sexual health. Policy of full disclosure: B. Hughes is a Government of Ireland Scholar. This Research is supported by the Irish Research Council for the Humanities and Social Sciences (IRCHSS).

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WHERE DO PATIENTS GO FOR TREATMENT OF URETHRITIS? Hoscan, M. B.1; Tunçkiran, A.1; Oksay, T.2; Özorak, A.2; Özkardei, H.1 Baskent University Hospital, Urology, Alanya-Antalya, Turkey; 2Süleyman Demirel University, Urology, Isparta, Turkey

1

Objective: To describe and identify predictors of health-care seeking behavior among men with urethritis. Methods: Ninety-eight male patients aged between 16 and 52 (mean 30.9 ± 8.7) who presented to our clinic with the symptoms of urethritis and diagnosed were included in the study. We interviewed patients face-to-face using a nine-item survey questionnaire. Results: The source of treatment in 44 of 98 (44.9%) patients was doctors, in 38 (38.77%) drugstores, in 13 (13.26%) friends and in 3 (3.06%) their partners respectively. All patients had a history of unprotected sexual intercourse. The given or advised therapies from sources except doctors were out of standart therapy regimens and commonly not enough or as overtreatment. The most common factors associated with seeking care at sources rather than doctors were economic reasons in 19 (35.18%), confidentiality concerns in 24 (44.4%), and to be easy to reach in 11 (20.37%). Conclusion: A substantial proportion of patients with urethritis are attending to sources rather than doctors. Uncompleted treatment or delay in therapy in this group of patients increase their likelihood of complications and of transmission of infection to others. It is important to upgrade the knowledge and conscious level of society with informative studies and educational materials in order to promote patients for attending clinics for rapid and complete treatment from the right source. Policy of full disclosure: None.

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MICROBIOLOGICAL CONTROL OF AZITROMYCIN THERAPY IN SEXUALLY TRANSMITTED MIXED INFECTIONS Tarabrina, N.1; Khamaganova, I.2; Akhmedov, K.3; Khromova, S.4; Mezenceva, M.4; Kovalchuk, L.5; Gankovskaya, L.5; Degtyareva, L.4; Khamaganova, I.3 1 RSMU, Microbiology, Moscow, Russia; 2RSMU, Dermatology & Cosmetology, Moscow, Russia; 3RSMU, Dermatology & Cosmetology, Moscow, Russia; 4 RSMU, Microbiology, Moscow, Russia; 5RSMU, Immunology, Moscow, Russia Objective: Sexually transmitted mixed infections have a high rate of drug-resistance. The insufficient efficacy and certain risk of adverse reactions of different antibacterials are well known. The objective of this study was to assess efficiency of azitromycin in sexually transmitted mixed infections by microbiological control. Methods: Seventy-two patients (39 males and 33 females) aged 18–47 years with sexually transmitted mixed infections were examined and

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Unmoderated Poster Presentations treated. The patients who suffered from HIV, hepatitis B & C, lues, gonorrhea, genital warts, genital herpes, molluscum contagiosum, trichomonas were excluded from the examination. Polymerase chain reaction (PCR) and bacteriological method (inoculation of scrapings from urogenital tract on culture media) were used to establish a diagnosis of mixed-infection and for identification obligate and transient microorganisms. Azitromycin was given in a dose 500 mg orally at the first day of treatment, in a dose 250 mg for the next 4 days. Results: Main causative agents of mixed infections were detected by PCR: Chlamydia trachomatis + Ureaplasma urealyticum + Gardnerella vaginalis in 34% cases; C. trachomatis + Mycoplasma genitalium or U. urealyticum, in 30% cases, M. genitalium + U. urealyticum + G. vaginalis in 36% cases. The structure of microflora included also microorganisms with higher level in comparison with normal level: Staphylococci, Streptococci, Enterococci, Gardnerellas, Peptostreptococci, Corynebacterias. The course of azitromycin therapy was effective in 96.5% No adverse reaction was noted. Clinical efficacy was accompanied by the considerable inhibition of growth and elimination of main causative agents. Bacteriological investigation demonstrated as well inhibition of growth of Staphylococci, Streptococci, Enterococci, Gardnerellas, Corynebacterias. Conclusion: The results of the study demonstrated actuality of microbiological control in sexually transmitted mixed infections. Azitromycin can be used as the first choice for the treatment of sexually transmitted mixed infections. Policy of full disclosure: None.

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Unmoderated Poster Presentations PO-15

Miscellaneous

PO-15-001

THE RISK OF HYPOGONADISM IN CANCER SURVIVORS WITH STAGE-I TESTICULAR SEMINOMA TREATED BY ADJUVANT RADIOTHERAPY Gravina, G. L.1; Bonfili, P.2; Di Staso, M.2; Carosa, E.3; Limoncin, E.3; Ciocca, G.3; Di Sante, S.3; Lenzi, A.4; Gandini, L.4; Tombolini, V.5; Jannini, E. A.3 1 University of Laquila, Experimental Medicine, Italy; 2San Salvatore Hospital, L´aquila, Italy; 3University of L´Aquila, Experimental Medicine, Italy; 4 University “La Sapienza”, Experimental Medicine, Rome, Italy; 5University “La Sapienza”, Rome, Italy Objective: Regarding long-term toxicities, it remains unclear what is the clinical impact of irradiation of men with Stage I seminoma on testosterone, FSH and LH levels. Aim of this study is to assess the risk of hypogonadism in cancer survivors with stage I testicular seminoma. Methods: The present study was performed retrospectively on 71 patients with histologically proven pure seminoma. All patients received radical orchiectomy and adjuvant RT (para-aortic field with a median RT dose of 26 Gy [95% CI from 19.6 to 36 Gy]) without chemotherapy. Three time points were chosen for hormonal analysis: after orchidectomy, but before radiotherapy (T0) and 24 and 48 months (T24 and T48) after radiotherapy. Hypogonadism was defined as follow: testosterone levels below 10 nmol/L and/or LH above 10 IU/L. Results: No subject developed hypogonadism after radiotherapy. The testosterone and LH levels did not significantly change from T0 (testosterone 16.1 nmol/L [CI 95% 12.3–20.2]; LH 4.2 UI/L [CI 95% 3.1–6.3]) to the other time points (testosterone [T24] 15.3 nmol/L [CI 95% 13.1–20.3]; testosterone [T48] 15.7 nmol/L [CI 95% 12.3–20.2]) (LH [T24] 4.5 UI/L [CI 95% 3.4–6.8]; LH [T48] 4.9 UI/L [CI 95% 3.1–6.9]) (P = 0.470 for testosterone and P = 0.579 for LH). A significant increase in FSH levels was documented respect to baseline (P < 0.001). Conclusion: In despite of a limited field of treatment, cancer survivors with stage I testicular seminoma did not experience a significant risk of hypogonadism. Cryopreservation in this subpopulation should be always suggested before RT. Policy of full disclosure: None.

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THE ROSA EXPERIENCE: LESSONS FROM A HEALTH PROFESSIONNAL NETWORK TO REDUCE THE INEQUALITY OF ACCESS TO ONCOSEXOLOGICAL CARE Bondil, P.1; Habold, D.2; Damiano, T.3; Champsavoir, P.3 Centre Hospitalier, Urology-Andrology, Chambery, France; 2Centre Hospitalier, Support Care Center ERMIOS, Chambery, France; 3Centre Hospitalier, The ROSA Process, Chambery, France

1

Objective: In daily practice, the request for care for sexual difficulties related to cancer or to its treatment is mainly center or physician dependant. As cancer is increasingly a chronic disease, sexual health troubles should be taken into account without the problem of health care access. For this reason, the pilot plan ROSA has been set up. Our objective is to analyze the different problems observed during the period of setting up from 2006–2010. Methods: ROSA included successively: (i) a proximity care response whatever the stage, treatment or topography of cancer, thanks to a dedicated (patient/couple) consultation, (ii) a regional response by structuring our cancer network (5 millions inhabitants), (iii) an ongoing national response by diffusing a specific guideline for health professional Results: Year 2006–2008 = 3 main points: (i) real but not sufficient awareness of health professionals; (ii) necessity to structure the onco-

sexological health care chain; (iii) large gaps (knowledge and skills) require to inform and to educate all health professionals. Year 2009– 2010 = 5 additional points: (i) neither over nor under-estimated care demand; (ii) mandatory to adapt both information and training to different health professionals; (iii) “sexual” demands often change with time; (iv) structuring of regional/national offer requires a transversal approach for identifying all the potential targets (institutions, health professionals . . .) and “sexological” resources (human/tools/teaching aids . . .); (v) the place of nurses, GPs and patients associations appears as very efficient and well-adapted relays. Conclusion: For optimizing the oncosexological care, our experience shows three key points: (i) the local supportive health care have a key role, (ii) the structuring must be progressive by creating locally dedicated consultations, then to inform/educate the concerned health professional/structures, (iii) the approach must be pragmatic and transversal using the numerous human/institutional local and regional resources. Policy of full disclosure: None.

PO-15-003

ONCOSEXOLOGY: ASSESSMENT AND POTENTIAL ROLE FOR THE MAJOR FRENCH PATIENTS ASSOCIATION LCC (LA LIGUE CONTRE LE CANCER) Bondil, P.1; Champsavoir, P.2; Damiano, T.2; Habold, D.1 Centre Hospitalier, Urology-Andrology, Chambery, France; 2Centre Hospitalier, ROSA, Chambery, France

1

Objective: The cancer survivor associations have an increasing role in the field of quality of life that includes sexual life. No survey has concerned this specific topic among patient associations. Our aim: to analyze the current situation and recognize the “oncosexological” needs/demands of the major French association of patients LCC with 727 918 members. Methods: The survey included: (i) dispatch to the 101 counties Committees of a questionnaire approved by the national Committee, (ii) telephone interviews (95 Committees) analyzing five parameters: 1) patients, 2) health professionals, 3) voluntary helpers, 4) care availability, 5) LCC available strategy at the county, regional and national levels. Results: The survey was more difficult than anticipated. Two years were necessary to obtain 70% of responses due to: 1) structural heterogeneity of counties Committees, 2) finding of relevant speaker, 3) reluctance to discuss this topic. If a strong majority is not or little confronted, it appears very important (92% yes/rather). For 75%, the oncosexological appropriation by the carers is not realized. 65% consider that physicians are not or little aware, the nurses appears as the best carers. The only organized response relies on useful written League documents and rare Committee dependant responses according to specific local offers or knowledgeable members. To know where to direct patients is a real challenge for Committee (26% without available addresses). Motivation is strong since for 96%, the League is a valid relay for informing and directing patients explaining their strong wish to be more involved. Conclusion: This “audit” points up: (i) a low patient demand despite a high voluntary helper awareness/motivation, (ii) the feeling of disappointing response due to a major lack of information and absence of organized response, (iii) the need of a better offer visibility and a more active Committee response, (iv) not a real lake of listening but a double problem of validated process and know-how. Policy of full disclosure: None.

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464 PO-15-004

ONCOSEXOLOGY AND HEALTH CARE OFFER: A SPECIFIC SURVEY IN 285 HEALTH CARERS IN ORDER TO SPECIFY THE PERCEIVED NEEDS FOR INFORMATION OR TRAINING Bondil, P.; Habold, D. Centre Hospitalier, Urology-Andrology, Chambery, France Objective: Preservation of sexual life is a real parameter for the quality of life of cancerous patients. Our objective was to analyze and evaluate perceptions and attitudes of health carers : a) personal and professional awareness concerning the oncosexological dimension, b) attitudes and skills for listening and treating it. Methods: Use of a validated questionnaire (questions quoted 0, 1, or 2); survey done among French health carers: (i) 126 various health carers of our hospital, and (ii) 76 residents (urology, oncology and radiotherapy) and 83 urologists from other institutions. Results: (number = mean) (i) Frequency: (a) personal awareness: higher in urologists (1.7), our hospital (1.6) than residents (1); (b) professional confrontation: usual for urologists (1.8), less in our hospital (1.4) and residents (1.1); (c) attitude if patient demand: urologists (1.7) more reactive than residents (1.2) and our hospital (1.1). Urologists have more proactive attitude (1.7) than residents (0.8) or our hospital (0.5). (ii) Seriousness: to be listening (1.9) and reactive (1.8) to sexual complaint and demand is important in our hospital and for urologists but less for residents (1.3). (iii) Problems: theoretical knowledge: insufficient in our hospital (0.3), better for residents (0.9), good for urologists (1.6); technical skills: low (0.1) in our hospital, better for residents (1), good for urologists (1.6); relational skills: better in our hospital, residents (1.2) and urologists (1.5). These insufficiencies explain the importance (1.8 our hospital, 1.7 urologists, 1.2 residents) to know how to inform and where to send. Conclusion: The excellent survey acceptance shows a high awareness and an usual confrontation with the oncosexological problem. But, the responses (listening and care) appear insufficient except for urologists. The rarity of the oncosexological skill explains the strong demand for: (i) better information and visibility for all, (ii) specific guidelines and training for the most concerned and motivated. Policy of full disclosure: None.

PO-15-005

MODERN TREATMENT OF PENILE CANCER: RESULTS FROM A SUPRAREGIONAL CENTER Ahmed, S.1; Rukin, N.2; Foster, M.2 Derby, UK; 2Good Hope Hospital, Birmingham, UK

1

Objective: In the UK, penile cancers are referred to specialist regional centers. We have examined the role of initial biopsy, prophylactic lymph node dissection (LND) and the value of the proposed subclassification of T2 disease. Methods: We have performed a retrospective review of all cases of penile cancer referred to our center between 2005 and 2010. Results: We reviewed 108 patients, median age 62.5 years (range 35–90). 54 patients (50%) had a biopsy prior to referral and 35 (65%) of these had T2 disease or worse. We subdivided T2 cancers into groups T2a and T2b based on spongiosum/cavernosal invasion. Of those who underwent lymph node dissection, 88% of T2a and 75% of T2b patients had positive nodes. Median survival for T2a and T2b disease was 15 months and 6 months, respectively. Seventy-six patients (70%) were defined as high risk according to EAU guidelines. Thirtyeight (50%) of these received a LND (either prophylactic or for suspected nodal disease). Twenty-five high-risk patients (33%), with negative clinical examination and normal radiology did not undergo prophylactic LND and to date no patients have developed nodal disease or any form of disease progression. The remaining 13 patients had widespread metastases at presentation, were unfit for surgery or declined the procedure.

J Sex Med 2011;8(suppl 5):406–469

Unmoderated Poster Presentations Conclusion: EAU guidelines recommend biopsies are not indicated with obvious penile tumours. In our cohort many patients are having unnecessary biopsies for obvious (T2) disease, resulting in delay in definitive treatment. Subclassification of T2 disease shows no difference in nodal status, but does reflect overall prognosis, which may be important during the counseling process. EAU guidelines recommend prophylactic LND for high-risk disease, but in our cohort its role appeared limited in those with no clinical or radiological evidence of nodal disease. Due to the associated morbidity of prophylactic LND a more conservative approach may be appropriate. Policy of full disclosure: None.

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EVALUATION OF PATIENT’S SEXUAL FUNCTION BEFORE AND AFTER RENAL TRANSPLANTATION Darabi Mahboub, M. R.; Shakibi, M. H. Mashhad University of Medical, Urology in Imam Reza Hospital, Islamic Republic of Iran Objective: Chronic renal failure and hemodialysis may cause impotency, oligospermia, germinal cell dysplasia and delayed sexual maturity. After renal transplantation, improvement in patients’ libido, potency and orgasm has been observed. We evaluated changes in libido, potency and fertility in these patients. Methods: The study included 100 males with history of renal transplantation aged 18–61 (mean 33) the most prevalent causes of chronic renal failure were diabetes mellitus (16%) and unknown causes (22%). Of these, 98% had history of hemodialysis before renal transplant and 2% had peritoneal dialysis. 90 cases had received kidneys from unrelated living donors andlo from lived related donors. After transplantation 36 cases received double drug regimen and 64 triple drug regimen. Results: Out of 100 patients: 16 were single, 84 were married, 12 had renal failure before marriage. Before transplantation the libido was good in 22 cases, 52 cases had intermediate and 26 poor (no libido). Potency was good in 30 cases, intermediate in 52 and poor in 18 cases (impotent). 22 cases did not have children after their marriage (infertile). After transplantation the libido improved: 80 cases became good, and libido in 16 cases was intermealiate and 10 4 patients was poor, potency and fertility improved as well so potency in 76 cases became good in 18 ones, in remediate and in 6 cases was poor. 27 cases became parents after transplantation. Before transplantation 15 patients had no children. Conclusion: Kidney transplantation only improves and increases the quality of life and health of patients with chronic renal failure which compromises the libido, potency and fertility but also improves libido, potency and fertility and this may bring more satisfaction to couples. Policy of full disclosure: None.

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SUICIDAL BEHAVIOR IN STREET PROSTITUTES Teixeira, A. Vila Nova de Gaia, Portugal Objective: Despite the few international studies correlating suicidal behavior and prostitution, the literature shows several suicidal risk factors in female prostitutes, mainly in those working on the streets. Thus, we intended to explore the incidence of suicidal behavior in a sample of street prostitute women in Oporto (Portugal) and to correlate this with some other data, such as social support and their level of victimization. The objective of this paper is to show some of the results we obtained in a study in which we interviewed 52 street prostitutes. Methods: To gather the data we applied the Suicide Ideation Questionnaire (QIS) and the Scale for Social Support Satisfaction (ESSS). Results: Among other results, the QIS obtained an average of 41.71 points with a standard deviation of 29.92 points, values that indicate a high risk of suicide. Moreover, 46.15% of these women performed

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Unmoderated Poster Presentations higher than 41 points in the QIS, which is a significantly high value. With regard to perceived social support, we found a statistically significant negative correlation with the level of suicidal ideation. Conclusion: We conclude that suicidal ideation in this sample is much higher than in general population, and also that there is a higher prevalence of suicide attempts. Policy of full disclosure: None.

PO-15-008

SEXUAL MOTIVATION: AN EXPLORATORY STUDY IN A GREEK SAMPLE Nakopoulou, E.1; Papaharitou, S.2; Macaskill, A.3; Wylie, K.4; Florou, H.5; Hatzichristou, D.1 1 Aristotle University, Center for Sex & Reprod Health, Thessaloniki, Greece; 2 Aristotle University, Center for Sex & Reprod Health, Thessaloniki, Greece; 3 Sheffield Hallam University, UK; 4Porterbrook Clinic, Sheffield, UK; 5 Higher Technological Institute, Midwifery department, Thessaloniki, Greece Objective: Based on previous work in sexual motivation, the preset study aimed to provide an initial exploration of expressed sexual motives in a Greek sample. Methods: An exploratory study was conducted employing an opportunity sample of men and women aged 18–50 years old. Participants were recruited from the students and employees of the Higher Technological Institute at Thessaloniki. Meston’s questionnaire was used to assess reasons motivating people to engage in sexual activity. The scale consists of four large factors and 13 subfactors: physical reasons (stress reduction, pleasure, physical desirability, and experience seeking), goal attainment (resources, social status, revenge, and utilitarian), emotional (love and commitment and expression), and insecurity (selfesteem boost, duty/pressure, and mate guarding). Data were analyzed using Cronbach’s a and factor analysis as independent samples t-test. Results: A total of 200 participants (110 men and 90 women) returned completed forms. They had a mean age of 34.09 (+8.98) with the majority (70%) having higher/highest education and 66% (N = 133) of them being either married or in a relationship. Factor analysis yielded results similar to Meston’s taxonomy though some factors had complex structure. Reliability analysis showed high internal consistency in all the four factors and 13 subfactors with Cronbach’s a ranging from 0.69 to 0.95. Significant (P < 0.01) gender differences were obtained on each of the physical, goal attainment, and insecurity factors and subfactor composites; men more frequently than women, endorsed reasons centering on the physical appearance and physical desirability of a partner as well as improvement of self-esteem. Advancing age in women was also related with frequent endorsement of emotional reasons (r = 0.263, P = 0.013). Conclusion: Consistent to previous studies, present findings support the notion about the complexity of sexual motivation which, together with gender, appears to be influenced by age as well. This issue warrants further exploration to detect possible cultural differences. Policy of full disclosure: None.

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INTEGRATING SEXOLOGY EDUCATION INTO PSYCHIATRY RESIDENCY TRAINING: PERSPECTIVES FROM THE USA Lin, D.; Kleinbart, E. Beth Israel Medical Center, Department of Psychiatry, New York, NY, USA Objective: This oral presentation will focus on how sexology and psychosexual medicine education can be integrated into psychiatry residency training. Methods: The Psychosexual Medicine Program currently being implemented at Beth Israel Medical Center, Department of Psychiatry and Behavioral Sciences in New York City, USA, will be described. Results: An argument will be made why it is important to teach sexology in psychiatry residency training and how psychiatrists are uniquely positioned to be good sexologists.

Conclusion: It will be recommended that sexology education become an integrated part of psychiatry residency training everywhere in the United States and the world. Policy of full disclosure: None.

PO-15-010

AN EVALUATION OF TELEPHONE FOLLOW-UP CONSULTATION FOR MANAGEMENT OF PATIENTS WITH ERECTILE DYSFUNCTION Joshi, U.; Agius, J. Castle Hill Hospital, Dept of GU M and Sexual Health, Cottingham, UK Objective: To offer effective and efficient follow-up care to patients with ED in the familier environment of home at their own choice, saving their valuable time (both travel and work) and to use the limited medical resources efficiently for seeing new patients. Methods: Patient requiring uncomplicated management like oral therapy with PDE5i or requiring titration of dosage were offered the option of either face to face or telephone follow-up consultation. An inclusion and exclusion criteria were laid.Patient satisfaction questionnaire was given to patients qualifying for telephone consultation. Results: Sixteen pts returned the questionnaire and the results were analyzed. 87.5% (14/16) found it more convenient. Fourteen people who more convenient, the reasons stated—100% (14/14) agreed that no need to travel to the hospital. Over 70% (10/14) said there was no waiting. 100% 14/14 agreed that there was no need to find a parking space and more than 85% (12/14) agreed that they could save a lot of time. It is possible it could be due to the question whether the patient felt that they had an adequate discussion and explanation about their treatment from the nurse specialist 4–5 (13/14) confirmed that they had an adequate discussion and explanation about their treatment. Majority of these people were not working either because of retirement or disability. Conclusion: Eighty-seven percent of the responders thought that the service was more convenient particularly with regard to time and money saved in travel, convenient, not to take time off work and having the discussion of their treatment at the comfort of their own home in familiar surroundings. Reduced waiting time for new patients.The service will continue to provide telephone consultation with increasing number of follow-up appointments. Policy of full disclosure: None.

PO-15-011

BISEXUAL IDENTITY AND PSYCHOLOGICAL DISTRESS IN A SAMPLE OF CZECH MALE SEX WORKERS Johnson, M. Charles University, 1st Medical Faculty, Praha 3, Czech Republic Objective: The Czech Republic is among the more sexually tolerant countries in Europe and because prostitution is decriminalized and wages are low, it has also become a popular sex tourism destination among gay or hebepedophile foreigners seeking sex with men. Methods: This study examined a sample of male sex workers (N = 40) on a range of demographic, sexual, and psychological variables using a quantitative survey administered face-to-face. Results: The results indicate that working as a prostitute per se has little impact on the psychological functioning of these young men, but only in the case where they identify as either heterosexual or homosexual. However, for those who identify themselves as bisexual, they suffer significantly more emotional distress, engage in more hypersexual and risky sexual behavior, and more frequently have problems with drugs and alcohol. Conclusion: Homosexuals are engaging in orientation congruent sexual behavior, and heterosexuals in economically validated behavior, but for bisexuals, it seems that working as a male prostitute makes the process of developing a sexual identity more complex and distressing. Policy of full disclosure: None.

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466 PO-15-012

IS THE WEB CHANGING THE RELATIONSHIP BETWEEN THE CLINICIANS AND THE PATIENTS WITH SEXUAL DISORDERS? RESULTS OF AN EXPLORATORY ANALYSIS Salonia, A.1; Abdollah, F.1; Saccà, A.1; Ferrari, M.1; Castiglione, F.1; Moretti, D.2; Castagna, G.1; Clementi, M. C.1; Zanni, G.1; Rigatti, P.1; Montorsi, F.1 1 University Vita-Salute San Raffaele, Urology, Milan, Italy; 2Urological Research Institute, Urology, Milan, Italy Objective: Numerous patients come to the office already with a load of self-retrieved information and misconceptions regarding their sexual disorders. This study was aimed at assessing the patients’ habit to surf the web before asking for an outpatient visit for these disorders. Methods: A cohort of 479 patients consecutively attending for the first time a sexual and reproductive medicine center anonymously completed a brief self-administered structured questionnaire including general demographic data and questions about individual’s habit to surf the web regarding health-related problems. Results: Complete data collection was available for 476/479 (99.4%) patients (women: 115 [24.2%]; men 361 [75.8%]; mean age 37.6 years; range 18–72). Primary reason for attending the office was couple’s infertility in 273 (57.4%), erectile dysfunction in 63 (13.2%), premature ejaculation (PE) in 17 (3.6), Peyronie’s disease in 13 (2.7), and a miscellanea of genital disorders in 111 (23.3%) patients, respectively. Overall, 376/476 (78.9%) reported having surfed the web concerning regarding their specific health disorder. At multivariate analysis younger age (OR: 0.947, P = 0.01) was the only independent predictor of web surfing. Among the surfers, 152 (40.2%) reported to feel themselves prepared on the subject after having surfed the web. Likewise, 200/476 (42%) patients participated in a web blog regarding the object of their visit. Younger age (P = 0.001), female sex (P < 0.001), and having a stable relationship (P = 0.03) emerged as independent predictors of patients’ participation to a web blog. Couple’s infertility, PE, and Peyronie’s disease emerged as the main reasons for participating in a web blog (chi2 trend: 12.292; P = 0.02). Conclusion: This exploratory analysis showed that the vast majority of patients usually surf the web regarding sexual and reproductive issues and they also participate in targeted web blogs before attending outpatient visits. This attitude is rapidly changing the scenario of the doctor-patient relationship. Policy of full disclosure: None.

Unmoderated Poster Presentations during intercourse and in 13 cases impotency there was good for intercourse and 3 cases then was impotency after treatment. Conclusion: Diabetes is a system disease and in diabetic patients there was loss of libido, impotency or both. Causes of these problems included: hormonal imbalance–polyneuropathy and vascular diseases. By used of drugs for increase libido, potency we can treatment loss of libido, impotency or both in these patients with high success rate. Policy of full disclosure: None.

PO-15-014

NEEDLE ELECTRODE COAGULATION OF PRONOUNCED PEARLY PENILE PAPULES Fekete, F. Hungarian Society for Sexual Medicine, Budapest, Hungary Objective: Pearly penile papules are tiny bumps around the rim of the glans penis. They are small concentric angio-myo-fibromatous proliferations without risk of malignization. It is a frequent opinion that pearly penile papules do not need any treatment, but there are some cases when they are very pronounced causing aesthetic and hygienic problem and influence the sexual self-esteem of the patients. Methods: Fourty-four patients with pronounced pearly penile papules treated by needle electrode coagulation from November 2009 to August 2011. Mean age was 24 years/19–32/. Careful monopolar electrocoagulation of the papules with needle electrode with 20-W energy/ ERBE ICC 80/used after topical lidocaine ointment and 0–5 mL 1% local lidocaine infiltration. Local rinse with diluted Betadine solution and epithelizing cream used for 2–3 weeks after the treatment. Results: All patients were satisfied with the cosmetic result. 11/25%/ patient required repeated coagulation of two to three residual papules later. One patient reported minor bleeding at 1 week after the procedure. No inflammation or any other complication observed. Conclusion: Monopolar electrocoagulation with needle electrode is a safe and effective method of treatment of pronounced pearly penile papules. Policy of full disclosure: None.

PO-15-013

ERECTILE DYSFUNCTION IN DIABETIC MEN Darabi Mahboub, M. R.; Taghavi, R.; Rezaei Ardani, A. Mashhad University of Medical, Urology in Imam Reza Hospital, Islamic Republic of Iran Objective: There is erectile dysfunction in diabetic men controlled and uncontrolled. We evaluated erectile dysfunction treatment in diabetic men in our department. Methods: Seventy patients with diabetic disease with age between 45 and 65 years evaluated in our department. They have erectile dysfunction (loss of libido, impotency or both). All of patients received Glybenclamid or Metformine or Insuline for his disease. Loss of libido there was in 28 patients and impotency there was in 30 patients and both in 14 cases. Hormonal study was done in all patients and hormonal imbalance there was in 30 patients (testosterone was low). Blood sugar controlled in all patients and all of patients treated for erectile dysfunction with androgen drugs, sildenafil or tadalafil or intracorporal injection with vasoactive drugs. Results: From 70 patients in our study 40 cases with loss of libido in 31 cases after treatment libido was very good are in 9 cases libido was better. In 44 cases with impotency in 28 cases there was full erection

J Sex Med 2011;8(suppl 5):406–469

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PHARMACOKINETICS OF AVANAFIL; A NOVEL, RAPIDLY-ABSORBED, SELECTIVE PDE5 INHIBITOR FOR THE TREATMENT OF MILD TO SEVERE ERECTILE DYSFUNCTION (ED) Allison, M.1; Grant, T.1; Obaidi, M.2; Marenco, T.3; Yee, S.4; Day, W.4 Celerion, Tempe, AZ, USA; 2Celerion, Lincoln, NE, USA; 3Celerion, Montreal, Canada; 4Vivus, Inc., Clinical Development, Mountain View, CA, USA

1

Objective: Avanafil, a potent (IC50 = 4.3–5.2 nM) PDE5 inhibitor with onset of action as early as 15 minutes, has been tested in several phase

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Unmoderated Poster Presentations 1 studies to elucidate its pharmacokinetic (PK) properties as it relates to age, food intake and single vs. multiple dosing in male subjects. Methods: Single (12.5–800 mg) and multiple oral doses (50–200 mg QD for 2 weeks and 200 mg BID for 1 week) were tested in young male subjects. A single 200-mg dose was administered to elderly males. The food effect study was conducted as a single dose (200 mg) crossover design. Results: Avanafil was rapidly absorbed after oral administration, with a median Tmax of 30–45 minutes and a terminal half-life (T1/2) of 3–5 hours. Single-dose pharmacokinetics of avanafil was comparable in elderly and young male subjects. Maximum concentration (Cmax) and plasma and area-under-the-curve (AUC) values increased in a linear manner from 12.5–600 mg and 12.5–800 mg, respectively. Data from multiple-dose studies showed no meaningful accumulation of avanafil based on AUC when administered once or twice daily over a 2-week or 1-week period, respectively. In a study of avanafil given during fasted and fed conditions, 90% confidence intervals of the AUC geometric LS means ratio were within 80–125%, however, Cmax was ∼39% lower and the median Tmax was delayed under fed vs. fasted conditions. Conclusion: Avanafil is rapidly absorbed from the gastrointestinal tract (Tmax 30–45 minutes), with a relatively short (3–5 hour) plasma T1/2, and the AUC was not influenced by ingestion of food. The PK of avanafil was linear, independent of age and did not accumulate on multiple dosing, suggesting that this novel PDE5 inhibitor has a PK profile well-suited for on-demand treatment of conditions such as erectile dysfunction. Policy of full disclosure: Studies sponsored by Vivus and conducted by Celerion.

PO-15-016

CLINICAL, BIOCHEMICAL, AND MALE GENITAL TRACT COLOR DOPPLER ULTRASOUND CORRELATES OF SEMINAL VESICLES STATIC AND DYNAMIC ULTRASOUND FEATURES IN MEN ATTENDING AN ANDROLOGY CLINIC FOR INFERTILITY Lotti, F.1; Corona, G.1; Colpi, G. M.2; Filimberti, E.1; Degli Innocenti, S.1; Mancini, M.2; Baldi, E.1; Noci, I.3; Forti, G.1; Maggi, M.1 1 University of Florence, Clinical Physiopathology, Italy; 2University of Milan, San Paolo Hospital, Italy; 3University of Florence, Obstetrics and Gynaecology, Italy Objective: Nowadays, studies concerning ultrasound (US) evaluation of seminal vesicles (SV) have been performed on limited series of subjects, often only before ejaculation and without assessing sexual abstinence of the patients. The aim of this study is to evaluate possible associations between SV static and dynamic US features and clinical, biochemical and male genital tract (MGT) color Doppler ultrasound (CDU) characteristics. Methods: SV of 368 men seeking medical care for couple infertility have been evaluated by US. All patients underwent simultaneous testosterone evaluation and seminal analysis, including seminal interleukin 8 (sIL-8), a reliable surrogate marker of prostate inflammatory diseases, along with scrotal and transrectal CDU, before and after ejaculation. Prostatitis symptoms were evaluated by National Institutes of HealthChronic Prostatitis Symptom Index questionnaire. A new dynamic parameter, SV ejection fraction (SVEF), has been calculated. Results: After adjusting for sexual abstinence and age, we observed that subjects with higher SV volume, before and after ejaculation, lower SVEF (<21.6%) or areas of endocapsulation (AE), reported more often prostatitis symptoms (higher NIH-CPSI score) and signs (higher sIL-8). Furthermore, subjects with higher post-ejaculatory SV volume, lower SVEF or AE, showed more often CDU signs of MGT inflammation (prostatic or epididymal CDU abnormalities) and of MGT subobstruction (ejaculatory duct dilation or cysts, higher epididymal-deferential diameters). Accordingly, subjects with lower SVEF showed also lower ejaculate volume and pH. In addition, higher SV volume was often associated with specific SV US findings (utricular

cyst, SV wall thickening and septa, SV giant cysts). No association between SV and testis US features or sperm parameters was observed. Conclusion: Higher SV volume, lower SVEF or AE are associated with prostatitis symptoms and signs, along with MGT CDU signs suggestive of inflammation and subobstruction. SVEF could represent a new dynamic parameter suggestive of subobstruction, in particular when <21.6%. Policy of full disclosure: None.

PO-15-017

IDIOPATHIC PARTIAL THROMBOSIS OF THE CORPUS CAVERNOSUM (IPT)—A CASE REPORT AND REVIEW OF THE LITERATURE Hulth, M.; Fode, M.; Bisbjerg, R.; Sønksen, J. Herlev Hospital, Department of Urology, Denmark Objective: IPT is a rare condition involving thrombosis within the proximal corpora cavernosa. We report a recent case and provide a review of the literature. Methods: A 35-year-old male treated for non-seminoma testicular cancer 6 years earlier presented with a 6-day history of a painful mass at the right base of the penis. The corpora and glans were flaccid. He denied drug use or trauma, but reported to be a devoted bicycle rider. There was no history of priapism or thrombosis. Biochemistry was normal and cancer recurrence was excluded. MRI showed a 6 × 2 cm thrombus, and a membranous structure within the corpora cavernosa (see figure below). The patient was treated with oral pain medication and anticoagulants for 1 month. Furthermore we conducted a systematic review of the literature on IPT. Results: At 1 month pain was reduced, and at 7 month both the pain and the thrombus were gone. However, the membranous structure was still present. At no point did the patient report erectile dysfunction. We identified 27 IPT cases in the literature. While the pathogenesis remains unknown, IPT has been associated with bicycle riding, vigorous sexual activity, drugs, hematological disease and priapism. A congenital septum within the corporal tissue, as seen in our patient, has also been implicated. Treatments have included surgery, shunts, and corporal injections, which have proven effective. Most commonly the condition has been treated with oral analgesics and anticoagulants and in all 13 cases with this treatment, resolution of symptoms and preservation of erectile function has been reported. Conclusion: Based on our experience and the available literature the first choice of treatment for IPT should be conservative and include pain medication and systemic anticoagulation. Policy of full disclosure: None.

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SURGICAL CORRECTION OF GRADE III GYNECOMASTIA AND ITS IMPACT ON SEXUALITY Shaeer, O. Cairo University, Andrology, Egypt Objective: Gynecomastia denotes benign enlargement of the male breast. It is a common belief that gynecomastia is stigmatizing and may frequently cause social embarrassment and psychological stress. It is possible that this may reflect on erectile function of the afflicted. High grade gynecomastia requires radical breast tissue excision and skin reduction ending up in aesthetically unappealing scars. The purpose of this study is to evaluate the reduction mammaplasty using no vertical scar technique in males with high grade gynecomastia; as regards technical refinements and outcome in the hope of providing a cosmetically appealing solution to this condition. This study also reports on the effect of high grade gynecomastia on erectile function, as well as the effect of surgery. Methods: Fifteen male patients with gynecomastia underwent breast reduction using the “no vertical scar reduction mammaplasty.” Erectile function was evaluated before and after surgery. Results: All patients but one were satisfied with the outcome. Complications were minimal and manageable. Eleven out of 15 patients had a preoperative IIEF score less than 20 denoting ED. All but one (N = 10) showed improvement in their IIEF score following surgery. The difference between preoperative IIEF (average 17.8) and postoperative (average 23.5) was statistically significant. Conclusion: The “no vertical scar reduction mammaplasty” is a reliable technique in cases with gynecomastia and significant ptosis. It has the added benefits of avoiding the vertical scar, hiding the transverse scar in the shadow of the inferior aspect of the breast, with minimal complications. Gynecomastia as a condition causing a feminized outlook may have a negative impact on self confidence and body image. We suggest that this may have a potential negative effect on erectile function that can be improved by adequate surgical correction. Policy of full disclosure: None.

PO-15-019

THE USE OF PHOTODYNAMIC THERAPY (PDT) IN THE TREATMENT OF PENILE VASCULAR MALFORMATIONS

Unmoderated Poster Presentations in all three cases. Posttreatment pain and swelling were successfully controlled with steroids and analgesics. Conclusion: PDT is a minimally invasive modality which can be used with success in the management of penile vascular malformations, with minimal side effects. Policy of full disclosure: None.

PO-15-020

THE CORRELATION BETWEEN CIRCUMCISION AND A DECREASE IN SENSITIVITY OF THE PENIS Kim, J. Y.; Kim, P. B. Pilip & Paul Medical Institut, Urology, Jeongjadong, Boondanggu, Korea Objective: There have been discussions from the medical perspective so far on the necessity of circumcision. One of the many disputes is the possibility of a decrease in penile sensitivity. Circumcision may cause edema and histologic changes. The authors have measured penis sensitivity after circumcision. This study aims to report the correlation between circumcision and a decrease in sensitivity of the penis. Methods: A biothesiometry test was conducted on men who have phimosis and those who were circumcised. For those who have phimosis, it was measured on the back area of the distal penis that is 1.5–2.0 cm from the glans corona and on the front area of the proximal penis that is 1.5–2.0 cm from the penopubic junction. For those who were circumcised, it was measured at the area between the glans corona and the incision line and on the front area of the proximal penis that is 1.5–2.0 cm from the penopubic junction. Results: The average age of men having phimosis is 41 years old and the number of subjects was 22. The threshold from the distal penis and that from the proximal penis was 6.4 and 6.3. The average age of men who were circumcised is 39 years old and the number of subjects were 81. The threshold from the distal penis and that from the proximal penis was 5.6 and 6.1. Conclusion: This study showed that the sensitivity that was expected to decrease due to a histological change from surgery turned out to be more sensitive on the distal area than on the proximal area. On the other hand, the men who were uncircumcised showed less sensitivity on the distal area than on the proximal area. Although the subjects were small in number, it is assumed from the findings that circumcision would not have any influence on a decrease in sensitivity of the penis. Policy of full disclosure: None.

PO-15-021

Raheem, A.1; Ralph, D.1; Hopper, C.2 1 University College London Hosp, Urology, UK; 2University College London Hosp, Oral and Maxillofacial Surgery, UK

THE INFLUENCE OF THE PENILE CONSTRICTION BAND AND THE PENILE CIRCUMFERENCE OF KOREAN MEN

Objective: Photodynamic therapy (PDT) is a minimally invasive technique that uses a photosensitizing drug that is activated by exposure to a laser light of a specific wavelength. Illumination of the target site by light at the activating wavelength, excites the photosensitizing drug and results in the destruction of cells by a non-free radical oxidative process with cytotoxic activity and microvascular damage. Because PDT is a cold photochemical process, there is no tissue heating, and connective tissues are relatively unaffected, thus there is healing of the treated site with minimal scarring. This study looks into the use of PDT in the treatment of penile vascular malformations. Methods: Three patients with penile vascular malformations were included. All received Foscan 0.15 mg/kg given by slow intravenous injection 4 days before therapy. The dose of light was 20 joules per bare tip fiber. PDT was conducted under a general anesthetic. Fibers were positioned in the lesion via Ultrasound guidance (2) and clinically (1) using spinal needles. Following treatment there was controlled re-exposure to light over 2–3 weeks with sunlight avoidance with the use of sunglasses. Results: While posttreatment pain was significant, there were no immediate or delayed complications. Outcome was assessed by MRI at 3 months following therapy, and showed a significant reduction in the volume of abnormal tissue without damage to the overlying skin

Kim, J. Y.; Kim, P. B. Pilip & Paul Medical Institut, Urology, Jeongjadong, Boondanggu, Korea

J Sex Med 2011;8(suppl 5):406–469

Objective: The penile constrictive band that is commonly observed on the penis of men who were not circumcised. Negative influences due to constrictive bands include sexual pain, skin damage, edema, and inferior growth. In the event that a serious constrictive band was created clinically, it is often observed that circumference around the band is thinner than other areas. The authors of this study aim to report the influence of constrictive bands, in the flaccid state of penis, and on the penile circumference. Methods: The subjects of this study were men who were not circumcised. The circumference was measured in three areas: in the fully flaccid state of the penis; second, it was measured at the the distal penis that is 1.5–2.0 cm from the glans corona; and third, on the constrictive band area and on the proximal penis that is 1.5 cm from the penopubic junction. Results: The number of subjects were 18 and the average age of the subjects was 41.6 years old. As to the circumference, it was 7.4 cm of the penile distal area; 7.1 cm of the constrictive band area; and 7.9 cm of the penile proximal area. The circumference of the proximal area was longer than that of the distal area.

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Unmoderated Poster Presentations Conclusion: This study confirmed a decrease in the circumference of the penile constrictive band that has been generally observed clinically although the subjects in this study were small in number. Although more research is required to confirm these conclusions, considering the possibility that a serious constrictive band may deter the growth of the penis and generate other side effects, circumcision may be considered in a positive light in order to insure preventive effects. Policy of full disclosure: None.

PO-15-022

CROSS-CULTURAL ANALYSIYS OF SEXUAL SELF-DISCLOUSURE AMONG COUPLES Quattrini, F.; Belfiglio, E. University of l’Aquila, Italy Objective: The scientific literature on human sexuality underlines the importance of the Self- Disclosure as a real need of people to discuss many aspects of themselves with others. The analysis of a specific Sexual self-Disclosure among couples is one of the purposes of the present study. We aimed to inquire, the existence of differences about the Grade of Sexual Self-Disclosure between two different samples sourced from different geographic areas. Methods: The study involves 170 college students like sample, 80 from Italy and 80 from the United States, 54%male and 46% female, from 18 to 42 years old. The research is made using the Revised Sexual Self-disclosure Scale (SSDS) of W. Snell et al. 1989, consisting of 24 three-item subscales measuring people’s willingness to discuss many sexual topics. Results: By conducting the analysis of variance (anova) we found out that there are no statistic meaningful differences between the American and Italian students sampled. We just found out that only three variables, (F17 Sexual calmness, F8 Sexual dishonesty and F9 Sexual delay preferences) behave differently inside the randoms compared to the two factors we found (Factor 1, Positive aspects of sexuality and Factor 2-Negative aspects of sexuality). Conclusion: Moreover, Stereotypes inside the two different samples are much more stronger than the differences. As much as the randoms are geographically far from each other, they behave, instead, definitely in the same way about Sexual Self-disclosure’s Grade. That happened because of similar stereotypes inside both samples and also for the fact that social-cultural-environmental factors inside them, are almost the same. Focalizing maybe the same research on two different samples, first of all culturally and then geographically apart, (ex. India or Asia), will let us be able to point out more meaningful statistical differences. Policy of full disclosure: None.

ADDENDUM PO-11-010

AWARENESS OF PREMATURE EJACULATION (PE) IN AUSTRIA: ANALYSES OF >5000 INTERNET-BASED DATA Müller Raphael M.D.1, Pinggera M. Germar M.D.1, Horninger Wolfgang Univ.Prof.1, Jungwirth Andreas Univ. Prof.2 1 Medical University of Innsbruck- Dept. of Urology; 2EMCO private hospital Salzburg Objective: The aim of the present study was to assess the awareness and psychological strain of premature ejaculation (PE) in Germanspeaking heterosexual men in Austria. Design and Methods: The Index of Premature Ejaculation questionnaire (IPE) was self-administered by 5489 men by an open access, internet-based platform from 12/2009 to 03/2011. The 10-item questionnaire was originally designed to investigate subjectively perceived control over ejaculation, sexual satisfaction and distress in men suffering from PE. Symptoms have to be present for at least 4 weeks and were scaled from 1, in case of highest distress, to maximum of 5. Subanalysis and age stratification in decades were performed to assess the impact of age dependency in PE awareness. Results: A total of 5489 male participants with a mean age of 36.5 years (range 16 to 76) completed the IPE independently and without any specific instruction; 284 out of them (5.2%) were excluded due to implausible or missing values. The results are reported in the table below. 44% of all participants were between 16 to 31 years of age. The item sexual satisfaction with a mean score of 3.17 decreased independently of aging. In contrast, young subjects had more problems in ejaculation-control with an average scoring of 2.22 compared to older the group 2.46 points (46–61).

age-group

participants

percent

control

satisfaction

psychological strain

16–31 32–45 46–61 62–76

2229 1521 1041 297

44 30 20 6

2,22 2,30 2,46 2,72

3,23 3,08 3,13 3,24

3,42 3,20 3,08 2,92

Conclusion: This is the first and largest open access study conducted in Austria reflecting a general increased awareness of PE. Individuals with PE are searching specifically for help in internet-based, anonymous platforms. The high percentage of young participants completing the IPE questionnaire suggests not only a higher degree of information lack for this age group but even more some kind of psychological insecurity. Accordingly, youngest men showed the lowest ability for ejaculation control. Medical professionals should take into account that PE is a perceived distressing condition for affected men irrespective of aging. Even in a developed European country, these men are actively seeking for help via the internet. The high interest shown soon after launching the IPE questionnaire shows the need to offer specific help to men suffering from PE.

J Sex Med 2011;8(suppl 5):406–469