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1153 ERECTILE HEMODYNAMICS ASSESSMENT IN MEN WITH PERSISTENT ERECTILE DYSFUNCTION AFTER 5-ALPHA REDUCTASE INHIBITOR USE
Vol. 187, No. 4S, Supplement, Monday, May 21, 2012
and the mean waist circumference (WC) drop was 11 cm ⫾ 6 [-13; 24]. There is a strong linear relationship between weight loss, decrease in BMI and decrease in WC and time on TU treatment (Fig 1). CONCLUSIONS: Long-term treatment with TU testosterone replacement therapy results in significant reduction of all parameters of obesity.
THE JOURNAL OF UROLOGY姞
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life as well as a markedly reduced frequency of sexual activity. Sexual satisfaction was directly associated with QOL but not with age, level or grade of SCI, capacity to have ejaculation and type of urinary management. Source of Funding: None
1153 ERECTILE HEMODYNAMICS ASSESSMENT IN MEN WITH PERSISTENT ERECTILE DYSFUNCTION AFTER 5-ALPHA REDUCTASE INHIBITOR USE Raanan Tal*, Nelson E. Bennett, Doron S. Stember, Darren J. Katz, Joseph B. Narus, Andrea Martelli, John P. Mulhall, New York, NY
Source of Funding: None
1152 IMPACT OF SPINAL CORD INJURY IN MALE SEXUAL FUNCTION Jose Castro, Cristiano Gomes*, Jose Bessa Jr, Homero Bruschini, Carmita Abdo, Luiz Abreu, Julio Araujo Filho, Daniel Souza, Marcia Scazufca, Eduardo Miranda, Victor Srougi, Linamara Battistella, Tarcisio Barros, Miguel Srougi, Sao Paulo, Brazil INTRODUCTION AND OBJECTIVES: Spinal cord injury (SCI) may have a devastating impact on the sexual function. We assessed the sexual life of men with SCI and its impact in their sexual satisfaction, adjustments in sexual life and overall quality of life (QOL) as well as association with depressive symptoms. METHODS: We prospectively evaluated 185 men with SCI (⬎12 months) with a mean age of 41.6 ⫾ 14.7 years (range 18 to 75). Mean time from SCI was 6.21 ⫾ 5.3 years. SCI level was cervical in 67 (36.2%) patients, thoracic in 99 (53.%) and lumbar in 19 (10.2 %). The American Spinal Injury Association (ASIA) impairment scale was A in 112 (60.5%) patients, B in 29 (15.7%), C in 20 (10.8%), D in 15 (8.1%) and E in 9 (4.9%). A structured questionnaire was applied to all subjects including the International Index of Erectile Function (IIEF-5), the Life Satisfaction questionnaire (LiSat - general QOL) and a detailed sexual anamnesis regarding orgasmic and ejaculatory functions, frequency and modalities of sexual activities and overall satisfaction with sexual life. Urinary continence and type of urinary management was also evaluated. RESULTS: The mean satisfaction with sexual life varied from 8.73 ⫾ 2.1 to 3.8 ⫾ 2.9 (0 ⫽ dissatisfied and 10⫽ satisfied; p⬍ 0.001) before and after SCI, respectively. Before SCI, 149 (80.5%) patients had a frequency of ⬎4 monthly sexual intercourses, 24 (13%) had 1 to 4/month, 3(1.6%) ocasional intercourse and 9 (4.9%) were not sexually active. After SCI, 79 (42.7%) patients were sexually inactive, 40 (21.6%) had occasional intercourses (⬍1/month), 39 (21.1%) had 1 to 4/month and 27 (14.6) had ⬎ 4/month (p⬍0.0001). Vaginal, oral, anal sex, and masturbation were performed by 98,2%, 45.6%,25.0%, and 37.0% of the patients before SCI and by 57,7%, 16,3%, 7.7% and 9.5% after SCI. The median IIEF score after SCI was 9 [3-18]. Only 40(21.6%) patients were able to ejaculate. Urinary management consisted of intermittent catheterization in 116 (62.7%) patients, condom catheter in 19 (10.2%), Foley catheter in 8 (4.3%) while 30 (16.2%) used no catheters. The median LiSat score was 35 [29-41]. Sexual satisfaction was directly associated with general QOL (r⫽ 0,584, p⬍ 0.001) and was not associated with age, level or grade of SCI, capacity to have orgasm/ejaculation, urinary continence and type of urinary management. CONCLUSIONS: Sexual function is tremendously affected by SCI leading to a significant decrease in overall satisfaction with sexual
INTRODUCTION AND OBJECTIVES: There has been tremendous interest recently in the concept that 5-alpha reductase inhibitors (5-ARI) are associated with persistent sexual side effects after cessation of these medications. While there is animal evidence supporting structural and functional changes in erectile tissue and some human evidence supporting alterations in neurosteroid production, there does not yet exist any formal objective erectile function assessment in such patients. This analysis was conducted to define the erectile hemodynamic profiles of men presenting with this condition. METHODS: Study population consisted of: (i) men presenting with the complaint of erectile dysfunction (ED) only after commencement of 5-ARI (ii) presentation to sexual medicine clinic ⱖ6 months (m) after cessation of 5-ARI and (iii) at least 3 months use of 5-ARI (finasteride, dutasteride). Demographic data, comorbidity parameters and treatment history were recorded. All patients underwent duplex Doppler penile ultrasound (DUS) in a vasoactive agent re-dosing fashion. Criteria for normal erectile hemodynamics were PSV⬎30cm/s and EDV⬍5cm/s. RESULTS: 35 men had a mean age ⫽ 36⫾18 years (y). 27 had used Propecia (Group A) for alopecia prevention. 8 had used 5-ARI (Proscar 5, Avodart 3) for benign prostate hyperplasia (BPH) (Group B). Mean ages in these groups ⫽ 27⫾7y, 48⫾11y respectively. Median vascular risk factor (VRF) number: A 1 (0-2); B 2 (0-4). Duration of 5-ARI exposure: A 17⫾11 months (m); B 18⫾22m. Duration off 5-ARI at presentation: A 9⫾7 (6-22)m; B 11⫾10 (6-37)m. None had ED prior to 5-ARI use. Overall, mean PSV and EDV values ⫽ 62⫾22cm/s and 1.5⫾1.5 cm/s respectively. 2/35 DUS were demonstrating impaired cavernosal artery inflow with mean PSV ⫽ 24 (22-26) cm/s. Both these men were in Group B, were ⱖ50y old and both had ⱖ2 VRF. CONCLUSIONS: In this group of men complaining of ED onset after 5-ARI use, erectile hemodynamics were normal in Propecia users. 2/8 men with ED onset after use of 5-ARI for BPH had abnormal DUS although it is plausible that these changes are related to VRF-associated vascular changes rather than the 5-ARI exposure. Source of Funding: None
1154 ASSOCIATION BETWEEN CHRONIC PROSTATITIS/CHRONIC PELVIC PAIN SYNDROME AND ERECTILE DYSFUNCTION: A POPULATION-BASED STUDY Wei-Che Wu*, Shiu-Dong Chung, New Taipei City, Taiwan; Herng-Ching Lin, Taipei, Taiwan INTRODUCTION AND OBJECTIVES: Previous studies have demonstrated that chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) has a negative influence on erectile function. All the previous studies focused on the prevalence of erectile dysfunction (ED) among patients with CP/CPPS and neglected to explore the magnitude of this association. Using a population-based dataset, this study aimed to examine the association between ED and a previous diagnosis of CP/CPPS. METHODS: The data for this case-control study was sourced from the National Health Insurance Database.
and the mean waist circumference (WC) drop was 11 cm ⫾ 6 [-13; 24]. There is a strong linear relationship between weight loss, decrease in BMI and decrease in WC and time on TU treatment (Fig 1). CONCLUSIONS: Long-term treatment with TU testosterone replacement therapy results in significant reduction of all parameters of obesity.
THE JOURNAL OF UROLOGY姞
e467
life as well as a markedly reduced frequency of sexual activity. Sexual satisfaction was directly associated with QOL but not with age, level or grade of SCI, capacity to have ejaculation and type of urinary management. Source of Funding: None
1153 ERECTILE HEMODYNAMICS ASSESSMENT IN MEN WITH PERSISTENT ERECTILE DYSFUNCTION AFTER 5-ALPHA REDUCTASE INHIBITOR USE Raanan Tal*, Nelson E. Bennett, Doron S. Stember, Darren J. Katz, Joseph B. Narus, Andrea Martelli, John P. Mulhall, New York, NY
Source of Funding: None
1152 IMPACT OF SPINAL CORD INJURY IN MALE SEXUAL FUNCTION Jose Castro, Cristiano Gomes*, Jose Bessa Jr, Homero Bruschini, Carmita Abdo, Luiz Abreu, Julio Araujo Filho, Daniel Souza, Marcia Scazufca, Eduardo Miranda, Victor Srougi, Linamara Battistella, Tarcisio Barros, Miguel Srougi, Sao Paulo, Brazil INTRODUCTION AND OBJECTIVES: Spinal cord injury (SCI) may have a devastating impact on the sexual function. We assessed the sexual life of men with SCI and its impact in their sexual satisfaction, adjustments in sexual life and overall quality of life (QOL) as well as association with depressive symptoms. METHODS: We prospectively evaluated 185 men with SCI (⬎12 months) with a mean age of 41.6 ⫾ 14.7 years (range 18 to 75). Mean time from SCI was 6.21 ⫾ 5.3 years. SCI level was cervical in 67 (36.2%) patients, thoracic in 99 (53.%) and lumbar in 19 (10.2 %). The American Spinal Injury Association (ASIA) impairment scale was A in 112 (60.5%) patients, B in 29 (15.7%), C in 20 (10.8%), D in 15 (8.1%) and E in 9 (4.9%). A structured questionnaire was applied to all subjects including the International Index of Erectile Function (IIEF-5), the Life Satisfaction questionnaire (LiSat - general QOL) and a detailed sexual anamnesis regarding orgasmic and ejaculatory functions, frequency and modalities of sexual activities and overall satisfaction with sexual life. Urinary continence and type of urinary management was also evaluated. RESULTS: The mean satisfaction with sexual life varied from 8.73 ⫾ 2.1 to 3.8 ⫾ 2.9 (0 ⫽ dissatisfied and 10⫽ satisfied; p⬍ 0.001) before and after SCI, respectively. Before SCI, 149 (80.5%) patients had a frequency of ⬎4 monthly sexual intercourses, 24 (13%) had 1 to 4/month, 3(1.6%) ocasional intercourse and 9 (4.9%) were not sexually active. After SCI, 79 (42.7%) patients were sexually inactive, 40 (21.6%) had occasional intercourses (⬍1/month), 39 (21.1%) had 1 to 4/month and 27 (14.6) had ⬎ 4/month (p⬍0.0001). Vaginal, oral, anal sex, and masturbation were performed by 98,2%, 45.6%,25.0%, and 37.0% of the patients before SCI and by 57,7%, 16,3%, 7.7% and 9.5% after SCI. The median IIEF score after SCI was 9 [3-18]. Only 40(21.6%) patients were able to ejaculate. Urinary management consisted of intermittent catheterization in 116 (62.7%) patients, condom catheter in 19 (10.2%), Foley catheter in 8 (4.3%) while 30 (16.2%) used no catheters. The median LiSat score was 35 [29-41]. Sexual satisfaction was directly associated with general QOL (r⫽ 0,584, p⬍ 0.001) and was not associated with age, level or grade of SCI, capacity to have orgasm/ejaculation, urinary continence and type of urinary management. CONCLUSIONS: Sexual function is tremendously affected by SCI leading to a significant decrease in overall satisfaction with sexual
INTRODUCTION AND OBJECTIVES: There has been tremendous interest recently in the concept that 5-alpha reductase inhibitors (5-ARI) are associated with persistent sexual side effects after cessation of these medications. While there is animal evidence supporting structural and functional changes in erectile tissue and some human evidence supporting alterations in neurosteroid production, there does not yet exist any formal objective erectile function assessment in such patients. This analysis was conducted to define the erectile hemodynamic profiles of men presenting with this condition. METHODS: Study population consisted of: (i) men presenting with the complaint of erectile dysfunction (ED) only after commencement of 5-ARI (ii) presentation to sexual medicine clinic ⱖ6 months (m) after cessation of 5-ARI and (iii) at least 3 months use of 5-ARI (finasteride, dutasteride). Demographic data, comorbidity parameters and treatment history were recorded. All patients underwent duplex Doppler penile ultrasound (DUS) in a vasoactive agent re-dosing fashion. Criteria for normal erectile hemodynamics were PSV⬎30cm/s and EDV⬍5cm/s. RESULTS: 35 men had a mean age ⫽ 36⫾18 years (y). 27 had used Propecia (Group A) for alopecia prevention. 8 had used 5-ARI (Proscar 5, Avodart 3) for benign prostate hyperplasia (BPH) (Group B). Mean ages in these groups ⫽ 27⫾7y, 48⫾11y respectively. Median vascular risk factor (VRF) number: A 1 (0-2); B 2 (0-4). Duration of 5-ARI exposure: A 17⫾11 months (m); B 18⫾22m. Duration off 5-ARI at presentation: A 9⫾7 (6-22)m; B 11⫾10 (6-37)m. None had ED prior to 5-ARI use. Overall, mean PSV and EDV values ⫽ 62⫾22cm/s and 1.5⫾1.5 cm/s respectively. 2/35 DUS were demonstrating impaired cavernosal artery inflow with mean PSV ⫽ 24 (22-26) cm/s. Both these men were in Group B, were ⱖ50y old and both had ⱖ2 VRF. CONCLUSIONS: In this group of men complaining of ED onset after 5-ARI use, erectile hemodynamics were normal in Propecia users. 2/8 men with ED onset after use of 5-ARI for BPH had abnormal DUS although it is plausible that these changes are related to VRF-associated vascular changes rather than the 5-ARI exposure. Source of Funding: None
1154 ASSOCIATION BETWEEN CHRONIC PROSTATITIS/CHRONIC PELVIC PAIN SYNDROME AND ERECTILE DYSFUNCTION: A POPULATION-BASED STUDY Wei-Che Wu*, Shiu-Dong Chung, New Taipei City, Taiwan; Herng-Ching Lin, Taipei, Taiwan INTRODUCTION AND OBJECTIVES: Previous studies have demonstrated that chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) has a negative influence on erectile function. All the previous studies focused on the prevalence of erectile dysfunction (ED) among patients with CP/CPPS and neglected to explore the magnitude of this association. Using a population-based dataset, this study aimed to examine the association between ED and a previous diagnosis of CP/CPPS. METHODS: The data for this case-control study was sourced from the National Health Insurance Database.