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133 Grey-Scale Penile Ultrasound Findings in Young Men with Erectile Dysfunction (ED) Who Used Finasteride for Androgenic Alopecia: A Retrospective Review
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SMSNA Abstracts 1
Bayer AG, Germany; 2Private Urology Practice, Bremerhaven, Germany; 3Boston University School of Public Health, Boston, MA, USA; 4Boston University School of Medicine, Boston, MA, USA
Objective: Effects of long-term testosterone therapy (TTh) on anthropometric parameters in hypogonadal men published so far are from observational registry studies. Here, we present data of propensity-matched subgroups from a controlled registry study. Methods: Of 656 hypogonadal men from a single center’s registry study, 360 opted for (T-group) and 296 against TTh (CTRL). 82 patients from each group were propensity-matched by age, waist circumference and BMI resulting in 82 matched pairs (n¼164). 8 year results were analyzed. Estimated differences between groups were adjusted for components of the metabolic syndrome and quality of life (Aging Males’s Symptoms scale). Results: Mean age was 61.6±4.2 years, mean follow-up time 6.7, median 7 years. T-levels rose from 277±41 to trough levels of 481±54 ng/dL in the T-group (p<0.0001) and dropped from 276±33 to 253±47 in CTRL (p<0.05). Waist circumference decreased from 106.1±9.2 to 98.3±6.0 cm in the T-group (p<0.0001) and increased from 106.0±6.7 to 107.7±5.7 cm in CTRL (p<0.005), difference between groups: -11.1 cm (p<0.0001). Weight decreased from 96.7±15.8 to 83.2±8.4 kg in the T-group (p<0.0001) and increased from 93.9±9.4 to 95.1±7.8 in CTRL (NS), difference between groups: -18.9 kg (p<0.0001). Body mass index (BMI) decreased from 30.7±4.9 to 26.6±2.6 kg/m2 in the T-group (p<0.0001) and increased from 30.5±3.3 to 31.0±3.0 kg/m2 in CTRL (NS), difference between groups: -6.0 kg/m2 (p<0.0001). The per cent weight change at 8 years was -13.6±9.0% in the T-group (p<0.0001) vs +0.9±2.1% in CTRL (NS), difference between groups: -18.1% (p<0.0001). The waist:height ratio declined from 0.6±0.05 to 0.56±0.03 in the T-group (p<0.0001) and increased from 0.6±0.04 to 0.61±0.04 in CTRL (p<0.05), difference between groups: -0.06 (p<0.0001). Major adverse cardiovascular events (MACE): in CTRL, there were 5 deaths (6.1%), 8 myocardial infarctions (9.8%), and 8 strokes (9.8%). There were no MACE in the testosterone-treated group. Medication adherence in the T-group was 100 per cent as all injections were performed in the doctor’s office and documented. Conclusions: Weight, waist circumference and BMI decreased in a progressive and sustained fashion in men receiving long-term testosterone therapy and increased with advancing age in untreated hypogonadal controls. These changes may have contributed to reducing MACE in hypogonadal men receiving adequate TTh. Disclosure: Work supported by industry: yes, by Bayer AG, Berlin, Germany (industry funding only - investigator initiated and executed study). The presenter or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.
J Sex Med 2017;14:e1ee104
133 GREY-SCALE PENILE ULTRASOUND FINDINGS IN YOUNG MEN WITH ERECTILE DYSFUNCTION (ED) WHO USED FINASTERIDE FOR ANDROGENIC ALOPECIA: A RETROSPECTIVE REVIEW Goldstein, I.1; King, S.A.2; Goldstein, S.W.2 1 Alvarado Hospital, USA; 2San Diego Sexual Medicine, United States Objectives: ED has been reported following use of finasteride in young men with androgenic alopecia. Animal studies reveal erectile tissue fibrosis after exposure to 5 alpha reductase inhibitors. Material and Methods: 8 men (mean age 32) met inclusion/ exclusion criteria: potent prior to and developed ED since use of finasteride for androgenic alopecia; less than 40 years old without obvious cardiovascular risk factor exposure; underwent Greyscale and color duplex Doppler ultrasound (Aixplorer 15.4 MHz transducer) during maximal pharmacologic erection, performed using axial B-mode imaging at multiple gains/multiple locations. Presence/absence of erectile tissue homogeneity or observation of hyperechoic/hypoechoic regions, presence/absence of cavernosal artery atherosclerosis, cavernosal artery diameter, and tunical thickness values were noted. Most patients completed: International Index of Erectile Function (IIEF), Sexual Distress ScaleRevised (SDS-R), Patient Heath Questionnaire (PHQ-9), Perceived Stress Scale (PSS) questionnaires. Results: Patients used finasteride for mean 7.4 years. Other complaints were low libido (63%), orgasm dysfunction (50%), cognitive changes (50%), mood changes (50%). Dihydrotestosterone (DHT) blood test values were low/in lower tertile in 63%. On IIEF, EF domain scores were < 26/30, mean 15; mean scores for desire, orgasm, intercourse satisfaction, overall sexual satisfaction were 5/10, 7.7/10, 6.6/15, 3.2/10 respectively, with mean total IIEF score 37.3/75. SDS-R scores were abnormal with depression and stress noted in 71% and 86%. All 8 patients had lack of homogeneity with obvious hyperechoic/hypoechoic regions in erectile tissue consistent with mild to mild-moderate corporal erectile tissue fibrosis. Other Grey-scale measurements included: absent atherosclerosis in right/left cavernosal arteries, mean dorsal/ ventral tunical thickness 1.3/1.2 mm; mean right/left cavernosal artery diameter 1.1/1.0 mm. Color duplex Doppler studies revealed mean right/left peak systolic velocity values 23.2/25.2 cm/sec, and mean right/left end diastolic velocity values 1.5/1.4 cm/sec. Conclusions: All results were consistent with corporal erectile tissue fibrosis. We thus propose the following hypothesis: low DHT induced corporal smooth muscle cells to undergo apoptosis and replacement by corporal connective tissue; altered smooth muscle to connective tissue imbalance results in lack of homogeneity and hyperechoic/hypoechoic regions in erectile tissue. Drug-induced ED is the consequence. Disclosure: Work supported by industry: no.
SMSNA Abstracts 1
Bayer AG, Germany; 2Private Urology Practice, Bremerhaven, Germany; 3Boston University School of Public Health, Boston, MA, USA; 4Boston University School of Medicine, Boston, MA, USA
Objective: Effects of long-term testosterone therapy (TTh) on anthropometric parameters in hypogonadal men published so far are from observational registry studies. Here, we present data of propensity-matched subgroups from a controlled registry study. Methods: Of 656 hypogonadal men from a single center’s registry study, 360 opted for (T-group) and 296 against TTh (CTRL). 82 patients from each group were propensity-matched by age, waist circumference and BMI resulting in 82 matched pairs (n¼164). 8 year results were analyzed. Estimated differences between groups were adjusted for components of the metabolic syndrome and quality of life (Aging Males’s Symptoms scale). Results: Mean age was 61.6±4.2 years, mean follow-up time 6.7, median 7 years. T-levels rose from 277±41 to trough levels of 481±54 ng/dL in the T-group (p<0.0001) and dropped from 276±33 to 253±47 in CTRL (p<0.05). Waist circumference decreased from 106.1±9.2 to 98.3±6.0 cm in the T-group (p<0.0001) and increased from 106.0±6.7 to 107.7±5.7 cm in CTRL (p<0.005), difference between groups: -11.1 cm (p<0.0001). Weight decreased from 96.7±15.8 to 83.2±8.4 kg in the T-group (p<0.0001) and increased from 93.9±9.4 to 95.1±7.8 in CTRL (NS), difference between groups: -18.9 kg (p<0.0001). Body mass index (BMI) decreased from 30.7±4.9 to 26.6±2.6 kg/m2 in the T-group (p<0.0001) and increased from 30.5±3.3 to 31.0±3.0 kg/m2 in CTRL (NS), difference between groups: -6.0 kg/m2 (p<0.0001). The per cent weight change at 8 years was -13.6±9.0% in the T-group (p<0.0001) vs +0.9±2.1% in CTRL (NS), difference between groups: -18.1% (p<0.0001). The waist:height ratio declined from 0.6±0.05 to 0.56±0.03 in the T-group (p<0.0001) and increased from 0.6±0.04 to 0.61±0.04 in CTRL (p<0.05), difference between groups: -0.06 (p<0.0001). Major adverse cardiovascular events (MACE): in CTRL, there were 5 deaths (6.1%), 8 myocardial infarctions (9.8%), and 8 strokes (9.8%). There were no MACE in the testosterone-treated group. Medication adherence in the T-group was 100 per cent as all injections were performed in the doctor’s office and documented. Conclusions: Weight, waist circumference and BMI decreased in a progressive and sustained fashion in men receiving long-term testosterone therapy and increased with advancing age in untreated hypogonadal controls. These changes may have contributed to reducing MACE in hypogonadal men receiving adequate TTh. Disclosure: Work supported by industry: yes, by Bayer AG, Berlin, Germany (industry funding only - investigator initiated and executed study). The presenter or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.
J Sex Med 2017;14:e1ee104
133 GREY-SCALE PENILE ULTRASOUND FINDINGS IN YOUNG MEN WITH ERECTILE DYSFUNCTION (ED) WHO USED FINASTERIDE FOR ANDROGENIC ALOPECIA: A RETROSPECTIVE REVIEW Goldstein, I.1; King, S.A.2; Goldstein, S.W.2 1 Alvarado Hospital, USA; 2San Diego Sexual Medicine, United States Objectives: ED has been reported following use of finasteride in young men with androgenic alopecia. Animal studies reveal erectile tissue fibrosis after exposure to 5 alpha reductase inhibitors. Material and Methods: 8 men (mean age 32) met inclusion/ exclusion criteria: potent prior to and developed ED since use of finasteride for androgenic alopecia; less than 40 years old without obvious cardiovascular risk factor exposure; underwent Greyscale and color duplex Doppler ultrasound (Aixplorer 15.4 MHz transducer) during maximal pharmacologic erection, performed using axial B-mode imaging at multiple gains/multiple locations. Presence/absence of erectile tissue homogeneity or observation of hyperechoic/hypoechoic regions, presence/absence of cavernosal artery atherosclerosis, cavernosal artery diameter, and tunical thickness values were noted. Most patients completed: International Index of Erectile Function (IIEF), Sexual Distress ScaleRevised (SDS-R), Patient Heath Questionnaire (PHQ-9), Perceived Stress Scale (PSS) questionnaires. Results: Patients used finasteride for mean 7.4 years. Other complaints were low libido (63%), orgasm dysfunction (50%), cognitive changes (50%), mood changes (50%). Dihydrotestosterone (DHT) blood test values were low/in lower tertile in 63%. On IIEF, EF domain scores were < 26/30, mean 15; mean scores for desire, orgasm, intercourse satisfaction, overall sexual satisfaction were 5/10, 7.7/10, 6.6/15, 3.2/10 respectively, with mean total IIEF score 37.3/75. SDS-R scores were abnormal with depression and stress noted in 71% and 86%. All 8 patients had lack of homogeneity with obvious hyperechoic/hypoechoic regions in erectile tissue consistent with mild to mild-moderate corporal erectile tissue fibrosis. Other Grey-scale measurements included: absent atherosclerosis in right/left cavernosal arteries, mean dorsal/ ventral tunical thickness 1.3/1.2 mm; mean right/left cavernosal artery diameter 1.1/1.0 mm. Color duplex Doppler studies revealed mean right/left peak systolic velocity values 23.2/25.2 cm/sec, and mean right/left end diastolic velocity values 1.5/1.4 cm/sec. Conclusions: All results were consistent with corporal erectile tissue fibrosis. We thus propose the following hypothesis: low DHT induced corporal smooth muscle cells to undergo apoptosis and replacement by corporal connective tissue; altered smooth muscle to connective tissue imbalance results in lack of homogeneity and hyperechoic/hypoechoic regions in erectile tissue. Drug-induced ED is the consequence. Disclosure: Work supported by industry: no.