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273 Efficacy of Dapoxetine in the Treatment of Premature Ejaculation Patients Who Previously Failed Sertraline Therapy
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is that with both high patient adherence and close health care provider monitoring, hormonal management will lead to subjective and objective improvements in signs and symptoms. Material and Methods: The aim of this study was to evaluate clinical benefit of hormonal replacement strategies for management of sexual dysfunction and GSM utilizing pre- and posttreatment: blood test monitoring; Female Sexual Function Index (FSFI) scores; and vulvoscopy findings. Charts from August 1, 2007 through December 1, 2015 were reviewed. Five bioidentical hormonal replacement efforts are designed to keep serum estradiol levels 35-50 pg/ml, serum progesterone levels at 1.0 ng/ml and calculated free testosterone levels at 0.8 ng/dl including daily topical vestibular and vaginal estradiol and testosterone applications. Subjects included were peri-menopausal or post-menopausal at their initial visit, naturally or surgically, and have both an initial and at least one follow-up vulvoscopy. Exclusions included cosmetic vulvar or vestibular surgery. Results: 110 menopausal women (mean age 62+/-13 years) with sexual health complaints met study criteria. Mean follow-up was 2.6+/-1.3 years. Pre-treatment vulvoscopic findings of labia minora resorption, urethral meatus telescoping, clitoral atrophy, vestibular erythema tenderness and pallor, minimally robust periurethral tissue, minimal vaginal rugae, with thin, pale vaginal mucosa and abnormal vaginal pH were noted in 100%. Serum sex steroid values returned to ideal values in 81%. FSFI total scores increased more than 5 points in 72%. Post-treatment vulvoscopic changes revealed pink moist pain-free vestibular tissue in 63%. Conclusion: Managing menopause with patient adherence and close monitoring, hormonal menopausal management has lead to subjective and objective improvement of female sexual function. Disclosure: Work supported by industry: no. The presenter or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry. 272 RENEWAL OF SEXUAL AND REPRODUCTIVE FUNCTIONS IN MEN WITH TRANSURETHRAL CATHETERIZATION OF THE EJACULATORY DUCTS Knigavko, O.1 1 Kharkiv National Medical University, Ukraine Objective: A frequent complication of chronic prostato-vesiculitis is prostate fibrosis and obstruction of ejaculatory ducts (EjD). Clinically it is manifested as obstructive azoospermia and often, premature ejaculation and dysorgasmia. Materials and methods: For the treatment of recent (less than 1 year) obstruction EjD, we developed and implemented a
WMSM 2016 Abstracts
method of transurethral catheterization and balloon dilation of the ducts. In 2005-2016, 77 patients with prostate fibrosis and obstructive azoospermia (56 patients noted an accelerated, obliterated, painful orgasm) on the background of antibacterial treatment of prostatitis underwent transurethral catheterization (TUC) and balloon dilatation of EjD. After 2 weeks and 3 months, we carried out a survey and semen analysis. Results: In 21 patients (27.3%), 2 weeks after TUC, spermatozoa were found in semen. After 3 months, the spermatozoa were still detected in 37 (48.1%), and in general, 58 patients with spermatozoa (75.4%). In 35 female patients diagnosed through a 1-4.2 year natural pregnancy. From 56 patients, marked improvement orgasm sensation was showed in 51 (91.1%) and prolonged to normal IVLT. Conclusion: Transurethral catheterization of EjD is a new effective treatment for obstructive prostatic azoospermia (75.4%) and improving orgasm sensations in 91.1% of patients with chronic prostate-vesiculitis and dysorgasmia. Disclosure: Work supported by industry: no. 273 EFFICACY OF DAPOXETINE IN THE TREATMENT OF PREMATURE EJACULATION PATIENTS WHO PREVIOUSLY FAILED SERTRALINE THERAPY Yang, L.1; Chen, X.F.1; He, D.L.1 1 The First Affiliated Hospital of Xian Jiaotong University, Xian, Shaanxi, China Introduction: Pharmacotherapy is a mainstay for the treatment of premature ejaculation (PE). PE can be treated with on-demand selective serotonin reuptake inhibitors (SSRIs) such as dapoxetine. Prior to the SFDA approval of dapoxetine for PE treatment in China, however, daily dosing with off-label sertraline was common. Objective: Before the China SFDA approved dapoxetine for the treatment of PE, sertraline, a selective serotonin reuptake inhibitor (SSRI), was commonly used off-label to treat PE. The aim of this study was to investigate the effectiveness of dapoxetine therapy in PE patients in whom sertraline therapy failed. Methods: This study included PE patients who previous treatment with sertraline, and who went on to receive dapoxetine therapy in our hospital from February 2014 to February 2015. Patients who received sertraline therapy in the immediate 2 months prior to the study were excluded. All patients received dapoxetine 30 mg prn (1e3 hours before sexual intercourse) for 4 weeks. Data on their IELT and Premature Ejaculation Profile (PEP) were recorded before and after the completion of dapoxetine treatment regimen. Data on the Clinical Global Impression of Change (CGIC) and treatment-emergent adverse events
J Sex Med 2017;14:S1-S131
S81
WMSM 2016 Abstracts
(TEAEs) were collected in the one-month follow-up after treatment completion. Results: A total of 72 patients with PE completed this study. These included 32 patients who reported that previous sertraline treatment was effective (Group A); and 40 patients for whom previous sertraline therapy was ineffective in treating PE (Group B). Both groups experienced a significantly increased IELT (Group A: an increase from 0.87 min to 2.84 min; Group B: an increase from 0.86 min to 2.79 min). Dapoxetine therapy was reported effective by 66.7% of PE patients according to their CGIC rating (Group A: 68.8% vs Group B: 65.0%, P>0.05). Similar results were also reported for PEP and TEAEs outcomes. Conclusions: Although both dapoxetine and sertraline are SSRIs, dapoxetine therapy is effective for PE patients who previously failed off-label sertraline treatment. The effect of dapoxetine was independent of the effect of sertraline. Disclosure: Work supported by industry: no. 274 SILDENAFIL VERSUS CONTINUOUS POSITIVE AIRWAY PRESSURE FOR ERECTILE DYSFUNCTION IN MEN WITH OBSTRUCTIVE SLEEP APNEA: A META-ANALYSIS Li, X.1; Dong, Z.1; Wan, Y.2; Wang, Z.1; Cheng, P.1 1 Institute of Urology, Second Hospital, Lanzhou University, Gansu, China; 2Institute of Urology, Second Hospital, Lanzhou University, Gansu, China Objective: To evaluate the effectiveness of sildenafil versus continuous positive airway pressure (CPAP) for patients with erectile dysfunction (ED) and obstructive sleep apnea (OSA). Methods: This is a meta-analysis of a randomized controlled trial. The main outcome measures for effectiveness were the percentage of successful intercourse attempts, International Index of Erectile Function (IIEF) domain scores (erectile function, EF) and the satisfaction levels of the patients and their partners with the treatment for ED. Results: Two randomized controlled trials totaling 70 patients were included. Meta-analysis results are as follows: after 12 weeks of treatment, patients under sildenafil demonstrated a significant advantage over under CPAP in terms of the percentage of successful intercourse attempts [OR ¼ 3.24, 95% CI (2.37e4.43)], EF scores [WMD ¼ 3.57, 95%CI (1.68e5.45)], and the satisfaction levels of the patients and their partners with the treatment for ED [OR ¼ 3.56, 95% CI (1.27e9.98)]. Conclusion: Current clinical studies might confirm that both therapeutic methods were safe and effective, but sildenafil was superior to CPAP in the treatment of ED in men with OSA. We conclude that new therapeutic agents or a combination of the two methods should be studied further. Disclosure: Work supported by industry: no.
J Sex Med 2017;14:S1-S131
275 AZOOASPERMIA WITH UNILATERAL ABSENCE AND CONTRALATERAL PALPABLE SCROTAL VAS DEFERENS: CLINICAL FINDINGS AND TREATMENT OPTIONS Zhang, Y.1; Yang, X.1; Wu, X.1; Chen, S.1; Feng, J.1 1 The Third Affiliated Hospital, Sun Yat-Sen University, China Introduction and Objectives: To review the clinical findings in azooaspermic men with congenital unilateral absence of the vas deferens (CUAVD) and contralateral palpable scrotal vas deferens. Material and Methods: From April 2008 to July 2015, a total of 9 of 10 consecutive azoospermia patients who had CUAVD and contralateral palpable scrotal vas deferens were performed surgical exploration for the potential vasoepdidymostomy(VE). A retrospective review of their clinical findings were performed. Results: At the time of scrotal exploration, the patency of contralateral vas deferens was evaluated with injection of diluted methylene blue in 8 of 9 patient and vasography in 1 of 9 patients. Three (33%) of the 9 patients had contralateral vas deferens distal obstructon and failed to perform VE. Among these three distal obstructive patients, 1 had contralateral seminal vesicle hypoplasia, 1 had bilateral seminal vesicle hypoplasia, and 1 had bilateral absence of the seminal vesicles; Among 6 of the vas deferens patent patients, 5 patients carried out VE, 1 patient give up VE because of hypospermatogenesis. Among the 5 patients who underwent VE, 1 loss to follow-up, 2 were patent, 1 of the patent patient had given birth to a daughter naturely, so the patency rate was 50%, natural pregnancy rate was 25%. In the 5 patients who did not accept VE, 2 loss to follow-up, 2 carried out ICSI and gave birth to a baby respectively, the tenth patient who had contralateral seminal vesicle hypoplasia decided to select intracytoplasmic sperm injection(ICSI) instead of surgical exploration when we told him the poor results of those three patients who had contralateral seminal vesicle hypoplasia or absence. Conclusions: In CUAVD patients combined with contralateral seminal vesicle aplasia or absent, the rate of distal obstruction is high (3/4), thought of the lower success rate, we recommended ICSI as the first choice in these patients. Disclosure: Work supported by industry: no. 276 THE MALLEABLE IMPLANT SALVAGE TECHNIQUE: INFECTION OUTCOMES AFTER MULCAHY SALVAGE PROCEDURE AND REPLACEMENT OF INFECTED INFLATABLE PENILE PROSTHESIS WITH MALLEABLE PROSTHESIS Gross, M.S.1; Phillips, E.A.2; Balen, A.K.3; Eid, J.F.4; Yang, C.5; Simon, R.M.6; Martinez, D.R.7; Carrion, R.E.6; Perito, P.E.8; Levine, L.A.9; Greenfield, J.M.10; Munarriz, R.M.3
is that with both high patient adherence and close health care provider monitoring, hormonal management will lead to subjective and objective improvements in signs and symptoms. Material and Methods: The aim of this study was to evaluate clinical benefit of hormonal replacement strategies for management of sexual dysfunction and GSM utilizing pre- and posttreatment: blood test monitoring; Female Sexual Function Index (FSFI) scores; and vulvoscopy findings. Charts from August 1, 2007 through December 1, 2015 were reviewed. Five bioidentical hormonal replacement efforts are designed to keep serum estradiol levels 35-50 pg/ml, serum progesterone levels at 1.0 ng/ml and calculated free testosterone levels at 0.8 ng/dl including daily topical vestibular and vaginal estradiol and testosterone applications. Subjects included were peri-menopausal or post-menopausal at their initial visit, naturally or surgically, and have both an initial and at least one follow-up vulvoscopy. Exclusions included cosmetic vulvar or vestibular surgery. Results: 110 menopausal women (mean age 62+/-13 years) with sexual health complaints met study criteria. Mean follow-up was 2.6+/-1.3 years. Pre-treatment vulvoscopic findings of labia minora resorption, urethral meatus telescoping, clitoral atrophy, vestibular erythema tenderness and pallor, minimally robust periurethral tissue, minimal vaginal rugae, with thin, pale vaginal mucosa and abnormal vaginal pH were noted in 100%. Serum sex steroid values returned to ideal values in 81%. FSFI total scores increased more than 5 points in 72%. Post-treatment vulvoscopic changes revealed pink moist pain-free vestibular tissue in 63%. Conclusion: Managing menopause with patient adherence and close monitoring, hormonal menopausal management has lead to subjective and objective improvement of female sexual function. Disclosure: Work supported by industry: no. The presenter or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry. 272 RENEWAL OF SEXUAL AND REPRODUCTIVE FUNCTIONS IN MEN WITH TRANSURETHRAL CATHETERIZATION OF THE EJACULATORY DUCTS Knigavko, O.1 1 Kharkiv National Medical University, Ukraine Objective: A frequent complication of chronic prostato-vesiculitis is prostate fibrosis and obstruction of ejaculatory ducts (EjD). Clinically it is manifested as obstructive azoospermia and often, premature ejaculation and dysorgasmia. Materials and methods: For the treatment of recent (less than 1 year) obstruction EjD, we developed and implemented a
WMSM 2016 Abstracts
method of transurethral catheterization and balloon dilation of the ducts. In 2005-2016, 77 patients with prostate fibrosis and obstructive azoospermia (56 patients noted an accelerated, obliterated, painful orgasm) on the background of antibacterial treatment of prostatitis underwent transurethral catheterization (TUC) and balloon dilatation of EjD. After 2 weeks and 3 months, we carried out a survey and semen analysis. Results: In 21 patients (27.3%), 2 weeks after TUC, spermatozoa were found in semen. After 3 months, the spermatozoa were still detected in 37 (48.1%), and in general, 58 patients with spermatozoa (75.4%). In 35 female patients diagnosed through a 1-4.2 year natural pregnancy. From 56 patients, marked improvement orgasm sensation was showed in 51 (91.1%) and prolonged to normal IVLT. Conclusion: Transurethral catheterization of EjD is a new effective treatment for obstructive prostatic azoospermia (75.4%) and improving orgasm sensations in 91.1% of patients with chronic prostate-vesiculitis and dysorgasmia. Disclosure: Work supported by industry: no. 273 EFFICACY OF DAPOXETINE IN THE TREATMENT OF PREMATURE EJACULATION PATIENTS WHO PREVIOUSLY FAILED SERTRALINE THERAPY Yang, L.1; Chen, X.F.1; He, D.L.1 1 The First Affiliated Hospital of Xian Jiaotong University, Xian, Shaanxi, China Introduction: Pharmacotherapy is a mainstay for the treatment of premature ejaculation (PE). PE can be treated with on-demand selective serotonin reuptake inhibitors (SSRIs) such as dapoxetine. Prior to the SFDA approval of dapoxetine for PE treatment in China, however, daily dosing with off-label sertraline was common. Objective: Before the China SFDA approved dapoxetine for the treatment of PE, sertraline, a selective serotonin reuptake inhibitor (SSRI), was commonly used off-label to treat PE. The aim of this study was to investigate the effectiveness of dapoxetine therapy in PE patients in whom sertraline therapy failed. Methods: This study included PE patients who previous treatment with sertraline, and who went on to receive dapoxetine therapy in our hospital from February 2014 to February 2015. Patients who received sertraline therapy in the immediate 2 months prior to the study were excluded. All patients received dapoxetine 30 mg prn (1e3 hours before sexual intercourse) for 4 weeks. Data on their IELT and Premature Ejaculation Profile (PEP) were recorded before and after the completion of dapoxetine treatment regimen. Data on the Clinical Global Impression of Change (CGIC) and treatment-emergent adverse events
J Sex Med 2017;14:S1-S131
S81
WMSM 2016 Abstracts
(TEAEs) were collected in the one-month follow-up after treatment completion. Results: A total of 72 patients with PE completed this study. These included 32 patients who reported that previous sertraline treatment was effective (Group A); and 40 patients for whom previous sertraline therapy was ineffective in treating PE (Group B). Both groups experienced a significantly increased IELT (Group A: an increase from 0.87 min to 2.84 min; Group B: an increase from 0.86 min to 2.79 min). Dapoxetine therapy was reported effective by 66.7% of PE patients according to their CGIC rating (Group A: 68.8% vs Group B: 65.0%, P>0.05). Similar results were also reported for PEP and TEAEs outcomes. Conclusions: Although both dapoxetine and sertraline are SSRIs, dapoxetine therapy is effective for PE patients who previously failed off-label sertraline treatment. The effect of dapoxetine was independent of the effect of sertraline. Disclosure: Work supported by industry: no. 274 SILDENAFIL VERSUS CONTINUOUS POSITIVE AIRWAY PRESSURE FOR ERECTILE DYSFUNCTION IN MEN WITH OBSTRUCTIVE SLEEP APNEA: A META-ANALYSIS Li, X.1; Dong, Z.1; Wan, Y.2; Wang, Z.1; Cheng, P.1 1 Institute of Urology, Second Hospital, Lanzhou University, Gansu, China; 2Institute of Urology, Second Hospital, Lanzhou University, Gansu, China Objective: To evaluate the effectiveness of sildenafil versus continuous positive airway pressure (CPAP) for patients with erectile dysfunction (ED) and obstructive sleep apnea (OSA). Methods: This is a meta-analysis of a randomized controlled trial. The main outcome measures for effectiveness were the percentage of successful intercourse attempts, International Index of Erectile Function (IIEF) domain scores (erectile function, EF) and the satisfaction levels of the patients and their partners with the treatment for ED. Results: Two randomized controlled trials totaling 70 patients were included. Meta-analysis results are as follows: after 12 weeks of treatment, patients under sildenafil demonstrated a significant advantage over under CPAP in terms of the percentage of successful intercourse attempts [OR ¼ 3.24, 95% CI (2.37e4.43)], EF scores [WMD ¼ 3.57, 95%CI (1.68e5.45)], and the satisfaction levels of the patients and their partners with the treatment for ED [OR ¼ 3.56, 95% CI (1.27e9.98)]. Conclusion: Current clinical studies might confirm that both therapeutic methods were safe and effective, but sildenafil was superior to CPAP in the treatment of ED in men with OSA. We conclude that new therapeutic agents or a combination of the two methods should be studied further. Disclosure: Work supported by industry: no.
J Sex Med 2017;14:S1-S131
275 AZOOASPERMIA WITH UNILATERAL ABSENCE AND CONTRALATERAL PALPABLE SCROTAL VAS DEFERENS: CLINICAL FINDINGS AND TREATMENT OPTIONS Zhang, Y.1; Yang, X.1; Wu, X.1; Chen, S.1; Feng, J.1 1 The Third Affiliated Hospital, Sun Yat-Sen University, China Introduction and Objectives: To review the clinical findings in azooaspermic men with congenital unilateral absence of the vas deferens (CUAVD) and contralateral palpable scrotal vas deferens. Material and Methods: From April 2008 to July 2015, a total of 9 of 10 consecutive azoospermia patients who had CUAVD and contralateral palpable scrotal vas deferens were performed surgical exploration for the potential vasoepdidymostomy(VE). A retrospective review of their clinical findings were performed. Results: At the time of scrotal exploration, the patency of contralateral vas deferens was evaluated with injection of diluted methylene blue in 8 of 9 patient and vasography in 1 of 9 patients. Three (33%) of the 9 patients had contralateral vas deferens distal obstructon and failed to perform VE. Among these three distal obstructive patients, 1 had contralateral seminal vesicle hypoplasia, 1 had bilateral seminal vesicle hypoplasia, and 1 had bilateral absence of the seminal vesicles; Among 6 of the vas deferens patent patients, 5 patients carried out VE, 1 patient give up VE because of hypospermatogenesis. Among the 5 patients who underwent VE, 1 loss to follow-up, 2 were patent, 1 of the patent patient had given birth to a daughter naturely, so the patency rate was 50%, natural pregnancy rate was 25%. In the 5 patients who did not accept VE, 2 loss to follow-up, 2 carried out ICSI and gave birth to a baby respectively, the tenth patient who had contralateral seminal vesicle hypoplasia decided to select intracytoplasmic sperm injection(ICSI) instead of surgical exploration when we told him the poor results of those three patients who had contralateral seminal vesicle hypoplasia or absence. Conclusions: In CUAVD patients combined with contralateral seminal vesicle aplasia or absent, the rate of distal obstruction is high (3/4), thought of the lower success rate, we recommended ICSI as the first choice in these patients. Disclosure: Work supported by industry: no. 276 THE MALLEABLE IMPLANT SALVAGE TECHNIQUE: INFECTION OUTCOMES AFTER MULCAHY SALVAGE PROCEDURE AND REPLACEMENT OF INFECTED INFLATABLE PENILE PROSTHESIS WITH MALLEABLE PROSTHESIS Gross, M.S.1; Phillips, E.A.2; Balen, A.K.3; Eid, J.F.4; Yang, C.5; Simon, R.M.6; Martinez, D.R.7; Carrion, R.E.6; Perito, P.E.8; Levine, L.A.9; Greenfield, J.M.10; Munarriz, R.M.3