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408 Failing Our Patients - Intracavernous Injection Treatment Success is Dependent on Optimized Testing and Teaching
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different types of erectile dysfunction (ED) patients in Thailand. Material and Method: To treat different type of ED patients with LI-ESWT at shaft and crura in total of 5 places. Twice a week for three weeks then rest for 3 weeks and repeat the procedure to 12 treatment times. Result: Enrolled 50 patients, treated by LI-ESWT, average age 58.78 ±10.58 years old. 47 have experience ED for at least 3 years. 3 patients do not suffer with ED. After being treated with LI-ESWT, it was found that 22 ED subjects(/patients) from 26 ED subjects (84.62%) have better erection hardness score (EHS) which were improved from 2 To 3. Moreover, it was also found that there were 11 ED subjects from 19 ED subjects whose EHS have increased from 3 to 4 (57.89%). However, there was only 5.04 points improvement from the international index of erectile function (IIEF) -5 score and only 3 subjects with an increase of IIEF-5 score of more than 10 points. Those three subjects previously mentioned are patients who suffer from moderate and severe ED in which we found a satisfactory improvement of IIEF-5 score of 6.09 and 8.20 respectively from these 2 groups. It was also found that an IIEF score increases according to a severity of the disease. After the treatment, approximately 15-20% of patients mentioned that they do not need to rely on PED5I to help with erection before their sexual activity. Conclusion: LI-ESWT method is potentially useful for the treatment of different types of ED patients, with or without vascular problems, while the result showed different improvement level. Disclosure: Work supported by industry: no. 408 FAILING OUR PATIENTS INTRACAVERNOUS INJECTION TREATMENT SUCCESS IS DEPENDENT ON OPTIMIZED TESTING AND TEACHING Bella, A.J.1; Laing, L.1; Littlemore, A.M.2 1 Ottawa Urology and Men’s Health, Canada; 2Human Kinetics, University of Ottawa, Canada Objectives: The success or failure of intracavernous injection (ICI) therapy is often dependent on health care provider (HCP) factors. Success in the office should be followed by success at home, yet in our experience there is a not insignificant number of men who are taught ICI and present for evaluation of surgery (penile prosthesis - PP) because of ICI failure. In our subspecialty clinic, the daily volume for team-based care under surgeon and registered practical nurse (RPN) is 4 new consult/cavernous injection and stimulation (CIS) test appointments, 12 cavernous injection and stimulation tests, 4 ICI teaches (based on successful CIS tests to EHS 4 or DS Trimix 1 cc test giving maximum usable response). We present observations for optimizing ICI success. Methods and Materials: All patients with a CIS test performed from January 1, 2016 to May 30, 2016 were reviewed. Twenty-one
WMSM 2016 Abstracts
patients were referred for failed ICI or for PP surgery due to failed ED treatments. Results: Of the 21 patients, 17 were salvaged to ICI success. The primary factor identified was lack of rigorous CIS testing in the office to an EHS score of 4 or maximum dosing of medication before prescriptions were given, resulting in no successful intercourse events (9/17). Eight of 17 were not taught to standards acceptable in our practice, which includes detailed teaching and observation of injection to EHS 4 or maximum dose (allowing an usable EHS 3). The average number of visits, including consult, for satisfactory self-injection was 3.8, which compares to 3.4 visits in 2014-2015 at the University of Ottawa Clinic. This increase has been as a result of utilizing a novel self-reporting EHS based report card that is completed by the patient at each test and includes rigidity and duration data, from time of injection to detumesence. The objective evaluation card has improved our precision in delivering ICI care. Conclusions: ICI offers a safe and durable treatment option for many men with erectile dysfunction, however the testing and teaching are labour intensive and remuneration is often less than for other office visits or procedures. Suboptimal structure and execution of an ICI program defeats success. 81% of treatment failures were in fact, failures of the HCP to provide state-of-the art care. Our use of a novel EHS score based “scorecard” for each CIS test has improved our successful delivery of care; concurrently it has also increased the mean number of patient visits. From the patient’s viewpoint, seeing a full erection sufficient for penetration is encouraging, and in-office teaching to this level instills confidence for at-home use. Disclosure: Work supported by industry: no. 409 TREATMENT OF PERSISTENT GENITAL AROUSAL DISORDER (PGAD) WITH ZOLPIDEM, A NON-BENZODIAZEPINE INDIRECT GABA A RECEPTOR AGONIST: MECHANISM OF ACTION AND PRELIMINARY CLINICAL EXPERIENCE Goldstein, I.1; Cataldo, L.2; Komisaruk, B.R.3; Pfaus, J.4 1 Alvarado Hospital, United States; 2PGAD Support Group, United States; 3Rutgers University, United States; 4Concordia University, Canada Objectives: Persistent Genital Arousal Disorder (PGAD) is characterized by persistent or recurrent, unwanted or intrusive, bothersome or distressing feelings of genital arousal or being on the verge of orgasm, genital dysesthesia, not associated with concomitant sexual interest, thoughts or fantasies. With no FDA-approved treatments, strategies to manage PGAD include: elimination of excess sensory excitation from various peripheral genital (S2, S3, S4) or central nervous system pathologies centrally misdirected to the hypothalamus and misinterpreted as genital arousal/orgasm; inhibition of central relay information to the hypothalamus. J Sex Med 2017;14:S1-S131
different types of erectile dysfunction (ED) patients in Thailand. Material and Method: To treat different type of ED patients with LI-ESWT at shaft and crura in total of 5 places. Twice a week for three weeks then rest for 3 weeks and repeat the procedure to 12 treatment times. Result: Enrolled 50 patients, treated by LI-ESWT, average age 58.78 ±10.58 years old. 47 have experience ED for at least 3 years. 3 patients do not suffer with ED. After being treated with LI-ESWT, it was found that 22 ED subjects(/patients) from 26 ED subjects (84.62%) have better erection hardness score (EHS) which were improved from 2 To 3. Moreover, it was also found that there were 11 ED subjects from 19 ED subjects whose EHS have increased from 3 to 4 (57.89%). However, there was only 5.04 points improvement from the international index of erectile function (IIEF) -5 score and only 3 subjects with an increase of IIEF-5 score of more than 10 points. Those three subjects previously mentioned are patients who suffer from moderate and severe ED in which we found a satisfactory improvement of IIEF-5 score of 6.09 and 8.20 respectively from these 2 groups. It was also found that an IIEF score increases according to a severity of the disease. After the treatment, approximately 15-20% of patients mentioned that they do not need to rely on PED5I to help with erection before their sexual activity. Conclusion: LI-ESWT method is potentially useful for the treatment of different types of ED patients, with or without vascular problems, while the result showed different improvement level. Disclosure: Work supported by industry: no. 408 FAILING OUR PATIENTS INTRACAVERNOUS INJECTION TREATMENT SUCCESS IS DEPENDENT ON OPTIMIZED TESTING AND TEACHING Bella, A.J.1; Laing, L.1; Littlemore, A.M.2 1 Ottawa Urology and Men’s Health, Canada; 2Human Kinetics, University of Ottawa, Canada Objectives: The success or failure of intracavernous injection (ICI) therapy is often dependent on health care provider (HCP) factors. Success in the office should be followed by success at home, yet in our experience there is a not insignificant number of men who are taught ICI and present for evaluation of surgery (penile prosthesis - PP) because of ICI failure. In our subspecialty clinic, the daily volume for team-based care under surgeon and registered practical nurse (RPN) is 4 new consult/cavernous injection and stimulation (CIS) test appointments, 12 cavernous injection and stimulation tests, 4 ICI teaches (based on successful CIS tests to EHS 4 or DS Trimix 1 cc test giving maximum usable response). We present observations for optimizing ICI success. Methods and Materials: All patients with a CIS test performed from January 1, 2016 to May 30, 2016 were reviewed. Twenty-one
WMSM 2016 Abstracts
patients were referred for failed ICI or for PP surgery due to failed ED treatments. Results: Of the 21 patients, 17 were salvaged to ICI success. The primary factor identified was lack of rigorous CIS testing in the office to an EHS score of 4 or maximum dosing of medication before prescriptions were given, resulting in no successful intercourse events (9/17). Eight of 17 were not taught to standards acceptable in our practice, which includes detailed teaching and observation of injection to EHS 4 or maximum dose (allowing an usable EHS 3). The average number of visits, including consult, for satisfactory self-injection was 3.8, which compares to 3.4 visits in 2014-2015 at the University of Ottawa Clinic. This increase has been as a result of utilizing a novel self-reporting EHS based report card that is completed by the patient at each test and includes rigidity and duration data, from time of injection to detumesence. The objective evaluation card has improved our precision in delivering ICI care. Conclusions: ICI offers a safe and durable treatment option for many men with erectile dysfunction, however the testing and teaching are labour intensive and remuneration is often less than for other office visits or procedures. Suboptimal structure and execution of an ICI program defeats success. 81% of treatment failures were in fact, failures of the HCP to provide state-of-the art care. Our use of a novel EHS score based “scorecard” for each CIS test has improved our successful delivery of care; concurrently it has also increased the mean number of patient visits. From the patient’s viewpoint, seeing a full erection sufficient for penetration is encouraging, and in-office teaching to this level instills confidence for at-home use. Disclosure: Work supported by industry: no. 409 TREATMENT OF PERSISTENT GENITAL AROUSAL DISORDER (PGAD) WITH ZOLPIDEM, A NON-BENZODIAZEPINE INDIRECT GABA A RECEPTOR AGONIST: MECHANISM OF ACTION AND PRELIMINARY CLINICAL EXPERIENCE Goldstein, I.1; Cataldo, L.2; Komisaruk, B.R.3; Pfaus, J.4 1 Alvarado Hospital, United States; 2PGAD Support Group, United States; 3Rutgers University, United States; 4Concordia University, Canada Objectives: Persistent Genital Arousal Disorder (PGAD) is characterized by persistent or recurrent, unwanted or intrusive, bothersome or distressing feelings of genital arousal or being on the verge of orgasm, genital dysesthesia, not associated with concomitant sexual interest, thoughts or fantasies. With no FDA-approved treatments, strategies to manage PGAD include: elimination of excess sensory excitation from various peripheral genital (S2, S3, S4) or central nervous system pathologies centrally misdirected to the hypothalamus and misinterpreted as genital arousal/orgasm; inhibition of central relay information to the hypothalamus. J Sex Med 2017;14:S1-S131