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A REVIEW OF OUTCOMES IN AN INTRACAVERNOSAL INJECTION THERAPY PROGRAM
THE JOURNAL OF UROLOGY®
Vol. 181, No. 4, Supplement, Tuesday, April 28, 2009
Placebo (N=78)
Tadalafil (N=264)
n
Correlation coefficient (p-value)
n
Correlation coefficient (p-value)
SEP1 and partner SEP1 73
0.81 (<.001)
249
0.89 (<.001)
SEP2 and partner SEP2 73
0.76 (<.001)
249
0.94 (<.001)
SEP5 and partner SEP3 73
0.61 (<.001)
249
0.64 (<.001)
69
0.57 (<.001)
236
0.57 (<.001)
69
0.55 (<.001)
236
0.62 (<.001)
Variables
SQoL domain and partner SQoL domain THX domain and partner THX domain
Source of Funding: Eli Lilly and Company
1472 THE IMPACT OF EXERCISE ON ERECTILE FUNCTION AS EVALUATED BY INTERNATIONAL INDEX OF ERECTILE FUNCTION (IIEF) IN YOUNG MEN Wayland Hsiao*, Adam B Shrewsberry, Amanda W Cai, Peter Stuhldreher, Beau Dusseault, Chad WM Ritenour, Atlanta, GA INTRODUCTION AND OBJECTIVES: Authorities recommend an exercise energy expenditure of 1400 kcal/week for overall general health. Previous studies in middle-aged men have shown a direct correlation between exercise expenditures of >1000 kcal/week and IIEF scores as well as improved erectile function scores for those started on a regimen of increased physical activity. However, data linking erectile function and physical activity are lacking in young men. METHODS: 74 male patients, aged 18-40 years, selfadministered validated questionnaires for both erectile function (IIEF) and physical activity (Paffenberger Physical Activity Questionnaire). Subjects were stratified based on weekly energy expenditure [<1400 kcal (sedentary) vs. q1400 kcal/week]. Student’s t-tests was performed. RESULTS: Mean weekly energy expenditures for the sedentary (n=27) and non-sedentary (n=47) groups were 716 kcal and 4552 kcal, respectively (p<0.005). There were no significant differences in age (p=0.45) or BMI (p=0.67). Results for the IIEF domains of the two groups are shown (Table 1). CONCLUSIONS: Exercise may influence sexual function even at an early age. In this young, healthy population, IIEF scores were higher across all subdomains. This confirms the commonly held perception that increased physical activity improves various components of sexual health. However, prospective studies with baseline physical activity measures are needed to evaluate the impact of exercise on the natural history of erectile dysfunction.
Source of Funding: None
1473 A REVIEW OF OUTCOMES IN AN INTRACAVERNOSAL INJECTION THERAPY PROGRAM. Matthias Heck*, Patricia Guhring, John P Mulhall, New York, NY INTRODUCTION AND OBJECTIVES:Since 1983 intracavernosal injection (ICI) therapy has become a staple therapeutic option for men with erectile dysfunction (ED). Depending upon the agent utilized, high success rates are achieved. However, priapism is a significant concern and drop-out rates are estimated to be in excess of 50%. This analysis was undertaken to review outcomes, adverse events and drop-out rates in a large sexual medicine practice over a 5 year period.
527
METHODS: Patients presenting with ED who enrolled in an ICI program between September 2002 and August 2006 were followed at least annually. Patients were trained over 2 training sessions and were followed for the first 4-6 at-home injections by close telephone monitoring of response by a single nurse. Prescriptions for intracavernosal vasoactive drugs were not prescribed unless the patient attended followup visits. Patient demographic information, agents utilized, erectile function outcomes and adverse events were recorded. RESULTS: 1412 patients had complete data. Mean age was 58±34 (17-87) years. Comorbidity profiles included: diabetes 46%, hyperlipidemia 52%, radical prostatectomy 40%, coronary artery disease 20%, pelvic radiation 9%. 7% of patients had a single vascular risk factor, 40% two, 31% three and 22% q4 vascular comorbidities. 85% of patients were using trimix, 13% bimix and 1% papaverine and PGE1 monotherapy. 7 cases of priapism were recorded (<0.1%). Drop-out rates at 12, 24 and 36 months were 26%, 38% and 51% respectively. 89% of men using trimix had successful intercourse consistently. These figures for RP, RT and diabetes patients were 92%, 78% and 76% respectively. CONCLUSIONS: ICI therapy is associated with very high success rates even in men with high comorbidity profiles, however the majority of men in this program ceased injection therapy by the end of the third year injecting. Of note, the recorded priapism rate was extremely low. This is believed to be the result of the structured training program and the close early at-home response monitoring and dose titration. Source of Funding: None
1474 HOW COGNITIVE-BEHAVIORAL THERAPY CAN IMPROVE THE 5 PHOSPHODIESTERASES INHIBITORS TREATMENT IN PATIENTS WITH ERECTILE DYSFUNCTION Daniel H Porav*, Targu Mures, Romania; Ramona Moldovan, Bogdan Feciche, Zoltan Mihaly, Cluj-napoca, Romania; Radu Boja, Targu Mures, Romania; Ioan Coman, Daniel David, Cluj-napoca, Romania INTRODUCTION AND OBJECTIVES: Although the introduction of 5 phosphodiesterases inhibitors has brought a revolution on the treatment of erectile dysfunction, in some patients the results are modest because of psychological conditions incomplete investigated and treated. The objective of this study was to establish the effectiveness of cognitive behavioral therapy in combination with 5 phosphodiesterases inhibitors in patients with erectile dysfunction. METHODS: A total of 107 patients were included in a this study. Patients were randomized in three groups: group A (31 patients) followed a treatment with tadalafil 5 weeks associated with 5 sessions of cognitive behavioral therapy (1/week), group B (36 patients) followed therapy with tadalafil 5 weeks associated with a protocol of education, and group C (40 patients) followed only medical treatment. Patients were surveyed on erectile function with the International Index of erectile function (IIEF), quality of life with the effect of erectile dysfunction on quality of life - (ED - EqoL). These questionnaires were applied to patients before treatment, at the middle and at the end of treatment. RESULTS: The age of patients included in the study varies between 26 and 68 years, with an average age of 50.20 years (SD = 12.34). Improving IIEF average was 19.8 in group A, group B at 15.8 and 14.8 in group C (p <0.05). Quality of life was improved in all three groups. ED - EqoL improved in group A from 43.9 at the beginning of treatment to 25.9 at the end of treatment, group B from 46.6 to 29.4, while in group C from 45.6 to 34.5 CONCLUSIONS: The 5 phosphodiesterases inhibitors therapy for erectile dysfunction is very effective, but the combination of this type of medication with a cognitive behavioral therapy has increased efficiency on erectile function, but mostly on the quality of life of these patients. Source of Funding: For the data in this abstract I received an educational grant provided by the Ministry of Research from Romania
Vol. 181, No. 4, Supplement, Tuesday, April 28, 2009
Placebo (N=78)
Tadalafil (N=264)
n
Correlation coefficient (p-value)
n
Correlation coefficient (p-value)
SEP1 and partner SEP1 73
0.81 (<.001)
249
0.89 (<.001)
SEP2 and partner SEP2 73
0.76 (<.001)
249
0.94 (<.001)
SEP5 and partner SEP3 73
0.61 (<.001)
249
0.64 (<.001)
69
0.57 (<.001)
236
0.57 (<.001)
69
0.55 (<.001)
236
0.62 (<.001)
Variables
SQoL domain and partner SQoL domain THX domain and partner THX domain
Source of Funding: Eli Lilly and Company
1472 THE IMPACT OF EXERCISE ON ERECTILE FUNCTION AS EVALUATED BY INTERNATIONAL INDEX OF ERECTILE FUNCTION (IIEF) IN YOUNG MEN Wayland Hsiao*, Adam B Shrewsberry, Amanda W Cai, Peter Stuhldreher, Beau Dusseault, Chad WM Ritenour, Atlanta, GA INTRODUCTION AND OBJECTIVES: Authorities recommend an exercise energy expenditure of 1400 kcal/week for overall general health. Previous studies in middle-aged men have shown a direct correlation between exercise expenditures of >1000 kcal/week and IIEF scores as well as improved erectile function scores for those started on a regimen of increased physical activity. However, data linking erectile function and physical activity are lacking in young men. METHODS: 74 male patients, aged 18-40 years, selfadministered validated questionnaires for both erectile function (IIEF) and physical activity (Paffenberger Physical Activity Questionnaire). Subjects were stratified based on weekly energy expenditure [<1400 kcal (sedentary) vs. q1400 kcal/week]. Student’s t-tests was performed. RESULTS: Mean weekly energy expenditures for the sedentary (n=27) and non-sedentary (n=47) groups were 716 kcal and 4552 kcal, respectively (p<0.005). There were no significant differences in age (p=0.45) or BMI (p=0.67). Results for the IIEF domains of the two groups are shown (Table 1). CONCLUSIONS: Exercise may influence sexual function even at an early age. In this young, healthy population, IIEF scores were higher across all subdomains. This confirms the commonly held perception that increased physical activity improves various components of sexual health. However, prospective studies with baseline physical activity measures are needed to evaluate the impact of exercise on the natural history of erectile dysfunction.
Source of Funding: None
1473 A REVIEW OF OUTCOMES IN AN INTRACAVERNOSAL INJECTION THERAPY PROGRAM. Matthias Heck*, Patricia Guhring, John P Mulhall, New York, NY INTRODUCTION AND OBJECTIVES:Since 1983 intracavernosal injection (ICI) therapy has become a staple therapeutic option for men with erectile dysfunction (ED). Depending upon the agent utilized, high success rates are achieved. However, priapism is a significant concern and drop-out rates are estimated to be in excess of 50%. This analysis was undertaken to review outcomes, adverse events and drop-out rates in a large sexual medicine practice over a 5 year period.
527
METHODS: Patients presenting with ED who enrolled in an ICI program between September 2002 and August 2006 were followed at least annually. Patients were trained over 2 training sessions and were followed for the first 4-6 at-home injections by close telephone monitoring of response by a single nurse. Prescriptions for intracavernosal vasoactive drugs were not prescribed unless the patient attended followup visits. Patient demographic information, agents utilized, erectile function outcomes and adverse events were recorded. RESULTS: 1412 patients had complete data. Mean age was 58±34 (17-87) years. Comorbidity profiles included: diabetes 46%, hyperlipidemia 52%, radical prostatectomy 40%, coronary artery disease 20%, pelvic radiation 9%. 7% of patients had a single vascular risk factor, 40% two, 31% three and 22% q4 vascular comorbidities. 85% of patients were using trimix, 13% bimix and 1% papaverine and PGE1 monotherapy. 7 cases of priapism were recorded (<0.1%). Drop-out rates at 12, 24 and 36 months were 26%, 38% and 51% respectively. 89% of men using trimix had successful intercourse consistently. These figures for RP, RT and diabetes patients were 92%, 78% and 76% respectively. CONCLUSIONS: ICI therapy is associated with very high success rates even in men with high comorbidity profiles, however the majority of men in this program ceased injection therapy by the end of the third year injecting. Of note, the recorded priapism rate was extremely low. This is believed to be the result of the structured training program and the close early at-home response monitoring and dose titration. Source of Funding: None
1474 HOW COGNITIVE-BEHAVIORAL THERAPY CAN IMPROVE THE 5 PHOSPHODIESTERASES INHIBITORS TREATMENT IN PATIENTS WITH ERECTILE DYSFUNCTION Daniel H Porav*, Targu Mures, Romania; Ramona Moldovan, Bogdan Feciche, Zoltan Mihaly, Cluj-napoca, Romania; Radu Boja, Targu Mures, Romania; Ioan Coman, Daniel David, Cluj-napoca, Romania INTRODUCTION AND OBJECTIVES: Although the introduction of 5 phosphodiesterases inhibitors has brought a revolution on the treatment of erectile dysfunction, in some patients the results are modest because of psychological conditions incomplete investigated and treated. The objective of this study was to establish the effectiveness of cognitive behavioral therapy in combination with 5 phosphodiesterases inhibitors in patients with erectile dysfunction. METHODS: A total of 107 patients were included in a this study. Patients were randomized in three groups: group A (31 patients) followed a treatment with tadalafil 5 weeks associated with 5 sessions of cognitive behavioral therapy (1/week), group B (36 patients) followed therapy with tadalafil 5 weeks associated with a protocol of education, and group C (40 patients) followed only medical treatment. Patients were surveyed on erectile function with the International Index of erectile function (IIEF), quality of life with the effect of erectile dysfunction on quality of life - (ED - EqoL). These questionnaires were applied to patients before treatment, at the middle and at the end of treatment. RESULTS: The age of patients included in the study varies between 26 and 68 years, with an average age of 50.20 years (SD = 12.34). Improving IIEF average was 19.8 in group A, group B at 15.8 and 14.8 in group C (p <0.05). Quality of life was improved in all three groups. ED - EqoL improved in group A from 43.9 at the beginning of treatment to 25.9 at the end of treatment, group B from 46.6 to 29.4, while in group C from 45.6 to 34.5 CONCLUSIONS: The 5 phosphodiesterases inhibitors therapy for erectile dysfunction is very effective, but the combination of this type of medication with a cognitive behavioral therapy has increased efficiency on erectile function, but mostly on the quality of life of these patients. Source of Funding: For the data in this abstract I received an educational grant provided by the Ministry of Research from Romania