Erectile Dysfunction and Mental Health: Results of the Portuguese Erectile Dysfunction Study (PEDS)

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ASSOCIATION BETWEEN MARITAL STATUS AND ERECTILE DYSFUNCTION: RETROSPECTIVE STUDY AT CIPTO MANGUNKUSUMO NATIONAL REFERRAL HOSPITAL

DIODE LASER CONTACT VAPORIZATION OF THE PROSTATE ON A DAY-SURGERY BASIS: EARLY COMPLICATIONS AND SHORT-TERM FOLLOW-UP OF 63 CASES

Charles Johanes, Firtantyo A. Syahputra, Widi Atmoko, Denny A. Prayoga, Ponco Birowo ∗ , Nur Rasyid, Akmal Taher

A. Agud ∗ , A. Bosch, H. López, J. Sáenz de Cabezón, L. Sos, JM. Malet

Division of Urology Department of Surgery Faculty of Medicine, University of Indonesia/Department of Urology, Cipto Mangunkusumo Hospital, Jakarta, Indonesia E-mail address: [email protected] (P. Birowo). Background: Previous studies have shown association between marital status and erectile dysfunction (ED). The results vary due to culture and ethnic differences. Particularly in Indonesia, formal marriage (husbandwife relationship) is mandatory for couple to live together. We aimed to assess association between marital status and erectile dysfunction among our patients. Methods: Amount of 289 ED patients, with median age 49.0 (19.0; 79.0) years old, had completed the questionnare at the time of diagnosis. The questionnaire contained sociodemographic characteristics (age, marital status, educational status, occupation), ED duration, and The International Index of Erectile Function-5 (IIEF-5). This study was done retrospectively. Subjects were enrolled consecutively at Cipto Mangunkusumo National Referral Hospital (Urology Outpatient Clinic), from 2005 to 2010. Results: Of the patients, 23.2% were organic type ED, 18.7% were psychogenic type ED, 49.8% were mixed type ED, and 8.3% were classified as other type ED. Median ED duration among our patients was 52.0 (1.0; 1040.0) weeks. Based on marital status, there were 8.3% single, 85.8% married, 3.1% divorced, and 2.8% widower. We found that marital status is associated with ED duration (p < 0.01). In addition, ED patients who were not having wife had longer ED duration compared to those who were having wife at that time 144.0 (2.0; 520.0) weeks vs. 52.0 (1.0; 1040.0) weeks. Otherwise there was no association between other variables with marital status. Conclusion: This finding may reflect that marital status contributes in determining ED duration. Furthermore, currently married patients had lower ED duration. doi:10.1016/j.jomh.2010.09.216

ISMH World Congress 2010 Abstract 216 ADAM QUESTIONNAIRE IS NOT USEFUL FOR DIABETIC PATIENTS Ricardo M.R. Meirelles ∗ , Bianca Ayres Puppin State Institute of Diabetes and Endocrinology and Catholic University, Rio de Janeiro, Brazil E-mail address: [email protected] (R.M.R. Meirelles). Background: Questionnaires have been proposed as screening tools for diagnosis of hypogonadism [the St. Louis University Androgen Deficiency in Aging Male (ADAM), the Aging Male Survey (AMS) and the Massachusetts Male Aging Study (MMAS)]. The ADAM questionnaire was shown to have the best sensitivity, although relatively nonspecific. We aimed to verify whether this questionnaire could be useful for patients with Diabetes Mellitus. Methods: Sixty male patients with type 2 Diabetes Mellitus (DM2), aged 40 to 78 years, randomly selected from the outpatient unit of the State institute of Diabetes and Endocrinology were asked to answer to the ADAM questionnaire and had the plasma testosterone measured. Diabete duration was at least 5 years. Specificity and sensitivity were calculated based on the concordance between positive questionnaires and low levels of testosterone. Results: Questionnaire sensitivity was 85% and specificity was only 2%. The majority of the DM2 patients (75%) presented positive questionnaire. However, only 21% of these patients with signs and symptoms of androgen deficiency of aging, had low levels of plasma testosterone. Conclusion: We concluded that ADAM questionnaire is not useful for the screening of hypogonadism in DM 2 patients. doi:10.1016/j.jomh.2010.09.217

Urology Department, Altahia, Manresa, Barcelona, Spain E-mail address: [email protected] (A. Agud). Background: Since September 2007 laser urological procedures have been performed at our institution. In March 2010 we started using Diode laser 980 nm on a day-surgery basis for diode laser vaporization of the prostate (DioVaP) Objectives: To assess intraoperative and immediate postoperative complications and short-term follow-up Materials and methods: DioVaP performed in 63 patients from March 2010 to september 2010. We reviewed the demographic data, intraoperative and early postoperative complications and short-term follow-up data. We used Diode 980 nm generator laser with contact hook fibers (Intermedic TM- Spain) on a pulsed mode and Holmium laser to deal with bladder lithiasis (Lumenis TM). Local spinal anesthesia. Patients were dismissed in the afternoon. Results: Mean age is 70.5 (+/- 10, 5). Average pre-operative PSA 2.69 (+/2.76). Mean prostate volume in grams 47 (+/- 16.76). 22% (n = 14) indwelling catheter prior to surgery. 9.5% (n = 6) bladder lithiasis. Intraoperative complications occurred in 11% (n = 7): 1 neck bleeding coagulated by monopolar TUR and 2 cases where cystoscope introduction was difficult due to urethral stricture. The other cases were fiber early degradation or tip breaking. No post-TUR syndrome occurred. Postoperative complications occured in 35% of the cases (n = 23). Acute urinary retention in 9.5% (n = 6). 5 recovered spontaneous urination, 1 is awaiting new surgery due to relapsed urethral stricture. 6.3% urinary tract infection (n = 4). 9.5% (n = 6) dysuria. 11% (n = 7) haematuria, of whom 2 required re-cathetrerization and bladder irrigation for 24 hours 1 month after surgery. The rest presented with very mild initial haematuria. IPSS mean value at 1 month after surgery is 6.6 Conclusion: Contact diode laser vaporization of the prostate is a safe technique that can be performed on a day-surgery basis under local spinal anesthesia. Indication for surgery is the same as that for TURP, and 1 laser fiber should rech for medium prostates. The main intraopartive drawback for the technique is the need for Holmium laser in associated lithiasis. Short-term follow up shows no major early complications, the most frequent one being self-limited mild initial haematuria. Patients’subjective post-operative evaluation regarding their improvement in symptomatology is favourable. doi:10.1016/j.jomh.2010.09.218

ISMH World Congress 2010 Abstract 218 ERECTILE DYSFUNCTION AND MENTAL HEALTH: RESULTS OF THE PORTUGUESE ERECTILE DYSFUNCTION STUDY (PEDS) V. Alarcão a,∗ , M. Carreira a , J. Garcia e Costa b , A. Galvão-Teles b a b

Institute of Preventive Medicine, Faculty of Medicine, University of Lisbon, Portugal, Endocrinology, Diabetes and Obesity Unit, Lisbon, Portugal

E-mail addresses: [email protected], [email protected] (V. Alarcão). Background: Erectile dysfunction (ED) and poor mental health (MH) are highly prevalent conditions and frequently concomitants with other comorbid conditions. The connection of ED and MH has not been studied extensively. ED may have a direct association with poorer MH, but the association between ED and MH could also be influenced through mediating factors, such as satisfaction with and importance attached to sex life. Our aim was to explore the association between ED and MH using data of the Portuguese Erectile Dysfunction Study (PEDS). We hypothesized that ED was negatively associated with MH. Methods: PEDS is a cross-sectional population-based study carried out in a regionally representative sample of 3,548 Portuguese men aged 40 to 69 years. International Index of Erectile Function (IIEF) was used to evaluate erectile function, and also intercourse and overall satisfaction. Mental problems were evaluated by the 12-item General Health Ques-

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ISMH Congress 2010 Abstracts tionnaire (GHQ-12). Internal consistency of both scales was assessed by the Cronbach’s alpha coefficient: results were high for all the items (0.94 for IIEF and 0.85 for GHQ-12). In all bivariate and multivariate analyses, ED was dichotomized as “none” or “any degree”. Baseline differences between men with and without ED were tested. First, statistical significance (P≤0.05) was assessed by the chi-squared test for categorical variables and by Student’s t-test and analysis of variance for continuous variables. Second, the association between ED and poorer MH was examined using analysis of covariance (ancova). Results: ED prevalence rate was 48%: 35% presented minimal, 9% moderate, and 4% complete ED. The mean GHQ-12 score was 9.59 (SD = 4.2). Men with ED presented significantly poorer MH (10.43 ± 4.6) than men without ED (8.82 ± 3.6). Severity of ED was correlated with poor MH. Considering people who scored above the mean, 43% of the respondents showed an indication of mental health problems (52% of men with ED versus 35% of men without ED). Satisfaction with sex life and relationship satisfaction were inversely correlated with poorer MH. Men with ED but satisfied with their sexual life presented better MH than men without ED but dissatisfied with their sexual life. Conclusion: ED was associated with poorer MH and satisfaction with sex life was found to play a mediating role in this association. Could MH be preserved by helping men with ED to be satisfied with their sex lives despite ED? doi:10.1016/j.jomh.2010.09.219

ISMH World Congress 2010 Abstract 219 INVERSE ASSOCIATION BETWEEN TOTAL TESTOSTERONE CONCENTRATIONS, INCIDENT HYPERTENSION, AND BLOOD PRESSURE Sarah Torkler a , Henri Wallaschofski a , Sebastian E. Baumeister b , Henry Völzke b , Marcus Dörr c , Stephan Felix c , Rainer Rettig d , Matthias Nauck a , Robin Haring a,∗ Institute of Clinical Chemistry and Laboratory Medicine, b Institute for Community Medicine, c Department of Cardiology, d Institute of Physiology; University of Greifswald, Germany

a

E-mail address: [email protected] (R. Haring). Background: Studies on the relationship between testosterone concentrations and blood pressure have yielded inconsistent results. Therefore, this study investigated the prospective association of total testosterone (TT) concentrations with risk of incident hypertension and blood pressure change in 1,484 men aged 20-79 years. Methods: Data from the population-based Study of Health in Pomerania, Germany, were used. Serum TT concentrations, measured by chemiluminescent enzyme immunoassays, were categorized into age-specific quartiles. Generalized Estimating Equation (GEE) models, adjusted for age, waist circumference, physical activity, smoking, and alcohol consumption were specified. Results: During a median follow-up time of 5.0 years, the prevalence of hypertension increased from 50.6% to 57.1%. TT concentrations were significantly lower in men with baseline and incident hypertension. Analyses revealed that men with baseline TT concentrations in the lowest quartile had an increased risk of incident hypertension (odds ratio (OR), 1.19 (95% CI, 1.11-1.27)) compared to men with higher TT concentrations. Furthermore, we found a significant inverse association of TT concentrations and blood pressure, showing that men with baseline TT concentrations in the lowest quartile showed the slightest change in SBP (-5.52 mmHg), DBP (2.10 mmHg), and PP (-3.43 mmHg). Sensitivity analyses in a subpopulation of men without antihypertensive medication confirmed these findings. Conclusion: These results show that low male TT concentrations are predictive of hypertension, suggesting TT as a potential biomarker of increased cardiovascular risk. doi:10.1016/j.jomh.2010.09.220

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ISMH World Congress 2010 Abstract 220 MANAGEMENT OF ERECTILE DYSFUNCTION (ED) IN METABOLIC SYNDROME PATIENTS M. Abou-Farha ∗ , S. El-Abd, M. El Gharabawy, O. Abou-Farha Urology Dep., Tanta University, Egypt E-mail address: m [email protected] (M. Abou-Farha). Objectives: To investigate the epidemiology, etiology and management of erectile dysfunction (ED) in patients with metabolic syndrome in Egyptian men. Patients and methods: This prospective study included 227 patients suffering from ED, patients with ED and fulfill criteria of metabolic syndrome according to the Adult treatment panel III (ATP-III) were estimated, the incidence of hypogonadism in patients with metabolic syndrome were estimated and the corelation between testosterone level and the individual metabolic risk factors were studied. Patients with ED and metabolic syndrome were divided into 3 groups according to their IIEF-EF domain score (mild, moderate and severe) then received stepwise treatment protocol: 1st line management included lifestyle modification and treatment of metabolic risk factors for 3 months then reevaluated with IIEF-EF and measuring (waist circumference, Triglycerides, HDL, blood pressure, fasting blood sugar and Testosterone). Patients who reported no improvement on lifestyle modification received on demand PDE-5 inhibitors 50-100 mg sildenafil citrate for 4 months then reevaluated by the same parameters. Patients whom not improved after on demand PDE-5 inhibitors received chronic daily dosing of PDE-5 inhibitors (Tadalafil 5 mg) for another 4 months then revaluated. Patients who reported no improvement with the chronic dosing of Tadalafil received combination therapy in the form of Tadalafil 5 mg daily and PGE1 (alprostadil 5-20 ␮g) prior to intercourse for 4 months then reevaluated. Results: 86 patients out of 227 patients with ED fulfill the criteria of the metabolic syndrome according to the ATP-III (37.8%) incidence of hypogonadism in those patients was (37.2%). At the end of the 3montths with lifestyle modification improvement in the IIEF-EF score reported by (14.6%) of the patients this improvement was not statistically significant. At the end of the use of on demand PDE-5 inhibitors the overall improvement was reported by (34.3%) of the patients and mainly in patients with mild ED. At the end of the use Tadalafil chronic dosing the overall improvement reported by (41.5%). After combination therapy improvement was reported by (30.4%)of the patients. Conclusion: incidence of the metabolic syndrome is significantly high among Egyptian patients with ED and associated with high incidence of hypogonadism. Following our stepwise upgraded medical regimen patients with metabolic syndrome and ED have overall successful results in (78.7%). doi:10.1016/j.jomh.2010.09.221

ISMH World Congress 2010 Abstract 221 VASECTOMY REVERSAL (VASO-VASOSTOMY) WITH VATSYAYANN’S ‘DUAL-PURPOSE, SINGLE-SUTURE’ TECHNIQUE S. Vatsyayann ∗ Humanity, 4A Cunningham Road Beerescourt Hamilton 3200 New Zealand E-mail address: [email protected]. Aim: Vaso-vasostomy conventionally requires special training in microsurgery technique, long procedure time, longer postoperative care and prolonged wait for positive semen analysis. As a result, there is significant human, technological, physical, time and financial cost involved, unaffordable to many, needing creative simplification in the operative technique Method: Literature reviews on vaso-vasostomy, review of vas anatomy and physiology of healing, and review of suture material characteristics. Result: The findings suggested that we need to develop a technique where we could avoid multiple sutures to put vas ends together to avoid foreign body reaction that could be implicated in causing local resultant complications, especially of leakage and, or blockage. Also, it is because of this, we need to use a microscope, be that a single layer or double layer suturing. We need to avoid longer scrotal incision as well as longer vas exposure during surgery to avoid operative and post-operative com-