HIGHLIGHTED POSTER TOURS

303

PODIUM SESSIONS Friday, 7 December 2012 11.30–12.00 Auditorium PS-01 Psychosexual issues male Chairs: P.-S. Kirana, Greece P. M. Leusink, The Netherlands PS-01-001

CHARACTERIZATION OF PRIMARY AND SECONDARY HYPOACTIVE SEXUAL DESIRE IN MALE PATIENTS WITH SEXUAL DYSFUNCTION Corona, G.1; Rastrelli, G.2; Jannini, E. A.3; Vignozzi, L.2; Forti, G.4; Maggi, M.2 1 Andrology Unit, Dept., Clinical Physiopathology, Florence, Italy; 2Sexual Medicine and Andrology, Florence, Italy; 3School of Sexology, L’Aquila, Italy; 4 Endocrinology Unit, Florence, Italy Objective: Introduction. Primary hypoactive sexual desire (PHSD) is defined as a persistent or recurrent deficient or absent sexual fantasies or desire for sexual activity which should not be comorbid with general medical conditions or with the use of psychoactive medications (i.e. secondary HSD; SHSD). The aim of this study is to characterize PHSD or SHSD in a large series of male patients consulting an Andrological clinic for sexual dysfunction. Methods: A consecutive series of 3714 men (mean age 53.2 +/− 12.5 years) attending our outpatient clinic for sexual dysfunction was retrospectively studied. Several clinical, biochemical and instrumental (penile color doppler ultrasound; PCDU) factors were evaluated. Patient’s HSD was evaluated using question #14 of SIEDY (“Did you have more or less desire to make love in the last three months?”). Results: Among patients studied, HSD was comorbid with erectile dysfunction, premature ejaculation and delayed ejaculation in 38%, 28.2% and 50%, respectively, whereas isolated HSD was complained of by 5.1% of subjects. HSD was substantially increased by hypogonadism, almost doubled by psychopathology and universally present in subjects with hyperprolactinemia (SHSD). Conversely subjects with PHSD (those without aforementioned conditions), were characterized by higher post-school qualification, more disturbed in domestic and dyadic relationships, with an overall healthy body (lower glycaemia and triglyceride levels). Accordingly, in patients with PHSD the risk of major cardiovascular events as calculated with the Progetto Cuore algorithm was lower than in the rest of the sample. Conclusion: Primary and secondary HSD have different risk factors and clinical characteristics. Recognizing PHSD or SHSD will help clinicians to identify comorbidities (psychiatric disorders, hypogonadism, hyperprolactinemia) and to tailor appropriate treatment protocols. Policy of full disclosure: None.

PS-01-002

CORRELATION BETWEEN SEXUAL DYSFUNCTIONS, FATIGUE, DEPRESSION AND QUALITY OF LIFE IN PATIENTS WITH RELAPSING-REMITTING AND PROGRESSIVE MULTIPLE SCLEROSIS Dell’ Atti, L.1; Compagnucci, L.2; Danni, M.2; Gesuita, R.2; Russo, G. R.3; Provinciali, L.2 1 Arcispedale, Urology Unit, Ferrara, Italy; 2Ospedali Riuniti, Ancona, Italy; 3 Arcispedale “S.ANNA”, Ferrara, Italy Objective: Among the common symptoms in Multiple Sclerosis (MS), both in Relapsing-Remitting (RR) and in Primary and Secondary

Progressive Forms (PP, SP), sexual dysfunction (SD) is too often underestimated. The aim of this study was to evaluate the correlation between sexual functioning, demographic and clinical characteristics (neurological status, fatigue and psychological functioning) and quality of life in Relapsing-Remitting Forms and in Primary and Secondary Progressive Forms, to assess the influence of the individual disorders, especially of sexual dysfunction, on quality of life. Methods: 115 consecutive unselected patients with MS (RR, PP-SP). MSISQ-19 (Multiple Sclerosis Intimacy and Sexuality Questionnaire-19) for SD, MusiQol (Multiple Sclerosis International Quality of Life Questionnaire) for QoL, mFIS (Modified Fatigue Impact Scale) for fatigue and Hamilton Depression Scale for depression were used. A non-parametric approach was used in all the analysis. Subjects were evaluated according to two MS forms (RR, PP+SP) and comparisons were performed using Wilcoxon test for quantitative variables and Fisher exact test for categorical ones. The effect of fatigue, depression and sexual dysfunctions was estimated by multiple quantile regression analysis, adjusted for sex, age and disease duration. When the 95% Confidence Intervals did not contain the 0 value, the estimates were considered statistically significant. Results: 83 out of 115 subjects were found to suffer from RR form of MS. The two groups resulted significantly different for all the considered aspects, a part from the gender distribution. RR group was found significantly younger and with a disease duration shorter than PP+SP group. Subjects with PP+SP disease form had significant higher degree of disease, sexual dysfunctions, fatigue and depression severities; moreover, PP+SP subjects had a significant lower QoL score. Conclusion: When the effects of MS forms, fatigue, depression and sexual dysfunctions on QoL were analyzed, we found that the PP+SP form significantly decreased QoL; besides, the higher the sexual dysfunction and fatigue scores were, the worst subjects’ QoL resulted. Policy of full disclosure: None.

PS-01-003

PSYCHOSEXOLOGISTS AND ANDROLOGISTS IN: A PREVENTIVE INTERVENTION FOR YOUNG MALES (ANDROLIFE ESPERIENCE IN ITALY) Duretto, V.1; Barbero, G.2; Allasia, S.3; Lanfranco, F.4; Castellano, E.3; Manieri, C.3 1 ASST Associazione. della Scuo. Sess., Psychology – Sexology, Turin, Italy; 2 SSSC-SC, Super. Sessuol. Clinic, Turin, Italy; 3University of Turin, Andrology, Italy; 4University of Turin, Italy Objective: Androlife campaign has been organized by the Italian Society of Andrology and Sexual Medicine (SIAMS) with the aim to: promote primary prevention of reproductive tract pathologies in males, inform young males on the importance to check risk factors of male infertility, sensitize public awareness of males reproductive health, collect data on lifestyle, habits and general health status of young males aged 18 to 30 years, diagnose possible andrological pathologies. Methods: Androlife campaign in Turin (Italy) was organized by a team of andrologists and clinical psychosexologists in March 2012. Possibility to perform a psychosexological consultation was available to all patients. Psychosexological consultation included a semistructured interview with possible use of International Index of Erectile Function-5 tests. Results: 192 young males, aged 18–30, underwent clinical andrological evaluation. Following previously unknown andrological disorders were detected: 20% had left or bilateral varicocele, 15% past or present genital-urinary infections, 13% premature ejaculation, 9% reduced androgenization, 8% phymosis, 5% erectile dysfunction, 2,5% cryptorchidism. Specific clinical work-up was indicated. Following the

J Sex Med 2012;9(suppl 5):303–335

304 clinical evaluatation 12 young males (6.25%) accepted to undergo psychosexological consultation. Main reasons of consultation were: erectile disfunction (ED – 7 subjects, 3.6%), premature ejaculation (PE – 2 subjects, 1%), infertility (2 subjects, 1%), no previous sexual intercourses (1 subject, 0,52%). Seven subjects have University Degree and 5 High School Diploma. Main diagnosis was anxiety. All subjects received appropriate information and help during first consultation. Non one required further psychological help. Conclusion: Androlife campaign is an excellent observatory on young male sexual health, allowing to diagnose for the first time andrological disorders in young adults. A combined intervention by andrologists and clinical psychosexologists allows to better respond to needs of young males to take care of their sexual health addressing to qualified professionals. Andrologists and Psychosexologist suggest that this combined clinical approach be regularly perfomed. Policy of full disclosure: None.

PS-01-004

PSYCHOSEXUAL CORRELATES: A COMPARISON BETWEEN PATIENTS TREATED WITH SILDENAFIL CITRATE AND THOSE ON INTRACORPOREAL INJECTION Gadalla, A.1 Cairo University, Andrology, Giza, Egypt

1

Objective: To evaluate the personality, anxiety, and sexual satisfaction in normal volunteers and patients with Erectile Dysfunction (ED) treated with Sildenafil Citrate and Intracorporeal Injection (ICI) home therapy. Methods: This is a cross sectional case control study. 100 male subjects were recruited to participate in the study. The sample was divided into 3 groups: ICI-treated Group; included 30 patients complaining of ED & treated with ICI, Sildenafil-treated Group; included 30 patients complaining of ED & treated with Sildenafil Citrate (both groups were treated for a minimum of two months of regular sexual practice), and Control Group; included 40 normal subjects with no history of psychosexual illnesses. The 100 male subjects were interviewed and the following questionnaires were administered: Beck Anxiety Inventory, Eysenck Personality Questionnaire, Sexual Satisfaction Scale, and International Index of Erectile Function Questionnaire (IIEF-5). Results: Comparing ICI group with Sildenafil group, there was a statistically significant difference in the Beck Anxiety Inventory (p < 0.05); however, there was no significant difference in sexual satisfaction scale (p = 0.148) or IIEF-5 (p = 1). Moreover, the Eysenck personality profile questionnaire did not show any significant difference in Psychoticism (P) (p = 0.265), Neuroticism (N) (p = 0.165), Extraversion (E) (p = 0.749), Lie (L) (p = 0.595), and Criminality (C) (p = 0.413). Conclusion: Anxiety is lower in ICI group compared to Sildenafil group. No significant difference was found upon comparing the personality profile five dimensions, IIEF-5, nor the sexual satisfaction scale. Policy of full disclosure: None.

PS-01-005

DIFFERENT ASPECTS OF QUALITY OF LIFE AND SEXUAL FUNCTIONING IN MEN AND WOMEN WITH PSYCHIATRIC DISORDERS Maroevic, S.1; Ivezic, E.2; Arbanas, G.3; Muzinic, L.4; Jerkovic, I.2; Mirjanic, L.5 1 Univerity Psychiatric Hospital, Zagreb, Croatia; 2Zagreb, Croatia; 3General Hospital Karlovac, Psychiatry, Croatia; 4University Hospital Dubrava, Zagreb, Croatia; 5Croatian Association for HIV, Zagreb, Croatia Objective: Quality of life is a complex, syntactic experience of dis/ satisfaction with one’s life (way of life, life’s course, perspectives, possibilities). Sexual functioning is essential part of quality of life. The aim of this study was to assess correlations between different aspects of

J Sex Med 2012;9(suppl 5):303–335

Podium Sessions quality of life and sexual functioning in men and women with different psychiatric conditions. Methods: Subjects were collected in three day hospitals in two towns in Croatia. There were 238 subjects (73% men), with the different mental disorders (posttraumatic stress disorder, depression, anxiety disorders, alcohol dependence). The average age of the subjects was 47.5. Data were collected with three questionnaires/scales: the initial questionnaire on sociodemographic data and satisfaction with a partner; the Sexual Functioning Scale and Quality of Life Scale. Results: In both, men and women, there is a high correlation between the quality of sexual functioning and scores on the Quality of life questionnaire and with the satisfaction with sexual partner with higher values in women. All the aspects of life important for the sexual functioning in men were also important for women. Aspects of life important for the quality of sexual functioning in women, but not in men are: satisfaction with emotional part of the relationship, financial security and religion. Conclusion: There is a high correlation between quality of sexual functioning and quality of life and satisfaction with one’s partner in both men and women, but the correlation is higher in women. Quality of sexual functioning is correlated with more aspects of life in women than in men. So, could we say: it s more difficult to satisfy women than men?! Policy of full disclosure: None.

305

Podium Sessions Friday, 7 December 2012 11.30–12.00 Forum PS-02 Women’s health epidemiology Chairs: F. Tripodi, Italy A. Christensen PS-02-001

EFFECTS OF FEMALE GENITAL CUTTING ON THE SEXUAL FUNCTION OF EGYPTIAN WOMEN. A CROSS SECTIONAL STUDY Anis, T.1; Aboul Gheit, S.2; Awad, H.2 Cairo University, Andrology, Egypt; 2Cairo University, Egypt

1

Objective: The existing literature is conflicting regarding effects of female genital cutting (FGC) on sexual functions. Several studies from Africa over the past 20 years have challenged the negative effect of genital cutting on sexual feelings, while other studies indicated that sexual function of genitally cut women is adversely altered. The aim of the study was to investigate the effects of FGC on the female sexual function of Egyptian women. Methods: This is a cross-sectional study conducted between February and May 2011 at the outpatient clinic of Cairo University Hospitals. The study included 650 Egyptian females between 16 and 55 years of age (333 genitally cut women, and 317 uncut women). Participants were requested to fill the Arabic Female Sexual Function Index (ArFSFI), and were then subjected to clinical examination where the cutting status was confirmed. Main Outcome Measures is the total score of the ArFSFI and its individual domains. Results: The mean age of cutting was 8.59 (±1.07) years. Of the cut participants 84.98% showed signs of type I genital cutting, while 15.02% showed signs of type II genital cutting. After adjusting for age, residential area and education level, uncut participants had significantly higher ArFSFI total score (23.99 ± 2.21) compared with cut participants (26.81 ± 2.26). The desire, arousal, lubrication, orgasm, and satisfaction domains were significantly higher in the uncut participants (4.02 ± 0.78, 4.86 ± 0.72, 4.86 ± 0.75, 4.86 ± 0.68, 5.04 ± 0.71 respectively) compared with those of the cut participants (3.37 ± 0.89, 4.13 ± 0.71, 4.16 ± 0.84, 4.50 ± 0.79, 4.69 ± 0.92 respectively). No significant difference between the two groups was found regarding the pain domain. Conclusion: Female genital cutting is associated with reduced scores of ArFSFI in Egyptian women. It is hoped that documenting the negative effects of FGC on female sexual function would assist the efforts to abandon that tradition. Policy of full disclosure: None.

PS-02-002

OXIDATIVE STRESS IS NOT RELATED WITH SEXUAL DISORDERS AND SEXUAL DISTRESS IN WOMEN WITH TYPE 1 DIABETES MELLITUS Dimitropoulos, K.1; Tzortzis, V.2; Liakos, P.2; Melekos, M.2; Koukoulis, G.2; Bargiota, A.2 1 University of Thessaly, Department of Urology, Larissa, Greece; 2University of Thessaly, Larissa, Greece Objective: According to current data, sexual disorders and sexual distress in women with diabetes mellitus (DM) are correlated with psychological and contextual factors. Oxidative stress has been shown to be highly related with development of diabetic complications, however its role as a risk factor for FSD in diabetic women has not been studied. The aim of the present study was to evaluate whether oxidative stress is implicated in the pathogenesis of FSD in women with T1DM. Methods: Forty four T1DM women and 45 controls were enrolled in the study. Sexual functioning and sexual distress were evaluated with FSFI and FSDS questionnaires while stable radical 2,2-diphenyl-1-

picrylhydrazyl (DPPH), thiobarbituric acid reactive substances (TBARS), advanced glycoxidation end products (AGEs) and nitric oxide (NO) were used as oxidative stress biomarkers. Parametric and non parametric tests were used in statistical analysis. Results: Women with T1DM had significantly worse FSFI and FSDS score compared with control women (P = 0.005 and 0.026, respectively). Moreover, in comparison with non diabetics, T1DM women had significantly higher AGEs (P = 0.000) and TBARS (P = 0.038); no difference was found in DPPH and NO (P = 0.974 and 0.296 respectively). No other differences were found between the 2 groups. According to the FSFI and FSDS results, diabetic women were further grouped to women with and without sexual disorders (n = 11 and 33 respectively) and to women with and without FSD (n = 7 and 37 respectively). No significant difference was found between these groups in all markers of oxidative stress (P > 0.05). Moreover, correlation analysis in the T1DM group did not reveal any significant correlations between the oxidation biomarkers and age, BMI, HbA1c, FSFI and FSDS scores (P > 0.05). Conclusion: Our results show that in T1DM women, sexual disorders and sexual distress are not related with oxidative stress. These findings confirm that factors other than diabetes related ones are implicated in the pathogenesis of FSD in T1DM women. Policy of full disclosure: None.

PS-02-003

EVALUATION OF PREVALENCE OF SEXUAL DYSFUNCTION AMONG IRANIAN WOMEN Khezri, F.1; Mohebinezhad, S.2 Medcare Hospital, Urology, Dubai, United Arab Emirates; 2Azad Medical University, Kazeroon, Islamic Republic of Iran

1

Objective: Previous studies about sexual dysfunction in female shows that this problem has high prevalence and biological, psychological, and interpersonal behaviours have effect on it. Because there is limited information about this subject in Iran, in this study, we try to be the pioneer for this kind of study about the prevalence, reasons, and treatment of this problem in Iranian women. Methods: This is a cross-sectional study and one thousand women selected by random in different place out of hospitals and health centers, in public places like mosques, beauty salons, and in women parties. We chose women out of hospitals because women with problems come to hospitals and we need data from public. Data was prepared by questionnaire. In questionnaire, age, education, job, duration of marriage, personal idea about sexual interest and satisfaction after intercourse and some other questions are asked. We develop new questionnaire for this study. Since there is cultural difference with western countries, we couldn’t used standard questionnaires and so we develop ours. Results: The results show that sexual problems in women have high prevalence. -about 23% of women have lack of sexual interest. -about 20% of women have sexual arousal disorder and dryness of vagina during intercourse. -between 10.5–22% of women have pain during intercourse. -9% of women have anorgasmia. (leiblum, 1992- 5–8% in lectures) -about 40% of women have dissatisfaction after intercourse. Conclusion: According to these results, female sexual dysfunction has high prevalence in Iran. Because this problem is affecting the interpersonal relationships, quality of life, self-esteem, and mood state of couples, we should try to know the effective factors and treatment of these problems. Policy of full disclosure: None.

J Sex Med 2012;9(suppl 5):303–335

306 PS-02-004

ASSOCIATION BETWEEN SEXUAL SELFCONCEPT AND PREMARITAL SEX AMONG PROPOSED MARITAL COUPLES Ziaei, T.1; Merghati Khoei, E.2; Salehi, M.3 Isfahan University of Medical, Reproductive Health, Islamic Republic of Iran; 2Tehran University of Medical, Islamic Republic of Iran; 3Isfahan University of Medical, Islamic Republic of Iran

1

Objective: Premarital sex is a risk taking behavior with the potential negative consequences such as STIs and HIV/AIDS, unwanted pregnancy and social conflicts. Because of these consequences this subject is the interest of researchers, policy makers and health practitioners. Some factors associated with delayed sexual initiation which more studies rely on them are religiosity, personality traits, assertive skills and parent-child closeness and parental control. Recently researchers found that sexual self-concepts is another factor which associated with premarital sex. Although, lesser studies have done on it. Since the sexual experience before marriage is not accepted from the view of socio-cultural and religious in Iran, we designed this study to assess correlation between sexual self-concept and premarital sex among proposed marital couples. Methods: In a cross–sectional study, 202 proposed marital couples enrolled via simple random sampling from couples who participated in premarital class in Isfahan-Iran in 2012. Data gathering was done by Persian modified version of Multidimensional Sexual SelfConcepts Questionnaire. The questionnaire includes 78 items in 18 dimensions. Results: Mean age of women and men were 23.04 and 26.4 years. From 33.4% of participants had sex experience before marriage, men were twice than women. Analyze of variance showed that sexual anxiety score of women was higher than men (p < .005) and sexual self-efficacy (p < .01), sexual consciousness, motivation to avoid risky sex men have higher score than women (p < .005). Correlation between premarital sex and sexual anxiety was not significant but there was negative correlation with sexual self-efficacy, sexual consciousness and avoiding high risk behavioral sex. (p < .001) Conclusion: Training is quite recommended to be given to adolescents and young people in friendly youth services and schools. This training is an effort to improve their positive sexual self-concepts. Young people who trained can delay premarital sex until marriage, and then we see decrease in negative consequences of premarital sex. Policy of full disclosure: None.

PS-02-005

BASSON’S CIRCULAR SEXUAL RESPONSE MODEL IS ACCOMPANIED WITH WORSE SEXUAL FUNCTIONING AND HIGHER SEXUAL DISTRESS COMPARED WITH LINEAR SEXUAL RESPONSE MODELS Dimitropoulos, K.1; Bargiota, A.2; Gravas, S.2; Melekos, M.2; Koukoulis, G.2; Tzortzis, V.2 1 University of Thessaly, Department of Urology, Larissa, Greece; 2University of Thessaly, Larissa, Greece Objective: Circular sexual response model has been suggested to better reflect women with sexual problems. The present study aims to evaluate the profile of women whose sexual functioning is best described by circular and linear sexual response models. Moreover, the relationship between sexual response models and sexual disorders and sexual distress is investigated. Methods: Sexual functioning and sexual distress of eighty two women were evaluated with the use of the FSFI and the FSDS questionnaire respectively. A flyer describing the two major linear sexual response models (Masters & Johnson’s and Kaplan’s) and Basson’s circular sexual response model was distributed to all women. Participants were asked to choose the one that best suited their sexual functioning. According to their selections, women were categorized to Circular

J Sex Med 2012;9(suppl 5):303–335

Podium Sessions Model Group (CMG) and Linear Model Group (LMG). Mann Whitney – U test was used for between groups comparisons. Results: In total, 33 women selected Basson’s model and formed the CMG, while the 49 remaining formed the LMG (33 selected Masters and Johnson’s model and 16 Kaplan’s model). Compared with women of LMG, women of CMG were older (P = 0.000), with higher BMI (P = 0.001), in longer term relationships (P = 0.000) and with less total number of sexual partners (P = 0.002). Furthermore, women of the CMG had worse total FSFI score (P = 0.006), lubrication (P = 0.016), orgasm (P = 0.030), satisfaction (P = 0.031) and FSDS score (P = 0.012) in comparison with women of the LMG. No other differences were found (P > 0.05). Conclusion: Present study results show that linear models prevail in younger ages and short term relationships. In contrast, Basson’s circular sexual response model is more frequent in older women, who participate in long term relationships and is related with higher levels of sexual distress and worse sexual functioning, especially in the domains of lubrication, orgasm and satisfaction. Policy of full disclosure: None.

307

Podium Sessions Friday, 7 December 2012 13.00–14.00 Auditorium PS-03 Men’s sexual health: Surgery I Chairs: B. Cuzin, France A. Muneer, United Kingdom PS-03-001

THE MEDTRONIC ZOTAROLIMUS-ELUTING PERIPHERAL STENT SYSTEM FOR THE TREATMENT OF ERECTILE DYSFUNCTION IN MALES WITH SUB-OPTIMAL RESPONSE TO PDE5 INHIBITORS – 6 MONTH RESULTS Goldstein, I.1; Köhler, T.2 Alvarado Hospital, Univ. of Calofornia, California, USA; 2Southern Illinois University, Springfield, USA

1

Objective: Organic ED is largely vasculogenic and predates coronary artery disease (CAD) symptoms by approximately three years. Up to 75 percent of men with CAD have ED. Prior research revealed men poorly responsive to PDE5i had 50% blockages in one or both internal pudendal arteries. This study evaluated the first in human safety and feasibility of the Medtronic Zotarolimus-Eluting Peripheral Stent System (ZEPS) to improve erectile function in men with a sub-optimal response to PDE5i and atherosclerotic lesions of the internal iliac and/ or internal pudendal arteries. Methods: Men ≥18 years with ED and sub-optimal response to PDE5i with atherosclerotic lesion(s) of the internal iliac and/or internal pudendal arteries were treated unilateraly or bilaterally with ZEPS. Subjects were identified after undergoing a duplex Doppler ultrasound study during pharmacologic induced erection to confirm inflow limitations and exclude venous insufficiency. The target reference vessel diameter was >2.25 mm and <4.20 mm and lesion length <27 mm by visual estimate. Results: The primary feasibility endpoint for this study is increase in erectile function as measured by the improvement of IIEF EF domain score by ≥4 points. The 3 and 6 month data show that 68.2% and 69.6%, respectively, of the subjects treated per protocol experienced improved erectile function. There were no instances of stent fracture through 6 months and study patients experienced no major adverse events, implying the treatment’s short-term safety. Conclusion: These are the first 6 month safety and efficacy data utilizing drug eluting stent therapy for treatment of erectile dysfunction. While the early results of this feasibility study are promising, more research is needed to determine whether pelvic artery stenting could become a viable adjunctive treatment option for those with suboptimal response to PDE5i and vasculogenic ED. Policy of full disclosure: SOURCE OF FUNDING: Medtronic Vascular. Dr. Goldstein is an investigator and consultant for Medtronic. Dr. Köhler is an investigator for Medtronic.

PS-03-002

PENILE PROSTHESIS INSERTION IN PATIENTS WITH REFRACTORY ISCHEMIC PRIAPISM: IMMEDIATE VERSUS DELAYED IMPLANTATION Zacharakis, E.1; Garaffa, G.2; Spilotros, M.1; Raheem, A. A.2; Christopher, N. A.2; Ralph, D. J.2 1 University College Hospital, Urology, London, United Kingdom; 2University College Hospital, London, United Kingdom Objective: The long-term results of immediate and delayed insertion of penile prosthesis in patients with refractory low flow priapism are presented. Methods: A penile prosthesis was inserted in 95 patients with refractory ischemic priapism. Immediate insertion was carried out in 68 patients (mean age 42 y; range 26–73) within a mean of 171 hours (24–408) from the onset of the priapic episode while delayed implan-

tation was offered to the remainder (mean age 45 y; range 28–69) after a median of 5 months (range 2–14) from the initial conservative management of the episode. All patients had failed aspiration and instillation of alpha-agonists and 28 patients had had unsuccessful shunt surgery performed prior to referral. Results: In the immediate insertion group, a malleable prosthesis was inserted in 64 patients, 10 of which were later electively revised to a 3-piece-inflatable device, while 4 patients had a 3-piece-inflatable prosthesis implanted. After a mean follow-up of 17 months, 6 patients needed revision surgery due to infection (n = 5) or curvature (n = 1). Overall the satisfaction rate was 96% with 67 patients able to have sexual intercourse without penile shortening. In the delayed implantation group, dilatation of the corpora has been difficult in all cases due to dense fibrosis and second distal corporal incision was required in 80% of patients to complete the dilatation. A penile implant was inserted in all cases (malleable 12, 3 pieces inflatable 15) but downsized cylinders were required in 22. After a mean follow-up of 21 months, 7 patients required revision surgery due to infection (n = 5), erosion (n = 1) and mechanical failure. Overall, 25 patients are currently able to engage in sexual intercourse but dissatisfaction rate is 40% due to significant penile shortening. Conclusion: Patients with refractory ischemic priapism should be offered immediate implantation of a penile prosthesis as this is simpler than delayed implantation, yields superior functional results and allows the preservation of penile length. Policy of full disclosure: None.

PS-03-003

ANALYSIS OF COMPLICATIONS IN PATIENTS AFTER PENILE IMPLANT SURGERY Gorpynchenko, I.1; Romaniuk, M.2; Kornienko, A.1; Aksenov, P.1 Institute of Urology, Kiev, Ukraine; 2Kiev, Ukraine

1

Objective: To study the frequency and structure of post-operative complications in patients after penile prosthesis implantation. Methods: 144 patients with severe erectile dysfunction (ED) have undergone the penile implantation. Average age: 51,4 ± 3,8. Penile implants used: Semirigid implants-78; AMS 650(plastic)-16;AMS Spectra-40; AMS 700 Ultrex-10. Results: Complications after implantation required surgical management (13 patients (9,1%)): purulent cavernitis-2(1,4%); urethrocavernous fistula-1(0.7%); protrusion of the prosthesis-2(1,4%), implant damage-6(4.2%) required explantation of the implant, followed by reimolantation. Hypermobility of prosthesis–2(1.4%) required plasty of tunica albuginea. The factors that led to the development of these problems included: the initial state of the cavernous tissue and tunica albuginea. 4 cases of complications (purulent cavernitis and hypermobility of prosthesis) were observed in patients with insulin-dependent diabetes mellitus. Protrusion of the prosthesis was observed in 2 patients who underwent reimplantation. Patients required dynamic monitoring: 66 people(46%): penile lymphostasis-26(18.2%), penile and scrotal hematoma-1(0.7%), the loss of sensitivity of the glans–12(8.4%). Dissatisfaction: 27(18.7%) required a rational psychotherapy or penile reimplantation. The average score for the sexual function satisfaction scale was 15,3 ± 2,1 (N = 106), which certainly indicates a significant improvement of quality of life of our patients. Conclusion: The frequency of complications after penile implantation are connected to both somatic and psychological status of patients undergoing surgery. In 18.7% of the operated patients dissatisfaction, as a complication of implantation, has no physical cause and are considered to be the decompensation of psycho-emotional status, that requires subsequent psychotherapeutic interventions. Policy of full disclosure: None.

J Sex Med 2012;9(suppl 5):303–335

308

Podium Sessions

PS-03-004

ENDOVASCULAR COIL OCCLUSION AS AN ALTERNATIVE METHOD FOR PROXIMALVENOUS LEAK CORRECTION IN PATIENTS WITH VENO-OCCLUSIVE ED Kurbatov, D.1; Sitkin, I.2; Lepetukhin, A.2; Dubskiy, S.2 Endocrinologic Research Centre, Andrological, Moscow, 2 Endocrinologic Research Centre, Moscow, Russia

1

Russia;

Objective: There is a causal or accompanying venous insufficiency in 40–65% of patients with ED. In patients with proximal venous leak and non-responded for PDE-5 inhibitors, conventional methods include penile cruses plication or prosthesis implantation. We successfully use the cavernous veins and/or prostatic plexus endovascular coil occlusion as alternative low invasive method for proximal venous leak correction in patients with veno-occlusive ED. Methods: We examined 68 pts [18–39 ys] with proximal type of venous leakage during the period 09/2008–9/2012. IIEF – erectile function (EF) domain was 7–12 (9,2 ± 1,6). Laboratory tests included total plasma Testosterone, FSG, LG, SHBG, Prolactin, Estradiol, Blood count, Glucose, Lipid metabolism, PSA (after 45 years). All men applied initially PDE-5 inhibitors with different results. Patients including criteria were: age < 50 years, ED duration < 2 years, no smoking, no hypogonadism. In 62 pts we applied antegrade endovascular coil occlusion via dorsal penile vein and in 6 pts – retrograde transfemoral endovascular coil occlusion via internal iliac vein. Results: The surgery time was 20–60 min. The average follow-up was 34 months (range 2–48). The total restoration of ED function had 56 pts (82%), partial improvement – 10 pts (14%) (had satisfactory coitus with on demand low dose PDE-5 inhibitors) and 2 pts (4%) had negative result due to cavernous fibrosis. Complications were: – transitory oedema of the penis in two cases and dorsal vein bleeding in one patient. EF domain scores (IIEF) increased to 24,5 ± 0,5. Conclusion: Endovascular coil occlusion of cavernous veins and / or prostatic plexus can be the real alternative method of veno-occlusive ED correction in selected patients with proximal venous leak. Policy of full disclosure: None.

PS-03-005

PEROVIC PLICATION TECHNIQUE RESULTS IN CONGENITAL PENILE CURVATURES AND STABLE PEYRONIE DISEASE Mavilla, L.1; Pisanti, F.2; Giulianelli, R.1; Albanesi, L.1; Attisani, F.1; Gentile, B. C.1; Granata, D.1; Mirabile, G.1; Schettini, M.1; Shestani, T.1 1 Nuova Villa Claudia Clinic, Rome, Italy; 2Nuova Villa Claudia Clinic, Urology, Rome, Italy Objective: Penile curvature can be congenital or acquired. Acquired curvature is secondary due to La Peyronie (Peyronie’s) disease. Severe curvature can cause penetration problems, unconfortable intercourses and psycological disconfort leading to surgical procedure. Methods: Perovic tecnique (plication of the tunica albuginea using nonabsorbable sutures) is an efficacy procedure to correct the recurvatum when the curvature angle is less than 60 degrees and penile lenght is acceptable From 01.2010 to 09.2011, 37 patients, affected by penile curvature, underwent surgical treatment. Mean age was 45 (range 16–67 years). Palpable nodes or plaques were dorsal in 13 pts, left lateral in 3 and right lateral in 4. The curvatures were between 30 and 60 degrees. Tecnique consisted of a plication of the tunica albuginea performing a six passages S shape using a non absorbable twisted 0 wire creating bumps of the tunica albuginea. All surgical procedures have been recorded with pre and post operative photos. Results: After 3 months surgical results and satisfaction of the patients have been evaluated performing IIEF-5 and Duplex US. None of our patients referred erectile disfunction; one patient (2,7%) showed a severe wound infection, 6 (15%) hypoesthesia from soft to mild, 5 (12,5%) palpation of knots and stitches underneath the skin, 2 (5,2%) residual curvature (about 20 degrees), 3 (8,1) penile shortening related

J Sex Med 2012;9(suppl 5):303–335

to unsatisfaction, 30 (81%) normal or high satisfaction from the results of the procedure. Conclusion: Penile curvature correction using the plication of the tunica albuginea tecnique performing a non absorbable S shape suture is a simple and effective procedure. It’s absolutely necessary the right indication to the use of plication tecnique to avoid possibilities of residual curvature or penile shortening compromising the final result. Using this safe tecnique severe complications are rare and patients are usually very satisfied. Policy of full disclosure: None.

PS-03-006

THE “SLIDING TECHNIQUE” FOR THE ENDSTAGE PEYRONIE’S DISEASE WITH SEVERE SHORTENING OF THE PENIS: SURGICAL OUTCOMES AND PATIENTS’ SATISFACTION AFTER 2 YEARS OF EXPERIENCE Rolle, L.1; Timpano, M.1; Ceruti, C.1; Sedigh, O.1; Falcone, M.2; Galletto, E.1; Destefanis, P.1; Preto, M.1; Fontana, D.1 1 Molinette Hospital, Turin, Italy; 2Molinette Hospital, Urology 2, Turin, Italy Objective: In 2010 we proposed an original lengthening technique for end stage Peyronie’s disease (PD) with severe shortening of the penis, called “The Sliding technique”. The aim of this study is to assess the surgical outcome and the patients’ satisfaction about this procedure after 2 years of experience. Methods: 7 patients affected by PD, severe shortening of the penis, erectile dysfunction and curvature of the shaft < 30° were recruited from June 2010 to August 2012. All the procedures were performed by a three surgeon staff and under spinal anaesthesia. The “Sliding Technique”, a new lengthening surgical procedure based on a ventrodorsal incision of the tunica albuginea, penile prosthesis implantation and double dorsal-ventral patch grafting, was performed. We implanted a three-component penile prosthesis in 5 cases (AMS 700 CX) and a non-inflatable concealable prosthesis in 2 cases (AMS Spectra). Results: In our patients this procedure has allowed us to obtain an average real lengthening of the penis of 3.5 cm. The mean operative time was 2 hours and 50 min. No major intraoperative neither postoperative complications (ischemia / necrosis of the glans) were detected. One patient, as a result of a malfunction of the scrotal pump, complained a shortening of the penis of about 1 cm as a consequence of the retraction of the patch. The IIEF, at a mean follow-up period of about 1 year, is 60.8, while the EDITS is 51. Conclusion: The “sliding technique” is a reliable and safe procedure to treat end-stage PD with severe shortening of the penis. Policy of full disclosure: None.

PS-03-007

A NEW MODIFIED NESBIT TECHNIQUE FOR THE CORRECTION OF CONGENITAL PENILE CURVATURE BASED ON GEOMETRIC PRINCIPLES AND SUPERFICIAL TUNICA ALBUGINEA EXCISIONS Kuehhas, F.1; Herwig, R.2; Egydio, P. H.3 Medical University of Vienna, Urology, Austria; 2Medical University of Vienna, Austria; 3Specialized Centre of Penile, Sao Paulo, Brazil

1

Objective: Congenital penile curvature can have detrimental effects on the life of patients. Surgical correction of a congenital penile deviation is associated with several side effects such as loss of penile length and formation of “dog ears”. We report our experience with a new technique for the correction of congenital penile curvature based on geometric principles. Methods: Between January 2006 and February 2012, 237 men with congenital penile curvature underwent our modified Nesbit technique. The technique consists of an objectivation of the degree of curvature

309

Podium Sessions and distribution of the bending force by multiple, small, superficial, elliptical excisions of the tunica albuginea. Results: Overall success rate was 98.7%. Residual curvature of less than 20 degrees was reported in 6% (n = 14) of the cases, none of those patients opted for further surgical correction. Residual curvature of up to 30 degrees was observed in 1.3% (n = 3), these patients underwent a re-operation. It was clearly shown, that the acquisition or the recovery of the ability to perform sexual intercourse brought major relief and high rates of satisfaction and self-esteem. After 6 months no recurrence of a ventral curvature occurred. Conclusion: Our modified Nesbit technique, consisting of superficial tunica albuginea excision according to the geometric principles of the Egydio technique leads to rapid and excellent results due to an objectivication of the curvature. It is a safe and valid alternative for the treatment of congenital ventral or ventro-lateral penile deviation. Policy of full disclosure: None.

PS-03-008

SURGICAL TREATMENT OF PEYRONIE’S DISEASE USING QUADRATIC DERMA GRAFT Herwig, R.1; Kuehhas, F.2 Medical University Vienna, Urology, Wien, Austria; 2Medical University Vienna, Wien, Austria

1

Objective: Surgical treatment of Peyronie’s disease includes excision of the plaque and using autologous or heterologous graft materials for defect closure. The optimal graft material, however, has not been defined yet. We report our results of a modified dorsal repair technique and the use of a dermal graft as closure material after plaque excision. Methods: 51 patients with Peyronie’s disease underwent surgical treatment. Mean patient age was 52 years (21–74) and mean interval between onset of disease and surgery was 11.3 months (6–24). 45/51 had full rigidity prior to surgery. Our surgical approach included degloving of the penile skin, preservation of the neurovascular bundles, intraoperative identification of the curvature by artificial erection and excision of the plaque. The defect was closed with a quadratic dermal graft. Postoperative diazepam 5 mg was given every 4 hours for two days. Results: Dorsal curvature, ventral curvature and circular lesions were seen in 45 (88.2%), 5 (9.8%) and 1 (2%) patients, respectively, 20° to 180° (mean 73.47°). Intraoperative plaque size ranged from 2 × 2.5 cm up to 7 × 5 cm. Penile curvature was straightened (residual curvature < 10°) in 49 patients after a mean follow-up of 9.5 months (3–21). 2 patients developed recurrent curvature but reported satisfactory sexual intercourse. No re-operation was necessary. No post-operative infection, hematoma, bulging at the graft site, or a local reaction to the dermal graft was seen. All patients were able to have intromission for satisfactory sexual intercourse, 49 patients unaided and 2 patients with PDE-5 inhibitor. Conclusion: Surgical treatment of Peyronie’s disease using a quadratic derma-graft is a viable approach with excellent postoperative functional outcome. Policy of full disclosure: None.

PS-03-009

REPORT OF NEWLY DEVELOPED MULTILAYER DISSECTION METHOD AND MULTILAYER SUTURE LENGTHENING WITH MINIMAL INCISION IN PENILE ENHANCEMENT SURGERY

multi-layer suture procedure with minimal incision in penile enhancement surgery. Methods: 2000 patients underwent penile enhancement surgery. All patients adopted allogenic dermal graft for girth enhancement and pre-pubic minimal incision were performed. Before allogenic dermal draft is attached to buck’s fascia of penile shaft, we dissect subcutaneous tissue and dartos fascia. We use newly developed dissection technique with simultaneous curved iris scissor and electro-cutting. And same dissection procedures were performed at lengthening operation. After dissecting fundiform ligament, multi-layer transverse sutures were done for approximation of pre-pubic dead space with PDS 2.0. Results: Mean operation time is 48 min and mean incision length is 3.3 cm. Postoperative penile length (from the glans tip to the penoscrotal junction) after 3 months was elongated to 4.7~7.5 cm compared with preoperative length of 2.4~5.7 cm. The average elongated length of the penis was 2.6 cm. Postoperative inflammation rates were 26 cases (1.3%) and gaft failure was 1 case (0.05%). Conclusion: For penile augmentation and lengthening surgery, newly developed multi-layer dissection method and multi-layer suture lengthening procedure with minimal incision (3 m) are very effective. Policy of full disclosure: None.

PS-03-010

OUTCOME AND RISK FACTORS FOR VAGINECTOMY IN FEMALE-TO-MALE TRANSEXUALS Spilotros, M.1; Garaffa, G.2; Ralph, D. J.3; Christopher, N. A.3 University College Hospital, Urology, London, United Kingdom; 2The Institute of Urology, St Peter’s Andrology, London, United Kingdom; 3 UNiversity College Hospital, London, United Kingdom

1

Objective: To determine outcome and risk factors for vaginectomy in female-to-male (FTM) transsexuals undergoing sex reassignment surgery. Methods: 89 FTM patients underwent mucosal vaginectomy between April 2004 and October 2011. This was performed as sole procedure in 15 (16.9%) and as a combined procedure in 74 (83.1%). All patients were discharged with either an urethral or a suprapubic catheter for at least 3 weeks in case of bladder hypotonia. Non-parametric MannWhitney tests were used to evaluate the data. Results: Median operative blood loss was 700 ml (mean 762, range 100–3000); median post-operative blood loss was 200 ml (mean 261, range 20–1490); median blood transfusion was 0 units (mean 0.5, range 0–7) and 20 (22%) were transfused. Operative complications include 3 bladder perforations and 2 urethral injuries both treated with immediate primary repair with no future consequence. Post-operative complications included wound infection (n = 11, 12.3%), UTI (n = 5, 5.6%), wound bleeding (n = 13, 14.6%) and vaginal haematoma/ abscess (n = 6, 6.7%) of which 5 were re-explored. Median catheter removal was 28 days (range 21–73) and 23 days (range 17–99) for urethral and suprapubic respectively. Post-op LUTS occurred in 10 (11.2%) patients. 4 patients with hypotonic bladder (2 pre-existing) were successfully managed with prolonged catheterisation and 6 with overactive bladder were treated with anti-cholinergics. There was 1 (1.1%) posterior urethral (vaginal) fistula and 1(1.1%) urethral stricture directly related to the vaginectomy. There was a significant increase in total bleeding and complications with long vaginas (p < 0.001). There was no correlation of post-op LUTS with vagina length. Conclusion: Urological complications are few and are easily manageable. Most complications are related to bleeding which appears to be related to vagina length. Policy of full disclosure: None.

Jang, S.-Y.1 1 LJ Genitouriry Surgery Ins., Seoul, Republic of Korea Objective: To accomplish better results of penile enhancement surgery, lesser time consuming and bleeding process are very important. We aim to introduce newly developed multi-layer dissection method using simultaneous curved iris scissor, electro-cutting and

J Sex Med 2012;9(suppl 5):303–335

310 Friday, 7 December 2012 15.30–16.30 G102/103 PS-04 Preclinical research I Chairs: E. Snoeren, Norway H. W. Elzevier, The Netherlands PS-04-001

GALANIN IS UPREGULATED IN THE MAJOR PELVIC GANGLION IN THE ENDOGENOUS NEUROREGENERATIVE RESPONSE TO CAVERNOUS NERVE INJURY Albersen, M.1; Hannan, J.2; Hakim, L.3; Liu, X.2; van der Aa, F.3; Hedlund, P.4; Bivalacqua, T.2 1 University Hospitals Leuven, Experimental Urology, Belgium; 2Johns Hopkins University, Baltimore, USA; 3University Hospitals Leuven, Belgium; 4San Raffaele University, Milan, Italy Objective: Galanin has been proposed as an endogenous trophic neuropeptide and may therefore play a role in the neuroregenerative response to CNI. In autonomic ganglion neurons, Galanin has been indicated to act via galanin receptor 2 (GalR2) in activating nerve regeneration. It has been suggested that nerve growth factor (NGF) depletion after nerve injury enhances Galanin expression via c-Jun. This study was designed to gain a further insight in the expression and temporal regulation of galanin and its receptors and regulators in the MPG following CNI. Methods: Thirty male rats were subjected to bilateral CNI. The MPGs were harvested at 2, 7, 14, 30 and 60 days following injury in 5 rats per time-point. Sham operated rats (n = 5) served as controls. MPGs were lysed and RNA was isolated, followed by reverse transcription and qPCR for Galanin, GalR1–3, NGF and c-Jun expression. Furthermore, we evaluated the expression of GalR1, 2, and 3 and Galanin in the MPG of sham rats by IHC. Data are given as mean ± SEM. Results: Galanin, and its receptors GalR1 and GalR2 are expressed in the MPG, and are located in the neuronal population of the ganglion. Galanin expression significantly increased acutely after CNI and gradually started to decrease after 14 days (2d: 231,4 ± 63,3; 7d: 251 ± 55; 14d: 128,9 ± 94,8; 30d: 28,6 ± 9,1; 60d: 10,2 ± 3,8 fold regulation of sham). GalR1–3 expression showed a gradual decrease following CNI. Galanin upregulation was paralleled by a downregulation in NGF, and a persistent long-lasting upregulation of c-Jun. Conclusion: Galanin is upregulated in the MPG in the early phase after CNI after which it gradually decreases. Gal-receptor expressions show a decrease after injury, likely reflecting apoptosis of neurons expressing these receptors. Based on previous in-vitro reports and our results we hypothesize that Galanin upregulation is an important factor in the endogenous neuroregenerative response to CNI. Policy of full disclosure: None.

PS-04-002

CHRONIC INHIBITION OF CGMP PHOSPHODIESTERASE 5A IMPROVES DIABETIC CARDIOMYOPATHY EXERTING AN ANTI-REMODELING EFFECT: A RANDOMIZED, CONTROLLED CLINICAL TRIAL WITH MAGNETIC RESONANCE IMAGING Isidori, A.1; Giannetta, E.2; Galea, N.3; Iacopo, C.3; Mandosi, E.3; Morano, S.3; Vizza, C. D.3; Lenzi, A.3 1 University of Rome, La Sapienza, Roma, Italy; 2Sapienza University of Rome, Roma, Italy; 3University of Rome, Roma, Italy Objective: Inhibition of phosphodiesterase type 5 (PDE5) exerts a relaxant effect on the smooth muscle cells of the trabecular structures

J Sex Med 2012;9(suppl 5):303–335

Podium Sessions of the corpora cavernosa, resulting in improved erections. More recently, PDE5-inhibitors have been claimed to offer cardioprotective effects. However, it has never been ascertained whether PDE5i exerts an antiremodeling effect in humans. Methods: We explored the cardioreparative properties of a selective phosphodiesterase type 5 inhibitor, sildenafil, in men with diabetic cardiomyopathy. Fifty-nine diabetic men (60.3 ± 7.4 years) with cardiac magnetic resonance imaging consistent with nonischemic, nonfailing diabetic cardiomyopathy (reduced circumferential strain [σ], −12.6 ± 3.1; increased left ventricular [LV] torsion [θ], 18.4 ± 4.6°; and increased ratio of LV mass-to-volume, 2.1 ± 0.5 g/mL) were randomized to receive sildenafil (100 mg/d) or placebo. Results: At baseline, the metabolic indices were correlated with torsion, strain, N-terminal pro-B-type natriuretic peptide, VEGF, monocyte chemotactic protein-1 (MCP-1), and blood pressure. After 3 months, sildenafil produced a significant improvement in LV torsion (Δθ: sildenafil, −3.89 ± 3.11° versus placebo, 2.13 ± 2.35°; P < 0.001) and strain (Δσ: sildenafil, −3.30 ± 1.86 versus placebo, 1.22 ± 1.84; P < 0.001), and consistent changes in chamber geometry and performance, with a 6.5 ± 11 improvement in mass-to-volume ratio over placebo (P = 0.021). MCP-1 and TGF-β were the only markers affected by active treatment. Conclusion: In concentric hypertrophy secondary to diabetic cardiomyopathy, chronic phosphodiesterase type 5 inhibition exerts an antiremodeling effect, resulting in improved cardiac kinetics and circulating markers. This effect is independent of any other vasodilatory or endothelial effects and is apparently exerted through a direct intramyocardial action. REF: http://www.clinicaltrials.gov. NCT00692237. Giannetta et al. Circulation. 2012 May 15;125(19): 2323–33. Policy of full disclosure: None.

PS-04-003

CHARACTERIZATION OF THE BLOOD VESSELS AND THEIR NITRERGIC INNERVATION IN THE RAT MAJOR PELVIC GANGLIA Beetson, K.1; Smith, S.2; Cellek, S.2; Cameron, N.3; Cotter, M.3 Cranfield University, Health, Bedfordshire, United Kingdom; 2Cranfield University, Bedfordshire, United Kingdom; 3University of Aberdeen, United Kingdom

1

Objective: The neuronal cell bodies of autonomic nerves innervating the urogenital organs are housed in the major pelvic ganglion (MPG) in the rat; similar to pelvic plexus in human. Although recent studies suggest that blood flow to the MPG might be compromised in diseases such as diabetes that may lead to erectile and urological dysfunction, the blood vessels supplying the MPG and their autonomic innervation have not been characterized. The aim of this project was therefore to study the vascular density in and around the MPG as well as to characterise the nitrergic innervation of these blood vessels. Methods: The MPG were obtained from male non-diabetic and streptozotocin-induced diabetic rats, prepared and frozen before being sectioned using a cryostat. Characterization of blood vessels (vasa nervorum) and the autonomic nerves innervating these vessels were accomplished using immunohistochemical methods and a laser scanning confocal microscope. Results: The neuronal cell bodies within the MPG are contained within a capsule. The capsule’s wall thickness was measured to be approximately 13 μm. Approximately 52% of neuronal cell bodies in control MPG were nNOS-positive. Blood vessels were observed within the capsule of the MPG as well as outside the capsule. The blood vessels inside the capsule were CD31-positive capillaries with no alpha-smooth muscle actin (SMA) staining. Outside the capsule in average 30 SMA- and CD31-positive blood vessels per mm2 were observed with an average diameter of 43 μm. All of the extracapsule blood vessels were innervated by nNOS-positive nitrergic nerve fibres. Similar measurements in diabetic rat MPG are currently on-going.

311

Podium Sessions Conclusion: To the authors’ knowledge, this is the first characterisation of blood vessels and their nitrergic innervation in and around rat MPG. The comparison of control and diabetic MPG is envisaged to shed a further light on the pathophysiology of diabetic erectile dysfunction. Further similar studies using human plexus have been planned. Policy of full disclosure: Fully funded by a research grant from European Society for Sexual Medicine.

quantification showed an increase of MPO (diabetic group: 125.36 ± 2.65 vs non-diabetic controls: 108.7 ± 1.86; p < 0.05) and 3-NT (diabetic group: 110.6 ± 4.3 vs non-diabetic controls: 95.5 ± 3.16; p = 0.056) expression levels in diabetic erectile tissue. No differences were observed between type 1 and type 2 diabetes. Further, higher expression of OS markers in diabetic individuals correlated with patient’s age, low IIEF-5 and increased apoptosis levels. This is an ongoing study and more cases are being gathered for further analysis. Conclusion: These data suggests a significant increase in OS in diabetic CC. Increased OS levels may alter erectile tissue functionality, by hampering NO though MPO actions and by loss of protein function through nitration, thus contributing to ED. Policy of full disclosure: None.

PS-04-005

STEM CELL THERAPY FOR PEYRONIE’S DISEASE: MORPHOLOGICAL AND FUNCTIONAL OUTCOMES OF INTRAPLAQUE INJECTION OF ADIPOSEDERIVED STEM CELLS ON A RAT MODEL OF PEYRONIE’S DISEASE Ferretti, L.1; Qiu, X.2; Fandel, T.2; Orabi, H.2; Banie, L.2; Lin, G.2; Lue, T.2 University Hospital, Urology, Bordeaux, France; 2UCSF, San Francisco, USA

1

PS-04-004

INCREASED EXPRESSION OF OXIDATIVE STRESS MARKERS IN HUMAN DIABETIC CAVERNOSAL TISSUE – COMPARISON WITH CLINICAL DATA Costa, C.1; Castela, A.2; Gomes, P.2; Soares, R.2; Van Antwerpen, P.3; Zouaoui Boudjeltia, K.4; Roumeguere, T.5; Vendeira, P.6; Virag, R.7 1 Faculty of Medicine of Porto, Dept of Biochemistry (U38/FCT), Portugal; 2 Faculty of Medicine of Porto, Portugal; 3Universite Libre de Bruxelles, Brussels, Belgium; 4CHU Charleroi, Hopital Vésale, Montigny-le-Tilleul, Belgium; 5Erasme Hospital, Brussels, Belgium; 6Clínica Saúde Atlântica, Porto, Portugal; 7CETI, Paris, France Objective: Erectile Dysfunction (ED) is a prevalent complication of diabetes, a condition characterized by increased oxidative stress (OS). Nitric Oxide (NO) is a crucial molecule for the erectile process; however through several OS mechanisms NO may induce oxidative nitration reactions, which may be responsible by injuring normal tissues. Since it is poorly understood the biological outcome of OS in diabetic corpus cavernosum (CC), we aimed to evaluate the biomarkers myeloperoxidase (MPO) and 3-nitrotyrosine (3-NT) in cavernosal tissue of ED-patients. Methods: Fragments of CC were collected during surgery from 23 diabetic patients with ED and 9 non-diabetic non-ED individuals. Generation of oxidative lesions in samples was evaluated by the immunohistochemical detection of MPO and 3-NT. Quantitative analysis of immunostaining intensity was performed by ImageJ color deconvolution and data was compared to each patient age, type of diabetes, arterial risk factor number, erection hardeness score (EHS), IIEF-5, Penile Nitric Oxide Release Test (PNORT) and apoptosis cell density index (ACD). Results: Our results revealed that the expression of 3-NT and MPO was predominantly localized perivascularly in cavernosal tissue of diabetic ED and non-diabetic non-ED samples. Immunohistochemical

Objective: Peyronie’s disease (PD) is characterized by an abnormal scarring process of the tunica albuginea. Anti-inflammatory and vasculogenic properties of ADSC permit to consider this stem cell therapy as first choice for PD treatment. Therefore we experiment the efficacy of autologous ADSC intraplaque injection after penile remodeling in a rat model of Peyronie’s disease. Methods: Twenty 16 weeks old SD male rats underwent a tunica allograft as PD model. Two months later rats were randomly divided in two groups of 10 rats. Penile angles were measured and compared among the two groups (control and ADSC group). Then, penile remodeling was performed by a highly pressurized saline injection in the penile plaque, followed by autologous ADSC injection in ADSC group. Penile angle, erectile function and histological analysis was performed eight weeks after treatment. Results: Front penile angles were 26.54 ± 4.09 in group C and 23.85 ± 2.99 in group A before penile remodeling, and no statistical difference was observed (p = 0.6, Mann-Whitney). After treatment, penile angles were 14.34° ± 3.48 in group C and 11.76° ± 2.60 in group A (p = 0.55). Eight weeks later, penile angles were 28.32° ± 2.74 in C group and 12.36° ± 1.645 in A group (p = 0.0005, Mann Whitney). No difference was observed in erectile function. Histological analysis showed neovascularization within the penile plaque in ADSC group but not in control group. Conclusion: Autologous ADSC treatment is more efficient to straighten the penis after penile remodeling compared to penile remodeling alone at 2 months of follow up in a rat model of PD. Neoangiogenesis is a potential mechanism that can explain this phenomenon. Policy of full disclosure: None.

J Sex Med 2012;9(suppl 5):303–335

312

Podium Sessions Methods: Male Sprague-Dawley rats underwent sham or bilateral cavernous injury (BCNI) and MPGs were isolated 2, 7, 14, 30 and 60 days following injury (n = 5/group). MPG gene expression analysis by qtPCR was performed for glial cell line-derived neurotrophic factor (GDNF), nerve growth factor (NGF), neurturin (NRTN), neurotrphin-3 (NT3) and neurotrophin-4 (NT4). Additional rats were injured and MPGs were removed 24 h, 48 h, 3 and 7 days following BCNI (n = 3/group). MPGs were cultured in reduced growth factor matrigel with vascular endothelial growth factor (VEGF, 25 ng/ml) for 48 h and neurite growth was measured. Results: GDNF was significantly increased in MPGs at all time points following BCNI (p < 0.05). There was a significant decrease in NGF, NT3 and NT4 in all injured MPGs (p < 0.05). No significant changes in NRTN were evident between sham and BCNI MPGs. MPG neurite growth from 24 h and 48 h BCNI was significantly higher than sham (508 ± 19 μm; 497 ± 24 μm; 373 ± 23 μm, respectively, p < 0.05). Neurite growth from 3 and 7 day BCNI MPGs was not different from shams (328 ± 24 μm; 387 ± 32 μm; 373 ± 23 μm, respectively, p > 0.05). Conclusion: Changes in neurotrophic factors GDNF, NT3 NT4 and NGF contribute to neuromodulation and enhanced neurite outgrowth following BCNI. Increased neurite outgrowth is seen in MPGs from 24 h and 48 h BCNI rats and should be used as a tool to assess the impact of pharmacological interventions. Further studies examining the roles of neurotrophic factors in modulating signaling pathways may provide therapeutic avenues for neurogenic-mediated ED. Policy of full disclosure: None.

PS-04-007

KINETICS OF INTRACELLULAR SILDENAFIL UPTAKE AND RETENTION IN CULTURED HUMAN PENILE CAVERNOSAL CELLS Kim, N.1; Su, Y.2; Goldstein, I.3; Su, Y.4 1 Institute for Sexual Medicine, San Diego, USA; 2Alvarado Hospital, San Diego, USA; 3Alvarado Hospital, Univ. of Calofornia, California, USA; 4 UCSD, San Diego, USA

PS-04-006

TEMPORAL CHANGES IN NEUROTROPHIC FACTORS AND NEURITE GROWTH FOLLOWING CAVERNOUS NERVE INJURY Hannan, J.1; Albersen, M.2; Stopak, B. L.3; Lui, X.3; Burnett, A. L.3; van der Aa, F.2; Hedlund, P.4; Bivalacqua, T. J.3 1 Johns Hopkins University, Urology, Baltimore, USA; 2University Hospital Leuven, Belgium; 3Johns Hopkins University, Baltimore, USA; 4Lund University, Sweden Objective: Surgical treatments for prostate, bladder and colorectal cancers often lead to neuronal damage and erectile dysfunction (ED). Despite nerve-sparing techniques and treatments that protect cavernous smooth muscle, ED prevails and protecting/preventing neurodegeneration may be of greater importance. The aim of this study was to characterize the changes in neurotrophic factors and neurite growth from the major pelvic ganglion (MPG) following cavernous nerve injury.

J Sex Med 2012;9(suppl 5):303–335

Objective: To determine kinetics of cellular uptake and retention for the PDE5 inhibitor sildenafil and its duration of efficacy in cultured human corpus cavernosum cells. Methods: Penile cavernosal tissue from consenting human donors was minced and incubated with 0.5% collagenase A to dissociate stromal cells. For uptake studies, cells were incubated with 400 ng/ml of sildenafil (plasma Cmax after ingestion of 50–100 mg tablet) for varying times. Retention studies were performed by incubating cells with SIL for 30 min and exchanging with fresh medium without SIL. Cells were then harvested at varying times. All incubations were terminated on ice and cells quickly washed, harvested, and homogenized. Cytosolic fractions were extracted with a mixture of diethylether: dichloromethane (3:2), dried under N2 gas, and analyzed by LC-MS/MS. In separate experiments, cGMP was measured by ELISA for uptake and retention time courses. PDE5 enzyme activity and protein expression were also assessed in cells incubated with sildenafil. Results: Sidenafil uptake occurred rapidly, plateauing by 20 minutes (85 ng/106 cells). The mean basal cGMP level was 10.4 fmol/ μg DNA. Upon stimulation with 1 μM nitroprusside, cGMP levels increased 2.2-fold in the absence of sildenafil and 7.9-fold after 30 min of sildenafil uptake. In retention studies, cGMP levels increased 3.7fold after stimulation with nitroprusside, suggesting that the remnant intracellular sildenafil concentration could effectively inhibit PDE5. Enzyme activity studies demonstrated that cGMP hydrolysis remains significantly suppressed even after cell washing, homogenization and significant dilution (500–1000 fold). PDE5 protein levels (Western blots) did not change in response to high concentrations (0.1–1 μM) or prolonged incubations (24 h) with sildenafil. Conclusion: Sildenafil is transported rapidly into penile stromal cells and apparently remains tightly associated with PDE5 even after significant loss of intracellular drug or cell disruption and significant dilution. Policy of full disclosure: SOURCE OF FUNDING: Investigator Initiated Grant from Pfizer Inc.

313

Podium Sessions PS-04-008

VASOSCOPY AS A NEW DIAGNOSTIC AND THERAPEUTIC TOOL FOR DISEASES AFFECTING MALE REPRODUCTION Trottmann, M.1; Braun, C.2; Schaaf, H.-G.3; Liedl, B.4; Stief, C.2; Graw, M.2; Koelle, S.5 1 Ludwig-Maximilians-Universität, Urology, Munich, Germany; 2University of Munich, Germany; 3Polydiagnost GmbH, Freiburg, Germany; 4Clinics of Surgery, Munich, Germany; 5University of Munich, Department of Urology, Germany Objective: Because of the small lumen of the seminal duct and the narrowness of the internal inguinal ring, the endoscopy of the Vas deferens has not been successfully performed yet. Therefore the aim of our study was to establish vasoscopy using a new prototype of a micro-endoscope. Methods: In a first pre-clinical randomized study the Vasa deferentes of transsexual men were investigated ex vivo after surgery. In a second step the Vasa deferentes of men within 24–48 hours after death were investigated in situ. For the experiments a semi-rigid micro-endoscope of 0.9 mm outer diameter offering the possibility to insert 0.4 mm thick tools and with integrated fiberoptics (10000 pixels) and a depth of field from 3–20 mm was used. Results: Antegrade and retrograde views of the inner lumen of the vas deferens were achieved. Using a working channel a biopsy forceps and a laser fiber were introduced into the inner lumen allowing to obtain probe material and to close or open the lumen by coagulation and vaporization, respectively. Conclusion: Vasoscopy might be used as a valuable tool for successful treatment of obstructive azoospermia, e.g. by application of a laser or by dilatation, or for the assessment of a site-specific ejaculatory function, e.g. in varicocele patients. Vasoscopy could also be performed for sperm recovery in case of ejaculatory dysfunction by washout, e.g. in patients with injuries of the spinal cord. Furthermore vasoscopy for the first time enables to obtain material for histological and microbiological investigations of the seminal duct or to locally apply drugs for therapy. Policy of full disclosure: None.

PS-04-009

INTRACAVERNOSAL BONE MARROWDERIVED MESENCHYMAL STEM CELL THERAPY RECOVERS ERECTILE DYSFUNCTION AFTER CAVERNOUS NERVE INJURY IN RATS ONLY WHEN COMBINED WITH ORAL TADALAFIL ADMINISTRATION Angulo, J.1; Martínez-Salamanca, J. I.2; Zurita, M.2; Martínez-Salamanca, E.3; Fernández, A.3; Cuevas, P.3; Vaquero, J.2; Carballido, J.2 1 Hospital Ramón y Cajal-IRYCIS, Histologia-Investigación, Madrid, Spain; 2 Hospital Puerta de Hierro, Madrid, Spain; 3Hospital Ramón y CajalIRYCIS, Madrid, Spain Objective: Since the treatment of erectile dysfunction secondary to radical prostatectomy still remains as an outstanding challenge, this work was aimed to evaluate the efficacy of dual targeted strategy to promote cavernosal tissue preservation using systemic PDE5 inhibition and local stem-cell therapy in a rat model of cavernous nerve (CN) injury. Methods: Bilateral CN crush injury (BCNI) was produced in anesthetized male Wistar rats. Tadalafil was orally administered at 5 mg/ kg/day dose, Bone marrow-derived mesenchymal stem cells (BMSC) were obtained from donor rats and in vitro expanded and characterized before intracavernosal implantation by means of an automated microinjector pump. Ex vivo function of corpus cavernosum (CC) and In vivo intracavernosal pressure (ICP) responses to CN electrical stimulation (CNES) were evaluated 4 weeks after BCNI. Results: Relaxations of CC to carbachol or sodium nitrroprusside were not altered by BCNI or any of the treatments while nitrergic

relaxations were almost abolished in CC from BCNI rats and improved by tadalafil, BMSC or combined strategy. In contrast, neurogenic contractions driven by adrenergic system were enhanced in CC from BCNI rats, an effect antagonized by tadalafil administration. BCNI resulted in marked reduction of erectile responses to CNES (39.1% of maximum ICP in sham group) which were partially recovered by treatment with tadalafil (64.2%) or by intracavernosal implantation of BMSC (46.0%). The complete recovery of erectile function was only achieved when both treatments were combined (92.1%, not significant from sham). Conclusion: BCNI did not impair endothelial or smooth muscle relaxation of CC but selectively blunted nitrergic relaxation which was improved by oral tadalafil and intracavernosal BMSC. Only the combination of both therapies recovered erectile function. These results support the use of dual therapeutic approaches, cell therapy and oral PDE5 inhibitors, for recovering erectile function in patients undergoing radical prostatectomy. Policy of full disclosure: This work was supported by a ESSM Grant. JI Martínez-Salamanca and J Angulo have received a research grant from Eli Lilly & Co.

PS-04-010

ERECTILE AND BLADDER DYSFUNCTIONS IN THE TYPE 2 DIABETIC GOTO-KAKIZAKI RAT Behr-Roussel, D.1; Oger-Roussel, S.2; Caisey, S.2; Kergoat, M.3; Charon, C.3; Audet, A.3; Bernabé, J.2; Giuliano, F.2 1 Pelvipharm, Faculté de Médecine, UVSQ, Montigny Le Bretonneux, France; 2Pelvipharm, Montigny Le Bretonneux, France; 3Metabrain Research, Chilly-Mazarin, France Objective: Bladder and erectile dysfunctions (ED) impact the quality of life of diabetic patients. Most experimental in vivo studies on ED/ bladder dysfunction due to diabetes rely on type 1 diabetes models. A robust model for type 2 diabetes is lacking. Bladder and erectile function in the Goto-Kakizaki (GK) rat model of type 2 diabetes and its responses to standard-of-care treatments for each condition have been assessed. Methods: Bladder function was assessed by cystometry in conscious 18-weeks old male GK (n = 20, GK/Par colony) and Wistar rats (n = 19), previously characterized for their metabolic parameters, and treated by solifenacin (iv, 1 mg/kg) or vehicle. Subsequently, erectile function was assessed in the same rat under anaesthesia following electrical stimulation of the cavernous nerve and the effects of sildenafil (iv, 0.3 mg/kg) or vehicle were evaluated. Results: GK rats displayed detrusor overactivity characterized by a significant increase in the frequency (+374.1%) and the amplitude (+63.3%) of non-voiding contractions (NVC) and a significant decrease in the volume threshold to elicit NVC (−29.3%) compared to Wistar rats. The intercontraction interval, the voided volume, the maximal pressure and the AUC of voiding contraction (VC) were significantly increased in GK compared to Wistar rats (+67.5%; +71.7%; +14.0% and +67.1%). The bladder baseline pressure and the pressure threshold necessary to elicit the VC were unchanged. Solifenacin significantly decreased the maximal pressure and the AUC of VC in both Wistar and GK rats. Conclusion: GK rats display both diabetic bladder dysfunction characterized by detrusor overactivity and ED. Furthermore, standard-ofcare treatments for both conditions are effective in GK rats. Thus, GK rats represent a suitable and validated model to investigate the pathophysiology of type 2 diabetes-associated bladder and erectile complications and to assess efficacy of new therapeutic agents targeting either condition. Policy of full disclosure: None.

J Sex Med 2012;9(suppl 5):303–335

314

Podium Sessions

Friday, 7 December 2012 15.30–16.30 Forum PS-05 Men’s sexual health: Conservative treatment I Chairs: F. Fusco, Italy N. Cruz, Spain PS-05-001

PDE5 INHIBITOR TREATMENT PERSISTENCE AND ADHERENCE IN LATIN AMERICAN MEN WITH ERECTILE DYSFUNCTION Cairoli, C. E.1; Magno, L. A.2; Henneges, C.3 Hospital Sao Lucas PUC-RS, Porto Alegre/RS, Brazil; 2Eli Lilly do Brazil, Sao Paolo., Brazil; 3Lilly Deutschland GmbH, Global Statistical Sciences, Bad Homburg V. D. H., Germany

1

Objective: Erectile dysfunction (ED) negatively impacts quality of life. PDE5 inhibitors (PDE5-I) are effective in treating ED; however, discontinuation rates remain high. We assessed treatment persistence and adherence in Latin American men. Methods: An observational, non-interventional study was performed in 511 men from Brazil, Mexico, and Venezuela who were ≥8 years of age, naïve to PDE5I therapy, and sexually active in a heterosexual relationship. Men were followed over 6 months of therapy selected per routine standard of care. This post-hoc subgroup analysis compared men from Brazil (N = 104) and Mexico (N = 355). Persistence (taking ≥1 dose in the prior 4 weeks) and adherence (taking the last dose per physician instructions) were assessed by questionnaire and analyzed at 6 months. Spearman and Kruskal-Wallis tests were used to assess correlations. Results: Mean (SD) age was 57.8 (10.9) years for Brazilian men and 51.3 (12.48) years for Mexican men. For Brazilian men, baseline characteristics were generally similar between men receiving tadalafil (N = 36), sildenafil (N = 50), and vardenafil (N = 15). Persistence and adherence at 6 months are shown (figure). In Brazilian patients, factors significantly (p < 0.05) associated with adherence included employment status and coronary artery disease. In Mexican patients, age, diabetes, race, ED etiology, and PDE5I treatment and dose were associated with persistence and/or adherence. In Brazilian men, the most common reasons for discontinuation were unspecified (n = 9), lack of efficacy (n = 4) and change in health status (n = 3); in Mexican men these reasons were cost of therapy (n = 30), lack of efficacy (n = 15), and improvements in ED (n = 12). Conclusion: In Brazilian and Mexican men, persistence and adherence were >65% at 6 months. Different social and demographic factors were associated with persistence/adherence in post-hoc analyses or cited as reasons for discontinuation in each group, suggesting that differences in population or treatment characteristics may be important to consider in future studies. Policy of full disclosure: Dr. Cairolia has been an investigator in clinical studies for Amgen, Eli Lilly and Company, Pfizer, and EMS; has received speaker fees from Bayer, GlaxoSmithKline, and Eli Lilly and Company, and has served on advisory boards for Eli LIlly and Company. Drs. Henneges and Magno are full time employees of Eli Lilly and Company.

J Sex Med 2012;9(suppl 5):303–335

PS-05-002

LONGER-LASTING ERECTION AND INTERCOURSE WITH VARDENAFIL ORODISPERSIBLE (ODT) TABLETS IMPROVES SEXUAL QUALITY OF LIFE OF THE COUPLE Martin Morales, A.1; Gutierrez Hernandez, P.2; Romero Otero, J.3; Romero Martin, J. A.4 1 Carlos Haya Hospital, Servicio de Urología, Malaga, Spain; 2Hosp. Universitario de Canarias, Tenerife, Spain; 3Hospital 12 de Octubre, Madrid, Spain; 4Hospital de Mataro, Barcelona, Spain Objective: Longer-lasting erections allowing prolonged sexual intercourse are key in sex satisfaction for men and women. We aimed to assess the efficacy of vardenafil orodispersible tablets (ODT) regarding duration of erection and intercourse in patients with erectile dysfunction (ED) and comorbidities, and its impact on the sexual quality of life of these patients and their partners. Methods: Multicentre, randomized, double blind, fixed-dose comparison of vardenafil ODT 10 mg on demand vs. placebo during 12 weeks in 172 men aged ≥18 with ED (EF-IIEF 5 to 22) and at least one comorbidity, and their partners wishing to participate (n = 46). Main outcomes were the number of successful intercourses (Sexual Encounter Profile question 3) and changes in EF-IIEF scores and in erection duration (min) in men, and in the Female Sexual Function Index (FSFI) scores and in intercourse duration (min) in women. Durations were recorded using a chronometer. Changes in the modified Sexual Life Quality Questionnaire (mSLQQ-QOL) were assessed in both. Measurements were made at 4, 8 and 12 weeks. Results: No significant differences in age, anthropometric measurements, comorbidities, sexual function, or main outcomes were observed at baseline between both groups. At 12 weeks only vardenafil ODT significantly improved erection duration (49.3%; p < 0.0001) and intercourse (172.4%; p < 0.0001) vs. baseline; FSFI score difference reached a plateau at week 8. Changes in EF-IIEF and mSLQQ mean scores in men and women were also significant and higher in the vardenafil group (8.2 points, p < 0.0001; 200.6 points, p < 0.0001; and 132.1 points, p = 0.0007, respectively). All differences were statistically significant vs. baseline since week 4 (p < 0.05). Adverse events were similar in both treatment groups.

315

Podium Sessions Conclusion: Treatment with vardenafil ODT 10 mg improves erection and therefore intercourse duration, as assessed by partners, with a high impact on the sexual quality of life of the couple. Policy of full disclosure: Supported by an unrestricted grant from Bayer Pharma.

PS-05-003

EFFECT OF ONCE-DAILY TADALAFIL ON CONFIDENCE IN PERFORMING SEXUAL INTERCOURSE AND DIFFICULTY IN PERFORMING SEXUAL INTERCOURSE FOR MEN WITH ERECTILE DYSFUNCTION, WHO WERE INCOMPLETE RESPONDERS TO AS-NEEDED PDE-5 INHIBITOR TREATMENT Seftel, A.1; Goldfischer, E. R.2; Hayes, R. P.3; Wang, P.3; Rosen, R. C.4; Althof, S. E.5; Sontag, A.3 1 Cooper University Hospital, Urology, Camden, Nj, USA; 2Hudson Valley Urology, Poughkeepsie, USA; 3Eli Lilly and Company, Indianapolis, USA; 4 New England Research Institute, Watertown, USA; 5Centre for Marital&Sexual Health, West Palm Beach, USA Objective: To determine the impact of once-daily tadalafil on confidence and difficulty in performing sexual intercourse, using 2 new validated patient-reported outcome (PRO) instruments. Methods: Multicenter, randomized, double-blind, parallel (2 studies), placebo-controlled trial in men with erectile dysfunction (ED) who were incomplete responders to maximal dose of as-needed phosphodiesterase-5 (PDE5) inhibitor therapy. Men were randomized to once-daily tadalafil 2.5 mg titrated to 5 mg, tadalafil 5 mg, or placebo for 12 weeks. Confidence in Performing Sexual Intercourse Questionnaire (CPSIQ; 10 questions, 1–7 total score range) and Difficulty in Performing Sexual Intercourse Questionnaire (DPSIQ; 3 questions, 1–5 total score range) instruments were given at baseline and 12-week endpoint, as part of an addendum to the study. Results were similar for both tadalafil treatment arms and for the 2 sub-studies; therefore, the arms and sub-studies were combined for analysis. Results: Baseline characteristics were similar across study groups. Mean age (N = 255) was 58. Mean change from baseline in CPSIQ was 1.81 for tadalafil (vs. 0.47 for placebo; p < .0001), which represents an average shift from “very low” to “moderate” sexual confidence. Mean change from baseline in DPSIQ was 1.62 for tadalafil (vs. 0.44 for placebo; p < .0001), which represents an average shift from “very difficult” to “moderately difficult”/“slightly difficult” sexual performance. Mean change in International Index of Erectile FunctionErectile Function (IIEF-EF) domain was 8.64 for tadalafil versus 2.92 for placebo (p < .0001). Mean change in CPSIQ scores, with and without a ≥4 change in IIEF-EF, was 2.40 for tadalafil (vs. 1.19 for placebo) and 0.33 for tadalafil (vs. 0.04 for placebo), respectively. Conclusion: Confidence improved and difficulty in performing sexual intercourse decreased in men with ED who were incomplete responders to as-needed PDE5 inhibitor therapy. This study represents the first utilization of 2 new PROs and demonstrates their utility in a clinical trial. Policy of full disclosure: Allen Seftel consults for Eli Lilly and Company.

PS-05-004

VIAGRA (SILDENAFIL CITRATE) ORDERED VIA THE INTERNET IS RARELY GENUINE Campbell, N.1; Clark, J.1; Stecher, V.1; Thomas, J.2; Goldstein, I.3 Pfizer, New York, USA; 2Pfizer Intellectual Property, Groton, USA; 3 Alvarado Hospital, Univ. of Calofornia, California, USA

1

Objective: Counterfeit medication is a growing problem, amplified by Internet purchasing. This study assessed the requirement for prescription, cost, origin, and content of medication sold via the Internet purporting to be the phosphodiesterase type 5 inhibitor Viagra (sildenafil).

Methods: Pfizer Global Security monitored top search results for the phrase ‘buy Viagra’ on the 2 leading Internet search engines in March 2011. Orders were placed from 22 unique websites claiming to sell Viagra. Tablets received were assessed for chemical composition. Results: No website examined required a prescription or a health screening survey; 90% offered illegal “generic Viagra.” Cost per tablet ranged from $3.28–$33.00. Postal origins of purchases were most commonly Hong Kong (n = 11), the United States (n = 6), and the United Kingdom (n = 2), as well as Canada, China, and India (n = 1 each). Notably, 4 Internet pharmacies claiming to be Canadian did not ship medication from Canada. Of 22 sample tablets examined, 17 (77%) were counterfeit, 4 (18%) were authentic, and 1 (5%) was an illegal generic. Two of the 6 US shipments contained authentic medication, as did 2/2 of the UK shipments, which were diverted from their original market. The spectral match for the illegal generic sample was <80% compared with genuine Viagra; counterfeit tablets showed spectral match 25–55% vs genuine Viagra. Counterfeit tablets were analyzed for sildenafil citrate, and contents varied between 30– 50% (averaging 35%) of label claim. Counterfeits lacked product information leaflets and each counterfeit lacked the genuine Viagra formulation. Conclusion: Internet sites claiming to sell authentic Viagra medication shipped counterfeit medication 77% of the time; counterfeits usually came from non-US addresses and had 30–50% of the labeled claim. Caution is warranted when purchasing Viagra via the Internet. Policy of full disclosure: SOURCE OF FUNDING: Pfizer Inc Authors Campbell, Clark, Stecher and Thomas are employees of Pfizer Inc.

PS-05-005

THE EFFECT OF A SECOND COURSE OF LOW INTENSITY SHOCK WAVES FOR ED IN PARTIAL OR NON-RESPONDERS TO ONE TREATMENT COURSE Gruenwald, I. E.1; Appel, B.2; Vardi, Y.2 Haifa, Israel; 2Rambam Medical Center, Haifa, Israel

1

Objective: To evaluate the added effect of a second treatment course (2nd round) of penile Low Intensity Shock Wave therapy (LI-ESWT) in patients who underwent an unsuccessful or non-satisfactory 1st course. Methods: During the past 15 months we treated 84 ED patients of various degrees of ED severity and different etiologies, all received the same treatment protocol. They were offered a 2nd round if the first one was unsatisfactory or if endpoint criteria for success were unmet. These included subjective measures (IIEF-ED Domain scores, clinical judgment) and objective hemodynamic parameters measured by Flow Mediated Dilatation (FMD) test.Evaluation of differences in changes from baseline (V1), one-month after first treatment course (FU1) and one-month after the 2nd round (FU2) was performed with nonparametric Wilcoxon tests. Results: Twenty-two patients were included, fifteen (68%) had severe ED, mean age 59 y ± 10. After the 2nd round 7/22 (31.8%) achieved an increase of ≥5 points in IIEF-ED Domain score. This positive impact was further supported by the overall improvement in median IIEF-ED Domain scores (from 9.5 at FU1 to 13 at FU2). This 3.5 point-increase at FU2 was significant compared to the poor increase of only 0.5 at FU1 (P = 0.0235). According to the investigators’ Clinical Global Impression of Change (CGIC) 12/22 (54.5%) improved, resulting in 6 more successful patients at FU2. According to FMD parameters, an additional significant increase of 4.24 ml/mm2 tissue in maximal penile blood flow was recorded (P = 0.0029). Conclusion: We have demonstrated that a 2nd round of LI-ESWT to the penis is beneficial in difficult cases of partial or unsatisfactory response to one round. A larger scale of ED patients who failed LI-ESWT is needed in order to fully evaluate the effect of the 2nd round. Policy of full disclosure: None.

J Sex Med 2012;9(suppl 5):303–335

316 PS-05-006

PATIENT AND PARTNER SATISFACTION FROM EXTRACORPOREAL SHOCKWAVE THERAPY (ESWT) FOR ED TREATMENT Hattat, H.1; Hattat, E.2; Hattat, I.3 Hattat Uro-Andrology Clinic, Uro-Andrology, Istanbul, Turkey; 2Hattat Clinic, Uro-Andrology, Istanbul, Turkey; 3Hattat Clinic, Istanbul, Turkey

Podium Sessions Policy of full disclosure: ‘This abstract presents independent research commissioned by the National Institute for Health Research (NIHR) under its Research for Patient Benefit (RfPB) Programme (Grant Reference Number PB-PG-0107–11391). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.’

1

Objective: ESWT is a new therapy option for ED. The aim of this study was to assess the effect of the treatment on erectile quality and on the sexual satisfaction of couples. Methods: 40 men with vasculogenic ED were chosen as treatment (n:23) and placebo groups (n: 17) Treatment included 2 sessions/week for 3 weeks, repeated after a 3 week no-treatment interval. At each session ESWT was applied on the penile shaft and crura in 10 different anatomical sites, 300 shock waves per site (frequency 3.5 Hz, energy density 0.25 mJ/mm²). No other ED treatment were included. IIEF 15 ED, intercourse satisfaction and general satisfaction domain scores pre and 1 month post treatment as well as post treatment EDITS (Erectile dysfunction inventory of treatment satisfaction) scores for the patients and their partners were assessed. Results: Treatment and placebo groups were not statistically different regarding age, IIEF ED, intercourse satisfaction and general satisfaction scores (p = 0,458; p = 0,761; p = 0,399; p = 0,063). At posttreatment, IIEF ED, intercourse satisfaction and general satisfaction scores were significantly higher for the treatment group compared with placebo (p = 0,043; p = 0,0001; p = 0,0001). Both the patient and the partner EDITS scores were significantly higher than the placebo group (p = 0,0001; p = 0,0001). EDITS patient and partner scores were positively correlated with IIEF ED scores (r = 0,951 p = 0,0001; r = 0,923 p = 0,0001). Age was positively related to EDITS patient score averages (r = 0,317 p = 0,012). On the other hand, age is negatively related to IIEF ED, intercourse satisfaction and general satisfaction sub-scores (r = −0,908 p = 0,0001; r = −0,357 p = 0,024; r = −0,385 p = 0,015). Conclusion: ESWT has the potential to improve erectile function with high treatment satisfaction rates for both the patients and the partners. The treatment satisfaction is higher for older age groups. Policy of full disclosure: None.

PS-05-007

THE ERECTILE DYSFUNCTION AND STATINS (EDS) TRIAL [ISRCTN66772971] Kirby, M.1; Trivedi, D.2; Welsted, D.2 1 University of Hertfordshire, CRIPACC, Bygrave, United Kingdom; 2 University Of Hertfordshire, Hatfield, United Kingdom Objective: Men with untreated erectile dysfunction (ED). Does lowering LDL cholesterol with simvastatin 40 mg improve ED? Improve sexual health related quality of life? Is it cost effective?. Methods: 173 men were randomised to receive either 40 mg simvastatin or a placebo for six months. Results: The average age of the patients was 56.1 years, BMI 27.7, testosterone 15.1 nmol/L, 10 year CVD risk 8.2%. The average IIEF score 13.5. 113 patients completed all the study measures. Improvement in IIEF (1.28 versus 0.07, z = 1.1, p = 0.27). Patients with Severe ED at baseline show a larger change than patients with Mild/Moderate ED (1.8 and 0.08, z = 8.5, p < 0.001). MED QoL (5% vs 2%, z = 2.09, p = .04), Severe ED (12% vs 5%, z = 4.52, p < 0.001). Increase in reported Satisfaction over time (z = 2.17, p = .03), Mild/Moderate ED report greater Satisfaction than those with Severe ED (z = 2.04, p = .04). Both 10 year CVD risk and LDL were reduced by Statin treatment. Placebo (CV risk, z = −3.67, p < .001; LDL, z = −5.46, p < 0.001). The cost and QALY regression results indicate that simvastatin may potentially reduce costs in this group. Conclusion: Simvastatin improved the sexual health related quality of life of these men. The impact on ED is uncertain but, a larger longer trial with a more potent statin is needed. This approach has a >80% probability of being cost effective.

J Sex Med 2012;9(suppl 5):303–335

PS-05-008

VALSARTAN IN PATIENTS WITH HYPERTONIC DISEASE: IMPACT ON CARDIOVASCULAR, METABOLIC, INFLAMMATORY PARAMETERS AND ON THE QUALITY OF SEXUAL FUNCTION IN MEN Romaniuk, M.1; Kornienko, A.2; Aksenov, P.2 Kiev, Ukraine; 2Institute of Urology, Kiev, Ukraine

1

Objective: The objective of the study was to learn the impact of angiotensin-receptor blocker (ARE) Valsartan on cardiovascular system, sexual function and on the parameteres of metabolism. Methods: Prospective, randomized, open-labeled study with fixed regimen of monotherapy. Analysis group consisted of 60 male patients (average age = 48,4 ± 9,6 years). The open phase continued 12 weeks (160 mg/day). There were 3 control visits. Results: Mean decrease of systolic pressure during Valsartan usage was 22,5 ± 17,0 mm Hg (p < 0,001), diastolic 16,8 ± 9,3 mm Hg (p < 0,001). The course of Valsartan didn’t change significant body mass index, HbA1c parameter, insulin and glucose levels. There were no changes in lipid profile. Mean IIEF score improved after treatment from 49,1 ± 6,9 to 58,9 ± 7,1 (p = 0,032). Valsartan therapy also increased peak systolic velocity in penile arteries (registered be pharmacodopplerography with alprostadil) (+5,2 ± 0,7 cm/sec, p = 0,04). Testosterone levels didn’t change significantly, but there was a trend to its’ growth (+1,4 ± 0,3 ng/ml, p = 0,062). Conclusion: Thus, ARE Valsartan is an effective antihypertensive drug, which improves the qiality of sexual life in patients with hypertension. Policy of full disclosure: None.

PS-05-009

ADHERENCE RATES TO THE MEDITERRANEAN DIET ARE LOW IN ERECTILE DYSFUNCTION PATIENTS Aggelis, A.1; Vlachopoulos, C.2; Ioakeimidis, N.2; Terentes-Printzios, D.2; Synodinos, A.2; Rokkas, K.2; Askitis, T.2; Stefanadis, C.2 1 Athens Medical School, 1st Department of Cardiology, Greece; 2Athens Medical School, Greece Objective: Endothelial dysfunction is a key event in the pathophysiology of erectile dysfunction (ED). Adherence to Mediterranean diet has been associated with improved endothelial function. The aim of this study was to investigate the relationships of adherence to a Mediterranean type of diet with the presence and severity of ED. Methods: We studied 45 ED patients (aged 56 ± 11 years) and 22 nonED subjects (contol group) matched for age and risk factors. ED diagnosis and score were evaluated according to the International Index of Erectile Function (IIEF) questionnaire. Overall assessment of dietary habits was evaluated through a special diet score (the MedDietScore, theoretical range 0–55), which assesses adherence to the Mediterranean dietary pattern. Higher values on the score indicate greater adherence to this pattern and, consequently, healthier dietary habits. Results: Compared to controls, ED patients had significantly lower Med-DietScore (29 ± 5 vs 34 ± 4, P < 0.05). In univariate analysis Med-DietScore was positively associated with erectile performance as expressed by SHIM-5 score (r = 0.39, P < 0.01). The association of MedDietScore with SHIM-5 score remained significant in a linear

317

Podium Sessions regression model after controlling for age, risk factors and testosterone levels (b = 0.27, P < 0.05). Conclusion: This work revealed that poor long term adherence to a Mediterranean type of diet has an unfavorable effect on erectile function, irrespectively of other traditional risk factors. Dietary intervention promoting consumption of patterns enriched with fruits, legumes, vegetables and poor in animal protein, with moderate alcohol consumption, may be proved useful in improving erectile performance. Policy of full disclosure: None.

PS-05-010

ASSESSING EXPERIENCE AND OUTCOMES WITH COMBINED USE OF PHOSPHODIESTERASE-5 INHIBITORS IN ERECTILE DYSFUNCTION TREATMENT McCarty, E.1; Hollow, K.; Sadeghi-Nejad, H.2; Ashby, J.3; Goldmeier, D.4 Royal Victoria Hospital, GUM Dept., Belfast, United Kingdom; 2Hackensack University Medical, New Jersey, USA; 3Berkshire PCT, United Kingdom; 4 Imperial College NHS Trust, London, United Kingdom

1

Objective: Determine frequency of combination PDE5i use amongst clinicians treating ED and assess reported clinical efficacy and outcomes. Methods: Web-based survey designed using SurveyMonkey and invitations distributed to members of BASHH & SMSNA. Responses were collected from December 2011–June 2012. Results: 123 clinicians completed the survey (including 62% urologists, 27% sexual health physicians and 6% General Practitioners). Mean number of patients each reported treating per month was 90 (range 2–300). Initial treatment of choice was PDE5i in 69%, intracavernosal injection 17%, vacuum device 6%, MUSE 2% and psychosexual therapy 6%. The % of patients which participants estimated satisfactory response to PDE5i ranged between 15–100% (mean 63%). Only 37% respondents had experience of prescribing combinations of PDE5i. Combination PDE5i’s were trialled in 7.5% of patients reporting partial response to single PDE5i and 10% reporting no response. Improved response with combination therapy was estimated in 7.5% of patients with partial response and 8% with no response to single PDE5i. Various PDE5i combinations had been trialled, however the majority (60%) recommended daily tadalafil 5 mg alongside ondemand dosing with any PDE5i. Majority (77%) reported no increased side effects/adverse events in any patients using combination PDE5i therapy. All of remaining 23% reported only minor side effects. Conclusion: Combined PDE5i use appears to be a reasonable treatment option in those with unsatisfactory response to single PDE5i however more studies are required to explore efficacy, safety and tolerability. Policy of full disclosure: None.

Friday, 7 December 2012 16.30–17.30 Forum PS-06 Prostate health Chairs: A. Leivar Tamayo R. Tal, Israel PS-06-001

TIME MAY CONVERT INITIAL PDE5INHIBITOR FAILURE INTO SUCCESS FOLLOWING RADICAL PROSTATECTOMY Fode, M.1; Sønksen, J.2; Jakobsen, H.2 Herlev Hospital, Department of Urology, Denmark; 2Herlev Hospital, Denmark

1

Objective: The most commonly prescribed erectile dysfunction (ED) treatment after radical prostatectomy is PDE5-inhibitors. If this fails, more invasive and inconvenient options may be necessary. However, as post-prostatectomy erectile function can improve over time, the effect of PDE5-inhibitors may also improve. Our study evaluates the presence and magnitude of this phenomenon. Methods: Prospectively collected data from patients with post-prostatectomy ED, initial failure of PDE5-inhibitor treatment at 3 and/or 6 months, and at least 12 months follow-up were included. All patients had undergone radical prostatectomy at a large university hospital between 1999 and 2011, and had completed IIEF-5 questionnaires before surgery and at follow-up visits. Response to PDE5-inhibitors was defined as an IIEF-5 score ≥17. Statistics were performed using SAS 9.2. Results: Data were avalible for 349 patients. At 12 month follow-up, 228 of these patients were still using PDE5-inhibitors. Overall 42 PDE5-inhibitor users (18%) were considered responders at 12 months. Logistic regression analysis revealed that only bilateral nerve sparing was an independent predictor of a late respons (Odds ratio: 2.9; 95% CI 1.4–5.8; p = 0.003). Thus, 28% of bilaterally nerve spared patients were responders while corresponding numbers for unilaterally nerve spared patients and non-nerve spared patients were 13% and 6% respectivly. Of the patients who had abandoned PDE5-inhibitors at 12 months, 30 patients had switched to other ED treatments while 91 patients were not using erectogenic aids. Only one patient had an IIEF-5 score >17 without treatment. Conclusion: Patients who have undergone bilaterally nerve sparing radical prostatectomy should be encouraged not to give up on PDE5inhibitor treatment even if the treatment is unsuccessful initially, as almost a third may still see a satisfactory effect within one year. Meanwhile unilaterally nerve spared patients and especially non-nerve spared patients are likely to need more agressive treatment. Policy of full disclosure: Mikkel Fode: Advisory bord member, Eli Lilly Jens Sønksen: Advisory bord member, Eli Lilly.

PS-06-002

MECHANISM OF ACTION OF PHOSPHODIESTERASE TYPE 5 INHIBITION IN METABOLIC SYNDROME-ASSOCIATED PROSTATE ALTERATIONS: AN EXPERIMENTAL STUDY IN THE RABBIT Maggi, M.1; Morelli, A.2; Comeglio, P.2; Filippi, S.2; Sarchielli, E.2; Vignozzi, L.2; Maneschi, E.2; cellai, I.2; Gacci, M.2; Lenzi, A.3; Vannelli, G. B.2 1 University of Florence, Department of Clinical, Italy; 2University of Florence, Italy; 3Sapienza University of Rome, Italy Objective: Phosphodiesterase type 5 (PDE5) inhibitors improve benign prostatic hyperplasia (BPH)-related lower urinary tract symptoms (LUTS), often associated with metabolic syndrome (MetS). This study investigated the effects of PDE5 inhibition in the prostate of rabbits fed a high fat diet (HFD) for 12 weeks. HFD-rabbits develop the most important features of human MetS (glucose intolerance,

J Sex Med 2012;9(suppl 5):303–335

318 dyslipidemia, increased abdominal adiposity and hypertension), along with hypogonadism and LUT abnormalities (prostate and bladder inflammation/tissue remodelling). Methods: HFD rabbits were treated with tadalafil (2 mg/Kg/day, in drinking water) for twelve weeks or during the last week of twelve. Gene expression was evaluated by quantitative RT-PCR. Prostate morphological changes and oxygenation were evaluated by immunohistochemistry. Results: HFD prostates showed increased PDE5 expression, suggesting a peculiar sensitivity of prostate to the action of PDE5 inhibitors during MetS. Accordingly, prostate PDE5 mRNA was negatively associated to plasma testosterone/estradiol ratio, whose reduction characterizes MetS, and positively with the expression in prostate of several genes exploring pathogenetic processes for BPH/LUTS, such as inflammation, leukocyte infiltration and fibrosis/myofibroblast activation. Most of these genes was up-regulated by HFD, and significantly reduced by PDE5 inhibition, through either chronic (12-weeks) or, at a lower extent, acute (1-week) tadalafil dosing. Tadalafil was also able to reduce blood pressure and visceral fat in HFD rabbits, without changing any other MetS parameter. Interestingly, 1-week tadalafil administration to HFD rabbits, significantly blunted prostate inflammation (increased CD45 immunopositivity), fibrosis (reduced muscle/ fiber ratio) and hypo-oxygenation, thus suggesting a potential curative effect of PDE5 inhibition on MetS-related prostate alterations. Conclusion: Our data provide the experimental evidences to support the multiple potentiality of PDE5 inhibitors as a useful therapeutic tool in LUTS. Policy of full disclosure: Annamaria Morelli, Paolo Comeglio, Sandra Filippi, Erica Sarchielli, Linda Vignozzi, Elena Maneschi, Ilaria Cellai, Mauro Gacci, Andrea Lenzi, Gabriella B. Vannelli have no conflict of interest to disclose. Mario Maggi is a scientific consultant for Bayer Pharma A.G, Germany, and for Eli-Lilly Indianapolis, Indiana.

PS-06-003

TESTOSTERONE AND PROSTATE CANCER / RISING PSA: IS THE LINK GETTING WEAKER AND THE PICTURE CLEARER?

Podium Sessions PS-06-004

THE INCIDENCE AND TYPES OF SEXUAL DYSFUNCTION AMONG PROSTATE CANCER PATIENTS Serefoglu, E. C.1; Saitz, T. R.2; Douglass, L. M.2; Gokce, A.2; Thomas, R.2; Hellstrom, W.2 1 Ankara, Turkey; 2Tulane University, New Orleans, USA Objective: Although the incidence and treatment options for erectile dysfunction (ED) has been reported among prostate cancer patients, little attention has been focused on the other domains of sexual function, such as ejaculatory dysfunction and loss of libido. The aim of this study is to assess the incidence and types of sexual dysfunction among prostate cancer patients. Methods: Between July 2011 and May 2012, patients who were diagnosed with prostate cancer included into the study. After taking a careful medical and sexual history, the patients were instructed to complete Male Sexual Health Questionnaire (MSHQ) to assess their pre-treatment sexual function. Answers to the questions of MSHQ were analyzed and patients who scored 0–2 points from each question accepted to be symptomatic. Erection, Ejaculation, Satisfaction, Sexual Activity and Desire scales were separately evaluated. Results: A total of 60 patients who were recently diagnosed with prostate cancer were studied. The mean age were 60.28 ± 6.25 (range 44–73) and 13.8% reported no sexual activity within the previous month (Q19). Erectile problems, especially getting an erection (13.6%, Q1), were common. Ejaculatory dysfunction was also highly prevalent and bothersome in men with prostate cancer, with decreased force of ejaculation (13.2%), diminished volume of ejaculate (18.5%) and decreased pleasure with ejaculation (20.4%) being the most commonly reported symptoms. Approximately, 31.5% of patients were unsatisfied with their sex activity (Q15). Conclusion: The incidence of sexual dysfunction is high among prostate cancer patients. These problems need to be considered when discussing treatment options with prostate cancer patients. Policy of full disclosure: None.

Chitale, S.1; Banerjee, S.2; Hull, S.2; Rooney, E.2 Hall Farm Barn, Carleton Forehoe, Norwich, United Kingdom; 2Norfolk & Norwich University H., United Kingdom

1

Objective: Testosterone replacement therapy (TRT) is indicated in patients with male sexual disorder (MSD) with evidence of hypogonadism. Traditionally, there has been reluctance on part of the clinicians to commence TRT for fear of “inducing” prostate cancer, rise in PSA or worsening their lower urinary tract symptoms (LUTS) particularly in men over 40 yrs of age. Lately, there have been a lot of studies suggesting the contrary. This study aims at ruling in / ruling out the presumed association between TRT and initiation of prostate cancer or a rise in PSA. Methods: 100 consecutive men seen in the Andrology outpatients for MSD / LUTS were prospectively recruited in this longitudinal observational study. Their initial work-up included clinical assessment inc. QoL questionnaire, testosterone and PSA assay at baseline and at 4–6 monthly follow-up. Patients with rising PSA were offered prostate scan and biopsies whilst their TRT was put on hold. Results: Of the 20 patients on TRT for MSD with a mean follow-up of 18 months, 16 showed a therapeutic benefit with significant rise in their testosterone without a concomitant rise in their PSA. 3/20 had a rise in PSA but negative biopsies for prostate cancer and 1/20 patients with normal PSA but an abnormal DRE also had negative biopsies. Conclusion: Men with MSD on TRT do not show any rise in PSA in the majority and those with a minimal rise in PSA show no evidence of prostate cancer. Larger longitudinal studies with longer follow-up are needed to convince clinicians that with close monitoring it is not unsafe to offer TRT for men with MSD. Policy of full disclosure: None.

J Sex Med 2012;9(suppl 5):303–335

PS-06-005

LONG-TERM ERECTILE FUNCTION OUTCOMES AFTER HOLMIUM LASER ENUCLEATION OF THE PROSTATE (HOLEP) Salonia, A.1; Ferrari, M.2; Clementi, M. C.2; Castagna, G.2; Capitanio, U.2; Capogrosso, P.2; Colicchia, M.2; Ventimiglia, E.2; Briganti, A.2; Rigatti, P.2; Montorsi, F.2 1 University Vita-Salute San Raffaele, Urology, Milan, Italy; 2IRCCS San Raffaele, Milan, Italy Objective: To assess the rate of erectile function (EF) improvement at long-term follow-up (FU) in patients who underwent HoLEP for symptomatic BPH.

319

Podium Sessions Methods: Complete sociodemographic, clinical and psychometric data from 135 patients submitted to HoLEP were analysed. All patients completed a remembered (= targeting EF regarding a period before HoLEP) IIEF (EF domain); likewise, a real-time (= targeting the 4 weeks before HoLEP) IIEF (all domains) was filled. EF was stratified according to Cappelleri criteria. Both a remembered and a real-time International Prostate Symptom Score (IPSS) were also completed. Positive outcomes also considered Minimal Clinically Important Differences (MCIDs) criteria. Results: Mean (median) age at surgery was 63 (63.6) years. PostHoLEP FU was 152 (164) months. At long-term FU, mean (SD) IPSS score significantly improved [16 (8.7) vs 5.4 (5.6); p < 0.0001]. At longterm FU, mean was: IIEF-EF: 19 (23). IIEF-EF significantly changed [mean delta −3.9 (−1)] as compared with the preoperative assessment, with 23 (17%) patients reporting an improved IIEF-EF. Preoperative EF was normal EF, mild ED, mild-to-moderate ED, moderate ED, and severe ED in 61%, 9%, 12%, 6%, and 12% patients, respectively. Conversely, postoperative ED severity was normal EF, mild ED, mild-to-moderate ED, moderate ED, and severe ED in 42%, 16%, 10%, 5%, and 27% patients, respectively. Of all, 37% patients worsened of at least one IIEF-EF category; conversely, 56% and 7% patients maintained and eventually improved their IIEF-EF domain category, respectively. MCIDs criteria showed a significant improvement in 6.7% patients. At MVA, both preoperative IPSS (OR: 1.12; p = 0.002) and IIEF-EF (OR: 0.92; p = 0.005) scores were significantly associated with postoperative improvement of IIEF-EF. Conclusion: Long-term FU data showed that HoLEP significantly improved urinary symptoms in patients with symptomatic obstructive BPH, with a concomitant clinically significant EF improvement in roughly 7% of the individuals. Policy of full disclosure: None.

PS-06-006

RECOVERY OF ERECTILE FUNCTION FOLLOWING RADICAL PROSTATECTOMY: A TWO YEAR FOLLOW-UP STUDY Fode, M.1; Sønksen, J.2; Jakobsen, H.2 Herlev Hospital, Department of Urology, Denmark; 2Herlev Hospital, Denmark

1

Objective: Erectile function has been shown to improve with time after a radical prostatectomy but reported rates of recovery vary widely. We evaluate the outcomes at our center. Methods: Prospectively collected data from patients with preoperative IIEF-5 ≥17 and two years follow-up who underwent open or robotassisted radical prostatectomy at a large university hospital between 1999 and 2010 were used. Medical treatments for erectile dysfunction were noted and patients with postoperative IIEF-5 ≥17 were considered to have regained erectile function. Descriptive statistics were performed along with chi squared test for univariate analyses and logistic regression for multivariate analyses. Results: Data were available for 199 patients. Forty-two had undergone non-nerve sparing surgery, 95 had undergone unilateral nerve sparing, and 63 had undergone bilateral nerve sparing. The cumulative rate of patients regaining spontaneous or medically assisted erectile function was 16 (8%) at 3 months, 27 (13.6%) at 6 months, 48 (24.1%) at 12 months, 62 (31.2%) at 18 months, and 76 (38.2%) at 24 months. Of patients who regained function, 11/14 in the non-nerve spared group, 4/27 in the unilaterally nerve spared group, and 0/35 in the bilaterally nerve spared group were dependent on intracavernosal injection therapy (p < 0.0001). Of the remaining patients, 39 received oral PDE5-inhibitors while 22 did not require medications. Bilateral nerve sparing (OR 2.3, 95% CI; 1.2–4.4, p = 0.014) and age at surgery (OR 1.1, 95% CI ; 1.05–1.18, p = 0.0003) were predictors of regaining erectile function. Neither tumor chareteristics nor surgical approach made a difference. Conclusion: Erectile function may continue to improve until at least two years after radical prostatectomy. However, most patients will not return to preoperative levels. Not surprisingly younger patients who undergo bilateral nerve sparing have the best postoperative function.

Non-nerve spared patients, will likely need injection therapy to regain erectile function. Policy of full disclosure: Mikkel Fode: Advisory board member, Eli Lilly Jens Sønksen: Advisory board member, Eli Lilly.

PS-06-007

PREVALENCE OF SEXUAL DYSFUNCTION, PDE5 INHIBITOR USE, AND LOWER URINARY TRACT SYMPTOMS IN HYPOGONADAL MEN: BASELINE FINDINGS FROM THE REGISTRY OF HYPOGONADISM IN MEN (RHYME) Rosen, R.1; Curto, T.1; Behre, H.2; Maggi, M.3; Meuleman, E.4; Martín Morales, A.5; Porst, H.6; Martha, J.1; Araujo, A.1 1 NERI Inc., Watertown, USA; 2University Hospital Halle, Germany; 3 University of Florence, Italy; 4VU University Medical Center, Amsterdam, Netherlands; 5Carlos Haya University Hospita, Malaga, Spain; 6Private Practice Urology/Andrology, Hamburg, Germany Objective: Hypogonadism (HG), sexual dysfunction and lower urinary tract symptoms (LUTS) are common disorders in the aging male. We describe the baseline prevalence of sexual dysfunction, PDE5 inhibitor (PDE5i) use, and LUTS in a large cohort of hypogonadal men. Methods: RHYME is a multi-center registry of 999 men with clinically-diagnosed HG (naïve to androgen treatment) from 25 sites in 6 European countries (DE/ES/IT/NL/SE/UK). In sexually active patients (N = 752), ED was assessed by the IIEF EF domain and low libido by the IIEF sexual desire domain. In sexually inactive men, ED and low libido were assessed by medical record review. PDE5i use was also assessed by medical record review. LUTS was assessed by IPSS. Results: The mean age of the cohort was 59.1 ± 10.5 y. Among sexually active men, 65.9% had moderate/severe ED, compared to 89.3% of sexually inactive men. PDE5 inhibitors were used by 29.5% of sexually active men with moderate/severe ED, and were more likely to be prescribed by urologists (35.9%) than other study physicians (16.1%). The prevalence of low libido among sexually active men was 31.7%, compared to 76.3% of sexually inactive men. The prevalence of moderate/severe LUTS was 40.0%, with 31.6% and 49.3% reporting voiding- and storage-type LUTS symptoms, respectively. The UK had the highest rates of moderate/severe ED (81.5%), low libido (46.2%), and LUTS (52.1%). PDE5i use was highest in ES (44.2%) and lowest in IT (9.4%). Conclusion: Prevalence of sexual dysfunction, LUTS, and PDE5i use was relatively high in European hypogonadal men naïve to androgen treatment, although substantial variations were observed by physician specialty and country. The role of androgen deficiency is evident in the marked decreases in erectile function and libido observed, in combination with a characteristic pattern of LUTS suggesting a role of low testosterone in storage-type symptoms. Policy of full disclosure: Funded by Bayer Pharma AG.

PS-06-008

A CLINICAL SEXOLOGIST APPEARS TO PLAY AN IMPORTANT IN A PENILE AND SEXUAL REHABILITATION PROGRAM MAY IMPROVE THE OUTCOME OF SEXUAL FUNCTION ONE YEAR AFTER PROSTATE CANCER SURGERY – A PROSPECTIVE INTERVENTIONAL STUDY Ljunggren, C.1; Stroberg, P.2 1 Ryhovs County Hospital, Urology, Jönköping, Sweden; 2Ryhovs County Hospital, Jönköping, Sweden Objective: To prospectively evaluate if including a clinical sexologist in a penile and sexual rehabilitation program improves the outcome of sexual function one year after daVinci Radical Prostatectomy (dVP).

J Sex Med 2012;9(suppl 5):303–335

320 Methods: CONTROL GROUP(CG): In 2008; 28 fully potent (IIEF-5 > 21) and sexually active men (47–69 yrs; M 61 yrs) were enrolled in a postoperative penile rehabilitation (PR) program regardless of nerve sparing (NS) procedure or not – 16 had bilateral nerve sparing (BLNS), 9 had unilateral nerve sparing (ULNS) and 3 non nerve sparing (NonNS) surgery. Based on their post-op function the patients received A) no treatment, B) oral PDE-inhibitors (daily dosing or on demand), C) Intrauretral prostaglandin-E1 (pGE1), D) Intracavernousal pGE1, or any combination of B, C and D. They were followed up at 1,3,6,9, months with adjustments of therapy according to function. Outcome was evaluated at 12 months. STUDY GROUP(SG) In 2009; 79fully potent (IIEF-5 > 21) and sexually active men (45–74 yrs; M 61 yrs) who had a dVP due PC regardless of NS procedure or not (37 had BLNS, 30 had ULNS and 12 had NonNS surgery), were enrolled in a postoperative sexual rehabilitation with a clinical sexologist (CLS) who in addition to the PR, evaluated the patient and his partner prior to surgery, followed them at 1,3, 6, months and instituted additional interventions when needed. Outcome was evaluated at 12 months. Results: Results CG: At 12 months 60% were sexually active with penetrating sexual activity regardless if NS or NonNS procedure. SG: At 12 months 83% were sexually active with penetrating sexual activity regardless NS or NonNS procedure, 38 patients had extra visits with CLS whereof 14 with short-term cognitive behavior therapy. Conclusion: Including a clinical sexologist in a sexual rehabilitation program appears to improve the overall outcome of sexual function one year after dVP regardless of NS or NonNS procedure. Policy of full disclosure: None.

PS-06-009

THE SEXUAL RESPONSE IN MEN WITH PROSTATE CANCER – INTRODUCING “THE SUSPICION-DIAGNOSIS-TREATMENT MODEL” Salonia, A.1; Montorsi, F.2 University Vita-Salute San Raffaele, Urology, Milan, Italy; 2IRCCS San Raffaele, Milan, Italy

1

Objective: To describe a model of sexual response for men with prostate cancer (PCa) that appears to be an accurate representation of their experiences, in order to improve the understanding of men’s sexual psychophysiology after suspicion, diagnosis and consequent treatment of PCa. Methods: Using the available traditional models of human sexual response, along with the Basson’s reconceptualization of women’s sexual response, we developed an evidence- and clinical-based conceptualization of sexual response specific for men with PCa which combines interpersonal, contextual, personal psychological and biological factors throughout the time slot from cancer suspicion to the posttreatment life span. Results: Essential substrate to and across the entire model are man’s age and aging, sexual orientation, relationship status, and comorbid conditions; likewise, partner’s psycho-biological and sexual health status are comprehensively considered. Hence, the model accurately analyses the impact of three different moments (namely, cancer suspicion, cancer diagnosis and eventual cancer treatment – any type) over 1) sexual desire (either spontaneous or responsive) and the willingness to be sexually receptive; 2) genital and non-genital sexual arousal (including coital and non coital sex); and, 3) orgasm (±ejaculation) of men with PCa. Moreover, the model takes into account the psychological variables either consequent or related to the three moments (thus including non-sexual rewards; emotional intimacy and wellbeing; self-perception of masculinity; eventual impact over fatherhood possibility; collapse of attractiveness toward partner/s). The impact of patient/partner’s decision making at any stage from cancer suspicion to cancer treatment is also considered, along with partner feelings and perception throughout the post-treatment time frame. Conclusion: The conceptualization of the “Suspicion-DiagnosisTreatment model” of sexual response with overlapping phases in variable order may facilitate both the assessment and the management of

J Sex Med 2012;9(suppl 5):303–335

Podium Sessions uneasiness and dysfunctions associated with sexuality and sexual functioning in men with PCa in the real-life setting. Policy of full disclosure: None.

PS-06-010

PENILE MORPHOMETRIC CHANGES AFTER RADICAL PROSTATECTOMY: IMPACT OF A REHABILITATION PROGRAM Osorio Cabello, L.1; Martinez Salamanca, J. I.2; Egui Rojo, A.2; Linares Espinos, E.2; Areche Espiritusanto, J.2; Martinez Ballesteros, C.2; Carballido Rodriguez, J.2 1 Hospital Puerta de Hierro, Urology, Majadahonda, Spain; 2Hospital Puerta de Hierro, Majadahonda, Spain Objective: To analyze the morphometric changes of the penis in patients after radical prostatectomy (RP) and validate the impact of a penile rehabilitation program in the shortening of the penis. Methods: 32 patients who underwent RP during the period July 2009 to December 2010 were selected. All patients were preoperatively evaluated (V1) and after 2 (V2), 6 (V3) and 9 (V4) months. At each visit patients filled in a SHIM, EHS, SEP02, SEP03 questionnaire and measurements of length and girth at rest were taken. Patients were distributed into two groups according to their preferences; control groups (no treatment) and rehabilitation group (tadalafil 5 mg daily, vacuum pump (VED), penis extender, intracavernosal injection (ICI), alone or in combination). Results: Mean age was 61.4 years (49–72). 14 patients (43.7%) underwent nerve sparing. The control group composed of 11 (34’4%) patients and the rehabilitation group of 21 (65.6%) of whom 17 (53.1%) took tadalafil 5 mg, 2 (6.3%) used VED, 1 (3.1%) penis extensor device, and 1 (3.1%) IIC. There is an average decrease in length of 2.5 cm (95% CI 0.7 and 4.3) p = 0.09 in the length between V1 and V4 but there are no significant changes in the thickness of the penis. We found no correlation between length and thickness with age or with neurovascular preservation. In none of the outpatient visits, we did not find significant differences (p > 0.05) between rehabilitation and control groups in the length or thickness. Conclusion: There are penile morphometric changes in patients undergoing RP with a more pronounced decrease in length in the first 6 months after surgery. In our experience penile rehabilitation has not shown to influence the preservation of the length and girth. Policy of full disclosure: None.

321

Podium Sessions Saturday, 8 December 2012 08.00–09.00 G102/103 PS-07 Men’s sexual health: Hormones Chairs: J. Sonksen, Denmark A. D. Fisher, Italy PS-07-001

CAG REPEAT LENGTH AND ARTERIAL REACTIVITY AFTER ACUTE TESTOSTERONE GEL ADMINISTRATION IN MEN WITH SEVERE HYPOGONADISM Aversa, A.1; Francomano, D.2; Bruzziches, R.2; Radicioni, A.2; Anzuini, A.2; Romanelli, F.2; Fattorini, G.2; Gandini, L.2; Lenzi, A.2 1 Sapienza University of Rome, Dept. of Medical, Italy; 2Sapienza University of Rome, Italy Objective: Introduction: The possibility that testosterone (T) may have detrimental effects on cardiovascular system is receiving increasing attention. We investigated the acute effects of T administration on vascular function in men with severe hypogonadism. Methods: Materials and methods: 10 men (18–40 years) with severe hypogonadism (mean plasma T = 0.6 ng/mL ± 0.3 SD) of any origin were enrolled after a 4-weeks washout period. This was a 4-days, double-blind, placebo-controlled crossover study with 40 mg fixed dose of transdermal-T gel (Tostrex®) or matched placebo gel. Primary endpoints were variations from baseline of the reactive hyperemia index (RHI) as calculated by fingertip peripheral arterial tonometry (PAT) and of the Augmentation Index (AI). Also, the relationship between polymorphism of the androgen receptor gene (CAG repeat) and arterial reactivity was investigated. Results: Results: 4 and 96 hours after T administrations, T levels significantly increased reaching mean plasma levels of 4.0 ± 2.1 ng/mL, (p < 0.0001) and 2.0 ± 1.48 ng/mL (p < 0.001) respectively, without variations in estradiol and SHBG levels. RHI significantly improved at time 4 h (p < 0.05), while AI improvement was recorded at 4 h at 96 h, respectively (p < 0.01 and p < 0.001). Interestingly, a direct relationship between Δ-Total T and Δ-RHI variations (p < 0.01 r = 0.37) and an inverse relationship between Δ-Total T and Δ-AI (p < 0.01 r = −0.35) were found, respectively. Finally, a direct relationship between RHI and CAG repeat length was found (r2 = 0.64, p < 0.005) in overall patients. No adverse event was reported. Conclusion: Conclusions: Acute administration of a fixed dose of transdermal-T causes an acute vasodilation and improvements in arterial stiffness probably due to non-genomic actions of testosterone. The endothelial response was more pronounced depending from higher CAG repeat length. Policy of full disclosure: None.

PS-07-002

METABOLIC AND CARDIOVASCULAR OUTCOMES OF FATHERHOOD:RESULTS FROM A COHORT STUDY IN SUBJECTS WITH SEXUAL DYSFUNCTION Fisher, A. D.1; Rastrelli, G.2; Bandini, E.2; Corona, G.3; Monami, M.4; Mannucci, E.4; Maggi, M.5 1 Sexual Medicine and Andrology, Clinical Physiopathology, Florence, Italy; 2 Sexual Medicine and Andrology, Florence, Italy; 3Andrology Unit, Dept., Clinical Physiopathology, Florence, Italy; 4Diabetes Section, Geriatric Unit, Florence, Italy; 5University of Florence, Department of Clinical, Italy Objective: Previous cross-sectional and longitudinal studies reported a negative correlation between fatherhood and testosterone (T) levels, likely due to a centrally-mediated down-regulation of the hypothalamic-pituitary-gonadal axis. Moreover, epidemiological data indicate that fatherhood might affect metabolic and cardiovascular outcomes, although different results have been reported. Up to now, no studies

have evaluated these associations in a population of men seeking treatment for sexual dysfunction (SD). The aim of the study was to explore biological and clinical correlates of number of children (NoC) and its possible associations with forthcoming major cardiovascular events (MACE)in a sample of men with SD. Methods: A consecutive series of 4,045 subjects (mean age 52 ± 13.1 yrs old) attending the Outpatient Clinic for SD was retrospectively studied. A subset of the previous sample (n = 1,687) was enrolled in a longitudinal study.Information on MACE was obtained through the City of Florence Registry Office. Results: Among patients studied, 31.6% had no children, while 26.3% reported having one child, 33.4% two, and 8.8% three or more children. Although fatherhood was negatively related with FSH levels and positively with testis volume, we found a NoC-dependent, stepwise decrease in T plasma levels, not compensated by a concomitant increase in LH.NoC was associated with a worse metabolic and cardiovascular profile, as well as worse penile blood flows and a higher prevalence of metabolic syndrome (MetS). In the longitudinal study, after adjusting for confounders, NoC was independently associated with a higher incidence of MACE. However, when the presence of MetS was introduced as a further covariate, the association was no longer significant. Conclusion: This study supports the hypothesis that bond maintenance contexts and fatherhood are associated with an adaptive downregulation of the gonadotropin-gonadal axis, even in a sample of men with SD. Moreover, our data suggest that NoC predicts MACE, most likely because of an unfavorable, lifestyle-dependent, parenthoodassociated behavior. Policy of full disclosure: None.

PS-07-003

TESTOSTERONE MEASUREMENT IMPROVES RISK PREDICTION WHEN ADDED TO FRAMINGHAM RISK SCORE IN HYPERTENSIVE MALES WITH ERECTILE DYSFUNCTION Ioakeimidis, N.1; Vlachopoulos, C.2; Aznaouridis, K.2; Terentes-Printzios, D.2; Aggelis, A.2; Aggelakas, A.2; Synodinos, A.2; Rokkas, K.2; Askitis, T.2; Stefanadis, C.2 1 Athens Medical School, 1st Department of Cardiology, Greece; 2Athens Medical School, Greece Objective: Androgen deficiency confers an independent risk for cardiovascular events. Hypertension has been associated with increased prevalence of low testosterone. The aim of our analysis was to assess whether testosterone levels can meaninigfully reclassify hypertensive patients that have been characterized with classical risk scores such as the Framingham (FRS) to higher or lower risk categories, a feature of principal clinical importance. Methods: Major adverse cardiovascular events (MACE) in relation to total testosterone (TT) were analyzed in 228 patients (mean age 56 years). Results: During a mean follow-up of 44 months, 19/228 participants experienced a MACE. Compared to patients who did not experience MACE, hypertensive subjects who developed MACE had lower TT concentration (P < 0.01) and a higher prevalence of hypogonadism (P = 0.025). As we had only 44 months of follow-up in our study, for the reclassification analysis we did not use standard risk categories based on 10-year FRS-predicted risk cut-off points (<10%, 10–20%, >20%). Instead, we computed the predicted risk for all patients using a Cox regression model that included only the standard risk factors used for calculation of FRS (age, systolic blood pressure, total cholesterol, HDL-cholesterol, smoking). Then we defined cut-off points for risk groups according to the tertiles of the predicted risk in patients who experienced an event during the 44-month follow-up (33rd percentile of risk = 3%, 66th percentile = 9%), which resulted in a uniform distribution of events across risk categories. Then we cross-classified groups of risk (<3%, 3%–9%, >9%) based on a model that included standard risk factors against groups of risk based on a model where TT was added (Table). Addition of TT to standard risk factors model

J Sex Med 2012;9(suppl 5):303–335

322 yielded correct patient reclassification to higher or lower risk category by 38.8 % (P = 0.033). Conclusion: Testosterone improves risk prediction when added to FRS and may represent a valuable biomarker of prediction of MACE risk in hypertensive patients. Policy of full disclosure: None.

Podium Sessions Results: There was a positive association between TT and penile peak systolic velocity (p < 0.01) and negative associations between TT and body mass index (p < 0.01), systolic blood pressure (p < 0.01) and blood pressure medication use (p < 0.01). FRS was negatively associated with TT (p < 0.001). Patients with high FRS (>20%) were more likely to have laboratory HypG as compared to subjects with intermediate (10–20%) and low FRS (<10%) (figure). Conclusion: Lower plasma TT may suggest the presence of cardiovascular risk factors and potentially increased risk for heart disease in ED patients. Policy of full disclosure: None.

PS-07-005

“LATE ONSET HYPOGONADISM” IS NOT AN ISOLATED CONDITION – COMORBIDITIES IN ELDERLY HYPOGONADAL MEN PRESENTING OR REFERRED TO UROLOGICAL INSTITUTIONS IN GERMANY Farid, S.1; Haider, A.2; Yassin, A.3 Bayer Pharma AG, Global Medical Affairs, Berlin, Germany; 2Private Urology Practice, Bremerhaven, Germany; 3Institute of Urology and Andrology, Norderstedt, Germany 1

PS-07-004

PLASMA TESTOSTERONE IS ASSOCIATED WITH FRAMINGHAM RISK SCORE IN ERECTILE DYSFUNCTION PATIENTS Rokkas, K.1; Vlachopoulos, C.2; Ioakeimidis, N.2; Aggelis, A.2; Terentes-Printzios, D.2; Synodinos, A.2; Abdelrasoul, M.2; Aggelakas, A.2; Askitis, T.2; Stefanadis, C.2 1 Athens Medical School, 1st Department of Cardiology, Greece; 2Athens Medical School, Greece Objective: The Framingham risk score (FRS) predicts a patient’s 10-year risk of developing cardiovascular disease. Many risk factors included in its calculation influence or are influenced by circulating testosterone. Low levels of testosterone are involved in the pathophysiology of erectile dysfunction (ED). To investigate the possible association between testosterone and cardiovascular risk, as defined by the Framingham score, a database of ED patients was analyzed. Methods: FRS in relation to total testosterone (TT) were analyzed with proportional hazards models in 415 patients (mean age 56 years). Hypogonadism (HypG) was defined when TT levels were below 3.4 ng/ml. Exclusion criteria included pre-existing cardiovascular disease, stroke and diabetes.

J Sex Med 2012;9(suppl 5):303–335

Objective: Testosterone declines with aging, not primarily determined by calendar age per se but rather by factors impairing the health of aging men. Methods: In two separate cumulative registry studies following identical protocols, two cohorts of 516 mainly elderly men were analyzed for concurrent diseases. Cohort A (Haider) consisted of 255 men, cohort B (Yassin) of 261 men. These men had either sought urological consultation or had been referred by other disciplines because of suspected hypogonadism. All men received treatment with injections of long-acting testosterone undecanoate. Results: The following comorbidities were encountered: Cardiology: hypertension: A: 40%, B: 45% ; coronary artery disease: A: 16%, B: 13%; condition post myocardial infarction: A 15%, B: <1%. Internal Medicine: Diabetes mellitus: A: 31%, B: 26%; dyslipidemia: A: 18%, B: 33%. Gastroenterology: inflammatory bowel disease: A: 16%, B: <1%. Urology: chronic prostatitis: A: 38%, B: 11%. Dermatology: psoriasis: A: 5%, B: <1%. Orthopedics: osteoporosis: A: 14%, B: 6%. Endocrinology: Klinefelter’s syndrome: A: 9%, B: 2%. In addition, there were a total of 14 patients with a history of maldescensus testis and 19 patients with a history of unilateral or bilateral orchiectomy following testicular cancer. Conclusion: 1) Most middle-aged to elderly patients with hypogonadism have comorbidities. Hypogonadal men should be examined for concurrent diseases. Testosterone administration may be a significant element in their treatment. 2) With progression of their age elderly men will suffer increasingly from ailments and hypogonadism may be an element, so far not often diagnosed. Testosterone treatment may contribute to a better quality treatment. 3) 60/516 men had conditions which cannot be categorized as “LOH”. Klinefelter’s syndrome may still have been undiagnosed, and a history of maldescensus testis may

323

Podium Sessions be unknown. The term “LOH” should be used with caution, and the general term “hypogonadism” may be preferable. Policy of full disclosure: Farid Saad is an employee of Bayer Pharma, manufacturer of testosterone products. Ahmad Haider and Aksam Yassin have received speakers’ fees and travel grants from Bayer Pharma, Takeda Pharma, Ferring Pharmaceuticals and GSK.

FAT BOOSTS, WHILE ANDROGEN RECEPTOR ACTIVATION COUNTERACTS, BENIGN PROSTATIC HYPERPLASIAASSOCIATED PROSTATE INFLAMMATION 2

2

2

3

SEXUAL FUNCTION IN MEN WITH A HISTORY OF HYPERPROLACTINEMIA (HPRL) AFTER LONG-TERM TREATMENT WITH CABERGOLINE (CAB) Galdiero, M.1; Lo Calzo, F.2; Auriemma, R. S.2; Vitale, P.2; Colao, A.2; Jannini, E. A.3; Maggi, M.4; Pivonello, R.2 1 Federico II University, Molec. and Clinic Endocrinology, Naples, Italy; 2 Federico II University, Naples, Italy; 3University of Aquila, Italy; 4 University of Florence, Italy

PS-07-006

1

PS-07-007

2

Vignozzi, L. ; Gacci, M. ; Cellai, I. ; Santi, R. ; Corona, G. ; Morelli, A. ; Rastrelli, G.2; Comeglio, P.2; De Nunzio, C.4; Carini, M.2; Maggi, M.2 1 Sexual Medicine and Andrology, Clinical Physiopathology, Florence, Italy; 2 University of Florence, Italy; 3Maggiore-Bellaria Hospital, Bologna, Italy; 4 Sapienza University of Rome, Italy Objective: Metabolic syndrome (MetS) and benign prostate hyperplasia (BPH) are often comorbid. Chronic inflammation has been proposed as a putative link between the two conditions, as it is a determinant factor for BPH development and progression. This study was aimed at evaluating whether MetS is associated with BPH-related inflammation and at investigating the in vitro effect of oxidized lowdensity lipoprotein (oxLDL)–the most relevant autoantigen described in dyslipidaemia–on human prostate stromal cells. Methods: We have examined the histological characteristics of inflammatory infiltrates in prostatectomy specimens from a cohort of BPH patients and their correlation with pre-operatory MetS features, including hypogonadism. In vitro experiments using stromal cells isolated from BPH patients (hBPH) was also performed. Results: In a multi-center cohort of BPH patients (n = 244), inflammatory infiltrates score (IS) in prostatectomy specimens showed a step-wise association with the number of MetS factors (p = 0.001). After adjusting for age, reduced HDL cholesterol and elevated triglycerides were the only factors significantly associated with IS. Increased IS was significantly associated with hypogonadism. Adjusting for age and testosterone, dyslipidaemia was still associated with IS. To investigate whether metabolic factors could directly trigger prostate inflammation, we performed preliminary studies in hBPH. Among the different factors, oxLDL showed the highest secretion of IL-8 (>10-folds)-a surrogate marker of prostate inflammation-as well as IL-6, and bFGF. Co-treatment with DHT significantly inhibited oxLDL-induced secretion of IL-8, whilst an androgen receptor antagonist, bicalutamide, reversed DHT effects. DHT suppresses oxLDL receptor expression. Conclusion: Our data indicate that fats could have a detrimental effect on prostate health, boosting prostate inflammation, a key factor in the development and progression of BPH/LUTS. Conversely, beneficial effects of DHT in counteracting lipid- and insulin-induced prostatic alterations, suggest that androgens may have unexpected beneficial effects on prostate health. Policy of full disclosure: Linda Vignozzi, Mauro Gacci, Ilaria Cellai, Annamaria Morelli, Paolo Comeglio, Marco Carini, Giovanni Corona, Raffaella Santi, Cosimo De Nunzio have no conflict of interest that could be perceived as prejudicing the impartiality of the research reported and have nothing to declare. Mario Maggi is a scientific consultant for Bayer Pharma A.G, Germany, Eli-Lilly Indianapolis, Indiana.

Objective: No data are available on sexual function in men with Hyperprolactinemia(HPRL) under chronic Cabergoline(CAB)treatment. The aim is to evaluate sexual behaviour in hyperprolactinemic men after long-term treatment with CAB. Methods: Thirty-one HPRL patients were recruited after long-term CAB-induced normalization of PRL. Seventeen men (Group 1) had normal T, whereas 14 men (Group 2) showed T < 3 ng/ml. SIEDY, with its three domains (S1, S2, S3), MHQ (anxiety, phobia (Ph), somatization, depression and hysteria scales), IIEF (erectile function, orgasm, sexual desire (SD), intercourse satisfaction (IS), overall satisfaction) and premature ejaculation (PE) questionnaires were used to investigate sexual behaviour. Patients were compared to 62 age and BMI-matched healthy controls. Results: Compared to controls, patients showed significantly lower T levels; S2, Ph and IS scores were significantly impaired. S1 and S2 significantly correlated with patients age, and S2 with Ph, somatization and PE score. Global IIEF correlated directly with T and inversely with PRL. Compared to controls, Group 1 showed a significant impairment of S2 and Ph scores, whereas Group 2 had a significant increase in S1, S2 and Ph scores and a significant decrease in global IIEF, IS and SD. Compared to Group 1, Group 2 showed significantly lower T levels; global IIEF, IS and SD were significantly decreased. Conclusion: HPRL men under long-term treatment with CAB show an impairment of sexual behaviour compared to control subjects. In particular, hypogonadic men show impairment in organic and relational sexual behaviour and display phobic attitudes, whereas normogonadic men maintain an altered relational sexual behaviour and a phobic attitude despite T normalization, probably consequence of the past sexual dysfunction during the course of HPRL although a possible interference of dopaminergic treatment cannot be excluded. Policy of full disclosure: None.

PS-07-008

RELATIONSHIP BETWEEN ERECTILE FUNCTION AND METABOLIC SYNDROME IN A COHORT OF MEN WITH LOW TESTOSTERONE LEVELS García-Cruz, E.1; Piqueras, M.1; Cardeñosa, Ó.2; Luque, P.1; Alcaraz, A.1 Hospital Clínic de Barcelona, Urology, Spain; 2Bayer España, Sant Joan d’Espí, Spain

1

Objective: To determine the relationship between erectile function and Metabolic Syndrome (MS) in a cohort of men with low testosterone (T) levels. Methods: A multi-centre, cross-sectional study recruited 1094 consecutive men older than 45 years old with low T levels (<12 nmol/L). MS was defined as 3 or more of the following factors: abdominal obesity ≥94 cm, triglycerides ≥150 mg/dl, Hypertension ≥130/85 mmHg, HDL-cholesterol <40 mg/dL or Fasting Glucose ≥100 mg/dl. IIEF questionnaire was used to assess erectile function. Multivariate analysis was carried out to determine the variables related to ED and MS. P < 0,05 was considered statistically significant. Results: Mean age was 61,2 ± 8,1. Erectile function rate: No ED (>21) 2,4%; Mild ED (17–21) 14,1%; mild to moderate ED (12–16) 31,9%; Moderate ED (8–11) 29,9% and Severe ED (<8) 21,7%. MS rate 69%. The IIEF scoring was related to the number of MS factors (0 MS 12,8 ± 5,2; 1 MS 14,1 ± 4,9; 2 MS 12,7 ± 4,6; 3 MS 11,3 ± 4,9 (overall MS

J Sex Med 2012;9(suppl 5):303–335

324 −3 or more factors- 10,8 ± 5); 4 MS 10,4 ± 5,1 and 5 MS 9,8 ± 4,6; p < 0,001). Inversely, erectile function was related to the number of factors of MS (no ED 2,54 factors; mild ED 2,48 factors; mild to moderate 2,94 factors; moderate ED 3,09 factors and severe ED 3,41 factors; p < 0,001). Conclusion: In a cohort of men with low T levels, erectile function and MS were related in a bidirectional manner: IIEF worsened as the number of MS raised and MS factors raised as IIEF worsened. Policy of full disclosure: This study was financially supported by a grant for investigation from BAYER ESPAÑA.

PS-07-009

CHANGES IN MEN’S SEXUAL, EMOTIONAL AND COGNITIVE FUNCTIONING AFTER TAKING FINASTERIDE FOR HAIR LOSS: A CHART REVIEW Hartzell, R.1; Goldstein, I.2; Goldstein, S.1 San Diego Sexual Medicine, USA; 2Alvarado Hospital, Univ. of Calofornia, California, USA

1

Objective: Patterns of persistent bothersome and distressful cognitive, emotional and sexual changes have been observed in a subset of young men after 5 alpha reductase inhibitor (5-ARI) use for hair loss. More research is needed to better identify, diagnose and treat these individuals. Methods: A retrospective review was conducted on charts of men seen by a sex therapist and sexual medicine physician at a sexual medicine practice August 2010-April 2012. Inclusion criteria included: men over 18 years; used finasteride for hair loss; presented with sexual dysfunction as well as with emotional, physical and/or cognitive symptoms; symptoms began while using or after discontinuation of finasteride. Of 43 charts reviewed 15 patients met eligibility requirements. Eligible charts were analyzed qualitatively for themes across patients. Results: Mean age was 33.6 years; 54% were from the United States; 31% were married or in a monogamous relationship. Length of use of finasteride ranged from 10 days to 11 years; sexual, emotional and/or cognitive symptoms persisted from 3 months to 10 years. Sexual symptoms reported included lowered sexual drive (77%), erectile dysfunction (73%), decreased penile sensitivity (54%), loss of morning erections (31%), and muted orgasm (23%). The majority also reported emotional symptoms including depression/anxiety (77%) and emotional numbness (69%). Common physical symptoms included fatigue (54%) and sleeping difficulties (38%); some (23%) also reported chest pain, headaches and “sweats.” Cognitive changes (46%) included brain fog and short-term memory problems. Conclusion: Several theories have been proposed for the side effects persisting after finasteride is discontinued. 5-ARI may lead to diminished synthesis of critical centrally-acting neurosteroids and/or increased synthesis of androgen receptor with subsequent androgen receptor insensitivity. Clinicians prescribing 5-ARIs for hair loss or benign prostatic hypertrophy should inform patients of possible persistent emotional, cognitive and sexual side effects resulting from finasteride use. Policy of full disclosure: None.

PS-07-010

PHARMACOKINETICS AND PHARMACODYNAMICS OF INTRAMUSCULAR TESTOSTERONE UNDECANOATE: SERUM AND SALIVARY LEVELS OF TESTOSTERONE IN TRANSSEXUALS WITH MALE IDENTITY AND IN MEN WITH HYPOGONADISM Wahlberg, J.1; Webe, C.2; Ekman, B.3; Aardal-Eriksson, E.4 , Endocrinology, Linköping, Sweden; 2Linköping University, Sweden; 3 Endocrinology, Linköping, Sweden; 4Clinical Chemistry, Linköping, Sweden

1

Objective: Salivary testosterone is a filtrate of plasma mainly consisting of free testosterone and more accurately reflects androgen expo-

J Sex Med 2012;9(suppl 5):303–335

Podium Sessions sure in target tissues than serum total testosterone. In this study we investigated the relationships between total testosterone, calculated free testosterone and salivary testosterone during treatment with intramuscular injections of testosterone undecanoate every 12:th week. In addition a healthy control group was investigated. Methods: Males with primary or secondary hypogonadism (n = 16) and transsexuals with male identity (n = 16), and for comparison a healthy control group of men (n = 32) were investigated. Total testosterone was analysed with the Roche Elecsys testosterone II assay and salivary testosterone was collected via Salivette tubes and measured with enzyme immunoassay on Tecan Freedom EVOlyzer. Free testosterone was also calculated using the law of mass action; the calculation was based on the measurement of total testosterone, total SHBG and albumin. Results: Both in patients and controls salivary testosterone showed high correlation with total testosterone. Salivary testosterone correlated even better with calculated free testosterone and the total testosterone/SHBG ratio. In general total testosterone and salivary testosterone showed comparable kinetic pattern over time. However in several patients’ discrepancies between the total testosterone values (i.e. low or high values) and salivary testosterone (more normal values) value were found. For comparison reference values was calculated from the control group: total testosterone <50 yrs. 20.1 + 4.8 nmol/L vs. >50 yrs. 13.9 + 3.1 nmol/L and, salivary cortisol <50 yrs. 0.52 + 0.17 nmol/L vs. >50 yrs. 0.40 + 0.10 nmol/L. Conclusion: In conclusion: Salivary testosterone seems to be an additional tool to monitor long term testosterone replacement therapy and gives further information, especially if total testosterone values are inappropriate high or low. Policy of full disclosure: None.

325

Podium Sessions Saturday, 8 December 2012 09.00–10.00 G102/103 PS-08 Women’s sexual health: Miscellaneous Chairs: L. Lowenstein, Israel S. Wåhlin, Denmark PS-08-001

OBJECTIVE MEASUREMENT OF THE SEXUAL AROUSAL RESPONSE IN WOMEN WITH TYPE 1 DIABETES MELLITUS Both, S.1; Enzlin, P.2; Ter Kuile, M.3; Weijenborg, P.3 Leiden University Medical Center, Psychosomatic Gynecology and S, Netherlands; 2Institute for Family and Sexuality, Leuven, Belgium; 3 Leiden University Medical Center, Netherlands

1

Objective: Controlled questionnaire studies indicate a higher prevalence of sexual dysfunction in women with diabetes mellitus (DM), particular complaints of reduced sexual arousal and vaginal lubrication. It is assumed that a lower genital arousal response plays part in these complaints, and that this might be related to diabetes complications. However, to date, only few studies measured genital response in women with DM objectively. In this study, genital and subjective sexual arousal responses of women with type 1 DM were compared with those of healthy controls. Methods: In pre-and postmenopausal women with type 1 DM (N = 42) and healthy controls (N = 46), genital response was measured as vaginal pulse amplitude (VPA). VPA was assessed at rest, during erotic film viewing, and during vibrotactile clitoral stimulation. Subjective sexual arousal was measured using a questionnaire. Data on diabetes complications were obtained from medical records. Results: No significant differences in VPA or subjective sexual arousal were found between women with DM and healthy controls. Postmenopausal women–both DM and controls–showed weaker genital arousal than premenopausal women. Compared with women without DM complications, DM women with retinopathy showed lower vaginal blood flow. Also, women with DM and neuropathy were less sensitive to vibrotactile stimulation. Conclusion: The results do not indicate a disruption of the genital arousal response in women with type 1 DM. However, the observed associations between retinopathy and vaginal blood flow and between neuropathy and clitoral sensitivity show that these DM complications can have an adverse effect on the physiological basis of female sexual response. Policy of full disclosure: The study was supported by the Dutch Society of Sexology (NVVS).

PS-08-002

FEMPROX®, A TOPICAL ALPROSTADIL CREAM TREATMENT CONVEYS SUSTAINED IMPROVEMENT OF SEXUAL AROUSAL, LUBRICATION AND DESIRE IN WOMEN SUFFERING FROM FEMALE SEXUAL AROUSAL DISORDER (FSAD) Goldstein, I.1; Damaj, B.2; Fernando, Y.2; Frank, D.2; Moncada, I.3 Alvarado Hospital, Univ. of Calofornia, California, USA; 2Apricus Biosciences, San Diego, USA; 3Hospital La Zarzuela, Madrid, USA

1

Objective: Comparative analyses of patient reported outcome scores during first two treatment periods in 400 women with FSAD. Methods: Patients were randomized into 4 groups (placebo, 500, 700 or 900 mcg dose) for two 4-week treatment periods. Changes from baseline in SSE, FSFI, and FSDS are reported at end of each treatment period and GAQ score at end of study. Results: Compared to placebo, mean change of SSE was significant at the 900 mcg dose, 38.65 (period 1) and 51.4 (period 2). Mean change of total FSFI was significant at 700 and 900 mcg doses with 5.8 and 6.8, respectively at period 1. At period 2, changes in total FSFI score

were 7.7, 8.1 and 8.6 for 500, 700 and 900 mcg doses, respectively. Changes in FSFI arousal domain were significant for period 1: 0.81 for 500 mcg, 0.86 for 700 mcg and 1.09 for 900 mcg doses. After period 2 mean changes were 1.21, 1.31 and 1.41, respectively. Mean changes of lubrication and desire domains were significant at 900 mcg. Changes in lubrication were 1.31 (period 1) and 1.64 (period 2). Changes for desire were 0.93 (period 1) and 1.20 (period 2). The FSDS score was significant at 900 mcg dose with a mean change of −18.62 (period 1) and −25.97 (period 2). The GAQ score showed 66.3% of patients were satisfied with their sexual encounters. Conclusion: Analyses demonstrate that 900 mcg Femprox improved arousal, lubrication and desire in a treatment-and time-related fashion in women suffering from FSAD. Policy of full disclosure: SOURCE OF FUNDING: Apricus Biosciences. Drs. Bamaj, Fernando and Frank are employees of Apricus Biosciences. Drs. Goldstein and Moncada are consultants.

PS-08-003

FREE TESTOSTERONE LEVELS AND ANDROGEN-RELATED GENETIC POLYMORPHISMS MODERATE THE ASSOCIATION BETWEEN SOCIOSEXUAL ORIENTATION AND FEMALE SEXUAL DESIRE: A POPULATION-BASED STUDY Gunst, A.1; Jern, P.2; Westberg, L.3; Ankarberg-Lindgren, C.3; Eriksson, E.3; Sandnabba, K.2; Santtila, P.2 1 Abo Akademi University, Department of Psychology, Turku, Finland; 2 Abo Akademi University, Turku, Finland; 3University of Gothenburg, Sweden Objective: Despite high prevalence rates, the factors contributing to hypoactive sexual desire in women remain unclear. A deeper understanding of the interplay between biological and environmental factors and the identification of the specific components contributing to sexual desire may provide important targets for intervention and prevention in the field of sexual health. Based on prior research suggesting a relationship between 1) sociosexual orientation and sexual desire and 2) free testosterone levels and sexual desire, we hypothesized that levels of free testosterone in the body and androgen-related genes would influence the association between sociosexual orientation and sexual desire in women. Methods: The Sociosexual Orentation Instrument and the Sexual Desire Inventory were used to assess sociosexual orientation and sexual desire in a population-based sample of female adult Finnish twins and their sisters (N = 1413). Self-administered saliva samples were obtained from participants to facilitate genotyping and testosterone level analyses. Based on previous studies, we decided to include three androgen-related polymorphisms in the statistical analyses: the androgen receptor CAG repeat polymorphism, as well as two single nucleotide polymorphisms linked to the SRD5A2 gene, which is involved in the conversion of testosterone into the more potent dihydrotestosterone. Results: Preliminary screenings indicate that free testosterone and androgen-related genetic polymorphisms moderate different aspects of sociosexuality. Levels of free testosterone were found to moderate the association between sociosexual attitudes and sexual desire, whereas all three androgen-related genetic polymorphisms were found to moderate the association between sociosexual behavior and sexual desire at nominal levels of statistical significance. Conclusion: Our results suggest that endocrine and genetic factors affect female sexual behavior, attitudes and functioning. Policy of full disclosure: None.

J Sex Med 2012;9(suppl 5):303–335

326 PS-08-004

NEUROGENIC PERINEAL AND PELVIC PAIN? AN EMG STUDY Vodusek, D.1 University Medical Center, Neurology, Ljubljana, Slovenia

1

Objective: It is difficult to exclude a localised neuropathy in patients with pelvic and perineal pain (PPP). It was our aim to examine the contribution of anal sphincter EMG and bulbocavernosus reflex testing to clarification of PPP. Methods: Data from all nondiabetic patients examined in our laboratory from January 3, 2000 to July 31, 2012, referred as R 10.2 (ICD 10: “pelvic and perineal pain”), were analysed. Results: 39 patients (21 females) have been included, aged 36 to 77 years (Mean/SD: 57/3 years; females 55/12; males 58/14). There were 2 nulliparas, 1 caesarean section, 18 vaginal deliveries; one patient related her PPP to episiotomy. Pain was localized to perineum (21/39 patients, in 3/21 unilaterally); in 2/21 pain appeared during sitting. The remaining patients reported pain: in anorectum (9/39;1/9 unilaterally), in urethra (2/39), in testes (4/17;1/4 unilaterally), in penis (2/17), in vagina (1/21). 6/39 patients had previous pelvic surgery. 3/39 patients (all females) had a localised perineal sensory deficit. Concentric needle EMG of anal sphincter was performed in 38/39 patients, neurophysiological evaluation of the bulbocavernosus reflex in 37/39 patients. Sphincter EMG results were abnormal in 4/38 patients (3 females and one male) and bulbocavernosus reflex testing results were abnormal in 2/37 patients (1 female and 1 male–both in patients with abnormal EMG). Abnormalities were unilateral and correlated with the sensory deficit. In further 6/21 female patients borderline changes were reported on sphincter EMG. In summary out of 39 patients with suspected neuropathic PPP, three had sensory loss and four had clear neurophysiological abnormalities; three (all females) had concordant signs and deficits and a plausible cause for a pudendal nerve lesion. Conclusion: Anal sphincter EMG and bulbocavernosus reflex testing may help in assessing suspected peripheral neurogenic lesions in the uroanogenital region in patients with PPP. Policy of full disclosure: None.

PS-08-005

ANDROGENS AND SEXUAL DESIRE: ARE ANDROGEN METABOLITES THE ANSWER TO MANY YEARS OF RESEARCH? Wåhlin, S.1; Kristensen, E.2; Lundqvist, M.3; Cohen, A. S.3; Hougaard, D. M.3; Læssøe, N. C.2; Pedersen, A. T.4; Giraldi, A.2 1 Sexological Clinic, Psychiatric Center Copenhagen, København, Denmark; 2 Sexological Clinic, København, Denmark; 3Statens Serum Institut, København, Denmark; 4Department of Gynecology, København, Denmark Objective: To investigate the relationship between androgen levels and women’s sexual desire. Methods: A cross-sectional community study of 560 healthy women aged 18–65 years, who completed a questionnaire including Female Sexual Function Index (FSFI) and Female Sexual Distress Scale (FSDS). Blood samples were collected at a standardized time during the menstrual cycle and analyzed using mass spectrometry for the levels of the androgen metabolite (ADT-G), testosterone, free testosterone and the precursor hormones androstenedione and dehydroepiandrosterone sulfate. Based on a suggested diagnostic cutpoint of the FSFI sexual desire domain the participants were divided into two groups: 205 women with low sexual desire (Low SD) and 355 women with normal sexual desire (Normal SD). A subgroup of the Low SD group was established: 123 women with low SD and sexual distress (Low SD+D) defined as a score larger than or equal to 15 on the FSDS. Linear regression was performed to age adjust the differences in androgen levels in the Low SD and Low SD+D groups compared to the Normal SD group. The results are significant at a 0.05 level. Results: No statistically significant difference in ADT-G between the Low SD or Low SD+D group and the Normal SD group was observed either before (p = 0.779 and p = 0.832) or after age adjust-

J Sex Med 2012;9(suppl 5):303–335

Podium Sessions ment (p = 0.774 and p = 0.517). The Low SD and Low SD+D group had significantly less of the precursor hormone androstenedione both before and after adjustment for age compared to the Normal SD group (p = 0.000 and p = 0.017). None of the other androgens showed significant differences between the low sexual desire groups and the normal sexual desire group. Conclusion: In a cross-sectional setting we found a statistically significant correlation between the precursor hormone androstenedione and sexual desire in women with or without concurrent distress. No statistically significant correlation between the androgen metabolite and sexual desire was found. Policy of full disclosure: None.

PS-08-006

BLADDER, ANORECTAL AND SEXUAL FUNCTION AFTER NERVE-SPARING RADICAL HYSTERECTOMY FOR THE TREATMENT OF CERVICAL CANCER; A LONGITUDINAL PROSPECTIVE COHORT STUDY Pieterse, Q.1; Kenter, G.2; de kroon, C.3; Creutzberg, C.3; Trimbos, B.3; ter Kuile, M.3 1 Den Haag, Netherlands; 2AMC, Amsterdam, Netherlands; 3LUMC, Leiden, Netherlands Objective: Introduction: Conventional radical hysterectomy with pelvic lymphadenectomy (RHL) for early stage cervical cancer is associated with significant bladder, anorectal and sexual dysfunction. Nerve-sparing modification of RHL (NS RHL) has been developed with the aim to reduce surgical treatment related morbidity. Postoperative radiation therapy (RT) is offered to patients with unfavourable prognostic features to improve local control. Aim: to assess selfreported morbidity of various types of treatment in cervical cancer patients. Methods: Methods: Self-reported symptoms were prospectively assessed before, 1 and 2 years after treatment by the Dutch Gynaecologic Leiden Questionnaire. Results: Main outcome measures and results: Included were 229 women (123 NS-RHL and 106 conventional RHL). Ninety-four (41%) received RT. Up to 2 years (response-rate 81%), women reported significantly more bowel, bladder and sexual symptoms compared to the pre-treatment situation. No significant difference was found between the conventional RHL and NS-RHL with the exception of the unexpected finding that a smaller percentage in the NS-RHL group (34% versus 68%) complained about numbness of the labia. RT had a negative impact on diarrhoea, urine incontinence, lymphedema and sexual symptoms (especially a narrow/short vagina). Conclusion: Conclusion: In the current longitudinal cohort study, treatment for early stage cervical cancer was associated with worse subjective bladder, anorectal and sexual functioning, irrespective of the surgical procedure used. Postoperative RT resulted in a significant deterioration of these functions. The results have to be interpreted with caution in view of the study design and method used in the sense that subjective assessment of particular functions not necessarily concurs with the objective, physical performance of these systems. Policy of full disclosure: None.

327

Podium Sessions PS-08-007

GLANS AUGMENTATION BY GRAFTING: SHAEER’S TECHNIQUE Zaki Shaeer, O.1 Cairo University, Andrology, Egypt

1

Objective: Augmentation of the glans penis may be indicated for cosmetic reasons, lack of glans tumescence following implantation of a penile prosthesis, or asymmetry following girth augmentation of the shaft. Many augmentation techniques have been offered to increase the length and girth of penile shaft, but not the glans penis, with the exception of Hyaluronic Acid gel injection that is known to decrease sensitivity of the glans and is restricted for cases with premature ejaculation. This work is the first report on glans augmentation by grafting. Methods: Ten males requesting augmentation of the glans were selected for the study after failing counseling, with normal erectile function and ejaculatory control. Two ventral incisions were cut along the ventral aspects of the coronal sulcus, one on either side of the frenulum. Lateral glans flaps were dissected on either sides. The urethra was circumvented, creating a plane all around it. A dermal fat graft was inserted into the space created. The flaps were closed by simple absorbable sutures. Results: Maximum circumference of the glans increased by 16.6% declining to 14.2% by the last follow up visit (10–12 months), a 2.3% decline. Self-reported impression of the augmented volume was high, and well maintained over the follow up period. Glans sensation, engorgement, erectile function and ejaculatory control were preserved. Conclusion: This pilot study on glans augmentation by grafting reports promising results with retention of the added volume at one year follow up, preservation sensitivity and engorgement, and no adverse effects on erectile function or ejaculatory control. Policy of full disclosure: None.

PS-08-008

THE EFFECT OF GEPIRONE-ER, FLUOXETINE, AND PAROXETINE (SSRIS) COMPARED TO PLACEBO ON SEXUAL FUNCTION IN SUBJECTS WITH AND WITHOUT SEXUAL DYSFUNCTION PRIOR TO TREATMENT AS MEASURED BY THE DEROGATIS INVENTORY OF SEXUAL FUNCTION (DISF) Fabre, L.1; Smith, L. C.1; DeRogatis, L. R.2 Fabre Kramer Pharmaceuticals, Houston, USA; 2Maryland Center Sexual Health, Lutherville, MD, USA 1

Objective: Introduction: Many treatments of major depression cause sexual dysfunction. Are new medications the same or different? Data from rating scale mean data are suspect because sexual dysfunction in untreated major depression is as high as 70–80%. Therefore, the baseline population should be divided into those with sexual dysfunction and those without prior to analysis. The gepirone-ER effect on total depressed population DISF mean baseline scores reveals an increase in sexual function, where the SSRI effect was generally negative. Aim: To study the effect of gepirone-ER and SSRIs on sexual function in populations of depressed subjects that have sexual dysfunction at baseline and those who do not. Methods: Methods: In four 8 week placebo controlled studies of gepirone-ER, two with SSRI comparators, the DISF was measured at baseline and endpoint. The DISF has 5 domains: cognition (desire), arousal, behavior, drive, and orgasm. Subjects were divided into those without and those with baseline sexual dysfunction (identified as those one standard deviation below normal). Gepirone-ER was given in escalating doses from 20–80 mg/day, fluoxetine 20–40 mg/day, and paroxetine 20–60 mg/day. Results: Results: For women, men and the combined population, the results are similar for those with and without baseline sexual dysfunc-

tion. For gepirone-ER, positive results were found for total score, desire, behavior, and drive. The magnitude and significance of the results were greater in the group with baseline sexual dysfunction. Numerically, the gepirone-ER treated group had increased scores on all domains compared to placebo. For fluoxetine and paroxetine, total score, drive and orgasm were statistically worse than placebo. Conclusion: Conclusions: Gepirone-ER treatment of depression in subjects with no baseline sexual dysfunction has a positive effect on sexual function, while fluoxetine and paroxetine have a negative effect. The results are not different from the all patients treated population. Policy of full disclosure: Dr. Fabre is a full time employee of and shareholder in Fabre Kramer Pharmaceuticals. Drs. Smith and DeRogatis are paid consultants to Fabre Kramer Pharmaceuticals.

PS-08-009

NON-PHARMACOLOGIC WEIGHT LOSS IMPROVES SEXUAL AND ENDOTHELIAL FUNCTION IN SEVERELY OBESE WOMEN Francomano, D.1; Bruzziches, R.1; Greco, E. A.1; Lenzi, A.1; Donini, L. M.1; Aversa, A.2 1 Sapienza University of Rome, Italy; 2Sapienza University of Rome, Dept. of Medical, Italy Objective: Introduction: It is not clear whether obesity represents a risk factor for female sexual dysfunction (FSD). Aim of this study was to investigate the effects of weight loss on FSD complaints and endothelial function in young severe obese females. Methods: Material and methods: 44 fertile women (18–40 years) with sexual complaints at Female Sexual Function Index-6 ≤ 19 (FSFI-6 score) were enrolled into an 8-weeks intensive residential program with hypocaloric diet plus controlled physical exercise at specialized clinic (Group A, N = 23), or into a simple non-intensive outpatient clinic program consisting of hypocaloric diet and physical exercise (Group B, N = 21). An 8-weeks follow-up period consisting of outpatient clinic controlled diet plus physical exercise was carried out. Primary endpoints were modifications of FSFI-6 scores and endothelial function as measured by reactive hyperaemia (RHI) with EndoPat2000. Secondary endpoints were modifications in body composition as measured by DEXA. Results: Results: After 16-weeks, FSFI-6 score and the frequency of sexual activity were significantly higher in Group A compared to Group B (p < 0.01) and significant improvement in arousal, lubrication and satisfaction sub-domain scores were also found (p < 0.01). Group A but not group B, showed improvements in RHI (p < 0.01). Finally, group A showed marked improvement in HOMA-IR (p < 0.001) and anthropometric parameters as weight (p < 0.01), BMI (p < 0.01), fat mass (p < 0.0001), percentage of fat mass (p < 0.005) and fat-free mass (p < 0.01). Conclusion: Conclusion: A multidisciplinary non-pharmacologic approach to female obesity appears to be superior to conventional outpatient clinic treatment and produces permanent improvements both in cardio-metabolic parameters and in several aspects of sexual dysfunction. Policy of full disclosure: None.

PS-08-010

EROTICAL IMAGES OF LUST IN WESTEUROPEAN ROMANESQUE CHURCHES OF THE 11TH CENTURY Mattelaer, J.1 History Office EAU, Kortrijk, Belgium

1

Objective: In many medieval Romanesque churches we are confronted with very expressive erotical sculptures. The aim of our study was to collect an overview of thes unusual sculptures and to give an explanation of their presence in a religious place. Methods: We visited more than 60 medieval Romanesque churches in Spain, France and England and reviewed and photographed large

J Sex Med 2012;9(suppl 5):303–335

328 series of erotical sculptures on capitals, corbels and bosses of Romanesque churches in Westen Europe. Results: Most Romanesque sculpture is pictural and Biblical in subject. But around the upper wall of many chancels of churches are figures depicting lust, intemperance and other sins. The purpose of these obscene sculptural shemes was to convey a message to the people, that could not read, that the Christian believer should recognise sexual wrongdoing, repent and be redeemed. The last judment with all kind of horrible tortures by devils reminds the believer to repent. Common motifs include Sheela na Gig, women with exposed genitals, big phallusses, circumcised Jews and Muslims etc. The Seven Deadly Sins, including lust, gluttony and avarice are most frequently represented. The appearance of many figures with oversizes genitals can be equated with carnal sin. pulling one’s beard was a sign of masturnation and pulling one’s mouth wide open a sign of lewdity. Conclusion: The erotical and obscene sculptures in Romanesque churches of the 11 th century must be seen as a daily warning against the deadly sins of lust and lewdity. Policy of full disclosure: None.

Podium Sessions Saturday, 8 December 2012 10.00–10.30 G102/103 PS-09 Men’s sexual health: Surgery II Chairs: C. Rojas Cruz, Spain K. Rokkas, Greece PS-09-001

SEXUAL SATISFACTION AFTER PENILE PROSTAHESIS IMPLANTATION: PENOSCROTAL VERSUS INFRAPUBIC APPROACH Onem, K.1; Asci, R.1; Beyaz, C.1; Yalman, C.1; Serdas, T.1; Sirtbas, A.1; Ozen, M.1 1 Ondokuz Mayis University, Medi, Urology, Samsun, Turkey Objective: Surgical approaches for penile prosthesis implantation include the infrapubic and penoscrotal. One of the disadvantages of the infrapubic approach was possibly damage on the dorsal neural bundle of penis that causing sensory loss. We aimed to evaluate sexual and overall satisfaction after inflatable penile prosthesis implantation in term of penoscrotal and infrapubic approaches. Methods: 140 patients with penile prosthesis implantation were reviewed retrospectively. IIEF erectile function, satisfaction and total IIEF scores were compared within infrapubic (group I) and penoscrotal (group II) approaches with independent sample test. ANOVA was used additionally comparisons. Results: The mean age were 56.61 ± 10.7 and 55.3 ± 13.9 in group I and group II respectively (p = 0.6). All corporotomy were done with surgical blade due to avoid thermal damage of dorsal neurovascular bundle complex. Total IIEF, IIEF-Erectile Function (EF) domain and IIEF satisfaction domain in preoperative and postoperative period were given in table I. There was no statistically significant between groups in term of total IIEF, IIEF-EF and sexual satisfaction (Figure I). In additionally ANOVA analysis demonstrated that three pieces prosthesis was most satisfied independently surgical approach (p = 0.01).No patients were reported lack of penile sensation. In term of infection, one patients has prosthesis infection (p = 0.9). Conclusion: Infrapubic approach was more favors to allow the reservoir implanted direct vision. In this study we demonstrated that infrapubic approach have similar result in term of IIEF domain scores. Surgeons who want to reservoir implanted to direct vision can choice infrapubic approach without avoid to damage on dorsal nerve bundle. Policy of full disclosure: None.

PS-09-002

TOTAL PHALLIC CONSTRUCTION IN PATIENTS WITH THE EXSTROPHYEPISPADIAS COMPLEX Garaffa, G.1; Spilotros, M.2; Raheem, A. A.3; Christopher, N. A.3; Ralph, D. J.3 1 The Institute of Urology, St Peter’s Andrology, London, United Kingdom; 2 University College Hospital, Urology, London, United Kingdom; 3University College Hospital, London, United Kingdom Objective: Our 8-year experience of total phallic construction with the radial-artery-free-flap (RAFF) in patients with exstrophy// epispadias complex (EEC) is reported.

J Sex Med 2012;9(suppl 5):303–335

329

Podium Sessions Methods: Patients had already undergone a median of 12 surgical procedures (range 9–42) for the correction of EEC at the time of the phalloplasty and 7 had a closed bladder neck and were voiding through a Mitrofanoff. The technique, carried out in three separate stages, was similar to the one used for patients following penectomy. However, an adequate epigastric artery was missing in 8 patients and therefore the radial artery was anastomosed to the superfial femoral artery with the interposition of a saphenous graft. The previously reconstructed penile urethra was primarily anastomosed to the phallic one in all patients to allow ejaculation from the phallic tip. Results: After an average follow-up of 20,5 months (range: 2–38), 8 patients have completed the 3 stages of the process with the implanation of an inflatable penile prosthesis. Acute arterial thrombosis at the level of the saphenous graft had occurred in one patient (6%). Although immediate exploration of the anastomosis and thrombolisis allowed to save the phallus, delayed necrosis of its distal third occurred, and therefore the patient required delayed salvage phalloplasty with an anterolateral thigh flap. Fistulas occurred in 5 patients (31%), typically at the junction between the penile and phallic urethra, and were all repaired during stage 2. Of the patients who have already undergone penile prosthesis implantation, 2 have required revision surgery due to mechanical failure of the device (24%) and 3 are engaging in penetrative sex (37%). Conclusion: Athough commplication rates are higher than in patients who underwent penile amputation because a competent epigastric artery is frequently missing and the proximal reconstructed urethra has a poor blood supply, RAFF phalloplasty still represents the solution of choice in patients with EEC. Policy of full disclosure: None.

PS-09-003

TOTAL CORPORAL RECONSTRUCTION AND PENILE PROSTHESIS IMPLANTATION IN PATIENTS WITH SEVERE FIBROSIS AND ERECTILE DYSFUNCTION Sansalone, S.1; Garaffa, G.2; Leonardi, R.3; Vespasiani, G.4; Ieria, F. P.1; Loreto, C.5; Ralph, D.6 1 University Tor Vergata, Rome, Italy; 2The Institute of Urology, St Peter’s Andrology, London, United Kingdom; 3GECAS, Catania, Italy; 4 University Tor Vergata, Rome, Italy; 5Dpt of Bio-Medical Sciences, Catania, Italy; 6St. Peter’s Hospitals and The Institute of Urology, London, United Kingdom Objective: The aim of this study is to report our experience of simultaneous corporal reconstruction and penile prosthesis implantation in patients with severe penile contracture consequence of diffuse fibrosis. Methods: From March 2006 through February 2010, 18 patients with severe penile contracture due to diffuse corporal fibrosis underwent simultaneous corporal reconstruction and implantation of a penile prosthesis. Clinical outcome and any postoperative complications were recorded at 6 months and every year thereafter. Patient satisfaction was assessed at 6 months using the modified Erectile Dysfunction Index of Treatment Satisfaction questionnaire. Results: Despite the difficulty in dilating the corpora, all patients received a prosthesis, a 3-piece inflatable device in 14 cases and a malleable device in the other four. After an average follow-up of 26 months (range 6–36), elective revision surgery was performed in 4 patients (conversion to a 3-piece inflatable device in 3 cases and upsizing in one). Although all patients achieved penetrative sexual intercourse, four were partially dissatisfied because of significant penile shortening. Conclusion: In expert hands, simultaneous prosthesis implantation and reconstruction of severely scarred corpora provides satisfactory results. Patients must be aware that severe fibrosis entails significantly higher complication rates and that contracture of the tunica albuginea may require implantation of downsized cylinders. Policy of full disclosure: None.

PS-09-004

THE ROLE OF IMAGING IN SUSPECTED PENILE FRACTURE Shah, P.1; Shabbir, M.1; Ralph, D.1 University College London Hosp, Urology, United Kingdom

1

Objective: Although penile fracture is primarily diagnosed clinically, imaging can help confirm the nature and location of injury, and allow alternative surgical approaches. We evaluated the usefulness and accuracy of imaging in cases of suspected penile fracture. Methods: From 2005–2012, 35 patients presented with suspected penile fracture (mean age 40.3 yrs(range 21–72 yrs). Mechanisms of injury were intercourse (91.44%), masturbation (2.85%), and turning in bed (5.71%). 28/35 (80%) had imaging (US Doppler 78.5%, MRI 21.5%). 28/35 (80%) had surgical exploration. The surgical approach was guided by imaging, where available, and included transverse penoscrotal (53.5%), midline ventral over the marked defect (25%), circumferential de-gloving (17.9%), and perineal (3.6%) incisions. Results: 28 patients (80%) had penile fracture, of which 24 (86%) were unilateral tunical injuries, and 4 (14%) were bilateral tunical tears. 6 patients (17%) had no fracture, and 1 (3%) absconded before investigation/treatment. Imaging correctly identified the site of penile fracture in 80% and excluded fracture in 10% (diagnostic accuracy 90%). Imaging guided the surgical approach in 89% (de-gloving approach 12% imaged vs. 50% non imaged, penoscrotal 53% imaged vs. 17% non-imaged). Urethral injuries occurred in 8 cases (28.5%). 5/8 were complete transections, seen most commonly with bilateral tunical tears. Imaging correctly identified only 67% of complete transections, and none of the partial urethral injuries. Conclusion: Pre-operative imaging has a high degree of accuracy for confirming the nature and location of injury in suspected penile fracture, allowing alternative approaches to de-gloving incisions. It is less accurate at detecting urethral injury, although presence of bilateral tunical tears should significantly raise the suspicion of such an injury. Policy of full disclosure: None.

PS-09-005

WHICH ONE IS GUILTY IN SELF-INDUCED PENILE FRACTURES: MARITAL STATUS, CULTURE OR GEOGRAPHIC REGION? A CASE SERIES AND LITERATURE REVIEW Alzubaidi, R.1 1 Hamad Medical Corporation, Urology, Doha, Qatar Objective: To determine whether marital status, culture other than geographic region is involved in the etiology of penile fracture in our country. Methods: The charts of 122 men diagnosed with penile fracture from January 2005 to January 2012 at our andrology unit were retrospectively reviewed. pre-intra and post op. and compairing our data with other simillar reported data. Results: The most common cause of penile fracture in our study was manually bending the erected penis in 66 out of 122 (54.1 %) patients. Most of the cases (62.3 %) were working temporarily in a foreign country. The real-time marital status was actually single in 89 (68 single and 21 married but live separate) out of admitted 122 cases. Erectile functions of the 94 (95.9 %) cases that were performed immediate repair (98 cases out of 109) were normal after 3 months according to self-reported single-question. Immediate and delayed surgical repair (>24 hours) was performed in 98 and 11 patients, respectively. Patients who were performed delayed repair had reported erectile dysfunction in two cases (18.2 %) out of eleven. Potential limitation of our study is directly related to its retrospective nature.

J Sex Med 2012;9(suppl 5):303–335

330 Conclusion: Our study supported immediate surgical intervention and showed good functional results with low morbidity. Although we revealed that manually bending the erected penis was the most common cause in our series, review of 1619 patients’ etiology reported in the last decade demonstrated that vigorous sexual intercourse was the most common cause mainly in the Middle East region. We believe that the prime causes of bending penis were being single and culture that were influencing factors irrespective of the geographic distribution. Policy of full disclosure: None.

Podium Sessions Saturday, 8 December 2012 10.30–11.00 Room G102/103 PS-10 Ejaculatory and orgasmic disorders Chairs: Z. Kopa, Hungary F. Giuliano, France PS-10-001

CLINICAL CORRELATES OF ERECTILE DYSFUNCTION AND PREMATURE EJACULATION IN MEN WITH COUPLE INFERTILITY Lotti, F.1; Corona, G.2; Rastrelli, G.2; Forti, G.2; Jannini, E. A.3; Maggi, M.2 University of Florence, Clinical Physiopathology, Italy; 2University of Florence, Italy; 3University of L’Aquila, Italy

1

Objective: To assess the prevalence of erectile dysfunction (ED) and premature ejaculation (PE) and their clinical correlates in men with couple infertility. Methods: A consecutive series of 244 men (mean age 35.2 ± 7.8) with couple infertility was systematically evaluated. Erectile function was investigated with the International Index of Erectile Function-15 erectile function domain (IIEF-15-EFD), whereas ejaculatory status with the Premature Ejaculation Diagnostic Tool (PEDT). An IIEF-15EFD < 26 indicated ED. A PEDT score ≤ 8 indicates no-PE. All patients underwent psychological (Middlesex Hospital Questionnaire, MHQ), prostatitis symptoms (National Institutes of Health-Chronic Prostatitis Symptom Index, NIH-CPSI), hormonal, seminal and interleukin 8 (sIL-8; a surrogate marker of prostatitis) evaluation, along with scrotal and transrectal colour-Doppler ultrasound (CDU) assessment. Results: ED was found in 43 (17.8%) and PE in 38 (15.6%) subjects. After adjusting for age, IIEF-15-EFD score was negatively associated with depressive symptoms (MHQ-D score), somatization (MHQ-S score), NIH-CPSI total and Quality of Life (QoL) subdomain score. In a logistic multivariate model, among all these variables, only depression was significantly associated with ED (adjusted OR = 1.19 [1.02– 1.39]; p < 0.05). PEDT score was positively associated with prostatitis symptoms and signs, such as sIL-8 and prostate CDU abnormalities (including arterial prostatic peak systolic velocity, APPSV), phobic anxiety (MHQ-P score) and calculated free testosterone (cFT). The association between PE and NIH-CPSI score or APPSV was confirmed even after adjustment for age, MHQ-P score and cFT (adjusted OR = 1.11 [1.05–1.17]; p < 0.0001 and 1.22 [1.03–1.44]; p = 0.02, for NIH-CPSI score and APPSV, respectively). Conclusion: ED and PE are reported by one out of six infertile patients. ED is mainly associated with depressive symptoms, while PEDT score is positively associated with prostatitis symptoms and signs, phobic anxiety and cFT. Policy of full disclosure: None.

PS-10-002

VARDENAFIL AMELIORATES INTRAVAGINAL EJACULATORY LATENCY TIME BY MODULATING SYMPATHETIC TONE IN MEN WITH LIFELONG PREMATURE EJACULATION: A PILOT STUDY Aversa, A.1; Francomano, D.2; Bruzziches, R.2; Lenzi, A.2 Sapienza University of Rome, Dept. of Medical, Italy; 2Sapienza University of Rome, Italy 1

Objective: Vardenafil prn is a promising treatment in lifelong (LL) premature ejaculation (PE) but studies providing a possible explanation of its action on intravaginal ejaculatory latency time (IELT) are lacking. We evaluated the adrenergic system changes in men with LL-PE after vardenafil administration. Methods: 20 men (18–40 years age) with a score of the Premature Ejaculation diagnostic tool ≥11 were enrolled in a 12-week, double-

J Sex Med 2012;9(suppl 5):303–335

331

Podium Sessions blind, placebo-controlled study with vardenafil 10 mg fixed dose prn. Also, the presence of anxiety was assessed in all patients by the administration of rapid tests (Stai-X1 for state-anxiety and Stai-X2 for traitanxiety). 10 age-matched subjects without sexual disturbances served as a control group. We investigated modifications induced by vardenafil within the first 60-second interval during reactive hyperemia induced by 5-minute forearm cuff occlusion by using a fingertip peripheral arterial tonometry (PAT) and improvements in IELT as measured by the stop-watch technique and in anxiety levels. Results: PAT ratios were lower in men with LL-PE compared with controls (90% vs. 145%, P < 0.01); accordingly, both Stai-X1 and StaiX2 scores were significantly higher in LL-PE (p < 0.05) compared with controls. Vardenafil treatment markedly improved PAT ratio in men with LL-PE when compared with placebo (180% vs. 95%, p < 0.01) but was ineffective in controls. Mean changes in geometric IELT (0.6 ± 0.3 vs. 4.5 ± 1.1 min) were higher after taking vardenafil (p < 0.01), compared with placebo. Stai-X1 and Stai-X2 scores fell to within the normal range after treatment with vardenafil (p < 0.01) but not placebo. Conclusion: Vardenafil is an effective treatment in men with LL-PE; improvements of IELT may be due to increased NO production which is able to reduce adrenergic over-activity. Policy of full disclosure: None.

PS-10-003

EFFECT OF BOTULINIUM-A TOXIN INJECTION INTO BULBOSPONGIOSUS MUSCLE ON EJACULATORY LATENCY TIME IN MALE RATS Serefoglu, E. C.1; Hawley, W.2; Lasker, G.2; Grissom, E.2; Sikka, S.2; Dohanich, G.2; Hellstrom, W.2 1 Ankara, Turkey; 2Tulane University, New Orleans, USA Objective: Bulbospongiosus muscle (BSM) is involved in ejaculation and local administration of the Botulinium-A Toxin (Btx-A) has been shown to impact muscle contractions. The current study was conducted to examine the effect of Btx-A injection into the BSM on the ejaculatation latency of male rats. Methods: After confirming sexual behavior in 33 male Long-Evans rats with sexually receptive females, those that exhibited the entire repertoire of sexual behaviors received an additional 4 sexual experiences over the course of the following week in which all sexual behaviors were recorded by trained observers. On the day after their last experience, rats were lightly anesthetized, and received an injection of either 0.5 (n = 11), or 1 unit (n = 11) of Btx-A, or saline vehicle (n = 11). Btx-A was delivered bilaterally in 0.1 ml of saline vehicle injected percutaneously into the BSM. Two days after treatment, sexual behaviors were re-examined over the course of the following week on 4 separate occasions. The latency to ejaculation was recorded by trained observers blind to the conditions. Results: Relative to pre-treatment ejaculation latencies, bilateral injection of saline into the BSM did not impact ejaculation latencies (402.3 ± 220.1 sec vs. 453.8 ± 275.2 sec, p = 0.53); however, rats treated with either 0.5 or 1 unit Btx-A exhibited significantly longer latencies to achieve ejaculation relative to pre-treatment performance (357.9 ± 237.3 sec vs. 590.2 ± 306 sec, P = 0.04 and 302.8 ± 171.0 sec vs. 668.0 ± 376.8 sec, P = 0.013, respectively). Btx-A did not impact the ability to achieve mount or intromission. Conclusion: These results demonstrate that Btx-A injection into the BSM is a safe and effective treatment which can lengthen the latency time to ejaculate in rats without suppressing sexual behavior. Further studies are required to evaluate the therapeutic concept of this drug in PE patients. Policy of full disclosure: None.

PS-10-004

INTERNET SURVEY OF MEN’S HELPSEEKING BEHAVIOUR FOR SEXUAL PROBLEMS Akpinar, E.1; Uysal, Y.2 Cukurova University, Family Medicine, Adana, Turkey; 2Turkish Health Ministry, Diyarbakir, Turkey 1

Objective: Although medical advances motivated more patients with sexual concerns to consult their physicians, so little is currently known about how gender, psychosocial states and cultural factors might influence help-seeking patterns for sexual problems among men. Our study investigates male sexual problems, as reported by men in order to seek information, advice and counselling. Methods: The data were gathered through self-completed web-based survey of sociodemographic and sexual problem questionnaire. Helpseeking behaviour of the six specific sexual problems was ascertained by asking the respondents to indicate ways in which they had sought any help for the sexual problems they had experienced. Results: 139 participants (30–80 years) took part in the study. 61% of participants reported experiencing at least one sexual problem. Premature ejaculation (58%) was the most common problem and difficulty in achieving/maintaining erection (26%) the second one. A large percentage of participants (81.7%) had sought no professional help or advice for their sexual problems. Only 13.2% of participants had made an attempt to seek medical help and 74.3% of them had used drugs for their problem(s). The most frequent action taken by participants (41.2%) was looking for information in books/magazines or via a telephone helpline or the internet. 11.9% of participants “talk to partner” and 18.6% talked to a friend or family member about their sexual problems. The frequency of seeking psychological help (psychiatrist, psychologist or marriage counselor) was low (3.2%). ‘Talk to a clergy person or religious adviser’ was the least common action taken by men (0.9%). Conclusion: Participants for not referring themselves to a doctor may reflect their convictions of sexual problems are not medical problems and may have considerable anxiety and frustration about treatment. On the contrary, they may think to be an inevitable part of getting older and therefore, there is not much a doctor could do about them. Policy of full disclosure: None.

J Sex Med 2012;9(suppl 5):303–335

332 PS-10-005

AN ANALYSIS OF THE RELIABILITY AND VALIDITY OF THREE DIAGNOSTIC INSTRUMENTS FOR EARLY EJACULATION: RESULTS FROM CLINICAL AND POPULATION-BASED SAMPLES Jern, P.1; Piha, J.2; Gunst, A.3; Santtila, P.3 Abo Akademi University, Dept. of Psychology, Turku, Finland; 2Medical Center Mehiläinen, Turku, Finland; 3Abo Akademi University, Turku, Finland

1

Objective: Both the scientific literature and clinical diagnostic practice regarding early ejaculation (EE) has been suffering from inconsistencies in definitions and diagnostic criteria. Unlike the case of erectile dysfunction, no diagnostic instrument for EE has been universally accepted by clinicians or scholars. In the present study, we evaluate the reliability and diagnostic precision of three questionnaires intended to measure EE, and discuss the implications of these results in light of the recent debate regarding definitions and diagnostic criteria for EE. Methods: A data collection involving a clinical sample of at least 130 male patients with clinician-diagnosed EE, as well as a populationbased sample of approximately 1,000 men is currently ongoing. Participants in both groups responded to three questionnaires: the Index of Premature Ejaculation (IPE); the Premature Ejaculation Profile (PEP), and the Multiple Indicators of Premature Ejaculation (MIPE), as well as a number of questionnaires measuring relevant covariates (e.g. erectile function, sexual distress). Stop-watch measured ejaculatory latency during partnered sexual activity is being collected from a subsample. The population-based data collection will allow for investigating some longitudinal aspects of ejaculatory function, as participants in the population-based group have responded to the MIPE questionnaire six years prior to the current data collection. Results: Preliminary screenings suggest good to excellent internal consistency for all three diagnostic instruments, but the IPE and PEP lack a specific inquiry about ejaculatory latency, which has been suggested as an important diagnostic factor by the International Society of Sexual Medicine. Conclusion: This is, to the best of our knowledge, the first study to rigorously cross-validate different diagnostic instruments for EE in both clinical and large population-based samples. Policy of full disclosure: None.

Podium Sessions Saturday, 8 December 2012 13.00–13.30 Emerald Room PS-11 Hormosexuality and gender disorders Chairs: J. Dean, United Kingdom A. Shindel PS-11-001

PSYCHOPATHOLOGICAL SIMILARITIES AND DIFFERENCES BETWEEN GENDER IDENTITY DISORDER AND EATING DISORDERS SUBJECTS: THE ROLE OF THE BODY Bandini, E.1; Fisher, A. D.2; Fisher, A. D.2; Castellini, G.3; Casale, H.1; Lo Sauro, C.3; Lelli, L.3; Ferruccio, N.1; Meriggiola, M. C.4; Dettore, D.5; Maggi, M.6; Ricca, V.3 1 Sexual Medicine and Andrology, Florence, Italy; 2Sexual Medicine and Andrology, Clinical Physiopathology, Florence, Italy; 3Psychiatry Unit, Florence, Italy; 4Department of Obstetrics and Gynaecology, Bologna, Italy; 5 Psychology University of Florence, Florence, Italy; 6University of Florence, Department of Clinical, Italy Objective: Subjects with Gender Identity Disorder (GID) have been reported to be highly dissatisfied with their body, and it has been suggested that the body is their primary source of suffering. The aim of this study is to evaluate quality and intensity of body dissatisfaction in GID subjects, comparing them with a sample of Eating Disorders patients and a control group. To detect similarities and differences between subgroups of GID subjects, on the basis of genotypic sex and transitional stage. Methods: Fifty Male-to-Female (MtF) GID (25 without and 25 with genital reassignment surgery), 50 Female-to-Male (FtM) GID (28 without and 22 with genital reassignment surgery performed), 88 Eating Disorders subjects (26 Anorexia Nervosa, 26 Bulimia Nervosa, and 36 Binge Eating Disorder), and 107 healthy subjects were evaluated. Subjects were studied by means of the Structured Clinical Interview for DSM-IV, the Symptom Checklist (SCL-90), and the Body Uneasiness Test (BUT). Results: GID and controls subjects reported lower psychiatric comorbidity rate and lower SCL-90 GSI scores than Eating Disorders subjects. GID MtF without genital reassignment surgery showed the highest BUT values, while GID FtM without genital reassignment surgery and Eating Disorders subjects showed higher values compared with both GID MtF and FtM who underwent genital reassignment surgery and controls. Considering BUT subscales, a different pattern of body dissatisfaction was observed in GID and Eating Disorders subjects. GID MtF and FtM without genital reassignment surgery showed the highest BUT GSI/SCL-90 GSI ratio compared with all the Eating Disorders groups. Conclusion: GID and Eating Disorders are characterized by a severe body dissatisfaction, which represents the core of distress in both conditions. Different dimensions of body dissatisfaction seem to be involved in GID-subsamples, depending on reassignment stage and genotypic sex. In Eating Disorders subjects body dissatisfaction is primary linked to general psychopathology, whereas in GID such a relationship is lacking. Policy of full disclosure: None.

PS-11-002

THE IMPACT OF MINORITY STRESSORS ON THE MENTAL AND PHYSICAL HEALTH OF YOUNG GAYS, LESBIANS AND BISEXUALS Shilo, G.1; Mor, Z.2 1 Israel; 2Ministry of Health, Ramla Department of Health, Israel Objective: To compare the mental and physical health of young lesbian, gay and bisexuals (YLGBs) in Israel with that of heterosexual, and to identify minority stressors, coping resources, and demographic determinants predicting mental and physical health among YLGBs.

J Sex Med 2012;9(suppl 5):303–335

333

Podium Sessions Methods: Web convenient sampling targeting Jewish participants aged 12–30. Results: The questionnaire was completed by 952 participants (53.4%), of whom 72% YLGBs, and 28% were heterosexuals. YLGBs had lower levels of mental and physical health than heterosexuals. Among YLGBs, high levels of internalized homophobia and anti-gay harassment and low levels of coping resources predicted lower levels of mental health. Factors such as age older than 19, being LGB, high levels of outness, exposure to anti-gay harassments, and low levels of mental health predicted lower levels of physical health. Being a male, receiving greater support from friends, and stronger connectedness to the YLGB community was associated with sexual risk behaviors. Conclusion: YLGBs have poorer mental and physical health determinants than heterosexuals. Stressors, such as anti-gay harassment experiences, internalized homophobia and lack of social support providers should be recognized as risk factors for lower mental health, with a negative effect on physical health and promote sexual risk behaviors – and should be addressed by health educators. Coming out as a member of a sexual minority, while a protective factor for mental health, puts YLGBs at risk for physical and sexual risk behaviors. Policy of full disclosure: None.

PS-11-003

SOCIODEMOGRAPHIC AND CLINICAL FEATURES OF GENDER IDENTITY DISORDER: AN ITALIAN MULTICENTRIC EVALUATION Fisher, A. D.1; Bandini, E.2; Casale, H.2; Ferruccio, N.2; Meriggiola, M. C.3; Gualerzi, A.4; Manieri, C.4; Jannini, E.5; Mannucci, E.6; Ricca, V.7; Maggi, M.8 1 Sexual Medicine and Andrology, Clinical Physiopathology, Florence, Italy; 2 Sexual Medicine and Andrology, Florence, Italy; 3Center of Reproductive Health, Bologna, Italy; 4Endocrinological Disease, Turin, Italy; 5Course of Endocrinology, L’Aquila, Italy; 6Diabetes Section, Geriatric Unit, Florence, Italy; 7Psychiatry Unit, Florence, Italy; 8University of Florence, Department of Clinical, Italy Objective: Male to female (MtFs) and female to male (FtMs) subjects with Gender Identity Disorder (GID) seem to differ in regards to some socio-demographic and clinical features. Currently no descriptive studies focusing on MtFs and FtMs attending an Italian clinic are available. The aim of the present study was to describe the sociodemographic characteristics of a GID population seeking assistance for gender transition, and to assess possible differences in those features between MtFs and FtMs. Methods: A consecutive series of 198 patients was evaluated for gender dysphoria from July 2008 to May 2011 in 4 dedicated centers. A total of 140 subjects (mean age 32.6 ± 9.0 years old) meeting the criteria for GID, with their informed consent and without genital reassignment surgery having already been performed, were considered (92 MtFs and 48 FtMs). Diagnosis was based on formal psychiatric classi_cation criteria.Medical history and socio-demographic characteristics were investigated. Subjects were asked to complete the Body Uneasiness Test (BUT, a self-rating scale exploring different areas of body-related psychopathology), Symptom Checklist-90 Revised (SCL-90-R, a self-rating scale to measure psychological state), and the Bem Sex Role Inventory (BSRI, a self-rating scale to evaluate gender role). The presence of psychiatric comorbidities was evaluated using the Structured Clinical Interviews for DSM-IV (SCID I and SCID II). Results: Several significant differences were found between MtFs and FtMs regarding lifestyle and socio-demographic factors, and in psychometric test scores. No differences were found in terms of psychiatric comorbidity. Conclusion: This is the first large study reporting the sociodemographic characteristics of a GID sample referring to Italian clinics, and it provides different profiles for MtFs and FtMs. In particular, FtMs display significantly better social functioning. Policy of full disclosure: None.

PS-11-004

OLDER BROTHERS INFLUENCE THE FEMINIZED FINGER RATIO OF MALE TO FEMALE TRANSSEXUALS Mas, M.1; Alonso, C.1; Hernandez, P.1; Gutierrez, P.1 University of La Laguna, Physiology & CESEX, La Laguna, Tenerife, Spain

1

Objective: To test the hypothesis that the feminized finger ratio shown by Male to Female transsexuals (MtoF) might be related to the numbers of preceding siblings. Methods: Three groups of subjects were compared: Control Males (n = 109), MtoF attracted to men (73) and Control Females (104). The ratio of the index finger to the ring finger lengths (2D4D) were calculated for right and left hands. Besides, the subjects provided information about their siblings’ number and sex. The data were analyzed by parametric and non-parametric statistical methods as appropriate. Results: As expected the MtoF group had 2D4D ratios in both hands that were significantly intermediate between the Control Males (lowest) and Females (highest). No differences were found in the total number of siblings between the three groups, but the MtoF group had a higher number of older brothers. Only the MtoF group showed a significant positive correlation between both the number of older brothers and the Fraternal Index (n older brothers/n all brothers) with the 2D4D ratio of both hands (especially for the right hand). No correlations were found for the 2D4D ratios between the numbers of older sisters or total siblings in any group. Conclusion: This study reports a hitherto undocumented relationship between the number of older brothers and the feminized finger ratio usually found in MtoF subjects. To date an “older brother effect” has been described for male homosexuality, yet it seems unlikey that sexual orientation would explain the present findings since a rather “hypermasculinized” finger ratio has been reported in male homosexuals with older brothers (Williams et al, Nature 2000; 404:455). Policy of full disclosure: None.

PS-11-005

GENITAL REASSIGNEMENT SURGERY IN MALE TO FEMALE TRANSSEXUALS: A MODIFIED TECHNIQUE Pottek, T.1; Ovenbeck, R.2; Sadri, B.2; Furchert, S.2; Pape, D.2; Igelmann, H.2; Böhmer, T.2 1 Asklepios Westklinikum Hamburg, Urology, Germany; 2Asklepios Westklinikum Hamburg, Germany Objective: For a part of transsexual persons surgical procedures are important sometime in their life. Genital reassignement surgery has been published in the beginning of 20th century, whenever the first serious series had been published by Burou from Casablanca using inverted penile skin to create a neovagina. In our experience we had seen several stenosis of the introitus and the neovagina. We created a new combined technique to have a neovagina wide and deep. Methods: Genital skin is incised in the midline from frenulum over the raphe scrotalis into the perineum. The urethra is completely mobilized and opened at 12 h to the female urethral meatus location. Corporal bodies are dissected and removed exept a dorsal strip of tunica albuginea harbouring the neurovasscular bundle for the glans. Glans penis is transported to the place where the clitoris has to be. Labia minor are carved from inner prepuce, labia major from penile skin. Neovagina is carved using Ultracision-ACE between prostate and rectum. The roof of neovagina is the spatulated urethra, side walls and floor are penile and epilated scrotal skin. Results: 13 operations had been performed using the before mentioned method. 8 of them had a planned second operation to correct overdimensioned skin flaps as major labia and 3 had corrections of the neovaginal introitus. All are compliant with the result and have erotic experiences after the surgery. Conclusion: Using urethral pediculed flap for creating a neourethral roof is highly effective in sexual reassignment surgery in male-tofemale-transsexuals. Long term result have to be expected. Policy of full disclosure: None.

J Sex Med 2012;9(suppl 5):303–335

334 Saturday, 8 December 2012 13.30–14.00 Emerald Room PS-12 Men’s sexual health: Miscellaneous Chairs: J. Romero, Spain A. Shechter, Israel PS-12-001

CATIONIC SURFACTANTS: A POSSIBLE FUTURE FOR CONTRACEPTION? AN IN VITRO APPROACH Baptista, M.1; Tavares, R.1; Publicover, S.2; Ramalho-Santos, J.1 CNC, University of Coimbra, Portugal; 2School of Biosciences, Birmingham, United Kingdom

1

Objective: Population growth in developing countries is often accompanied by lack of health care and spreading of STDs. Recent setbacks for development of methods acting as women-controlled contraception devices stimulated efforts to identify cheap and efficient compounds. This work focuses on relevant effects of cationic surfactants on human sperm. Methods: Human normozoospermic sperm samples were exposed to the cationic surfactants Benzalkonium Bromide (C12Bzk) and Pyridinium Bromide (C12Pyr) at non-toxic concentrations. Viability (live/ dead assay), mitochondrial membrane potential (MMP; JC-1), acrosomal status (AR; PSA-FITC), protein tyrosine phosphorylation (PY; PY antibody) and sperm calcium movements (sperm-cell imaging with OG BAPTA-1) were assessed. Results: Viability was assessed in order to find LD10 and LD50 of the compounds chosen. C12Bzk decreased MMP at LD10 after 180’ (minutes) of incubation (p < 0.05), and at LD50 after 60’ and 180’ (p < 0.05). Furthermore, the percentage of PY was decreased at LD50, 180’ (p < 0.05), and no differences were found for spontaneous AR. C12Pyr led to a significant loss of MMP at LD10, after 180’ of incubation, and at LD50, after 60’ and 180’ (p < 0.05), as well as the inhibition of capacitation and the reduction of intact sperm acrosomes, at LD50 (60’ and 180’) (p < 0.05). Additionally, 20.2–45.1% and 60.3–81.7% of the spermatozoa exposed to C12Bzk and C12Pyr, respectively, increased their [Ca2+]i. The stronger effect of C12Pyr on the modulation of calcium signaling is consistent with its effect on the percentage of intact acrosomes. To note that these compounds are more toxic to sperm cells than to Caco-2 cells (mimic vaginal epithelia). Conclusion: Both cationic surfactants seem to impair sperm function at various levels, although C12Pyr was shown to be more effective. To our knowledge, this is the first study that addresses contraceptive compounds evaluating sperm calcium signaling. Policy of full disclosure: None.

PS-12-002

HIGH AORTIC/PENILE INDEX (API) IS A MARKER OF CORONARY ARTERY DISEASE IN ASYMPTOMATIC MIDDLE-AGED HYPERTENSIVE PATIENTS WITH ERECTILE DYSFUNCTION Vlachopoulos, C.1; Ioakeimidis, N.2; Rokkas, K.2; Aggelis, A.2; Terentes-Printzios, D.2; Aggelakas, A.2; Synodinos, A.2; Pietri, P.2; Askitis, T.2; Stefanadis, C.2 1 Athens Medical School, 1st Department of Cardiology, Greece; 2Athens Medical School, Greece Objective: It has been reported that there is a strict correlation between hypertension, erectile dysfunction (ED) and coronary artery disease (CAD), but the importance of a risk prediction tool that enables more accurate prediction of cardiovascular risk in asymptomatic hypertensive ED patients needs to be addressed. Methods: 155 consecutive asymptomatic non-diabetic treated hypertensive men (40–60 y/o) with ED were evaluated using exercise tread-

J Sex Med 2012;9(suppl 5):303–335

Podium Sessions mill test and stress echocardiography. Men with positive one or both of the two non-invasive tests were referred for coronary angiography in order to document CAD. All patients underwent penile Doppler ultrasonography and carotid–femoral pulse wave velocity (PWV) evaluation. Reduced penile peak systolic velocity (PSV) is associated impaired penile arterial function and increased atherosclerotic burden. Aortic/penile index (API) was developed to describe the severity of extracoronary vascular dysfunction with the formula: API = PWV/ PSV. Results: Coronary angiography revealed coronary stenotic lesions in 19 men with non-invasive evidence for ischemia (12%). The prevalence of Grade II/III hypertension was not different between CAD patients and subjects without CAD. CAD patients compared to subjects without CAD had higher PWV (9.3 vs 8.6 m/s, P < 0.01), lower PSV (23 vs 30 cm/s, P < 0.01) and a higher API (left figure). Right figure illustrates the diagnostic performance of API for CAD prediction. Further analysis revealed that the area under the curve (AUC) for API was significantly greater than the AUC for either parameter alone (all P < 0.05). Conclusion: API allows an accurate interpretation for the interrelationships between hypertension, ED and CAD and predicts CAD with high values of both sensitivity and specificity. Our findings allow identification of hypertensive men who might warrant more intensive follow-up. Policy of full disclosure: None.

PS-12-004

CHARACTERIZATION OF HYPOACTIVE SEXUAL DESIRE DISORDER (HSDD) IN MEN DeRogatis, L.1; Rosen, R.2; Goldstein, I.3; Werneburg, B.4; Kempthorne-Rawson, J.4; Sand, M.4 1 Sheppard Pratt, Baltimore, USA; 2NERI, Inc., Watertown, USA; 3 Alvarado Hospital, Univ. of Calofornia, California, USA; 4Boehringer Ingelheim, Ridgefield, USA Objective: Little is known about Hypoactive Sexual Desire Disorder (HSDD) in men. Patient-reported outcomes (PROs) were used to develop the first comprehensive characterization of men diagnosed with HSDD (Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision [DSM-IV-TR]). Methods: 200 men with or without symptoms of low sexual desire and related distress were recruited for this 4-week non-treatment study. Exclusions included erectile dysfunction, serum testosterone < 300 ng/ dL, depression. Men underwent structured interviews for the diagnosis of HSDD and completed the Sexual Desire Inventory (SDI), Male Desire Scale (MDS), Sexual Concerns Inventory-Male (SCI-M), and Sexual Desire Relationship Distress Scale (SDRDS) on day 28, as well as University of California, Los Angeles (UCLA) Psychosexual Diary on days 21–27. The PROs served as primary endpoints. Scores are presented as median. Results: Of the 200 men enrolled, 109 were diagnosed with HSDD. There were no clinically relevant differences in age, serum testosterone, depressive symptomatology, erectile function, concomitant illness, or medication use between the two groups. Clinically meaningful differences were observed in sexual desire according to the SDI score (40.0 [21.0] vs. 65.0 [25.0]) and the MDS sexual desire domain score (18.0 [8.0] vs. 31.0 [13.0]), in sex-related distress according to the SCI-M score (22.0 [12.0] vs. 6.0 [12.0]) and the SDRDS score (36.0

Podium Sessions [17.0] vs. 10.0 [16.0]), and in the UCLA Psychosexual Diary sexual activity domain score (2.6 [2.7] vs. 4.9 [3.9]) (P < 0.0001, for all). Conclusion: Men with and without HSDD as determined by a brief structured interview, diagnosis according to DSM-IV-TR criteria for HSDD, were comparable in age, serum testosterone, concomitant illness and medication use. Their experience of sexual desire and distress associated with low desire was different. These controlled data characterize HSDD in men as a distinct sexual dysfunction. Policy of full disclosure: SOURCE OF FUNDING: Boehringer Ingelheim Drs. Werneburg, Kempthorne-Rawson and Sand are employees of Boehringer Ingelheim.

PS-12-005

THE SEXUAL PATTERNS IN MEDICAL STUDENTS AND ITS PREDICTIVE FACTORS – A SINGLE INSTITUTION STUDY IN PORTUGAL Peixoto, C.1; Botelho, F.2; Tomada, I.2; Tomada, N.2 Universidade do Porto, Faculty of Medicine, Portugal; 2Universidade do Porto, Portugal

1

Objective: To assess the prevalence of risky behaviour, sexual behaviour and sexual dysfunctions in Portuguese medical students.

335 Methods: Students of the Faculty of Medicine of Universidade do Porto were divided into three groups according to the year they are enrolled in: group 1 (1st and 2nd year, n = 288), group 2 (3rd and 4th year, n = 267) and group 3 (5th and 6th year, n = 250). The students filled in an anonymous and confidential questionnaire about sexuality and risky behaviour. The frequency distribution and the Chi-square Test were used to analyse categorical variables. Spearman’s Correlation was used to analyse continuous variables. Results: A total of 805 students answered the questionnaire (female = 547, male = 258), with the median age of 20 years. Regarding marital status, 51.1% were single, 47.1% were in a long-term relationship and 1.8% were married. The median age of the first sexual experience was 17 years, but 33.9% of the students denied having any sexual experience. The most common sexual practice is the joint practice of oral and vaginal sex (56.2%). Ejaculatory dysfunction was the sexual dysfunction most referred by men (18.2%), followed by erectile dysfunction (7.8%), particularly when associated to drugs consumption (22.2%). The sexual dysfunctions most mentioned by women were dyspareunia (40.8%), difficulty attaining an orgasm (34.7%) and lack of lubrication (18.5%). Conclusion: Although this cross-sectional study is very inclusive, further studies are needed in this area in order to evaluate the sexual patterns amongst the general population and allow comparison with medical students. Policy of full disclosure: None.

J Sex Med 2012;9(suppl 5):303–335

336

HIGHLIGHTED POSTER TOURS Friday, 7 December 2012 11.00–11.30 Upper Lounge HP-01 Male sexual health I Chairs: S. Droupy, France N. Calomfirescu, Romania HP-01-001

SEXUAL DYSFUNCTIONS AMONG ALCOHOLIC PATIENTS DURING ALCOHOL WITHDRAWAL: PREVALENCE AND DEMAND FOR SPECIFIC CARE Grellet, L.1; Pelletier, S.2; Plassot, C.2; Faix, A.3; Perney, P.2 Montpellier, France; 2Addictologie, CHU Nîmes, France; Clinique Beausoleil, Montpellier, France

1

3

Urologie,

Objective: Sexual dysfunctions (SD) represent a frequent complication of alcohol use disorders. The prevalence of SD is about twice in alcoholic patients as compared to control. However, the diagnosis of SD is usually not performed in alcoholic patients. The aim of this study was to assess, among patients hospitalized for alcohol withdrawal, the prevalence of SD and the demand for specific care. Methods: A sexual questionnaire (IIEF, 15 questions, or FSFI, 19 questions) was systematically proposed to alcoholic inpatients after alcohol withdrawal, as well as a single question sexual self-assessment. Using a visual scale (score from 0 to 10), questions were also asked concerning the feelings of patients about the relationships between their alcohol consumption and their SD, and for their demand for sexual care. The exclusion criteria were: psychiatric disorders and cognitive impairment. Results: The questionnaire was proposed to 214 patients, with a refusal rate of 4% (6/149) in males and 14% (9/65) in females, p < 0.02. Thus, 198 patients (72% males and 28% females mean age 47 ± 9 years) were included. A SD was found in 109/143 males (76%) and in 34/55 females (62%) (NS). The self-assessment was significantly correlated either with the IIEF (p < 0.0001) or with the FSFI (p = 0.02). 46% of the patients considered that alcohol consumption had an important or a very important negative impact (score ≥ 5/10) on their SD; 65% thought that alcohol withdrawal would have a positive impact on their SD; and 41% agreed with the proposal of a simultaneous care for either alcohol and sexual problems. Conclusion: Our study confirms the high prevalence of SD in alcoholic patient. The patients generally know the negative impact of alcohol on sexual function, and positively considered sexual care proposal. Policy of full disclosure: None.

HP-01-002

VALIDATION OF PORTUGUESE VERSION OF QUALITY OF ERECTION QUESTIONNAIRE (QEQ) THROUGH INTERNATIONAL INDEX OF ERECTILE FUNCTION (IIEF) AND RAND 36-ITEM HEALTH SURVEY Reis, L. O.1; Reis, A. L.2; Destro Saade, R.2; Santos Jr., C. A.2; Fregonesi, A.2 University of Campinas-Unicamp, Urology, Brazil; 2University of Campinas-Unicamp, Brazil

1

Objective: Considering socio-cultural particularities, this study adapts and evaluates the tool designed to specifically assess satisfaction with the quality of erections called Quality of Erection Questionnaire (QEQ) in Portuguese version. Methods: The translated version of the QEQ underwent back translation by two teachers fluent in English. The original English version

J Sex Med 2012;9(suppl 5):336–356

was submitted to a new translation by two other teachers for comparison with the version provided. Through this it was found equivalence, then urologists experts in Andrology verified the QEQ Portuguese version for adequacy. Patients in routine visits at Andrology clinic were invited to perform QEQ, International Index of Erectile Function (IIEF) and RAND 36-Item Health Survey questionnaires. Internal consistency (Cronbach’s α); test-retest reliability (Spearman); convergent validity (Spearman correlation) coefficients and knowngroups validity (ability of the QEQ Portuguese version to differentiate among erectile dysfunction severity groups) were accessed. Results: Among 192 patients, including 162 clinically diagnosed with erectile dysfunction (ED), and 30 without ED, mean 34 and median 33 years old (23–61 y), the Portuguese version of the QEQ showed high internal consistency (Cronbach α 0.93), high stability between test and retest reliability (ICC 0.83, 95% CI: 0.76, 0.88, p < 0.001) and a Spearman coefficient of correlation r = 0.82 (p < 0.001), reinforcing the high correlation between the IIEF scores and values of QEQ. However, the correlation between the values of the QEQ and the total RAND 36-Item Health Survey were significantly lower for patients with (r = 0.19, p = 0.01), and without ED (r = 0.37, p = 0.04). Conclusion: The QEQ Portuguese version demonstrated good psychometrics properties and highly convergent validity with IIEF scores and poorly correlated with quality of life (QoL) RAND 36-Item Health Survey scores; certainly due to psychic activity of compensatory mechanisms. Furthermore, it showed to be useful in patients with and without ED. Policy of full disclosure: None.

HP-01-003

ASSESSING METABOLIC SYNDROME PREVALENCE AMONG PATIENTS ATTENDING UROLOGY OFFICES, IS IT REALLY A GOLD OPPORTUNITY TO DO HELP DETECT THE SYNDROME? Martin Morales, A.1; Vozmediano Chicharro, R.2; Baena Gonzalez, V.2 Carlos Haya Hospital, Servicio de Urología, Malaga, Spain; 2Carlos Haya University Hospita, Malaga, Spain

1

Objective: It has been suggested that urologists are in a privileged position to detect metabolic syndrome (MetS) and to manage these patients accordingly. To confirm this hypothesis, we assessed the prevalence of MetS among men visiting Urology offices for any reason, and its relationship with the reasons to seek urology attention, and the presence of testosterone deficit syndrome (TDS). Methods: Prospective, observational, single-location study performed between December 2010 and November 2011 among 1,022 men aged ≥45 visiting Urology offices for any reason. Reasons for seeking medical attention, sociodemographic and anthropometric data, and medical conditions related to the MetS were collected. Testosterone laboratory determinations were performed. TDS was diagnosed on the basis of the presence of three sexual symptoms (decreased frequency of morning erection, decreased frequency of sexual thoughts, and erectile dysfunction) and a free testosterone level (cFT) < 220 pmol/ l1. MetS was diagnosed following NCEP-ATPIII criteria. Results: Mean age of participants was 62.8 years [45–86]. Sexual dysfunctions were among the most frequent reasons to visit the Urologist (67.8%), ED concerns represented 33.7% and libido reduction 18.1%. Prevalence of MetS was 31.9%, and was age-independent. ED concerns were significantly higher among patients with MetS (37.1 % vs 29.3, respectively). Prevalence of TDS was 17.4%, and increased with age (P < 0.01). TDS had no relationship with the reasons to visit the urologist. Prevalence of MetS was higher among patients with TDS (18.6% vs 13.1%; P < 0.001). Having TDS increased the probability of presenting MetS (OR = 2.7 [IC 95% 2.0–3.7]). Total testos-

337

Highlighted Poster Tours terone (TT) levels and number of MetS components showed linear correlation (r = −0.274; P = 0.000). Conclusion: Prevalence of MetS among men visiting Urology offices is high, especially among those consulting for ED and with TDS, as assessed in this study, which reinforces the need to assess MetS and to develop strategies to tackle this condition. Policy of full disclosure: None.

HP-01-004

ADDRESSING SEXUAL FUNCTION IN THE CARDIOLOGY PRACTICE Nicolai, M.1; Both, S.2; Liem, S.-S.2; van Bavel, J.2; Putter, H.2; Pelger, R.2; Schalij, M.2; Elzevier, H.2 1 LUMC, Urology, Leiden, Netherlands; 2LUMC, Leiden, Netherlands Objective: In patients with cardiovascular disease sexual dysfunction (SD) is frequently encountered. Erectile dysfunction (ED) shares similar modifiable risk factors with coronary artery disease (CAD) and the use of cardiac medication can cause several SD. Furthermore, the fear of triggering cardiovascular events can create stress and anxiety impacting the sexual lives of patients and their partners. We aimed to examine cardiologists’ practices of communication about sexuality and their barriers towards discussing sexual matters. Methods: A 31-itemed anonymous questionnaire was mailed to all 980 members of the Dutch Society of Cardiologists (cardiologists and fellows in training). The questionnaire addressed awareness, knowledge and practice patterns about sexual dysfunction in cardiac patients. Results: Fifty-four percent of the Dutch cardiologists responded (n = 530). Sixteen percent stated to discus sexual function regularly, 69.4% said that patients’ sexual function is the responsibility of the general practitioner. An estimated 2% of the patients with a SD was referred for professional help. The majority of cardiologists seldom counseled patients about resuming sexual activity after myocardial infarction or heart failure, in female patients significantly less often than in male patients (p = 0.0001). Experienced cardiologists discussed sexual function significantly more often than their younger colleagues (p = 0.0001). Important reasons not to discus sexual health were a lack of initiative of the patient (53.7%), a lack of time (43%) and a lack of training (35%). Sixty-three percent of the respondents indicated it would be helpful to have a list of healthcare professionals to make referral of patients with sexual problems easier. Conclusion: Sexuality is not routinely discussed in the cardiology practice. Explanations for the lack of attention towards sexual matters are ambiguities about responsibility and a lack of time, training and experience regarding the communication and treatment of SD. Policy of full disclosure: None.

HP-01-005

IMPAIRED MASTURBATION INDUCED ERECTIONS: A NEW CARDIOVASCULAR RISK FACTOR FOR MALE SUBJECTS WITH SEXUAL DYSFUNCTION Rastrelli, G.1; Boddi, V.2; Corona, G.2; Mannucci, E.2; Maggi, M.2 University of Florence, Clinical Physiopathology, Italy; 2University of Florence, Italy

1

Objective: Erectile dysfunction (ED) is considered an early surrogate marker of silent, or even overt, cardiovascular diseases (CVD). However, epidemiological studies take into account only sexual intercourse-related erections. Although autoeroticism is a very common practice, data on masturbation-induced erections as a possible predictor of major adverse cardiovascular events (MACE) are lacking. The aim of the study is to evaluate the clinical correlates of impaired masturbation-induced erections and to verify the importance of this sexual aspect in predicting MACE. Methods: A consecutive series of 4,031 male patients attending the Outpatient Clinic for sexual dysfunction for the first time was retrospectively studied. Among these subjects, 64% reported autoeroticism

during the last three months and only this subset was considered in the following analyses. In the longitudinal study, 862 subjects reporting autoeroticism were enrolled. Several clinical, biochemical and instrumental (PGE1 test and penile color Doppler ultrasound) parameters were studied. Results: Subjects with an impaired erection during masturbation (46% of those reporting autoeroticism) had more often a positive personal or family history of CVD, a higher risk of reduced intercourse- and sleep-related erections, hypoactive sexual desire and perceived reduced ejaculate volume, and impaired PGE1 test response. Prolactin levels were lower in those having impaired erection during masturbation. In the longitudinal study, unadjusted incidence of MACE was significantly associated with impaired masturbationinduced erections. When dividing the population according to the median age and diagnosis of diabetes, the association between impaired masturbation-induced erections and incidence of MACE was maintained only in the youngest (<55 year-old) and in non-diabetic subjects, even after adjusting for confounders (HR = 3.348[1.085–10.335], p = 0.032 and HR = 2.108 [1.002–4.433], p = 0.049; respectively). Conclusion: This study indicates that, in subjects with male sexual dysfunction, evaluating an often neglected sexual parameter, such as masturbation-induced erections, can provide further insights on forthcoming MACE in particular in “low risk” subjects. Policy of full disclosure: None.

HP-01-006

HISTOLOGICAL EXAMINATION OF THE CORPORA CAVERNOSA OF THE PENIS IN MEN WHO DIED OF CORONARY HEART DISEASE Bogolyubov, S.1; Astahova, A.2; Dmitriev, B.2 Tver State Medical Academy, Urology, Russia; 2Tver State Medical Academy, Russia

1

Objective: Today erectile dysfunction (ED) is considered as a factor, prior and concomitant coronary artery disease (Schwartz BG, 2011). The aim of the investigation was to compare the morphological changes in the erectile tissue with the changes in heart muscle. Methods: We studied fragments of the cavernous tissue of the penis and the myocardium 45 men who died of various diseases. Histological method (hematoxylin and eosin stain), microscopic examination and also morphometry. The age of men ranged from 20 to 86 years, mean age – 51.5 years. There were made 45 micropreparations of cavernous tissue and myocardium. Patients were divided into appropriate groups: 23 (51.1%) died from coronary heart disease, 22 (48.9%) died from other causes. Comparison of two independent groups on quantitative characters was performed with a nonparametric method using the Mann-Whitney test. Results: When assessing the histological changes observed in the cavernous tissue to varying degrees in all cases of death from coronary heart disease. When comparing the cavernous tissue of men who died from coronary heart disease and other causes there were identified the following types of lesions that were significantly more common in men who died from coronary heart disease: reduced blood content – 80% and 45.5%, cavernous fibrosis – 95.7% and 18, 2%, focal disruption of erectile tissue in combination with adiposis – 43.4% and 21.7% respectively (p < 0.05). Conclusion: In men, who died from coronary heart disease, in each case under consideration are revealed morphologic changes in cavernous tissue of varying degrees of severity. It is necessary to consider ED as a harbinger of coronary heart disease or as a companion to her condition. The work took place in the ethical review of the Ethics Committee of GBOU VPO Tver State Medical Academy of Health Ministry of Russia. Policy of full disclosure: None.

J Sex Med 2012;9(suppl 5):336–356

338 HP-01-007

TURKISH SOCIETY OF ANDROLOGY ERECTILE DYSFUNCTION PREVALENCE STUDY Cayan, S.1; Kendirci, M.2; Yaman, Ö.3; Asci, R.4; Orhan, I.5; Usta, M. F.6; Ekmekcioglu, O.7; Kadioglu, A.8 1 Univ. of Mersin School of Med., Department of Urology, Turkey; 2, Department of Urology, Istanbul, Turkey; 3Ankara University, Turkey; 4 19 Mayis University, Samsun, Turkey; 5Firat University, Elazig, Turkey; 6 Akdeniz University, Antalya, Turkey; 7Erciyes University, Kayseri, Turkey; 8 Istanbul University, Turkey Objective: Previous study conducted by Turkish Society of Andrology in 1999 reported prevalence of ED as 69.2% in men over40 years of age, using single-item non-validated question. Current study investigated ED prevalence, severity, and its correlates in men over 40 years of age using nationally-validated 6-item IIEF questionnaires. Methods: This cross-sectional, observational, population-based field survey conducted between April-October 2010 was carried out in randomly-selected males of >40 years from 19 provinces of Turkey. All participants completed a survey included with socio-demographic and socio-economic characteristics, medical and sexual history, associated physical and medical comorbidities. Erectile function was assessed by nationally-validated 6-item IIEF questionnaires based on a total score of 30. Data sets were statistically compared and p < 0.05 was considered as significant. Results: Mean age of 2.760 males was 54.17 years. The prevalence of ED was calculated as 33% among all males of >40 years of age. When subjects were stratified by age; ED prevalence was 17% for 40–49 years, 35.5% for 50–59 years, 68.8% for 60–69 years, and 82.9% for ≥70 years. Among all ED men; 76.9% had mild, 16.3% had moderate, and 5.7% had severe ED. At logistic regression analyses; age, medical comorbidities including diabetes, hypertension, atherosclerosis, dyslipidemia, and LUTS, and socio-demographic features including educational status and monthly income were found to be independent risk factors for having ED. Conclusion: This population-based survey in Turkish men of >40 years of age reported the prevalence of ED as 33%. Besides, this study reported age as the main predictor for presence and severity of ED. Policy of full disclosure: None.

Highlighted Poster Tours Friday, 7 December 2012 11.00–11.30 Upper Lounge HP-02 Male sexual health II Chairs: R. Tal, Israel F. Palumbo, Italy HP-02-001

EVALUATION OF SEXUAL FUNCTIONS IN MALES RECEIVING RENAL REPLACEMENT THERAPIES Demir, R.1; Yakupoglu, Y. K.1; Bostanci, Y.2; Atac, F.1; Ozden, E.1; Karatas, A.1; Sarikaya, S.1 1 Ondokuz Mayis University, Samsun, Turkey; 2Ondokuz Mayis University, Urology, Samsun, Turkey Objective: To determine the factors mediating the changes in sexual functions by evaluating sexual functions of male patients who had renal transplantation (RT) due to ESRD. Methods: 76 male patients were evaluated including 51 patients who underwent RT and 25 patients who were actually undergoing hemodialysis. The study enrolled patients who may be sexually active, had achieved stability following RT, is not diabetic and has no genital anatomic deformity, previous pelvic surgery history and severe psychiatric disorder. Results: Mean age was 39.84 ± 8.6 and 40.16 ± 3.3 years in the RT and ESRD group, respectively (P = 0.153). No difference was found for results of routine laboratory tests and physical examination findings. ED was found in 39.2% and 72% in the RT and ESRD group, respectively (P = 0.043). Mean IIEF score was 25.58 ± 4.4 and 21.01 ± 4.1 in the RT and ESRD group, respectively (P = 0.039). Mean age was 45 ± 8.3 years in the group with ED, while it was 35 ± 6.9 years in the group without ED (P = 0.001). When duration of dialysis was examined, who underwent RT, it was 63.7 ± 53 months in the group with ED and 36 ± 42.8 months in the group without ED (P = 0.01). 37 patients had living donors in comparison with 14 patients with cadaveric donors; considering this fact, duration of dialysis was 21.4 ± 29.2 months in the living donor group and 99.8 ± 39.2 months in the cadaveric donor group (P = 0.01). Frequency of ED was 35% in cases with transplantation from living donor, while 50% for transplantation from cadaveric donor (P = 0.525). Conclusion: Frequency of sexual dysfunction was higher in patients with dialysis therapy. It was observed that the frequency of sexual dysfunction was higher in patients who had pre-transplantation hemodialysis for longer time. It is believed that renal transplantation made in early period of ESRD will reduce frequency of sexual dysfunction in the post-transplantation period. Policy of full disclosure: None.

HP-02-002

ERECTILE DYSFUNCTION IN EUROPEAN MEN WITH AND WITHOUT BENIGN PROSTATIC HYPERPLASIA: ANALYSIS OF EUROPEAN NATIONAL HEALTH AND WELLNESS SURVEY Foster, S.1; Annunziata, K.2; Shortridge, E.1; Freedman, D.2; Viktrup, L.1 Eli Lilly and Company, Indianapolis, USA; 2Kantar Health, Princeton, USA

1

Objective: The purpose of this study was to assess the prevalence of erectile dysfunction (ED) without a diagnosis of benign prostatic hyperplasia (BPH) (ED only) and coexisting ED and BPH (ED+BPH) in European men. Methods: Men ≥40 years old who self-reported experiencing ED in the past six months and/or being diagnosed with BPH were identified from the 2010 European Union (EU) National Health and Wellness Survey (NHWS), a cross-sectional, self-administered online survey. The EU NHWS included populations from France, Germany, Italy,

J Sex Med 2012;9(suppl 5):336–356

339

Highlighted Poster Tours Spain, and the United Kingdom. Data were weighted by age based on data from the Organization for Economic Cooperation and Development to reflect the demographics of each country’s population. Results: The prevalence of ED only and ED+BPH was 35% and 6%, respectively. Men reporting ED only or ED+BPH had a mean age of 59 and 67 years, respectively. About a third of men with ED only and 49% of men with ED+BPH reported speaking to their physician about ED. Only 29% of men with ED only and 25% of men with ED+BPH reported currently using ED medication. Approximately 48% of men with ED+BPH were taking BPH medication. About 10% of men with ED only were seen by an urologist in comparison to 44% of those with ED+BPH. About 33% of men with ED only and two-thirds of those with ED+BPH reported moderate-severe BPH symptoms (an AUA-SI score ≥ 8). Conclusion: In this European population-based study, ED was common; however, the majority of men did not appear to seek care. Coexisting ED+BPH was less common but men appeared slightly more likely to seek care, which may be due, in part, to increased symptoms related to BPH. This study allows a greater understanding of the characteristics of men with ED with and without BPH in a general population setting. Policy of full disclosure: Funding for this study was provided by Eli Lilly and Company. Shonda Foster is an employee and stockholder of Eli Lilly and Company. Kathy Annunziata is an employee of Kantar Health which received funding from Eli Lilly and Company to conduct this analysis. Emily Shortridge is an employee and stockholder of Eli Lilly and Company. Deborah Freedman is an employee of Kantar Health which received funding from Eli Lilly and Company to conduct this analysis. Lars Viktrup is an employee and stockholder of Eli Lilly and Company.

HP-02-003

KNOWLEDGE AND SKILLS IN THE ASSESSMENT AND MANAGEMENT OF THE SEXUAL PROBLEMS BY DIFFERENT MEDICAL SPECIALISTS IN A UNIVERSITY HOSPITAL Garcia-Rojo, D.1; Muñoz, J.2; Barrio-Muñoz, M.2; Hannaoui, N.2; Abad, C.2; Prera, A.2; Oliva, J. C.2; Vicente, E.2; Gonzalez-Sala, J. L.2; Martos, R.2; Prats, J.2 1 Corporacio Parc Tauli, Urology, Barcelona, Spain; 2Corporacio Parc Tauli, Sabadell, Spain Objective: We analyze the knowledge and attitude of different doctors about of sexual health of their patients. Methods: Survey tool: FSP questionnaire: F = frequency with which the subject is confronted with the problem. S = given seriousness for the professional exercises. P = problems of skills to bring a response in terms of theoretical and practical knowledge’s, technical skills and how to be a relational aptitudes. The questionnaire is quoted 0 (rarely), 1 (sometimes) or 2 (many). Survey done with 62 physicians: 19 gynecologists, 15 general practitioners, 13 urologists, 11 general surgeons and 4 oncologists. Comparison of means were performed with Student t test. Results: Frequency: Personal awareness: higher in urologists (1.77) and oncologists than in surgeons (0.64) (p = 0.001). Professional confrontation with the sexual complaint: usual for urologists (1.54) and general practitioners (1.4) and rarely in surgeons (0) (p = 0.00) Attitude when patient demand: urologists (1.62) and similar in other groups (p = 0.257). Urologists have a more proactive attitude (1.54) than gynecologists (1.05) and general surgeons (0.64) (p = 0.03). (B) Seriousness: to be listening (1.92) and reactive (1.85) to both sexual complaint and demand is very important for urologists but less for oncologists (1.0 and 1.0), gynecologists (1.37 and 1.37), general practitioners (1.67 and 1.33) and surgeons (1.45 and 0.91) (p = 0.02 and p = 0.01 respectively). (C) Problems: theoretical knowledge: good in urologists (1.54) tan the other specialists (p = 0.026); technical skills: low in general practitioners (0.6) and general surgeons (0.73) and good for urologists (1.54 (p = 0.005)); relational skills: better in urologists (1.77) and low in general practitioners (0.73) (p = 0.003).

Conclusion: Our results are similar to those presented previously by Bondil. It should conduct a specific education in order to have a proactive and sufficient knowledge about the sexual quality of life of the patients. Policy of full disclosure: None.

HP-02-004

AGING MALE SYMPTOMS SCALE AS A WAY TO DETECT HYPOGONADISM IN YOUNG MEN Bogolyubov, S.1; Artamonov, A.2; Pokrovskaja, M.2; Dmitriev, B.2 Tver State Medical Academy, Urology, Russia; 2Tver State Medical Academy, Russia

1

Objective: Testosterone deficiency is associated with diseases such as metabolic syndrome, diabetes, cardiovascular pathology, erectile dysfunction, etc. However, the prevalence of hypogonadism in young men is poorly studied. The aim of the investigation was to determine the possibility of using the scale Aging Males Symptoms (AMS) in young men to identify hypogonadism. Methods: We examined 216 men aged 17–23 years. Survey was carried out on a scale of Aging Males Symptoms (AMS), examination, calculation of body mass index, blood test for testosterone and sex steroids binding globulin, the calculation of the free and bioavailable fraction of testosterone. Results: Symptoms of androgen deficiency of various degrees were found in 27.3%. During the inspection of young men with symptomatic androgen deficiency (n = 59), scrotal pathology was detected in 21 persons (35.6%), and in 11 men (18.6%) left varicocele grade 2–3 Sixteen men with symptomatic androgen deficiency performed blood sampling to determine the level of testosterone. In assessing the androgenic hormonal status was revealed that 6 (37.5%) had low total testosterone (<12 nmol/L). Calculation of free and bioavailable testosterone showed that 2 (12.5%) surveyed men had decreased free testosterone and 11 (68.8%) had a low bioavailable testosterone. Therefore, the symptoms of androgen deficiency in combination with low testosterone (including total, free and bioavailable) were detected in 14 (87.5%) of young men. Men who have low testosterone in 14.3% of cases had overweight. Conclusion: Aging Males Symptoms scale can be used to screen for androgen deficiency in young men in the initial stages of diagnosis. Policy of full disclosure: None.

HP-02-005

PREVALENCE OF MALE PELVIC DYSFUNCTION: RESULTS FROM THE TURKISH SOCIETY OF ANDROLOGY SEXUAL HEALTH STUDY GROUP Kendirci, M.1; Asci, R.2; Çayan, S.3; Yaman, Ö.4; Orhan, I.5; Usta, M. F.6; Ekmekcioglu, O.7; Kadioglu, A.8 1 , Department of Urology, Istanbul, Turkey; 219 Mayis University, Istanbul, Turkey; 3Mersin University, Turkey; 4Ankara University, Turkey; 5Firat University, Elazig, Turkey; 6Akdeniz University, Antalya, Turkey; 7Erciyes University, Kayseri, Turkey; 8Istanbul University, Turkey Objective: Recently, there has been an increasing interest in male pelvic health. Although accumulating evidences have provided a relationship between LUTS suggestive of BPH and sexual dysfunctions, epidemiological studies investigating the prevalence of male pelvic dysfunction (MPD) have yet to be conducted. The aim of this study was to determine the prevalence of MPD in a population-based study. Methods: This study, conducted between April 2010 and October 2010, was designed as a non-interventional, observational crosssectional field survey. Participating males were over 40 years of age and randomly selected from 19 provinces of Turkey. All participants were asked to complete a survey including data regarding sociodemographics and socioeconomic status, medical and sexual history, comorbidities, and three validated questionnaires including IPSS,

J Sex Med 2012;9(suppl 5):336–356

340

Highlighted Poster Tours

IIEF, and MSHQ-4. MPD was defined using certain criteria. All data were analyzed statistically and p < 0.05 was accepted as significant. Results: A total of 2,760 males over 40 years (mean 54.17 years) were enrolled into the study. Prevalence of MPD was found to be 24.4% among all participants. The prevalence of MPD was lowest at age between 40–49 years (16.7%) and highest at age of ≥70 years (76.60%), exhibiting correlation with age. Presence of obesity did not have significant impact on presence of MPD. At logistic regression analyses; age, diabetes, hypertension, dyslipidemia, atherosclerosis, educational status, and monthly income were found to be independent predictors for increased prevalence of MPD. Conclusion: This study reports the prevalence of MPD as 24.4% in males of >40 years. Furthermore, age was found to be the main independent predictor of having MPD. Policy of full disclosure: None.

HP-02-006

SEXUAL SIDE EFFECTS OF CARDIAC MEDICATION, WHAT DO CARDIOLOGISTS KNOW ABOUT IT? Nicolai, M.1; Liem, S.-S.2; Both, S.2; Pelger, R.2; Putter, H.2; Schalij, M.2; Elzevier, H.2 1 LUMC, Urology, Leiden, Netherlands; 2LUMC, Leiden, Netherlands Objective: Several cardiac drugs, such as diuretics and β-blockers, can negatively affect sexual function, leading to noncompliance with therapy. At the other end of the spectrum, Angiotensin II Receptor Blockers (ARBs), can improve patients’ sexual function. We are unaware of cardiologists’ knowledge of these side effects. Neither do we know whether they take them into account when prescribing drugs. The use of PDE5-inhibitors is contraindicated in combination with nitrates, we are unaware of cardiologists’ practice towards PDE5inhibitor use. Methods: I: A 31-itemed anonymous questionnaire was mailed to 980 members of the Dutch Society of cardiologists (cardiologists and residents). The questionnaire addressed counseling about sexual side effects, prescribing routines and knowledge about side effects. II: A review of the literature was performed to give a practical overview of the sexual side effects of commonly prescribed cardiac drugs classes. Results: Fifty-four percent of the Dutch cardiologists responded. The majority (76.8%) stated to inform patients after myocardial infarction (MI) or heart failure about sexual adverse effects of medication. Fortyfive percent of cardiologists was aware of the negative effects that diuretics can have on sexual function, 93.1% knew about the negative effects of β-blockers. Only a minority was aware that ACE inhibitors and ARBs can benefit sexual health (8.2% resp. 9.2%). Almost half of the respondents (48.2%) stated to change medication regularly in attempt to improve sexual function. Experienced cardiologists did this more often than younger colleagues and residents (p < 0.001). Nineteen percent inquired regularly about PDE5-inhibitor use in outpatient care, while 43.6% said to counsel patients about the possibility to use a PDE5- inhibitor after MI or heart failure. II: Review results, see table 1. Conclusion: Cardiologists’ knowledge about the sexual side effects of cardiac drugs appears to be incomplete. Sexual side effects are not routinely taken into account when drugs are prescribed. Policy of full disclosure: None.

J Sex Med 2012;9(suppl 5):336–356

HP-02-007

ONE PATIENT OUT OF FOUR WITH NEWDIAGNOSED ERECTILE DYSFUNCTION IS A YOUNG MEN Salonia, A.1; Capogrosso, P.2; Colicchia, M.2; Ventimiglia, E.2; Suardi, N.2; Ferrari, M.2; Clementi, M. C.2; Castagna, G.2; Rigatti, P.2; Montorsi, F.2 1 University Vita-Salute San Raffaele, Urology, Milan, Italy; 2IRCCS San Raffaele, Milan, Italy Objective: To assess sociodemographic characteristics of young men (defined as ≤40 years) seeking first medical help for new-onset erectile dysfunction (ED) as their primary disorder. Methods: Complete data from 790 consecutive patients seeking first medical help for new-onset sexual dysfunction were analysed. Comorbidities were scored with the Charlson Comorbidity Index (CCI). All patients completed the International Index of Erectile Function (IIEF) domains. Descriptive statistics was applied. Results: New-onset ED as the primary disorder was found in 439 (55.6%) men; of them, 26% were ≤40 years of age [mean (median) age: 32.4 (33.0); range: 17–40 years]. Young ED men had a lower mean BMI (25.1 vs 26.4 kg/m2; p = 0.003; BMI ≤ 25 in 57.4% vs 38.7%; chi2 15.19, p = 0.002), a higher circulating total testosterone (5.3 vs 4.5 ng/mL; p = 0.003), and a lower CCI in a greater rate (chi2 39.12, p < 0.001) as compared with patients >40 years. Non differences were found in terms of rate of hypogonadism and metabolic syndrome. Younger ED men had a higher educational status (chi2 9.29, p = 0.05), more frequently a homosexual sexual orientation (chi2 5.66, p = 0.02), but a lower rate of stable sexual relationship (chi2 27.51, p < 0.001), compared to men <40 years. Younger ED men used drugs (ie, marijuana, cocaine and heroin) (chi2 34.46, p < 0.001) and were current cigarette smokers (chi2 7.56, p = 0.02) more frequently than older patients. IIEF-domains scores did not significantly differ between younger and older ED patients; likewise, rates of severe ED were comparable between the two groups. Conclusion: This analysis showed one in four patients with new-onset ED was younger than 40 years, with comparable rates of severe ED with older patients. Younger men differed from older men in terms of both clinical and sociodemographic parameters. Policy of full disclosure: None.

341

Highlighted Poster Tours Friday, 7 December 2012 15.00–15.30 Upper Lounge HP-03 Male sexual health III Chairs: M. Kendirci, Turkey F. Colombo, Italy HP-03-001

SIEDY SCALE 3, A NEW INSTRUMENT TO DETECT PSYCHOLOGICAL COMPONENT IN SUBJECTS WITH ERECTILE DYSFUNCTION Corona, G.1; Bandini, E.2; Rastrelli, G.2; Casale, H.2; Jannini, E. A.3; Forti, G.4; Maggi, M.2 1 Andrology Unit, Dept.of Clinical Physiopathology, Florence, Italy; 2Sexual Medicine and Andrology, Florence, Italy; 3School of Sexology, L’Aquila, Italy; 4 Endocrinology Unit, Florence, Italy Objective: We previously developed and validated a structured interview (SIEDY) dealing with the organic (Scale 1), relational (scale 2) and psychological (Scale 3) components of erectile dysfunction (ED). The aim of this study is to identify a pathological threshold for SIEDY Scale 3 and to analyze Scale 3 score with biological and psychological correlates in subjects with sexual dysfunction. Methods: A pathological threshold of SIEDY scale 3 score in predicting subjects with a medical history of psychopathology and using psychiatric drugs was identified through receiver operating characteristic (ROC) curve analysis, in a sample of 484 patients (Sample A). Sensitivity and specificity, along with possible interactions with biological and psychological (Middlesex Hospital Questionnaire, MHQscore) correlates were verified in a further sample of 1275 patients (Sample B). Results: In sample A, 39 (8%) and 60 (12.4%) subjects reported a positive medical history for psychiatric disturbances or for the use of psychotropic medication, respectively. The association with both conditions was present in 28 (5.8%) subjects. ROC curve showed that SIEDY scale 3 score predicts psychopathology with an accuracy of 69.5 ± 5.9% (p < 0.002), when a threshold of 3 was chosen. When the same threshold was applied in Sample B, it identified a higher ranking in MHQ-A (free-floating anxiety), MHQ-S (somatized anxiety) and MHQ-D (depressive symptoms) subscales, even after adjustment for age and Σ-MHQ (a broader index of general psychopathology). In the same sample, we also confirmed that pathological Scale 3 score was related to a higher risk of psychopathology at medical history or to the use of psychotropic drugs as well as with risky lifestyle behaviours, including smoking and alcohol abuse, and elevated BMI. Conclusion: SIEDY represents an easy tool for the identification of patients with a relevant intra-psychic component who should be considered for psychological/psychiatric treatment. Policy of full disclosure: None.

HP-03-002

THE IDENTIFICATION OF PRE-DIABETES CONDITION WITH ARIC ALGORITHM, PREDICTS LONG-TERM CV EVENTS IN PATIENTS WITH ERECTILE DYSFUNCTION Corona, G.1; Rastrelli, G.2; Silveri, A.2; Forti, G.3; Maggi, M.2 Andrology Unit, Dept., Clinical Physiopathology, Florence, Italy; 2Sexual Medicine and Andrology, Florence, Italy; 3Endocrinology Unit, Florence, Italy

1

Objective: The Atherosclerosis Risk in Communities (ARIC) algorithm, one of the most efficient instruments for the prediction of incident type 2 diabetes (T2DM), has been shown to predict another relevant cardiovascular (CV) risk factor, such as chronic kidney disease. To verify whether, in patients with erectile dysfunction (ED), the use of ARIC diabetes risk score might improve the efficacy in predicting major CV events.

Methods: A consecutive series of 2,437 men (mean age 52.5 ± 12.9 years) attending our outpatient clinic for sexual dysfunction was retrospectively studied. A subset of this sample (n = 1687) was enrolled in a longitudinal study (mean follow up of 4.3 ± 2.6 years).Several clinical, biochemical (including testosterone) and instrumental (penile color doppler ultrasound; PCDU) factors were evaluated. The assessment of metabolic risk was evaluated with the ARIC algorithm. The assessment of CV risk was evaluated using the Progetto Cuore risk engine. Results: In the cross sectional study ARIC score was inversely related with reduced testosterone levels, worse sexual functioning and reduced penile blood flow. When longitudinal sample was analyzed, higher baseline ARIC score significantly predicted MACE even when subjects with diabetes mellitus at baseline were excluded from the analysis (HR =; 1.522[1.086–2.135] p = 0.015 for trend). In addition, among subjects classified as “low-risk” (CV risk < 20% at 10 years corresponding to <9% at 4.3 years) by Progetto Cuore, a ROC curve analysis for ARIC (vs. MACE) allowed the identification of a threshold of 0.22, which had a positive predictive value for 4.3-year MACE of 9%. Applying the ARIC score (with a threshold of 0.22) to Progetto Cuore “low risk” subjects, we could classify as “at high risk” 89.8% of subjects with incident MACE versus 79.6% with Progetto Cuore only. Conclusion: In patients with ED identifying pre-diabetes, even with algorithms, predicts long-term CV events. Policy of full disclosure: None.

HP-03-003

CORRELATION OF ERECTILE DYSFUNCTION WITH METABOLIC RISK FACTORS OF INCREASED CARDIOVASCULAR RISK IN NEVER TREATED HYPERTENSIVE PATIENTS Ioakeimidis, N.1; Vlachopoulos, C.2; Rokkas, K.2; Terentes-Printzios, D.2; Aggelis, A.2; Synodinos, A.2; Samentzas, A.2; Abdelrasoul, M.2; Askitis, T.2; Stefanadis, C.2 1 Athens Medical School, 1st Department of Cardiology, Greece; 2Athens Medical School, Greece Objective: Hypertension is the most common comorbidity in patients with erectile dysfunction (ED) and hypertensive ED patients are at higher risk for future cardiovascular events. Glycosylated hemoglobin, C-reactive protein (CRP), plasma homocysteine and albuminuria correlate with uncontrolled blood pressure and augment the cardiovascular risk in hypertensive individuals. Aim of this study was to investigate the association of these metabolic risk factors with the presence and severity of ED in hypertensive patients. Methods: We studied 71 never treated hypertensive men with vasculogenic ED, and 21 age matched hypertensive subjects without ED (controls). ED was diagnosed according to history and score of the 5-item Sexual Health Inventory for Men (SHIM-5, cut-off value < 21). Results: ED patients were divided into subgroups by the degree of SHIM-5 score. Hypertensive patients with moderate/severe ED (n = 28) exhibited higher systolic pressure and pulse pressure, compared to hypertensive patients with mild ED (n = 43) and subjects with normal erectile function (P < 0.01 and P < 0.001, respectively). Glycosylated hemoglobin (HbA1c), urinary albumin : creatinine ratio (ACR) and high sensitivity CRP were significantly increased in patients with moderate/severe ED compared to patients with mild ED and subjects without ED. (figure, all P < 0.001 by ANCOCA). Plasma homocysteine levels in ED patients and subjects with normal erectile function were similar. Conclusion: Our finding highlight the need for targeted interventions to aggressively treat BP, elevated HbA1c and microalbuminuria, to improve erectile function and ED-associated cardiovascular morbidity and mortality. Policy of full disclosure: None.

J Sex Med 2012;9(suppl 5):336–356

342

HP-03-004

INCREASING TRENDS OF HIV/AIDS AMONG ARAB AND JEWISH MALES IN ISRAEL, 1986–2010 Mor, Z.1; Grayeb, E.2; Beany, A.3; Grotto, I.4 Ministry of Health, Ramla Department of Health, Israel; 2Hadassah Medical Center, Jerusalem, Israel; 3Bnai Zion Medical Center, Haifa, Israel; 4 Ministry of Health, Jerusalem, Israel

1

Objective: This study aims to compare HIV/AIDS-burden in males between Israeli Jews and Arabs, which are the biggest monitory in Israel. Methods: The National HIV/AIDS Registry (NHAR) was the source for HIV/AIDS-infection records, while the Israeli Central Bureau of Statistics was used to determine groups-specific disease rates. Results: Between 1986 and 2010, 3,499 HIV/AIDS-infected males were reported: 3,369 (96.3%) Jews and 130 (3.7%) Arabs, in an average annual incidence of 5.5 and 0.8 per 100,000 populations, respectively, p = 0.05. Of all Jews, 1,018 (29.9%) were born in Ethiopia, while 2,389 were Jews who were not Ethiopian-born (JNE). Most Arabs (N = 99, 74.8%) were Muslims, followed by 21 (16.2%) Christians and 13 (10%) Druze. AIDS rather than HIV upon reporting was diagnosed in 568 (23.8%) of JNE and 31 (23.8%) of the Arabs, p = 1. The most affected age-group among JNE was 25–34 and in Arabs 20–24, and the respective cumulative death rates were 24.9% (N = 594) and 32.5% (N = 40), p = 0.1. The point-prevalence in 2010 was 58.4 and 11.4 per 100,000 for JNE and Arabs, and in adults aged 15–49, was 98.0 and 20.4 per 100,000, respectively. In Muslims, Christians and Druze, the point-prevalence was 4.2, 11.2 and 7.1 per 100,000; and in adults aged 15–49 was 20.4, 52.6 and 21.6, respectively. The most common riskgroup among JNE and Arabs was MSM. Conclusion: HIV/AIDS-burden in Arab males was significantly lower than in Jews. Among Arab-males, HIV/AIDS-burden was highest in Christians than in Druze and Muslims. The proportion of MSM of all males, regardless of their religion is increasing. Policy of full disclosure: None.

HP-03-005

SEXUAL FUNCTIONING MIRRORS OVERALL MAN’S HEALTH STATUS, EVEN IRRESPECTIVE OF CARDIOVASCULAR RISK FACTORS Salonia, A.1; Colicchia, M.2; Ventimiglia, E.2; Suardi, N.2; Capogrosso, P.2; Ferrari, M.2; Clementi, M. C.2; Castagna, G.2; Rigatti, P.2; Montorsi, F.2 1 University Vita-Salute San Raffaele, Urology, Milan, Italy; 2IRCCS San Raffaele, Milan, Italy Objective: To assess whether sexual function, defined with the International Index of Erectile Function (IIEF)–domain scores, is associated with health-significant comorbidities scored with the Charlson Comorbidity Index (CCI), even irrespective of cardiovascular (CV) risk factors.

J Sex Med 2012;9(suppl 5):336–356

Highlighted Poster Tours Methods: Complete sociodemographic, clinical and psychometric data from the last 184 consecutive patients seeking first medical help for new-onset sexual dysfunction were analysed. Health-significant comorbidities were scored with the Charlson Comorbidity Index (CCI); likewise, a modified CCI score not considering usual CV risk factors was also compiled (CCI-CV). Descriptive statistics, one-way analysis of variance (ANOVA) and linear regression models tested the association among IIEF domain scores and either CCI or CCI-CV. Results: CCI was 0, 1, and ≥2 in 74.3%, 10.4%, and 15.3% patients, respectively. Conversely, CCI-CV was 0, 1, and ≥2 in 79.3%, 10.3%, and 10.3% patients, respectively. At ANOVA, erectile function (IIEFEF) (F: 4.35, p = 0.01) and orgasmic function (IIEF-OF) (F: 4.89, p = 0.009) domain scores were significantly lower according to categorized CCI. At UVA linear regression analysis IIEF-EF (Beta −0.184; p = 0.01 or Beta −0.168; p = 0.02) and IIEF-OF (Beta −0.183; p = 0.02 or Beta −0.199; p = 0.01) were inversely associated with increasing values of either CCI or CCI-CV. Moreover, at MVA linear regression analysis IIEF-EF (Beta −0.209; p = 0.01 or Beta −0.185; p = 0.03) and IIEF-OF (Beta −0.177; p = 0.04 or Beta −0.188; p = 0.02) confirmed an inverse association with increasing values of either CCI or CCI-CV, after adjusting for age and BMI. Conclusion: Severity of ED and impaired orgasmic function, as objectively interpreted with IIEF domains, account for both a higher CCI and a higher CCI-CV, which may be considered a reliable proxy of a lower general male health status irrespective of cardiovascular risk factors. Policy of full disclosure: None.

HP-03-006

CHRONOTROPIC RESPONSE TO EXERCISE TESTING IS ASSOCIATED WITH THE PRESENCE AND SEVERITY OF ERECTILE DYSFUNCTION IN MIDDLE-AGED MEN WITH ESSENTIAL HYPERTENSION: IMPLICATIONS FOR EVALUATING CARDIOVASCULAR RISK Rokkas, K.1; Vlachopoulos, C.2; Ioakeimidis, N.2; Aggelis, A.2; Synodinos, A.2; Samentzas, A.2; Katevatis, A.2; Fassoulakis, C.2; Askitis, T.2; Stefanadis, C.2 1 Athens Medical School, 1st Department of Cardiology, Greece; 2Athens Medical School, Greece Objective: Hypertension is the most common comorbidity in men with erectile dysfunction (ED). ED may carry an incremental predictive value for future cardiovascular events. Chronotropic incompetence, or an inability to increase heart rate during exercise, independently predicts death. The purpose of this study was to evaluate the association between ED and CI during EST in middle-aged hypertensive men. Methods: 97 non-diabetic, hypertensive (Grade I-II) ED patients (55 ± 9 y/o) and 32 age-matched hypertensive men without ED underwent maximal EST under the standard Bruce protocol. Chronotropic index (CI) was calculated as [(HRpeak –HRrest)/ (220– age– HRrest)]. The CI was considered abnormal when ≤0.8 in patients not taking betablockers. All men with ED underwent penile color Doppler and peak systolic velocity (PSV) was measured as an index of penile vascular disease. Reduced PSV is associated with increased risk for cardiovascular events as well as the degree and distribution of atherosclerotic lesions. Results: ED patients had a substantially reduced CI and a higher prevalence of abnormal CI than nonED subjects (0.82 ± 0.20 vs 0.91 ± 0.19 and 42 vs 21%, respectively, P < 0.01 for all) (left plot). CI was decreased (middle plot) and prevalence of abnormal CI was increased in patients with severe arterial insufficiency (PSV < 25 cm/s) compared to subjects with borderline insufficiency and men with normal penile arterial function (P < 0.01, by ANOVA) (middle plot). The combination of severe penile arterial disease (PSV < 25 cm/s) with an abnormal CI (≤0.8) showed a greater effect on 10-year risk of a CV event (right plot).

343

Highlighted Poster Tours Conclusion: Our finding indicates that chronotropic response to exercise testing is significantly associated with the presence and severity of ED among hypertensive patients.Our findings suggest that a comprehensive approach to cardiovascular risk reduction in hypertensive ED patients should include evaluation of chronotropic incompetence, which might identify those who require further cardiovascular assessment and improve overall vascular health, including sexual health. Policy of full disclosure: None.

Friday, 7 December 2012 15.00–15.30 Upper Lounge HP-04 Male sexual health IV Chairs: S. Cayan, Turkey I. E. Gruenwald, Israel HP-04-001

CAROTID INTIMA MEDIA THICKNESS CHANGES IN RELATION TO ADHERENCE TO MEDITERRANEAN DIET IN PATIENTS WITH ERECTILE DYSFUNCTION Aggelis, A.1; Vlachopoulos, C.2; Ioakeimidis, N.2; Synodinos, A.2; Terentes-Printzios, D.2; Rokkas, K.2; Askitis, T.2; Stefanadis, C.2 1 Athens Medical School, 1st Department of Cardiology, Greece; 2Athens Medical School, Greece

HP-03-007

ENDOTHELIAL-ERECTILE DYSFUNCTION AND CARDIOVASCULAR RISK FACTORS RELATIONSHIP Sramkova, T.1; Zamecnik, L.2; Sramkova, K.3 Charles University in Prague, Department of Urology, Czech Republic; 2 Charles University in Prague, Czech Republic; 3St Anne s Hospital-Dpt of Urology, Brno, Czech Republic

1

Objective: Endothelial monolayer plays a crucial role in vasodilatation and hemodynamic events involved in erection physiology. Endothelial dysfunction correlates with development of cardiovascular disease and also with erectile dysfunction (ED). There is an association between ED and coronary artery disease, and between ED and cardiovascular disease (CVD). ED may act as predictive risk factor for a future atherosclerotic cardiovascular event. We aimed to determine what proportion of men, that were diagnosed with ED previously, also suffer from endothelial dysfunction. We also assessed the risk factors for CVD. Methods: We randomised 50 ED patients (32–82 years, median 52 years). We monitored CV risk factors: hypercholesterolemia, diabetes, obesity, hypertension, smoking. We assessed endothelial function by medical device ENDO-PAT 2000 Itamar Medical. Patients underwent evaluation of peripheral arterial tonometry (PAT), based on bilateral comparative digital plethysmography. PAT signals were processed using specific software, and results expressed as post-oclusive reactive hyperemia index (RHI). The relationship between RHI and the risk factors was evaluated statistically. Results: Based on established border values, we confirmed endothelial dysfunction in 32% patients, absent endothelial dysfunction in 36%. 32% of patients fell in gray zone with possible predisposition for endothelial dysfunction. Risk factors for CVD: hypertension in 62% patients, diabetes mellitus in 24%, dyslipidemia in 70%, obesity in 60%, smokers 43%. Low-HDL cholesterol in 20%, testosterone defficiency in 22 %. Waist circumference >102 cm was assessed in 74%. Only 10% did not exhibit any risk factors. Conclusion: We conclude that only a third of our sample exhibited no endothelial dysfunction, with surprising two thirds either manisfesting endothelial dysfunction or falling in the gray zone. Visceral obesity seems to be prevalent, and constitutes an important risk factor for the metabolic syndrome. It would be therefore vital to evaluate both the endothelial function and the cardiovascular risk factors in all ED patients. Policy of full disclosure: This project was supported by Itamar Medical (providing the equipment) and by Pfizer (sponzoring the sensors for patients).

Objective: The Mediterranean type of diet is a widely studied dietary pattern and has been recognised as a non-pharmaceutical mean for the prevention cardiovascular disease due to the antioxidants and antiinflammatory properties. Endothelial dysfunction and subclinical inflammation are important pathophysiologic mechanisms underlying both vasculogenic erectile dysfunction (ED) and atherosclerosis in other vascular beds. The association of Mediterranean type of diet with structural changes in large arteries in ED patients has not been defined yet. Methods: Forty-five ED patients (aged 56 ± 11 years) underwent carotid ultrasound for evaluation of intima medial thickness (IMT). ED diagnosis and score were evaluated according to the International Index of Erectile Function (IIEF) questionnaire. Increased carotid IMT >0.9 mm is an established risk factor for cardiovascular events and considered a marker of subclinical organ damage in recent guidelines of hypertension. Overall assessment of dietary habits was evaluated through a special diet score (the Med-DietScore, theoretical range 0–55), which assesses adherence to the Mediterranean dietary pattern. Higher values on the score indicate greater adherence to this pattern and, consequently, healthier dietary habits. Results: In univariate analysis Med-DietScore was inversely associated with carotid IMT (figure). In order to further evaluate the impact of Mediterranean diet on carotid wall thickness, multiple linear regression analysis was applied, which revealed that MedDietScore was inversely associated with IMT after adjustment for history and treatment of hypertension, hypercholesterolemia, diabetes mellitus, as well as use of statins (b = −0.34, P = 0.006, adjusted R2 = 0.385). Patients with high IMT (>0.9 mm) had significantly lower Med-DietScore as compared to subjects with lower values (28 ± 4 vs 34 ± 5, P < 0.05). Conclusion: The inverse association between Med-DietScore and the carotid IMT could suggest a protective role of adherence to Mediterranean type of diet against the development of carotid atherosclerosis in ED patients considered at high cardiovascular risk. Policy of full disclosure: None.

J Sex Med 2012;9(suppl 5):336–356

344

Highlighted Poster Tours HP-04-003

ASSOCIATION BETWEEN ERECTILE DYSFUNCTION SEVERITY AND MAJOR ADVERSE CARDIOVASCULAR EVENTS IN MEN WITH METABOLIC SYNDROME Rokkas, K.1; Vlachopoulos, C.2; Ioakeimidis, N.2; Terentes-Printzios, D.2; Aggelis, A.2; Samentzas, A.2; Synodinos, A.2; Aznaouridis, K.2; Askitis, T.2; Stefanadis, C.2 1 Athens Medical School, 1st Department of Cardiology, Greece; 2Athens Medical School, Greece

HP-04-002

TADALAFIL ONCE DAILY FOLLOWING PRN PHOSPHODIESTERASE TYPE 5 INHIBITOR TREATMENT, AN ASSESSMENT OF RETURN TO NORMAL ERECTILE FUNCTION Seftel, A.1; Kim, E. D.2; Goldfischer, E. R.3; Ni, X.4; Burns, P. R.5 Cooper University Hospital, Urology, Camden, NJ, USA; 2Univ. of Tenn. School of Medicine, Knoxville, USA; 3Hudson Valley Urology Center, Poughkeepsie, USA; 4Eli Lilly and Company, Indianapolis, USA; 5Lilly USA, LLC, Indianapolis, USA

1

Objective: To determine if men not achieving normal erectile function (IIEF-EF domain ≥26) with the maximum dose of a PRN PDE5 inhibitor have: a) a significantly greater probability of return to normal erectile function; b) significant improvement in IIEF-EF domain score and; c) significant improvement in successful intercourse as measured by Sexual Encounter Profile question 3 (SEP3), when treated with tadalafil once daily compared to placebo. Methods: Two identical double-blind, randomized, placebo-controlled studies were conducted in which men following a 1 month maximum dose PRN PDE5 treatment and 1 month nondrug lead periods were randomized to once daily therapy with tadalafil 2.5 mg to 5 mg, tadalafil 5 mg, or placebo for 12 weeks. Combined results are reported. Results: In men with ED (n = 590), average age of 58, erectile function significantly improved with tadalafil once daily compared to placebo. A significantly higher percentage of men treated with tadalafil 2.5 to 5 mg (39%) and tadalafil 5 mg (40%) had an IIEF-EF domain ≥26 compared to placebo (12%) (both p < .001). An 8-point improvement from a baseline IIEF-EF domain of 14 was observed for both tadalafil groups, compared to 2 points for placebo (p < .001). Significant improvement was seen in change from baseline in SEP3 with tadalafil 2.5 to 5 mg of 38% (endpoint 68) and tadalafil 5 mg of 40% (endpoint 69) compared to12 % (endpoint 43) for placebo (both p < .001). Tadalafil was generally well tolerated and adverse reactions observed were consistent with previous reports of tadalafil once daily. Conclusion: Approximately 40% of men who did not achieve normal IIEF-EF domain score when using the maximum dose of a PRN PDE5I achieved normal scores when treated with tadalafil once daily. Treatment with tadalafil once daily may be a viable option for men with ED that could help restore normal erectile function. Policy of full disclosure: Allen D. Seftel consults for Eli Lilly and Company.

J Sex Med 2012;9(suppl 5):336–356

Objective: Metabolic syndrome (MetS) is a risk factor for severe erectile dysfunction (ED). ED confers an independent cardiovascular risk, however the predictive role of ED severity in patients with MetS has not been investigated. Accordingly, we sought to investigate whether ED severity predicts major adverse cardiovascular events (MACE) in patients with MetS. Methods: Three hundred and two ED patients (mean age 56 years) without a previous history of CV disease were followed up. ED was assessed by the International Index Erectile Function-5 questionnaire. Low score indicates severe ED. Results: During the mean follow-up period of 41 months, a total of 20 MACE occurred. The prevalence of MetS between patients with and those without MACE was not statistically significant (45 % vs 35%; p = 0.232). Kaplan–Meier survival analysis revealed that severe ED is associated with a higher risk of MACE in patients with MetS (n = 136), but not in patients without MetS. (p = 0.004, by log-rank test, figure). A Cox proportional hazard model showed that among men with MetS, subjects with severe ED had an approximately 2.7-fold higher MACE risk compared to those with mild and moderate ED after adjustment for age, MetS components, smoking, antihypertensive therapy and statins (HR 2.7, 95% CI 1.25 to 5.12, p = 0.024). Conclusion: Our data first show that severe ED is a powerful predictor of MACE among patients with MetS. Policy of full disclosure: None.

345

Highlighted Poster Tours HP-04-004

HP-04-005

SEXUAL SELF-CONFIDENCE AND SPONTANEITY AFTER INITIATION OF TREATMENT WITH TADALAFIL ONCE A DAY, TADALAFIL ON DEMAND OR SILDENAFIL CITRATE ON DEMAND: A RANDOMIZED OPEN-LABEL STUDY IN PREVIOUSLY UNTREATED PATIENTS WITH ERECTILE DYSFUNCTION

TEN YEARS LATER, ARE WE EMPLOYING UNDER THE BEST CONDITIONS THE IPDE5?

1

2

3

Garcia, B.1; Romero, J.2; Jimenez, E.2; Garcia, L.2; Garcia, E.3; Leibar, A.4; Rodriguez, A.2 1 Hospital 12 de Octubre, Urology, Madrid, Spain; 2Hospital 12 de Octubre, Madrid, Spain; 3Hospital Clinic, Barcelona, Spain; 4Hospital Galdakao, Spain

4

Hatzimouratidis, K. ; Büttner, H. ; Buvat, J. ; Vendeira, P. A. ; Moncada, I.5; Böhmer, M.6; Henneges, C.2; Boess, F.7 1 Aristotles University, 2nd Department of Urology, Thessaloniki, Greece; 2 Lilly Deutschland GmbH, Bad Homburg, Germany; 3Centre ETPARP, Lille, France; 4Saúde Atlântica, Porto, Portugal; 5Hospital La Zarzuela, Madrid, Spain; 6Diabetological Practice, Warburg, Germany; 7Lilly Deutschland GmbH, Medical Department, Bad Homburg, Germany Objective: To compare the impact of initiating treatment with the PDE5 inhibitor tadalafil once a day (OaD), on demand (PRN, pro re nata) or sildenafil citrate (sildenafil) PRN on sexual self-confidence, spontaneity, and other outcomes in men with erectile dysfunction (ED) naïve to PDE5 inhibitors. Methods: In this multicenter, open-label study (NCT01122264), 770 men (≥18 yrs) with ED were randomized to initiate PDE5 inhibitor treatment with tadalafil 5 mg OaD (N = 257), tadalafil 10 mg PRN (N = 252), or sildenafil 50 mg PRN (N = 261). A 4-week treatment-free run-in period was succeeded by 8 wks on randomized treatment (dose adjustment possible) and 16 wks of pragmatic treatment allowing men to switch PDE5 inhibitor according to efficacy, tolerability, and personal preference. Primary outcome was treatment adherence. Secondary outcomes included sexual self-confidence and spontaneity domains of the Psychological and Interpersonal Relationship Scales (PAIRS). Changes from baseline to end of randomized treatment were estimated by ANCOVA. The global assessment question 1 (GAQ1) “Has the treatment you have been taking during this study improved your erections?” was analyzed by logistic regression for the overall study period. Results: Mean changes[SE] in the PAIRS sexual self-confidence domain were statistically significantly higher for tadalafil OaD (0.90[0.048]) and PRN (0.93[0.050]) compared to sildenafil (0.73[0.049]; p = 0.006 and p = 0.001 respectively). Improvements in the spontaneity domain were statistically significantly higher for tadalafil OaD (0.11[0.035]) or PRN (0.13[0.035]) compared to sildenafil (0.02[0.035]; p = 0.044 and p = 0.010 respectively). GAQ1”Yes” responses at the end of study (tadalafil OaD 219, 90.5%; PRN 218, 91.6%; sildenafil 203, 85.7%) did not differ significantly between groups (p = 0.052). Conclusion: Patients initiating treatment with tadalafil OaD or PRN experienced similar improvement of erection, but greater improvements in sexual self-confidence and spontaneity compared to sildenafil PRN, suggesting psychological benefits of the long-acting PDE5 inhibitor tadalafil. Policy of full disclosure: KH has served as speaker for Eli Lilly. JB has received honorary as scientific advisor for Eli Lilly and has been clinical trial investigator for trials sponsored by Eli Lilly, BayerSchering, Boehringer Ingelheim, and Janssen-Cilag. IM has served as scientific advisor and speaker for Janssen-Cilag, Eli Lilly and Co., Bayer-Schering; and has received research grants from Pfizer. IM, KH, MB and PV have been clinical trial investigator for trials sponsored by Eli Lilly. HB, CH and FB are employees of Eli Lilly and Company; HB and FB also own Lilly stock.

Objective: Our main objective in this study is to detect which are currently the most common errors in the administration of iPDE5s in our healthcare area and secondly to evaluate what percentage of patients can be recovered for therapy with iPDE5s, depending of the −5PDE the patient is using. Methods: Between January 2009 and June 2010, 250 patients considered as non responders to iPDE5s, and remitted to evaluate a second therapeutic strategy were included consecutively in the study. Erectile function was evaluated administering the IIEF-5. 1. Evaluation of the correct administration of the drug: a non validated questionnaire, consisting of 6 questions, was completed. 2. Evaluation of patients recovered for therapy with iPDE5: In those individuals where an alteration in the patterns of administration was detected, a personalized consultation was realized to highlight the aspects in need of correction. They were reevaluated two months later. Results: 69% (172) of patients had committed at least one deviation from the theoretical best conditions of the drugs application. For each question were: Q1: 3%; Q2: 33%; Q3:31%; Q4:22%; Q5:17%; Q6:41%. Without differences between the three available PDE5i. After reeducation in the second interview, 33% decline to continue for several reasons. Of the remainning 67%, 23.5% showed no improvement of reeducation, and 76.5% did. Global improvement on IIEF-5 was 9.8 points for this group, independently of the i5PDE. Conclusion: In our institution, 2/3 of the patients sent to try a second line treatment for ED were not taking the PDE5i under optimal conditions. According to this study, near 60% of the patients classified as non-responders can be rescued to the therapy with PDE5i, independently of the PDE5i. Policy of full disclosure: None.

HP-04-006

USAGE OF ANGIOTENSIN CONVERTING ENZYME INHIBITOR LISINOPRIL IN THE TREATMENT OF HYPERTENSIVE PATIENTS WITH ERECTILE DYSFUNCTION Gorpynchenko, I.1; Romaniuk, M.2; Gurzhenko, J.1; Kornienko, A.1; Gurzhenko, A.1 1 Institute of Urology, Kiev, Ukraine; 2Kiev, Ukraine Objective: Currently, angiotensin converting enzyme (ACE) inhibitors are the drugs of “choice” in the treatment of arterial hypertension (AH), especially in patients with an actual current sexual function. The aim of this study was to learn the impact of ACE inhibitor Lisinopril on the erectile function of patients with AH. Methods: The study included 108 patients with stage II AH, aged 45–68 years. While Lisinopril treatment patients described their sexual function by the mean of questionnaire IIEF, and the use of the drug led to some improvement of integrative parameters characterizing the sexual sphere patient. Results: After 3 weeks of Lisinopril taking the blood pressure returned to normal in 97 patients (89.8%). The daily dose was 10 mg in 66 patients, 20 mg–in 31. In 11 patients blood pressure on monotherapy with lisinopril reduced by 10–15% and did not reach the target range. Thus, taking Lisinopril was effective in 62 (89.8%) patients, suggesting high antihypertensive efficacy. Mean systolic blood pressure decreased from 161.0 ± 13,2 to 133.5 ± 9.4 (p < 0.05), diastolic blood pressure– from 98.2 ± 8.9 to 78.2 ± 5.4 (p < 0,05). Indicator “erectile function” of IIEF has increased from 10,44 ± 0,57 to 16,27 ± 0,42 (p < 0,01), «satisfaction with sexual intercourse” from 6,98 ± 0,25 to 10,55 ± 0,44 (p < 0,05), “orgasm”–from 5,21 ± 0,32 to 6,11 ± 0,37 (p < 0,05), “overall

J Sex Med 2012;9(suppl 5):336–356

346 satisfaction”–from 4,02 ± 0,27 to 6,33 ± 0,36 (p < 0,01), “libido”–from 7,12 ± 0,39 to 11,74 ± 0,87 (p < 0,01). Side effects were noted only by 12 (11.1%) patients, none of them refused further treatment. Conclusion: According to the researcher, the drug produces excellent results in 47 (43.6%), good–in 21 (19.4%), satisfactory–in 32 (29.6%) and unsatisfactory–in 8 (7.4%) of 108 patients. Policy of full disclosure: None.

Highlighted Poster Tours Saturday, 8 December 2012 11.00–11.30 Upper Lounge HP-05 Preclinical research II Chairs: M. Mas, Spain S. Ückert, Germany HP-05-001

HP-04-007

EFFECT OF SARM + TADALAFIL IN MEN WHO DEMONSTRATE AN INCOMPLETE RESPONSE TO TADALAFIL ALONE FOR TREATMENT OF ERECTILE FUNCTION: A SINGLE-BLIND TADALAFIL LEAD-IN, DOUBLE-BLIND RANDOMIZED, PARALLEL, CONTROLLED STUDY Benson, C. T.1; Beardsworth, A.1; Gomez, E.1 Lilly Research Laboratories, Indianapolis, USA

1

Objective: To assess the efficacy of a selective androgen receptor modulator (SARM) LY2452473(LY)+tadalafil when taken once daily over 12 weeks compared to tadalafil alone in improving the erectile function (EF) of men who incompletely respond to tadalafil alone, as measured by the Erectile Function (EF) Domain of the International Index of Erectile Function (IIEF). Methods: Study GPEC was a Phase 2 multicenter, outpatient, singleblind tadalafil lead-in, double-blind randomized, parallel, controlled clinical trial. Male subjects, 45–70 years of age, with an IIEF-EF domain score of 6 to 25 after 28 days of lead-in tadalafil 5 mg daily (baseline) were randomly assigned to 1 of 5 treatment groups (LY 1 mg+tadalafil 5 mg, or LY 5 mg+tadalafil 5 mg, tadalafil 5 mg, tadalafil 10 mg, and LY 5 mg) in a 3:3:3:3:2 ratio for a 12-week double-blind treatment period followed by a 4-week drug free follow-up period. Randomization was stratified by IIEF score and testosterone levels. Approximately 50% of subjects randomized were required to have had a total serum testosterone level <300 ng/dL obtained at screening. Results: Of 894 screened patients, 531 entered the lead-in period, 410 were randomized and 341 completed the study. At 12 weeks, the least square mean treatment differences change from baseline of the IIEF-EF domain of either combination (LY+tadalafil 5 mg) group compared to tadalafil 5- or 10-mg group were not statistically significantly different (p > .10)[see table below]. Evaluation using subgroups based on baseline total testosterone level (<300 ng/dL, ≥300 ng/dL) was supportive of the primary analysis. Eleven patients (2.7%) discontinued due to treatment-emergent adverse events. Four patients had at least 1 serious adverse event, one of which resulted in death (considered related to LY 5 mg therapy by investigator). Conclusion: In men with erectile dysfunction who have an incomplete response to daily tadalafil alone, the combination of a SARM LY+tadalafil for 12 weeks did not improve EF versus daily tadalafil alone. Policy of full disclosure: Charles Benson is an employee and stockholder of Eli Lilly and Company.

SYNERGISTIC EFFECTS OF BAY-604552 AND VARDENAFIL ON RELAXATION OF CORPUS CAVERNOSUM TISSUE OF PATIENTS WITH ERECTILE DYSFUNCTION AND CLINICAL PDE5-INHIBITOR FAILURE Albersen, M.1; Linsen, L.2; Tinel, H.3; Sandner, P.3; Van Renterghem, K.2 University Hospitals Leuven, Experimental Urology, Belgium; 2Jessa Hospital, Hasselt, Belgium; 3Bayer AG–Bayer Healthcare, Wuppertal, Germany

1

Objective: Overall efficacy rates of phosphodiesterase 5 inhibitors (PDE5-i) for erectile dysfunction (ED) are 60–70%. PDE5-i treatment failures currently have to resort to invasive treatment options for restoration of erectile function. This study aims to assess changes in the nitric oxide-cyclic (NO)/ cyclic guanosine monophosphate (cGMP)/ protein kinase G (PKG) pathway in human corpus cavernosum (HCC) of PDE5-I nonresponders compared to healthy controls. To evaluate the effects of BAY 60–4552, a stimulator of soluble guanylate cyclase (sGC), and vardenafil on relaxation of HCC strips from PDE5-I nonresponders. Methods: HCC tissues were harvested after consent from individuals undergoing penile prosthesis implantation (patients) and potent patients undergoing transurethral surgery (healthy controls, needle biopsy). HCC tissues of patients were compared to those of healthy controls for the expression of mRNA coding for PDE5A, eNOS, PKGα1, PKG2, sGCα1, sGCα2, sGCβ1, sGCβ2, α-smooth muscle actin (aSMA) and β-actin by quantitative polymerase chain reaction (qPCR). The respective proteins were localized using immunofluorescence. Tissue strips of patients were precontracted with phenylepinephrine followed by incubation with 1 μM of either vardenafil or BAY 60–4552, or both simultaneously. Outcomes were measured by mRNA expression, morphological localization of the NO/cGMP/ PKG pathway, and relaxant capacity of both compounds alone or combined. ANOVA, T-test or Mann-Whitney test based upon number of groups and normality of data. Results: The main targets in the NO/cGMP/sGC pathway were downregulated in PDE5-i non responders, while aSMA levels were not diminished. The pathway was morphologically located to HCC smooth muscle. BAY 60–4552 and Vardenafil have synergistic effects on relaxation of HCC of PDE5-i nonresponders. Conclusion: Despite downregulation of the NO/cGMP/PKG pathway, combining BAY 60–4552 with Vardenafil significantly enhanced relaxation HCC strips of PDE5-i non-responders. Policy of full disclosure: Hanna Tinel and Peter Sandner are employees of Bayer Pharma AG – Bayer HealthCare Global Drug Discovery.

HP-05-002

THE DOSE-DEPENDENT EFFECTS OF NEW HERBAL FORMULA (KBMSI-2) ON PENILE ERECTION AND EXPRESSION OF NITRIC OXIDE SYNTHASE ISOFORMS IN RAT MODEL OF TYPE 1 DIABETES COMPARED WITH PHOSPHODIESTERASE 5 INHIBITOR Bae, W. J.1; Choi, Y. S.2; Bae, J. H.2; Kim, S. J.2; Cho, H. J.2; Hong, S. H.2; Lee, J. Y.2; Hwang, T.-K.2; Kim, S. W.2 1 Seoul St. Mary’s Hospital, Urology, Republic of Korea; 2Seoul St. Mary’s Hospital, Republic of Korea Objective: This study aimed to investigate whether the herbal formulations (KBMSI-2) can improve the erectile dysfunction in diabetes mellitus compared with phosphodiesterase 5 (PDE5) inhibitors.

J Sex Med 2012;9(suppl 5):336–356

347

Highlighted Poster Tours Methods: Forty eight Sprague-Dawley male rats were randomly divided into six groups; control (n = 8), diabetes (DM) (n = 8), DM + KBMSI-2 50 mg/kg treatment (n = 8) groups, DM + KBMSI-2 100 mg/kg treatment (n = 8) groups, DM + KBMSI-2 200 mg/kg treatment (n = 8) groups, DM + tadalafil 2 mg/kg treatment (n = 8) groups. The DM induced groups received a single intraperitoneal injection of streptozotocin (STZ). 4 weeks after treatment, erectile function was assessed by intracavernosal pressure (ICP) and mean arterial pressure (MAP) measurement. Serial sections of the penis were used to perform Masson’s trichrome stain. We analyzed the expression of nitric oxide synthase (nNOS, eNOS) and cGMP concentration in the isolated corpus cavernosum by western blotting. Results: Peak ICP/MAP ratio was significantly increased in high-dose (200 mg/kg) KBMSI-2 treatment group and tadalafil treatment group compared with DM untreated group (P < 0.05). Masson’s trichrome staining confirmed that the smooth muscle component was increased in tadalafil treatment group compared with DM untreated group. The expression of nNOS, eNOS and the levels of cGMP were increased in the KBMSI-2 treatment groups and tadalafil treatment group by dose-dependent manner. Conclusion: This study showed that herbal formula of KBMSI-2 improved the erectile function in dose-dependent manner by preserving the smooth muscle content and inhibiting the fibrosis of the corpus cavernosum in streptozotocin-induced diabetic rat model. Policy of full disclosure: None.

HP-05-003

ERECTILE DYSFUNCTION SECONDARY TO RADICAL PROSTATECTOMY IN HUMANS IS RELATED TO SELECTIVE IMPAIRMENT OF NITRERGIC RESPONSES IN CORPUS CAVERNOSUM WHILE ENDOTHELIAL FUNCTION IS PRESERVED Angulo, J.1; Martínez-Salamanca, J. I.2; La Fuente, J. M.3; Fernández, A.4; Martínez-Salamanca, E.4; Cardoso, P.5; Cuevas, P.4 1 Hospital Ramón y Cajal-IRYCIS, Histologia-Investigación, Madrid, Spain; 2 Hospital Puerta de Hierro, Madrid, Spain; 3Hospital Santo Antonio, Porto, Portugal; 4Hospital Ramón y Cajal-IRYCIS, Madrid, Spain; 5Hospital Amadora-Sintra, Lisboa, Portugal Objective: Despite the advent of nerve sparing techniques a significant percentage of men continue to suffer from erectile dysfunction (ED) following radical prostatectomy (RP). Alteration of cavernosal tissue subsequent to RP has been postulated but functional evaluation of human erectile structures is lacking. The aim of this work was to evaluate the impact of RP on endothelial and neurogenic responses of human corpus cavernosum (HCC) and penile resistance arteries (HPRA). Methods: HCC strips and HPRA were obtained from organ donors without notice of ED (No-ED) and patients with ED who gave informed consent at the time of penile prosthesis implantation. ED patients were segregated depending on ED etiology: secondary to RP (ED-RP, average time from RP 4.3 years) or due to other causes (EDnoRP, mainly vasculogenic). HCC and HPRA were mounted in organ chambers and microvessel myopraphs, respectively. Results: Endothelium-dependent relaxations to acetylcholine (ACh) were significantly impaired in HCC and HPRA from ED-noRP patients while these responses in ED-PR patients were not different to those in patients without ED (Table). Interestingly, although adrenergic contractions induced by electrical field stimulation (EFS) in HCC are small with respect to other contractile stimuli, these responses were potentiated in HCC from both ED-RP and ED-noRP (Table). In contrast, a marked reduction of nitrergic relaxation of HCC in ED-RP patients with respect to the other groups was manifested (Table). Conclusion: In erectile tissue from patients with ED secondary to RP, endothelial function is preserved, adrenergic system is potentiated and nitrergic function is selectively degenerated. The knowledge of functional impact of RP in erectile tissue is necessary to develop therapeutic strategies and to re-target adequate prophylactic approaches. Policy of full disclosure: None.

HP-05-004

INFLUENCE OF BARIATRIC SURGERY ON THE MORPHOLOGIC AND BIOCHEMICAL CHARACTERISTICS OF CORPUS CAVERNOSUM IN THE TYPE 2 DIABETIC RAT Choi, Y. S.1; Bae, W. J.1; Bae, J. H.1; Kim, S. J.1; Cho, H. J.1; Hong, S.-H.1; Lee, J. Y.1; Hwang, T.-K.1; Kim, S. W.1 1 The Catholic University of Korea, Seoul, Republic of Korea Objective: The incidence of erectile dysfunction(ED) induced by type 2 diabetes mellitus(T2DM) has been growing as the increasing number of people with T2DM caused by insulin resistance which is related with obesity. Recently, bariatric surgery was introduced one of the effective treatment options for obesity related T2DM. However, the effect of bariatric surgery on the erectile function is lacking. So, we studied the morphologic and biochemical characteristic of corpus cavernosum in OLETF rat undergone bariatric surgery. Methods: OLETF (n = 15) male rats were assigned to 2 groups: Group I (undergone sham operation, n = 5) and Group II (undergone gastric bypass surgery, n = 10). At 4-week operation, intraperitoneal glucose tolerance test (IPGTT) was performed. Histologic evaluation of corpus cavernosum was done by H&E and Masson’s trichrome staining at 4-week operation In addition, western blot analysis of eNOS, nNOS and Rho kinase were done in corpus cavernosum. The level of 8-OHdG was measured in corpus cavernosum. Results: The body weight of Group II was lower than Group I, however, there was no significance. The IPGTT of Group II was also lower than Group I and the significant differences were observed only at 120 minutes after (222.5 ± 66.4 mg/dl vs 149.5 ± 10.9 mg/dl, p < 0.05). Significant higher smooth muscle/collagen ratio was observed in Group II (18.1 ± 15%) than Group I (39.1 ± 24%) (p < 0.05). The significant increased expressions of eNOS and nNOS were observed in Group II (p < 0.05). And significant decreased expression of Rho kinase was observed in Group II (p < 0.05) The 8-OHdG level of Group II was significantly decreased (p < 0.05). Conclusion: In this study, the body weight loss and improvement of blood glucose level, the morphological and biochemical improvement were observed after operation. We suppose that ED associated T2DM can be restored with the help of bariatric surgery. Policy of full disclosure: None.

J Sex Med 2012;9(suppl 5):336–356

348 HP-05-005

IMMUNOFLUORESCENT DETECTION OF RECEPTOR TIE1 IN ENDOTHELIUM OF CORPUS CAVERNOSUM OF AGED RAT AND HUMAN Fonseca, J.1; Tomada, I.2; Tomada, N.3; Almeida, H.1; Neves, D.1 Faculty of Medicine of Porto, Portugal; 2Faculty of Medicine of Porto, Dept. of Experimental Biology, Portugal; 3Urology of Hospital S. João, Porto, Portugal

1

Objective: Vasculogenic erectile dysfunction is an age-related vascular disease partially dependent on vascular growth factors availability and their specific endothelium receptors activation. Amongst them, angiopoietins-Tie2 system seems to be particularly dependent on aging, both in rat and in human corpus cavernosum (CC). Nevertheless, Tie1 role remains poorly understood. In the present study, we demonstrate the expression of Tie1 in the endothelium of CC in the aged Rat and Human. Methods: Twenty-five male Wistar rats were divided in five groups (n = 5) and sacrificed by decapitation when they reached the ages of study 6, 12, 18, 24 and 36 months. The penises were excised and immediately fixed in formalin solution. Human CC fragments were obtained from organ donors without known risk factors to ED and divided in two groups: young (16–35 years) and aged (59–74 years). Dual-immunolabeling of Tie1 and specific markers of endothelium and smooth muscle cell (PECAM1 and alpha-actin, respectively) was performed employing appropriate antibodies. Nuclei counterstaining was achieved with 4′-6-Diamino-2-phenylindole. Images were acquired in an Apotome microscope (Zeiss System, Göttingen, Germany). Results: Tie1 was detected in the endothelium in the CC of Rat, colocalizing with PECAM1. No co-localization with alpha-actin was observed. The intensity of Tie1 immunolabeling was higher in the older animals (24 and 36 months). Tie1 was also detected in Human CC endothelium, presenting an apparent up-regulation in samples obtained from older individuals. Conclusion: The present results demonstrate for the first time the expression of Tie1 in the endothelium of CC in Rat and Human, with an apparent age-dependent up-regulation. Further on course molecular studies will clarify this aspect. Policy of full disclosure: None.

HP-05-006

EFFICACY OF A NEW INTRAVAGINAL GEL, CONTAINING PURIFIED BOVINE COLOSTRUM, IN OVARIECTOMIZED RATS WITH VAGINAL ATROPHY Vailati, S.1; Melloni, E.2; Riscassi, E.3; Behr-Roussel, D.4; Sardina, M.2 Zambon S.p.A, Bresso (Milan), Italy; 2Zambon S.p.A, Bresso (Milan), Italy; 3 PRC s.r.l, Milan, Italy; 4Pelvipharm, Montigny-Le-Bretonneux, France

1

Objective: Vaginal dryness due to vaginal atrophy is a common complaint of postmenopausal women, interfering with sexual function and quality of life. The major hallmarks of vaginal atrophy are thinning epithelia and local blood flow decrease. Hormone replacement therapy (HRT) is the only effective therapy but with known risks that leave unmet medical needs. A new product containing purified bovine colostrum has been developed for the treatment of vaginal dryness secondary to vaginal atrophy. Aim of this study was to investigate the effects of gel application on vaginal atrophy in ovariectomized rats. Methods: Three weeks after ovariectomy, Sprague-Dawley rats were intravaginally treated twice-a-day for 4 weeks with gels at different colostrum concentrations. Vaginal blood flow variations after pelvic nerve stimulation were assessed by Laser Doppler Flowmetry and vaginal tissues were collected for histological assay. Results: Treatment with the product increased vaginal blood flow and thickness of vaginal epithelium compared to control group. After treatment with the gel containing 2.3% of colostrum, a statistically sig-

J Sex Med 2012;9(suppl 5):336–356

Highlighted Poster Tours nificant increase in vaginal blood flow parameters was observed: vascular capacitance, amplitude and AUC of the response (***p < 0.001, 2-way ANOVA). Vaginal epithelium showed a physiological oestrous cycle aspect in treated animals, with at least 5 cell layers, vs. 1 or 2 cell layers of epithelium of untreated animals. Gel application did not modify rat weights and uterine wet weights. Conclusion: The new vaginal gel containing colostrum improved vaginal hemodynamics and thickness of vaginal epithelium in rats with vaginal atrophy and could be considered a safe and effective alternative to HRT for the treatment of vaginal dryness and atrophy. Policy of full disclosure: S. Vailati, E. Melloni and M. Sardina are employees of Zambon S.p.A. and E. Riscassi is an independent consultant supporting Zambon S.p.A in the development projects.

HP-05-007

PROTEIN KINASE ENZYMES IN THE HUMAN VAGINA–RELATION TO KEY MEDIATORS OF THE CYCLIC AMP AND CYCLIC GMP PATHWAYS Ückert, S.1; Sonnenberg, J.2; Sonnenberg, J.3; Assadi-Pour, F.4; Hedlund, P.5; Kuczyk, M.2 1 Hannover Medical School, Department of Urology, Germany; 2Hannover Medical School, Germany; 3IBFA, Barsinghausen, Germany; 4FAPO GmbH, Hannover, Germany; 5University Vita Salute, Milano, Italy Objective: Aside from cAMP- and cGMP-degrading phosphodiesterase (PDE) enzymes, protein kinases (cAK = cAMP-binding protein kinase, cGK = cGMP-binding protein kinase) have also been identified important receptors for cyclic nucleotides. Although a significance of protein kinases in the control of the function of the male and female reproductive tract has been suggested, only a few approaches have addressed those enzymes in female genital tissues. The present study aimed to investigate in the human vagina by means of biochemical and immunohistochemical methods the expression and distribution of cAK and cGK. Methods: Cytosolic supernatants prepared from homogenized specimens of the human vaginal wall or epithelium were subjected to anion exchange chromatography and the activities of cAK and cGK(I) measured in the eluted volume. In order to evaluate the distribution of cAK and cGK(I) in relation to the vasoactive intestinal polypeptide (VIP), cyclic AMP PDE4 and calcitonin gene-related peptide (CGRP) in sections of the human vaginal wall (full wall specimens), immunohistochemistry (double-labelling technique) was commenced. Results: Distinct peaks of activities representing cGK(I) and cAK, respectively, were resolved from the DEAE column. The presence of cGK(I) or cAK protein in the volume fractions was verified by means of Western blot analysis. Immunostaining specific for cAK was identified in both vascular and non-vascular vaginal smooth musculature, immunoreactivity for cGK(Iβ) was observed in the smooth muscle and endothelium of small arteries interspersing the sections. cAK-positive vessels were found innervated by slender varicose nerve fibers presenting the expression of VIP and CGRP. These arteries also expressed PDE4. Conclusion: Our results demonstrate the expression and distribution of cAK and cGK in the human vagina. The localization in close relation to key mediators of the cAMP (PDE4, VIP) and cGMP (CGRP) pathways indicate that in human vaginal tissue both signalling systems may synergistically work together. Policy of full disclosure: None.

349

Highlighted Poster Tours

incision along the marks was made without cutting into the Corpus cavernosum. Instead of plicating with one suture for 4 dots, our modification uses one suture for two dots with the knot buried in a shallow trough created by a scalpel. Results: The average operation time was 64 minutes. We observed a loss of penile length in 30% of the patients (0.5–1 cm). There were no problems with erectile function. In a follow-up of 2 years, 90% of the patients remained without recurrence of deviation. None of patients reported problems with the suture knots. Conclusion: Our technique achieves penile straightening with minimal loss of length and no erectile dysfunction. Policy of full disclosure: None.

Saturday, 8 December 2012 11.00–11.30 Upper Lounge HP-06 Surgery Chairs: F. Fekete, Hungary P. Vendeira, Portugal HP-06-001

ROLE OF DYNAMIC PENILE DOPPLER ULTRASONOGRAPHY IN THE DIAGNOSTIC WORK UP OF PEYRONIE’S DISEASE: COMPARISON TO PATIENTS AT-HOME PHOTOGRAPHY 1

2

3

4

HP-06-003 5

Colombo, F. ; Franceschelli, A. ; Gentile, G. ; Vagnoni, V. ; Schiavina, R. Policlinico S. Orsola-Malpighi, Andrology Unit, Bologna, Italy; 2Andrology Unit, Bologna, Italy; 3School of Urology, Univ Bologna, Italy; 4School of Urology Univ Bologna, Italy; 5Urology Dept, Univ. Bologna, Italy

1

Objective: In order to evaluate the reliability of the at-home photography (AHP) of the penis in the assessment of Patients affected by Peyronie’s disease (PD), we compared the photographs provided by the patients with those obtained after intracavernosal injection of vasoactive agents (ICI), in outpatient setting. Methods: We retrospectively evaluated 56 consecutive patients who came at our outpatient department for Peyronie’s disease. At all patients was asked to provide AHP, according to Kelamy indications, of their most rigid erection and afterwards they all underwent penile dynamic Ultrasonography (PDUS) performed by the same operator. The reports of the PDUS have always provided informations on the sonographic characteristics of the disease as well as the haemodynamic evaluation of the penis (PSV, EDV). In case of not complete penile rigidity following ICI, a re-dosing has been always performed. The photography obtained after ICI was compared to that taken at home. Results: In 26/56 pts a re-dosing of PGE1 was performed to obtain complete rigidity. The average bending resulted of 32° at AHP and 44° after ICI. 36 pts (64%) showed complex deformity of the penis with curvature associated with a “ring” in the site of deformity. In these patients we pointed out the greatest difference between AHP and that performed during PDUS. The remaining 20 pts had simple curvature of the penis (dorsal or lateral); in 7 pts (35%) AHP underestimated the degree of curvature. Conclusion: Our data seem to support the ICI as mandatory to obtain reliable information on the actual deformation of the penis. The AHP often appears not representative of the real penile deformation, because it is usually obtained during conditions of incomplete penile rigidity. For these reasons, in patients with PD, the photographs of the penis should always been performed after ICI, in outpatient setting, especially in the case of surgical indication. Policy of full disclosure: None.

HP-06-002

THE “KIEL KNOTS” TECHNIQUE FOR TREATMENT OF CONGENITAL AND ACQUIRED PENILE DEVIATION Osmonov, D.1; Jünemann, K. P.1 University Hospital, Schleswig-Holstein, Kiel, Germany

1

Objective: We propose a surgical correction of the penile curvature applying a technique based on the 16-dot plication technique modified by burying the knots in a shallow trough of incised tunica. We entitle this modification the “Kiel Knots”. Methods: 20 patients with a penile deviation, average age 36.8 years (24–52) were operated. Follow-up time was 26 months. In 8 patients the deviation was congenital, in 12 patients it was an acquired deviation. The deviation was >30° in all patients. Surgical technique: A circumcising incision was made and the penis was degloved. Buck’s fascia was incised exposing the tunica albuginea opposite the curvature. 8 dots were marked bilaterally on the tunica albuginea and a 5 mm

RELEVANCE OF THE EVALUATION OF THE FEMALE FACTOR IN PEYRONIE’S DISEASE Peraza-Godoy, M. F.1; Rojas Cruz, C.2; Gonzalez, M.3; Sarquella, J.3; Paredes, V.3 1 C.Urología, Andrología, S.Sexual, U. Disfunción Sexual Femenina, Palma de Mallorca, Spain; 2Barcelona, Spain; 3Fundacio Puigvert, Barcelona, Spain Objective: The morphologic changes of the penis can cause sexual dysfunction. The impact of these changes in the couple can be important for success of treatments. The aim of this study is to inquire about feminine factors which are associated to Peyronie’s disease (PD). Methods: The couples of patients with PD which were referred for a first visit to the Andrology Department of the Fundació Puigvert from December 2010 to March 2011 were asked to fill out a form with questions about the feasibility of intercourse and the presence of penile curves, lack of rigidity, vaginal pain. Other questions were concerns about the illness of their couple, the cosmetic aspects, sexual satisfaction, treatments with vaginal lubricants and the relation with improvement of penetration. Results: 46 women completed the questionnaire, with a median age of 56 year. Half of them reported no impossibility for penetration. 56% informed that the lack of rigidity interfered with intercourse, 37% indicated the presence of both factors. 13% referred that the penile curvature was the only reason to make intercourse imposible. Vaginal pain during intercourse was present in 30%. 87% do not use lubricants, 84% had no genital local treatmentl, 91% were not concerned about the cosmetic aspect of the penis, 34% reported a moderate concern level with regard to the illness of their couple. 39% referred a satisfactory sexual life and 56% considered that the capability for penetration could improve with the use of lubricants. Conclusion: The capability of penetration of patients with PD could be evaluated with the couple since there are femenine factors which could be modified and which influence the decisions on treatment in a patient with PD. Policy of full disclosure: None.

HP-06-004

MULTI-INSTITUTIONAL STUDY TO EVALUATE PATIENT AND PARTNER SATISFACTION AFTER THE IMPLANTATION OF A THREE PIECE INFLATABLE PENILE PROSTHESIS (PP): TITAN® (COLOPLAST) VS 700CXTM (AMS) Rojas Cruz, C.1; Garcia, B.2; Romero, J.3; Fraile, A.4; Sarquella, J.5; Ruiz, E.6; Navio, S.4; Rodriguez, A.3 1 Barcelona, Spain; 2Hospital 12 de Octubre, Urology, Madrid, Spain; 3 Hospital 12 de Octubre, Madrid, Spain; 4Hospital Ramon y Cajal, Madrid, Spain; 5Fundacio Puigvert, Madrid, Spain; 6Fundacio Puigvert, Barcelona, Spain Objective: Most employed PP worldwide are 700CXTM and Titan®. Several works have analized physician, patient and partner satisfaction for each PP. Nowadays there is no evidence for the superiority of any of them. We compare patient and partner satisfaction for both PP.

J Sex Med 2012;9(suppl 5):336–356

350 Methods: Multi-institutional, prospective, non-radomized (patients received the PP available at the moment of the implant) study. 248 patients enrolled between January 2009 and January 2011, 194 700CXTM vs 54 Titan®. Both groups were homogeneous for age and risk factors. All institutions were homogeneuous for implant procedure and postop cares. Inclusion criteria: 1.Older than 18 y, 2.First PP implant, 3.No previous penile surgery, 4.No penile deformities, 5.Stable partner. To evaluate patient satisfaction a modified EDITS (Erectile Dysfunction Index of Treatment Satisfaction) questionnaire was administered at least 6 months after surgery. To evaluate partner satisfaction a 3 question, non-validated questionnaire was developed. Data was collected and analyzed in one institution. Results: There were significative statistical differences in 2 questions: 71% of 700CXTM were very satisfied with sexual intercourse and only 44% of Titan®. In adition, 62% of the patients with 700CXTM were satisfied with the deflate ease, but only 38% of Titan®. There were no significative differences between both PP for most questions. 65% of the patients were very satisfied with their sexual intercourse. 60% had satisfied their previous expectations. 31% were very unsatisfied with the length of the pennis. For 91% took less than 6 months to manage the PP and 64% were satisfied with the erected pennis apperance. In both cases partners were satisfied and would recommend the surgey again. Conclusion: 700CXTM and Titan® seem to be very similar for both patient and partner. The degree of satisfaction for both is high. Selfconfidence in the treatment they received is high. PP met the expectations of the patient prior to surgery. Policy of full disclosure: None.

HP-06-005

A PROSPECTIVE ANALYSIS OF SURGICAL OUTCOMES AND PATIENTS SATISFACTION RATE AFTER AMS SPECTRA PENILE PROSTHESIS IMPLANTATION Rolle, L.1; Ceruti, C.1; Sedigh, O.1; Timpano, M.1; Falcone, M.2; Gallletto, E.1; Destefanis, P.1; Preto, M.1; Gonella, A.1; Fontana, D.1 1 Molinette Hospital, Turin, Italy; 2Molinette Hospital, Urology 2, Turin, Italy Objective: From the beginning of 2010, the AMS Spectra penile prosthesis can be used to treat erectile dysfunction (ED). The Spectra is a non-inflatable concealable penile prosthesis composed of a pair of cylinders, each with a center malleable section of articulating polymer and metal segments. The aim of this paper is to evaluate the outcomes, the patient and their partner satisfaction on the AMS Spectra penile prosthesis implantation. Methods: 22 patients, unresponsive or non satisfied with i-pde 5 oral therapy or prostaglandin intracavernous injection, underwent to a Spectra penile prosthesis implantation. No major intraoperative neither postoperative complications were assessed. The preoperative ED was rated by the IIEF questionnaire. The etiology of ED was Peyronie’s disease (PD) in 17 patients (77%), post-radical prostatectomy (RRP) in 3 patients (14%) and PD+RRP in 2 more patients (9%). To evaluate the satisfaction score, patients and partners were evaluated by IIEF and EDITS questionnaires by a telephonic interview at 3, 6 and 12 months after penile surgery. Results: The study demonstrates that 86,4% of patients are longterm satisfied by the AMS Spectra penile prosthesis. The pre-operative average IIEF score was 28,5 [13–39]. Postoperative IIEF rates were respectively 47,7 [43–53], 51,8 [48–58], 53,9 [50–58] at 3, 6, 12 months. The patient average EDITS score was respectively 39,5 [31– 48]; 43,4 [36–50]; 45,2 [38–50] at 3, 6, 12 months. The increasing between preoperative and postoperative IIEF and EDITS parameters resulted statistically significant. Partners EDITS medium scores were respectively 14,9 [10–20], 16,7 [11–24], 17,8 [11–24] at 3, 6, 12 months. Conclusion: AMS Spectra is a reliable device to treat the erectile dysfunction.This prosthesis should be considered, in selected patients, as an affective solution to treat severe ED. Policy of full disclosure: None.

J Sex Med 2012;9(suppl 5):336–356

Highlighted Poster Tours HP-06-006

EVALUATION OF THE EXPERT PHYSICIAN SATISFACTION BETWEEN THREE PIECE INFLATABLE PENILE PROSTHESIS: 700CXTM (AMS) VS TITAN® (COLOPLAST) Romero, J.1; Garcia, B.2; Cruz, N.3; Fernandez, M.4; Martin, A.5; Lledó, E.6; Rojas, C.7; Rosello, M.8; Ruiz, E.7; Sarquella, J.7; Leibar, A.9 1 Hospital 12 de Octubre, Madrid, Spain; 2Hospital 12 de Octubre, Urology, Madrid, Spain; 3Hospital Virgen del Rocio, Sevilla, Spain; 4Hospital del Henares, Madrid, Spain; 5Hospital Carlos Haya, Malaga, Spain; 6Hospital Gregorio Marañon, Madrid, Spain; 7Fundacio Puigvert, Barcelona, Spain; 8 Clinica Rotger, Mallorca, Spain; 9Reisho, Galdakao, Spain Objective: Most employed PP worldwide are 700CXTM and Titan®. Few background exists about surgeon’s opinion and satisfaction. The Spanish association for men’s health (Reisho) have completed a study to compare expert surgeon feedback on both PP. Methods: A 14 questions non-validated questionnaire was administered to 10 expert surgeons to evaluate their feedback on: 1.Ease of implantation, 2.Ease of use, 3.Penile morphological aspect, 4.Patient satisfaction, and 5.Expert satisfaction. 5 possible answers: 700CXTM much better, 700CXTM a little better; both very similar; Titan® a little better; and Titan® much better. Expert physician was considered when involved at least in the implant of 50 PP in the previous 2 years, at least 15 of each type. Questionnaire was returned anonymously. Data was collected at one institution. 9 experts returned the questionnaire. Results: The agreement degree between the 9 experts was very poor, the Kappa was 0,037. Category 5 was never elected. Higher agreement found with category 2 (K: 0.078) and 3 (K: 0.079). 1.Initial management of the PP; cylinders and pump implant were very similar. Implant of the reservoir was easier with 700CXTM. 2.Initial manage of the PP, management of the pump and training period was easier with 700CXTM. However, global management by the patient was for 8/9 very similar. 3.Penile appearance and rigidity was very similar or a little better with Titan®. 4.For 5/9 very similar, 1/9 much better 700CXTM, 1/9 little better 700CXTM and 1/9 little better Titan®. 5.For 4 very similar, 1 much better with 700CXTM, 2 little better 700CXTM and 2 little better Titan®. Conclusion: Experts’ opinion seems to be very heterogeneous for both PP. Most important differences have been observed for: 700CXTM seems to be easier to implant and to manage by the patient. Titan® achieves better penile appearance and rigidity. Patient and physician satisfaction seems to be very similar with both types. Policy of full disclosure: None.

HP-06-007

DISTAL SHAFT RECONSTRUCTION FOR SEVERE CASES OF PENILE PROSTHESIS EXTRUSION OR CORPORAL FIBROSIS Egydio, P. H.1; Kuehhas, F.2 Specialized Centre of Penile C., Sao Paulo, Brazil; 2Medical University of Vienna, Urology, Austria 1

Objective: Distal penile prosthesis reconstruction for extrusion or corporal fibrosis is a challenging procedure. The objective of this study is the description of a new method for distal corpora cavernous reconstruction with mesh and penile prosthesis implantation. Methods: Sixty-five patients were submitted to distal shaft reconstruction with polypropylene mesh. The mean age was 56 ± 9.2 years (range, 38–69). The neurovascular bundle was dissected until the tip of the glans. Two longitudinal incisions on tunica albuginea and corpora cavernosa dissection were performed. A distal corpora cavernosa cap was created with the polypropylene mesh, the cylindersinflatable or malleable- were put on place and the tunica albuginea was closed. A urethral reconstruction was needed in 4 cases associated with distal shaft reconstruction. In these cases a cystostomy tube was maintained for 3 to 4 weeks. Retrograde and voiding cystogram were per-

351

Highlighted Poster Tours formed before removal of the cystostomy tube. The mean follow-up time was 17.9 ± 9.6 months (range, 6–40). Results: No extrusion, infection, retraction or skin dehiscence was observed. The glans sensation, orgasmic ability, and ejaculation were preserved. Sexual intercourse was restored and patients referred satisfaction and recovered self-esteem. Conclusion: Distal shaft reconstruction with mesh is a safe and valid option for difficult cases of distal penile prosthesis reconstruction for extrusion or corporal fibrosis- even in cases associated with concomitant urethral reconstruction and concomitant penile prosthesis implantation. Policy of full disclosure: None.

Saturday, 8 December 2012 15.30–16.00 Upper Lounge HP-07 Women’s sexual health: Miscellaneous Chairs: S. Cacioppo, Switzerland E. Bragagna, Austria HP-07-001

A NEW DEVICE FOR SIMULTANEOUS MEASUREMENT OF PELVIC FLOOR MUSCLE ACTIVITY AND VAGINAL BLOOD FLOW: A TEST IN A NON-CLINICAL SAMPLE Both, S.1; Van Lunsen, R.2; Weijenborg, P.3; Laan, E.2 Leiden University Medical Center, Psychosomatic Gynecology, Netherlands; 2 Amsterdam Medical Center, Netherlands; 3Leiden University Medical Center, Netherlands

1

Objective: Dyspareunia in women, a persistent or recurrent genital pain associated with sexual intercourse, is hypothesized to be related to (fear associated) pelvic floor hyperactivity, and to diminished sexual arousal. Psychophysiological research to support these hypotheses is scarce, and concentrates mostly on the role of either pelvic floor activity or sexual arousal. To investigate both factors a measurement device that enables simultaneous assessment of pelvic floor muscle activity and genital sexual arousal would be most optimal. The aim of this study was to test a new vaginal device–a vaginal photoplethysmograph with build-in surface electromyography (EMG)–that allows simultaneous assessment of pelvic floor muscle activity and vaginal blood flow. Methods: 36 sexually functional women participated. To investigate the accuracy of genital arousal measurement and the sensitivity of the device for involuntary changes in pelvic floor activity, vaginal pulse amplitude (VPA) and vaginal surface EMG were monitored during exposure to sexual and anxiety-evoking film clips. In addition, vaginal surface EMG was monitored during voluntary flick and 3-second hold contractions. Results: VPA increased in response to the sexual film, and EMG values were significantly higher in response to the anxiety-evoking film. Higher EMG values in response to the anxiety film were associated with lower VPA. EMG during the instructed 3-second hold pelvic floor contractions showed, as expected, higher values during pelvic floor contractions with support of surrounding muscle groups, compared to pelvic floor muscles alone. Conclusion: The device is sensitive to changes in vaginal blood flow in response to sexual stimuli, and it is able to pick up small, involuntary changes in pelvic floor activity associated with anxiety. Also, the device is able to record changes in pelvic floor activity during voluntary pelvic floor contractions. This new device will be a valuable tool in further research on superficial dyspareunia. Policy of full disclosure: None.

J Sex Med 2012;9(suppl 5):336–356

352

Highlighted Poster Tours HP-07-003

THE ROLE OF METABOLISM OF NITROGEN OXIDE IN DEVELOPMENT OF UROGENITAL DISORDERS AND WOMEN’S SEXUAL DYSFUNCTIONS IN POSTMENOPAUSE Romashchenko, O.1; Soloviev, A.2; Melnykov, S.3; Bilogolovskaya, V.3; Kislova, V.2; Shcherbak, M.3 1 Dept. of Andrology and Sexology, Institute of Urology of the Academy, Kyiv, Ukraine; 2SI Pharmacology and Toxicology, Kyiv, Ukraine; 3SI, Institute of Urology, Kyiv, Ukraine

HP-07-002

VULVODYNIA Kocur, D.1 Katowice, Poland

1

Objective: Vulvodynia is still a little known disease. Unfortunately, according to studies, over 12% of women are reported to suffer from it. Vulvodynia is a disease consisting in the painful sensation of various nature and intensity in the female genital area. Due to its chronic nature, the disease has a significant influence on the psychological situation of those suffering from it. The studies were aimed at determining vulvodynia’s impact on the psychological situation of the ailing women, their relationships with physicians, sexuality and checking the possible interdependence between vulvodynia and psychological gender. Methods: During the study the Multidimensional Sexuality Questionnaire (MSQ) by William Snell, the Sex Role Inventory (IPP) developed by A. Kuczy ska and the proprietary tool for assessing the psychological situation of women and the quality of physician-patient contacts were used. The study comprised 30 women suffering from vulvodynia proper or vestibulodynia and 30 women from a control group. The study was carried out over the Internet, for a lack of any other possibilities. Results: In the group of women suffering from vulvodynia, as expected, the women displaying feminine psychological gender prevailed. Women suffering from vulvodynia were in worse overall psychological situation and had worse contacts with physicians. The studied women had also a lower sexuality self-control, higher level of sexual anxiety before sexual intercourses and the fear of sexual relationships. At the same time the motivation to have sexual intercourses and external sexuality control was identical in the study and the control group. Conclusion: The problem of vulvodynia should be further studied as this disease really changes the life of many women. It is of crucial influence on sexuality, well-being, mood or self-assessment of the ailing. Unfortunately, they rarely get appropriate help. Henceforth, it is necessary to educate medical staff with respect to vulvodynia. Policy of full disclosure: None.

J Sex Med 2012;9(suppl 5):336–356

Objective: Evaluation of the role of nitrogen oxide (NO2) in development of urogenital disorders and women’s sexual dysfunctions in postmenopause. Methods: 440 women aged 42 to 63 with a menopause lasting 2 to 21 years have been examined. Concentration of NO2 was evaluated in protein-free extracts of vagina contents by means of a Griess reagent by spectrophotometric method. The level of total protein in samples was evaluated by Bradford method. Results: The average age of the examined was 54.8, beginning of menopause – 49.0, duration of menopause – 6.1. Atrophic vaginitis with dyspareunia was diagnosed in 26.7% of women with menopause duration of up to 3 years, 30.5% – up to 6 years, and 5% – over 6 years. Development of sexual dysfunctions and urogenital disorders was observed in women who had a menopause duration of up to 3 years with the level of NO2 metabolites in vagina contents of 25.1 ± 2.4 nM/mg of protein, up to 6 years – 19.8 ± 2.5 nM/mg of protein, and over 6 years – 9.8 ± 1.1 nM/mg of protein. In the course of treatment with vaginal application of medicines containing estriol, the women with urogenital disorders and menopause duration of up to 3 years showed an increase in 1.5 times of NO2 metabolites level in vagina contents, in 1.9 times – up to 6 years, and in 2.6 times – over 6 years, by the 21st day of observation. Conclusion: Development of urogenital disorders and sexual dysfunctions in the menopause was accompanied by decrease of NO2 production in the course of the menopause. Vaginal application of medicines containing estriol for women in postmenopouse fosters stabilization of metabolism of NO2 in vessels of urogenital tract by the 21st day of its use resulting in better blood supply in genitals, elimination of urogenital disorders, and sexual comfort. Policy of full disclosure: None.

HP-07-004

EVALUATION OF SEXUAL FUNCTION OF THE PREGNANT WOMEN Tosun Guleroglu, F.1; Gördeles Beser, N.2 Bozok University, Health School, Yozgat, Turkey; 2Nigde University, Turkey

1

Objective: This research was descriptively conducted in order to evaluate sexual function of the pregnant women. 306 pregnant women who came to Women Birth Policlinics of Bozok Women Birth and Child Diseases Hospital between the 1st October 2010 and 31st March 2011 were included in the study sample. Methods: The data were gathered using Personal Information Form and Female Sexual Function Index (FSFI) and Kruskall-Wallis Variance Analysis and Mann-Whitney U test were used for the statistical analysis. Results: It was found out that mean age of the pregnant women was 25.6 ± 5.4, mean marriage age was 19.6 ± 3.5 and their marriage length was 5.93 ± 5.4 years. It was found out that 88.9% of the pregnant women had sexual desire disorders, 86.9% had sexual arousal disorder, 42.8% had lubrication disorders, 69.6% had orgasm disorders, 48% had sexual satisfaction disorder and 61.4% had pain disorders. It was found out that there was a statistically significant difference between Female Sexual Function Index (FSFI) medians and age, educational level, economical status, the living-place, husband’s educational level, gestational week, whether or not the pregnancy was a desired one and the number of the pregnancy (p < 0.05). There was also a statistically

353

Highlighted Poster Tours significant difference between Female Sexual Function Index (FSFI) medians and backache, constipation, respiratory difficulty, leg ache and cramp problems (p < 0.05). Conclusion: As the result of the study, it was determined that such factors as advanced age, low educational status, insufficient economical status, undesired pregnancy, gestational week, high number of pregnancy and such problems as backache, respiratory difficulty, leg ache and cramp problems affect the sexual lives of the pregnant women negatively. Policy of full disclosure: None.

HP-07-005

SEXUAL FUNCTION AND DEPRESSION IN THE THIRD TRIMESTER OF PREGNANCY – PRELIMINARY RESULTS Ribeiro, M. C.1; Nakamura, M. U.2; Torloni, M. R.2; Scanavino, M. d. Tubino2; Mattar, R.2 1 São Paulo Federal University, Obstetrics, Brazil; 2São Paulo Federal University, Brazil Objective: To evaluate the prevalence and association between depression and sexual function in the third trimester of pregnancy. Methods: Cross-sectional study conducted between March and August 2012 at the antenatal clinic of a public Brazilian teaching hospital, with 30 healthy women in the third trimester (>28 weeks) of pregnancy. The Female Sexual Function Index (FSFI), a self-responsive questionnaire, was used to assess sexual function; women scoring < or = 26 were classified as having sexual dysfunction symptoms. The Beck Depression Inventory (BDI) was used to access depression symptoms and those scoring >21 were classified as having depression symptoms. Two samples Student’s t and Fisher’s exact tests were used to compare mean BDI scores and the prevalence of depressive symptoms in women with and without sexual dysfunction symptoms. P < 0.05 was considered significant. Results: Mean gestational age of the participants was 34.9 (+ 3.7 SD) weeks. A total of 17 women (56.7%) had sexual dysfunction symptoms. Women in this group had significantly higher scores on the depression test than women without sexual dysfunction symptoms (16.2 + 11.2 versus 7.7 + 5.1, respectively, p = 0.02), According to the BDI, 41.2% of the women with sexual dysfunction also had depressive symptoms, versus 0% of the women without sexual dysfunction symptoms (p = 0.01). Conclusion: There is a high prevalence of sexual dysfunction in healthy women in the third trimester of pregnancy and these women are significantly more likely to be depressed than those without sexual dysfunction symptoms. Policy of full disclosure: This study was funded by a grant from CAPES – Coordenação de Aperfeiçoamento de Pessoal de Nível Superior and FAPESP – Fundação de Amparo à Pesquisa do Estado de São Paulo. Process n. 12/03670–4.

Results: 72% of the participants agree that sex is an important aspect of the life. Only less than 50% was satisfied with their sexual life. The typical frequency of sexual engagement is 2–3 per week. Only 49% feel his or her sexual life various. 89% of the sample is confident how to have a happy and fulfilling sexual life, 94% confident how to protect himself or herself against STDs and AIDS. Sexual problems were rare, but 1,5% of these marriages were unconsummated. 82% think that society is more open to talking about sex. Conclusion: Society is believed to be more open in sexually meaning, but in some points of view a lot of taboo remains. Well-designed psycho-sexual education, adequate communication and socially responsible mass-media can improve sexual well-being. Policy of full disclosure: None.

HP-07-007

SEXUAL FUNCTION OF BRAZILIAN OVERWEIGHT PREGNANT WOMEN – PRELIMINARY RESULTS Ribeiro, M. C.1; Nakamura, M. U.2; Torloni, M. R.2; Scanavino, M. d. Tubino3; Mattar, R.2 1 São Paulo Federal University, Obstetrics, Brazil; 2São Paulo Federal University, Brazil; 3University of São Paulo, Brazil Objective: To evaluate and compare the sexual function of healthy normal weight and overweight pregnant women between 14 and 40 weeks. Methods: Cross-sectional study conducted between March and August 2012 at the antenatal clinic of a public teaching hospital, with 26 normal weight (BMI 18.5–24.9 Kg/m2) and 26 overweight (BMI > or = 25 Kg/m2) pregnant women. All participants were healthy at the time of the survey. The Female Sexual Function Index (FSFI), a selfresponsive questionnaire, was used. The Chi-square and Student’s t tests were used to compare categorical and continuous variables between the two groups. P < 0.05 was considered significant. Results: Main sociodemographic characteristics between the two groups were similar. Final FSFI scores were higher in normal weight women but differences did not reach statistical significance: 26.2 ± 8.3 vs 18.4 ± 11.3 in the second trimester, and 23.3 ± 6.8 vs 19.1 ± 8.8 in the third trimester, for normal weight vs overweight women, respectively. Scores for the desire domain were significantly higher in normal weight women in the second trimester (7.4 ± 1.8 vs 4.4 ± 2.5, p = 0.0028) but not in the third trimester (5.2 ± 1.5 vs 5.1 ± 2.4, p = 0.9697, for normal vs overweight, respectively). Conclusion: Totals sexual function scores did not differ significantly between normal and overweight women in the second or third trimesters of pregnancy. Desire was significantly lower in overweight pregnant women in the second trimester of pregnancy compared to normal weight women. Policy of full disclosure: This study was funded by a grant from CAPES–Coordenação de Aperfeiçoamento de Pessoal de Nível Superior and FAPESP – Fundação de Amparo à Pesquisa do Estado de São Paulo. Process n. 12/03670–4.

HP-07-006

SEXUAL LIFE DURING FAMILY PLANNING PERIOD Eros, E.1 1 O.K. Marketing+Consultant Kft., Budapest, Hungary Objective: Sexual well-being is a vital and very sensitive aspect of family planning. It means not only the contraception but so-called positive family planning, which is qualitative family planning method to prevent pre-term delivery and congenital anomalies. Methods: 250 couples visiting the Family Planning Department of National Institution of Child Health were asked about sexual behaviour. Mean age of the participants was 31.4 years, typical social economical sate was middle or higher class due to their higher responsibility for their planned children’s health. This fact can be a little distorting according to analysing the results. Otherwise, the sample is representative to the general population.

J Sex Med 2012;9(suppl 5):336–356

354 Saturday, 8 December 2012 15.30–16.00 Upper Lounge HP-08 Hormones Chairs: E. Amar, France E. García-Cruz, Spain HP-08-001

ANDROGEN DEFICIENCY IN AGING-MALE: RELATIONSHIP BETWEEN PLASMA TESTOSTERONE AND COMPONENTS OF METABOLIC SYNDROME Becerra, A.1; Menacho, M.2; Pérez-López, G.2; Villar, R.3; Rodríguez-Molina, J. M.2; Llopis, J. L.4; Asenjo, N.2; Lucio, M.2; Del Rey, J. M.2 1 Hospital Ramon y Cajal, Endocrinologia, Madrid, Spain; 2Hospital U. Ramón y Cajal, Madrid, Spain; 3Hospital U. Fuenlabrada, Spain; 4 Complutense University, Madrid, Spain Objective: Androgen deficiency in the elderly man is a subject of growing interest due to the aging population and the findings of different studies that show a progressive fall in serum testosterone in relation to age. These values were inversely correlated with some markers of metabolic syndrome (MetS) and cardiovascular disease. We analyze the relationship between blood levels of testosterone and other sex hormones and the different components of the MetS in a male population. Methods: We studied 143 consecutive men with MetS (ATP III criteria), age mean 61.8 years, ranged 42.3–84.4 y. We measured body weight, waist circumference and blood pressure, and determine serum glucose, insulin, lipid profile, total testosterone (TT), globulin sex hormones (SHBG), dehydroepiandrosterone sulfate (DHEA-S) and estradiol. The insulin resistance was calculated by HOMA index. Results: Our population has a clear androgenic deficit (TT < 230 ng/ dl) in 4/143 cases (4.9%) and partial androgen deficiency (TT 230– 350 ng/dl) in 44/143 cases (30.7%). We found a significant inverse correlation between the values of TT with the HOMA index (r = −0.293, p < 0.05) and waist circumference (r = −0.312, p < 0.05). Conclusion: Our findings show that in patients with MetS you can find different degrees of androgen deficiency, so the presence of hypogonadism should be sought systematically in this population. The decline of testosterone in these patients may be related to insulin resistance, and thus to the development of diabetes mellitus and cardiovascular disease. Policy of full disclosure: None.

HP-08-002

LONG-TERM TREATMENT OF MIDDLEAGED TO ELDERLY HYPOGONADAL MEN WITH TESTOSTERONE UNDECANOATE DOES NOT INDICATE AN INCREASED RISK OF PROSTATE CANCER Farid, S.1; Doros, G.2; Haider, A.3; Yassin, A.4 Bayer Pharma AG, Global Medical Affairs, Berlin, Germany; 2Biostatistics Consulting Group, Boston, USA; 3Private Urology Practice, Bremerhaven, Germany; 4Inst. of Urology and Andrology, Norderstedt, Germany

1

Objective: There are still concerns regarding the safety of testosterone treatment, particularly in elderly men. This study investigated whether men receiving long-term treatment with testosterone were exposed to a higher risk of prostate cancer. Methods: Registry studies of 516 hypogonadal men with from two urology offices in Germany. They received parenteral testosterone undecanoate for up to 60 months. Results: Prostate: In cohort A (Haider), PSA increased from 1.77 to 1.82 ng/ml (p < 0.0001). Prostate volume increased from 28.51 to 30.23 ml (p < 0.0001). 3/255 patients were diagnosed with prostate cancer following elevated PSA (>4 ng/mL) at 18 weeks of treatment.

J Sex Med 2012;9(suppl 5):336–356

Highlighted Poster Tours The proportion was 1.18% with an incidence of 30.334 per 10.000 patient years. In cohort B (Yassin), PSA increased from 0.86 to 1.41 ng/ ml (p < 0.0001). Prostate volume increased from 27.9 to 34.79 ml (p < 0.0001). 6/261 patients were diagnosed with prostate cancer. The proportion was 2.3% with an incidence of 54.5 per 10.000 patient years. All patients underwent radical prostatectomy. For comparison: in the PLCO trial with a 7-year follow-up, the proportion of prostate cancer was 7.35% with an incidence of 116 per 10.000 patient years [1], in the ERSPC trial with a 11-year follow-up, 9.6% and 96.6, resp [2]. The International Prostate Symptom score (IPSS) improved from 6.73 to 2.83 (p < 0.0001) in cohort A and from 10.35 to 6.58 (p < 0.0001) in cohort B. Residual bladder volume declined from 46.61 to 19.74 and 23.82 to 17.59, resp. Conclusion: The incidence of prostate cancer does not suggest an increased risk of prostate cancer in hypogonadal men on long-term testosterone treatment. Parameters related to BPH/LUTS suggest an improvement of clinical symptoms. Policy of full disclosure: Farid Saad is an employee of Bayer Pharma, manufacturer of testosterone products. Gheorghe Doros has received financial compensation for statistical services from Bayer Pharma. Ahmad Haider and Aksam Yassin have received speaker’s fees and travel grants from Bayer Pharma AG, Takeda Pharma, Ferring Pharmaceuticals, and GSK Pharma.

HP-08-003

INVESTIGATION ON PSYCHOLOGICAL SYMPTOMS IMPROVES ANDROTEST ACCURACY IN PREDICTING HYPOGONADISM IN SUBJECTS WITH SEXUAL DYSFUNCTION Rastrelli, G.1; Corona, G.2; Bandini, E.2; Strada, C.2; Maseroli, E.2; Ricca, V.2; Faravelli, C.2; Mannucci, E.2; Maggi, M.2 1 University of Florence, Clinical Physiopathology, Italy; 2University of Florence, Italy Objective: The role of psychological symptoms in recognizing lateonset hypogonadism (LOH) is still controversial. The aim of the study is to evaluate the association between LOH and specific psychological symptoms and to verify whether investigating intra-psychic domain improves the accuracy of a validated case-history tool (ANDROTEST) in detecting LOH. Methods: A consecutive series of 1009 subjects (mean age 49.23 ± 13.34) consulting for sexual dysfunction was studied. Intra-psychic symptoms were investigated by Middlesex Hospital Questionnaire (MHQ), a self-reported questionnaire for screening of mental disorders. Results: A minimum set of 2 MHQ items was identified through iterative ROC curve analysis, with assessment of sensitivity and specificity for hypogonadism (calculated free testosterone < 0.225 nmol/L) in an exploratory sample of 462 patients. Sensitivity and specificity were verified in a validation sample of 547 subjects, in which the final 2-item version showed an accuracy of 58,4 ± 3.2% in detecting hypogonadism. The combination of the 2-item score with ANDROTEST increased the accuracy in predicting hypogonadism (0.741 ± 0.029; p < 0.0001), when compared to ANDROTEST (0.696 ± 0.018; p < 0.0001) and the 2-item score (p < 0.05) alone. Conclusion: Combining these two psychological symptoms with a physical scoring system improves its ability in detecting hypogonadism. The combination of the scores should be tested in other studies. Policy of full disclosure: None.

355

Highlighted Poster Tours HP-08-004

EFFECTS OF MICROSURGICAL TESTICULAR BIOPSY ON SEXUAL FUNCTION Sofikitis, N.1; Dimitriadis, F.2; Giannakis, D.2; Baltogiannis, D.2; Tsounapi, P.3; Saito, M.3; Tomita, S.3; Dafnis, D.4; Giakoumakis, I.5; Takenaka, A.3 1 University of Loannina, School of Medicine/ Urology, Greece; 2University of Loannina, Greece; 3Tottori University, Yonago, Japan; 4Mediterranean Fertility Center, Chania, Crete, Greece; 5University of Crese, Chania, Crete, Greece Objective: We evaluated the influence of micorsurgical testicular biopsy (MTB) on erectile function in men with non-obstructive azoospermia (NOA). Methods: A number of 18 NOA-men underwent bilateral MTB. All men were evaluated with the International Index of Erectile Function-5 (IIEF-5) before and nine months after the MTB. In addition, preoperatively and nine months postoperatively peripheral serum hormonal profiles were evaluated. Results: There were no significant differences (p > 0.05; Wilcoxon test for paired observations) between preoperative and postoperative mean IIEF-5 score (18 ± 3 vs. 15 ± 3, respectively) and mean serum testosterone value (9.1 ± 2.9 ng/ml vs. 5.9 ± 2.6 ng/ml, respectively). Among the 18 NOA-men MTB procedures resulted in testicular sperm recovery in nine men. There was no significant difference in the mean preoperative IIEF-5 score between the subgroup of the nine NOA-men who were positive for testicular spermatozoa (group A), and the subgroup of the nine NOA-men who were negative for spermatozoa in the MTB material (group B). Similarly there was no significant difference in the mean IIEF-5 score postoperatively between group A and group B. Conclusion: MTB procedures in NOA-men do not appear to have a significant detrimental effect on erectile function and on peripheral serum testosterone levels nine months postoperatively. Policy of full disclosure: None.

HP-08-005

SIGNIFICANT NOCTURIA IS ASSOCIATED WITH TESTOSTERONE DEFICIENCY, INDEPENDENT OF AGE AND PROSTATE SIZE Yang, D. Y.1; Kim, J.2; Lee, S. W.3; Moon, D. G.2 Hallym University Medical Centre, Seoul, Republic of Korea; 2Korea University Guro Hospital, Seoul, Republic of Korea; 3Samsung Seoul Hospital, Republic of Korea

1

Objective: Nocturia significantly impairs quality of life and is commonly associated with aging and general factors associated with LUTS. Disrupted circadian rhythms have also been shown to affect serum testosterone levels. The current study aims to show an association between nocturia and testosterone deficiency. Methods: From July 2011 to July 2012, first time outpatient visitors seeking treatment for LUTS were given 3 day frequency volume charts and screened for testosterone deficiency in addition to basic LUTS workup. Nocturia factors were analyzed by nocturnal polyuria, decreased nocturnal bladder capacity and presence of OAB or global polyuria. Results: 545 patients with a mean age of 58.48 ± 12.58 years, had mean nocturia of 2.12 ± 1.17 per night. Mean testosterone levels were 4.92 ± 2.02 ng/dL. Multivariate linear regression models showed serum testosterone levels were significantly affected by age, BMI, as well as nocturnal polyuria index but not nocturnal bladder capacity index. Logistic regression showed testosterone deficiency showed significant risk associated with nocturnal polyuria but not other factors associated with nocturia. Conclusion: Nocturia is associated with decreased serum testosterone, independent of age and prostate volume. Policy of full disclosure: None.

HP-08-006

LOW-ENERGY/LOW-FAT DIET REVERSES METABOLIC SYNDROME-INDUCED CHANGES IN CAVERNOUS TISSUE OF AGED RATS Tomada, I.1; Almeida, H.2; Neves, D.2 Faculty of Medicine of Porto, Dep. of Experimental Biology, Portugal; 2 Faculty of Medicine of Porto, Portugal

1

Objective: Age-related diseases, as Metabolic Syndrome (MetS) and Erectile Dysfunction (ED), are associated with high-fat-diets(HFD) intake. However, the effects of Energy Restriction (ER) alone/or after a HF-feeding period on vascular aging is poorly understood. Considering that structural alterations in corpus cavernosum (CC) depend of nutritional pattern, we aimed to evaluate in what extent ER counteracts HFD effects on CC of aged rat. Methods: Male Sprague-Dawley rats were grouped according to diet: maintenance diet (4%-fat)(controls, C, n = 10), high-fat-diet (45%-fat) (HFD, n = 15), and energy-restricted (75% of controls)(ER, n = 10). All animals were maintained in the same diet protocol, except a group of 5 HFD rats that was subjected to ER from 12- to 18-months(HF/ ER). Biometric, biochemical and hormonal evaluation were performed. Five animals from each group were euthanized at 12- or 18-mo-old. Adipose tissue was weighted, and penises were excised and processed for α-actin imunodetection and Masson’s trichrome staining. Connective tissue (CT) and smooth muscle (SM) contents were evaluated by histomorphometry, followed by statistical analysis. Results: HF-diet consumption led to an increase in adiposity, hypertension, dyslipidemia and insulin resistance, conditions clustered in MetS that constitute independent risk factors for ED. Collagen deposition was also favored in HF-older-rats CC, but ER counteracted these outcomes (45.5 ± 2.7% vs 24.0 ± 3.5%, P < 0.05). ER after HF-diet (HF/ER) improved the cardiometabolic profile, and led to a notable attenuation of CC collagen deposition (15.9 ± 2.2%, P < 0.05) without change of SM content (8.0 ± 0.9%) comparatively to agematched HFD (10.4 ± 0.8, ns) and C animals (12.2 ± 1.2%, ns). Conclusion: HF-diet triggers MetS and produce unwanted effects on CC structure, compromising normal erectile function which are preventable upon a low-energy/low-fat regimen starting, ideally, early in life. Molecular studies are ongoing in order to strengthen these findings. Policy of full disclosure: None.

J Sex Med 2012;9(suppl 5):336–356

356 HP-08-007

IMPAIRED POSTPRANDIAL GLUCOSE BUT NOT IMPAIRED FASTING GLUCOSE IS ASSOCIATED WITH LOW SERUM TESTOSTERONE LEVELS Ho, C.-H.1; Yu, H.-J.2; Pu, Y.-S.2; Liu, S.-P.2 NTUH, Urology, Taipei, Taiwan; 2NTUH, Taipei, Taiwan

1

Objective: We aimed to investigate whether pre-diabetic states, impaired fasting glucose (IFG) and impaired glucose tolerance (IGT), are associated with androgen deficiency. Methods: The prospective cohort study includes 774 men (aged 41 to 86) undergoing screening androgen deficiency during 2009. Serum levels of total testosterone (TT), albumin, and SHBG were measured. Symptoms related to androgen deficiency were surveyed by ADAM questionnaire. Multivariate analysis using logistic regression was performed to assess the association between androgen deficiency and different pre-diabetes/diabetes, adjusted for age, body mass index, cholesterol, blood pressure, triglyceride, high density lipoprotein, and c-reactive proteins. Results: Forty-seven (6.1%) with history of diabetes were excluded from the analyses for relationship between androgen deficiency and glucose. Multivariate analyses revealed that impaired postprandial glucose, but not impaired fasting glucose or glycated hemoglobin, was associated with a lower serum TT level. The odds ratio was 1.573 (95%CI: 0.994–2.488) in postprandial glucose of 140–199 mg/dl and 2.378 (95%CI: 1.250–4.523) in postprandial glucose of >= 200 mg/dl. The p-value for trend was 0.011. Adjusted proportions of low TT

J Sex Med 2012;9(suppl 5):336–356

Highlighted Poster Tours levels in normal, isolated IFG, isolated IGT, combined IFG/IGT, newly diagnosed DM, and known DM groups were 13.6%, 13.0%, 19.1%, 42.9%, 30.0%, and 22.6% respectively (p = 0.018 by ANOVA). Conclusion: It has been suggested that IFG and IGT may represent different metabolic states of insulin secretion and/or sensitivity. They may belong to distinct metabolic disturbances or just represent two points of the same spectrum. Our data generally support the concept that IFG and IGT can be different with respect to not only the glucose metabolism but also the underlying mechanism contributing to the presentations. More researches are still required to elucidate the mechanisms linking abnormal glucose homeostasis and low serum testosterone levels. Policy of full disclosure: None.

357

POSTER PRESENTATIONS P-01

Male sexual health

P-01-001

NEW-ONSET ERECTILE DYSFUNCTION IS MORE FREQUENTLY COMORBID WITH PRIMARY HYPOACTIVE SEXUAL DESIRE IN YOUNG MEN Salonia, A.1; Ventimiglia, E.2; Colicchia, M.2; Capogrosso, P.2; Suardi, N.2; Ferrari, M.2; Castagna, G.2; Clementi, M. C.2; Matloob, R.2; Rigatti, P.2; Montorsi, F.2 1 University Vita-Salute San Raffaele, Urology, Milan, Italy; 2IRCCS San Raffaele, Milan, Italy Objective: To investigate sociodemographic and clinical predictors of the comorbid condition of new-onset erectile dysfunction (ED) and primary hypoactive sexual desire (HSD). Methods: Complete sociodemographic and clinical data from 790 consecutive patients seeking first medical help for new-onset sexual dysfunction were analysed. Health-significant comorbidities were scored with the Charlson Comorbidity Index (CCI). All patients completed the International Index of Erectile Function (IIEF) domains. ED severity was stratified according to the IIEF-erectile function (IIEF-EF) domain scores. Normality for sexual desire (SD), intercourse satisfaction (IS) orgasmic function (OF) and overall satisfaction (OS) domain scores was arbitrarily defined for values ≥ medians. Descriptive statistics and logistic regression models tested the association between ED+HSD and potential predictors. Results: New-onset ED as the primary disorder was found in 439 (55.6%) men; overall, primary HSD was reported by 48 (6.1%) patients. Of 790, 33 (4.2%) patients did complain of both ED and HSD. Patients with ED+HSD were younger (mean [SD] age: 47.4 [13.7] vs 51.0 [8.2] years; p = 0.02) compared to ED-only individuals. Conversely, no differences were found regarding CCI, BMI, rate of metabolic syndrome, hypogonadism, concomitant premature ejaculation or acquired penile deformity. Likewise, no differences were found in terms of sexual orientation, educational and relationship status, and recreational habits (ie, cigarette smoking, drugs). Rates of ED severity, normal IIEF-OF, -IS, and OS domain scores were comparable between ED only and ED+HSD patients. Men with ED+HSD had a lower IIEF-SD value [4.92 (1.83) vs 6.90 (2.15); p = 0.003] and IIEF-SD normality scores were reached in a lower proportion of men (chi2 7.02, p = 0.008) compared to patients with ED only. At multivariable analysis, patient age was the only variable associated with ED+HSD (OR: 0.90; p = 0.02). Conclusion: Primary HSD is more frequently comorbid with newonset ED in younger patients, irrespective of sociodemographic and clinical variables. Policy of full disclosure: None.

P-01-002

PATIENTS ATTITUDE ABOUT PDE5IS INFORMATION LEAFLET IN THE INTERNET ERA Salonia, A.1; Ferrari, M.2; Castagna, G.2; Clementi, M. C.2; Suardi, N.2; Capogrosso, P.2; Ventimiglia, E.2; Colicchia, M.2; Moretti, D.2; Rigatti, P.2; Montorsi, F.2 1 University Vita-Salute San Raffaele, Urology, Milan, Italy; 2IRCCS San Raffaele, Milan, Italy Objective: To assess patients attitude about patient information leaflet (PIL) of PDE5Is in the Internet era. Methods: The last 149 consecutive patients with erectile dysfunction (ED) who were non naïve for PDE5Is anonymously completed a selfadministered structured questionnaire including sociodemographic

data and questions about individual attitude about reading PDE5is PIL. Descriptive statistics and regression models tested the associations with patients’ attitude toward reading PIL. Results: Mean (median) age: 51.2 (54) yrs; range: 22–73. Of 149, 107 (71.8%) men did regularly surf the Internet. Overall, 63.8%, 22.8%, and 13.4% patients reported taking 1, 2 or all 3 available PDE5Is at least once, respectively. Of all, 85.2% patients read PDE5Is PIL; of them, 81.1% read PIL of all three compounds, 93% read PIL before taking the drug, and 84.3% specifically read about the potential treatment-emergent adverse events (AEs). Of all, 56.4%, 18.1%, 6.0% patients reported to read regularly, more than or less than 50% of the times PIL for other types of drug, respectively. A greater rate of patients who read PIL of other drugs (all categories) did also regularly read first PDE5Is PIL (chi2: 34.72; p < 0.001). At MVA, reading PIL of other drugs was the only independent predictor for reading PDE5Is PIL (OR: 23.96; p < 0.001); conversely any other sociodemographic variable was significantly associated. At UVA, reading the PDE5Is PIL before intake did not increase the probability of reporting AEs (OR: 1.25; p = 0.65); conversely, having any type of AEs increased the likelihood of subsequently reading PDE5Is PIL both at UVA (OR: 4.32; p = 0.008) and MVA (OR: 6.51; p = 0.003). Of all, 53.7% patients had received PDE5Is advertising through Internet. Only 1.3% individuals had purchased the drugs over the Internet. Conclusion: These findings suggested that patients consider PDE5Is seriously and not as purely recreational drugs. Policy of full disclosure: None.

P-01-003

HORMONAL ASSOCIATIONS AND SEXUAL DYSFUNCTIONS IN MALE PATIENTS WITH IMPAIRED FASTING GLUCOSE: A CROSSSECTIONAL AND LONGITUDINAL STUDY Corona, G.1; Rastrelli, G.2; Lotti, F.2; Forti, G.3; Maggi, M.2 Andrology Unit, Dept.of Clinical Physiopathology, Florence, Italy; 2Sexual Medicine and Andrology, Florence, Italy; 3Endocrinology Unit, Florence, Italy

1

Objective: The category of impaired fasting glucose (IFG) denotes a state of non-diabetic hyperglycemia, considered a risk factor for the further development of diabetes mellitus (DM) and cardiovascular (CV)diseases.The aim of the present study is to evaluate the impact of IFG on sexual health in men. In addition its effect on CV morbidity and mortality will also be addressed. Methods: A consecutive series of 3451 men (mean age 57.3 ± 10.1 years) attending our outpatient clinic for sexual dysfunction was retrospectively studied. A subset of this sample (n = 1687) was enrolled in a longitudinal study. Several clinical, biochemical (including testosterone) and instrumental (penile color doppler ultrasound; PCDU) factors were evaluated. IFG was defined by fasting glucose concentrations between 5.6 and 6.9 mmol/L (100–125 mg/dl). A higher threshold (6.1–6.9 mmol/L, 110–125 mg/dl) was also considered. Results: Among the patients studied, 747 (21.7%) had DM. In addition, 659 (19.1%) subjects were classified as IFG. Patients with IFG, however defined, more often had severe ED, reduced penile blood flow and overt hypogonadism when compared to patients with normal glucose levels. In addition, men with ED and IFG show poorer blood pressure and lipid profile with an overall increase in CV risk. Unadjusted incidence of major adverse CV events was significantly associated with baseline DM, whereas there was a trend toward higher risk also for IFG, but this did not reach statistical significance. Conversely, both IFG and DM were significantly associated with a higher risk of fatal and non fatal cerebral events. Conclusion: Checking glucose and testosterone levels is mandatory in subjects with ED, because testosterone substitution in impotent IFG subjects might not only ameliorate their sexual life but also their overall health. Policy of full disclosure: None.

J Sex Med 2012;9(suppl 5):357–397

358 P-01-004

INHIBITORS OF 5A-REDUCTASE-RELATED SIDE EFFECTS IN PATIENTS SEEKING MEDICAL CARE FOR SEXUAL DYSFUNCTION Corona, G.1; Rastrelli, G.2; Maseroli, E.2; Forti, G.3; Maggi, M.2 Andrology Unit, Dept.of Clinical Physiopathology, Florence, Italy; 2Sexual Medicine and Andrology, Florence, Italy; 3Endocrinology Unit, Florence, Italy

1

Objective: Despite their efficacy in the treatment of benign prostatic hyperplasia (BPH) the popularity of inhibitors of 5α-reductase (5ARIs) is limited by their association with adverse sexual side effects. However, the real impact of 5ARIs on sex hormones and sexual function is controversial. the aim of this study is to investigate the role of 5ARIs therapy on hormonal parameters and sexual function in men already complaining of sexual problems. Methods: A consecutive series of 3837 men (mean age 63.5 ± 12.8 years) attending our outpatient clinic for sexual dysfunction was retrospectively studied. Several clinical, biochemical and instrumental (penile color doppler ultrasound; PCDU) factors were evaluated. Results: Among the patients studied, 78.7% reported erectile dysfunction, 51.1% hypoactive sexual desire (HSD), 86.7% perceived reduced sleep-related erections (PR-SREs) and 19.1% premature ejaculation. The use of 5ARIs was associated with an increased risk of HSD and PR-SRs whereas no relationship was found with erectile dysfunction and ejaculation disturbances. Subjects using 5ARIs also more frequently had gynaecomastia along with reduced SHBG and higher calculated free testosterone levels. All these associations were confirmed in a case-control study comparing 5ARIs users with age-body mass index-smoking status and total testosterone matched controls. Conclusion: Our data indicates that use of 5ARIs in men with sexual dysfunction does not significantly exacerbate pre-existing ejaculatory or erectile difficulties, but can further impair their sexual life by reducing sexual drive and spontaneous erection. Policy of full disclosure: None.

P-01-005

EFFECTS OF ARGINASE INHIBITION ON THE CONTRACTION OF HUMAN SEMINAL VESICLE SMOOTH MUSCLE – AN IN VITRO APPROACH Saljoughi, A.1; Ückert, S.2; Kedia, G.3; Kuczyk, M.3 KRH GmbH, Siloah Hospital, Hannover, Germany; 2Hannover Medical School, Department of Urology, Germany; 3Hannover Medical School, Germany

1

Objective: Premature ejaculation (PE) is the most common sexual dysfunction in adult males. The stategies to target PE are still in a state of controversial discussion. The nitric oxide (NO)/cGMP system has been suggested to be involved in the control of human SV smooth muscle. Arginase enzymes (ArgE) are known to compete with the nitric oxide synthases (NOS) for the common substrate, the amino acid L-arginine. The activity of L-arginine-degrading ArgE may attenuate the relaxation of smooth muscle by reducing local production of NO. The aim of the present study was to elucidate the effects of drugs known to inhibit arginase activity on the contraction responses of isolated human SV smooth muscle. Methods: Using the tissue bath technique, the effects of the arginase inhibitors DFMO, H-Orn-OH, H-lle-OH and nor-NOHA (10 nM–10 μM) on the tension induced by norepinephrine (10 μM) and the spontaneous contractile responses of isolated human SV smooth muscle were investigated. The tissue was also exposed to different concentrations of the compounds (0,1 μM, 1 μM, and 10 μM) and the production of cAMP and cGMP determined. Results: The reversion of tension was 37 ± 15% (H-Ile-OH), 21,2 ± 20,8% (H-Orn-OH), 11,3 ± 15% (DFMO), and 0,94 ± 11% (norNOHA). These effects were not paralleled by an enhancement in the production of cGMP. However, a 1.4–fold to 1.7-fold increase in cAMP was noted in response to the DFMO and H-Ile-OH. No pro-

J Sex Med 2012;9(suppl 5):357–397

Poster Presentations nounced inhibition was observed of the frequency of the spontaneous phasic contractions. Conclusion: In vitro, there is limited efficacy of arginase inhibitors to antagonize the contraction of human SV smooth muscle. The effects of these drugs might become more pronounced when applied to tissue affected by a pathological condition, i.e. where the rate of L-arginine degradation is increased. Policy of full disclosure: None.

P-01-006

EFFECTS OF CASTRATION ON PITUITARYGONADAL AXIS IN FEMALE-TO-MALE TRANSSEXUALS TREATED WITH TESTOSTERONE Becerra, A.1; Menacho, M.2; Pérez-López, G.2; Villar, R.3; Lucio, M.2; Asenjo, N.2; Rodríguez-Molina, J. M.2; Llopis, J. L.4; Del Rey, J. M.2 1 Hospital Ramon y Cajal, Endocrinologia, Madrid, Spain; 2Hospital U. Ramón y Cajal, Madrid, Spain; 3Hospital U. Fuenlabrada, Spain; 4 Complutense University, Madrid, Spain Objective: Testosterone replacement therapy of male hypogonadism seeks the most appropriate dose to achieve more physiological blood levels. In female to male transsexuals (FtM) androgen treatment aims the elimination of female sexual characters and the development of those male, and blood levels of testosterone are difficult to predict. We analyze the effect of androgen treatment in FtM transsexuals on blood levels of testosterone and other hormones. Methods: In 48 consecutive FtM transsexuals (18 castrated and 30 non-castrated) after 32 (12–180) months of testosterone undecanoate treatment (1000 mg each 12 weeks, i.m.), we studied the pituitary and gonadal hormone profile. Results: Our findings show total testosterone values highly variable between 212 and 1,126 ng/dl (mean 458.3), higher in castrated (532.8 ng/dl) than in non-castrated (342.2 ng/dl) (p = NS). Physiological values considered for men were reached in 8/18 (44.4%) in group castrated and 15/30 (50%) in group non-castrated (p = NS). By contrast the FSH and LH values were higher in the first group than in the second (24.3 +/− 6.8 vs. 14.2 +/− 4.5 IU/L, p < 0.03; and 16.3 +/− 2.9 vs 10.3 +/− 1.6 IU/L, p < 0.02, respectively). In both groups, the inverse physiological relationship between blood levels of FSH and LH, and total testosterone was lost. Conclusion: Androgen treatment in FtM transsexuals allows to achieve male sexual characters but does not produce the desired physiological blood levels of total testosterone and FSH and LH. After castration these values are significantly higher, missing the pituitarygonadal interaction, and they can produce osteoporosis. Policy of full disclosure: None.

P-01-007

PSYCHOBIOLOGICAL, ULTRASOUND AND SEMINAL CORRELATES OF METABOLIC SYNDROME IN MALE MEMBERS OF INFERTILE COUPLES Lotti, F.1; Corona, G.2; Degli Innocenti, S.2; Filimberti, E.2; Scognamiglio, V.2; Vignozzi, L.2; Forti, G.2; Maggi, M.2 1 University of Florence, Clinical Physiopathology, Italy; 2University of Florence, Italy Objective: To systematically evaluate possible associations between metabolic syndrome (MetS) and clinical characteristics in men with couple infertility. Methods: Out of 367 consecutive subjects, 351 men without genetic abnormalities were studied. MetS was defined according to the IDF&AHA/NHLBI classification. All men underwent physical, hormonal, seminal and scrotal ultrasound evaluation. Erectile and ejaculatory functions were assessed by IIEF-15-erectile function domain (IIEF-15-EFD) and Premature Ejaculation Diagnostic Tool (PEDT),

359

Poster Presentations respectively; psychological symptoms by Middlesex Hospital Questionnaire. Results: Out of 351 patients, 27(7.7%) fulfilled MetS criteria. Subjects with MetS were significantly older and had lower testosterone (T) levels compared to no-MetS men. In an age-adjusted model, MetS was associated with a stepwise decline in T (B = −1.25 ± 0.33, p < 0.0001), without concomitant rise in gonadotropins, suggesting central impairment. In an age-adjusted logistic model, testis ultrasound inhomogeneity was significantly associated with increasing MetS factors (HR = 1.36[1.09–1.70], p < 0.01), suggesting also peripheral impairment. Regarding semen parameters, in a multivariate model including age and T, only sperm morphology was significantly negatively related to the number of MetS components (B = −1.418 ± 0.42; p = 0.001). ED was observed in 69(19.9%) patients, with higher prevalence in MetS compared to no-MetS subjects (46.2% vs 16.7%;p = 0.001). The risk of ED increased as a function of the number of MetS factors, even after adjusting for age and T (HR = 1.45[1.08–1.95], p < 0.02). PE was observed in 53(15%) patients; no association with MetS was observed. Finally, after adjusting for age and T, somatization and depressive symptoms correlated with increasing MetS components (B = 0.66 ± 0.03, p < 0.05 and B = 0.69 ± 0.03, p < 0.02, respectively). Conclusion: In men with couple infertility, MetS correlates with hypogonadism, testis ultrasound inhomogeneity, poor sperm morphology, ED, somatization and depression. Recognizing MetS could help patients to improve not only fertility but also sexual/overall health. Policy of full disclosure: None.

P-01-008

BULBOSPONGIOUSUS MUSCLE ELECTROMYOGRAPHY: A NOVEL DIAGNOSTIC TOOL FOR LIFELONG PREMATURE EJACULATION Serefoglu, E. C.1; Koyuncu, H. H.2; Ugurel, B.2; Aktekin, B.2; Yencilek, F.2 Ankara, Turkey; 2Yeditepe University, Istanbul, Turkey

1

Objective: Ejaculation is a reflex which is constituted by emission and expulsion phases. Premature ejaculation (PE) is thought to be due to hyperexcitable ejaculatory reflex. The aim of this study is to compare the electromyographic (EMG) activity of bulbospongiosus muscle (BSM) in lifelong PE patients and healthy volunteers. Methods: Between January-May 2012, 10 lifelong PE patients and 5 healthy volunteers without PE complaints have been included. The EMG activity of BSM was recorded by concentric EMG needle electrode during masturbation with audio-visual stimulation. The EMG activity was displayed on the oscilloscope of a standard EMG apparatus until ejaculation occurs. The initiation time of the different electrical activity patterns and their frequencies have been compared along with the ejaculatory latency time. Results: The mean age of the patients and controls were 34.7 ± 4.3 and 32.4 ± 5.6, respectively (p = 0.393). Mean self-estimated intravaginal ejaculatory latency time was significantly shorter in PE patients (39.4 ± 13.3 sec vs. 386.8 ± 140.2, P = 0.005). The time of initiation of both intermittent (36.7 ± 18 sec vs. 128.6 ± 11.4 sec, P < 0.001) and sustained (289.3 ± 37.4 sec vs. 481.8 ± 14.3, P < 0.001) electromyographic activity was significantly shorter in lifelong PE patients. Similarly the frequency of intermittent and sustained activity were higher in lifelong PE patients (2.7 ± 1.2 Hz vs. 1.8 ± 0.5 Hz, p = 0.12 and 9.3 ± 2.8 vs. 2.6 ± 0.6, P < 0.001). Conclusion: Electromyographic activity of BSM is greater in lifelong PE patients during masturbation. This assessment has the potential of being used in diagnosis of lifelong PE. Further studies are required to establish the cut off frequency and time thresholds. Policy of full disclosure: None.

P-01-009

SEXUAL AND CARDIOVASCULAR CORRELATES OF MALE UNFAITHFULNESS Fisher, A. D.1; Bandini, E.2; Rastrelli, G.2; Corona, G.3; Monami, M.4; Mannucci, E.4; Maggi, M.5 1 Sexual Medicine and Andrology, Clinical Physiopathology, Florence, Italy; 2 Sexual Medicine and Andrology, Florence, Italy; 3Andrology Unit, Dept. ofClinical Physiopathology, Florence, Italy; 4Diabetes Section, Geriatric Unit, Florence, Italy; 5University of Florence, Department of Clinical, Italy Objective: To offer a summary of available data in literature about unfaithfulness. Methods: An extensive Medline search was performed including the following words “unfaithfulness,” “extramarital affairs,” “infidelity,” “men.” The search, up to December 4, 2011, was restricted to Englishlanguage articles. We reported literature data on the prevalence of unfaithfulness and on related psychobiological, sexual, and risk factors. Results: Some surveys reported that 1.5–4% of married men had extramarital coitus in any given year, others that 23.2% of men have cheated during their current relationship. Different studies reported a lifetime prevalence of unfaithfulness between 15% and 50%.With respect to factors related to unfaithfulness, several authors reported that men with extramarital affairs more frequently have a dysfunctional primary relationship, in both relational and sexual terms. In addition, parenthood, as well as conflicts within the family, seem to be associated with a higher risk of having an affair. Furthermore, unfaithful men display a higher androgenization, larger testis volume, lower prevalence of hypoactive sexual desire, and better sexual functioning. Only few studies have evaluated the correlation between infidelity and cardiovascular risk, reporting that having an extramarital affair could have a negative impact on cardiac morbidity and mortality. Conclusion: Several interpersonal, sexual, and biological factors are associated with having extramarital affairs. Unfaithfulness in men seems to be associated with a higher risk of major cardiovascular events. Policy of full disclosure: None.

J Sex Med 2012;9(suppl 5):357–397

360 P-01-010

SUSTAINABLE POSITIVE LONG-TERM RESULT OF A STRUCTURED POSTOPERATIVE SEXUAL REHABILITATION PROGRAM AFTER RADICAL PROSTATECTOMY REGARDLESS OF NERVE SPARING (NS) PROCEDURE OR NOT Ljunggren, C.1; Stroberg, P.2 1 Ryhovs County Hospital, Urology, Jönköping, Sweden; 2Ryhovs County Hospital, Jönköping, Sweden Objective: To study the long-term result of a penile and sexual rehabilitation program after prostate cancer surgery. Methods: In 2009; 79 fully potent (IIEF-5 > 21) and sexually active men (45–74 yrs; M 61 yrs) who had a daVinciProstatectomy (dVP) due Prostate Cancer regardless of NS procedure or not, were enrolled in a postoperative penile and sexual rehabilitation program with goal to have satisfactory sexual activity 1 year after surgery. Based on their post-op function the patients received A) no treatment, B) oral PDEinhibitors (daily dosing or on demand), C) Intrauretral prostaglandinE1 (pGE1), D) Intracavernousal pGE1, or any combination of B, C and D. They were followed up at 1,3,6,9, months with adjustments of therapy according to function. A clinical sexologist evaluated the patient and his partner prior to surgery at 1,3, 6, months and instituted cooping/intervention therapy when needed. At 12 months 83% (N = 66) had regular penetrating sexual activity. These 66 patients were followed up at 3 years post-op with a combination of a structured telephone interview, validated SAQ:s and review of medical charts. Sexual activity, frequency, reasons for discontinuation, use ED medication, life satisfaction (LISAT-8) was recorded and compared with data at 12 months. Results: At 35 months (25–39 m) 88% (n = 58/66) still had regular penetrating sexual activity and 81 % at least 1–2 times per month. Reason for discontinuation, partner not interested (5), loss of partner (2) and expensive treatment (1). The overall sexual experience at 3 years compared to pre-op was rated; worthless in 10 % acceptable in 67% equal in 17% and better in 5%. Conclusion: A structured combined penile and sexual rehabilitation program after dVP addressing the complexity of the sexual dysfunction, both medical and psychosocial, appears to have sustainable longterm positive effect on post-op penetrating sexual activity regardless nerve sparing(NS) procedure or not. Policy of full disclosure: None.

P-01-011

PATIENT PERSPECTIVE ON APPROACHING PHYSICIAN FOR ED TREATMENT AND PDE5 INHIBITOR PRESCRIPTION Lee, S. W.1; Kim, J.2; Yang, D. Y.3; Moon, D. G.2 Samsung Medical Center, Urology, Seoul, Republic of Korea; 2Korea University Guro Hospital, Seoul, Republic of Korea; 3Hallym University Medical Center, Seoul, Republic of Korea

1

Objective: Erectile dysfunction is a very personal matter for the patient. We investigated the difficulties and needs of the ED patient when approaching a physician. Methods: 100 consecutive patients who were prescribed PDE5 inhibitors from September 2011 were surveyed on their difficulties in approaching a physician for their ED problems. Patients were given a questionnaires inquiring their ED medication and prescription preferences. Results: The mean age of the patients was 58.81 ± 9.14 years, with 56% receiving medications for other diseases. 50% were recently started on PDE5 inhibitors. 75% found no particular difficulties in approaching the physician for these problems, despite the fact that 64% did not wish their partners knew of their current medications, and 52% currently kept their prescriptions a secret. Despite extensive consultations 67% of the patients confessed limited understanding of

J Sex Med 2012;9(suppl 5):357–397

Poster Presentations at least one or more key medication and side effect warnings. 55% of the patients preferred being receiving both PDE5 inhibitor prescription and medication at the clinic rather than separately from a clinic and pharmacy. Conclusion: Despite the private nature of ED, most patients are openly seeking medical attention, but are still quiet about this matter to their partners. Most patients required more understanding of proper medication and preferred being prescribed and receiving medication at the clinic. Policy of full disclosure: None.

P-01-012

IN VIVO TESTOSTERONE SUPPLEMENTATION IMPROVES METABOLIC SYNDROME-INDUCED ADIPOSE TISSUE DERANGEMENTS: A STUDY IN RABBIT Maggi, M.1; Maneschi, E.2; Morelli, A.2; Filippi, S.2; Cellai, I.2; Comeglio, P.2; Sarchielli, E.2; Vignozzi, L.2; Saad, F.3; Vettor, R.4; Vannelli, G. B.2 1 University of Florence, Department of Clinical, Italy; 2University of Florence, Italy; 3Bayer Pharma AG, Berlin, Germany; 4University of Padua, Italy Objective: Visceral obesity has been identified as the major factor linking hypogonadism to metabolic syndrome (MetS) in men. We recently demonstrated that testosterone dosing ameliorated the metabolic profile and reduced visceral adipose tissue (VAT) in a high-fat diet (HFD)-induced rabbit model of MetS. This study was aimed at investigating the effects of HFD and in vivo testosterone dosing on VAT function. Methods: HFD rabbits were left untreated or treated with testosterone for twelve weeks and compared to a rabbit group fed a regular diet (RD). VAT was studied by immunohistochemistry, Western blot, and RT-PCR. The adipogenic capacity was studied in preadipocytes isolated from VAT of each experimental group and exposed to adipocyte differentiating mixture (DIM). Results: Adipocyte size was significantly increased in HFD VAT, as compared to RD, indicating adipocyte dysfunction, which was normalized by testosterone dosing. Accordingly, perilipin, an antilipolytic protein, was significantly increased in HFD VAT, when compared to other groups. HFD VAT was hypoxic, while testosterone dosing normalized VAT oxygenation. In VAT, androgen receptor expression was positively associated with mRNA expression of GLUT4 (insulinregulated glucose transporter) and STAMP2 (androgen-dependent gene required for insulin signaling). In testosterone-treated HFD VAT, STAMP2 mRNA was significantly increased, when compared to other groups. Moreover, GLUT4 membrane translocation was significantly reduced in HFD VAT, as compared to RD, and increased by testosterone. In DIM-exposed preadipocytes from HFD, triglyceride accumulation, adipocyte-specific gene expression, insulin-stimulated triglyceride synthesis, glucose uptake and GLUT4 membrane translocation were reduced as compared to preadipocytes from RD rabbits and normalized by in vivo testosterone dosing. Conclusion: Testosterone dosing in a MetS animal model positively affects VAT functions. This could reflect the ability of testosterone supplementation in restoring not only eugonadism but also insulin sensitivity in VAT, thus counteracting metabolic alterations and thereby improving general and sexual male health. Policy of full disclosure: Elena Maneschi, Annamaria Morelli, Sandra Filippi, Ilaria Cellai, Paolo Comeglio, Erica Sarchielli, Linda Vignozzi, Roberto Vettor, Gabriella B. Vannelli have nothing to declare. Farid Saad is an employee of Bayer Pharma AG, Berlin, Germany. Mario Maggi is a scientific consultant for Bayer Pharma AG, Germany, EliLilly Indianapolis, Indiana; Intercept Pharmaceuticals Italia Perugia, Italy.

361

Poster Presentations P-01-013

TESTOSTERONE/ESTRADIOL RATIO REGULATES NITRIC OXIDE-INDUCED BLADDER RELAXATION AND RESPONSIVENESS TO PHOSPHODIESTERASE TYPE 5 INHIBITORS Vignozzi, L.1; Filippi, S.2; Morelli, A.2; Comeglio, P.2; Cellai, I.2; Sarchielli, E.2; Maneschi, E.2; Gacci, M.2; Vannelli, G. B.2; Maggi, M.2 1 Sexual Medicine and Andrology, Clinical Physiopathology, Florence, Italy; 2 University of Florence, Italy Objective: The efficacy of phosphodiesterase type 5 inhibitors (PDE5i) in treating lower urinary tract symptoms is supported by the extremely high expression and activity of PDE5 in male bladder. Although bladder function regulation is similar among genders, no data are available on PDE5 expression and activity in female bladder. we investigated sex-differences in PDE5 expression and biological activity in female bladder, as opposed to the male counterpart. Methods: We studied gene and protein expression, and enzymatic activity of PDE5 in bladder of male and female rats. A subgroup of female rats were ovariectomized and alternatively replaced with estradiol (E2), progesterone (P), testosterone alone or in combination with letrozole to completely abrogate T-induced E formation. As a readout of PDE5 activity, we studied vardenafil efficacy in potentiating sodium nitroprusside (SNP)-induced relaxation in bladder of the different experimental groups. Results: SNP was 3-log unit less potent in relaxing the male bladder than the female one. On the contrary, the PDE5 resistant cGMPanalog (SP-8-Br-PET-cGMPS) was equipotent in relaxing male and female bladder. Vardenafil was more effective in potentiating SNPinduced bladder relaxation in male than in female. Accordingly, the cGMP-hydrolyzing activity of PDE5 was higher in male vs. female homogenates. In ovariectomized female rats, with or without sex steroid replacement, vardenafil activity in potentiating SNP-induced bladder relaxation was associated with an increased T/E2 ratio. In particular, masculinization of ovariectomized rats–by the administration of T + letrozole – dramatically increased vardenafil capacity to potentiate SNP-induced relaxation. Conclusion: In this study, we demonstrated that PDE5 activity is more pronounced in male as compared to female bladder, and that T/E ratio positively regulates responsiveness to PDE5i, thus suggesting that male bladder is a more suitable target for PDE5i than the female counterpart. Policy of full disclosure: Linda Vignozzi, Sandra Filippi, Annamaria Morelli, Paolo Comeglio, Ilaria Cellai, Erica Sarchielli, Elena Maneschi, Mauro Gacci, Gabriella B. Vannelli have no conflict of interest that could be perceived as prejudicing the impartiality of the research reported and have nothing to declare. Mario Maggi is a scientific consultant for Bayer Pharma A.G, Germany, Eli-Lilly Indianapolis, Indiana.

P-01-014

THIRTY YEARS OF HIV IN ISRAEL – CURRENT EPIDEMIOLOGY AND FUTURE CHALLENGES Mor, Z.1; Levin, Y.2; Chemtob, D.2 Ministry of Health, Ramla Department of Health, Israel; 2Ministry of Health, Jerusalem, Israel

1

Objective: HIV burden in Israel continues to increase despite constant interventions. This study aimed to describe the Israeli HIVepidemiology and highlights areas of concern. Methods: HIV/AIDS is reportable nominally and data from National HIV/AIDS registry were analyzed. Results: From 1981 to 2010, 6,579 HIV/AIDS-cases were reported, in an upward incidence trend from 3.6:100,000 in 1986 to 5.6:100,000 in 2010. Individuals originating from countries of generalized epi-

demic (ICGE) comprised 2,717 (41.3%) of all cases: 2,089 (76.9%) were Israeli-citizens and 628 (23%) were non-nationals, mostly migrant-workers. The majority (N = 2,040) of ICGE Israeli-citizens were born in Ethiopia. The annual proportion of non-citizens ICGE to all HIV/AIDS-cases has increased between 2005 and 2010 from 4.2% to 16.5%. Only 796 (12.1%) of all HIV/AIDS cases were heterosexuals. Injecting drug-users (IVDU) comprised 13.4% (N = 882) of all cases. Men who have sex with men (MSM) accounted for 33.2% (N = 1,403) of all male reported, and the annual number of MSM reported with HIV/AIDS has quadrupled since 2000. It is estimated that of all known-HIV infected individuals in 2010 for Ethiopian-born Israeli-citizens, foreign-born non-citizens, IVDU and for the MSM aged 16–45 were 1,133, 261.5, 4,410 and 1,606 per 100,000 populations, respectively. Conclusion: HIV/AIDS burden is low among heterosexuals, but higher in designated high-risk populations. Prevention interventions should address the social norms of those different subgroups of the populations. Policy of full disclosure: None.

P-01-015

THE CEREBRAL MODIFICATION IN MTOF TRANSSEXUALS AFTER THE SEX REASSIGNMENT SURGERY: A NEUROPHYSIOLOGICAL STUDY BASED ON AN EMOTIONAL P300 Rolle, L.1; Molo, M. T.2; Falcone, M.3; Vighetti, S.4; Timpano, M.1; Ceruti, C.1; Sedigh, O.1; Galletto, E.1; Preto, M.1; Fontana, D.1 1 Molinette Hospital, Turin, Italy; 2Molo Onlus, Turin, Italy; 3Molinette Hospital, Urology 2, Turin, Italy; 4Neuroscience Dpt, Turin, Italy Objective: To assert if whether or not the Sex Reassignment Surgery (SRS) might provoke some indirect effects on the cerebral activity of MtoF transsexuals. Methods: We recruited 15 transsexuals MtoF. The average age was 35 years (23–63). The experiment has been carried out in all patients 6 months before and 6 months after the SRS. The hormonal therapy was discontinued at least 4 weeks before the preoperative recordings, in order to avoid a bias. 20 heterosexual healthy right-handed volunteers (10 male, 10 female), with an average age of 35 years, were also recruited. The emotional ERPs were achieved while the subjects were watching slides extracted from the International Affective Picture System. 60 pictures, divided in two series with positive/neutral and negative/neutral valence were dispensed in random series to the subjects. The subject was given the task of tapping the remote control with the finger while watching pleasant or unpleasant pictures. The parameters considered in our analysis were the area below the P300 wave, the amplitude and his latency. The P300 was finally compared between transsexual patients, before and after SRS and control groups. Results: Our analysis pointed out that female’s P300 was characterized by a larger latency, amplitude and area, comparing to the male’s one. This pattern was evidenced in response to pleasant and unpleasant pictures (p < 0,01). The MtoF transsexuals were characterized in response to positive or neutral stimuli by an augmentation of all the P300 parameters evaluated in the postoperative recordings, (p < 0,01). We didn’t found any difference (p > 0,05) concerning the parameters of the P300 wave in response to the neutral pictures. Conclusion: Transsexuals, who underwent a SRS as well as a genital surgical feminization, tend to assume female cerebral features. Our paperwork underlines the beneficial effects of the SRS to the patients, who react to the genital surgery conversion with a cerebral feminization. Policy of full disclosure: None.

J Sex Med 2012;9(suppl 5):357–397

362 P-01-016

IMPACT OF ATRIAL FIBRILLATION ON ERECTILE FUNCTION AND ARTERIAL STIFFNESS IN MALES WITHOUT CLINICAL ATHEROSCLEROSIS Vlachopoulos, C.1; Ioakeimidis, N.2; Samentzas, A.2; Terentes-Printzios, D.2; Synodinos, A.2; Aggelis, A.2; Lazaros, G.2; Askitis, T.2; Stefanadis, C.2 1 Athens Medical School, 1st Department of Cardiology, Greece; 2Athens Medical School, Greece Objective: Endothelial dysfunction and subclinical inflammation have a critical role in promoting erectile dysfunction (ED) and atrial fibrillation (AF). The association of AF with ED severity and functional changes in large arteries has not been defined yet. Methods: We studied 18 ED patients (aged 61 ± 9 years) with no clinical atherosclerosis who suffered from AF. A control group of 18 ED patients without AF who were matched for age and risk factors were enrolled. ED diagnosis and score were evaluated according to the International Index of Erectile Function (IIEF) questionnaire. Lower IIEF score indicates severe ED. Carotid-femoral Pulse Wave Velocity (PWV) was measured as an index of aortic stiffness and Augmentation Index (AIx) as a measure of wave reflections. All subjects underwent comprehensive ultrasound examination. Results: Patients with AF have lower IIEF score (left figure) and longer ED duration (51 vs 32 months, P < 0.05), as compared to subjects without AF. Furthermore, PWV and AIx were higher in patients with AF than in the control group (9.3 vs 8.6 m/s and 32 vs 24 %, respectively, all P < 0.05); C-reactive protein levels were higher in AF patients compared to men without AF (1.4 vs 0.9 mg/l, P < 0.05), whereas total testosterone did not differ (4.8 vs 5.2 ng/ml, P = NS). In patients with AF, a linear inverse relationship between left atrial dimension and IIEF score was observed (right figure). Conclusion: Erectile function is severely impaired and arterial stiffness is increased in ED patients with AF compared to men without AF. Patients with AF who reported severe ED had a significant left atrial enlargment which is an important marker for adverse cardiovascular events. Policy of full disclosure: None.

Poster Presentations accuracy in predicting major adverse CV events (MACE) is lower in high-risk populations, since they take into account only conventional risk factors. The aim of the study is to evaluate the accuracy of Progetto Cuore risk engine in predicting MACE in subjects with erectile dysfunction (ED), and to test the role of unconventional CV risk factors, specifically identified for ED. Methods: A consecutive series of 1,233 men (mean age 53.33 ± 9.08 years) attending our outpatient clinic for sexual dysfunction was longitudinally studied for a mean period of 4.4 ± 2.6 years. Several clinical, biochemical, and instrumental parameters were evaluated. Subjects were classified as high- or low-risk, according to previously reported ED-specific risk factors. Results: In the overall population, Progetto Cuore-predicted population survival was not significantly different from the observed one (p = 0.545). Accordingly, Receiver Operating Characteristic (ROC) analysis shows that Progetto Cuore has an accuracy of 0.697 ± 0.037 (p < 0.001) in predicting MACE. Considering subjects at high-risk according to ED-specific risk factors, the observed incidence of MACE was significantly higher than the expected for both low-educated and patients reporting partner’s hypoactive sexual desire (HSD, both < 0.05), but not for other described factors. The area under ROC curves of Progetto Cuore for MACE in subjects with low-education and reported partner’s HSD was 0.659 ± 0.053 (p = 0.008) and 0.550 ± 0.076 (p = 0.570), respectively. Conclusion: Overall, Progetto Cuore is a proper instrument for evaluating CV risk in ED subjects. However, in ED, other factors as low-education and partner’s HSD concur to risk profile. At variance with low-education, Progetto Cuore is not accurate enough to predict MACE in subjects with partner’s HSD, suggesting that the latter effect is not mediated by conventional risk factors included in the algorithm. Policy of full disclosure: None.

P-01-018

THE VALUE OF ENDOTHELIAL DYSFUNCTION AND ARTERIAL STIFFNESS FOR IDENTIFYING WALL MOTION ABNORMALITIES DURING STRESS TEST IN ERECTILE DYSFUNCTION HYPERTENSIVE MEN: COMPARISON OF VASCULAR MARKERS FOR IMPROVED DETECTION OF HEART DISEASE Aggelis, A.1; Vlachopoulos, C.2; Ioakeimidis, N.2; Rokkas, K.2; Terentes-Printzios, D.2; Synodinos, A.2; Aggelakas, A.2; Robolis, D.2; Askitis, T.2; Stefanadis, C.2 1 Athens Medical School, 1st Department of Cardiology, Greece; 2Athens Medical School, Greece

P-01-017

TWO UNCONVENTIONAL RISK FACTORS FOR MAJOR ADVERSE CARDIOVASCULAR EVENTS IN SUBJECTS WITH SEXUAL DYSFUNCTION: LOW EDUCATION AND REPORTED PARTNER’S HYPOACTIVE SEXUAL DESIRE IN COMPARISON WITH CONVENTIONAL RISK FACTORS Rastrelli, G.1; Corona, G.2; Fisher, A. D.2; Mannucci, E.2; Maggi, M.2 University of Florence, Clinical Physiopathology, Italy; 2University of Florence, Italy

1

Objective: The classification of subjects as low or high cardiovascular (CV) risk is usually performed by risk algorithms. However, their

J Sex Med 2012;9(suppl 5):357–397

Objective: Hypertension is the most common comorbidity in patients with erectile dysfunction (ED) and impaired arterial function appears to be a link between these conditions. We evaluated the arterial functional determinants of wall motion abnormalities during stress testing in hypertensive ED patients. Methods: 83 consecutive asymptomatic non diabetic men with essential hypertension and ED underwent:(1) dobutamine stress echocardiography (DSE) (2) endothelium-dependent, flow-mediated dilation (FMD) of the brachial artery during reactive hyperaemia using highresolution ultrasound and (3) evaluation of aortic stiffness with carotidfemoral pulse wave velocity (PWV) and wave reflections with augmentation index (AIx) using high-fidelity PW analysis. Criteria of positivity were regional dysfunction >2 segments demonstrated by DSE. A group of 30 hypertensive men with similar age, normal erectile function and negative DSE were also studied. Results: 18 hypertensive men (21%) exhibited regional wall motion abnormalities. Age-adjusted FMD values were comparable among ED patients and significantly lower as compared to control group (figure). PWV values were significantly higher in ED patients with positive DSE compared to men with normal stress testing (figure). AIx did not differ among the three groups. In ED patients, DSE positivity was predicted on multivariate analysis by higher PWV values (P < 0.05;

363

Poster Presentations OR = 3.6; 95%CI = 1.1–12.0), but not by either reduced FMD (P = 0.81; OR = 0.87; 95% CI = 0.27–2.8) or increased AIx (P = 0.13; OR = 0.47; 95% CI = 0.7–1.3). Conclusion: Increased aortic stiffness affects wall motion during stress, however, echocardiographic positivity is unrelated to systemic endothelial dysfunction. An integration of DSE and functional markers is warranted in evaluation of men with hypertension and ED. Policy of full disclosure: None.

with E/A ratio (b = 0.19, p < 0.05) and negatively associated with E/ Em ratio (b = −0.26, p < 0.01), indicating impaired left ventricular diastolic function in males with low TT. All participants were subdivided according to presence/absence of HypG. Patients with both HTN and HypG exhibited lower maximum workload and greater impairement of LVD function and aortic elastic properties compared to all the other groups (figure). Conclusion: Androgen deficiency confers an incremental unfavourable impact on maximal workload, LV early diastolic relaxation and aortic stiffness in men with HTN. Our data allow identification of hypertensive patients without overt CV disease who might warrant more intensive follow-up. Policy of full disclosure: None.

P-01-019

UNFAVOURABLE EFFECTS OF ANDROGEN DEFICIENCY ON LEFT VENTRICULAR DIASTOLIC RELAXATION, AORTIC STIFFNESS AND MAXIMAL EXERCISE CAPACITY IN HYPERTENSIVE MALES: CHARTING NEW DIRECTIONS FOR CARDIOVASCULAR DISEASE PREVENTION Ioakeimidis, N.1; Vlachopoulos, C.2; Aggelis, A.2; Terentes-Printzios, D.2; Rokkas, K.2; Christoforatou, E.2; Fassoulakis, C.2; Askitis, T.2; Stefanadis, C.2 1 Athens Medical School, 1st Department of Cardiology, Greece; 2Athens Medical School, Greece Objective: Impaired left ventricular diastolic (LVD) relaxation, reduced exercise capacity and increased aortic stiffness identify hypertensive patients at increased CV risk. Low testosterone concentration has been associated with increased risk for CV events, however, the influence of androgen deficiency on LVD function, exercise workload and aortic stiffness in patients with essential hypertension (HTN) is unknown. Methods: 82 non diabetic hypertensive men (56 ± 8 y/o, BMI < 30 kg/ m2) and 75 age-matched subjects with normal blood pressure (BP) underwent exercise treadmill testing. Peak exercise capacity was measured in metabolic equivalents, (METS). Diastolic Doppler parameters were used to assess LVD function. Aortic stiffness was evaluated with carotid femoral pulse wave velocity (PWVc-f). Total testosterone (TT) levels were measured in all participants. Hypogonadism (HypG) was defined when TT levels were below 3.4 ng/ml. Results: Compared to normotensive subjects, patients with HTN had decreased TT (3.9 vs 4.6 ng/ml) and a higher prevalence of HypG (34 vs 16%), (all P < 0.01). According to regression analysis, TT was positively associated with METS (b = 0.29, p < 0.01) and negatively associated with PWVc-f (b = −0.38, p < 0.001), independent of age, BP and metabolic profile. Furthermore, TT was positively associated

P-01-020

PREMATURE EJACULATION (PE) AND INFANTILE NOCTURNAL ENURESIS Longhi, E.1; Franceschelli, A.2; Colombo, F.2; Salonia, A.3 Sex. Med. Center San Raffaele, Milano, Italy; 2Andrology Unit, Bologna, Italy; 3University Vita-Salute San Raf, Urology, Milan, Italy

1

Objective: We studied the correlation between Premature Ejaculation and Infantile Nocturnal Enuresis in 75 subjects, affected by non physiological PE from the first instance of sexual intercourse. Methods: The subjects were recruited during outpatient visits in different cities of northern and central Italy (Milano, Bologna, Roma), average age 38 with a partner of at least one jear’s standing, were administered the following: DSI-R “Differentiation of Self Inventory”, SRO “Sex-Role Orientation Scale”, IMS “Index of Marital Satisfaction”, ISS “Index of Sexual Satisfaction”, HAM-D “The Hamilton Depression Evaluetion Scale”, AMS “The Aging Male’s Symptoms Scale”. The subjects complained of secondary enuresis at schoolage with episodes varjing from 2–3 times per week for at least 1–2 years. The first sexual intercourse ith the appearance of PE occurring between 17 and 25 years of age. Results: The data revealed that 47% of subjects had difficulty sleeping, suffered from irritability and excessive perspiration combined with a general decline in physical ability and beard growth. 63% showed a decrease in spontaneous morning erections. An excessive dependence on the partner was exhibited by 32% while 21% earned less than the partner. 19% found sex a chore, 15% experienced difficulty making

J Sex Med 2012;9(suppl 5):357–397

364 decisions in the absence of the partner, 37% were unable to feel pleasing for the partner while, 12% were inclined to do everything in a rush and 9% found it difficult to accept pleasure. Conclusion: The study seems to show that PE, in particularly emotional and insecure subjects, substitutes, in adult age, infantile nocturnal enuresis. It demonstrates the difficulty the subject has in controlling emotions and dealing with the beat of the female world. Policy of full disclosure: None.

P-01-021

UNCONSUMED MARRIAGES AND SEXUALITY Longhi, E.1; Franceschelli, A.2; Colombo, F.2; Salonia, A.3 Sex. Med. Center San Raffaele, Milano, Italy; 2Andrology Unit, Bologna, Italy; 3University Vita-Salute San Raffaele, Urology, Milan, Italy

1

Objective: The present study investigated the aspects of the relationship and sexuality of couples in unconsummated marriages using validated questionnaires and specific counselling in order to allow partners to discover an intimacy in keeping with the communicative style of the two. Methods: 32 couples (average age 34 years range 28–40), having been married for at least 7 years, were recruited in different cities of northern and central Italy (Milano, Bologna, Roma).Each partner was administered the following: Measuring Marital Satisfaction (MMS3G), The Conflict Tactics Scales (CTS), Sexual Satisfaction Scale (SSS), Communication Patterns Questionnaire (CPQ), Questionnaire for Reproductive Emotionality (QER). Afterwards there was and individual check-up interview and one as a couple. While the sexological counselling for couples finished after 5–8 fortnightly meetings the follow-up was carried out at 6 months and 1 year. Results: The couples were homogenous never having had sexual experiences other than with the partner. The trend is to exclude open verbal conflicts for fear of being abandoned by the other partner. Sexual teachings and the creative aspects of sexual games is entrusted to one partner. Disagreement on times and ways of spending time together is also due to the timing and ways intimacy is desired, sought and experienced. Mainly romantic and affectionate in the couple and erotically transgressive in autoeroticism. Both partners pursue fantasies and desires of betrayal without follow up. At the end of sexological counselling 95% of the couples began sexual relations. Conclusion: The sexological counselling to bring to life unconsummated marriages foresees a psycho-educational space where each partner is free to ask for information and redefine prejudices an fears on sexuality. The individual sexological exercise and those performed in couples, together with interviews as a couple have been a valid support in redefining in the couple emotive needs and sexual timing as well as expressing fantasies and desires. Policy of full disclosure: None.

P-01-022

SURGICAL CORRECTION OF CONGENITAL PENILE CURVATURE: PLICATION CORPOROPLASTY VERSUS NESBIT TECNIQUE Onem, K.1; Asci, R.2; Yalman, C.2; Beyaz, C.2; Serdas, T.2; Sirtbas, A.2; Ozen, M.2 1 Ondokuz Mayis University, Medi, Urology, Samsun, Turkey; 2Ondokuz Mayis University, Medicine, Samsun, Turkey Objective: The aim of this study is to evaluate long term results of tunica albuginea placation and Nesbit placation. Methods: 50 patients underwent surgery for correction of corporal curvature between 1995–2012 were evaluated. All patients were evaluated self photography on erection, asked for satisfactory intercourse, pain during erection, penile shortening, and palpable nodule after surgery. Plication technique was made by one or more crossed introflecting stitches and Nesbit placation was made as excision small part of tunica until sutured. Plication corporoplasty (group I) and Nesbit

J Sex Med 2012;9(suppl 5):357–397

Poster Presentations placation (group II) was compared independent sample test, chi-square test and Fisher’s exact test. Results: The mean age were 28,5 ± 10.1 and 26.0 ± 6.2 in group I (n = 30) and II (n = 20) respectively (p = 0.1). The mean follow up period was 39.3 (3–48) month Mean degree of curvature were calculated as 47 ± 12 and 53 ± 16 in groups I and II (p = 0.2). The most common curvature was ventral curvature (%56 vs. %60) in each group. Entirely correction was found 90% of patients. Residual or recurrent curvature less than 30 degree was reported in five patients (Group I = 3 pt. vs. Group II = 2 pt. p = 0.9). Five patients were noted palpable nodule (p = 0.6). Penile shortening was reported by five patients (p = 0.6). Loss of penile sensory was not reported. Pain during erection was observed in three patients(p = 0.7). Satisfactory sexual intercourse was reported 92% of patients (p = 0.7).There was no statistically significant differences between groups in term of functional and anatomic results. Conclusion: Correction of congenital penile curvature corporeal placation and Nesbit placation techniques have similar efficacy and safety in long term follow-up. Policy of full disclosure: None.

P-01-023

NEW WASHING PROTOCOL FOR REVISION SURGERY OF PENILE IMPLANTS Rojas Cruz, C.1; Sarquella, J.2 1 Barcelona, Spain; 2Fundacio Puigvert, Barcelona, Spain Objective: Revision surgery of penile implants is associated with a higher risk of infection. Different protocols have been proposed to avoid this complication. We present the evaluation of a new protocol for these cases. Methods: From January 2009 to July 2011 twelve revision surgeries for penile implants due to mechanical failure of the components were performed. The surgical approach was penoscrotal in all cases. Once the elements of the implant are taken out, a washing with 5000 cc of normal saline at a pressure of 60 cm H2O was performed in all the spaces of the previous implant. Immediately afterwards an AMS 700 CX penile prosthesis with Inhibizone was implanted. Microbiological evaluation before and after the procedure was registered. Clinical follow-up of the patients was performed. Results: The median follow-up of the patients was 19 months (6–24). Median surgical time was 67 min (48–70). No postoperative hematomas were observed. Cultures of periprosthetic spaces at the moment of the explants were positive in 8 cases and negative in all at the end of the washing maneuver. None of the patients presented infection during the follow-up period. Conclusion: Washing with normal saline at a constant volumen and pressure is a simple and efficacious alternative to prevent infections associated to revision surgery of penile implants. Policy of full disclosure: None.

P-01-024

TRIBULUS TERRESTRIS VERSUS PLACEBO IN THE TREATMENT OF ERECTILE DYSFUNCTION: A PROSPECTIVE, RANDOMIZED, DOUBLE-BLIND, PLACEBOCONTROLLED STUDY Santos Jr., C. A.1; Reis, L. O.2; Destro Saade, R.1; Reis, A. L.1; Fregonesi, A.1 University of Campinas-Unicamp, Brazil; 2University of CampinasUnicamp, Urology, Brazil

1

Objective: To evaluate the possible effects of Tribulus terrestris herbal medicine in the erectile dysfunction treatment and to quantify its potential impact on serum testosterone levels. Methods: Prospective, randomized, double-blind and placebocontrolled study including thirty healthy men who presented themselves spontaneously complaining of erectile dysfunction, ≥40 years of age, nonsmokers, not undergoing treatment for prostate cancer or erectile dysfunction, no dyslipidemia, no phosphodiesterase inhibitor

365

Poster Presentations use, no hormonal manipulation and, if present hypertension and/or diabetes mellitus should be controlled. International Index of Erectile Function (IIEF-5) and serum testosterone were obtained before randomization and after 30 days of study. Patients were randomized into two groups of fifteen subjects each. The study group received 800 mg of Tribulus terrestris, divided into two doses per day for thirty days and the control group received placebo administered in the same way. Results: The groups were statistically equivalent in all aspects evaluated. Before treatment, the study group showed mean IIEF-5 of 13.2 (5–21) and mean total testosterone 417.1 ng/dl (270.7–548.4 ng/dL); the placebo group showed mean IIEF-5 of 11.6 (6–21) and mean total testosterone 442.7 ng/dl (301–609.1 ng/dl). After treatment, the study group showed mean IIEF-5 of 15.3 (5–21) and mean total testosterone 409.3 ng/dl (216.9–760.8 ng/dl); the placebo group showed mean IIEF-5 of 13.7 (6–21) and mean total testosterone 466.3 ng/dl (264.3– 934.3 ng / dl). The time factor caused statistically significant changes in both groups for IIEF-5 only (p = 0.0004); however, there was no difference between the two groups (p = 0.7914). Conclusion: At the dose studied, Tribulus terrestris was not more effective than placebo on improving symptoms of erectile dysfunction or serum total testosterone. Policy of full disclosure: None.

P-01-025

MOST HYPOGONADAL MEN ARE OBESE; LONG-TERM TESTOSTERONE TREATMENT LEADS TO CONTINUOUS AND SUSTAINED REDUCTIONS OF BODY WEIGHT AND WAIST CIRCUMFERENCE Farid, S.1; Doros, G.2; Traish, A.3; Haider, A.4 Bayer Pharma AG, Global Medical Affairs, Berlin, Germany; 2Biostatistics Consulting Group, Boston, USA; 3BU School of Medicine, Boston, USA; 4 Private Urology Practice, Bremerhaven, Germany

1

Objective: Obesity is a disease which has more than doubled worldwide since 1980. Almost all healthcare professionals are exposed to obese patients because of their higher risk for morbidity and mortality. This study investigated the distribution of obesity and effects of testosterone replacement therapy (TRT) in an unselected cohort of hypogonadal men. Methods: Open-label, single-center, cumulative, prospective registry study of 255 men (mean age 60.6 years), with testosterone levels between 5.89–12.13 nmol/L (mean: 9.93 ± 1.38) receiving parenteral testosterone undecanoate for up to 5 years. Results: At baseline, 13 patients (5.1%) had normal weight (BMI ≤ 24.9 m/kg2). 61 (23.92%) were overweight, and 181 (70.98%) were obese (BMI ≥ 30 m/kg2). 36 men (14.12%) were morbidly obese (BMI ≥ 40 m/kg2). At baseline, 11 patients (4.31%) had a waist circumference <94 cm, 70 (27.45%) 94–101.9 cm indicating an increased cardiovascular risk, and 174 (68.24%) ≥102 cm indicating a substantially increased cardiovascular risk. After 5 years of testosterone treatment, weight (kg) decreased by 16.15 kg from 106.22 to 90.07. Waist circumference (cm) declined by 8.78 cm from 107.24 to 98.46. Both parameters showed a statistical significance (p < 0.0001 vs baseline and vs the previous year over 5 years) indicating continuous reductions. The mean per cent weight loss after 5 years was 13.21 ± 7.24%. 95% of men had any weight loss, 90% lost ≥ 5 kg, 76% ≥ 10 kg, 53% ≥ 15 kg, 31% ≥ kg. The 5% who gained exclusively belonged to the group with normal weight at baseline. 97% of men had any reduction in waist size, 86% lost ≥ 5 cm, 46% ≥ 10 cm, 7% ≥ 15 cm. Conclusion: Normalizing testosterone produced progressive loss of weight, and waist circumference over the full 5 years of the study. Policy of full disclosure: Farid Saad is an employee of Bayer Pharma, manufacturer of testosterone products. Gheorghe Doros has received financial compensation from Bayer Pharma for statistical services. Abdul Traish has received research grants from Bayer Pharma and other companies. Ahmad Haider has received travel grants and speaker’s fees from Bayer Pharma and Takeda Pharma.

P-01-026

PENILE LENGTH AND GIRTH RESTORATION IN SEVERE PEYRONIE’S DISEASE–CIRCULAR AND LONGITUDINAL GRAFTING Kuehhas, F.1; Herwig, R.2; Egydio, P. H.3 Medical University of Vienna, Urology, Austria; 2Medical University of Vienna, Austria; 3Specialized Centre of Penile, Sao Paulo, Brazil

1

Objective: Penile prosthesis implantation for Patients with Peyronie’s disease should be discussed in cases of severe erectile dysfunction, complex anatomical deformities and massive penile shortening. In up to 50% of cases patients are dissatisfied with their postoperative penile length after penile prosthesis implantation. We report our experience with a novel method for penile length and girth restoration with circular and longitudinal grafting during penile prosthesis implantation. Methods: Between November 2006 and February 2012, 121 patients with disabling Peyronie’s disease and associated erectile dysfunction underwent our surgical approach for penile length and girth restoration with concomitant penile prosthesis implantation. The technique consists of a straightening procedure based on the Egydio technique and circular as well as longitudinal grafting for maximum length and girth restoration. Results: After an average of 19.5 months (range, 6–49 months) of follow-up all patients except of one (n = 120; 99.0%), who developed a post-operative wound infection with subsequent prosthesis removal were able to have sexual intercourse. The mean functional penile length gain was 3.5 cm (2–5 cm). It was clearly shown, that the acquisition or the recovery of the ability to perform sexual intercourse brought major relief and high rates of satisfaction and self-esteem. Glans sensitivity, orgasmic ability and ejaculation were preserved in all patients. Conclusion: Our technique resulted in a maximum length and girth restoration with excellent functional outcome. Patient satisfaction was very high. Not only the ability to perform sexual intercourse again after surgery, but also length and girth restoration are very important for recovering self-esteem and patient satisfaction. Policy of full disclosure: None.

P-01-027

PENILE LENGTHENING AND PENILE PROSTHESIS IMPLANTATION IN PATIENTS WITH PEYRONIE’S DISEASE AND SEVERE PENILE SHORTENING Sansalone, S.1; Garaffa, G.2; Leonardi, R.3; Vespasiani, G.4; Ieria, F. P.1; Loreto, C.5; Ralph, D.6 1 University Tor Vergata, Rome, Italy; 2The Institute of Urology, St Peter’s Andrology, London, United Kingdom; 3GECAS, Catania, Italy; 4University Tor Vergata, Rome, Italy; 5Dpt of Bio-Medical Sciences, Catania, Italy; 6 St. Peter’s Hospitals and The Institute of Urology, London, United Kingdom Objective: The aim of this study is to report our experience of penile lengthening with circumferential graft during penile prosthesis implantation in patients with PD and severe penile shortening. Methods: Between March 2006 and February 2008, 23 patients with PD, refractory erectile dysfunction, and severe penile shortening underwent penile lengthening with circumferential graft and concomitant implantation of an inflatable penile prosthesis. Surgical outcome and complications have been recorded during postoperative follow-up. Patients’ satisfaction has been assessed 6 months postoperatively with the administration of the modified Erectile Dysfunction Index of Treatment Satisfaction (EDITS) questionnaire. Results: After an average follow-up of 22 months (range 6–36), 20 patients attended all the postoperative follow-up visits and returned the EDITS questionnaire. An average length gain of 2.8 cm (range 2.2–4.5) was recorded, and all patients were able to cycle the device and engage in penetrative sexual intercourse. Patient recorded complications included diminished glans sensitivity in four (20%) and

J Sex Med 2012;9(suppl 5):357–397

366 persistent dorsal curvature of less than 15° in three (15%). Overall, 18 patients (90%) were satisfied with the cosmetic and functional result of surgery. Conclusion: Penile lengthening with circumferential graft during penile prosthesis implantation in patients with PD represents a safe and reproducible technique that yields higher satisfaction rates than penile prosthesis implantation alone in patients with severe penile shortening. Policy of full disclosure: None.

P-01-028

COMBINED TREATMENT OF ERECTILE DYSFUNCTION IN PATIENTS WITH SECONDARY HYPOGONADISM Gorpynchenko, I.1; Romaniuk, M.2; Gurzhenko, J.1; Imshinetskaja, L.1; Aksenov, P.1 1 Institute of Urology, Kiev, Ukraine; 2Kiev, Ukraine Objective: The purpose of this study was to evaluate the therapeutic efficacy of long-acting testosterone undecanoate in combination with an inhibitor of phosphodiesterase type 5 vardenafil for the treatment of erectile dysfunction (ED) in patients with secondary hypogonadism (SH). Methods: The study involved 93 patients of the department of sexology and andrology of Institute of urology. The average age was 39,2 ± 2,6 years (M ± σ). Inclusion criteria were erectile dysfunction, age 35 to 55 years old, no effect after taking vardenafil 20 mg three times or more in patients with SH. Results: Statistically significant (p < 0.05) multidirectional changes affected both hormones: increase of serum testosterone levels from 4,8 ± 0,3 ng/ml to 8,9 ± 0,8 ng/ml (p < 0.05) and decrease of LH from 4,3 ± 0,6 mIU/ml to 1,6 ± 0,2 mIU/ml. Changes in the cavernous blood flow registered by Doppler ultrasonography showed the statistically and clinically significant changes: increase of systolic blood flow velocity from 10,3 ± 2,4 ml/s to 26,9 ± 3,1 ml/sec (p < 0.05) and decrease of diastolic with 5,6 ± 1,2 ml/s to 2,7 ± 0,6 ml/sec (p < 0.05). Lack of the treatment effect was observed in 5 (16.0%) cases. Conclusion: Thus, a combination of testosterone undecanoate with vardenafil be recommended for the treatment of patients with ED and SH. Therapeutic efficacy of this combination is 84%. Policy of full disclosure: None.

Poster Presentations marked “good” results (IELT – 7.3 ± 1.2). “Satisfactory” results were noted by 5 objects (16.1%), (IELT – 3.2 ± 0.5). 3 patients (9.7%) were not satisfied with the effect; subsequently they underwent similar surgery on contralateral side with a positive result. Results: The main advantage of the present technique is low-traumatic mini access into neurovascular fascicle projection (1.0–1.5 sm incision), predictable result, no overestimation of the result by the patients, shorter sexual activity restoration period, and 90% effectiveness. Minimally invasive one-sided selective neurotomy technique is highly effective and least traumatic surgical treatment of premature ejaculation. Policy of full disclosure: None.

P-01-031

ISOLATED INFLATABLE PENILE PROSTHESIS PUMP EROSION THROUGH THE SCROTUM: A CASE REPORT Alzubaidi, R.1 1 Hamad Medical Corporation, Urology, Doha, Qatar Objective: Penile prosthesis (PP) infection and erosion are disastrous complications for penile implant surgery. To evaluate the results of management of a case with an isolated inflatable PP pump erosion. Methods: We followed a diabetic patient who has undergone an inflatable PP implantation. He has been exposed to scrotal ulcer over the pump site, and eventually isolated pump erosion through scrotal skin. Conservative repair of the ulcer was first tried. Finally, the inflatable PP was replaced with a malleable one to avoid pump complication. Results: All endeavors to repair the scrotal ulcer have failed with recurrence of the same problem. Total replacement of the inflatable PP with a malleable one showed to be a good choice to overcome this problem and avoid possible corporal fibrosis. Conclusion: In case of isolated inflatable PP pump erosion, replacement of the inflatable PP with a malleable one looks to be a good alternative salvage treatment for the patient. Policy of full disclosure: None.

P-01-030

MINIMALLY INVASIVE ONE-SIDED SELECTIVE NEUROTOMY TECHNIQUE IN TREATING PATIENTS WITH PREMATURE EJACULATION Aliev, R.1 1 Altay State Medical University, Urology, Barnaul, Russia Objective: According to our data, standard non-invasive topical and drug therapy of premature ejaculation (PE) appears to be inefficient in 12–23% of cases, together with that the existing methods of surgical correction: neurotomy or neuroectomy of penile dorsal nerves, balanus augmentation with hyaluronic acid gel – are traumatic for the patients, those factors afforded a basis for development of a new surgical technique of PE elimination. Methods: The results of the treatment of 31 patients with PE, who had undergone inefficient conservative therapy or had refused a longterm ingestion of selective serotonin reuptake inhibitors, were studied. Average age of the objects was 29.3 ± 4.2, disease duration – 5.4 years, and average intravaginal ejaculation latent time (IELT) – 1.2 ± 0.7 minutes. After paragrandular test was carried out and informed consent was received, all the objects underwent minimally invasive one-sided selective neurotomy. The results were estimated one month later when natural sexual activity was restored. 16 patients (51.6%) assessed the operation results as “excellent” – IELT made 12.6 ± 1.5 minutes, a possibility to control coitus duration appeared. 7 males (22.6%)

J Sex Med 2012;9(suppl 5):357–397

P-01-032

“IT TAKES TWO TO TANGO: THE RELATIONAL DOMAIN IN A COHORT OF SUBJECTS WITH ERECTILE DYSFUNCTION (ED) Boddi, V.1; Corona, G.2; Fisher, A. D.3; Rastrelli, G.4; Maggi, M.4 Prato, Italy; 2Ospedale Bellaria, Bologna, Italy; 3Fisiopatologia Clinica, Prato, Italy; 4Fisiopatologia Clinica, Firenze, Italy 1

Objective: The relational domain of erectile dysfunction (ED) is difficult to investigate in a clinical setting. We developed and validated SIEDY, a 13-item structured interview, which assesses, beside the

367

Poster Presentations organic (Scale1) and intra-psychic (Scale 3) domains, also the relation one (Scale 2). We previously established a pathological threshold for SIEDY Scale 1 and 3. Methods: A non-selected, consecutive series of 2992 subject with ED was retrospectively evaluated. In a first consecutive series of 844 patients (Sample A, studied without systematically applying a psychometric test: Middlesex Hospital Questionnaire, MHQ) a pathological threshold of SIEDY Scale 2 score was identified through receiver operating characteristic, using, as surrogate marker of impaired couple relationship, at least a positive answer to two standard questions on conflict within the couple and on the presence of extramarital affairs. Sensitivity and specificity, along with possible associations with biological and psychological correlates were verified in a further sample of 2148 patients (Sample B). Results: In sample A, a threshold of Scale 2 score ≥2 predicts couple impairment with a sensitivity of 53% and specificity of 66%, and an overall accuracy of 62.0 ± 2.2% (p < 0.0001). When this threshold was verified in sample B, Scale 2 score ≥2 was associated with a higher risk of anxiety and depressive symptoms, higher prevalence of psychopathology, and higher Scale 3 scoring, even after adjusting for confounders. In the same sample, a Scale 2 score ≥2 was associated with a reduced intimacy during sexual intercourse and overall worse sexual functioning. Conclusion: Until now, no instrument is available to quantify the marital domain of ED. The validation of a threshold of SIEDY Scale 2 score (≥2) represents an easy tool for the identification of ED patients with a relevant marital impairment. Policy of full disclosure: None.

P-01-033

nerves in rats and analysed the effects on the corpus cavernosum (CC). We also investigated whether tadalafil would protect against alterations in the CC. Methods: Wistar rats aged 3 months were assigned to groups of 8 animals each: sham-operated (CONTR); neural lesion (NL); vascular lesion (VL); NL + tadalafil (NLT); and VL + tadalafil (VLT). Either the penile nerve or penile artery were bilaterally sectioned close to the CC. Tadalafil was administered daily (5 mg/kg body) for 45 days, starting after surgery. Analyzes were on the proximal third of the penis. Organization and content of CC components were assessed by histochemical, immunohistochemical, and biochemical methods. Results: Collagen was less organized in NL, and this change was prevented in NLT. Loss of collagen organization was more pronounced in VL, and this was also prevented in VLT. Elastic fibers increased in NL, and this change was nearly absent in NLT. Reduction in elastic fibers was apparent in VL, but in VLT the content was similar to CONTR. Smooth muscle content decreased markedly (p < 0.005) after NL, but was unaffected in VL. This change was prevented (p < 0.005) in NLT. Vascular space decreased by 50% (p < 0.05) in NL, and this was prevented in NLT, whereas VL did not induce alterations. Total collagen increased by 45% (p < 0.04) in VL, and in VLT it was similar to CONTR, whereas in NL it was unchanged. Density of blood vessels (CD31) increased markedly after NL (p < 0.005) and VL (p < 0.005), but especially in the former. Tadalafil prevented these changes (p < 0.005). Conclusion: Although changes due to VL differ from those produced by the better known NL, they should nonetheless have a negative impact on erection. Tadalafil is effective in preventing many of these alterations. Policy of full disclosure: None.

ESWT TREATMENT IN PEYRONIE’S DISEASE

P-01-035

Calomfirescu, N.1; Bancu, S.2; Belinski, C.3; Mihalca, R.3 1 AMSR Study Group, Bucharest, Romania; 2Medlife Hospital, Urology, Bucharest, Romania; 3Medlife Hospital, Bucharest, Romania

SHOULD MEN WITH MILD ERECTILE DYSFUNCTION BE CLOSELY EVALUATED FOR CARDIOVASCULAR DISEASES IN THE KOREAN POPULATION?

Objective: Introduction: ESWT treatment has many benefits in medicine, recently being introduced as an alternative to the non-surgical treatment in Peyronie’s Disease. Methods: Material and methods: Between July 2011 and August 2012 in Medlife Life Memorial Hospital ESWT treatment had been used in 20 patients with Peyronie’s Disease. All of them had various grades of erectile dysfunction associated with Peyronie’s Disease evaluated with IIEF-5 score. 75% (15/20) had penile curvature and 60% (12/20) penile pain. ESWT protocol included 4 weekly sessions with 3000 shock/waves per session. No anesthesia was required. Results: Results: Improvement of sexual life was reported in 70% (14/20) of cases and in 83% (10/12) of penile pain. Penile curvature was improved in 30% (6/20) of cases and 3 patients reported the complete resolution of the penile plaque. No complications were associated with this procedure. Conclusion: Conclusions: Improvements of the penile pain and sexual life are the main benefits of this procedure. For selected cases with inflammatory compound, ESWT represents an alternative to the medical treatment. Policy of full disclosure: None.

P-01-034

EFFECTS ON THE CORPUS CAVERNOSUM OF EXPERIMENTAL LESIONS OF NERVES OR ARTERIES SUPPLYING THE PENIS OF RATS TREATED OR NOT WITH TADALAFIL Cardoso, L. E. M.1; Toledo, A.2; Medeiros jr., J.3; Souza, A.3; Amaro, J.2; Costa, W.3; Sampaio, F.3 1 State Univ. Rio de Janeiro, Urogential Research Unit, Brazil; 2Fac. de Medicina de Botucatu, Brazil; 3State Univ. Rio de Janeiro, Brazil

Cho, S. Y.1; Kwon, O.2; Son, H.1; Kim, S. W.3; Paick, J.-S.3; Baik, K.3 Boramae Hospital, Seoul, Republic of Korea; 2Seoul National University, Urology, Republic of Korea; 3Seoul National University, Republic of Korea

1

Objective: To investigate and compare demographic characteristics and prevalence of cardiovascular comorbidities in Korean men with mild ED to men with ED except those with mild ED. Methods: Results were analyzed from the manufacturer’s database. Men with 6-month histories of ED and in monogamous heterosexual relationships were included. Non-responders to type 5 phosphodiesterase inhibitors or patients receiving regular treatment with nitrate, anticoagulants, androgens, and anti-androgens were excluded. Finally, 70 patients with mild ED (6.0%, group A) and 1,098 patients with ED except those with mild ED (94.0%, group B) were included in the analysis. Of them, 365 had mild to moderate ED (30.5%), 505 moderate (43.2%), and 233 severe (20.0%). Demographic characteristics, prevalence of comorbidities, and previous medications were compared between groups A and B. ED was defined by IIEF-EF scores. Results: Mean ages and body mass indices showed no significant differences between groups A and B. Group A had shorter mean duration of ED (p = 0.025), and range of duration was broader in group B (3.8 ± 3.3 yr vs 4.3 ± 3.6 years). The occurrence of organic diseases was similar. The most common comorbidity was diabetes, which was twice as likely to develop diabetes in group B. The prevalence of all diseases except diabetes in group A was comparable to that in group B. Conclusion: Patients with mild ED should be closely evaluated for cardiovascular comorbidities, and early diagnosis and management should be considered for cardiovascular comorbidites in these patients. Policy of full disclosure: None.

Objective: Injury to the vasculonervous bundle during prostatectomy often leads to erectile dysfunction. Here we injured pelvic arteries or

J Sex Med 2012;9(suppl 5):357–397

368

P-01-036

PROTECTIVE EFFECTS OF L-ARGININE AND L-GLUTAMINE ON THE PENIS OF RATS SUBMITTED TO PELVIC RADIATION Costa, W.1; Sampaio, F.2; Gallo, C.1; Cardoso, L.1; Benchimol, D.1; Felix, B.1; Gregorio, B.1; Medeiros Jr, J.1 1 State Univ. of Rio de Janeiro, Brazil; 2State Univ. of Rio de Janeiro, Urogenital Research Unit, Brazil Objective: External beam radiation therapy is widely used for management of pelvic malignant tumors. Although measures have been taken to reduce side effects, tissues adjacent to the tumor may be affected. We aimed to determine whether L-arginine (A) and Lglutamine (G) has protective effects against radiation-induced alterations in major components of the penis. Methods: Wistar rats aged 3 to 4 months were used. Animals were submitted to pelvic radiotherapy on the 8th day of the experiment. Animals were irradiated with a single dose of 1,164 cGy applied to the pelvic region, and then were killed 7 days (groups RAD7, RAD7+A, RAD7+G) and 15 days (groups RAD15, RAD15+A, RAD15+G) after irradiation. The amino acids were administered once a day (0.65 g/kg body weight), starting on day-1 (7 days before irradiation) until the last day of experiment. Histochemical techniques were performed for stereological analysis of smooth muscle, collagen and elastic fibers of corpus cavernosum. In the urethra we analyzed the thickness of urothelium and cell density. Confocal laser immunohistochemistry was used for qualitative analysis of collagen types I and III. Statistical analysis was performed by one way ANOVA. Results: RAD15 group showed an increase in collagen amount (p < 0.004). Smooth muscle increased in RAD7, RAD7+G, RAD7+A, RAD15+A and RAD15+G groups (p < 0.05). Elastic fibers of corpus cavernosum increased in RAD15 and RAD15+G (p < 0.05) and RAD15+A groups, when compared to controls. Radiation-induced decrease in cell density and thickness of the urothelium were seen only after 15 days (p < 0.004), and L-arginine and L-glutamine partially prevented these changes. Qualitative analysis of collagen type I showed an increase in RAD15. Conclusion: L-arginine and L-glutamine prevented radiation-induced changes in penile structures, although L-arginine was slightly more effective. Supported by grants from CNPq, FAPERJ and CAPES– Governmental Institutions. Policy of full disclosure: None.

P-01-037

SINUSOIDAL CONSTRICTION AND VASCULAR HYPERTROPHY IN THE DIABETES-INDUCED RABBIT PENIS Costa, W.1; Sampaio, F.2; Abidu-Figueiredo, M.1; Pereira, V.1; Chagas, M.1; Gregorio, B.1; Benchimol, D.1; Gallo, C.1 1 State Univ. of Rio de Janeiro, Brazil; 2State Univ. of Rio de Janeiro, Urogenital Research Unit, Brazil Objective: To assess the morphological changes of penile vascular structures and the corpus cavernosum area in alloxan-induced diabetic rabbits.

J Sex Med 2012;9(suppl 5):357–397

Poster Presentations Methods: Twenty male rabbits (2 months old) were divided into two groups with 10 rabbits each, the control group (CG) and the diabetic group (DG). The animals from DG received an intravenous injection of alloxan (100 mg/kg) to induce the diabetes. Ten weeks after the induction of diabetes, all animals were euthanized. Two fragments of the penile shaft were harvested and samples were processed and paraffin embedded. Sections (5 mm) were cut and stained for histological and immunohistochemical markers. Results: Twenty male rabbits (2 months old) were divided into two groups with 10 rabbits each, the control group (CG) and the diabetic group (DG). The animals from DG received an intravenous injection of alloxan (100 mg/kg) to induce the diabetes. Ten weeks after the induction of diabetes, all animals were euthanized. Two fragments of the penile shaft were harvested and samples were processed and paraffin embedded. Sections (5 mm) were cut and stained for histological and immunohistochemical markers. Conclusion: Alloxan-induced diabetes mellitus in rabbits promotes important changes in penile vascular structures, thereby decreasing blood supply and affecting penile hemodynamics, leading to erectile dysfunction. Supported by grants from CNPq, FAPERJ and CAPES– Governmental Institutions. Policy of full disclosure: None.

P-01-038

TESTOSTERONE ROLE ON CORPORA CAVERNOSA STRUCTURES MIranda, A.1; Gallo, C.1; Costa, W.1; Cardoso, L.1; Felix, B.1; Benchimol, D.1; Sampaio, F.2 1 State Univ. of Rio de Janeiro, Brazil; 2State Univ. of Rio de Janeiro, Urogenital Research Unit, Brazil Objective: To evaluate, through quantitative methods, the structural alterations in the corpora cavernosa of rats submitted to surgical castration as well as the role of late hormone replacement in reversing the possible structural alterations. Methods: We used 25 male Sprague-Dawley rats who were 12 weeks of age. The animals were divided into 5 groups composed of 5 animals each and treated as follows. ORCHIEC-1 group that underwent orchiectomy and were sacrificed after 1 month, C-1 control group sacrificed after 1 month, ORCHIEC-2 group that underwent orchiectomy and were sacrificed after 2 months, C-2 control group sacrificed after 2 months, T group that underwent orchiectomy, and after 1 month underwent testosterone replacement with a subcutaneous single dose of testosterone undecanoate at 100 mg/kg (T); after 1 month of hormonal replacement, the animals were sacrificed. For the comparative analysis, histochemistry, immunohistochemistry and scanning electron microscopy methods were used. For the evaluation of the 2 groups sacrificed in the first month, we used the Student’s t-test for comparison between the means. For the 3 groups sacrificed after 2 months we used the ANOVA with a Bonferroni post-test. Results: There were a significant decrease in the absolute values of collagen, smooth muscle, sinusoidal space and total area of corpora cavernosa after 2 months in the castrated group when compared with controls. Overall, as regards density, no significant differences were observed among the groups. The hormonal replacement with testosterone was able to reverse the alterations observed, demonstrating an increase in the elements studied. Conclusion: The method used for this research allowed demonstrating that absolute values are reliable to quantify the structural alterations of corpora cavernosa structures. The results suggest that hormonal replacement, even when instituted at a late stage, is effective in reversing the corpora cavernosa alterations produced by castration. Supported by grants from CNPq, FAPERJ and CAPES–Governmental Institutions. Policy of full disclosure: None.

369

Poster Presentations P-01-039

ERECTILE DYSFUNCTION IN DIABETIC MEN Darabi Mahboub, M. R.1; Rezaee Ardani, A.2 Mashhad University of Medical, Urology, Islamic Republic of Iran; 2 Mashhad University of Medical, Islamic Republic of Iran

1

Objective: There is erectile dysfunction in diabetic men controlled and uncontrolled. We evaluated erectile dysfunction treatment in diabetic men in our department. Methods: 70 patients with diabetic disease with age between 45 years until 65 years evaluated in our department. They have erectile dysfunction (loss of libido, impotency or both). All of patients received Glybenclamid or Metformine or Insuline for his disease. Loss of libido there was in 28 patients and impotency there was in 30 patients and both in 14 cases. Hormonal study was done in all patients and hormonal imbalance there was in 30 patients (Testosterone was low). Blood sugar controlled in all patients and all of patients treated for erectile dysfunction with Androgen drugs, Sildenafil or Tadalafil or intracorporal injection with vasoactive drugs. Results: From 70 patients in our study 40 cases with loss of Libido in 31 cases after treatment Libido was very good are in 9 cases Libido was better. In 44 cases with impotency in 28 cases there was full erection during intercourse and in 13 case impotency there was good for intercourse and 3 cases then was impotency after treatment. Conclusion: Diabet is a system disease and in diabetic patients there was loss of Libido, Impotency or both. Causes of these problems included: Hormonal imbalance–polyneuropathy and vascular diseases. By used of drugs for increase Libido, potency we can treatment loss of Libido, Impotency or both in this patients with high success rate. Policy of full disclosure: None.

P-01-040

L-ARGININE IMPROVES SPERMATOZOID PARAMETERS AND REPRODUCTIVE FUNCTION AFTER TESTICULAR TORSION IN PREPUBERTAL RATS de Souza, D.1; Milhomen, R.2; Ribeiro, C.2; Gregório, B.2; Gallo, C.2; Pereira-Sampaio, M.2; Costa, W.2; Sampaio, F.2 1 UERJ, Urogenital Research Unit, Rio de Janeiro, Brazil; 2UERJ, Rio de Janeiro, Brazil Objective: To assess changes in reproductive function of adult rats that underwent testicular torsion in the prepubertal period and the effects of L-arginine treatment. Methods: Twenty Wistar rats, 4 weeks old, were submitted to torsion of the right testicle during four hours. Ten animals were treated with 650 mg/Kg of L-arginine administered by gavage throughout the following seven days after detorsion, while the remaining ten animals received no treatment. Other ten animals were submited to sham surgery. After eight weeks, animals from all groups were mated with estrous females. At the end of pregnancy, the females were killed and the fetuses, absorptions, corpora lutea and implantation sites were counted. Two weeks after the fertility test, the males were killed and spermatozoids were collected from epididymal tail. The evaluation of sperm concentration, motility and viability was performed using optical microscopy in a Neubauer chamber. Statistical analysis was performed by ANOVA with Bonferroni post-test (for parametric data) or Kruskal-Wallis with Dunns post test (for nonparametric data), using the software Graphpad Prism. Differences were considered significant when p < 0.05. Results: Animals that underwent to torsion showed decreased in fertility and spermatozoid concentration, motility and viability when compared with the sham group. Animals treated with L-arginine had similar spermatozoid concentration in twisted testicle to the sham and contra-lateral testicles. Also, L-arginine improved the potency and fertility, as well diminished the pre-implantation losses in the treated animals when compared to the untreated group. Interestingly the

potency (ability to mate estrous females) of treated animals were even higher than the animals from sham group. Conclusion: Testicular torsion induced a decrease of spermatozoid quantity and quality in the twisted testicle, with prejudice in the fertility. L-arginine promoted a protection/recovery from testicular torsion, improving spermatozoid parameters and the reproductive function. Supported by grants from CNPq, FAPERJ and CAPES–Governmental Institutions. Policy of full disclosure: None.

P-01-041

MORPHOMETRIC STUDY OF THE CORPUS CAVERNOSUM AFTER CHRONIC ADMINISTRATION ANABOLIC ANDROGENIC STEROID IN PUBERTAL AND ADULT RATS de Souza, D.1; Sena, A.2; Vargas, R.2; Gregório, B.2; Gallo, C.2; Oliveira, L.2; Frankenfeld, S.2; Costa, W.2; Favorito, L.2; Sampaio, F.2 1 UERJ, Urogenital Research Unit, Rio de Janeiro, Brazil; 2UERJ, Rio de Janeiro, Brazil Objective: To evaluate the penile modifications of pubertal and adult rats chronically treated with supra-physiological doses of anabolic androgenic steroid. Methods: Twenty male Wistar rats were assigned into four groups: T65 (pubertal rats with 65 days of age, n = 5); T105 (adult rats with 105 days of age, n = 5) and their age matched controls C65 and C105. Treated animals were submitted to a weekly intra-muscular injection of nandrolone decanoate at a dose of 10 mg.Kg-1 of body weight, during eight weeks. Control animals received vehicle (peanut oil) injections for the same time. The rats were killed and their penises were collected, fixed and processed routinely for histology. Sections of 5 μm were stained with Masson’s trichrome and analyzed by morphometry. The surface density of smooth muscle, conjunctive tissue and sinusoidal space of corpora cavernosa were calculated by the pointcounting method. Means were compared by the Student’s-t-test considering p < 0.05 as significant. Results: In group T105 the sinusoidal space surface density increased by 21%, in comparison to C105 (p < 0.05). Also in the adult rats, smooth muscle reduced by 16% compared to its controls (P < 0.05), but no difference was found concerning the conjunctive tissue surface density. In group T65, the smooth muscle surface density was increased by 10% in relation to C65 (p < 0.05). The conjunctive tissue and sinusoidal space surface densities were not statistically different among control and treated pubertal animals. Conclusion: The use of supra-physiological doses of anabolic androgenic steroids promotes structural changes in the rat corpora cavernosa, which may be involved in erectile dysfunction. It seems that these alterations occur more prominently in adult animals. Supported by grants from CNPq, FAPERJ and CAPES–Governmental Institutions. Policy of full disclosure: None.

P-01-042

PRIAPISM IN TEENAGE BOYS FOLLOWING A CHANGE IN THE FORMULATION OF DEPOT TESTOSTERONE Donaldson, J.1; Rees, R.2; Davies, J.3; Davis, N.3; Steinbrecher, H.3 University Hospital, Southampton, United Kingdom; 2Royal Hampshire County Hospital, Winchester, United Kingdom; 3University Hospital Southampton, Southampton, United Kingdom

1

Objective: Priapism is rare in children and may result in erectile dysfunction and sexual aversion behaviours. Testosterone therapy is widely regarded as safe in children and is widely used in constitutional delay of growth and puberty, hypogonadism, hypospadias and micropenis. Methods: We report two cases of priapism in teenage boys (aged 14 and 15 years) with constitutional delay of growth and puberty after a change in the formulation of depot testosterone. Both patients received “Sustanon 250®” (Organon Laboratories Limited, Hertfordshire,

J Sex Med 2012;9(suppl 5):357–397

370 UK) following the discontinuation of “Sustanon 100®” (Organon Laboratories Limited). Results: The first case presented late (three days) and did not resolve following corporal aspiration (deoxygenated: pO2 0.4 kPa/3 mmHg) and phenylephrine injection so underwent bilateral T-shunts and midcorporal corporotomies. Oral pseudoephedrine and cytoproterone acetate were given for two weeks. At eight month follow-up he reported no erections and had palpable corporal thickening. The second case was preceded by stuttering priapism and was painful but resolved after twelve hours without surgical intervention. At ten month follow-up he reported normal erectile function. Conclusion: These cases illustrate the significant risks associated with changing drug formulations, especially in children. Pharmacokinetic studies are required in children. We postulate this drug error may easily recur in the absence of explicit guidance for use for children. We now routinely use a lower dose of “Sustanon 250®”. Patient and parent counselling is important before testosterone administration in children as early presentation and treatment of priapism can prevent corporal fibrosis and erectile dysfunction. Policy of full disclosure: None.

P-01-043

THE EDINBURGH PENILE CANCER AUDIT 2005–2011: MORBIDITY AND OUTCOMES OF CONTEMPORARY TREATMENT Donat, R.1; McFee, S.1 1 Western General Hospital, Edinburgh, United Kingdom Objective: Penile cancer requires a variety of procedures to obtain cancer control while optimizing cosmetic and functional outcomes. To audit treatment outcomes, morbidity and mortality in a contemporary patient group managed with minimal resection margins and sentinel lymph node biopsy. Methods: This retrospective study included all identifiable patients undergoing surgical treatment of penile cancer or carcinoma in situ between 2005 and 2011 in our unit. Results: 112 patients were identified of whom 100 were evaluable. Mean patient age was 62.2 yrs (range 35–93 yrs). Penile procedures included circumcision (22), local excision (15), glans resurfacing (9), meatoplasty (2), glansectomy (graft) = 37 (27), partial penectomy (graft) = 21 (10) and radical penectomy (11). Median deep resection margin was 2.5 mm. COMPLICATIONS – PENILE PROCEDURES Reoperation for bleeding 1 Wound infect (MRSA) 10 (4) Sepsis 1 UTI/Orchitis 3 Graft failure 2 Donor site non healing 1 Other wound problems 3 Buried penis 2 Urostomy stenosis 2 Urinary retention 2 Medical 2 Lymph node(LN) procedures included sentinel LN biopsy, superficial or radical LNectomy, local recurrence excision (1), groin dissection + rectus abdominis flap (3) and pelvic LN dissection (8). COMPLICATIONS–LYMPH NODE PROCEDURES Sentinel LN / Radical Lnectomy n = 92 groins / n = 53 groins) Wound infect(MRSA) 5/8(2) Sepsis 0/2 C difficile 0/1 Bleeding complications1/1 Wound dehiscence 0/8 Lymphocele/Lymph leak 1/11 Leg oedema (severe) 0/5(1)

J Sex Med 2012;9(suppl 5):357–397

Poster Presentations Penoscrotal oedema 0/3 Urinary retention 1/1 Other (TIA, DVT, neurapraxia) 0/3 91 patients were treated with curative intent (9 patients palliative). With a mean follow up of 23.7 months (2–68 mo), 79.1% of these patients (72) are alive and recurrence free, 13.2% (12) had recurrent cancer and 7.7% (7) died from penile cancer. There were 6.6% (6) deaths from other causes. Conclusion: Modern management offers acceptable morbidity and good cure chances for localized penile malignancy. Policy of full disclosure: None.

P-01-044

IS SENTINEL INGUINAL LYMPH NODE BIOPSY A REPRODUCIBLE TREATMENT OPTION IN PENILE CANCER? Donat, R.1; McFee, S.1 1 Western General Hospital, Edinburgh, United Kingdom Objective: Only few centres have reported the outcomes of dynamic sentinel lymph node biopsy(DSLNB) in penile cancer. Our aim was to evaluate the outcomes in a centre which has recently introduced the technique and add to the available literature. Methods: This was retrospective analysis of all patients undergoing DSLNB bwtween 2005 and 2011 in our centre. Results: 53 patients (mean age 60.7 yrs) underwent DSLNB, including 46 bilateral and 7 unilateral procedures involving 99 groins. The median follow up was 38 months. Subsequent radical lymphadenectomy for positive DSLNB was required in 14 groins. Recurrent groin metastasis occured in 3 patients (3 out of 75 groins) following negative DSNB. Out of these 3 patients only one definitely had a true false negative DSNB while the two others had had a local penile recurrence in the interim. Conclusion: The technique of DSNB is reproducible and has a low false negative rate. Policy of full disclosure: None.

P-01-045

PIPERACILLIN VS AZITHROMYCIN AND BOTH COMBINATION IN TREATMENT OF MALE WITH UREAPLASMA UREALYTICUM Drasa, K.1; Xhixha, A.2; Krasniqi, M.3; Koci, E.4 Central Polyclinic, Urology, Tirana, Albania; 2DSHP, Tirana, Albania; 3 Outpatient Care, Tirana, Albania; 4Bacteriological Laboratory, Tirana, Albania

1

Objective: Ureaplasma Urealyticum(UU)is an infrequent cause of urethritis but we don’t forget that it exist.The purpose of this study was to compare the action efficiency of Piperacilline(PIP)VS Azithromycin(AZI)and both combination in treatment of UU. Methods: 66outpts, male ≥18Y, infected with UU, were enrolled in study. A Gram stain of a urethral discharge, were tested by A. F. GenitalSystem. Outpts were separated in 3groups with 22. 1) PIP-2 gr/4 ml-IM, od for 7days. 2) AZI-1 mg, od for 7days. 3) PIP 2 gr/4 ml-IM, od for 7days then AZI 1 mg, od for 10days.All pts taken Cranberry/twocapsule, bid and tested for UUat baseline. ToC was performed one wk after therapy completation. Pts with microbiological eradication (ME) were ToC by A.F.G.S, six months after therapy completion. The primary endpoint was ME. The secondary was clinical improvement (CI), assessed by reduction in symptoms (RiS); recurrent infection rate after one wk and sixmonths and safety. Results: ME rate after one wk was: 1) 90.9% (n20), 2) 81.84% (n18) and 3) 100% (n22). At the end of the treatment the CI based by RiS was better in first than second group but in third was maximally reduced. The ToC of the pts with ME, after six months, results positive: 1) 2cases (10%), 2) 3cases (16.67%) 3) 1case (4.54%).8(12.12%), reinfected from untreated partners; 4(6.06%) have not been reinfected from untreated-partners. Pts with persistant UU were more likely to experience persistent symptoms (91%), compared to pts in whom UU

371

Poster Presentations was eradicated (16%), p < 0.0001. Safety was comparable in first and second but in third group was completely. Conclusion: Results, suggest that treatment in both combination was reflected by a trend to resolution of subjective symptoms. PIP and AZI, are in the first-second-line antibacterial agents for eradication of UU, respectively. Treatment of sexual partners is still mandatory. Policy of full disclosure: None.

P-01-046

ERECTILE DYSFUNCTION – THE FIRST SIGN OF CARDIOVASCULAR PATHOLOGIES CLINICALLY NOT MANIFESTED Dumbraveanu, I.1; Grajdieru, R.2; Balutel, B.2; Ghenciu, V.2; Tanase, A.2 State Medical University, Urology, Chisinau, Republic of Moldova; 2State Medical University, Chisinau, Republic of Moldova

1

Objective: Erectile dysfunction (ED) is a frequent manifestation in systemic diseases, including cardiovascular. The aim of the study is to identify cardiovascular pathologies in ED patients first addressed to andrologist, and who were not previously diagnosed with other diseases. Methods: Examined 388 patients, primary addressed with ED. Age ranged 21–73 years. Scores used IIEF, AMS, NIH-CPSI, IPSS. Laboratory examinations: cholesterol, triglycerides, glycemia, hormone levels. Instrumental examination: blood pressure, ultrasound, ECG, penile Doppler. Patients were divided into 3 age groups. First group– up to 40 years (202 patients), group 2–41–60 years (132 people) and group 3 – over 60 years (54 people). Results: Blood pressure assessment showed elevated levels in 12 pts (11%) in group 1, and 39 pts (29%) group 2 and 26 pts (48%) group 3. High BMI detected in 19 men (9%) in group, 80 pts (60%) and 31 pts (57%) in group 2 and 3 (p < 0.005). High levels of cholesterol in 68 pts (52%) in group 2, 24 pts (44%) in group 3, and 38 (19%) in group 1, elevated tryglicerides in 32 pts (16 %) in the first group, 41 pts (31%) in group 2 and 19 pts (35%) in group 3. Penile Doppler selectively performed in 64 patients from the first group, 38 pts from group 2 and 19 pts from group 3, showed the presence of vasogenic etiology of ED in 15% pts from the first group, 58% in group 2 and 78% in group 3 (p < 0.005). Conclusion: The obtained data showed that ED in patients aged over 40 years in most cases is associated with a clinically non-manifest cardiovascular pathology when first addressing, or biochemical changes (dyslipidemia) with increased cardiovascular risk. ED often constitutes the first manifestation of cardiovascular diseases and should be included in the list of risk factors for heart diseases. Policy of full disclosure: None.

P-01-047

SEXUAL DISORDERS – FIRST SIGN OF TYPE II DIABETES MELLITUS (DM) Ghenciu, V.1; Dumbraveanu, I.2 State Medical University, Chisinau, Republic of Moldova; 2State Medical University, Urology, Chisinau, Republic of Moldova

1

Objective: Diabetes and its complications are known as a risk factor for sexual disorders in both sexes. Sexual disorders as early signs of DM are very little studied. The aim is assessing the early effects of diabetes on sexual function, and examine the possibility of including sexual dysfunction as an early marker of diabetes mellitus. Methods: Studied 120 patients with primary diagnosed type II DM, 45 men and 75 women. Patients scored regarding the presence of sexual problems, and the correlation between their onset and being diagnosed with diabetes. Results: Positive response reported in 22 (49%) men and 31 (41%) women. The most common disorders of the male sex reported: Erectile dysfunction 16 (35%), lack of libido 19 (42%), premature ejaculation 6 (13%), urogenital infections 8 (18%). In women sexual dysfunction was manifested by genital itching 23 (30%), lack of libido or orgasm 18 (24%), dyspareunia – 12 (16%) or vaginismus – 2 (3%), urine incontinence – 3 (4%). In both sexes the onset of sexual

manifestations in most cases (16 men and 27 women) was 3 to 18 months before being diagnosed with type 2 diabetes mellitus. And 12 (54%) men and 19 (61%) women received treatment from their GP, urologist or gynecologist for sexual problems without a prior control of blood sugar. Conclusion: Patients aged over 40 years with sexual problems, regardless of gender, need to be investigated in the presence of a hyperglycemia. Sexual disorders in adult patient can serve as an early marker in the diagnosis of type 2 diabetes mellitus. The sexual activity assessment in primary diagnosed type 2 DM patients allows to detect the probably DM onset period and to establish timely and appropriate treatment for diabetic polyneuropathy or infectious complications. Policy of full disclosure: None.

P-01-048

IMPACT OF TESTOSTERONE DEFICIT SYNDROME (TDS) SEVERITY AND THE PRESENCE OF MOST FREQUENT SYMPTOMS OF TDS ON PATIENTS’ ERECTILE DYSFUNCTION TREATMENT PREFERENCES Gutierrez Hernandez, P.1; Fernandez Lozano, A.2; Rebollo, P.3 Universidad La Laguna, Tenerife, Spain; 2Fundacio Puigvert, Andrology, Sabadell Barcelona, Spain; 3La-Ser Outcomes, Oviedo, Spain

1

Objective: To assess preference of patients with erectile dysfunction (ED) for different ED treatment features and its relationship with patient characteristics: age, number of comorbidities, testosterone deficit syndrome (TDS) severity, presence of common TDS symptoms, and frequency of sexual intercourse. Methods: Single visit multicenter study on 314 consecutive ED patients aged ≥18 in Primary Care in Spain that had taken oral ED treatment in the last 8 intercourses. Ageing Males Symptoms (AMS) questionnaire was administered; presence of common symptoms of TDS (increased fat mass, libido, reduced erectile function, and mood changes) was assessed. Conjoint analysis research technique was used to estimate patient preferences. Five ED experts and 20 patients selected 4 relevant features: administration formats (tablet, orodispersible tablet (ODT) and injections), onset of action (10 or 30 min), food and alcohol interactions, and duration of action (6, 12 or 24 h). SPSS Orthoplan was used to get a 9-card orthogonal main-effect profile set. Ordinary Least Squares Regression was used to estimate expected utility. Ordered Logistic Regression was used to analyze correlations. Results: All patients had taken vardenafil ODT plus one of the 3 oral PDE5i tablets. Most valued feature was administration format (58% relative importance) followed by duration of action (16.7%), interactions (14.6%) and onset of action (10.7%). ODT showed the highest expected utility among administration formats (1.9 vs 0.8 tablets vs −2.7 injections). Patients with mild TDS preferred faster onset of action; the latter and those with increased fat mass preferred the ODT presentation; patients with severe TDS or mood changes preferred longer duration of action. Influences were mild. No other associations were observed. Conclusion: In ED treatment, administration format is the most valued feature over onset, duration of action and interactions, being ODT the preferred format. TDS severity and presence of common TDS symptoms influenced preferences mildly. Policy of full disclosure: on behalf of Bayer Spain Grant.

P-01-049

SEXUAL FREQUENCY AMONG MARRIED EGYPTIANS Gadalla, K.1 Alazhar Faculty of Medicine, Urology, Cairo, Egypt

1

Objective: To study the effects of many factors on frequency of intercourse. Methods: 1413 patients came to our Andrology clinic seeking for medival advice. All patients underwent detailed medical and sexual

J Sex Med 2012;9(suppl 5):357–397

372 history including frequency of intercourse. Patients asked about Diabetesellitus, Hypertension, Smoking, Age, and presence of Erectile Dysfunction and Premature Ejaculation. We studied the correlation between those factors and frequency of intercourse. Results: 1413 pateints were evaluated acoording to frequency of intercourse, 2–3 per week (in 270 patients), 2–3/week (in 252 patients), while 216 patients had daily intercourse. 24 patients with age group (21–25 years) had 2–3/week, 3–4/week, 4–5/week, while 99 patients at age group 26–30 years had frequency 3–4/week. There is increase in frequency between non diabetics other than diabetics. And increase also in non-hypertensive patients other than hypertensive patients. There is increase in frequency between non smokers. Conclusion: There is many factors associated with decreased frequency of intercourse as smoking, DM, Hypertension, and aging. And there is positive relation between patients with Erectile Dysfunction and Premature Ejaculation. Policy of full disclosure: None.

P-01-050

EVALUATION OF MALE SEXUAL FUNCTION IN ACTIVE ACROMEGALIC PATIENTS AND AFTER DISEASE REMISSION: PRELIMINARY STUDY Galdiero, M.1; Vitale, P.2; Grasso, L. F. Stella2; Lo Calzo, F.2; Cariati, F.2; Lotti, F.3; Maggi, M.3; Colao, A.2; Pivonello, R.2 1 Federico II University, Molec. and Clinic Endocrinology, Naples, Italy; 2 Federico II University, Naples, Italy; 3University of Florence, Italy Objective: Acromegaly is characterized by hypogonadotropic hypogonadism, endothelial dysfunction, hypertension and impaired glucose and lipid metabolism, classical risk factors for sexual dyfunction (SF). The purpose of this study was to evaluate the SF of patients with acromegaly. Methods: 72 patients were enrolled. Among them, 48 were in remission and 26 in active disease. All patients were subjected to the questionnaire for the evaluation of the SF (IIEF-15), together with the evaluation of the clinical profile and of glycolipid and hormonal status. Patients were divided into 2 groups according to normal (group A) or high(group B) IGF-1 levels. Results: ED was found in 23 patients (32%). In particular, 15 of 49 (30.6%) patients of group A showed ED (14 with mild ED and 1 with moderate ED) whereas 8 of 23 (35%) patients of group B showed ED (4 with mild ED and 4 with severe ED) (p = NS). There was no significant difference in the scores of all IIEF-15 scales subjects between group A and group B. Testosterone (T) (p < 0.05) and LH (p < 0.05) levels were lower while PRL (p < 0.05) and HbA1c (p < 0.05) levels were higher in group B than in group A. In patients with ED, BMI (p < 0.05) and waist circumference (p < 0.05) were significantly higher while the score of desire (p < 0.001) was significantly lower than those without ED. The score ED-IIEF correlated positively with desire score (P < 0.01) and the presence of T replacement therapy (P < 0.05) and negatively with BMI (P < 0.05), PRL (P < 0.05) and GH levels (P < 0.05). BMI was the major predictor of the ED-IIEF score. Overall satisfaction correlated negatively with PRL (P < 0.05) levels. Conclusion: Acromegaly is associated with a high prevalence of ED that does not seem to be completely resolved by normalization of IGF-I after disease remission. Policy of full disclosure: None.

P-01-051

METABOLIC SYNDROME COMORBIDITY IN A COHORT OF 1094 MEN WITH LOW TESTOSTERONE LEVELS García-Cruz, E.1; Cadeñosa, O.2; Piqueras, M.3; Luque, P.3; Alcaraz, A.3 Hospital Clínic de Barcelona, Urology, Spain; 2Bayer España, Sant Joan d’Espí, Spain; 3Hospital Clínic de Barcelona, Spain 1

Objective: To determine the prevalence and risk factors for Metabolic Syndrome (MS) in a cohort of men with low testosterone (T) levels.

J Sex Med 2012;9(suppl 5):357–397

Poster Presentations Methods: A multi-centre, cross-sectional study recruited 1094 consecutive men older than 45 years old with low T levels (<12 nmol/L). Alcohol intake and tobacco use were recorded. Obesity was defined as Body Mass Index >30 kg/m2. History of heart disease, peripheral vascular disease and other relevant entities were prospectively recorded. Metabolic Syndrome was defined as 3 or more of the following: abdominal obesity ≥94 cm, triglycerides ≥150 mg/dl, Hypertension ≥130/85 mmHg, HDL-cholesterol < 40 mg/dL or Fasting Glucose ≥100 mg/dl. AMSS questionnaire and IIEF were used to record low T symptoms and erectile function. Testosterone and SHBG were determined in blood sampling between 7 h00 AM and 11 h00 AM. Free and bioavailable T were calculated using Vermeulen’s formula. Multivariate analysis was carried out to determine the variables related to the presence of MS. P < 0,05 was considered statistically significant. Results: Mean age was 61,2 ± 8,1 years old. Hypertension 85%; Diabetes Mellitus 58,1%; HDL-Cholesterol <40 ng/dL 20,6%; Triglycerides ≥150 mg/dl 55,1% and Waist circumference ≥94 cm 81,1%. MS (3 or more factors) 69% (0 factors 2,1%; 1 factor 8,4%; 2 factors 20,5%; 3 factors 33,5%; 4 factors 27,4% and 5 factors 8%). Factors related to the presence of MS were AMSS (OR 1,018 p = 0,021), obesity (OR 2,406; p < 0,001), IIEF score (OR 0,936; p < 0,001), alcohol intake (OR 1,618; p = 0,002) and peripheral vascular disease (OR 2,006; p = 0,049). Conclusion: In a cohort of men with low T levels, the rates of hypertension, oral glucose intolerance, high triglycerides, low HDLcholesterol and high waist circumference, and thus MS, are high. Policy of full disclosure: This study was financially supported by a grant for investigation by Bayer España.

P-01-052

IS ULTRASONIC THERAPY EFFECTIVE IN PATIENTS WITH PEYRONIE’S DISEASE? Habous, M.1; Eldawy, S.2; Nada, E.2; Garaffa, G.3 Elaj Medical Centers, Urology&Andrology, Jedda, Saudi Arabia; 2Elaj Medical Centers, Jedda, Saudi Arabia; 3St. Peter Andrology Center, London, United Kingdom

1

Objective: To evaluate the efficacy of ultrasonic therapy (UT) in patients with Peyronie’s Disease (PD) in terms of reduction of pain and curvature and improvement of erectile function. Methods: 149 patients with PD who have completed 1 cycle of UT between June 2011 and July 2012 have been prospectively reviewed. In our UT protocol, each cycle consisted in 10 minutes of treatment 3 times a week for 12 successive weeks; the intensity of the ultrasound was 0.8 watt/cm2 and the frequency 1 mega Herz. The median patient’s age when commencing the treatment was 52 years (range 29–75) and PD presented with curvature and palpable/painful plaque in all cases. 92 patients (62%) had also a moderate to severe ED (IIEF-5 score < 16). Patients were assessed prior and at the end of treatment, at week 24 and 36 and the outcome of UT from patient and operator point of view were documented. Changes in erectile function were assessed with the administration of the IIEF-5 questionnaire, penile curvature was measured during a full artificial erection and patients were asked to score the level of pain between 1 and 10. Results: Median IIEF-5 score was 15 (range 9–23) and 18.5 (range 12–23) respectively pre and post treatment. Overall, 70% of patients had a higher post-treatment score. Pain scores improved in 76 patients (51%) while reduction in curvature and plaque size occurred respectively in 27% and 18% of cases. Conclusion: The present series confirms that UT may play a role in patients with PD to improve erectile function and pain scores, but has little impact on plaque size and curvature. Policy of full disclosure: None.

373

Poster Presentations P-01-053

P-01-055

EFFECT OF EXERCISE PARAMETERS AND BODY COMPOSITION ON ERECTILE QUALITY AND TESTOSTERONE LEVELS

PELVIC VENOABLATION FOR THE TREATMENT OF ERECTILE DYSFUNCTION CAUSED BY VENOUS LEAKAGE

1

Hattat, E.1; Hattat, H.2; Hattat, I.2 Hattat Clinic, Uro-Andrology, Istanbul, Turkey; 2Hattat Clinic, Istanbul, Turkey

1

Objective: Recent literature suggest that life style risks like exercise and body composition influence erection quality and sexual satisfaction. The aim of this study was to assess the relationship between erectile dysfunction, testosterone and objective exercise parameters like energy consumption (EC), Metabolic Equivalent of Task (MET), daily step count (DSC), daily sedentary time (DST), daily moderate activity time (DMA), daily vigorous activity time (DVA) as well as body mass index (BMI), % of body fat, waist circumference (WC). Methods: 170 men in an uro-andrology clinic were included. IIEF-15, serum total and free testosterone (TT, sFT), SHBG, calculated Free testosterone (cFT), bioavailable testosterone were measured. To assess exercise levels, Sensewear Pro3 (Bodymedia) armband that use skin temperature, heat flux, galvanic skin response and accelometer was used. For body composition, Tanita BC 418 was used. Results: 170 men with age of 44,99 ± 10,7, BMI 28,61 ± 3,82, % of body fat 25,63 ± 5,65, WC 108,83 ± 12,33 used the armband for 39,03 ± 17,24 hours. BMI, % body fat, WC were statistically different among IIEF ED score domains (p = 0,0001, being higher for the lower ED scores. Total EC, daily active EC, average MET, DSC, DST, DMA, DVA were statistically different among IIEF ED score groups (p = 0,0001) showing that exercise parameters are higher in higher ED scores. TT was positively related to total EC (r = 0,154 p = 0,045). sFT were negatively related to BMI (r = −0,201 p = 0,009)., % body fat (r = −0,175 p = 0,022), WC (r = −0,206 p = 0,007). cFT was positively related to daily EC (r = 0,196 p = 0,01). Bioavailable testosterone was positively related to non-fat body mass (r = 0,152 p = 0,049), total EC (r = 0,197 p = 0,011). Conclusion: Exercise parameters and body composition are important risk factors for sexual function. It is important to include life-style management in the treatment of ED as a part sexual wellness program. Policy of full disclosure: None.

Objective: Oral therapy with PDE5 inhibitors has become the standard treatment for erectile dysfunction (ED). However, results of PDE5 inhibitors are poor if the cause for ED is cavernous venous leakage. The aim of our study was to evaluate the short and long term results of a modified pelvic vein embolization technique with aethoxysclerol for the treatment of impotence due to venous leakage. Methods: A total of 69 patients with severe ED due to venous leakage underwent the modified embolization procedure. Venous leakage was identified by Color Doppler Ultrasound following intracavernous administration of 10 to 20 μg alprostadil. A 20-gauge needle was inserted into the deep dorsal penile vein under local anesthesia. All patient received a pelvic venogram prior to and after the embolization. Aethoxysclerol 3% as sclerosing agent was injected after air-block with valsalva manoeuvre. Success was defined as the ability to achieve vaginal insertion without the aid of any drugs, vasoactive injections, penile prosthesis, or vacuum device. Furthermore, the pre- and posttherapeutical IIEF score (International Index of Erectile Function) was assessed. Complete follow-up data was available on 55 out of 69 patients. Results: Patients mean age was 57.6 years. The overall success rate was 63.6% at a mean follow-up of 9.2 months (Range 3 to 12 months). The actual IIEF score improved from 38 to 72 points (means). 35 patients reported erections sufficient for vaginal insertion without the use of any drug or additional device. Partial improvement was seen in 8 further patients. No serious complications occurred. Conclusion: Venoablation using aethoxysklerol in aero-block technique is an effective, minimally invasive, and cost-effective therapy for patients with erectile dysfunction due to venous leakage. This new method may also be a feasible treatment option for patients with contra-indications against PDE5-inhibitors. Policy of full disclosure: None.

Herwig, R.1; Kuehhas, F.2 Medical University Vienna, Urology, Wien, Austria; 2Medical University Vienna, Wien, Austria

P-01-054

P-01-056

SEXUALITY IN LATER LIFE: A THEORETICAL MODEL

THE SOMATIC INNERVATION OF THE PENIS: PRELIMINARY EVIDENCE OF SEXUAL DYSFUNCTION AFTER MALE SLING SURGERY

Hattat, E.1 1 Hattat Clinic, Uro-Andrology, Istanbul, Turkey Objective: The aim of this study was to develop a theoretical model regarding the various medical, psychological and social factors that influence the sexuality of older persons using a qualitative methodology. Methods: The research included semi-structured, face-to-face, in depth, individual interviews of fifty older Turkish men and women, including ten couples. A self-formed 12-item questionnaire was administrated during the semi-structured interviews. The interviews were tape-recorded by oral-consent. For the couple interviews, the partners were interviewed separately. The interviews were analysed using an interpretative phenomenological method. Results: The thematic framework identified four main super-ordinate themes: Older Persons’ Attitudes Toward Sexuality and Sexual Behavior; Gender, Sexuality and Sexual Behavior; Sexuality and Sexual Behavior of the Older Couple and Health, Sexuality and Sexual Behavior. As the result of these findings, a theoretical circular model regarding later life sexuality was established. The model includes the four main determinants of older persons’ sexuality namely Perception of Sexuality, Sexual Compliance, Motivation and Adaptation. Conclusion: Results from this integrative model support the need to include all bio-psycho-social determinants of later life sexuality in managing older patients and couples with sexual concerns. Policy of full disclosure: None.

Hogewoning, C.1; Elzevier, H.2; Bekker, M.3; DeRuiter, M.3 Leiden University, Medical Centre, Den Haag, Netherlands; 2Leiden Uni. Medical Center, Netherlands; 3Leiden University Medical Center, Netherlands

1

Objective: The AdVance® male sling (American Medical Systems, 2006) is a minimally invasive retro-urethral surgical sling implant for the treatment of mild stress urinary incontinence (SUI). The AdVance® sling is placed using a transobturator outside-in approach with specially designed needle passers. The dorsal nerve of the penis (DNP), the main sensory nerve of the penis, is important for the preorgasmic and orgasmic sensations and is situated in the area of surgery. In 2009 a surgical procedure using the AdVance® sling was complicated with unilateral loss of penile sensibility that may have been caused by damage to neural genital structures. Aim of this study is the description of the course of the DNP in relation to the AdVance® sling procedure for SUI. Methods: The AdVance® sling procedure was performed on six donated adult male bodies. All bodies had been fixated with AnubiFIX TM to preserve natural flexibility and to ensure a reliable resemblance to the procedure in normal patients. After the procedure the pelves were removed and sectioned through the midline. The penile nerves were dissected and the shortest distance between the needle/sling and the DNP was documented.

J Sex Med 2012;9(suppl 5):357–397

374 Results: The DNP originates from the pudendal nerve in the Alcock canal and ascends from there, through the urogenital diaphragm, to the penile bodies. In the dissected pelves, the distance of the AdVance® sling to the DNP had a mean of 4.1 mm (range 0–10 mm), with no statistical difference between left or right. The tape was found to be located against the DNP (distance 0 mm) in four of the twelve hemipelves. Conclusion: The DNP is located inferior of the pubic ramus and was in four of the twelve hemipelves found to be disturbed by the AdVance® sling, possibly affecting sexual function. Policy of full disclosure: None.

P-01-057

THE SIAMS-ED STUDY: A SPONTANEOUS, MULTICENTER, OBSERVATIONAL STUDY ON THE EFFICACY OF VARDENAFIL IN MEN WITH ERECTILE DYSFUNCTION AND CARDIOVASCULAR RISK FACTORS Isidori, A.1; Corona, G.2; Aversa, A.3; Jannini, E. A.4; Foresta, C.5; Maggi, M.6; Lenzi, A.3; SIAMS-ED Study Group 3 1 University of Rome La Sapienza, Roma, Italy; 2Maggiore-Bellaria Hospital, Bologna, Italy; 3University of Rome, Roma, Italy; 4University of L’Aquila, Italy; 5University of Padua, Italy; 6University of Florence, Italy Objective: This was a spontaneous, 18-centers, open-label, interventional study performed in a large cohort of unselected men to assess health outcomes in men with erectile dysfunction (ED) who took vardenafil for 5-month in a real-life setting. Methods: A total of 604 men (55 ± 12 yrs) were enrolled. All had 4-week washout-period from pro-erectile drugs and underwent questionnaires, penile-Doppler-ultrasonography, cardiometabolic and hormonal screening, including pulse pressure (PP) and testosterone (T); cardiovascular risk (CVR) was stratified into classes predicting the likelihood of a major adverse cardiovascular event (MACE) within 10 yrs. Results: One third of patients (30.8%) had metabolic syndrome: 33.2% reduced HDL, 36% increased waist, 67.8% hypertension, 37.2% hypertriglyceridemia, 31.9% hyperglycaemia. Mean PP was 49.2 ± 10.4 mmHg. Stratification of cardiovascular risk was 58.8% for class I-II (<10% of MACE), 33.8% for class III-IV (10–20% of MACE) and 7.4% for the V-VI classes (>20% of MACE). PP was positively correlated with ED severity and negatively with androgens and waist (p < 0.01). Follow-up on 185 men treated with vardenafil documented, for all CVRs, a significant rise of Δ-IIEF5 (Δ = 6.1 ± 4.8) with greater increments observed in men with higher PP (p < 0.0001). Mild adverse events occurred in <5%, with no differences between CVR-classes. Conclusion: In the real life settings, ED is a frequent presenting symptom for patients with an elevated, ignored, risk of future MACE. Simple screening procedures to select patients deserving preventive measures are needed. Androgens levels and PP could serve as biomarkers of cardiovascular health. Vardenafil turned out safe and powerful in improving erections in severe ED patients, proving unaltered efficacy in higher CVR classes. Policy of full disclosure: Some of the authors have received unconditional grants from Eli-Lilly, Bayer and Pfizer.

P-01-058

SEXUALLY-RELATED URETHRAL INJURY IN WOMEN WITH MAYER–ROKITANSKY SYNDROME Ivanovski, O.1; Georgiev, V.2; Kojovic, V.3; Djordjevic, M.3 University Clinic of Urology, Medical Faculty of Skopje, Macedonia; 2 University Clinic of Urology, Skopje, Macedonia; 3University of Belgrade, Serbia

1

Objective: Sexually-related urethral injuries in women are extremely rare. Only a few reports exist resulting mostly from urethral coitus, rape or vigorous sexual petting and are most commonly seen with

J Sex Med 2012;9(suppl 5):357–397

Poster Presentations intact vagina. The aim of this article is to present our experience dealing with sexually-related urethral injury in women with vaginal atersia (Mayer Rokitansky Kustner Hauser Syndrome). Methods: We describe two unusual cases of urethral injury in women with vaginal atersia caused by urethral coitus. Painful sexual intercourse and urinary incontinence was the main symtomatology. Detailed physical examination confirmed absence of the vagina, as well wide open edemateus urethral orifice (Figure 1). On pelvic ultrasound and subsequently on magnetic resonance a complete absence (agenesis) of the uterus with an absent vagina was observed which confirmed the diagnosis of Mayer- Rokitansky-Kuster-Hauser) syndrome. There was no evidence of any other congenital anomaly. The management included rectosigmoid vaginoplasty and a tension free vaginal tape surgery for incontinence. Results: Three weeks after surgery the urinary catheter was removed and the patients were completely continent. The patients were evaluated on a monthly basis for the _rst 4 months, then every 3 months for the next 2 years. In three years of follow-up excellent functional and cosmetical results were obtained. The patients reported satisfactory sexual life and no evidence of urinary incontinence. Conclusion: Urethral coitus is a very rare entity which usually presents as urinary incontinence during and after intercourse and is most commonly seen in patients with vaginal atresia. Rectosigmoid vaginoplasty and a tension free vaginal tape surgery for incontinence present a safe and reasonable choice of treatment of these patients with acceptable complications and satisfactory results. Policy of full disclosure: None.

375

Poster Presentations P-01-059

CONSIDERATION OF THE BEST METHOD TO TREAT THE DELAYED RECOVERY CASE FOLLOWING PENILE ENHANCEMENT SURGERY Jang, S.-Y.1 1 LJ Genitouriry Surgery Ins., Seoul, Republic of Korea Objective: Many penile enhancement surgeries have been performed to men who want an improved outer appearance and sexual performance. We aim to report our experiences to manage postoperative courses following the penile enhancement surgeries. Methods: We performed and followed up 520 penile enhancement surgeries for at least 6months. We adopted the pre-pubic incision, insertion of cadaveric dermal graft and multilayer suturing lengthening procedure. Following the surgery the patients reported several discomforts or questions concerning a delayed recovery. Among them, temporary penile shortening is the most frequent (442 cases, 85%). Dullness of the penile shaft and the glans is second most frequent symptom (317 cases, 61%). There were abnormal sensations including tingling and sharp pain (291cases, 56%) and a sense of hardness of inserted graft material (125 cases, 24%). 62 cases (12%) wanted to get treatment due to the Irregular shape of the penis skin. After following up for 5months, we applied triamcinolone injection on pre-pubic granuloma and hyaluronic acid on penile shaft to fix temporary penile shortening on erect state and accelerate the recovery of painful sensations and hardness of inserted graft. To reduce the recovery time, we recommend taking the pentoxifilline. And to fix the irregular skin shape, we used a hyaluronic acid injection. Results: Within 5months after penile enhancement surgeries, 97% of patients had completely recovered without any additional treatment. 3% were treated with triamcinolone injection or hyaluronic acid injection. All cases fully recovered. Conclusion: In penile enhancement surgery, we have experienced several kinds of delayed recovery cases. All these cases were successfully treated with our follow up procedure. Policy of full disclosure: None.

P-01-060

EVALUATION OF THE SAFE AND EFFICIENT SURGICAL PROCEDURE OF THE PENILE ENHANCEMENT SURGERY IN UNCIRCUMCISED MEN Jang, S.-Y.1 1 LJ Genitouriry Surgery Ins., Seoul, Republic of Korea Objective: In many uncircumcised men who wish to have penile enhancement surgery, we have performed penile enhancement surgery by different surgical procedures. We aim to report the safest and most effective method in uncircumcised patients who want to get penile augmentation surgery. Methods: We have performed 480 penile enhancement surgeries in uncircumcised men with pre-pubic incision, cadaveric dermal graft insertion and multi-layer transverse suture lengthening procedure. We divided 2 groups according to the penis skin state after the preoperative consultation. Group 1 (435 cases) was characterized by uncircumcised men without narrowed skin band. Group 2 (45 cases) was defined as the uncircumcised patients having narrowed skin band. In group 2, we recommend the circumcision surgery first and then penile enhancement surgery after 6months. All patients in group 1 were performed with penile enhancement surgery first. In group 1, penile enhancement surgeries alone were done in 383 cases (79.8%) and 41 cases (8.5%) were performed by 2nd circumcision surgery after 1 month to 5months and 11 (2.3%) were performed by circumcision surgery within postoperative 10 day due to skin banding and ulceration. We never adopted the circumcision incision in penile enhancement surgery to prevent inserted dermal graft infection. We followed up from 1 month to 12 months. Average follow up period was 5.3 months.

Results: Wound dehiscence was occurred in 10 cases (2.3%) in group 1 and 1 cases (2.2%) in group 2 in penile enhancement surgery. At the time of circumcision surgery, wound dehiscence was occurred in 1 cases (2.2%) in group 2 and 3cases (5.7%) in group 1. All cases were safely fixed within at least 3weeks. There was no disfigurement of the penis during the follow up time. Conclusion: To perform the safest penile enhancement surgery in uncircumcised men, we have to consider the adequate timing of circumcision surgery following or prior to the penile enhancement surgery. Policy of full disclosure: None.

P-01-061

ALLOGENIC ADIPOSE DERIVED STEM CELL TRANSPLANTATION IN RATS WITH ERECTILE DYSFUNCTION INDUCED BY BILATERAL CAVERNOUS NERVE CRUSHING INJURY Kim, S. J.1; Choi, Y. S.1; Bae, W. J.1; Cho, H. J.1; Hong, S. H.1; Lee, J. Y.1; Hwang, T.-K.1; Kim, S. W.1 1 The Catholic University of Korea, Urology, Seoul, Republic of Korea Objective: The efficacy of autologus and syngenic adipose derived stem cell (ADSC) on the treatment of erectile dysfunction (ED) is well established, however, there was a little report using allogenic ADSC. Allogenic ADSC seems to have more benefits because stable supply of cells of uniform quality or use in an emergency are possible compared with autologus ADSC. Therefore, we studied about the effect and safety of allogenic ADSC on ED induced by bilateral cavernous nerve crushing injury. Methods: Male Sprague Dawley Rats (SD rats) were used: control group (Group I), bilateral cavernous nerve crushing group (Group II), administration with ADSC of SD rat into the major pelvic ganglion (MPG) after BCNC (syngenic; Group III), and administration with ADSC of wistar rats into the MPG adter BCNC (allogenic; Group IV). After 4-week, functional examination was done. MPG and corpus cavernosum were collected. Immunofluorescent staining of ADSCs was performed to compare the implantation degree. The degree of T-cell infiltration was compared to evaluate immune response. Western blot analysis of endothelial nitric oxide synthase (eNOS) and neuronal nitric oxide synthase (nNOS) were done in corpus cavernosum. Results: Intracavernosal pressure (ICP) /mean arterial pressure (MAP) ratios of group III and IV were similar and significantly increased compared with group I. In MPG, the number of implanted ADSC of wistar rat was lower than ADSCs of SD rat, however, there was no significance. Moreover, the degree of T-cell infiltration was not significantly different. Significant increase expression of eNOS and nNOS were observed in group III and IV compared with group II. Conclusion: The erectile function in the rats with allogenic ADSC administration was well preserved. And allogenic ADSC does not lead to severe immune response after administration. Therefore, it is possible to apply allogenic ADSC for the treatment of ED using stem cell. Policy of full disclosure: None.

P-01-062

INFLUENCE OF THE AMBULATORY BLADDER PRESSURE MONITORING DEVICE ON THE ERECTILE FUNCTION: A PRELIMINARY ANIMAL STUDY Kim, S. J.1; Choi, Y. S.1; Bae, W. J.1; Cho, H. J.1; Hong, S. H.1; Lee, J. Y.1; Hwang, T.-K.1; Kim, S. W.1 1 The Catholic University of Korea, Urology, Seoul, Republic of Korea Objective: Erectile and voiding dysfunction caused by neurologic diseases is serious disability to decrease quality of life. And erectile and voiding dysfunction is usually occurred simultaneously because of the pathophysiological similarities. Recently, ambulatory bladder pressure

J Sex Med 2012;9(suppl 5):357–397

376

Poster Presentations

monitoring device has been introduced to reveal the voiding pattern in real life. Moreover, influence of this device on the erectile function is necessary because majority of the neurogenic bladder coexisted with the erectile dysfunction. However, there were little studies considering with this aspect. Therefore we evaluated the influence of the invented device on the erectile function in rabbits. Methods: The manufactured prototype intravesical pressure sensor was placed into the intravesical space of each of 3 male rabbits. Conventional cystometry was performed and the intravesical pressure was measured by the prototype intravesical pressure sensor at the same time in all of the animals. The measured intravesical pressure by the prototype intravesical pressure sensor was compared with the measured value by conventional cystometry. The reliability between the two methods was determined using cross-table analysis. And then intracavenous pressure (ICP) was measured in the rabbits with or without invented sensor. Results: In each of the 3 animals, the index of coincidence was observed as 0.70, 0.79, and 0.77, espectively. This result meant that the intravesical pressure monitoring by the prototype intravesical pressure sensor showed good reproducibility with respect to the continuous intravesical pressure monitoring by conventional cystometry. The ICP of rabbits with the sensors was similar with the rabbits without sensors. Conclusion: In this study, we demonstrated the reliability of the prototype intravesical pressure sensor to monitor intravesical pressure change compared with the conventional cystometric result. In addition, the erectile function was maintained when the sensor was placed in the bladder. Further investigation about the long-term influence is necessary for real clinical application. Policy of full disclosure: None.

P-01-063

FIRST DESCRIPTION OF AMBROXOL AS A REMEDY IN POST-ORGASMIC PAIN 1

Kinzel, U. 1 AMEOS Klinikum Osnabrueck, Outpatients, Germany Objective: A single case study. Methods: A 25 year old patient with a nine year long history of postorgasmic pain was referred to our department for treatment. The patient, who was living in a stable partnership, presented with a burning pain in his penis, especially in the urethra, developing after orgasm and lasting for about one day. He had experienced this problem since adolescence and had consulted several urologists and clinics for urology without either any pathological results nor improvement in his problem. Former treatments had included analgetics, antibiotics, neuroleptics, anti -depressants and Dapoxetine without any result. Bodily examination showed signs of a conjunctivitis, but no other pathology. The penis was circumcised without signs of inflammation and irritation. Laboratory results, including hormones, showed no pathology. Allergy testing, including semen, brought no pathological results, too. The patient complained about penile pain after intercourse and masturbation, but no other sign of POIS. Administration of ambroxol resulted in disappearance of the penile pain. Results: Ambroxol has been used for three decades in the therapy of airway diseases (Weiser 2008). It is an agent with secretolytic, secretomotoric, anti-inflammatory and local-anaesthetic properties. In this case we could show that this agent works in the uro-genital tract, too. Conclusion: This single-case-study shows that Ambroxol has antinociceptive properties in sexual pain disorders. At present not much is known about nociceptors in the urethra. Nevertheless it is clear that Na+ channels exist in the urethra. Via an unspecific reduction of the stimulus res- ponsiveness through Na+-channel-blockade the oversensitive mucosa might be influenced. This might result in reduced pain perception. Further research in this aspect is necessary. Policy of full disclosure: None.

J Sex Med 2012;9(suppl 5):357–397

P-01-064

EFFECTS OF DAILY ADMINISTRATION OF LOW DOSE PHOSPHODIESTERASE TYPE-5 INHIBITOR (MIRODENAFIL 50 MG) ON MEN’S LIFE Lee, D. S.1; Lee, S.-J.2; Choe, H.-S.2 St. Vincent’s Hospital, Urology, Suwon, Republic of Korea; 2St. Vincent’s Hospital, Suwon, Republic of Korea

1

Objective: We investigated the effects of daily administration of low dose phosphodiesterase type-5 inhibitor (PDE5I) on diurnal as well as nocturnal erectile function and ultimately on health status. Methods: 26 patients who complained erectile dysfunction over 6 months were enrolled in the study. After 1 month washing period, mirodenafil 50 mg was administered daily after dinner for 2 months. International index of erectile function (IIEF-15), nocturnal penile tumescence (NPT) testing were checked at baseline and repeated at end-point. Eventually, we tried to compare patients’ health status with 36-item short form health survey questionnaire (SF-36) before and after continuous PDE5I treatment. Wilcoxon’s signed-ranks test and Spearman’s correlation test were used for statistical analysis. Results: Mean age in the study was 50.50 ± 11.14 years. Erectile function in IIEF-15 showed great improvement in all domains and NPT testing also showed significant improvement in tumescence and rigidity, however, frequency and duration of nocturnal erection were not increased in NPT testing (Table 1). Duration of nocturnal erection showed a potentiality to be improved by PDE5I continuous therapy. SF-36 revealed that mental component of patients’ health status was improved after PDE5I treatment. With correlation test, the change of mental health score in SF-36 was correlated to the change of erectile function score in IIEF-15 and that of standardized rigidity activity units score at penile tip in NPT testing, and the difference of social function score in SF-36 was correlated to that of intercourse satisfaction score in IIEF-15 (Table 2). Conclusion: Daily low dose PDE5I treatment would improve erectile function regardless of consciousness. Furthermore, the treatment would promote mental portion of patients’ health status and give positive effect on Men’s life. Policy of full disclosure: None.

377

Poster Presentations

sion and subsequent rejection of hypersexual disorder in DSM-V highlights this existing debate. The notion of hypersexual behavior as an addiction warrants further exploration, especially since how it is defined may dictate treatment modality. Policy of full disclosure: None.

P-01-066

MALE SEXUALITY AND PELVIC FLOOR SURGERY OF THEIR FEMALE PARTNER: A ONE YEAR FOLLOW UP STUDY Lonnee-Hoffmann, R.1; Salvesen, Ø.2; Mørkved, S.2; Schei, B.2 NTNU, Public Health, Trondheim, Norway; 2NTNU, Trondheim, Norway

1

P-01-065

SEX ADDICTION: FACT OF FICTION? Lin, D.1; Bergel, A.2; Gerz, E.2 Beth Israel Medical Center, Psychiatry, New York, USA; 2Beth Israel Medical Center, New York, USA

1

Objective: To determine whether hypersexual behavior can appropriately be characterized as an addiction, or rather, a symptom or manifestation of a co-existing Axis I or Axis II Disorder. Methods: A literature review is being conducted to explore these opposing viewpoints. Articles published from the year 2000 to present relating to the topic of sex addiction/ hypersexuality/ sexual compulsivity/ impulsivity will be reviewed to determine if hypersexual behavior can be characterized as an addiction or if it can only co-exist with a current Axis I or II disorder. Results: The concept of sexual addiction was introduced in the 1970’s. Since then, two schools of thought have emerged amongst sexologists and mental health providers. Proponents of sex “addiction” argue that the neurochemical changes associated with hypersexual behavior are quite similar to that of drug addiction. Both types of “addiction” activate reward centers in the limbic system, which eventually promote tolerance and repetition/increase in sexual behavior or drug use. It is also argued that sex “addicts” can experience a psychological withdrawal (ie marked dysphoria, anxiety) as experienced by those addicted to cocaine or amphetamines. Some proponents of sex addiction even advise a 12-step treatment program. Critics of sex addiction argue that increased sexual activity is a way of alleviating affective symptoms, or is reflective of the impulsivity, associated with concomitant Axis I or Axis II pathology. Some critics postulate that treating the underlying psychiatric disorder would actually ameliorate hypersexual behavior. Conclusion: Despite standard, and even increasing use of the term “sex addiction” in media and popular culture, mental health professionals remain divided in regards to this subject. The proposed inclu-

Objective: To compare sexual function of partners to women scheduled for pelvic floor surgery (PFS) with population based controls, to assess change after surgery and to explore subjective experience. Methods: Design: Observational, follow up study. Setting: Gynecological department, Trondheim University Hospital. Sample: 50 Partners to women scheduled for pelvic organ prolapse (POP) or stress urinary incontinence (SUI) surgery. Methods: Self-administered questionnaires with validated instruments to assess male sexual function were sent to women before, and one year after pelvic floor surgery. Degree of POP was measured in all women according to the pelvic organ prolapse quantification system before and after. Main Outcome Measure: The five items of the Brief sexual function instrument (BSFI), prevalence of erectile dysfunction (ED). Results: Results: At baseline, sexual function measured with BSFI did not differ significantly from population based controls. Total BSFI did not change at follow up, only the subscale of ejaculation was significantly improved, crude (p = 0.025) and remained so after adjustment for age, education, medication. Only partners in the POP group report their women to have dyspareunia, fewer after surgery. Dyspareunia was significantly negatively associated with ejaculation (P = 0.001). Size and location of POP or coital incontinence did not have effect on any item of the BSFI. Conclusion: Conclusions: Sexual function of partners to women scheduled for pelvic floor surgery was not different from controls; ejaculation was significantly improved after pelvic floor surgery and negatively associated with partner dyspareunia. Policy of full disclosure: None.

P-01-067

ANDROGENDEFICIENCY IN MALES WITH TYPE 2 DIABETES MELLITUS Luchytskiy, E.1; Luchytskyi, V.2; Zubkova, G.2 Institute of Endocrinology, Clinical Andrology, Kyiv, Ukraine; 2Institute of Endocrinology, Kyiv, Ukraine

1

Objective: Some of researches denied interlinks between type 2 diabetes (T2DM) and low testosterone levels in men, while other authors specify the presence of absolute or relative androgendefisiency in males with T2DM. The purpose of work was to research the functional state of the pituitary-reproductive system in men with type 2 diabetes to determine the condition of androgen status. Methods: 147 men were obserwed in age from 35 to 65 years with T2DM and 82 practically healthy men which made a control group. Concentration of total testosterone (tT) below 8,0 nmol/l was considered as a sign of absolute hypogonadysm 8,0−12,0 nmol/l – as a sign of partial androgenic insufficiency. Results: Variations of tT concentration were marked from 2,3 nmol/l to 29,9 nmol/l. Level of tT less than 12 nmol/l was observed in 53 % patients: in 19% cases it was below 8,0 nmol/l and in 34% patients– within the limits of 8–12 nmol/l. Average level of bioavailable testosterone (b/aT) was significantly reduced in 69.6% of patients (7,7 ± 0,7 nmol/l in T2DM patients versus 13,4 ± 1,1 nmol/l in controles, p < 0,001). No differences were observed in LH and FSH levels among both groups. Average level of sex steroid binding hormone (SSBH)

J Sex Med 2012;9(suppl 5):357–397

378

Poster Presentations

was lower in T2DM male patients group: 36,3 ± 1,3 nmol/l vs 43,1 ± 2,3 nmol/l in control group (<0,01). Analysis of individual performance showed that SSBH levels were reduced or were within the lower limits of normal values in 2/3 patients with T2DM. Conclusion: Men with type 2 diabetes mellitus are at risk group for development androgendefisiency. For the estimation of the state of the androgen supplementation in T2DM male patients it’s necessary to determine total testosterone level, as well as bioavailable testosterone and sex steroid binding hormone concentration. Policy of full disclosure: None.

P-01-068

CASE REPORT OF GENITAL AVULSION Mai Ba Tien, D.1; Duong Quang, H.2 Binh Dan Hospital, Andrology, Ho Chi Minh City, Viet Nam; 2Binh Dan Hospital, Hochiminh City, Viet Nam

1

Methods: Case report. Results: We report a case of a 28-year-old newly married patient with avulsion of the penile and scrotal skin, with exposure of the corpora cavernosal and corpus spongiosum of penis and testes, after an agricultural machine accident. Reconstruction was performed in Andrology department of Binh Dan Hospital by using a thin split–thickness skin graft, achieving a satisfactory sexual functions and aesthetic result. Policy of full disclosure: None.

P-01-069

PENILE ENHANCEMENT TECHNIQUES TO IMPROVE PATIENT SATISFACTION DURING PENILE PROSTHESIS IMPLANT Martínez Salamanca, J. I.1; Linares, E.2; Del Portillo Sánchez, L.1; Osorio Cabello, L.1; Martínez Ballesteros, C.1; Areche Espiritusanto, J.1; Carballido Rodríguez, J.1 1 Hospital Universitario, Puerta de Hierro, Madrid, Spain; 2Madrid, Spain Objective: Penile Prosthesis (PP) implantation in patients with erectile dysfunction refractory to previous treatment, is associated with a high level satisfaction for both patient and his partner. However, one of the main reasons for dissatisfaction is related to the length of the penis after surgery. Several studies have identified four groups of patients at risk: elderly, Peyronie disease, obesity and implant after radical prostatectomy. Methods: In our center we have implemented a procedure based on four steps to add to the PP standard implantation in selected patients. To try to improve customer satisfaction, maximizing penile length and cosmetic appearance. In this video we describe the main steps of the procedure which include: transverse incision with scrotoplasty, suspensory ligament section, selective infrapubic and base of the penis liposuction, and 700LGX AMS implant. Results: Between January 2010 to June 2012, we performed the procedure on 12 patients who met selected criteria for potential postoperative dissatisfaction. The increased operative time associated with standard procedure was 40 minutes and no complications were registered related to adjuvant procedure. Conclusion: From our experience, combination of these strategies provide a major benefit in penile length and cosmetic appearance; which helps minimize the negative effects increasing satisfaction in a subpopulation of patients undergoing penile prosthesis implantation. Policy of full disclosure: None.

P-01-070

SIMULTANEOUS DOUBLE IMPLANT: ARTIFICIAL URINARY SPHINCTER AND PENILE PROSTHESIS USING SCROTAL UNIQUE INCISION Martínez Salamanca, J. I.1; Linares, E.2; Del Portillo, L.3; Osorio Cabello, L.3; Martínez Ballesteros, C.3; Moncada Iribarren, I.4; Carballido Rodríguez, J.3 1 Hospital Universitario, Puerta de Hierro, Madrid, Spain; 2Madrid, Spain; 3 Hospital Puerta de Hierro, Madrid, Spain; 4Hospital de La Zarzuela, Madrid, Spain Objective: Radical prostatectomy (RP) is a common procedure in clinical practice in urology. Moderate to severe urinary incontinence

J Sex Med 2012;9(suppl 5):357–397

379

Poster Presentations and refractory erectile dysfunction after radical prostatectomy are two entities which worsen quality of life to patients. To present the surgical technique in simultaneous dual implantation of artificial urinary sphincter (AUS) and penile prosthesis (PP) through scrotal unique incision. Methods: Prospective outpatient evaluation was held. Most of our patients who are candidates for this approach had a previous radical prostatectomy (RP). Moderate to severe urinary incontinence (considered as use of >3 pads / day) and erectile dysfunction with no response to first and second line therapies were selection criteria. Considerations and the most important technical steps of surgical procedure are described in this video for simultaneous dual implantation. Results: Upper transverse scrotal incision is done. Following bulbar urethra dissection and AUS cuff is placed. Through the same window corpora cavernosa are exposed. We perform four stitches of absorbable 3/0 suture material; overhead traction is made followed by scalpel vertical corporotomy. Once measured proximally and distally with Furlow meter, the corresponding PP is implanted. Scott retractor is removed to proceed to reservoirs placement through the same incision. Prevesical reservoir location is accessed through the inguinal canal. Both pumps are introduced in the scrotum. Routinely catheter 12–16F was left 24 h, drain Blake type and 24 h compression bandage. Conclusion: Double implant of penile prosthesis and artificial urinary sphincter through unique incision is a safe and effective option in patient with loss of quality of life after radical prostatectomy. Candidates must be properly informed and motivated. Policy of full disclosure: None.

P-01-071

CORPOROPLASTY IN PENILE RECURVATUM: NEUROVASCULAR BUNDLES MOBILIZATION VERSUS DEEP DORSAL VEIN STRIPPING – COMPARING RESULTS Mavilla, L.1; Pisanti, F.2; Giulianelli, R.1; Albanesi, L.1; Attisani, F.1; Gentile, B. C.1; Granata, D.1; Schettini, M.1; Shestani, T.1 1 Nuova Villa Claudia Clinic, Rome, Italy; 2Nuova Villa Claudia Clinic, Urology, Rome, Italy Objective: Neurovascular bundles lesion and, afterward, glandular parestesia are the most common complications performing corporoplasty. We report our experience in neurovascular bundles preservation about ventral and dorsal penile curvature, congenital or secondary to Peyronie’s disease. We performed 2 different tecniques: the whole neurovascular bundles mobilization starting from para-urethral structures and the deep dorsal vein stripping together with her ramifications. Methods: From 01.2010 to 09.2011 27 patients underwent penile surgical treatment. Mean age 36 years (range 16–65 yrs). 10 patients showed dorsal penile curvature while 17 a ventral one. The recurvatum was between 30 and 90 degrees. All dorsal lesions, with a curvature more than 60 degrees, have been managed with a collagenous matrix graft by bovine pericardium; ventral congenital ones treated performing a modified plication sec. Nesbit To preserve neurovascular bundles on 16 patients we performed a complete mobilization of these structures starting from the para-urethral tissue (8 dorsal and 8 ventral recurvatum). On the contrary in 11 patients we performer a large deep dorsal vein stripping together with her ramifications (2 dorsal and 9 ventral recurvatum). Results: We found mild to moderate glandular hypoesthesia in 7 patients (43,7%) underwent neurovascular bundles mobilization: 3 of them with a graft and 3 with plication procedures; in the deep dorsal vein stripping group a mild parestesia referred by 2 patients (18%) underwent plication. None of the patient showed erectile dysfunction: one (2,7%) had a severe wound infection, 2 (5,4%) palpation of knots and stitches underneath the skin, 2 (5,4%) residual curvature (about 20 degrees), 20 (74%) normal or high satisfaction from the results of the procedure. Conclusion: Performing recurvatum correction of dorsal penile lesions, deep dorsal vein stripping, together with her ramifications, showed better results about glandular sensitivity than large neurovas-

cular bundles mobilization needed to correct severe curvatures. This tecnique would prevent venous occlusive deficit, really common in congenital ventral curvatures of larger penis. Policy of full disclosure: None.

P-01-072

TELE-CONSULTATIONS FOR MALE SEXUAL DYSFUNCTION AND LOWER URINARY TRACT SYMPTOMS: PATIENTS’ PERSPECTIVE Mistry, K.1; Penna, M.2; Fan, K.2; Chitale, S.2 Whittington Hospital, Urology, London, United Kingdom; 2Whittington Hospital, London, United Kingdom

1

Objective: After initial consultation and focussed examination patients with male sexual dysfunction (MSD) and lower urinary tract symptoms (LUTS) are followed up in clinic to monitor their progression. Often, subsequent consultations do not require physical examination. Teleconsultations have been used successfully in several specialities to monitor chronic disease. In this study we assessed patients’ attitudes towards a tele-consultation service for follow-up in place of the traditional face-to-face consultation in outpatient clinics. Methods: 47 patients were included in our study. Patients with MSD and LUTS were recruited to the study over a 3-month period by a consultant urologist after an initial outpatient clinic appointment. Following their first tele-consultation, patients were asked to complete a telephone questionnaire on their experience of the consultation with reference to quality of consult, monetary savings and time taken off work. All patients that had a telephone consultation and agreed to participate in out telephone questionnaire were included. Results: 89% of patients of rated their tele-consultation experience as excellent or good and 77% would be happy continue with having teleconsultations. The majority of patients reported a considerable time and financial saving by not having to attend the outpatients department without compromising the quality of consultation and level of information gained. Over two thirds of patients reported taking less time off work as a result of the tele-consultation. Conclusion: Follow-up tele-consultations can be effectively used as an alternative to traditional face-to-face consultations for patients with MSD and LUTS. Our study has shown high rates of satisfaction with the service in addition to cost and time saving benefits for the patient. Despite the telephone charges that will be incurred, tele-consultations will lead to savings to the hospital through reduced consultation room occupancy, nursing and administrative input. Policy of full disclosure: None.

P-01-073

AVANAFIL FOR ON-DEMAND TREATMENT OF ERECTILE DYSFUNCTION (ED): AN ANALYSIS OF PATIENTS ATTEMPTING SEXUAL INTERCOURSE WITHIN 15 MINUTES OF DOSING Mulhall, J. P.1; Didonato, K.2; Hellstrom, W.3; Burnett, A.4; Day, W.5 Memorial Sloan Kettering Cancer, Center, Dept. of Surgery, New York, USA; 2Burlingame, USA; 3Tulane University, New Orleans, USA; 4Johns Hopkins Hospital, Baltimore, USA; 5Vivus., Inc., Mountain View, USA

1

Objective: Avanafil, a rapidly absorbed (Tmax = 30–45 minutes), highly specific PDE5 inhibitor is the first ED drug to receive FDA approval (April 2012) in nearly a decade. Participants in the randomized, placebo-controlled studies were instructed to dose approximately 30 minutes prior to sexual activity, however 277 patients (18.3%) recorded intercourse attempts within 15 minutes of dosing with avanafil. The objective of this study was to evaluate the per-patient success rates (SEP 3) at less than or equal 15 minutes from dosing. Methods: Patients with (n = 85) and without (n = 391) diabetes in addition to patients who had undergone bilateral, nerve sparing radical prostatectomy (n = 121) were included in the analysis. To evaluate

J Sex Med 2012;9(suppl 5):357–397

380 successful intercourse by time interval from dose administration to attempt, mean individual patient success rates were calculated and compared to baseline. Results: For the integrated analysis of subjects making sexual attempts within 15 minutes of dosing, treatment comparisons between each avanafil dose and placebo were statistically significant (P < 0.05). On a per-attempt basis, 59.7% (237/397) of diabetic and non-diabetic patients and 36.4% (38/77) of post-prostatectomy patients experienced one or more successful attempt at ≤15 minutes from dosing with avanafil compared with 27.6% (34/123; P ≤ 0.0001) and 4.5% (2/44; P≤0.0005) for placebo, respectively. Conclusion: A rapid onset of action (≤15 minutes) suggests avanafil is well-suited for on-demand treatment of men with mild to severe erectile dysfunction. Policy of full disclosure: I am an employee of VIVUS Inc.

P-01-074

BASELINE CHARACTERISTICS ASSOCIATED WITH LOW TESTOSTERONE AND THE IMPACT OF LOW TESTOSTERONE ON IMPROVEMENTS IN EJACULATORY AND ORGASMIC FUNCTION IN POOLED DATA FROM CLINICAL TRIALS OF TADALAFIL VERSUS PLACEBO ONCE-DAILY Paduch, D. A.1; Bolyakov, A.2; Ni, X.3; Polzer, P.3 Weill Cornell Medical College, Dept of Urology, New York, USA; 2Weill Cornell Medical College, New York, USA; 3Eli Lilly and Company, Indianapolis, USA 1

Objective: To evaluate associations of baseline total testosterone (TT) level with baseline characteristics and with changes in ejaculatory function (EjF) or orgasmic function (OF) over 12 weeks in men receiving tadalafil 5-mg or placebo in tadalafil clinical trials. Methods: Baseline data were integrated from 5 tadalafil studies (4 placebo-controlled, 1 open-label). Response was assessed in men who were ≥18 years old and sexually active in the 4 placebo-controlled studies of tadalafil once-daily for erectile dysfunction (ED) or for lower urinary tract symptoms suggestive of benign prostatic hyperplasia (BPH/LUTS). Men were categorized as hypogonadal (TT < 300 ng/ dL) or eugonadal (TT ≥ 300 ng/dL) at baseline. EjF was assessed via International Index of Erectile Function (IIEF) Q9 (ejaculatory frequency) and OF via Q10 (orgasmic frequency). Change from baseline (randomization) to 12-week endpoint (or last measurement) was analyzed using ANCOVA for the placebo and tadalafil 5-mg dose groups. Results: At baseline, hypogonadal men (N = 684) were older than eugonadal (N = 1528) men (mean [SD] 60.3 [9.6] vs. 58.0 [11.5] years, p < 0.001), had higher BMI (29.6 [4.4] vs. 27.0 [3.7] kg/m2, p < 0.001), and had higher prevalence of diabetes mellitus (22.1% vs. 11.8%, p < 0.001), but did not differ for IIEF Q9 or Q10. In men receiving tadalafil 5-mg (N = 612), change from baseline in EjF and OF were similar for hypogonadal and eugonadal men. However, among men receiving placebo (N = 532), response for EjF and OF was different (both p < 0.05) between baseline TT groups, favouring eugonadal men (Figure). Presence of hypogonadism had a negative impact on “placebo effect”. Conclusion: Improvements from baseline in ejaculatory or orgasmic function were comparable for hypogonadal versus eugonadal men receiving tadalafil 5-mg, however, placebo response was observed only in eugonadal men. Understanding impact of hypogonadism on placebo effect may lead to better clinical trials and treatments for sexual dysfunction or BPH/LUTS. Policy of full disclosure: Darius Paduch consults for Eli Lilly and Company.

J Sex Med 2012;9(suppl 5):357–397

Poster Presentations

P-01-075

SUPRAFASCIAL CONCEAL RESERVOIR: DO WE STILL NEED TWO-PIECES INFLATABLE PROSTHESES? Pescatori, E.1; Drei, B.2; Pisi, P.3 Hesperia Hospital, Andrology Service, Modena, Italy; 2Hesperia, Andrology Service, Modena, Italy; 3Hesperia, Imaging Dept., Modena, Italy

1

Objective: We report the first case of the reservoir of a three-pieces inflatable penile prosthesis electively implanted above the anterior rectus sheats. Methods: Case report. A 71 yo overweight (BMI 28.7) man s/p successful brachytherapy for prostate cancer presented with severe ED, and elected to undergo a three-pieces inflatable prosthesis insertion. Results: In consideration of patient prostate disease history it was decided to use the flat, low-profile AMS Conceal IZ reservoir, to be placed above the anterior rectus sheats. Preoperatively patient was evaluated in both sitting and standing position, to identify and mark the optimal area for reservoir placement, taking in account also the individual site of pants belt. Surgery: an AMS 700 LGX, MS pump, IZ, preconnected device was used, through a penoscrotal approach. Through a infraumbilical longitudinal medial incision an adequate pocket for the Conceal reservoir was fashioned immediately above the fascial plane (see picture). Through a nasal speculum a passage medial to the right inguinal ring was created to reach the scrotal pump. The infraumbilical incision was closed in layers (fatty tissue, subcutaneous layer, skin). Postoperative course was uneventful and patient is starting to use the device without any complaint of bulging or discomfort in the area of reservoir placement. Conclusion: To the best of our knowledge this is the first case of resevoir of a three-pieces prosthesis electively implanted above the anterior rectus sheats. This strategy has been possible thanks to: the new AMS low-profile Conceal reservoir, and the case of an overweight patient. In selected cases, as in patients with former abdominopelvic surgery or former radiation therapy, the described strategy represents a new alternative to Retzius or intraperitoneal reservoir placements, and allows the patient to benefit of all the pros of a three-component implant, avoiding the compromise of a two-pieces prosthesis. Policy of full disclosure: None.

381

Poster Presentations P-01-076

ACCEPTANCE OF AND DISCONTINUATION RATE FROM ERECTILE DYSFUNCTION TREATMENT Ravnik-Oblak, M.1; Bizjak, I.2 Univ. Medical Centre Ljubljana, Dpt. of Endocrinoly & Diabetes, Slovenia; 2 General Hospital Celje, Slovenia

1

Objective: According to data in the literature patients with erectile dysfunction (ED) stopped treatment in 30–80%. The purpose of the pilot study was to determine the causes of treatment discontinuation in our patients with ED as well as their well-being and erectile function after abandoning of treatment. Methods: Patients treated for ED in Department for Urology in General Hospital Celje received a questionnaire on the treatment of ED, possible discontinuation of treatment and the reasons for this decision as well as a questionnaire on well-being (WHO-5) and a questionnaire of erectile function (IIEF-5). For data analysis, univariate statistical analysis was used. Statistically significant differences (p < 0.05) were assessed with a “t-test for two independent samples.” Results: The questionnaires were sent to 61 patients, 26 patients (43%) responded. The average age of the patients was 56,2 ± 11.0 years (X ± SD), 9 (35%) had ED < 2 years, 12 (46%) 2–5 years, 5 (19%) >5 years. At the time of the survey, 11 (42 %) patients were treated for ED (Group 1), 15 (58%) patients abandoned the treatment (Group 2), 11 (73%) of them in the first year. The main reason was the price of the medicines (64%) and failure of efficacy of the medicines (43%). On average, patients’ well-being was 53% (100% being the best possible score). Group 1 estimated their well being on average with 63 % and Group 2 with 45% (statistically significant difference). The average IIEF-5 in Group 1 was 18.6 points, in Group 2 was 16.1 points (statistically non-significant difference). Conclusion: Almost two-thirds of our patients stopped the treatment of erectile dysfunction. The main reasons were price and inefficiency of the medicines. The well-being and IIEF-5 scores were lower in untreated group of patients. Policy of full disclosure: None.

P-01-077

ADULT MALE CIRCUMCISION AND THE EFFECT ON SEXUAL FUNCTION Safarfashandi, L.1; Borley, N.2; Dinneen, M.2; Khoubehi, B.2 Chelsea & Westminster Hospital, Urology, Sudbury, United Kingdom; 2 Cheslea & Westminster Hospital, London, United Kingdom

change that limited sexual intercourse highlighting an area of concern, suggesting that circumcision is not the without it’s side effects as a solution for skin dermatoses. Sexual orientation does not appear to affect patient experience. Policy of full disclosure: None.

P-01-078

THE ASSOCIATION BETWEEN PEYRONIE’S DISEASE AND DIABETES MELLITUS Stebbeds, W.1; Mateus, M.2; Beetson, K.2; Cellek, S.2; Ralph, D.3 Cranfield University, Cranfield Health, United Kingdom; 2Cranfield University, United Kingdom; 3University College London Hospital, United Kingdom

1

Objective: Recent clinical experience suggests that Peyronie’s disease (PD) is often diagnosed in men with diabetes mellitus (DM). We present a novel paradigm in which PD can be considered a direct consequence of DM, akin to the classical chronic diabetic complications such as diabetic nephropathy through the twin diabetic insults of advanced glycation end-products (AGEs) and hypoxia, a phenomenon known to be associated with fibrosis and DM. The aim of this project is to investigate the association between DM and PD at the cellular and molecular level. Methods: Human dermal fibroblasts were subjected to hypoxia (2% O2) through nitrogen displacement using a hypoxic incubator and/or 50–200 μM AGEs for 1–8 days. The effects of these insults was measured through evaluating growth kinetics over a period of 8 days, measuring cell numbers and viability; detection of myofibroblasts, using immunocytochemistry to detect α-smooth muscle actin (α-SMA) and evaluation of interleukin-8 (IL-8) production through ELISA in cells. Results: Results indicated that human dermal fibroblasts exposed to diabetic insult, as described above, present growth inhibition; increased proliferation of α-SMA positive myofibroblasts and increased intracellular production of interleukin-8. Conclusion: These results suggest that DM, specifically the presence of advanced glycation end products and hypoxia, is the “perfect storm” for fibrosis to occur and can induce a PD-like process in dermal fibroblasts. Tentatively, these results support the hypothesis of PD being a direct diabetic complication. Work is currently being carried out to observe the synergistic effect of AGEs and hypoxia as well as using primary human tunica albuginea from patients with PD. Policy of full disclosure: None.

1

Objective: To look at a population of adult males who underwent circumcision for pathological disorders of the foreskin, at a centre that included specialist HIV and dermatology services, to assess possible alterations in sexual function. Differences between men of different sexual orientations, were also studied. Methods: Men who had previously had a circumcision with a minimum of 2 months follow up were sent a satisfaction survey. Changes in quality and maintenance of erections, timing and quality of ejaculation, changes to sensation, frequency of intercourse or masturbation, and libido were rated on a 7 point scale and cosmetic satisfaction on a 10 point scale. Results: 83 patients responded (50%), 18% identified themselves homo- or bi-sexual. 48% patients reported no change to sensation that adversely affected frequency of sexual intercourse or masturbation. 9% patients reported a moderate–great change in sensation. Minimal changes to erections, ejaculation and libido were seen following circumcision. Median cosmetic satisfaction was 9/10. Deterioration in frequency of sexual intercourse or masturbation was seen in 72% of patients, with mild-great improvement in 13% following circumcision. There was no apparent difference in results seen between men of different sexual orientations. Conclusion: From this study the largest concern following circumcision is the effect on sensation. The majority of patients reported no change to sensation, however a significant proportion did note a

P-01-079

FORMAL AND INFORMAL SEX EDUCATION: YOUNG IRANIANS’ EXPERIENCE Tabatabaie, A.1; Mofatteh, Z.2 University of Cambridge, Wolfson College, United Kingdom; 2University of Cambridge, United Kingdom

1

Objective: Although crucial in providing young people with better sexual health outcomes, sex education (SE) is still a highly problematic notion in Iran. In the absence of an effective formal SE, young Iranians seek information, and are influenced by, the informal sources of SE including families and peer groups. No study has previously explored the experience of young Iranians of formal and informal learning about sexuality and this study aims to do so. Methods: Employing a qualitative thematic analysis methodology, semi-structured interviews were used to explore in depth the experience of 10 young Iranian males and 10 females, aged 18 to 22, of sexual learning. Results: All the participants in this study emphasised the problematic nature of their experience regarding SE and an absence of a formal SE. Families, peer groups and the internet were discussed as major sources of informal SE. Those who were not provided with any SE portrayed their experience as ‘suffering in silence’ and discussed how such lack has negatively affected their sex lives. A minority whose families had provided them with appropriate and timely education

J Sex Med 2012;9(suppl 5):357–397

382 perceived such communication as constructive. It was demonstrated that religion can be constructively utilised to deliver sexual health messages in religious families. Those of non-religious families had experienced home-school conflict where the school’s sexually restrictive approach was in contrast to their family’s permissive approach. Participants’ experience of youth culture around sexuality indicated that it contradicted school culture and family culture in in religious families. In this context, sexual exploration was discussed as a means to challenge the authority (school or family). Conclusion: The findings of this study calls for a serious attention to be paid to the notion of SE in Iran. Families, peer groups and the internet are major sources of informal SE and the interplay between family culture, school culture and youth culture around sexuality needs further attention. Policy of full disclosure: None.

P-01-080

THE EFFECT OF THE METHOD OF ED DIAGNOSIS ON PREDICTION OF CARDIOVASCULAR EVENTS WITH ERECTILE DYSFUNCTION Terentes-Printzios, D.1; Vlachopoulos, C.2; Ioakeimidis, N.2; Aggelis, A.2; Rokkas, K.2; Aznaouridis, K.2; Synodinos, A.2; Samentzas, A.2; Stefanadis, C.2 1 Athens Medical School, 1st Cardiology Department, Greece; 2Athens Medical School, Greece Objective: Erectile dysfunction (ED) carries an independent risk for cardiovascular (CV) events. We conducted a meta-analysis of all longitudinal studies for determining the ability of ED to predict risk of CV events and the effect of the method of ED diagnosis on this predictive ability. Methods: A comprehensive search of electronic databases was conducted through July 2012. Longitudinal studies that reported relative risk (RR) estimates with 95% confidence intervals (CI) were included. Results: We found 13 studies (14 articles) that reported results on total CV events (91,834 individuals).The pooled RR for total CV events was 1.44 (95% CI: 1.25 to 1.63). (Figure) The RR for studies that diagnosed ED with the use of a questionnaire compared with a single question was higher (RR: 1.61, 95% CI: 1.38 to 1.86 vs. RR: 1.27; 95% CI: 1.18 to 1.37, respectively; P = 0.006). Conclusion: ED is associated with increased risk of CV events. The use of questionnaire enhances this predictive value. Policy of full disclosure: None.

Poster Presentations P-01-081

TRANSRECTAL PROSTATE NEEDLE BIOPSY HAS A NEGATIVE EFFECT ON NEUROVASCULAR TISSUE AND ASSOCIATED WITH AN INCREASED RISK OF ERECTILE DYSFUNCTION: RESULTS OF POWER DOPPLER IMAGING OF THE PROSTATE Tuncel, A.1; Toprak, U.2; Balci, M.2; Koseoglu, E.2; Aksoy, Y.3; Karademir, A.2; Atan, A.2 1 Ankara Numune Hospital, Urology, Turkey; 2Ankara Numune Hospital, Turkey; 3Middle East Tech. University, Ankara, Turkey Objective: To evaluate the impact of transrectal prostate needle biopsy (TPNB) on men’s erectile function and to assess the TPNB’s impact on prostate and bilateral neurovascular bundles with using Doppler imaging of the prostate. Methods: A total of 42 patients underwent TPNB were included in this study. Men were evaluated for erectile function before biopsy, and the third months after the biopsy with the first five-version of the international index of erectile function (IIEF-5). Before biopsy and three months after biopsy transrectal Doppler ultrasonography was performed. RI of prostate parenchyma and both neurovascular bundles were measured. Results: The mean age of men was 64.2 (47–78) years. Before TPNB, 10 (23.8%) patients did not have erectile dysfunction (ED) and 32 (76.2%) patients had ED. The mean IIEF-5 score was 20.8 (range 2 to 25) before the biopsies, whereas, the mean IIEF-5 scores was 17.4 (range 5 to 25) (p < 0.001) after 3 months. According to IIEF-5, for patients who were previously potent, the ED rate was 40% at the third month evaluation. In these patients, post-biopsy prostate blood supply was significantly increased, and all RI values were significantly decreased. Conclusion: In conclusion, TPNB may have a negative impact on erectile function. In the present study, semi-quantitative Doppler ultrasonography findings represent inflammation of the prostate parenchyma and the surrounding of the neurovascular bundle. The presence of ED in male patients after TPNB might be originated from organic basis. Policy of full disclosure: None.

P-01-082

FROM RUN THE RISK TO BE AT RISK: FROM CHECKING STI TO PSYCHOLOGICAL ILLNESS Wiksten-Almstromer, M.1; Sandstrom, E.2 Stockholm School Youth Clinic, Skärholmen Stockholm, Sweden; 2 Skärholmen, Sweden

1

Objective: During 2010 and 2011 Stockholm School Youth Clinic were in a project, focusing on young men with sexual risktaking behavior. One of the goals were to increase male visitors at the clinic. Another goal were to influence young men to change their sexual lifestyle and to investigate psychosocial factors behind their sexual risktaking behavior. Methods: The project were advertised in schools and with banners at a webb-gay-community (QX). Based on scientific publications, three criteras were stated: one or more unprotected anal intercourse, two or more STI (by the law in Sweden) during the last 12 month, and finally, eight or more sexual partners during the last 12 month and not always using condom. Men fullfilling one or more criteras were offered STIand HIV-tests, revisit after one week (HIV-testresult), revisit for further STI-samples after two and six month and psychologic counselling. The psychologist investigated four domains: anxiety, depression, attachment style and self-esteem. Results: Mens visits increased from 600 (2010) to 1200 (2011). Of the visitors 72 men were identified by the criterias. Fiftyfour men had sex with women, 10 with men and eight with both men and women. The majority (50 men) came back for one or more visits (retesting STI).

J Sex Med 2012;9(suppl 5):357–397

383

Poster Presentations Twentythree out of 72 men accepted the psychological counselling. The majority had problems with anxiety, depression and self-esteem. Eleven men were recommended contact with psychological/psychiatric clinics. The young men carried their psychological illness by them self. They didn’t say anything about their situations to anyone, especially not to friends. Conclusion: The young men used sexual riskbehavior as a compensation for psychological illness and psychosocial problems and the three criterias were signals to identify those men. Policy of full disclosure: None.

P-01-083

HOW MANY DOTS IN THE 16 DOT TECHNIQUE? Zaazaa, A.1; Abdelal, A.2; Selim, O.2; Ghanem, H.2 Cairo, Egypt; 2Andrology Dept., Cairo University, Egypt

1

Objective: Evaluation of the 16 dot technique in correction of congenital penile curvature. Methods: 19 patients with congenital curvature of the penis underwent correction of their curvature using the 16 dot technique described by lue et.al. Curvatures ranged from purely ventral, to ventral with lateral deviation, to curvature associated with axis rotation of the penis. Exposure was done with a circumsinzing incision of the penis and plication was done using 2/0 Ethibond sutures. Results: All patients had successful correction of their curvature with no erectile dysfunction noted in any of the patients and minimal recurrence of less than 10 degrees occurring in one patient only. The number of dots used in the operation varied from 16 to up to 40 dots in some cases depending on penile length, degree of curvature and complexity of curvature. Conclusion: The 16 dot technique is a very safe and reliable technique in correcting congenital penile curvatures. But as the original technique described by Lue et.al. entailed only 16 dots, many more dots could be safely applied to correct higher degree or complex curvatures in different penile lengths. Policy of full disclosure: None.

Prolong (TM) in conjunction with a specific programme incorporating the start stop technique. The first trial was a 6 subject case series and the second was a randomised controlled trial (RCT) comparing Prolong (TM) prototype with Psychosexual Therapy (PST), currently considered as the gold standard treatment for PE. Due to the large expected effect size a sample of 52 subjects was needed for an RCT with an 80% power. Results: 5 out of 6 subjects of the case series showed a 4.5 fold improvement in latency period during intercourse at weeks 6. Subjects showed increase interest in intercourse with increased initiative, frequency and satisfaction. Effects appeared at week 1 and were maximal at week 6. In the RCT (52 subjects with 26 per arm), 61% of the prototype group showed a mean 11 fold improvement (from 0.8 minutes to 8.8 minutes) during intercourse compared to 40% of the PST group showing a mean 3 fold improvement (from 0.8 minutes to 2.6 minutes) at week 6 (p < 0.002). Both groups maintained improvement at 3 months. There were no side effects associated with the use of Prolong (TM) prototype. Conclusion: Prolong (TM) is a safe and effective treatment for PE. Given the large effect size, the lack of side effects, the long term benefits as well as the cost/benefit ratio, Prolong (TM) should be used as a first line as well as adjunctive treatment in the management of PE. Prolong (TM) can thus be used on its own or can be combined with PST or drug treatment if required. Policy of full disclosure: Dr A Zamar is the inventor of Prolong TM and the prototypes. He is a major shareholder in the Auris group of companies created to exploit Prolong TM. The clinical trials were independently conducted at 2 London Teaching hospitals and the Local Research Ethics Committees specifically excluded Dr Zamar from any aspects of the trials except from advising on the method of use of the prototypes. Dr Zamar complied with the Ethics committee’s preconditions. The prototypes were supplied by one of Dr Zamar companies for the purpose of the trial.

P-01-085

EFFECT OF LDD175, A NOVEL BENZOFUROINDOLE COMPOUND, ON THE MODULATION OF CORPORAL SMOOTH MUSCLES TONE

P-01-084

PROLONG (TM): REVIEW OF A NEWLY APPROVED TREATMENT FOR PREMATURE EJACULATION IN EUROPE Zamar, A.1 1 The London Psychiatry Centre, United Kingdom Objective: Is Prolong (TM) an effective treatment for premature ejaculation (PE)? Should Prolong (TM) be recommended as first line and adjunctive treatment in PE? Methods: A review of the physiological rationale of Prolong (TM) as well as 2 independent clinical trials conducted using a prototype for

Lee, S. W.1; Chae, M. R.2; Sung, H. H.2; Ko, M. K.2; Kang, S. J.2; Park, J. K.2 1 Samsung Medical Center, Urology, Seoul, Republic of Korea; 2Samsung Medical Center, Seoul, Republic of Korea Objective: BKCa channel is a key modulator of smooth muscle tone and serve as a potential therapeutic target for the treatment of various urological diseases. LDD175 is a product of synthetic chemistry and has been shown to inhibit contraction of the bladder and uterine by activation of the BKCa channel. In this study, we investigated whether LDD175 relaxes CSM via BKCa channel activation. The effects were compared with udenafil, a PDE5 inhibitor. Methods: Isolated rabbit corporal strips were mounted in an organ bath system, and the effects of LDD 175 were evaluated in endothelium-intact and endothelium-denuded strips after precontraction with PE (10–5 M). For the electrophysiological studies, the whole-cell patch clamp recording technique was used to record the changes in

J Sex Med 2012;9(suppl 5):357–397

384 BKCa currents in short-term cultured smooth muscle cells of the human corpus cavernosum. Results: LDD175 caused an endothelium independent relaxation of corporal tissues, and this effect was abolished by pretreatment with 200 nM iberiotoxin (IbTX), selective inhibitor. The relaxation effect of LDD175 (10–4 M) was significantly more potent than udenafil (10–6 M) (54.0 ± 3.1%, n = 10 vs. 34.5 ± 3.9%, n = 6, p < 0.05). In patch clamp recordings, LDD175 increased K+ currents in a dosedependent manner, and washout of LDD175 or blockade of BKCa channel with IbTX or TEA fully reversed the increase. The activation threshold of BK channel currents were shifted to more negative voltages, which is close to the resting potential of the cells. The potency and efficacy of LDD175 were significantly higher than that of NS1619, a selective BKCa channel opener (at –40 mV, NS1619: 1.3 fold, LDD175: 42.8 fold vs. control). Conclusion: LDD175 leads to an endothelium independent relaxation of erectile tissue primarily through opening BKCa channels. The results suggest that LDD175, a novel Benzofuroindole compound, might be a new candidate for ED treatment depending upon further studies. Policy of full disclosure: None.

P-01-086

CLINICALLY SIGNIFICANT IMPROVEMENT OF ERECTILE FUNCTION FOLLOWING TREATMENT WITH ALPROSTADIL CREAM (VITAROS®) IN 1651 PATIENTS WITH ERECTILE DYSFUNCTION Buvat J.1; Fernando, Y.2; Damaj, B.2; Moncada I.3; Frank, D.4; Burger M.2 Centre d’Etude et de Traitement de la Pathologie de L’appareil Reproducteur and de la Psychosomatique, Lille, France; 2Apricus, San Diego, USA; 3 Hospital La Zarzuela, Madrid, Spain; 4NexMed USA, San Diego, USA

1

Objective: To assess effectiveness of the alprostadil cream Vitaros® as treatment of men with erectile dysfunction (ED) in terms of clinically significant improvement (CSI). Methods: Post-hoc analysis of two parallel groups, double-blind placebo-controlled trials, which compared equal numbers of EDpatients with broad range etiology (total 1651) treated with placebo or 100, 200 and 300 μg doses of alprostadil cream for 12 weeks. Efficacy assessment: IIEF Erectile Function Domain (IIEF-ED), questions 2 and 3 of the Sexual Encounter Profile (SEP), and Global Assessment Question (GAQ). CSI was defined as a change from baseline > the minimal clinically important differences (MCID) worked out by Rosen et al. (IIEF-EF score) and Araujo et al. (SEP-2 and 3) according to ED severity. Regarding SEP-2, only the overall calculated MCID was used since the MCID for mild ED-cases was considered not reliable by the authors. Results: Mean CSI rates of IIEF-ED were 35 to 39% with each of the three doses of alprostadil cream versus 21% with placebo (p < 0.0001). Corresponding rates were of respectively 21 to 30% for SEP-2 and 31.5 to 39% for SEP-3, versus 16.5 and 18% with placebo (p < 0.01 to <0.0001 for the 200 and 300 μg doses). Normal IIEF-ED score (>26) was obtained in 11 to 16.5% of patients treated with the 3 alprostadil doses versus 6% on placebo (p = 0.02 to <0.0001). 40 to 51.5% of patients receiving alprostadil responded positively to GAQ, versus 20% with placebo (p < 0.0001). Figures detailed by dose and ED severity will be reported during presentation. Overall, success rates were inversely related to ED-severity, and higher with the 200 and even more the 300 μg alprostadil doses. Conclusion: 31.5 to 39% of ED-patients reported a CSI following treatment with alprostadil cream, with a trend to better outcomes with the 300 μg dose. Policy of full disclosure: None.

J Sex Med 2012;9(suppl 5):357–397

Poster Presentations P-01-087

A MID–TERM ANALYSIS (6 MONTHS) OF THE EFFECT OF PENILE LOW INTENSITY SHOCK-WAVE THERAPY FOR PATIENTS OF VARYING ED ETIOLOGIES AND DIFFERENT DEGREES OF ED SEVERITY Gruenwald, I.1; Appel, B.1; Vardi, Y.1 Rambam Healthcare Campus, Haifa, Israel1 Objective: To evaluate the overall efficacy of penile Low Intensity Shock Wave therapy (LI-ESWT) after 6 months in patients with a variety of ED etiologies, a range of ED severities and with different responses to PDE5i’s. Methods: During the past 32 months we have followed up and evaluated the efficacy of LI-ESWT on 191 ED patients (155 treated and 36 Sham). These subjects represent a heterogeneous group of ED patients with regard to ED severity and etiology. All received the same treatment protocol but participated in different trials. Follow-up of subjective parameters using validated questionnaires (IIEF-ED Domain score, clinical judgment) was performed 6 months after end of treatment and compared to the patients’ baseline scores. Results: Mean age was 59 ± 10 years, 86% were cardiovascular patients, 50 (40%) were diabetics. Based on changes in IIEF-ED Domain scores, 57.4% of all patients had a significant clinical improvement 6 months after therapy (mean change of 6.44 points in the IIEF-ED Domain score). When sub-dividing the patients to initial severe, moderate and mild ED groups, we found that 46, 72 and 46 percent improved respectively according to minimal clinical improvement criteria. Nineteen percent of the entire group reached normalization. Conclusion: In this study we have demonstrated that still after 6 months, applying LI-ESWT directly to the penis has a significant clinical effect for all ED severities, for cardiovascular and diabetic patients and for either responders or non-responders to PDE5i therapy. Policy of full disclosure: an unrestricted grant was provided for this study by medispec.

P-01-088

RETROSPECTIVE ANALYSIS OF THE EFFICACY AND SAFETY OF ONCE-DAILY TADALAFIL IN MEN WITH ERECTILE DYSFUNCTION WITH OR WITHOUT DIABETES MELLITUS Seftel, A.1; Kim, E.2; Ni, Y.2; Burns, P.3 Cooper University Hospital, Camden, NJ, USA1, University of Tennessee, USA2, Lilly Research Laboratories, Indianapolis, IN, USA3 Objective: To evaluate effects of tadalafil in men with erectile dysfunction (ED) with or without comorbid diabetes mellitus (DM). Methods: Data were pooled from 5 placebo-controlled trials of men with a ≥3-month history of ED randomized to tadalafil 2.5 or 5 mg, or placebo, once daily. Least-squares (LS) mean changes (±SE) from baseline were assessed by treatment group for the International Index of Erectile Function erectile function (IIEF-EF) domain; and per patient percent “yes” responses to Sexual Encounter Profile question 2 (SEP2; penetration); and SEP3 (successful intercourse). Analysis of covariance (ANCOVA) models included terms for protocol; centeredbaseline IIEF-EF, SEP2, and SEP3; treatment group; DM indicator; treatment-by-centered-baseline interaction (if P < 0.100); and treatment-by-DM indicator interaction (if P < 0.100). Results: At baseline, subjects with DM (n = 459) were older (mean age = 57.2 vs. 55.3 years) and had more severe ED (mean IIEF-EF = 13.1 vs. 14.9) versus those without DM (n = 848). Once-daily tadalafil significantly improved erectile function (vs. placebo) on the IIEF-EF domain and SEP3 (Table). The P value for the treatment-by-DM indicator interaction term in the ANCOVA model for SEP2 was not significant. Tadalafil significantly improved other IIEF domains

385

Poster Presentations (intercourse-satisfaction, overall-satisfaction, orgasmic-function) versus placebo within DM subgroups (i.e. treatment-by-DM interactions were significant at P < 0.100). Of all subjects using tadalafil 5 mg, 46.2% with baseline IIEF-EF scores <26 had normal scores at endpoint, including 26.5% of subjects with DM and 53.8% without DM (each P < 0.050 vs. placebo). Tadalafil was well tolerated. Adverse events included headache, dyspepsia, and back pain. Conclusion: Once-daily tadalafil was well tolerated by men with or without comorbid DM and significantly improved most measures of erectile function. Policy of full disclosure Funding statement: The original (“base”) placebo-controlled studies of once-daily tadalafil, the present analysis, and this communication were supported by Eli Lilly and Company (Indianapolis, IN USA). Author disclosures: Dr. Seftel: paid consultant to Abbott, Auxilium, Eli Lilly, Endo, and Pfizer. Research grant recipient from Eli Lilly and Auxilium. Dr. Kim: advisor, recipient of honoraria, and paid consultant/investigator for Eli Lilly. Speaker for Astellas, Auxilium, and Watson. Drs. Ni and Burns: employees of, and stock (or option) holders in, Eli Lilly (minor). Acknowledgments: Writing/editorial support: Stephen W. Gutkin, Rete Biomedical Communications Corp. (Wyckoff, NJ USA), with support from Eli Lilly. Statistical support and review: Drs. Shuyan Li, Rodrigo Juarez Y Ruíz, and Anne Esler, i3 PharmaNet/i3, Indianapolis, IN USA, with support from Eli Lilly.

P-01-089

IN-VITRO EFFECTS OF PDE5 INHIBITOR AND STATIN TREATMENT ON THE CONTRACTILE RESPONSES OF EXPERIMENTAL HYPERLIPIDEMIC RABBIT’S CORPUS CAVERNOSUM SMOOTH MUSCLE Erdem, Y,1; Korgali, E.1; Ayan, S.1; Gökce, G.1; Yildirim, S.1; Gültekin, Y.1 Cumhuriyet University Medical, Sivas, Turkey1 Objective: Hypercholesterolaemia (HC) promotes erectile dysfunction (ED) through increased superoxide formation and decreased nitric oxide (NO) bioactivity in cavernosal tissue. The source of superoxide has not been clearly defined however role of NO on erectile function is well known. Statins have lipid lowering properties and can modulate endothelial NO bioavailability. Sildenafil, type 5 Phosphodiesterase inhibitor, enhances smooth muscle relaxation in normal human and rabbit corpus cavernosum. We invastigated in-vitro effects of sildenafil and rosuvastatin (RSV) on non-adrenergic, non-cholinergic and NO mediated cavernosal smooth musle relaxation in HC and diabetic rabbits, since alterations in this pathway are recognised in diabetic and HC erectile dysfunction. Methods: Ten male New Zealand white rabbits were fed a standart diet as control group, fourty male New Zealand white rabbits were fed a HC diet for 12 weeks. HC group were randomly divided into four groups; HC without treatment, HC+ RSV treatment, HC+ sildenafil teratment, HC+ RSV+ Sildenafil treatment (N = 10 per groups). Results: Serum levels of cholesterol and glucose were significantly higher in the experimental group than in the control group (p < 0.05). After six weeks theraphy no differences were found among the groups in relaxation responses to sodium nitroprusside. The relaxation responses to carbocol and EFS were significantly reduced in HC group to control group (p < 0.05), but there were no differences between the other groups and control group. There was a significantly lower invitro relaxation response in the HC rabbits Than in controls and the others (p < 0.05). Conclusion: Both agents improve in-vitro relaxation responses of erectile tissue from HC and Diabetic rabbits to endothelial nonadrenergic, non-cholinergic and NO. This finding supports to the results of other clinical studies with these drugs. Policy of full disclosure: None

P-01-090

DO THE PELVIC FLOOR MUSCLES PLAY A ROLE IN THE CONTROL OF EJACULATION AND WHAT THIS MIGHT IMPLY? La Pera, G.1 Rome, Italy1 Objective: So far the definition of premature ejaculation (PE) and concepts of improving and healing this condition do not take into account the role of pelvic floor muscles (PFM) in the voluntary control of the ejaculatory reflex. Should PFM play a decisive part in the voluntary control of ejaculation, then men should be aware of their role and should be able to use them at the right moment. According to this hypothesis, in some cases men who are not aware or in other cases not using PFM may have PE not only because of the early arrival of the ejaculatory reflex but simply because they do not know what to do at the right moment. The objective of the present investigation was to measure the prevalence of the awareness of the role of PFM and the use of PFM’s contraction in the control of the ejaculatory reflex among PE and non-PE subjects Methods: We validated a test able to discriminate subjects who use PFM and are aware of the part PFM play from those who do not use PFM and are not aware. 80 patients with PE and 78 non-PE subjects were recruited. Results: 7 patients out of 80 with PE and 64 out of 78 without PE use PFM to delay ejaculation and are aware of their role (Fisher exact test p < 0.0001) Conclusion: The majority of subjects with PE are not aware of the role of PFM in the control of ejaculatory reflex and do not use these muscles to delay ejaculation. Although this study shows a simple association and does not proves the existence of a cause-effect relationship, it supports the hypothesis that the definition, improving and healing concepts of PE should take into consideration the role of pelvic floor muscles. Policy of full disclosure: I am participating to the “Pause” study a PE research sponsored by Janssen and Cilag

P-01-091

SEXUALITY IN PATIENTS WITH PARKINSON DISEASE: DYNAMIC AND UNPREDICTABLE Bronner, G.1 Sheba Medical Center, Sexual Medicine Center, Urology, Ramat-Gan, Israel1 Objective: Patients with Parkinson’s disease (PD) report on frequent sexual dysfunction (SD), including hypoactive sexual desire, erectile dysfunction, premature ejaculation, difficulties reaching orgasm and sexual dissatisfaction. Hypersexuality or compulsive sexual behaviour (CSB), an under reported sexual behaviour in PD, is part of impulse control disorders involving compulsive and reward-based behaviors. Motor and non-motor symptoms contribute to further manifestations of sexual problems. Studies have indicated that the need for intimacy and sexual expression are important dimensions of quality of life for people with PD. New medical and psychosexual treatments increase awareness and demand for treatment by patients and their spouses. The objectives of this presentation: to facilitate diagnosis and treatment of SD in PD, a medical aspect, which may be neglected due to the disease complexity. Methods: This presentation will focus on the dynamics and unpredictable nature of SD in PD patients. Analysis of cases and dilemmas will enable evaluation, diagnosis and understanding the sexual interventions. Results: The physician will gain better understanding of SD in PD patients and intervention methods specifically designed for these patients. In addition, the ability to differentiate between SD and CSB will facilitate adequate professional treatments. Conclusion: The physical and emotional changes in PD and various treatments of the disease have a major effect on SD in PD. All patients

J Sex Med 2012;9(suppl 5):357–397

386 and their partners may experience impairment of sexual function and quality of life. Physicians and other health care providers can proactively address sexual health issues by providing information, by recognizing the sexual needs of the patients and by offering effective treatments and suitable interventions, thus improving quality of life of couples who cope with PD. Policy of full disclosure: None

P-01-092

RELATIONSHIP BETWEEN TESTOSTERONE, AMSS AND METABOLIC SYNDROME IN A COHORT OF MEN WITH LOW TESTOSTERONE LEVELS García-Cruz, E.1; Piqueras, M.1; Cardeñosa, O.2; Luque, P.1; Alcaraz, A.1 Hospital Clínic de Barcelona, Spain1, Bayer España, Sant Joan d’Espí, Spain2 Objective: to determine the relationship between AMSS, testosterone (T) levels and Metabolic Syndrome (MS) in a cohort of men with low testosterone levels. Methods: a multi-centre, cross-sectional study recruited 1094 consecutive men older than 45 years old with low T levels (<12nmol/L). Alcohol intake and tobacco use were recorded. Obesity was defined as Body Mass Index >30kg/m2. History of heart disease, peripheral vascular disease and other relevant entities were prospectively recorded. Metabolic Syndrome was defined as 3 or more of the following: abdominal obesity ≥94cm, triglycerides ≥150 mg/dl, Hypertension ≥130/85 mmHg, HDL-cholesterol <40mg/dL or Fasting Glucose ≥100 mg/dl. AMSS questionnaire and IIEF were used to record low T symptoms and erectile function. Testosterone and SHBG were determined in blood sampling between 7h00 AM and 11h00 AM. Free and bioavailable T were calculated using Vermeulen’s formula. Multivariate analysis was carried out to determine the variables related to the presence of MS. P < 0,05 was considered statistically significant. Results: mean age was 61,2 ± 8,1 years old. AMSS classification: >27 5,1%; 27–36 28,6%; 37–49 37,5% and >49 28,8. AMSS was related to the number of factors of MS (0 factors 38,5; 1 factor 38,7; 2 factors 40,1; 3 factors 42,9 (overall 3 or more factors 44,67); 4 factors 46,4 and 5 factors 45,8; p < 0,001). T levels were related to the number of factors of MS (0 factor 7nmol/L; 1 factor 6,7nmol/L; 2 factors 6,76nmol/L; 3 factors 6,5nmol/L; 4 factors 6,5nmol/L and 5 factors 5,9 nmol/L). Conclusion: in a cohort of men with low T levels, the intensity of hypogonadism symptoms and the descend in T levels are related to the number of factors of MS. Policy of full disclosure: This study was financially supported by a grant for investigation from BAYER ESPAÑA.

P-01-093

HYSTOCHEMICAL OUTCOMES OF TISSUE REMODELING AFTER PENILE GIRTH ENHANCEMENT USING BIODEGRADABLE SCAFFOLDS Bumbasirevic, U.1; Djordjevic, M.1; Kravic, T.1; Martinovic, T.1; Bizic. M.1; Ojovic, V.1; Majstorovic, M.1; Stojanovic, B.1; University of Belgrade, Serbia, Belgrade, Serbia1 Objective: Autologous tissue engineering by using biodegradable scaffolds as a carrier is a new and safe therapeutic approach for penile girth enhancement. The principle of this technique is to transplant autologous cells onto biocompatible and biodegradable scaffolds that will provide appropriate mechanical strength to induce three-dimensional tissue growth and consequent penile enlargement. The aim of this study was to perform microscopic evaluation of tissue remodeling after penile girth enhancement using this technique. Methods: Between 2007 and 2011, a group of 17 patients, aged 22–37 years, underwent repeated penile enhancement using biodegradable scaffolds, after psychiatric evaluation, and after approval of

J Sex Med 2012;9(suppl 5):357–397

Poster Presentations institutional review board. During repeated procedure, samples of newly formed tissue after previous surgery were obtained. Surgically removed specimens were fixed in 4% formaldehyde for light microscopy and in 3% glutaraldehyde for electron microscopy, and routinely processed for microscopic analysis. Results: Connective tissue with an abundance of connective tissue fibers, with small blood vessels and inflammatory cells were seen in all analyzed surgically removed tissue. Ultrastructural analysis of these tissue samples discovered the presence of large quantity of collagen fibrils that were regularly arranged in parallel, forming bundles, with a few widely spread fibroblasts. Mast cells were present in all tissue samples and some were partly degranulated. In one sample, groups of fibroblast were observed, in contrast to other samples studied where fibroblasts were largely separated from one another with abundant collagen fibers. In these fibroblasts the presence of lipid droplets were found. Lipid droplets were small, but variable in size and number in lipid-laden fibroblasts. Lysosomes were also observed in the cytoplasm of these fibroblasts. Conclusion: Microscopic evaluation of newly formed tissue induced by autologous tissue engineering by using biodegradable scaffolds showed the presence of vascularized loose connective tissue with abundance of collagen fibers, fibroblasts and inflammatory cells, indicating active neovascularization and fibrillogenesis. Policy of full disclosure: None

P-01-094

REPAIR OF FAILED EPISPADIAS PRESENTING IN ADULTS Bizic, M.1; Djordjevic, M.1; Majstorovic, M.1; Kojovic, V.1; Stojanovic, B.1; Korac, G.1; Krstic, Z.1; University of Belgrade, Serbia, Belgrade, Serbia1 Objective: Reconstruction of failed epispadias always presents a great challenge. We present a radical approach for correction of all severe penile deformities as well as urethral reconstruction in patients after failed epispadias repair in childhood. Methods: Between 2006 and 2012, 23 patients, aged 16 to 47 years (mean 24) underwent two-stage surgery due to failed epispadias repair in childhood. Severe dorsal curvature with corpora cavernosa deformities were noted in all cases. Radical approach included complete separation of corpora cavernosa from glans cap with neurovascular bundle as well as urethra. Urethra was short in all cases and divided at the glans level. Corporeal bodies are straightened and lengthened by tunical incisions and grafting. Short urethra was dissected and transposed ventrally creating hypospadiac meatus. Penile entities were reassembled in normal anatomical relation. Penile shaft was covered using remaining vascularized skin flaps. Second stage included reconstruction of hypospadiac urethra using buccal mucosa graft and hairless skin flap. Results: Follow-up ranged from 12 to 76 months (mean 38 months). Postoperatively good functional and esthetic results were achieved. Twenty one patients have completely straightened and lengthened penises. Two patients developed minor curvature that was clinically insignificant. Eighteen patients were sexually active and reported regular sexual intercourse. In 3 cases, urethral fistula occurred and was repaired 6 months after urethroplasty. Conclusion: Redo surgery of failed epispadias is very demanding procedure. Radical approach is necessary for successful outcome. Policy of full disclosure: None

387

Poster Presentations P-02

P-01-095

PREVALENCE OF SEXUAL DYSFUNCTION AMONGST VETERANS SUFFERING OF PTSD 1

2

Kamnerdsiri, W. ; Weiss, P. Paris, France1; Charles University in Prague, Czech Republic2 Objective: Inform sexology specialists the correlation between PTSD and sexual dysfunction. Methods: Method: Literature review. This review will focus the attention of sexology specialists on the correlation that exists between Post-Traumatic Stress Disorder and sexual dysfunction. United States armed service veterans that are male benefit from regular health checks. Along with patients themselves reaping the rewards of therapy and treatment, their health problems are welldocumented for future studies and statistics. Recent U.S. studies illustrate and prove that American servicemen are prone to be victims of and suffer from such dysfunctions. Surprisingly, they endure urological problems at a rate twice that of the general population. PTSD appears to be an aggravating factor, also doubling the rate of sexual dysfunction for men who suffer from traumatism consequences as compared to other military men. Results: Military status doubles urinary risk compared to general population. PTSD doubles sexual dysfunction among military men. Conclusion: Proper information of physicians and therapists is essential to understanding, diagnosis and cure of the negative consequences of PTSD on sexual functions. Policy of full disclosure: None

Female sexual health

P-02-001

DOING IT ALL GIVES ME A BETTER SEX LIFE: THE EFFECT OF ROLE-CONFLICT ON DEPRESSION AND SEXUAL SATISFACTION AMONG FEMALE MEDICAL STUDENTS Peleg-Sagy, T.1; Shahar, G.2 Ben-Gurion University, Psychology, Beer Sheva, Israel; University, Beer Sheva, Israel

1

2

Ben-Gurion

Objective: To test psychosocial predictors of sexual dissatisfaction and depression among female medical students using a one-year follow up. Predictors were: Commitment to life domains (professional, marital, domestic) and personality pathologies (self criticism and silencing of the self ). Methods: 149 female medical students from 1st, 4th and 7th (internship) years of all medical schools in Israel, who were also involved in serious romantic relationships, were assessed twice over a one-year interval using self-report questionnaires. Results: A significant 3-way interaction was found among selfsilencing, marital and domestic commitment (b = −.02, β = −.18, t = −2.24, p < .03). The regression model accounted for % of the variance in depressive symptoms (n = 149, R² = .75, f [1, 124] = 11.33, p < .00). Among self-critical women (Figure 1), when marital commitment was low, a higher domestic commitment predicted greater sexual dissatisfaction. However, such an effect was not found when marital commitment was high. For depression, a reversed significant 3-way interaction was found between marital and home commitment and self-silencing (b = .42, β = .185, t = 2.06, p < .05). The regression model accounted for 75% of the variance in depressive symptoms (n = 145, R² = .75, f [1, 124] = 11.33, p < .00). Among participants with high degree of self-silencing (Figure 2), when domestic commitment was high, higher marital commitment predicted greater depression. When domestic commitment was low, the effect presented the same direction, but was much weaker. Conclusion: Regarding sexual satisfaction, being highly committed to multiple-roles seems to serves as a protective factor, reducing dissatisfaction. This is mostly evident among women who tend to conceal their inner voice. In contrast, regarding depression, a commitment to more than a single role might create stress, particularly among selfcritical women, in turn leading to depression. Policy of full disclosure: None.

J Sex Med 2012;9(suppl 5):357–397

388 P-02-002

THE ROLE OF DIABETES TYPE IN THE PATHOGENESIS OF SEXUAL DISORDERS AND SEXUAL DISTRESS IN WOMEN Dimitropoulos, K.1; Bargiota, A.2; Mouzas, O.2; Bristianou, M.3; Karatzas, A.2; Zachos, I.2; Panou, C.3; Melekos, M.2; Koukoulis, G.2; Tzortzis, V.2 1 University of Thessaly, Department of Urology, Larissa, Greece; 2University of Thessaly, Larissa, Greece; 3General Hospital of Lamia, Greece Objective: Diabetes Mellitus (DM) has been shown to impair sexual functioning in women, however it has not been clarified whether it is type 1 DM (T1DM) or type 2 DM (T2DM) that prevails in prevalence of sexual disorders. The current study aims to determine the type of diabetes that correlates with more frequent sexual disorders and higher sexual distress. Methods: Fifty women with T1DM and 50 with T2DM were enrolled in the study. The FSFI, FSDS and GHQ – 28 questionnaires were used to study sexual functioning, sexual distress and general health respectively. Student’s t-test. Fisher’s exact test and Pearson’s correlation test were used in statistical analysis. Results: T1DM women had significantly lower age (P = 0.000) and BMI (P = 0.000) compared with T2DM women. Women with T1DM had significantly higher Total FSFI (P = 0.003), Desire (P = 0.001), Arousal (P = 0.042), Lubrication (P = 0.044) and Pain (P = 0.009) compared with T2DM patients, however no difference was found in Orgasm, Satisfaction, Sexual Distress and General Health (P > 0.05). Although FSD frequency was higher in T1DM group compared with T2DM group (20% vs 16% respectively), the difference was not significant (P > 0.05). In women with T1DM, sexual disorders correlated with worse general health status, anxiety, social dysfunction and depression, while sexual distress correlated with worse general health status, more frequent physical symptoms, anxiety, social dysfunction and depression. In T2DM women, both sexual disorders and sexual distress correlated with worse general health status, more frequent physical symptoms, anxiety and depression. Moreover, sexual distress correlated with higher BMI. Conclusion: Current study shows that in comparison with T1DM, T2DM is related with worse sexual functioning in women, especially in the domains of desire, arousal, lubrication and pain. Sexual distress, FSD frequency and correlates of sexual disorders and distress were similar in both types of DM. Policy of full disclosure: None.

P-02-003

THE GLOBAL ONLINE SEXUALITY SURVEY (GOSS): FEMALE SEXUAL DYSFUNCTION AMONG INTERNET USERS IN THE REPRODUCTIVE AGE GROUP IN THE MIDDLE EAST Zaki Shaeer, O.1; Shaeer, E.2 Cairo University, Andrology, Egypt; 2Cairo University, Egypt

1

Objective: The exact prevalence of female sexual dysfunction (FSD) in the Middle East is exceptionally difficult to measure in the light of its sensitive nature and the conservative tinge of the population. The Global Online Sexuality Survey – Arabic – Females “GOSS-AR-F” is a community based study of female sexuality in the Middle East through an online survey. Methods: GOSS-AR-F was offered via online advertising. The survey is comprised of the Female Sexual Function Index questionnaire (FSFI) among other questions. Results: Out of 2920 participants, 344 completed all survey questions. Average total FSFI score was 23 ± 6.5 with 59.1% of participants suffering rFSD. Age adjusted prevalence of rFSD was 59.5%, standardized to World Health Organization (WHO) World Standard Population. There was a statistically significant higher prevalence of rFSD among cases with subjectively reported depression and male partner-related shortcomings such as erectile dysfunction and prema-

J Sex Med 2012;9(suppl 5):357–397

Poster Presentations ture ejaculation as reported by the female participant, in addition to dissatisfaction with partner’s penile size, insufficient foreplay and practice of masturbation. This was not the case with advancing age, diabetes mellitus, hypertension, smoking, ongoing pregnancy, mode of previous child delivery, infertility, menstrual irregularities, dysmenorrhea, interpersonal distress, subjectively reported hirsutism, and female genital cutting. Participants were found to require longer duration of coitus and better ejaculatory control, but not necessarily a higher coital frequency. Conclusion: Female sexual function in the reproductive age appears to be adversely affected by psychological factors and shortcomings in male sexual function more than anything. These findings point to the possibility that many cases of female sexual dysfunction can be managed with the focus on male partner’s ailments and attitudes that are relatively easier to manage. Policy of full disclosure: None.

P-02-004

SEXUAL FUNCTION OF OVERWEIGHT PREGNANT WOMEN WITH GESTATIONAL DIABETES – PRELIMINARY RESULTS Ribeiro, M. C.1; Nakamura, M. U.2; Torloni, M. R.2; Scomparini, F. B.2; Scanavino, M. d. Tubino3; Mattar, R.2 1 São Paulo Federal University, Obstetrics, Brazil; 2São Paulo Federal University, Brazil; 3University of São Paulo, Brazil Objective: To evaluate and compare the sexual function of normal weight and overweight pregnant women with Gestational Diabetes Mellitus (GDM) between 28 and 40 weeks. Methods: Cross-sectional study conducted between March 2010 and August 2012 at the antenatal clinic of a public teaching hospital. A total of 34 normal weight, (BMI 18.5–24.9 Kg/m2) and 35 overweight (BMI ≥ 25) women between 28 and 40 weeks’ gestation were enrolled. Participants answered the Female Sexual Function Index (FSFI), a selfresponsive test with 19-questions that assess five sexual domains. Chi-square and Student’s test were used to analyze differences between the groups; p < 0.05 was considered significant. Results: Mean gestational age was 34.4 ± 1.8 weeks. Sociodemographic characteristics were similar and the mean final FSFI scores did not differ significantly between the two groups: 23.4 ± 5.4 vs 25.6 ± 7.9, p = 0.18, for normal weight vs overweight women, respectively. A total of 16 normal weight women presented symptoms of sexual dysfunction (FSFI score ≤ 26) compared to 14 overweight pregnant women (47% × 40%, p = 0.73).The desire domain score was similar in both groups (5.4 ± 2.2 vs 5.9 ± 2.1, p = 0.34, for normal weight vs overweight women, respectively). Almost half of the women in each group (44% normal weight × 43% overweight, p = 0.91) had scores below the threshold that identifies desire difficulties. Conclusion: According to our preliminary results, being overweight does not seem to affect the sexual function of women with GDM in the third trimester of pregnancy, as measured by the FSFI questionnaire. Policy of full disclosure: This study was funded by a grant from CAPES–Coordenação de Aperfeiçoamento de Pessoal de Nível Superior and FAPESP – Fundação de Amparo à Pesquisa do Estado de São Paulo. Process n. 9/54509–6 and 2010/11733–0.

P-02-005

SEXUAL ABUSE IN A CLINICAL COHORT OF CANADIAN PATIENTS WITH PELVIC FLOOR RELATED COMPLAINTS Nicolai, M.1; Beck, J.2; Berzuk, K.3; Putter, H.4; Pelger, R.4; Elzevier, H.4; Voorham- van der Zalm, P.4 1 LUMC, Urology, Leiden, Netherlands; 2Zuwe Hofpoort & St Antonius, Woerden, Netherlands; 3IPPC, Winnipeg, Canada; 4LUMC, Leiden, Netherlands Objective: Sexual Abuse (SA) is found in an important fraction of patients presenting with complaints of micturition, defecation and/or

389

Poster Presentations sexual function. The pelvic floor is the overlapping structure supporting urethra, vagina and rectum; therefore in patients referred for the treatment of Pelvic Floor Dysfunction (PFD), a higher prevalence of SA can be expected, compared to controls. The aim of this study was to find the prevalence of SA in a Canadian sample of patients presenting to a tertiary referral center with complaints related to the pelvic floor, compared to a control group. The second aim was find correlations between the different domains of PFD and a history of SA and/ or rape. Methods: An administered validated questionnaire, the Pelvic Floor Inventories (PelFIs), was used to evaluate 55 patients with PFD and 50 recruited controls without PFD. The PelFIs contains questions regarding complaints in the domains of the pelvic floor: Pelvic Organ Prolapse (POP), stress and urge urinary incontinence, obstructive micturition, defecation, faecal incontinence, constipation, pelvic pain and sexual dysfunction. Results: The group of patients with PFD showed a significantly higher percentage of SA (22%) compared to controls (2.1%; p = 0.008). SA is correlated with urinary incontinence (rs = 0.26, p = 0.01), sexual dysfunction (rs = 0.31, p = 0.003) and with various questions from the domain pelvic pain. Rape was reported by 10% of patients and associated with urinary incontinence (rs = 0.22, p = 0.04) and faecal incontinence (rs = 0.27, p = 0.01). Conclusion: SA and rape are very prevalent in patients presenting with PFD compared to controls. SA is associated with multiple PFD’s including urinary incontinence and sexual dysfunction. Rape is associated with urinary and faecal incontinence. The PeLFIs is a good clinical tool to appreciate a history of SA or rape within patients presenting with PFD. Policy of full disclosure: None.

P-02-006

SEXUAL HEALTH OF WOMEN OF POSTMENOPAUSAL AGE IN UKRAINE Gorpynchenko, I.1; Romashchenko, O.2; Melnykov, S.3; Bilogolovskaya, V.3; Koval, S.3; Shcherbak, M.3 1 Institute of Urology, Kiev, Ukraine; 2Dept. of Andrology and Sexology, Institute of Urology of the Academy, Kyiv, Ukraine; 3SI Institute of Urology, Kyiv, Ukraine Objective: To define the rate and range of women’s sexual dysfunctions in postmenopause. Methods: 517 women aged 43 to 62 with a menopause (physiological and surgical) lasting 2 to 21 years have been examined in terms of sexology, gynecology and somatically. Results: It has been determined that an average age for beginning of a menopause is 48.9 years. 62.1% had somatic disorders (cardiovascular diseases, chronic diseases of gastrointestinal tract, diabetes mellitus), 72.5% had early and middle-aged menopause disorders with prevailing urogenital disorders (54.4%). Regular sexual relations (4 to 8 times per month) had 54.4% of the examined, while 27.2% had irregular relations (1–2 times per month), and 18.4% had no sexual intercourse. The examined had different sexual dysfunctions in terms of severity and nature of combination, including: decrease of desire – 48.6% and arousal – 46.9%, primary anorgasmia – 10.6%, secondary anorgasmia – 17.8%, lubrication disorders – 61.4%, dyspareunia – 49.1%. Degree of sexual disorders aggravated in the course of the menopause combined with somatic and gynecological disorders. Most of the examined consulted an obstetrician-gynecologist regarding development of early and middle-aged menopause disorders, and all of them sought consulting on issues of gaining sexual comfort in view of age peculiarities. Indeed, 45.5% of women aged over 50 and 24.7% aged over 60 underlined the significance of sexual activity as a part of life quality. Conclusion: The rate and range of women’s sexual dysfunctions in postmenopause grew over the years, in the course of menopause, followed by somatic and gynecological disorders. Evaluation of gynecological and sexual health of women in postmenopause should be held in the common context with consideration of age peculiarities, which should favor maintaining life quality and vitality. Policy of full disclosure: None.

P-02-007

EVALUATION OF SEXUAL FUNCTIONS IN FEMALES RECEIVING RENAL REPLACEMENT THERAPIES Demir, R.1; Yakupoglu, Y. K.1; Bostanci, Y.2; Atac, F.1; Ozden, E.1; Kaya, C.1; Sarikaya, S.1 1 Ondokuz Mayis University, Samsun, Turkey; 2Ondokuz Mayis University, Urology, Samsun, Turkey Objective: To determine the factors mediating the changes in sexual functions by evaluating sexual functions of female patients who had renal transplantation (RT) due to ESRD. Methods: 46 female patients were evaluated including 23 patients who underwent RT and 23 patients who were actually undergoing hemodialysis. The study enrolled patients who may be sexually active, had achieved stability following RT, is not diabetic and has no genital anatomic deformity, previous pelvic surgery history and severe psychiatric disorder. Results: Mean age was 39.3 ± 5.2 and 37.04 ± 4.7 years in the RT and ESRD group, respectively (P = 0.130). There was no difference between two groups with regards to the physical examination findings and laboratory parameters. FSFI scores were 36.3 ± 6.7 and 17.7 ± 4.2 in the RT and ESRD group, respectively (P = 0.001). FSFI full scale scoring was superior in all parameters in the RT group (Table 1). When comparison was made with regards to FSFI scores between patients who underwent RT, it was ≥26 in 14 and < 26 in 9 women. Mean age was 36.7 ± 5 years in group with FSFI ≥ 26 and it was 43.2 ± 2.2 years in group with FSFI < 26 (P = 0.001). Mean duration of dialysis therapy was 31.2 ± 46.8 months in the group with FSFI ≥ 26 and it was 66.6 ± 18.1 months in the group with FSFI < 26 (P = 0.001). 83.3% of patients had FSFI ≥ 26 and 16.7% had FSFI < 26 in the living donor group. In the cadaveric donor group, 36.3% had FSFI ≥ 26 and 63.7% had FSFI < 26 (P = 0.029). Conclusion: It was found that the frequency of sexual dysfunction was higher in patients who had pre-transplantation hemodialysis for longer time. It is believed that renal transplantation made in early period of ESRD will reduce frequency of sexual dysfunction in the posttransplantation period. Policy of full disclosure: None.

P-02-008

SCATTERING METAL SPARKS IN THE MIDDLE OF EMERGENCY ROOM TO RESCUE THE PENIS: TWO CASE REPORTS Alzubaidi, R.1 1 Hamad Medical Corporation, Urology, Doha, Qatar Objective: The aim of this article IS to describe our experience in using rotating saw and also combination of the instrument with 4-needle aspiration. Methods: Here we describe two cases of self penile strungulation with metallic constricting rings presenting to our emergency department with different clinical presentation, and diffrent surgical approach.

J Sex Med 2012;9(suppl 5):357–397

390

Poster Presentations

Results: The two cases were managed successfully in the emergency room with different techniques to remove the penile metallic constructing ring without penile injury. Conclusion: Penile strangulation should be accepted as a self-induced priapism and managed as an emergency in order to preserve erectile function and to prevent penile necrosis. Surgical creativity and patience are necessary in order to have a successful outcome. Policy of full disclosure: None.

P-02-009

CLINICAL PRACTICE ONE YEAR AFTER TRAINING AT THE ESSM SCHOOL OF SEXUAL MEDICINE 1

2

Andrews, S. ; Arbanas, G. Woking, United Kingdom; 2Opca Bolnica Karlovac, United Kingdom

1

Objective: The 5th European School of Sexual Medicine brought together 29 professionals from 23 countries for an incredible learning experience, not only from the expert tutors but also the culturally and professionally diverse participants. This short survey of the participants aims to look at clinical practice one year after the course. Methods: All participants were invited to a web-base survey from 16 to 31 August 2012. Results were collected, collated and analysed using Google docs. Results: Eighty three percent (24/29) responded, 23 participants from 18 countries (10 Asian, 13 European) continue to practice Sexual Medicine and completed the survey. Median age was 40 years (range 30–58), 6 (26%) were women. Seventeen (75%) had undertaken additional training. Thirteen (57%) spent <25% and 5 (22%) spent over 75% of their professional time in Sexual Medicine. The four most common presentations were erectile dysfunction, premature/early ejaculation, sexual arousal disorder in women and hypoactive sexual desire disorder in men. The majority (19, 83%) manage erectile dysfunction, all 19 offer cardiovascular risk assessment and testosterone/ hormonal tests but only a half (11/23) are able to offer tests such as duplex scan, Rigiscan, intra-cavernous injection tests. For treatment of erectile dysfunction, 18 offer PDE5i, 15 testosterone-replacement and 17 psychotherapy. Seventeen (77%) manage women with decreased sexual desire. All are able to offer investigations when necessary. The Asian professionals were predominantly male (90% vs. 62%) and Urologists (60% vs. 23%) compared to the Europeans. Conclusion: Almost all participants manage sexual dysfunction a year after the course, and offer their patients a range of diagnostics and treatment. A larger study ideally before and after training would help explore interesting differences in this diverse group, such as the impact of culture, medical speciality, training and group-interaction on practice of Sexual Medicine. Policy of full disclosure: None.

J Sex Med 2012;9(suppl 5):357–397

P-02-010

ASSOCIATION OF A TRIAD MORBID: DEPRESSION, ERECTILE DYSFUNCTION AND ISCHEMIC HEART DISEASE Asselah, F.1; Bélaid, A.2; Issad, M. s.3 Hopital Drid Hocine, Faculté de Médecine D’Alger, Algeria; 2Hopital Mahfoud Boucebci, Alger, Algeria; 3Hopital Universitaire, Alger, Algeria

1

Objective: Hypothesis and objective Hypothesis When coronary heart disease exists, it may be associated with erectile dysfunction and depression. Objective Describe the association of erectile dysfunction and depression in a population of coronary by conducting a descriptive study. Methods: Methods To assess depression, anxiety level, the traitanxiety and erectile function in the study population. Scales of selfassessment were performed: The Beck Depression Inventory, the HAD scale (Hospital Anxiety and Depression Scale), the questionnaire STAI (State-Trait Anxiety Inventory) and the International Index of Erectile Function (IIEF). Results: Results The study involved 88 patients undergoing coronary angiography. The average age was 58 years ± 10 years. The prevalence of depression is high 36,4 %. The prevalence of erectile dysfunction was 64,8 %. The interrelationship between depression, erectile dysfunction and ischemic heart disease was present in 31,82 % with a statistically significant (p = 0.015). This result confirms the coexistence of these three diseases. Conclusion: Conclusions A key finding of this study reveals the importance and the role of depression and erectile dysfunction in coronary patients. Keywords: depression–anxiety–erectile dysfunction–ischemic heart disease–infarct–acute coronary syndromes–angina. Policy of full disclosure: None.

P-02-011

“CANCER, SEXUAL HEALTH AND INTIMACY”: THE FIRST GENERAL GUIDELINE ON MANAGEMENT AND TREATMENT APPROACHES FOR HEALTH CARE PROFESSIONALS REALIZED BY THE FRENCH-SPEAKING SUPPORTIVE CANCER CARE ASSOCIATION (AFSOS) Bondil, P.1; Habold, D.2; Farsi, F.3; Rondali, W.4 Centre Hospitalier, Urology-Andrology, Chambery, France; 2Centre Hospitalier, Chambery, France; 3Reseau Espace Sante Cancer, Chambery, France; 4France

1

Objective: Knowledge and skills gaps concerning oncosexology require a careful effort of information/training well adapted to different health professionals during the cancer care continuum (CCC). Objectives: to set up a specific guideline on “Cancer, sexual health and intimacy”: a) to integrate this care dimension into daily practice, b) to share a common language and clinical judgment aiming to detect and distinguish simple/complex problems; c) to organize the prevention / treatment of (iatrogenic or not) sexual dysfunctions at each CCC stage. Methods: This guideline concerns exclusively non reproductive sexuality and outlines the minimum pre-requisite that every health professional must know regardless of the primary cancer diagnosis/treatment. The guideline development group was multidisciplinary. The peer review was realized during 2 different national workshops (2010 + 2011) of the French supportive care association (AFSOS). Results: a) difficulty of evidence reviews owing to the absence of published guidelines, b) development mainly based on a strong expert/ professional consensus as this multi-thematic topic cannot be analyzed using other recommended methods, c) limited scientific data explaining its level rating (D grade 3), d) true clinical value as this first general clinical guideline points up several main points (why a guideline on cancer and sexuality, for whom, which cancers, for which treatments, who is involved, when to tackle it with the patient/couple, who should speak about it and how, diversity of potential sexual/intimate impacts, specific check-list during the CCC).

391

Poster Presentations Conclusion: Owing to its usefulness for improving the daily care response, its national implementation is ongoing. Its translation into different languages is also ongoing with learned societies. A new lecture and validation of its English version will assess if it may serve as a relevant basis for the professional health careers of foreign countries according to both national sociocultural aspects and health systems. Policy of full disclosure: None.

P-02-012

AGE-RELATED CHANGES IN THE CONCENTRATION OF ELASTIC FIBERS IN DIFFERENT REGIONS OF THE RABBIT PENIS Cardoso, L. E. M.1; Costa, W.2; Chagas, M.2; Abidu-Figueiredo, M.2 State Univ. Rio de Janeiro, Urogential Research Unit, Brazil; 2State Univ. of Rio de Janeiro, Brazil

1

Objective: The rabbit penis is particularly suitable for studies on penile function and disorders. Elastic fibers are located in the different regions of the rabbit penis and play important roles in erection. However, it is not known whether they change with age. This study aims to investigate whether the concentration of elastic fibers in the corpus cavernosum (CC), corpus spongiosum (CS) and tunica albuginea (TA) of the rabbit penis undergo modifications with age, especially with the onset of senescence. Methods: New Zealand rabbits were sacrificed, in groups of ten animals each, at 30, 120, 240, and 730 days of age. The middle shaft of the penis was then formalin-fixed and embedded in paraffin. Histological sections were stained with a Weigert’s resorsin fuchsin method which stains all types of elastic fibers. The relative content of of elastic fibers was determined using stereological methods, and were expressed as volume fraction. Results were analyzed by ANOVA and the Bonferroni test. Results: At 730 days of age, the concentration of elastic fibers was increased by 54% (p < 0.004), 78% (p < 0.004), and 87% (p < 0.004) in the TA, CC and CS, respectively, compared with animals aged 30 days. Additionally, from 30 days of age onward, the concentration gradually and significantly increased until 240 days of age. In 730-day old animals, however, the concentration, compared with the previous age group, was unchanged in the CC and decreased by 20% in the TA (p < 0.004). Conclusion: The different regions of the rabbit penis contain different concentrations of elastic fibers, which correlate with properties of penile tissues. Although from one month of age onward there is a gradual increase in these concentrations, in two-year old animals this trend is already interrupted, which suggests that this could be an early alteration due to senescence. Policy of full disclosure: None.

P-02-014

LASER TREATMENT OF EARLY STAGES OF STRESS URINARY INCONTINENCE SIGNIFICANTLY IMPROVES SEXUAL LIFE Fistonic, I.1; Fistonic, N.2; Findri Gustek, S.3; Sorta Bilajac Turina, I.4; Fistonic, M.5 1 Ob/Gyn Clinic, Zagreb, Croatia; 2Comunity Health Center, Zagreb, Croatia; 3Ob/Gyn Clinic, Sesvete, Croatia; 4Medical School Univ. of Rijeka, Croatia; 5Psychiatry Clinic, UC Dubrava, Zagreb, Croatia Objective: Vaginal deliveries distend pelvic musculature irreversibly, often induce stress urinary incontinence (SUI) and reduce vaginal contraction level during the intercourse as well. This effect could diminish sexual arousal and satisfaction. The use of laser in the treatment for vaginal tightening (LVT) is a novel, non-invasive method based on photo thermal effect that produce tightening and shrinking of endopelvic fascia and pelvic floor tissue. The intense thermal stimuli will produce the collagen neogenesis enhancing sexual gratification in women with previous SUI.

Methods: This prospective case control study was conducted in 83 woman patients who were scheduled for LVT after completing inclusion criteria: history of vaginal delivery; pelvic organ prolapse of the 1st or 2nd grade; Q-tip test over 30 degrees; low score of PISQ12 and positive score of ICIQ-UI questionnaires; low perineometry values assessing pelvic floor muscle strength and endurance. Procedure was performed with Er-Yag laser XS Dynamis® (Fotona, Slovenia). Results: Preliminary results showed significant improvement (p < 0.05) in all the domains tested: ICIQ-UI scores decreased by more than 3 points at all follow-ups. A mean duration of muscle contraction measured with perineometry at 1 month increased by 4.7 s, at 3 months by 11.8 s and at 6 months by 22.8 s. Q-tip angle decreased by 14.7° at 1 month follow-up, by 15.9° at 3 months and by 22.5° at 6 months. PISQ-12 scores increased after 1 month by 5.4 points, after 3 months by 5.9 points and after 6 months by 6.6 points. Conclusion: This is the first study that objectivizes the effect of exclusively laser photo treatment on vaginal tightening without using any kind of surgical adjuvant techniques. The results after LVT treatment show significant improvement in reducing SUI episodes empowering vaginal and pelvic wall strength, simultaneously enhancing better sexual response. Policy of full disclosure: None.

P-02-015

MCP-1 AND FETUIN A LEVELS IN PATIENTS WITH PCOS AND/OR OBESITY BEFORE AND AFTER METFORMIN TREATMENT Gateva, A.1; Kamenov, Z.2; Tsakova, A.2 University Hospital Alexandrov, Endocrinology, Sofia, Bulgaria; 2University Hosp. Alexandrovska, Sofia, Bulgaria 1

Objective: PCOS is a common endocrine condition in young women that is thought to be linked to increased rate of metabolic syndrome and cardiovascular risk in later life. The aim of the study is to investigate MCP-1 and fetuin A levels in women with PCOS and/or obesity and to compare them to other classical cardiovascular risk factors before and after metformin treatment. Methods: The study included 59 patients – 19 obese, 27 nonobese PCOS and 13 obese PCOS. Anthropometric measurements and biochemical study, including MCP-1 and fetuin A measurement, were performed. For patients that were diagnosed with insulin resistance and started metformin treatment (1500–3000 mg/day) all the laboratory tests and anthropometric measurements were repeated after 6 months. Results: MCP-1 and fetuin A levels did not differ between patients with obesity with and without PCOS, between patients with PCOS with and without obesity. MCP-1 levels were significantly higher in patients with hyperandrogenemia than in patients without (456.3 ± 141.1 pmol/l vs. 372.5 ± 108.5 pmol/l), while fetuin A levels were significantly higher in patients with metabolic syndrome (MetS) than in patients without MetS (278.5 ± 41.1 mcg/ml vs. 240.0 ± 42. mcg/ ml). MCP-1 levels correlated positively with testosterone levels (r = 0.4, p = 0.002) but not with other androgens. Fetuin A levels correlated positively with ASAT levels (r = 0.4, p = 0.003) and erythrocyte sedimentation rate (r = 0.43, p = 0.001). There was no significant change in MCP-1 and fetuin A levels after of metformin treatment. Conclusion: MCP-1 levels were higher in patients with hyperandrogenemia and fetiun A levels were higher in patients with metabolic syndrome. MCP-1 and fetuin A levels did not change significantly after metformin treatment. Policy of full disclosure: The study was conducted with the financial support of Medical University-Sofia, Bulgaria, Grant 2011, Project 48, Contract 49/18.08.2011.

J Sex Med 2012;9(suppl 5):357–397

392

Poster Presentations

P-02-016

P-02-018

THE EFFECT OF EDUCATION BASED ON JAMES BROWN PATTERN ON KNOWLEDGE OF REPRODUCTIVE AND SEX HEALTH IN WOMEN IN SHIRAZ

SEXUAL FUNCTION IN AGING FEMALE

Homayon, M.1 Tehran, Islamic Republic of Iran

1

Objective: Introduction and objectives: More than half of made sexual problems that because of insufficient knowledge lead to unsafe marriage relation ship. By considering the sexual and reproductive health education role in preventing sexual problems and health promotion, the aim of this paper was studding the effect of the education based on James brown pattern on knowledge of sexual and reproductive health in women in Shiraz. Methods: Material and Method: The quasi –experimental study conducted on 220 women in case and control group in 2010.In case group education was done based on James brown pattern and the control group took part in usual education class. Data analyze was done by SPSS version 11, T test and Chi- square. Results: Result: Knowledge average scale in case group, including sex health, anatomy, physiology, divers aspects of sexual health and awareness of AIDS- STDS and family planning after education increase significantly rather than pre education stage, While knowledge average scale in control group has no meaning ful statistical differences. Conclusion: Conclusin: According to the result James brown pattern can increase the awareness of the sexual health, therefore this pattern suggested to generalize the reproductive and sexual health education to other women. Key Words: James Brown pattern, Health education, Reproductive. Policy of full disclosure: None.

P-02-017

THE CASTRATI – A VOICE FROM THE HEAVENS Kumar, P.1; Ibrahim, R.2; Stanford, R.2; Kunkler, R.2; Bell, R.2; Miller, M.2 Northampton General Hospital, Urology, United Kingdom; 2Northampton General Hospital, United Kingdom

Jonusiene, G.1; Zilaitiene, B.2; Adomaitiene, V.2; Aniuliene, R.2 LUHSH Kaunas Clinics, Psychiatry, Lithuania; 2LUHSH Kaunas Clinics, Lithuania

1

Objective: explore the relation of female sexual function in postmenopause to their previous sexual behaviour and partners’ health. Methods: 246 postmenopausal women who fulfilled inclusion criteria were asked to fill in the Female Sexual Functioning Index (FSFI) for the assessment of sexual function and also sociodemographic questionnaire where were included the questions about their previous sexual behaviour and partners’ sexual and somatic health. Results: The mean age of the 246 study participants was 55.5 ± 5.22 years (range 45–65). 76.4 % of them (n = 188) lived in marriage, while 23.6 % (n = 58) were not married. No difference in sexual function was observed between those two groups of respondents. 48 % (n = 118) of the participants started their sexual activity at ≤20 and 52.0 % (n = 128) in their twenties. Desire, arousal, satisfaction, and total sexual function were better in those who started sexual activity before their twenties. 48.4 % (n = 119) of the responders have had one partner only, while 51.6% (n = 127) more then one partner. Better sexual function was observed in those women who had had more sexual partners. Women whose partners hadn’t somatic disorders demonstrated a higher sexual function. According responders, 30.9 % (n = 76) of partners had a low sexual desire, while 69.1 % (n = 170) did not demonstrate it. The women whose partners did not have a low sexual desire had better sexual function. According responders, 18.7 % (n = 46) of partners had erectile dysfunction, while 81.3 % (n = 200) hadn’t. Women whose partners hadn’t erectile dysfunction scored higher in arousal, orgasm, and total sexual function. Conclusion: Significant relationships of female sexual function in postmenopause to partners’ somatic and sexual health and previous sexual behaviour were determined The financial support forthcoming from Lithuanian State Science and Studies Foundation. We are grateful Prof. John Bancroft for his consultations. Policy of full disclosure: None.

1

Objective: Castration has been performed in history for a variety of purposes including punishment, ritual, therapeutic and also for preservation of the pre-pubertal male voice. We aimed to narrate the story of the castrati through history. Methods: A comprehensive review was undertaken of medical and historical texts. Results: The earliest reference to castrati and singing is from the Byzantine church in the fourth century with Brison who was then choirmaster. The choir of Hagia Sophia was an all castrati affair and persisted till the fall of Constantinople in 1204. Castrati resurface then in sixteenth century Italy. The reasons may have been due to the rise in complex polyphonic church music which required higher pitched voices and women were explicitly forbidden from performing. They were normally castrated between the age of 7 to 9 by ligating the spermatic cords. Although illegal in law and by the church the Papal authorities turned a blind eye. The castrati subsequently became widespread in the Catholic Church. The other driving force was the introduction of opera in the seventeenth century which called for their unique voice. Castrati were at their zenith during the eighteenth century with performers such as Farinelli who were very much superstars of their day. They were also in demand for amorous adventures by noble ladies as there was no danger of pregnancy. Their decline came in the nineteenth century with their abolishment in 1902. The last castrati was Alesandro Moreschi whose voice is preserved on early records as a testament to the great castrati. Conclusion: Although divine their voices may have been it raises a few issues with regard to the prices paid by young boys to achieve this. This is more in context considering that not all castrated boys would be successful. Policy of full disclosure: None.

J Sex Med 2012;9(suppl 5):357–397

P-02-019

HISTOLOGIC FINDINGS OF GRAFTED IMPLANTS AFTER PENILE AUGMENTATION SURGERY Kim, J.1 Philip and Paul Medical Group, Urology, Jeongjadong, Boondanggu, Republic of Korea

1

Objective: Popular materials that have been used for penile augmentation surgery. Nonetheless, there have been few reports on the histologic changes and safety of the grafted tissues. This study is to report on the safety of penile augmentation surgery through grafts. Methods: Histologic examination was conducted for people that took surgery at least one year earlier with the materials that were approved for use on the human body by the FDA or the KFDA. The tissues obtained from autologous dermal fat graft, allograft and xenograft (bovine, type I collagen) were H-E stained. Results: Implanted dermafats were well preserved and have maintained viability with no inflammatory cell infiltration and newly formed fibrocollagenous tissue. Implanted allograft tissues grafted with vessel proliferation and had normal collagen components. Implanted type I collagen tissues were progressively and slowly replaced by endogenous connective tissue with new vessel proliferation. Conclusion: Penile augmentation surgery using the above described grafted tissues showed histologic safety. Since the above materials surgery showed positive results in terms of the histological aspects, this study reports that those materials may be considered as safe materials for penile augmentation surgery. Policy of full disclosure: None.

393

Poster Presentations P-02-020

P-02-021

MULTI-SLIT AND MULTI-PIECE TECHNIQUE: SURGICAL TECHNIQUES FOR THE ALLOGRAFTS IN PENILE AUGMENTATION SURGERY

OUT OF EASTERN AFRICA: DEFIBULATION AND SEXUAL FUNCTION IN WOMAN WITH FEMALE GENITAL MUTILATION

1

2

Whnag, Y. s. ; Kim, J. L & c, Jeongjadong, Boondanggu, Republic of Korea; 2Philip and Paul Medical Group, Urology, Jeongjadong, Boondanggu, Republic of Korea 1

Objective: Allogenic dermal matrix has been used recently in penile augmentation surgery; however, the surgical techniques for safety and success for allografts have not been widely known. This study aims to introduce a method for enhancing graft success and safety using allogenic dermal matrix in penile augmentation surgery. Methods: The allogenic dermal matrix(Megaderm) were used. Explaining the surgical method, 1–2 cm from the subglans was incised at a length of 3 to 5 cm to expose the Bucks fascia and was then dissected up to the prepubic junction. Implant was designed according to the size of the penis, with about 4–6 cm in width, 5–7 cm in length, and 3–5 mm in thickness. By dissecting the matrix with a knife horizontally and vertically to form a multi-slits or dividing the matrix into multiple pieces, the dead space could be reduced and sexual stimuli could be enhanced with a little flexion. The technique improves the deviation and swelling symptoms of the penis. After the matrix was soaked in a saline solution for 20 minutes, then affixed to the Bucks fascia. With the matrix in, dartos layer and skin layer were closed with an absorbable suture. Results: The surgery was conducted on 13 patients who had small penis complexes from January 2012 to February 2012. There was no complication and side effect. When using the multi-slit and multipiece technique for graft, the side effects reduced more remarkably than when the technique was not used. Conclusion: Compared with the autologous dermal-fat grafts or xenografts that have been used many times to date, the allograft using these techniques showed positive results in terms of safety and surgical effectiveness. In that sense, using the above-described technique will improve success rate, satisfaction and recovery. Policy of full disclosure: None.

Krause, E.1 1 University- Hospital of Bern, Gynecology, Switzerland Objective: Female genital mutilation (FGM) is defined by the World Health Organization (WHO) as all procedures that involve partial or total removal of the female external genitalia and/or injury to the female genital organs for cultural or any other non-therapeutic reasons.Aim of this study was to determine sexual function before and after defibulation using a CO(2) laser in migrant women who had undergone FGM in the past. Methods: MAIN OUTCOME MEASURES: Female Sexual Function Index (FSFI) before and 6 months after defibulation. Patients were asked to fill the FSFI before surgery and at 6 months follow-up. Defibulation took place under general anesthetic using a CO(2) laser. Results: Eighteen patients underwent defibulation in a standardized manner and filled in the FSFI completely. Female sexual function improves after surgical defibulation in the domains desire, arousal, satisfaction, and pain whereas lubrification and orgasm remained unchanged. Conclusion: Defibulation using CO(2) laser may improve some aspects of sexual function in patients who undergo defibulation but not all. Policy of full disclosure: None.

P-02-022

THE EFFECT OF PREGNANCY AND PREGNANCY-RELATED MYTHS ON WOMEN’S SEXUALITY. A QUESTIONNAIRE SURVEY AMONG SOUTH EAST HUNGARIAN POSTPARTUM WOMEN Lakatos, A.1; Dweik, D.2; Mészáros, G.1 University of Szeged, Hungary; 2University of Szeged, Obstetrics and Gynecology, Hungary

1

Objective: Pregnancy plays an important but ambivalent role in a couple’s sexual life. By the end of the third trimester many couples switch to sexual techniques non-characteristic to preconception era or even quit sexual activity due to myths about possible relationship between coitus and miscarriage or premature birth in spite of the numerous scientific data confirming that sexual activity has no harmful effect on a healthy pregnancy.Our primary aim was to assess the qualitative and quantitative changes of South-East Hungarian women’s sexual life, and to find the possible explanations in the background. Secondary aim was to assess the amount and quality of information on sexuality they acquired during pregnancy. Methods: Between January and May 2011 structured questionnaires were distributed to 150 women on 2nd/3rd postpartum day at Department of Obstetrics and Gynecology, University of Szeged, Hungary. Exclusion criteria were illiteracy/not speaking Hungarian as a mother tongue. The response rate was 81,3% (122). Results: Sexual desire and the frequency of sexual activity gradually decreased during pregnancy, according to respondents’ memories. Moreover, the rate of those refraining from sexual activity was almost 1/3 (39) in the third trimester. Most frequently this was explained by the fear of the well-being of the fetus and the loss of sexual desire on behalf of the women. Only 31% (38) of women received medical information on sexuality during the course of pregnancy, but it was even less than 10% of them who found it satisfactory enough not to look for more information on this topic e.g. via internet. Conclusion: In spite of the lack of medical ban, 1/3 of respondents quitted sexual life reaching the third trimester that can be explained by myths about the harmful effect of sexual intercourse. These misconceptions could most effectively be resolved by medical experts providing proper and satisfactory information on this topic. Policy of full disclosure: None.

J Sex Med 2012;9(suppl 5):357–397

394 P-02-023

TRANSITION TO WOMANHOOD: IRANIAN WOMEN EXPERIENCING VAGINISMUS Molaeinezhad, M.1; Merghati Khoei, E.2; Latifnjad Roudasari, R.3; Salehi, M.4; Yousefy, A.4 1 Mashhahd University of Medical, Reproductive Health, Islamic Republic of Iran; 2Tehran University of Medical, Tehran, Islamic Republic of Iran; 3 Mashhahd University of Medical, Islamic Republic of Iran; 4Isfahan University of Medical, Islamic Republic of Iran Objective: Exploring the experiences of Iranian women with vaginismus in transition from girlhood to the womanhood. Methods: Using narrative analysis, we purposefully selected 19 married Iranian women with vaginismus and interviewed them in the psychosexual clinic in Isfahan.. Interviews were analyzed using a content narrative and thematic analysis. Content narrative was used to explore the participants’ life line while experiencing unconsummated marriage due to vaginismus. Thematic analysis was carried out to find themes in each plot of story line. Results: Three plots were identified throughout the women’s lives times: girlhood, dating period, and post-marital life. Themes emerged from the micro-narrative analysis explain how these women transferred from childhood to a period called girlhood, on the path to becoming women in the Iranian cultural context. During it, participants were constructed as non-sexual beings, due to restriction and silence toward sexual matters, non-intimate relationship with mother, and uncomfortable feeling with own sexual organs as essential elements of postponing their sexual awareness. Themes emerged during the event of dating were explains how the majority of women involved in a non-romantic traditional marriage, had dilemma about good spouse selection, held idea of virginity preservation, wanted the joyous non penetrative sexual relationship, and held the catastrophic thoughts about first sexual intercourse. Macro-narrative analysis of the life stories show the events and symbolic representations through which the women made sense of their own experiences during womanhood—with a specific focus on inter-personal sexual encounters in the context of marriage. Conclusion: The narratives demonstrated how the symbolic and representative dimensions of morality, norms, family and marital roles, are powerful in constructing of feminine sexuality, the meanings women assign to their sexuality, their access to sexual experiences, and the kinds of relationships they have with their male partner(s). Policy of full disclosure: None.

P-02-024

WIDOWHOOD AND SEXUALITY; EXPERIENCES OF IRANIAN WIDOWS ABOUT AN UNSPOKEN ISSUE Molaeinezhad, M.1; Kohan, S.2 1 Mashhahd University of Medical, Reproductive Health, Islamic Republic of Iran; 2Isfahan University of Medical, Islamic Republic of Iran Objective: Exploring the experiences of Iranian widows about their sexual and emotional needs, during widowhood period. Methods: Using descriptive phenomenology approach, semistructured interviews carried out with 12 widows who lost their spouse for at least 5 years. Colaizzi’s (1978) phenomenological method used for analysis of transcript interviews. Results: 4 main categories emerged throughout the widows’ lives after their partner death. The meaning of widowhood, Unmet sexual and emotional needs, and ambiguous future of the second marriage. Widows described their sexual needs as obvious but inexpressible. They faced a need and fear dilemma for expressing their unmet sexual needs which aggrvated during the time after their spouse death. Participants choose abstinence or joyous masturbation after multiple temporary sexual relationship as a process of adjusting to widowhood. They described unmet emotional needs as femininity vs. mothering role and explained how their need to nonsexual touch by a person of the opposite sex, faced them with the hesitancy about their role as a supportive mother.

J Sex Med 2012;9(suppl 5):357–397

Poster Presentations Conclusion: The results demonstrated a close-up shot of Iranian widows’ lives. It also showed, how after the loss of spousal emotional support, the social norms force widows through a role transition process choose a nonsexual life to support their children. Policy of full disclosure: None.

P-02-025

EFFECT OF DESMOPRESSIN – ON DEMAND – COMBINED WITH ANTICHOLINERGICS IN TREATING COITAL INCONTINENCE IN FEMALES SUFFERED FROM OVERACTIVE BLADDER (PILOT STUDY) Moossa, F.1 1 El Sahel Teaching Hospital, Urology, Helwan, Egypt Objective: Coital urinary incontinence (CI) deserves much more attention in clinical practice; women should be specifically interviewed for this disturbance because It has a very negative impact on their sexuality and quality of life. The aim of the study was to evaluate the effect of desmopressin, taken as needed with anticholinergic in treating CI not improved with anticholinergics alone in females suffered from overactive bladder (OAB). Methods: The study included a selected 58 females, embarrassed by their urinary incontinence during climax due to (OAB). Age from 28–65 yrs with mean (50 ± 11 yrs). Sexual activity 2–3 per week. All patients treated by Tolterodine XL 4 mg single tablet daily for three months. 35 out of 58 patients (60 %) were completely continent, where 23 patients were still leak. With intended complete coital continence the 23 patients instructed to take MINIRIN 120 mcg/tablet, 3 hours before the expected act, and empty the bladder shortly before the sexual activity for three weeks, if still leak, they double the dose(240 mcg /2 tablets) for a further 3 weeks. Results: 19 out of 23 patients reported complete coital continence by 120 (mcg) for the six weeks study time, where the remaining 4 patients achieved complete continence by 2 tablets (240 mcg) in the last 3 weeks of study. The results are promising and statistically, showed that probability of complete cure of all patients = 0.8 ± 0.1, P < 0.01. No complications were reported in this limited number of patients. Conclusion: Desmopressin, combined-on demand-with anticholinrgics was effective in treating CI, not improved with antichlonergics alone in females with OAB. However; further study with a large number of patients was need. Policy of full disclosure: None.

P-02-026

CHARACTERISTICS OF AN EGYPTIAN SAMPLE OF PATIENTS WITH FEMALE SEXUAL DYSFUNCTION: A CROSSSECTIONAL STUDY Reda, M.1; Hussain, H.1 Ain-Shams University, Psychiatry, Cairo, Egypt

1

Objective: Researchers aimed to find out psychological characteristics of Egyptian females with FSD. Methods: 115 females attending birth control clinics were assessed for presence of (FSD) according to DSM IV diagnostic criteria. FSD patients (N = 30) and 15 healthy matching controls were assessed using Taylor’s Manifest Anxiety Scale (TMAS), Zung self rating depression scale (ZSDS), Eysenck Personality Questionnaire (E.P.Q), Guilford inventory of personality factor. Results: Female circumcision and expectation of first intercourse to be painful were significantly associated with development of sexual pain disorder (X² = 7.4, P = 0.01; X² = 4.8, P = 0.04). Patients scored higher on introversion and neuroticism domains of EPQ than controls (Z = −2.7, P = 0.006; Z = 2.09, P = 0.003 respectively) and on TAS, ZDI and obsession scales (Z = −3.5, P < 0.001; t = −3.2, P = 0.004; Z = −4.1, P < 0.001).

395

Poster Presentations Conclusion: FSD is strongly related to anxiety and depressive personality. Expectation of the first intercourse to be painful is a risk factor for the development of the disorder. Policy of full disclosure: None.

P-02-027

IMPORTANCE OF A MULTIDISCIPLINAR APROACH IN FEMALE SEXUAL DYSFUNCTION: CASE REPORT EVIDENCE Peraza-Godoy, M. F.1; Rosselló Gayá, M.2; Cañellas Engel, S.2; Rosselló Barbará, M.2 1 C.Urología, Andrología, S. Sexual, U. Disfunción Sexual Femenina, Palma de Mallorca, Spain; 2C. Urología, Andrología, S. Sexual, Palma de Mallorca, Spain Objective: Expose the importance of a multidisciplinary aproach in female sexual dysfunction. Methods: CASE: 38 year old female which consults due to decrease in primary sexual interest and desire, on the rise due to a 9 year old evolutional dyspareunia, with difficulty to achieve orgasm. Absence of formal psychosexual education, self-taught patient, no masturbatory practice, afraid of intimacy, alterations in established attachment and emotional bonds and dominance control behavior. Oral contraception during 10 years, 30 ug ethinylestradiol and 3 mg drospirenone. Results: Elasticity of the vaginal mucosa has decreased, trophic changes and pale minor labia, desquamation of the labia minor, and moderate contraction of the pelvic muscles, anus-vulva distance 2 cms. Blood tests: Hemogram: 10.8 g/dl, hematocrit 34%, Ferritin 5 ng/ml, transferrin saturation 6%. Hormones: 8th date of the cycle: 17 betaestradiol: <20 pg/ml, 17 alphahydroxiprogesterone: 0,07 ng/ml, free testosterone 0,02 ng/ml, Total <0,1 ng/ml SHBG 438 nmol/l DHEA 0,09 μmol/l. Conclusion: Diagnosis: 1.Hypoactive sexual desire and sexual arousal disorder. 2. Hypoandrogenism. 3. Dyspareunia 4. Iron deficiency anemia. Discussion: The sexual medical multidisciplinary evaluation allows us to have provides a global approach to the treatment: 1. Oral contraception halted to improve the SHBG metabolism to evaluate possibility of treatment with hexogen testosterone. 2. Local vaginal and perineal treatments: local estrogens, daily vulvar hydration, massages and local vibration. 3. Sexual Therapy, after thorough explanation aimed at normalizing strategies and reappraisal of beliefs and behaviors; education: bibliography, mirror technique, masturbatory technique, sensitive focalization and cognitive reorientation misgivings or fears about sexual intimacy. 4 Couple therapy. 5. Hematologic treatment and endocrine treatment. This case is a good. Policy of full disclosure: None.

P-02-028

PERCEPTION AND PRACTICE OF FEMALE CICUMCISION AND FEMALE GENITAL MUTILATION IN INDONESIAN MEDICAL PROFESSIONAL Saputra, G. N.1; Quintina, S.2 General Achmad Yani University, Medical Faculty, Bandung, Indonesia; 2 General Achmad Yani University, Bandung, Indonesia

1

Objective: Indonesian Ministry of Health made a beware that all of medicalization of Female circumcision is illegal. This was controversial, until Indonesian Council of Ulema made a fatwa forbidden to forbid female circumcision in 2008. Then in 2010, Minister of Health made a regulation about medicalization female circumcision. The aim of this study was to know the perception and practice about FC and FGM among the health profesionals. Methods: This was a descriptive cross sectional in design and conducted interviews using questionnaires to 43 medical profesionals who worked in Heath Center, Clinic and Hospital. Results: Mostly of respondents have heard about FC (97,6%); 40,4% said that female circumcision techniques is to stratching the skin that

covers the clitoris without injuring the clitoris using sterile needles and 16,7% respondents had done practical female circumcision. Compared of that data most of respondents said there was no advantages of FC but 71.4% respondents agree that female circumcision conducted in accordance with the requirements of hygiene will reduce health risks, because in Indonesia FC mostly done by traditional birth attendance. Even they agreed that, respondents will not do counseling/education about FC. Most of respondents said there was no custom/tradition and no religion’s advocate to do FC, but few of them believed contra of that. Few of respondents who ever heard about FGM said didn’t know about the technique and no advantages of FGM, disagreed that when FGM performed properly hygiene will reduce health risks, then will not do counseling/education about FGM to the patient because there were no custom/tradition, religion’s advocate to do FGM. Conclusion: There were variation of perception among respondents about FC and FGM. As many as 16,7% respondents did practical female circumcision. Policy of full disclosure: None.

P-02-029

SEROEPIDEMIOLOGY OF STI VIRUSES IN PREGNANT WOMEN: A RETROSPECTIVE STUDY 2010–2011 Sharify Heydarabad, H.1; Farid Soltany, F.2; montazam, s. h.3 Farabi Hospital, Management, Malekan, Islamic Republic of Iran; 2Shafa Clinic, Bockan, Islamic Republic of Iran; 3Bonab Islamic Azad University, Islamic Republic of Iran

1

Objective: The viruses like HCV, HBV, and HIV can transmit by sex. Co-infection between these three different diseases shows similar ways of transmission. High to low rates of hepatitis C virus (HCV), Hepatitis B virus (HBV) and HIV infections among people have been reported worldwide. The aim of this research is survey of HCV, HBV and HIV seroepidemiology rate in pregnancy. Methods: A total of 420 blood samples of pregnant women in first trimester were collected in Malekan city, Iran, from July 2010 to June 2012. Blood samples were estimated for HBsAg, HCVAb, and HIVAb by EIA (double check). Results were analyzed by SPSS software version15. Results: Seroprevalence rate of HBsAg was 0.95%, HCV Ab 0.48%, Anti-HIV1, 0%. Co -infection for HBsAg and HCVAb were seen in one people (0.23%). Conclusion: All people should be tested about STI factors before marriage and pregnancy time for prevention of infections in the future. Also, educational programs are necessary, because co-infection with HCV or HBV and other STI factors are a growing public health problem. Policy of full disclosure: None.

P-02-030

COMMON MYTHS AMONG A GROUP OF IRANIAN WOMEN CONCERNING SEXUAL RELATIONSHIPS DURING PREGNANCY Shojaa, M.1; Mohebbi, R.2; Jouybari, L.3 Tehran University of Medical, Islamic Republic of Iran; 2Imam Hospital, Emergency Department, Pars Abad, Islamic Republic of Iran; 3Nursing School, Gorgan, Islamic Republic of Iran

1

Objective: There are a variety of ideas and beliefs among women about sexual relationships during pregnancy. The aim of the study was to discover the beliefs of pregnant women about having sex during pregnancy. Methods: Open-ended interviews were conducted with 51 pregnant women who were referred to the teaching clinic in Iran. All of the interviews were tape recorded and transcribed line by line. The data were coded and categorized as is usual in qualitative methods. Results: Two main themes in the study are “Anxious of harmfulness” and “Feeling sinful”. Fear of abortion, fetus suffocation, fetus abnor-

J Sex Med 2012;9(suppl 5):357–397

396 mality, rupture of fetus hymen, and concern of harm to the mother are some of the myths among our participants. Conclusion: Since some of the beliefs are harmful and could have a negative impact on relationships, the role of evidence-based education in providing a healthy sex life should be considered. Policy of full disclosure: None.

P-02-031

ORGASM DETERMINING FACTORS IN YOUNG FEMALES Skrodzka, M.1; Kudelski, J.2; Chlabicz, M.2; Werel, T.2; Darewicz, B.2 University Hospital of Bialyst, Urology, Bialystok, Poland; 2University Hospital of Bialyst, Bialystok, Poland

1

Objective: Sexuality essentially affecting entirety of human functioning is an substantial element of quality of life. Orgasm affects sexual life satisfaction, therefore indirectly mood and motivation. Thus, the purpose of the study was to identify factors determining orgasm in population of young females. Methods: In questionnaire study adressed to female medical students, survey instrument projected by authors was used. Project has been executed after local research ethics committee approval. Questionnaires were filled out at home and returned in closed, blank envelopes. In research participated 528 female medical students. Response rate was 69,5% (367 surveys). After elimination of incomplete, inconsistent surveys, data out of 344 questionnaires were evaluated using cluster analysis with k-means method. Statistical significance was confirmed by Chi2 Pearson and Maximum Likelihood tests. Results: Among surveyed females, orgasm achieve respectively: 46,27% during every intercourse, 23,88% mostly and 9,85% rarely. Lack of orgasm was reported by 5,67% of students. As determinants of female orgasm were identified: intercourse duration over 10 minutes, higher activity and initiative during intercourse, changing of sexual position, higher percentage of satisfactory intercourses, usage of addictional accesories. Negative influence of oral contaceptive or condom was not observed. Higher frequency of orgasm was correlated to higher: self-esteem, partner relationship assessement and quality of sexual life. However we cannot clearly claim if orgasm determins selfassessement, relationship and sexual life appraisal or positive perception of above facilitates basis to easier orgasm achievement. We have to emphasize, that rare and no orgasm was often connected, but not equal to poor quality of sexual life and relationship. Conclusion: Orgasm influences females quality of sexual life, relationship and self-assessment, thus determining modifying factors may be potential implement to improve this appraisal. Orgasm as an expression of ultimate pleasure is not satisfaction synonim. We have to consider orgasm as multifaceted matter, important but not essential to physical and sexual satisfaction. Policy of full disclosure: None.

P-02-032

ALL YOU NEED TO KNOW ABOUT CULTURAL AND RELIGIOUS ISSUES IN SEXUAL HEALTH Tabatabaie, A.1 1 University of Cambridge, Wolfson College, United Kingdom Objective: The influence of ‘culture’ and ‘religion’ on issues around sexuality has been studied extensively. Culturally sensitive and religiously tailored strategies in approaching sexual health issues that take into consideration the notion of diversity are more likely to be successful. Culture can be defined as a system of shared beliefs, values, customs and behaviours that the members of a society use to cope with their world and with one another. Beyond its conventional usage, the concept of culture can be used to describe smaller and more specified sub-groups within a society such as family culture, school culture and peer culture. Although studying religious doctrines as important elements of every culture is relevant, they cannot capture the quality and reality of people’s everyday religious lives. In practice, individuals’

J Sex Med 2012;9(suppl 5):357–397

Poster Presentations lived religions are what really matters to them. This presentation intends to address the notion of culture and religion as they pertain to sexuality and sexual health, both at a macro and micro level. It begins with discussing the significance of addressing cultural and religious issues in the field of human sexuality. At a macro level, it employs Hofstede’s cultural dimensions to conceptualise different societies’ sexual cultures. At a micro level, it emphasises an approach that seeks to learn about the cultural backgrounds of those who approach us as clients, patients or educatees, individually and exclusively. It then moves on to highlight some key characteristics of both orthodox and non-orthodox approaches of the major religions in relation to sexuality. To understand modern religious lives and their influence on sexualities, this presentation encourages attending to the complexity, diversity, and fluidity of real individuals’ religions as practiced, in the context of their everyday lives. This presentation finishes with some practical and applicable suggestions and take-home-messages on how to approach different cultural and religious groups regarding sexual matters with more confidence. Policy of full disclosure: None.

P-02-033

SEXUAL DIFFICULTIES IN WOMEN AFTER CANCER TREATMENT Vanselow, W.1 Royal Women’s Hospital, Women’s Health Outpatients, Parkville, Australia

1

Objective: To illustrate by means of case presentations the common sexual difficulties in women treated for cancer. To demonstrate the application of a biopsychosocial approach to assessment and management of these problems. Methods: Apply the PLISSIT model, to women presenting to the Oncology Sex and Relationships (OSR) Clinic, a counselling service for women with (gynaecological, haematological, colon or breast) cancer at the Royal Women’s Hospital Melbourne Australia Formulate the problems and contributing factors and devise management for each patient using a biopsychosocial approach. Results: Common problems include difficult and painful intercourse and lack of desire as well as mismatched desire. This is similar to the common presentations in the general psychosexual service with the addition of problems specific to cancer treatment. Conclusion: Although women presenting to the OSR clinic have problems specific to their cancer treatment, the issues raised are common to all patients seen in the general psychosexual service. Major problems in relationships mostly preceded or were independent of the cancer diagnosis. Policy of full disclosure: None.

P-02-034

SEXUAL ISSUES AMONG CERVICAL CANCER SURVIVORS: HOW CAN WE HELP WOMEN SEEK HELP? Vermeer, W.1; Bakker, R. M.2; Stiggelbout, A. M.2; Kenter, G. G.3; de Kroon, C. D.2; ter Kuile, M. M.2 1 LUMC, Gynaecology and Sexuology, Leiden, Netherlands; 2LUMC, Leiden, Netherlands; 3CGOA, Amsterdam, Netherlands Objective: To assess which variables predict professional help seeking for sexual issues among cervical cancer survivors. Methods: A multi centre cross-sectional questionnaire study was conducted in a cohort of 399 women with a history of cervical cancer treated between 2000 and 2010. In addition, 178 partners participated in the study. Questions concerned (attitudes towards) help seeking for sexual issues and sexual health care needs. In addition, the questionnaire consisted of validated questionnaires assessing generic and disease-specific quality of life (EORTC QLQ-C30 and QLQ-CX24); sexual function, voiding- and bowel problems (gynaecologic LQ); impact of incontinence (IIQ-7); sexual distress (FSDS); anxiety and depression (HADS); relationship satisfaction (MMQ); and sexual dysfunction (GRISS, only for partners). Data will be analysed with logis-

397

Poster Presentations tic regression analyses with help seeking intentions and behaviour as outcome variables. Variables to be tested are: demographic characteristics (age, relationship status, and educational level), treatment characteristics (modality and time since treatment); sexual functioning; sexual distress; attitudes towards sexual dysfunctions; attitudes towards sexual health care; embarrassment; psychological distress (anxiety and depression); relationship satisfaction; response-efficacy; and partner variables (attitudes and sexual functioning). Variables that are associated (p < .05) with the outcome variables will be included in the stepwise multiple regression analysis to obtain a final prediction model. Results: Data were collected between June 2011 and June 2012. Data analysis will take place in September and results can be presented at the ESSM conference in December. Conclusion: With the results obtained in this study health care professionals will better be able to develop and target sexual rehabilitation programmes for cervical cancer survivors and their partners. Policy of full disclosure: This study was supported by the Dutch Cancer Society.

P-02-035

SEXUAL SATISFACTION IN PRIMIGRAVIDAS Zare, E.1 Tehran, Islamic Republic of Iran

1

Objective: Pregnancy and child birth is one of the most important stages of womens life. Sexual satisfaction may change during pregnancy that could be ignored by parents but, These changes could lead to negative long effects on mothers sexual and mental health. This study conducted with the aim of assessing sexual satisfaction of primigravida and its related factors in Shiraz hospitals. Methods: It was a descriptive cross-sectional study. The sample consisted of 310 primigravid women admitted to hospitals in shiraz. Data was collected by the adjusted version of Hudson s Index of sexual satisfaction(ISS) and were analyzed using SPSS (v-14). Results: The mean score for sexual satisfaction was 140.2 ± 10.5. The finding indicated that there is a significant relationship between womens age, their husband age, occupation, planned pregnancy and unplanned pregnancy, length of marriage, consult with midwife or gynecologist, pregnancy complications and sexual satisfaction (p < 0.0002).

Conclusion: Helping primigravidas to get moresexual pleasure during pregnancy would be accomplished by taking their sexual histories and resolve their misconception about sexual satisfaction. Policy of full disclosure: None.

P-02-036

THE ROLE OF SEXUAL-SELF CONCEPT, FIVE FACTOR PERSONALITY IN RISKY SEX BEHAVIOUR Ziaei, T.1; Ziaei, F.2 1 Isfahan University of Medical, Reproductive Health, Islamic Republic of Iran; 2Golestan Educational Organizat., Gorgan, Islamic Republic of Iran Objective: Prevention of risky sexual behavior is one of the important goals to improving the health of the community. Since the risky sexual behavior is influenced by positive and negative aspects of sexual selfconcept and Five Factor personality, could it be claimed that these two factors are related to each other and if we identify one, the other one can be controlled? Conclusion of this paper is answer to this question. Methods: Cross–sectional study was performed in Yas Marriage Counseling Center of Isfahan. Farsi version of Goldberg Big-Fivefactor personality and Snell’s Multidimensional sexual self-concept completed by 84 couples in dating. Internal consistency analyzed by Cronbach’s alpha of the questionnaire.Relations between the two questionnaires’ aspects and were analyzed by Pearson. Results: Mean age of women was 23/1 and for men 26/8 years. Cronbach’s alpha coefficient of Goldberg questionnaire was .65 To .86 and for MSSCQ was .68 To .87.Positive relationship was between sexual esteem and openness to experience (r = .46, p < .0001) and negative relationship was between sexual depression and emotional stability (r = −.33, p < .0001). Other aspects of five factor personality and MSSCQ were not significant relationship with each other. Conclusion: By Looking at the results, this Big five factor personality as a fixed and permanent of behavior patterns can be regarded as the underlying cause of the sexual self-concept.Then, for reinforcement positive SSC and reduction of negative SSC and consequent control of risky sexual behavior must be followed by other factors. Policy of full disclosure: None.

J Sex Med 2012;9(suppl 5):357–397