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IMPAIRED ARTERIOGENIC RATHER THAN VENO-OCCLUSIVE MECHANISMS ARE RESPONSIBLE FOR ERECTILE DYSFUNCTION IN DIABETICS
THE JOURNAL OF UROLOGY®
Vol. 181, No. 4, Supplement, Monday, April 27, 2009
curves assessed the time to EF in all patients. Life tables were then used to assess the rate of EF recovery using a 6 month-interval. RESULTS: Mean age was 61.7 yrs (median 62; range: 40-79). Overall, 262/578 (45.3%) reached a IIEF-EF domain score q22 after a mean follow-up of 25.2 months (median 22; range 4-69). Pre-operative IIEF-EF showed the presence of severe erectile dysfunction (ED) in 105 (18.1%), moderate ED in 45 (7.8%), mild to moderate ED in 56 (9.7%), mild ED in 112 (19.4%) and no ED in 260 (4.5%) patients. Of all 262 patients regaining normal erectile function after BNSRP, 220 (83.9%) patients recovered EF in the first 12 months, while the remaining 40 (15.3%) patients recovered EF between 12-24 months after surgery. No patient recovered EF beyond 2 years after surgery. CONCLUSIONS: Our analyses showed that 24 months after surgery represent the most reliable timing for the assessment of definitive EF after BNSRP. Conversely, assessing EF at 1 year after surgery is associated with a lower sensitivity (84.7%). This is crucial for patient counseling and for collecting reliable EF data after BNSRP. Source of Funding: None
331
Jamaica completed an interviewer administered questionnaire to obtain information on priapism, stuttering priapism, fertility, erectile function, libido and premature ejaculation. The study period was from January 1, 2008 to June 30, 2008. RESULTS: The mean age of the subjects was 34±10.4 years (mean±sd).The prevalence of priapism was 30%and stuttering priapism was 54%. There was no difference in mean ages by priapism and stuttering priapism groups. Priapism but not stuttering priapism was significantly greater in subjects with homozygous S sickle cell disease compared with Heterozygous SC (p<0.02) disease. Priapism was significantly associated with erectile dysfunction (p<0.001), and stuttering priapism (p<0.002). However, there was no association with fertility, libido and premature ejaculation. In contrast there was no association of stuttering priapism with fertility, erectile dysfunction, and libido. However there was a significant association of stuttering priapism with premature ejaculation (p<0.02) with significantly lower proportion of subjects with stuttering priapism having premature ejaculation. CONCLUSIONS: Priapism and stuttering priapism are important clinical determinants of sexual function in males with sickle cell disease. Source of Funding: None
927 IMPAIRED ARTERIOGENIC RATHER THAN VENO-OCCLUSIVE MECHANISMS ARE RESPONSIBLE FOR ERECTILE DYSFUNCTION IN DIABETICS. Suresh C Sikka*, Wayne JG Hellstrom, New Orleans, LA INTRODUCTION AND OBJECTIVE: In-office evaluation of erectile dysfunction (ED) by duplex Doppler ultrasound can benefit the decision making process concerning appropriate therapy. It is often unclear whether diabetic men who suffer from ED have impaired veno-occlusive mechanisms and/or arterial insufficiency or there is a neurological contribution. This study explored penile duplex Doppler ultrasonography with visual sexual stimulation to assess the hemodynamic function of the penis in cohorts of diabetic and non-diabetic patients with ED. METHODS: This retrospective analysis included 330 age-matched ED patients (90 with diabetes and 240 without diabetes). The penis was scanned using 10 mHz ultrasound probe before and after single intracorporal injection (ICI) of 7 to 20 micrograms of prostaglandin E1 (PGE1) by a single operator. The sagittal and cross-sectional diameter, the peak systolic velocity, end-diastolic velocity (if present), and resistance index (RI) for each cavernosal artery was evaluated at various time intervals up to 30 minutes after ICI by using color Doppler ultrasonography. RESULTS: Diabetic men with ED demonstrated lower peak systolic velocity (Mean 23.7 +/- 2 SEM cm/sec) compared to nondiabetic patients (45.2 +/- 3.7 cm/sec) at 15 minutes post PGE1 (15 micrograms). These differences in peak systolic velocity parameters were more pronounced at 15 and 20 micrograms PGE1 than at lower doses and after 10 to 20 minutes of ICI. No significant differences in RI and end-diastolic velocity in right and left cavernosal arteries were observed in the two groups. CONCLUSIONS: Our findings, contrary to common belief, show that diabetic men with ED are more likely to demonstrate arterial insufficiency rather than veno-occlusive dysfunction. Such testing needs be performed with at least 15 micrograms PGE1 for the intra-corporal injection. Source of Funding: None
928 THE PREVALENCE AND DETERMINANTS OF PRIAPISM IN ADULT MALES WITH SICKLE CELL DISEASE Belinda F Morrison*, Wendy AC Madden, Marvin E Reid, William D Aiken, St Andrew, Jamaica INTRODUCTION AND OBJECTIVE: Sickle cell disease has an incidence of 1 in 150 births in Jamaica. We sought to determine the prevalence and determinants of priapism in adult males with sickle cell disease METHODS: 108 consecutive male subjects, 87 with homozygous S (SS) and 21 with heterozygous C (SC) sickle cell disease attending the Sickle Cell Unit, University of the West Indies,
929 VULVOSCOPY IN THE DIAGNOSIS OF WOMEN WITH SEXUAL HEALTH COMPLAINTS Joanna B Korda*, Irwin Goldstein, San Diego, CA INTRODUCTION AND OBJECTIVE: The evaluation of women with sexual health problems involves psychologic interview, psychosocial, sexual and medical history, physical examination using magnification and laboratory testing. Vulvoscopy uses a high-powered microscope to identify and document by photography physical examination findings of the external genitalia and vagina. Concerning vulvoscopy, few reports have been published of: i) standardized methodologies utilized, ii) baseline prevalence of abnormal physical findings, iii) correlations between physical findings and pertinent biologic variables, such as sex steroid hormone blood test values, and iv) correlations of treatment outcome with longitudinal vulvoscopic changes. To review the results of vulvoscopy in the first 75 women (mean age 48 +/- 26 years) presenting to an out-patient sexual medicine clinic. METHODS: The vulvoscopy procedure (Zeiss colposcope, magnification x 5-25) was performed in a similar manner for each patient. Information was obtained concerning the integrity of the: 1) mons (including pubic hair distribution), right and left labia majora, and right and left interlabial sulci, 2) clitoris, prepuce and right and left frenulum, 3) right and left labia minora and posterior fourchette, 4) urethral meatus and right and left ejaculatory ducts, 5) hymen and minor and major vestibular glands with cotton swab testing at 1:00, 3:00, 5:00, 7:00, 9:00 and 11:00, and 6) vaginal rugae, cervix, vaginal pH, vaginal smear and wet mount procedures. RESULTS: Moderate to severe clitoral atrophy was detected in 42%, moderate to severe clitoral phimosis (18%), moderate to severe frenular atrophy (6%), frenular fibroepithelioma. (2%), moderate to severe labial resoprtion (82%), and mild to moderate urethral prolapse (5%). Cotton swab testing was positive for vulvar vestibulitis syndrome (82%). Decreased to absent vaginal rugae was noted in 28%, vaginal pH >5.0 (31%), and presence of yeast hyphae on vagnal smear (21%). There were positive correlations of vulvoscopic findings to baseline sex steroid hormone levels; presence of labial resorption with baseline estradiol and presence of VVS with baseline calculated free testosterone. CONCLUSIONS: Vulvoscopy enables documentation of anatomic abnormalities in the vulvar-vestibular-vaginal region at baseline (establishes diagnosis) and longitudinally (treatment outcome assessment) and it is a fundamental tool for the sexual medicine physician to provide objective insight into the biologic pathophysiologies of women with sexual health problems. Source of Funding: None
Vol. 181, No. 4, Supplement, Monday, April 27, 2009
curves assessed the time to EF in all patients. Life tables were then used to assess the rate of EF recovery using a 6 month-interval. RESULTS: Mean age was 61.7 yrs (median 62; range: 40-79). Overall, 262/578 (45.3%) reached a IIEF-EF domain score q22 after a mean follow-up of 25.2 months (median 22; range 4-69). Pre-operative IIEF-EF showed the presence of severe erectile dysfunction (ED) in 105 (18.1%), moderate ED in 45 (7.8%), mild to moderate ED in 56 (9.7%), mild ED in 112 (19.4%) and no ED in 260 (4.5%) patients. Of all 262 patients regaining normal erectile function after BNSRP, 220 (83.9%) patients recovered EF in the first 12 months, while the remaining 40 (15.3%) patients recovered EF between 12-24 months after surgery. No patient recovered EF beyond 2 years after surgery. CONCLUSIONS: Our analyses showed that 24 months after surgery represent the most reliable timing for the assessment of definitive EF after BNSRP. Conversely, assessing EF at 1 year after surgery is associated with a lower sensitivity (84.7%). This is crucial for patient counseling and for collecting reliable EF data after BNSRP. Source of Funding: None
331
Jamaica completed an interviewer administered questionnaire to obtain information on priapism, stuttering priapism, fertility, erectile function, libido and premature ejaculation. The study period was from January 1, 2008 to June 30, 2008. RESULTS: The mean age of the subjects was 34±10.4 years (mean±sd).The prevalence of priapism was 30%and stuttering priapism was 54%. There was no difference in mean ages by priapism and stuttering priapism groups. Priapism but not stuttering priapism was significantly greater in subjects with homozygous S sickle cell disease compared with Heterozygous SC (p<0.02) disease. Priapism was significantly associated with erectile dysfunction (p<0.001), and stuttering priapism (p<0.002). However, there was no association with fertility, libido and premature ejaculation. In contrast there was no association of stuttering priapism with fertility, erectile dysfunction, and libido. However there was a significant association of stuttering priapism with premature ejaculation (p<0.02) with significantly lower proportion of subjects with stuttering priapism having premature ejaculation. CONCLUSIONS: Priapism and stuttering priapism are important clinical determinants of sexual function in males with sickle cell disease. Source of Funding: None
927 IMPAIRED ARTERIOGENIC RATHER THAN VENO-OCCLUSIVE MECHANISMS ARE RESPONSIBLE FOR ERECTILE DYSFUNCTION IN DIABETICS. Suresh C Sikka*, Wayne JG Hellstrom, New Orleans, LA INTRODUCTION AND OBJECTIVE: In-office evaluation of erectile dysfunction (ED) by duplex Doppler ultrasound can benefit the decision making process concerning appropriate therapy. It is often unclear whether diabetic men who suffer from ED have impaired veno-occlusive mechanisms and/or arterial insufficiency or there is a neurological contribution. This study explored penile duplex Doppler ultrasonography with visual sexual stimulation to assess the hemodynamic function of the penis in cohorts of diabetic and non-diabetic patients with ED. METHODS: This retrospective analysis included 330 age-matched ED patients (90 with diabetes and 240 without diabetes). The penis was scanned using 10 mHz ultrasound probe before and after single intracorporal injection (ICI) of 7 to 20 micrograms of prostaglandin E1 (PGE1) by a single operator. The sagittal and cross-sectional diameter, the peak systolic velocity, end-diastolic velocity (if present), and resistance index (RI) for each cavernosal artery was evaluated at various time intervals up to 30 minutes after ICI by using color Doppler ultrasonography. RESULTS: Diabetic men with ED demonstrated lower peak systolic velocity (Mean 23.7 +/- 2 SEM cm/sec) compared to nondiabetic patients (45.2 +/- 3.7 cm/sec) at 15 minutes post PGE1 (15 micrograms). These differences in peak systolic velocity parameters were more pronounced at 15 and 20 micrograms PGE1 than at lower doses and after 10 to 20 minutes of ICI. No significant differences in RI and end-diastolic velocity in right and left cavernosal arteries were observed in the two groups. CONCLUSIONS: Our findings, contrary to common belief, show that diabetic men with ED are more likely to demonstrate arterial insufficiency rather than veno-occlusive dysfunction. Such testing needs be performed with at least 15 micrograms PGE1 for the intra-corporal injection. Source of Funding: None
928 THE PREVALENCE AND DETERMINANTS OF PRIAPISM IN ADULT MALES WITH SICKLE CELL DISEASE Belinda F Morrison*, Wendy AC Madden, Marvin E Reid, William D Aiken, St Andrew, Jamaica INTRODUCTION AND OBJECTIVE: Sickle cell disease has an incidence of 1 in 150 births in Jamaica. We sought to determine the prevalence and determinants of priapism in adult males with sickle cell disease METHODS: 108 consecutive male subjects, 87 with homozygous S (SS) and 21 with heterozygous C (SC) sickle cell disease attending the Sickle Cell Unit, University of the West Indies,
929 VULVOSCOPY IN THE DIAGNOSIS OF WOMEN WITH SEXUAL HEALTH COMPLAINTS Joanna B Korda*, Irwin Goldstein, San Diego, CA INTRODUCTION AND OBJECTIVE: The evaluation of women with sexual health problems involves psychologic interview, psychosocial, sexual and medical history, physical examination using magnification and laboratory testing. Vulvoscopy uses a high-powered microscope to identify and document by photography physical examination findings of the external genitalia and vagina. Concerning vulvoscopy, few reports have been published of: i) standardized methodologies utilized, ii) baseline prevalence of abnormal physical findings, iii) correlations between physical findings and pertinent biologic variables, such as sex steroid hormone blood test values, and iv) correlations of treatment outcome with longitudinal vulvoscopic changes. To review the results of vulvoscopy in the first 75 women (mean age 48 +/- 26 years) presenting to an out-patient sexual medicine clinic. METHODS: The vulvoscopy procedure (Zeiss colposcope, magnification x 5-25) was performed in a similar manner for each patient. Information was obtained concerning the integrity of the: 1) mons (including pubic hair distribution), right and left labia majora, and right and left interlabial sulci, 2) clitoris, prepuce and right and left frenulum, 3) right and left labia minora and posterior fourchette, 4) urethral meatus and right and left ejaculatory ducts, 5) hymen and minor and major vestibular glands with cotton swab testing at 1:00, 3:00, 5:00, 7:00, 9:00 and 11:00, and 6) vaginal rugae, cervix, vaginal pH, vaginal smear and wet mount procedures. RESULTS: Moderate to severe clitoral atrophy was detected in 42%, moderate to severe clitoral phimosis (18%), moderate to severe frenular atrophy (6%), frenular fibroepithelioma. (2%), moderate to severe labial resoprtion (82%), and mild to moderate urethral prolapse (5%). Cotton swab testing was positive for vulvar vestibulitis syndrome (82%). Decreased to absent vaginal rugae was noted in 28%, vaginal pH >5.0 (31%), and presence of yeast hyphae on vagnal smear (21%). There were positive correlations of vulvoscopic findings to baseline sex steroid hormone levels; presence of labial resorption with baseline estradiol and presence of VVS with baseline calculated free testosterone. CONCLUSIONS: Vulvoscopy enables documentation of anatomic abnormalities in the vulvar-vestibular-vaginal region at baseline (establishes diagnosis) and longitudinally (treatment outcome assessment) and it is a fundamental tool for the sexual medicine physician to provide objective insight into the biologic pathophysiologies of women with sexual health problems. Source of Funding: None