- Email: [email protected]
P-01-065 Effects of avanafil on semen quality and sperm cytoskeleton in oligoasthenospermic infertile men: a randomized controlled trial
S164
needs a precise intraoperative localization with high-frequency ultrasound, especially for nonpalpable tumours. Methods: We report two cases of nonpalpable intratesticular tumours successfully localised using (99mm)Tc nanocolloid injected with intraoperative US and detected with a g-ray detection probe. Results: In the case 1, the final pathology of the specimen revealed a 4mm classical seminoma with an intratubular germ cell neoplasm focus. In the case 2, the biopsy revealed a granulomatous inflammation compatible with testicular sarcoidosis. Both patient recovered successfully after surgery without complications. Conclusion: This method is easily reproducible and safe for the patient. This technique could guarantee complete excision of the tumour, especially if the mass is poorly delimited. Policy of full disclosure: None.
Male Sexual Dysfunction
presence of isolated foci with active spermatogenesis. Conventional testicular sperm extraction (c-TESE) in patients with no obstructive azoospermia (NOA) has been partially replaced by micro-TESE since the introduction of this technique and the preliminary results about the higher sperm retrieval rate (SRR). It is still under debate the problem regarding the high cost related to micro-TESE. In this study we evaluated SRR of c-TESE in naive patients suffering from NOA. Methods: From January 2013 to June 2015, 63 consecutive Caucasian males, suffering from primary infertility, were referred to our centre for a c-TESE. All these procedures were performed by the same surgeon (AS). For every patient, we collected demographic data, cause of infertility, time to first infertility diagnosis, serum levels of LH, FSH, total testosterone, prolactin. A statistical analysis was conducted in order to correlate all the clinical variables with the SRR (p-value was considered as statistically significant when <0.05). Results: In total, 63 patients with a mean (range) age of 37,3 (2653) years were included in the present study. Regarding the cause of the infertility 15 (23.8%) patients had obstructive azoospermia, 17 (27%) oligozoospermia and 31 patients (49.2%) had NOA. All patients in the obstructed group had positive sperm retrieval. The +SRR for the NOA group was 48.4%. No statistical differences were observed between positive versus negative SRR regarding mean FSH (17.12 vs 19.03 mUI/mL; p ¼ 0.72), LH (9.72 vs 6.92 mUI/mL; p ¼ 0.39). Interestingly, we found a statistically significant difference in terms of time of first infertility diagnosis (+SRR vs eSRR; 44.5 vs 57 months; p ¼ 0.02) and, in contrast with the literature, regarding to age (+SSR vs e SRR; 40.1 vs 35.3; p ¼ 0.04). Conclusion: In our case series successful SRR with c-TESE was 48.4%, similar to the reported retrieval rate of micro-TESE. Lower costs and high reproducibility of this technique still give a possible role to c-TESE in sperm retrieval. Policy of full disclosure: None. P-01-065
Figure 1. The intratesticular mass is localized with the g-ray detection probe.
P-01-064 CONVENTIONAL TESE AND NOA: IS THERE STILL A ROLE? RESULTS FROM A SINGLE NON-ACADEMIC COMMUNITY HOSPITAL Sacca, A.1; Pastore, A.L.2; Maruccia, S.2; Fuschi, A.2; Da Pozzo, L.F.2 1 A.O. Papa Giovanni XXIII, Urology, Bergamo, Italy; 2A.O. Papa Giovanni XXIII, Bergamo, Italy Objective: Spermatozoa can be retrieved in NOA patients despite the absence of ejaculated spermatozoa in their semen due to the
EFFECTS OF AVANAFIL ON SEMEN QUALITY AND SPERM CYTOSKELETON IN OLIGOASTHENOSPERMIC INFERTILE MEN: A RANDOMIZED CONTROLLED TRIAL Sofikitis, N.1; Dimitriadis, F.2; Skouros, S.1; Stavrou, S.1; Seminis, G.1; Giannakis, I.1; Tsounapi, P.3; Lantin, P.4; Chaliasos, N.4; Takenaka, A.3 1 University of Ioannina, Greece; 2Thessaloniki, Greece; 3Tottori Univesrity, Yonago, Japan; 4Ioannina University, Greece, Greece Objective: We evaluated the effects of avanafil on semen quality in oligoasthenospermic infertile (OAI) men. Methods: The present study was initially scheduled to include 39 OAI-men. When each patient was recruited they were randomly assigned to one of three groups A, B, and C. In all, 13 OAI-men were treated daily for 12 weeks with avanafil (50 mg three times a day; group A), or L-carnitine (14 men; positive control group; 1.5 g per day group B); another group of 12 OAI-men (group C; negative control group) received no treatment. Semen parameters, the mean length of sperm midpiece (LMP), the outcome of hypoosmotic swelling test (%HPST), and the seminal plasma J Sex Med 2016;13:S142eS166
S165
Male Sexual Dysfunction
citrate concentration (secreted by the prostate) were evaluated before and after the end of the treatment in each of groups A and B and before and at the end of the 12-week-experimental period (EP) in group C, respectively. Serum levels of testosterone were evaluated before and at the end of the EP in each of groups A, B, or C. Wilcoxon paired test was used for statistical analysis. A probability P smaller than 0.05 was considered as significant. Results: Within group A the peripheral serum mean testosterone concentration (ng/ml), semen citrate concentration (mg/dl), percentage of motile spermatozoa (%), the mean LMP (micrometers), the %HOST (%) and percentage of morphologically normal spermatozoa (%) were significantly greater after avanafil treatment (8.85 , 385, 39, 4.5, 59, and 9, respectively) than before treatment (7.99, 297, 26, 4.1, 46, and 3, respectively) . Within each group B and C, differences in the above parameters prior to the EP and at the end of the EP were not significant. Conclusion: The enhancement of prostatic secretory function, the longer LMP, and the increase in testosterone may explain the increase in sperm motility after avanafil administration. Policy of full disclosure: None. P-01-066 PrEP IN MONTREAL: GOOD ADHERENCE, NO SEROCONVERSION AND NO EVIDENCE OF RISK COMPENSATION Thomas, R.1; Galanakis, C.1; Vézina, S.1; Longpré, D.1; Kerba, J.-P.1; Landry, G.1; Charest, L.1; Lavoie, S.1; Huchet, E.1; Trottier, B.1; Machouf, N.2; Machouf, N.2 1 Clinique médicale l’Actuel, Montreal, Canada; 2Clinique Médicale l’Actuel, Epidemiology, Montreal, Canada Objective: This study presents the PrEP experience in one of the largest Canadian sexual health clinics evaluating treatment uptake, adherence and behavioral changes in a high-risk population. Methods: We prospectively assessed patients receiving TDF-FTC at Clinique l’Actuel from 2011 to August 2015. Patients were evaluated at baseline (BL) and at 3-month follow-up intervals (FU). Treatment adherence and behavioral data were measured by self-report. Risk behavior was defined in terms of condom use and number of sexual partners. Behavioral changes were analyzed by chi-square. Results: 355 patients were prescribed PrEP. Patients were male (99%) and MSM (97%) with a median age of 36 (Range ¼ 18-66y). The main indication for PrEP was regular unprotected anal intercourse (69%). 80% of patients had a history of STIs and 73% reported having >10 sexual partners in the last 12 months. Mean condom use was 49% for both receptive and insertive anal intercourse. 33 patients (9%) never started PrEP; 3/33 seroconverted within 8 months of the consultation. Among patients taking PrEP (n ¼ 322), 69% reported daily use, while 10% took PrEP as needed. No seroconversion was observed. The mean duration of PrEP was 6.5 months. 49 patients (21%) stopped PrEP with 49% of discontinuations occurring in the first 3 months of FU. 39% of discontinuations were due to patients feeling that PrEP was no longer needed and 23% were due to adverse events. Increases in J Sex Med 2016;13:S142eS166
high-risk behavior following PrEP use were observed in 25% of cases, while 43% of patients reported no change in behavior and 32% had improved behavior (p ¼ 0.018). Patients with improved behavior were those that were most at risk to acquire HIV at baseline. Conclusion: Patients receiving PrEP seem adherent to treatment. No seroconversions occurred among PrEP users. PrEP does not promote an increase in high-risk behaviors but rather raises awareness about sexual risk behavior. Policy of full disclosure: RT has been an advisory board member for Abbvie, Bristol-Myers Squibb, Gilead, Janssen, Merck and Viiv healthcare. LC has been an advisory board member for Abbott,Bristol-Myers Squibb, Gilead, Janssen, Merck and Viiv healthcare. BT has been a speaker/consultant for Abbvie, Bristol-Myers Squibb, Gilead, Janssen, Merck and Viiv healthcare. NM was a speaker for Merck and Gilead. Changes in behavior at 3-month PrEP follow-up: Table 1. Changes in Behavior at 3-Months PrEP Follow-Up Regular Inconsistent condom use condom use at BL (<80%) at BL (80%) Total Worsening behavior (less condom use, more partners) No change (no change in condom use or no. partners) Improved behavior (more condom use, fewer partners) Total
15 (24%)
17 (27%)
32 (25%)
21 (33%)
34 (53%)
55 (43%)
27 (43%)
13 (20%)
40 (32%)
63 (100%)
64 (100%)
127 (100%)
P-01-067 EFFECTS OF CHRONIC TREATMENT WITH TADALAFIL IN MONOCROTALINE-INDUCED PULMONARY HYPERTENSIVE RAT MODEL Vignozzi, L.1; Filippi, S.2; Comeglio, P.2; Cellai, I.2; Morelli, A.2; Sarchielli, E.2; Vannelli, G.B.2; Maggi, M.2 1 University of Florence, Sexual Medicine and Andrology, Italy; 2 University of Florence, Italy Objective: Pulmonary arterial hypertension (PAH) is a progressive disease, characterized by an increase in pulmonary vascular resistance, leading to right heart failure and ultimately death. The key pathologic change observed in PAH is the remodeling of small pulmonary arteries, characterized by thickening of the intima, media, and adventitia. The present study is aimed at investigating the effects of in vivo treatment with tadalafil, a selective PDE5 inhibitor, in the monocrotaline (MCT)-induced PAH rat model. The MCTinduced PAH rat model mimics PAH in humans, and is regarded as a useful model to study the effects of potential therapeutic agents, such as anti-inflammatory and anti-proliferative ones. Methods: The monocrotaline (MCT)-induced PAH rat model treated or not with tadalafil (10 mg/kg/day, in drinking water). Evaluation of right ventricular weight, wall thickness of pulmonary
needs a precise intraoperative localization with high-frequency ultrasound, especially for nonpalpable tumours. Methods: We report two cases of nonpalpable intratesticular tumours successfully localised using (99mm)Tc nanocolloid injected with intraoperative US and detected with a g-ray detection probe. Results: In the case 1, the final pathology of the specimen revealed a 4mm classical seminoma with an intratubular germ cell neoplasm focus. In the case 2, the biopsy revealed a granulomatous inflammation compatible with testicular sarcoidosis. Both patient recovered successfully after surgery without complications. Conclusion: This method is easily reproducible and safe for the patient. This technique could guarantee complete excision of the tumour, especially if the mass is poorly delimited. Policy of full disclosure: None.
Male Sexual Dysfunction
presence of isolated foci with active spermatogenesis. Conventional testicular sperm extraction (c-TESE) in patients with no obstructive azoospermia (NOA) has been partially replaced by micro-TESE since the introduction of this technique and the preliminary results about the higher sperm retrieval rate (SRR). It is still under debate the problem regarding the high cost related to micro-TESE. In this study we evaluated SRR of c-TESE in naive patients suffering from NOA. Methods: From January 2013 to June 2015, 63 consecutive Caucasian males, suffering from primary infertility, were referred to our centre for a c-TESE. All these procedures were performed by the same surgeon (AS). For every patient, we collected demographic data, cause of infertility, time to first infertility diagnosis, serum levels of LH, FSH, total testosterone, prolactin. A statistical analysis was conducted in order to correlate all the clinical variables with the SRR (p-value was considered as statistically significant when <0.05). Results: In total, 63 patients with a mean (range) age of 37,3 (2653) years were included in the present study. Regarding the cause of the infertility 15 (23.8%) patients had obstructive azoospermia, 17 (27%) oligozoospermia and 31 patients (49.2%) had NOA. All patients in the obstructed group had positive sperm retrieval. The +SRR for the NOA group was 48.4%. No statistical differences were observed between positive versus negative SRR regarding mean FSH (17.12 vs 19.03 mUI/mL; p ¼ 0.72), LH (9.72 vs 6.92 mUI/mL; p ¼ 0.39). Interestingly, we found a statistically significant difference in terms of time of first infertility diagnosis (+SRR vs eSRR; 44.5 vs 57 months; p ¼ 0.02) and, in contrast with the literature, regarding to age (+SSR vs e SRR; 40.1 vs 35.3; p ¼ 0.04). Conclusion: In our case series successful SRR with c-TESE was 48.4%, similar to the reported retrieval rate of micro-TESE. Lower costs and high reproducibility of this technique still give a possible role to c-TESE in sperm retrieval. Policy of full disclosure: None. P-01-065
Figure 1. The intratesticular mass is localized with the g-ray detection probe.
P-01-064 CONVENTIONAL TESE AND NOA: IS THERE STILL A ROLE? RESULTS FROM A SINGLE NON-ACADEMIC COMMUNITY HOSPITAL Sacca, A.1; Pastore, A.L.2; Maruccia, S.2; Fuschi, A.2; Da Pozzo, L.F.2 1 A.O. Papa Giovanni XXIII, Urology, Bergamo, Italy; 2A.O. Papa Giovanni XXIII, Bergamo, Italy Objective: Spermatozoa can be retrieved in NOA patients despite the absence of ejaculated spermatozoa in their semen due to the
EFFECTS OF AVANAFIL ON SEMEN QUALITY AND SPERM CYTOSKELETON IN OLIGOASTHENOSPERMIC INFERTILE MEN: A RANDOMIZED CONTROLLED TRIAL Sofikitis, N.1; Dimitriadis, F.2; Skouros, S.1; Stavrou, S.1; Seminis, G.1; Giannakis, I.1; Tsounapi, P.3; Lantin, P.4; Chaliasos, N.4; Takenaka, A.3 1 University of Ioannina, Greece; 2Thessaloniki, Greece; 3Tottori Univesrity, Yonago, Japan; 4Ioannina University, Greece, Greece Objective: We evaluated the effects of avanafil on semen quality in oligoasthenospermic infertile (OAI) men. Methods: The present study was initially scheduled to include 39 OAI-men. When each patient was recruited they were randomly assigned to one of three groups A, B, and C. In all, 13 OAI-men were treated daily for 12 weeks with avanafil (50 mg three times a day; group A), or L-carnitine (14 men; positive control group; 1.5 g per day group B); another group of 12 OAI-men (group C; negative control group) received no treatment. Semen parameters, the mean length of sperm midpiece (LMP), the outcome of hypoosmotic swelling test (%HPST), and the seminal plasma J Sex Med 2016;13:S142eS166
S165
Male Sexual Dysfunction
citrate concentration (secreted by the prostate) were evaluated before and after the end of the treatment in each of groups A and B and before and at the end of the 12-week-experimental period (EP) in group C, respectively. Serum levels of testosterone were evaluated before and at the end of the EP in each of groups A, B, or C. Wilcoxon paired test was used for statistical analysis. A probability P smaller than 0.05 was considered as significant. Results: Within group A the peripheral serum mean testosterone concentration (ng/ml), semen citrate concentration (mg/dl), percentage of motile spermatozoa (%), the mean LMP (micrometers), the %HOST (%) and percentage of morphologically normal spermatozoa (%) were significantly greater after avanafil treatment (8.85 , 385, 39, 4.5, 59, and 9, respectively) than before treatment (7.99, 297, 26, 4.1, 46, and 3, respectively) . Within each group B and C, differences in the above parameters prior to the EP and at the end of the EP were not significant. Conclusion: The enhancement of prostatic secretory function, the longer LMP, and the increase in testosterone may explain the increase in sperm motility after avanafil administration. Policy of full disclosure: None. P-01-066 PrEP IN MONTREAL: GOOD ADHERENCE, NO SEROCONVERSION AND NO EVIDENCE OF RISK COMPENSATION Thomas, R.1; Galanakis, C.1; Vézina, S.1; Longpré, D.1; Kerba, J.-P.1; Landry, G.1; Charest, L.1; Lavoie, S.1; Huchet, E.1; Trottier, B.1; Machouf, N.2; Machouf, N.2 1 Clinique médicale l’Actuel, Montreal, Canada; 2Clinique Médicale l’Actuel, Epidemiology, Montreal, Canada Objective: This study presents the PrEP experience in one of the largest Canadian sexual health clinics evaluating treatment uptake, adherence and behavioral changes in a high-risk population. Methods: We prospectively assessed patients receiving TDF-FTC at Clinique l’Actuel from 2011 to August 2015. Patients were evaluated at baseline (BL) and at 3-month follow-up intervals (FU). Treatment adherence and behavioral data were measured by self-report. Risk behavior was defined in terms of condom use and number of sexual partners. Behavioral changes were analyzed by chi-square. Results: 355 patients were prescribed PrEP. Patients were male (99%) and MSM (97%) with a median age of 36 (Range ¼ 18-66y). The main indication for PrEP was regular unprotected anal intercourse (69%). 80% of patients had a history of STIs and 73% reported having >10 sexual partners in the last 12 months. Mean condom use was 49% for both receptive and insertive anal intercourse. 33 patients (9%) never started PrEP; 3/33 seroconverted within 8 months of the consultation. Among patients taking PrEP (n ¼ 322), 69% reported daily use, while 10% took PrEP as needed. No seroconversion was observed. The mean duration of PrEP was 6.5 months. 49 patients (21%) stopped PrEP with 49% of discontinuations occurring in the first 3 months of FU. 39% of discontinuations were due to patients feeling that PrEP was no longer needed and 23% were due to adverse events. Increases in J Sex Med 2016;13:S142eS166
high-risk behavior following PrEP use were observed in 25% of cases, while 43% of patients reported no change in behavior and 32% had improved behavior (p ¼ 0.018). Patients with improved behavior were those that were most at risk to acquire HIV at baseline. Conclusion: Patients receiving PrEP seem adherent to treatment. No seroconversions occurred among PrEP users. PrEP does not promote an increase in high-risk behaviors but rather raises awareness about sexual risk behavior. Policy of full disclosure: RT has been an advisory board member for Abbvie, Bristol-Myers Squibb, Gilead, Janssen, Merck and Viiv healthcare. LC has been an advisory board member for Abbott,Bristol-Myers Squibb, Gilead, Janssen, Merck and Viiv healthcare. BT has been a speaker/consultant for Abbvie, Bristol-Myers Squibb, Gilead, Janssen, Merck and Viiv healthcare. NM was a speaker for Merck and Gilead. Changes in behavior at 3-month PrEP follow-up: Table 1. Changes in Behavior at 3-Months PrEP Follow-Up Regular Inconsistent condom use condom use at BL (<80%) at BL (80%) Total Worsening behavior (less condom use, more partners) No change (no change in condom use or no. partners) Improved behavior (more condom use, fewer partners) Total
15 (24%)
17 (27%)
32 (25%)
21 (33%)
34 (53%)
55 (43%)
27 (43%)
13 (20%)
40 (32%)
63 (100%)
64 (100%)
127 (100%)
P-01-067 EFFECTS OF CHRONIC TREATMENT WITH TADALAFIL IN MONOCROTALINE-INDUCED PULMONARY HYPERTENSIVE RAT MODEL Vignozzi, L.1; Filippi, S.2; Comeglio, P.2; Cellai, I.2; Morelli, A.2; Sarchielli, E.2; Vannelli, G.B.2; Maggi, M.2 1 University of Florence, Sexual Medicine and Andrology, Italy; 2 University of Florence, Italy Objective: Pulmonary arterial hypertension (PAH) is a progressive disease, characterized by an increase in pulmonary vascular resistance, leading to right heart failure and ultimately death. The key pathologic change observed in PAH is the remodeling of small pulmonary arteries, characterized by thickening of the intima, media, and adventitia. The present study is aimed at investigating the effects of in vivo treatment with tadalafil, a selective PDE5 inhibitor, in the monocrotaline (MCT)-induced PAH rat model. The MCTinduced PAH rat model mimics PAH in humans, and is regarded as a useful model to study the effects of potential therapeutic agents, such as anti-inflammatory and anti-proliferative ones. Methods: The monocrotaline (MCT)-induced PAH rat model treated or not with tadalafil (10 mg/kg/day, in drinking water). Evaluation of right ventricular weight, wall thickness of pulmonary