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P-05-008 Nebivolol plus sildenafil in PDE 5 inhibitors nonresponder men with arterial hypertention
S219
P-05 Late Breaking Posters - MSD
P-05-008 NEBIVOLOL PLUS SILDENAFIL IN PDE 5 INHIBITORS NONRESPONDER MEN WITH ARTERIAL HYPERTENTION Khelaia, A.1; Managadze, L.2 1 National Center of Urology, Urology, Tbilisi, Georgian; 2National Center of Urology, Tbilisi, Georgian Objective: PDE 5 inhibitors are the first-line therapy for erectile dysfunction (ED). Demonstrated efficacy is variable with different possible mechanisms in nonresponders cases. The main reason is related to the defect in NO/cGMP pathway. Nebivolol (selective beta - blocker with NO-mediated vasodilator properties) may be a chance for PDE 5 inhibitors nonresponders. Methods: we recruited 47 men with arterial hypertension (mean age 44,7 years) nonresponders to sildenafil (exclusion criteria were hipogonadism, dyslipidemia, diabetes mellitus). ED was assessed according International Index of Erectile Function 15 (IIEF e 15) score (baseline and after 3 months). Results: Baseline IIEF e 15 score mean level was 29,56. After combination treatment with sildenafil 100 mg on demand and Nebivolol 5 e 10 mg IIEF e 15 score was re-assessed, mean level became 50,34 (difference statistical significant p < 0,0001). Conclusion: Arterial hypertension is negative risk factor for penile vascularity. So, Nebivolol significantly enhance the capacity of PDF 5 inhibitors to relax erectile tissue and allow penile erection. It is a good opportunity combination of nebivolol with sildenafil to avoid necessity of intracavernosal injections. Policy of full disclosure: None. P-05-009 ASSOCIATION OF THE MODIFIED FRAILTY INDEX WITH ADVERSE OUTCOMES AFTER PENILE PROSTHESIS IMPLANTATION Al-Hajeri, D.1; Binsaleh, S.2 1 King Khalid University Hospital, Urology, Riyadh, Saudi Arabia; 2 King Khalid University Hospita, Riyadh, Saudi Arabia Objective: Background and Aim: A modified frailty index (mFI) has been extensively used to predict postoperative complications in various emergency and major surgeries. There were no reports on the use of mFI in penile prosthesis implantation, a relatively elective surgery. We therefore determine if we can use the mFI to predict adverse outcomes or even mortality among patients undergoing penile prosthesis implantation for treatment of erectile dysfunction. Methods: Retrospective analysis of the medical files of patients who underwent penile prosthesis implantation was done. mFI was calculated based on the Canadian Study of Health and Aging Frailty Index risk factors present in each patient. The Clavien classification system was used to assign the postoperative complications seen in our patients. J Sex Med 2016;13:S216eS226
Results: A total of 54 patients underwent penile prosthesis between 2005 and 2015. mFI was low in 48 (88.9%) of our patients (mFI of 0 - 0.27), and was intermediate (0.36 to 0.63) in 6 (11.2%) patients. There were 43 (79.6%) patients who fell into Clavien class I, one (1.9%) Clavien class II, and 10 (18.5%) Clavien class III. mFI was not significantly correlated with age, smoking, peyronie’s disease, duplex results, duration of procedure, type of anesthesia, and type of prosthesis. mFI predicted postoperative complications in patients undergoing penile prosthesis implantation, and dyslipidemia was found to be an independent risk factor for increased risk for postoperative complications. Conclusion: The mFI predicts preoperative risk in elderly male patients who undergo penile prosthesis implantation. Dyslipidemia is an independent risk factor that increases risk for postoperative complications almost twice more than patients who are not dyslipidemic. Policy of full disclosure: None. P-05-010 MECHANICAL FAILURE WITH INFLATABLE PENILE PROSTHESIS Oliveira, P.1; Oliveira, T.2; Gaspar, S.2; Martinho, D.2; Lopes, T.2 1 Hospital de Santa Maria, Urology, Lisbon, Portugal; 2Hospital de Santa Maria, Lisbon, Portugal Objective: In 1973, Scott et al. introduced the first inflatable penile prosthesis for the treatment of erectile dysfunction (ED). At that time, mechanical complications were more frequent, specially in the first years after implantation. Currently with technological evolution, is a less common condition, occurring typically more than 5 years after implantation, being the medically implanted device with the lowest replacement rate for mechanical failure. The most common mechanical complications are cylinder or reservoir leak, tubing fracture, cylinder aneurysm or conector disruption. The evidence of mechanical failure requires surgical revision of the prosthesis as well as replacement of all parts, once partial substituition is in association with a higher infection rate and frequent and repeated penile incisions tend to shorten the erections. We present a case of a 65 years old man who underwent implantation of a inflatable penile prosthesis 15 years ago for erectile dysfunction after radical prostatectomy. Methods: Patient presented incomplete insuflation of the prosthesis, with left angulation and penile shaft bulging. He underwent surgical revision with identification of a proximal aneurysm of the right cilynder. A total replacement of the prosthesis was performed. Results: Six weeks before, resumed sexual intercourse. Complete functioning device without any curvature. Conclusion: Mechanical failure of a penile prosthesis requires explantation of the entire device as well as irrigation of all prosthetic compartments, once this attitude is in association with a lower infection rate, not significantly different from infection rate of a first prosthetic implantation, as well as a lower reintervention rate. 5-year mechanical failure-free survival varies from
P-05 Late Breaking Posters - MSD
P-05-008 NEBIVOLOL PLUS SILDENAFIL IN PDE 5 INHIBITORS NONRESPONDER MEN WITH ARTERIAL HYPERTENTION Khelaia, A.1; Managadze, L.2 1 National Center of Urology, Urology, Tbilisi, Georgian; 2National Center of Urology, Tbilisi, Georgian Objective: PDE 5 inhibitors are the first-line therapy for erectile dysfunction (ED). Demonstrated efficacy is variable with different possible mechanisms in nonresponders cases. The main reason is related to the defect in NO/cGMP pathway. Nebivolol (selective beta - blocker with NO-mediated vasodilator properties) may be a chance for PDE 5 inhibitors nonresponders. Methods: we recruited 47 men with arterial hypertension (mean age 44,7 years) nonresponders to sildenafil (exclusion criteria were hipogonadism, dyslipidemia, diabetes mellitus). ED was assessed according International Index of Erectile Function 15 (IIEF e 15) score (baseline and after 3 months). Results: Baseline IIEF e 15 score mean level was 29,56. After combination treatment with sildenafil 100 mg on demand and Nebivolol 5 e 10 mg IIEF e 15 score was re-assessed, mean level became 50,34 (difference statistical significant p < 0,0001). Conclusion: Arterial hypertension is negative risk factor for penile vascularity. So, Nebivolol significantly enhance the capacity of PDF 5 inhibitors to relax erectile tissue and allow penile erection. It is a good opportunity combination of nebivolol with sildenafil to avoid necessity of intracavernosal injections. Policy of full disclosure: None. P-05-009 ASSOCIATION OF THE MODIFIED FRAILTY INDEX WITH ADVERSE OUTCOMES AFTER PENILE PROSTHESIS IMPLANTATION Al-Hajeri, D.1; Binsaleh, S.2 1 King Khalid University Hospital, Urology, Riyadh, Saudi Arabia; 2 King Khalid University Hospita, Riyadh, Saudi Arabia Objective: Background and Aim: A modified frailty index (mFI) has been extensively used to predict postoperative complications in various emergency and major surgeries. There were no reports on the use of mFI in penile prosthesis implantation, a relatively elective surgery. We therefore determine if we can use the mFI to predict adverse outcomes or even mortality among patients undergoing penile prosthesis implantation for treatment of erectile dysfunction. Methods: Retrospective analysis of the medical files of patients who underwent penile prosthesis implantation was done. mFI was calculated based on the Canadian Study of Health and Aging Frailty Index risk factors present in each patient. The Clavien classification system was used to assign the postoperative complications seen in our patients. J Sex Med 2016;13:S216eS226
Results: A total of 54 patients underwent penile prosthesis between 2005 and 2015. mFI was low in 48 (88.9%) of our patients (mFI of 0 - 0.27), and was intermediate (0.36 to 0.63) in 6 (11.2%) patients. There were 43 (79.6%) patients who fell into Clavien class I, one (1.9%) Clavien class II, and 10 (18.5%) Clavien class III. mFI was not significantly correlated with age, smoking, peyronie’s disease, duplex results, duration of procedure, type of anesthesia, and type of prosthesis. mFI predicted postoperative complications in patients undergoing penile prosthesis implantation, and dyslipidemia was found to be an independent risk factor for increased risk for postoperative complications. Conclusion: The mFI predicts preoperative risk in elderly male patients who undergo penile prosthesis implantation. Dyslipidemia is an independent risk factor that increases risk for postoperative complications almost twice more than patients who are not dyslipidemic. Policy of full disclosure: None. P-05-010 MECHANICAL FAILURE WITH INFLATABLE PENILE PROSTHESIS Oliveira, P.1; Oliveira, T.2; Gaspar, S.2; Martinho, D.2; Lopes, T.2 1 Hospital de Santa Maria, Urology, Lisbon, Portugal; 2Hospital de Santa Maria, Lisbon, Portugal Objective: In 1973, Scott et al. introduced the first inflatable penile prosthesis for the treatment of erectile dysfunction (ED). At that time, mechanical complications were more frequent, specially in the first years after implantation. Currently with technological evolution, is a less common condition, occurring typically more than 5 years after implantation, being the medically implanted device with the lowest replacement rate for mechanical failure. The most common mechanical complications are cylinder or reservoir leak, tubing fracture, cylinder aneurysm or conector disruption. The evidence of mechanical failure requires surgical revision of the prosthesis as well as replacement of all parts, once partial substituition is in association with a higher infection rate and frequent and repeated penile incisions tend to shorten the erections. We present a case of a 65 years old man who underwent implantation of a inflatable penile prosthesis 15 years ago for erectile dysfunction after radical prostatectomy. Methods: Patient presented incomplete insuflation of the prosthesis, with left angulation and penile shaft bulging. He underwent surgical revision with identification of a proximal aneurysm of the right cilynder. A total replacement of the prosthesis was performed. Results: Six weeks before, resumed sexual intercourse. Complete functioning device without any curvature. Conclusion: Mechanical failure of a penile prosthesis requires explantation of the entire device as well as irrigation of all prosthetic compartments, once this attitude is in association with a lower infection rate, not significantly different from infection rate of a first prosthetic implantation, as well as a lower reintervention rate. 5-year mechanical failure-free survival varies from