UNMODERATED POSTER PRESENTATIONS

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PROCEEDINGS FROM THE 14TH WORLD MEETING OF THE INTERNATIONAL SOCIETY FOR SEXUAL MEDICINE SEOUL, KOREA, SEPTEMBER 26–30, 2010

PODIUM (ORAL) PRESENTATIONS 001

EFFECTS OF FLIBANSERIN ON APPETITIVE AND CONSUMMATORY ASPECTS OF SEXUAL BEHAVIOR IN OVARIECTOMIZED FEMALE RATS PRIMED WITH ESTROGEN AND PROGESTERONE Allers, KA1; Gelez, H2; Sommer, B1; Giuliano, F2 1: Boehringer Ingelheim; 2: Pelvipharm Laboratories Objectives: To assess the activity of flibanserin, a 5-HT1a agonist and 5-HT2a antagonist, on appetitive sexual behaviors in the female rat. Materials and Methods: Females were ovariectomised (OVX) and given 10 training tests twice weekly to acquaint them with the testing apparatus and sexual behavior (with full estrogen and progesterone priming). After 1 week, female rats received treatment with two doses of flibanserin (15 and 45 mg/kg) or vehicle by gavage twice daily for a 29-day period. 48 hours before each test, rats were treated with estradiol benzoate (10 ug) and 4 hours prior to testing animals received progesterone (500 ug). For testing, females were placed into bilevel chambers with a sexually vigorous male and given 30-min tests of sexual behavior on Days 1, 8, 15, and 22, 29 of flibanserin treatment. Measures assessed: frequency of solicitation, hops and darts, level changes, and lordosis intensity and quotient from females and mounts, intromissions, and ejaculations from males. All behavioral scoring was done blind to treatment. Results: Flibanserin induced a dose dependent increase in solicitations on days 15 and 22, but not on days 1, 8 or 29. In this study, no increase in other measures of sexual motivation (hops and darts) or behavior (eg lordosis posturing) was observed. Conclusions: These data indicate that repeated flibanserin treatment increases appetitive sexual behaviors in OVX rats primed with estradiole and progesterone. The bilevel chamber model has not previously been used to assess chronic pharmacological treatment. At day 29, the flibanserin treated animals were no longer significantly different from vehicle, which may be due to the chronic nature of this study, or possibly repeated hormone priming with full hormone replacement. Disclosure: Work supported by industry: yes, by Boehringer Ingelheim (industry funding only—investigator initiated and executed study). The presenter or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.

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ACTIVATION OF THE IMMEDIATE EARLY GENE C-FOS BY ACUTE AND REPEATED TREATMENT WITH FLIBANSERIN Allers, KA1; Gelez, H2; Sommer, B1; Guiliano, F2 1: Boehringer Ingelheim; 2: Pelvipharm Laboratories Objectives: To determine the effect of acute and repeated (22-day) flibanserin administration on cellular activity in multiple brain areas using the immediate-early gene c-Fos. Materials and Methods: Thirty-one sexually naive adult female rats were habituated to handling and oral gavage for two days. In the acute study, animals were treated once with vehicle or flibanserin (15 mg/kg

or 45 mg/kg; 5 per group). In the chronic study, animals were treated twice daily with vehicle or flibanserin (15 mg/kg or 45 mg/kg; 5 or 6 per group) for 22-day. Two hours after final administration animals were anesthetised, perfused with paraformaldehyde and brains extracted and processed for immunocytochemistry to detect Fos protein. Results: Acute flibanserin treatment increased levels of c-Fos immunoreactivity in the core of the nucleus accumbens, the arcuate hypothalamic nucleus, the locus coeruleus, lateral paragigantocellular nucleus, and the nucleus of the solitary tract. Repeated (22-day) treatment with flibanserin increased levels of c-Fos immunoreactivity in the medial preoptic area and arcuate nucleus of the hypothalamus, the ventral tegmental area, the locus coeruleus, and the lateral paragigantocellular nucleus. Conclusions: Repeated (22-day) treatment with flibanserin increases activity in many brain regions known to be involved in the sexual response. In particular, the ventral tegmental area and locus coeruleus which contain dopamine and noradrenergic neurons are activated, and a previous study has demonstrated increased release of these neurotransmitters in the prefrontal cortex. These neurotransmitters are known to have an excitatory role in sexual function. The medial preoptic area of the hypothalamus is a key integration nucleus for sexual stimuli and motivation. These data support the hypothesis that flibanserin’s efficacy in treating premenopausal women with Hypoactive Sexual Desire Disorder may be due to effects on the monoaminergic brain systems. Disclosure: Work supported by industry: yes, by Boehringer Ingelheim (industry funding only—investigator initiated and executed study). The presenter or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.

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HIGH SALT DIET ELEVATES ENDOTHELIN1-MEDIATED CONSTRICTOR SENSITIVITY IN PUDENDAL ARTERIES FROM FEMALE ETB RECEPTOR-DEFICIENT RATS: LINKING FSD AND HYPERTENSION Allahdadi, KJ; Hannan, JL; Webb, RC Medical College of Georgia/USA Objective: There is a high correlation between female sexual dysfunction (FSD) and hypertension, which may share vasculogenic origins. The internal pudendal artery supplies blood to the vagina and clitoris. Inadequate blood flow through this artery may lead to insufficiencies in vaginal engorgement and clitoral erection. We previously reported female internal pudendal arteries are sensitive to the endogenous vasoconstrictor peptide, endothelin-1 (ET-1), which contracts vascular smooth muscle via Rho-kinase. This study used an ETB receptor deficient rat (ETBR-) on a high salt diet as our model of hypertension. Our objective was to investigate the role of ET-1 pudendal artery from hypertensive and control female rats. We hypothesized that ET-1 constrictor sensitivity will be elevated in pudendal arteries from hypertensive rats, via the ETA receptor (ETAR) and activation of Rho-kinase (ROCK). Material and Methods: High salt fed (8%) female ETBR- rats and wild type controls (24 weeks) were used. Mean arterial pressure was measured by tail cuff. Pudendal arterial segments were mounted in muscle baths and concentrations response curves to ET-1, phenylephrine (PE), acetylcholine (ACh) and sodium nitroprusside (SNP) were

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performed. Some pudendal segments were pre-incubated with inhibitors of ETAR or ROCK. Results: Female ETBR- rats displayed elevated MAP vs control (137 vs 114 mm Hg). Pudendal arteries from ETBR- showed elevated constrictor sensitivity to ET-1 compared to control (pD2: 10.1 ± 0.3 vs 9.0 ± 0.1). ETAR inhibition reduced ET-1 constriction concentration dependently in both ETBR- and control. ROCK inhibition reduced ET-1-mediated constriction in ETBR- (10.1 ± 0.3 vs 8.7 ± 0.1) but had no effect in control. ETBR- pudendal arteries demonstrated reduced ACh-mediated relaxation (6.0 ± 0.1 vs 7.1 ± 0.1, %Max: 74 vs 89). ETBR- and control pudendal arteries demonstrated no differences in PE constriction or SNP relaxation. Conclusion: These results suggest that hypertensive ETBR- female rats have a uniquely elevated constrictor sensitivity to ET-1, signalling through the ETAR and activation of ROCK. Additionally, ACh-mediated relaxation was reduced in pudendal arteries from ETBR- rats. We speculate that endothelial dysfunction and elevated ET-1 levels may play a role in vasculogenic FSD in hypertension by impairing vaginal and clitoral blood flow. (KJA: NIH HL066993-06; JLH: HSF Canada) Disclosure: Work supported by industry: no.

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DO CLINICAL RESEARCH DATA SUPPORT SEXUAL DESIRE AND AROUSAL DISORDERS AS DISTINCT DIAGNOSES? Clayton, AH1; DeRogatis, LR2; Rosen, R3; Pyke, R4; Garcia Jr, M4; Sand, M4 1: University of Virginia, USA; 2: Center for Sexual Medicine at Sheppard Pratt, USA; 3: New England Research Institutes, Inc., USA; 4: Boehringer Ingelheim Pharmaceuticals, Inc., USA Objectives: New diagnostic criteria that merge sexual desire disorders with arousal disorders into a condition called Sexual Interest/Arousal Disorder have been proposed. To determine whether research data support a merger of diagnostic criteria or demonstrate that the two populations are distinct, the proportion of premenopausal women diagnosed with HSDD (per DSM-IV-TR) (n = 2,573) in the flibanserin Phase III clinical research program who would also meet these newly proposed merged criteria were evaluated. Materials and Methods: Proposed diagnostic criteria of the combined disorder are absent/decreased (1) interest in sexual activity, (2) sexual/erotic thoughts or fantasies, (3) initiation of sexual activity and receptivity to a partner’s attempts to initiate, (4) sexual excitement/ pleasure during sexual activity, (5) desire triggered by any sexual/erotic stimulus, and (6) genital and/or non-genital physical changes during sexual activity. To qualify for diagnosis, ≥ 4 of 6 proposed criteria must be met. These criteria were compared with items in the database of women with HSDD from the flibanserin trials, excluding those with concomitant secondary FSAD (per DSM-IV-TR). The main outcome measure was the proportion of women with HSDD without concomitant FSAD who met proposed criteria for Sexual Interest/Arousal Disorder. Results: In 2,573 women with HSDD, mean baseline FSFI score (20.68) was suggestive of dysfunction and FSDS-R (30.1) score demonstrated distress in line with existing HSDD criteria: low sexual desire causing personal or interpersonal distress. All subjects met new criteria 1–3 based on a structured diagnostic interview and SIDI-F receptivity scores. In contrast to proposed criterion 4 (absent/reduced pleasure on ≥75% of sexual encounters), 68% of sexual encounters experienced were satisfying. Women reported mean FSFI arousal domain (2.96) and lubrication domain (4.15) scores indicating “moderate” arousal response and adequate lubrication response at “most times”, suggesting no significant genital or non-genital response impairment during sexual activity (proposed criterion 6). Triggering of desire (proposed criterion 5) could not be assessed using these data. Conclusions: The overwhelming majority of 2,573 premenopausal women diagnosed with HSDD would likely not meet criteria for the newly proposed Sexual Interest/Arousal Disorder. These results raise

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significant validity and utility concerns for the proposed new diagnostic classification. Disclosure: Work supported by industry: yes, by Boehringer Ingelheim (industry initiated, executed and funded study). The presenter or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.

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DO MULTIPLE CONVERGENT MEASURES OF FEMALE SEXUAL DYSFUNCTION (FSD) SUPPORT SEXUAL DESIRE AND AROUSAL DISORDERS AS DISTINCT DIAGNOSES? DeRogatis, LR1; Clayton, AH2; Rosen, R3; Sand, M4; Garcia Jr, M4; Pyke, R4 1: Center for Sexual Medicine at Sheppard Pratt, USA; 2: University of Virginia, USA; 3: New England Research Institutes, Inc., USA; 4: Boehringer Ingelheim Pharmaceuticals, Inc., USA Objectives: New diagnostic criteria have recently been proposed to merge sexual desire disorders with arousal disorders into a condition called Sexual Interest/Arousal Disorder. Do the available research data support such a merger of diagnostic criteria, or should these two populations remain distinct? The aim was to determine whether the proposed merger is supported by data from women diagnosed with sexual desire and arousal disorders. Material and Methods: Premenopausal women in non-treatment validation studies were diagnosed with Hypoactive Sexual Desire Disorder (HSDD) or Female Sexual Arousal Disorder (FSAD) as defined by DSM-IV-TR criteria via structured interview. These women were compared on baseline scores for Female Sexual Function Index (FSFI), Female Sexual Distress Scale-Revised (FSDS-R), sexual events, and satisfying sexual events (SSE). Mean values between the HSDD and FSAD groups were compared. Comparison of FSFI total and domain scores, FSDS-R scores, frequency of sexual events and SSE in women with HSDD and FSAD are reported. Results: Women with HSDD differed significantly from women with FSAD on all relevant measures of sexual function. FSFI domain scores in patients with HSDD were significantly lower on desire (1.94 vs. 2.73, P = 0.0001), higher on arousal (3.58 vs. 2.82, P = 0.0027) and lubrication (4.86 vs. 3.35, P = 0.0001) and similar only on measures not specific to desire or arousal: pain (5.36 vs. 4.97, NS) and satisfaction (3.41 vs. 3.49, NS), and total FSDS-R (sex-related distress) scores. Sexual behavior differed in the expected direction, as well: women with HSDD had fewer sexual encounters (4.45 vs. 7.73, P = 0.03), but reported a higher proportion of sexual events as satisfying (73% vs. 51%). Conclusions: Premenopausal women with FSAD differed significantly from those with primary HSDD on validated measures of sexual desire and arousal, with women diagnosed with primary HSDD showing more significant reductions in levels of desire and no significant impairment of arousal or lubrication. These findings provide compelling evidence against combining these disorders. Disclosure: Work supported by industry: yes, by Boehringer Ingelheim (industry initiated, executed and funded study). The presenter or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.

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WOMEN’S ENDORSEMENT OF MODELS OF SEXUAL RESPONSE AND MOTIVATION FOR SEXUAL ACTIVITY Giraldi, A1; Sand, M2; Kristensen, E1 1: Sexological Clinic, Copenhagen, Denmark; 2: Boehringer-Ingelheim Pharma, USA Objectives: Definitions of Female Sexual Dysfunction (FSD) are conceptually grounded in models of women’s sexual function, but need

Proceedings from the 14th World Meeting of the International Society for Sexual Medicine empirical testing in women with and without FSD. Several small studies have demonstrated that equal numbers of women endorse the models of Masters & Johnson (M&J), Kaplan, and Basson. The aim of this study was to assess in a large national sample the proportion of women who endorse different models of sexual response and motivation for engaging in sexual activity. Material and Methods: A population-representative sample of 1996 Danish women aged 20–65 years was mailed an 84-item questionnaire that assessed their perception of models of sexual response and motivation for engaging in sex, demographic data, sexual dysfunction (Female Sexual Function Index, FSFI) and sexual distress (Female Sexual Distress Scale, FSDS). Results: 573 women (29%) responded. Of these, 495 (86.3%) had a current partner or a partner within the last year. When asked about which model best described their sexual response, approximately equal proportions of women endorsed the M&J (29%), Kaplan (34%) and Basson (25%) models, whilst 13% endorsed none of the models. Mean FSFI score was significantly lower (and in the dysfunctional range, <26.55) in women who endorsed the Basson model or none of the models, compared to women who endorsed the M&J or Kaplan models (P < 0.001). In women with manifest FSD (FSFI < 26.55 and FSDS > 15) significantly more women endorsed the Basson model (46%) or none of the models (30%) (P < 0.001). When asked about motivation for sexual activity, based on descriptions of the models, 29% indicated the wish for arousal (M&J), 29% sexual thoughts and/or fantasies (Kaplan), 26% other reasons i.e the wish for intimacy (Basson) and 17% none of these. The majority of women (75%) in the non-dysfunctional range (FSFI > 26.55) indicated the wish for arousal or sexual thoughts and/or fantasies as the reason for sexual activity, whilst 70%of women in the dysfunctional range gave other reasons (i.e the wish for intimacy) or none of the above reasons as their motivation (P < 0.001). Conclusion: This study confirms in a large sample that women endorse different models of sexual response and that the Basson model may best reflect women with FSD. A majority of women without FSD report sexual thoughts and/or fantasies or the wish to become aroused as their primary motivation for sexual activity. Disclosure: Work supported by industry: yes, by BoehringerIngelheim (industry funding only—investigator initiated and executed study). The presenter or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.

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DO WOMEN AND MEN RESPOND SIMILAR TO SAME AUDIO-VISUAL STIMULATION?— THE SIGNIFICANCE OF GENDER DIFFERENCES Yoon, H; Chung, WS; Lee, DH; Lee, SJ; Jun, YS; Hong, KP Ewha Womans University Introduction: Considering the gender difference in medicine is one of the essential part when studying and managing patient in 21st century. However, investigators usually neglect that male and female have different preference to sexual stimuli. In this study, we aimed to investigate gender difference in preference to sexual stimuli by studying the activation areas of the brain and their gender differences according to different audio-visual stimuli (AVS). Materials and Methods: 20 physically and mentally healthy young male and female volunteers (10 males and 10 females) were joined to this study. Subjects’ mental and sexual health were screened and ensured by questionnaires (State-Trait Anxiety Inventory, Beck’s Depression Scale, IIEF for male and FSFI for female). AVS consisted of two different types of films (mood preference type and physically direct sexual stimuli preference type), and they were randomly played to the subjects during the session of functional MRI (fMRI) according to the preset schedule of audio-visual stimulation. Data were analyzed and compared to see the difference of each type of stimulation. Results: Mean age of male patient was 24.7 (20–28) years old and female patient was 23.6 (20–26) years old. Mean score to preference

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to physical type AVS was 2.14 (male) and 1.86 (female), respectively, which is more preferable in higher score. Meanwhile, mean preference score to mood type AVS was 1.86 (male) and 2.14 (female), respectively. On functional images, men showed the most activation in the temporal lobe, then the frontal lobe and parietal lobe whereas the women showed the most activation in the frontal lobe and occipital love, and then the temporal lobe. In general, the degree of activation differed among individuals, but male showed stronger activation in physical type AVS and female showed stronger activation in mood type AVS. Conclusion: Men and women had different area of activation in response to audio-visual sexual stimuli. Men and women also reacted differently to the kinds of audio-visual stimulus. Therefore, in choosing the appropriate sexual stimulus when conducting research on cerebral activation to audio-visual stimulus, the difference of genders should be taken into consideration. Disclosure: Work supported by industry: no.

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SEX STEROID PHYSIOLOGY IN POSTMENOPAUSAL WOMEN: EXCLUSIVE ROLE OF INTRACRINOLOGY AND DHEA Labrie, F. Endoceutics Inc, Quebec City, QC, Canada From the time of menopause, all estrogens and androgens originate exclusively from dehydroepiandrosterone (DHEA), thus resulting in cell-specific and locally-controlled formation of the two sex steroids by the mechanisms of intracrinology. As a clear example, recent data show that intravaginal DHEA not only rapidly and efficiently corrects all the symptoms and signs of vulvovaginal atrophy but also exerts benefits on the four domains of sexual dysfunction, namely desire, arousal, orgasm and pain at sexual activity without significant changes in serum estradiol (E2) or testosterone and their metabolites measured by mass spectrometry, thus avoiding systemic exposure and risks. It is thus of interest to examine the distribution of serum DHEA and its metabolites in individual women in order to find an explanation for the absence of menopausal symptoms in about 25% of women while 75% suffer from symptoms and signs of hormone deficiency, including vaginal atrophy. DHEA and eleven of its metabolites were measured by gas or liquid chromatography/mass spectrometry in 442 intact and 71 ovariectomized postmenopausal women aged 42 to 74 years. With a mean ± SD concentration of 2.03 ± 1.33 ng/mL, serum DHEA in intact postmenopausal women is highly variable with 5th and 95th centiles measured at 0.55 and 4.34 ng/mL, respectively, for a 7.9-fold difference. An even higher variability is observed for the eleven metabolites of DHEA. In addition to being decreased by approximately 60% at time of menopause compared to the maximal values found at the age of 30 years, the 5th and 95th centiles of serum DHEA and its metabolites vary by 8- to 12-fold in 42- to 72-year-old postmenopausal women. Since there is no regulatory mechanism to increase DHEA secretion when serum DHEA is low, it is logical to conclude that the only means of correcting postmenopausal hormonal deficiency is to supply exogenous DHEA to compensate for the low serum DHEA levels in symptomatic women. The ∼20% but parallel lower serum levels of DHEA and all its metabolites found in ovariectomized women, including E2 and testosterone, compared to intact women, suggest that the postmenopausal ovary secretes ∼20% of total DHEA in the 42- to 72-year-old age group with no significant amounts of E2 or testosterone secreted directly by the ovary. Disclosure: Work supported by industry: yes, by Endoceutics Inc. (industry initiated, executed and funded study). The presenter or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.

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30.5%, low arousal in 25.9%, low lubrication in 13.3%, low orgasm in 13.1%, low satisfaction in 9.2% and sexual pain in 19.0%. When compared with the controls (n = 930), after adjusting for age group, marital status, and menstrual cycle, women with SLE had a higher prevalence of low lubrication (OR 2.35, 95% CI: 1.30–4.23) and sexual pain (OR 1.75, 95% CI: 1.10–2.77). There was no significant difference between the prevalence of sexual difficulty in other domains between them. When the FSDS was taken into account, 15.1% of women with SLE had FSD. Conclusions: Female SLE patients had more sexual difficulties in lubrication and sexual pain but not in other areas than the controls.

SEXUAL DESIRE IN HYPERANDROGENIC WOMEN WITH POLYCYSTIC OVARY SYNDROME Rellini, AH1; Stratton, N2; Martini, E3; Terreno, E3; Santamaria, V3; Nappi, RE3 1: University of Vermont, USA; 2: Concordia University, Canada; 3: University of Pavia, Italy Objectives: Women with polycystic ovary syndrome (PCOS) suffer of a genetically-linked dysregulation of hormones. Researchers have identified three types of PCOS, including women with hyperandrogenism. In a previous study we have found that hormonal profiles were correlated with different aspects of sexual desire in women with PCOS (Rellini, et al., 2010). This study aimed at identifying whether hyperandrogenism in women with PCOS is correlated with their sexual desire. Material and Methods: A total of 82 sexually active Italian women (age 18–40) with PCOS according to ESHRE criteria completed a questionnaire on sexual function (McCoy Female Sexuality Questionnaire—Italian; Rellini et al., 2005) and one on sexual desire in response to different types of sexual cues: Erotic (e.g., anticipating sex, having a sexual fantasy), Emotional Bonding (e.g., feeling a sense of love, feeling emotionally close to a partner), Visual (e.g., seeing someone talk with confidence, seeing/talking to someone intelligent), or Romantic (e.g., dancing closely, watching a sunset) cues (McCall & Meston, 2006). Testosterone levels were obtained in the early follicular phase of the menstrual cycle in women with oligomenorrhea or independently from the cycle in amenorrheic women. Results: Hyperandrogenic women had significantly higher levels of sexual desire than women with normal androgen levels, F(1, 83) = 5.92, P < 0.05, but only when for desire in response to visual cues (e.g., “Seeing someone who is well-dressed or has class,” “Seeing/talking with someone powerful,” “Being in close proximity with attractive people,” “Seeing/talking with someone famous,” and “Seeing a welltoned body.”) Conclusions: These findings are in agreement with results from our previous study where we found that hormones may regulate some aspects of sexual desire but not others. This implies that looking at overall frequency and intensity of desire provides a simplistic view and may impair our ability to recognize different biological mechanisms implicated in this phenomenon. Ultimately, these findings need to be reproduced in a sample of women without PCOS and with clinical levels of hypoactive sexual desire disorder. Disclosure: Work supported by industry: no. The presenter or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.

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FEMALE SEXUAL DYSFUNCTION IN WOMEN WITH SYSTEMIC LUPUS ERYTHEMATOSUS Jiann, B-P Kaohsiung Veterans General Hospital Objective: Female sexual dysfunction (FSD) was seldom assessed in women with systemic lupus erythematosus (SLE). The aim of this study was to evaluate evaluate the prevalence of FSD in women with SLE Materials and Methods: Three hundred and eleven (311) consecutive woman outpatients with SLE were given a questionnaire contained the Female Sexual Function Index (FSFI), and the Female Sexual Distress Scale (FSDS) and their charts were reviewed. Their FSFI scores were compared with those of 930 woman employees of two hospitals. FSD was defined by the FSFI and the FSDS. Comparison of sexual difficulty in individual domains defined by the FSFI domain scores was done between the women with SLE and the controls. Results: Among the 282 respondents, 175 women who had some level of sexual activity during the previous month were eligible for analysis with a mean age of 37.6 years (range 21–71). Of them, 50.3% (88/175) had sexual difficulty in one or more domains, including low desire in

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Disclosure: Work supported by industry: no.

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INTERMITTENT CALORIE RESTRICTION PROMOTES FUNCTIONAL ERECTILE RECOVERY AFTER BILATERAL CAVERNOUS NERVE CRUSH INJURY IN THE RAT Bella, AJ1; Payne, R1; Plunet, W2; Carson, J3; Tetzlaff, W2; Renaud, LP1 1: University of Ottawa; 2: ICORD University of British Columbia; 3: University of Western Ontario Canada Objective: Preclinical data for therapeutic dietary restriction has been shown to improve outcomes from cervical spinal cord injury. The purpose of this study was to determine whether every-other-dayfasting (EODF), a form of intermittent caloric restriction, conferred an erectile recovery advantage following cavernous nerve (CN) crush injury in the rat. Materials and Methods: 44 3-month old Sprague-Dawley male rats were separated into a control (sham, n = 8) group and cohorts consisting of 9 animals divided into crush-injury only (non-treated, no EODF), and treatment arms of EODF started 2 weeks prior to injury, EODF at day of injury, and EODF initiated 2 weeks post-CN injury. The change in intracavernous pressure (ICP) standardized to mean arterial pressure (MAP) at 5 months was measured, with this extended in-treatment phase chosen in order to aid in washing out of any short term fasting effects between groups. Statistical significance was set at P < 0.50. The proximal corpora was cryosectioned and stained with primary antibodies against the catecholamine synthesis marker tyrosine hydroxylase, neuronal NO synthase (nNOS), and vesicular acetylcholine transporter (VaChT). Results: ICP/MAP (with standard deviation) for control animals was 0.673 (.09) versus the crush-control cohort (no caloric modification) ICP/MAP change of 0.17 (0.06). Rats treated with EODF started two weeks prior to injury demonstrated significant (P < 0.05) improvement in erectile function with ICP/MAP ratio of 0.37 (0.07) Fasting started day of injury demonstrated less robust recovery, with 0.28 (.05) compared to the “pre-treated” group. The final group, starting EODF two weeks post injury demonstrated results statistically similar to no caloric restriction, with a ICP/MAP ratio of .168 (0.06). Retrograde axonal transport of fluorogold to the major pelvic ganglion and cavernous body determination of nNOS and VaChT were significantly reduced in crush injury, and 2 week post-injury EODF, compared to EODF initiated 2 weeks prior to/and day of injury. Conclusions: This is the first study to demonstrate endogenous stressresponse neuromodulation in a model of radical prostatectomy induced CN injury. Intermittent caloric restriction in the form of EODF confers a recovery advantage for CN function post injury as measured by ICP/MAP and intact parasympathic neurons. Disclosure: Work supported by industry: no. The presenter or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.

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SKI2162, A NOVEL TRANSFORMING GROWTH FACTOR (TGF)-BETA TYPE I RECEPTOR KINASE (ALK5) INHIBITOR, ALLEVIATES PROFIBROTIC TGF-BETA1 RESPONSES IN FIBROBLASTS DERIVED FROM PEYRONIE’S PLAQUE Ryu, JK1; Piao, S1; Choi, MJ1; Tumurbaatar, M1; Kim, WJ1; Jin, HR1; Shin, SH1; Yin, GN1; Song, JS1; Kwon, MH1; Song, KM1; Suh, JK1; Song, YS2 1: National Research Laboratory of Regenerative Sexual Medicine and Department of Urology, Inha University School of Medicine, Incheon, Korea; 2: Department of Urology, Soonchunhyang University School of Medicine, Seoul, Korea Objectives: Transforming growth factor-beta1 (TGF-beta1) has been identified as an important fibrogenic cytokine associated with Peyronie’s disease (PD). Inhibition of the TGF-beta1 signal pathway might be a promising therapeutic strategy for the treatment of PD. In the present study, we investigated differential expression of the TGFbeta1 and Smad transcription factors in plaque tissue from PD patients. Next, we determined the antifibrotic effect of SKI2162, a novel smallmolecule inhibitor of activin receptor-like kinase 5 (ALK5), a type I receptor of TGF-beta, in primary fibroblasts derived from human PD plaque. Materials and Methods: Plaque tissue was isolated from 5 PD patients (mean age, 52.3 yr) and tunica albuginea tissue was obtained from 4 control patients (mean age, 47 yr). The plaque or tunica albuginea tissue was stained with antibody to TGF-beta1, phospho-Smad2 (P-Smad2), and phospho-Smad3 (P-Smad3). Plaque tissues from patients with PD were used for primary fibroblast culture. Fibroblasts were pretreated with SKI2162 (10 μM) and then stimulated with TGF-beta1 (10 ng/mL). Protein was extracted from treated fibroblasts for Western blotting and the membranes were probed with antibody to P-Smad2/Smad2, P-Smad3/Smad3, plasminogen activator inhibitor-1, fibronectin, collagen I, and collagen IV. We also determined the inhibitory effect of SKI2162 on TGF-beta1-induced nuclear translocation of Smad2/3 in fibroblasts. Results: The plaque tissue from PD patients showed higher TGFbeta1, P-Smad2, and P-Smad3 immunoreactivity than did tunica albuginea tissue from control patients. SKI2162 not only blocked TGF-beta1-induced phosphorylation and nuclear translocation of Smad2 and Smad3, but also inhibited production of extracellular matrix markers in fibroblasts derived from human PD plaque. Conclusions: In light of the pivotal role of TGF-beta and Smads in the pathogenesis of PD, pharmacologic inhibition of ALK5 may represent a novel targeted approach to treating PD. Disclosure: Work supported by industry: no.

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OPIORPHINS CAN PARTLY REVERSE THE EFFECTS OF DIABETIC VASCULOPATHY ON ERECTILE AND VASCULAR FUNCTION BY MODULATING SMOOTH MUSCLE TONE Davies, KP; Calenda, G; Tong, Y; Tar, MT; Kanika, ND; Zhang, X; Melman, A AECOM/USA Objective: Recently erectile dysfunction (ED) has been recognized as a strong predictor of cardiovascular disease (CVD). Several papers describe a link between decreased Opiorphin expression and ED through the regulation of corporal smooth muscle (SM) tone. Since Opiorphins are found in the circulation they may affect other SM cells, such as vascular SM, thereby providing a link between the development of ED and vascular disease. Materials and Methods: Sprague-Dawley rats were made diabetic for 2 months by streptozotocin (STZ) treatment and compared with age-match controls (AMC). Expression of the rat Opiorphin

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homologue gene Vcsa1 and peptide Sialorphin were analyzed using quantitative-RT-PCR and radioimmunoassay, respectively. Following intracorporal injection of plasmids over-expressing Sialorphin the effect on the physiology of STZ-diabetic animals was investigated by determining intracorporal pressure (ICP) and blood pressure (BP). The effect of Sialorphin on the tone of vascular and corporal SM was investigated, as well as its ability to regulate intracellular calcium in these cells. Results: STZ-diabetes in rats was associated with increased BP and decreased erectile function, and correlated with approximately 75% reduction of Vcsa1 in tissues where it is expressed and 30% reduction in circulating Sialorphin levels. Intracorporal injection of plasmids restored Sialorphin levels to those seen in AMC and reversed both of these physiological effects. Sialorphin was able to increase relaxation by C-type natriuretic peptide in both corporal and aortic SM strips. Sialorphin was able to modulate intracellular calcium levels in both corporal and aortic SM cells. Conclusion: Diabetic patients are at increased risk for the development of both ED and CVD. Our studies in animals demonstrate a correlation between ED, CVD and the levels of Sialorphin. Increasing levels of Sialorphin by gene transfer ameliorated these effects, suggesting Sialorphin gene therapy may be a useful strategy for treating several types of vascular diseases. Disclosure: Work supported by industry: no.

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RELEVANCE OF ESTRADIOL— TESTOSTERONE BALANCE IN ERECTILE FUNCTION OF RATS Kataoka, T; Mikumo, M; Ono, R; Shiota, A; Hotta, Y; Ohno, M Dr.; Maeda, Y; Kimura, K Nagoya City University, Japan Objective(s): The higher estrogen levels in the ageing males may be yet another organic risk factor for ED. We hypothesized that testosterone (T)—estrogen (E) balance is important for male erectile function and aimed to investigate the influence of changing the balance on male erectile function in rats. Material and Method(s): We investigated Wistar ST rats aged 11 weeks. We divided the rats into five groups (n = 6). High estrogen (High-E) group; the rats were injected estradiol (3 μg/kg/day, s.c.) daily from 2 weeks to 4 weeks. High estrogen and testosterone (HighE & T) group; the rats were injected estradiol and testosterone (3 mg/ kg/day, s.c.) daily for 4 weeks. Low testosterone (Low-T) group; the rats were injected goserelin (LH-RH agonist, 0.9 mg/kg). Low testosterone and high estrogen (Low-T + E) group; the rats were injected goserelin and estradiol daily from 2 weeks to 4 weeks. Control group; the rats were not injected any hormone. At 4 weeks after rats underwent erectile function testing in vivo by measuring maximum intracavernosal pressure (maxICP) and mean arterial blood pressure (MAP) upon electrical stimulation of the cavernous nerve. Measurement of serum testosterone and estradiol was performed with LC-MS/MS. For structural analyses rat penis were harvested. Masson’s trichrome staining was used to calculate the smooth muscle (SM)—collagen ratio. Result(s): MaxICP/MAP was 0.44 ± 0.03 in High-E group (P < 0.01 vs. Control group), 0.52 ± 0.03 in Low-T group (P < 0.01 vs. Control group), 0.49 ± 0.03 in Low-T + E group (P < 0.01 vs. Control group) and 0.70 ± 0.03 in Control group. SM/collagen ratio was 22.0 ± 1.4 % in High-E group (P < 0.05 vs. Control group), 11.7 ± 1.4 % in Low-T group (P < 0.05 vs. Control group), 20.2 ± 0.8 % in Low-T + E group (P < 0.01 vs. Low-T group) and 16.8 ± 1.7 % in Control group. Conclusion(s): In the model of sex hormone abnormality MaxICP/ MAP declined significantly. We suggest that abnormal T—E balance may cause the male sexual dysfunction. We hope that T—E balance correction may be developed to become clinically useful treatments for voiding ED. Disclosure: Work supported by industry: no.

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AN ANIMAL MODEL OF PEYRONIE DISEASE USING TGF BETA-1 AND THROMBOJET®: EVALUATING THE PLAQUE OUTCOME WITH INFLAMMATORY MARKER, SELDITOF-MS AND IMMUNOHISTOCHEMISTRY

ANALYSIS OF ERECTILE TISSUE CONTRAST ENHANCEMENT IN THE RAT CAVERNOUS NERVE INJURY MODEL USING DYNAMIC CONTRAST ENHANCED (DCE) MRI

Chung, E1; De Young, LX2; Garcia, F1; Brock, GB1 1: St Joseph Health Care; 2: University of Western Ontario Objectives: Advancement in the field of Peyronie’s Disease management is limited by the lack of robust animal models allowing investigation of innovative treatment strategies. In this report we describe our assessment of a chronic animal model of Peyronie’s disease using TGF β-1 and Thrombojet®. Material and Methods: Peyronie’s plaque was induced in 10 adult male Sprague Dawley rats with intra-tunical injection of TGF β-1 and 3% Thrombojet® (sodium tetradecryl sulphate) carrier solution. Serum C-reactive protein (CRP), Seldi-TOF-MS and immunohistochemistry was performed at 1, 2, 4, 6 and 8 weeks to evaluate the outcome of the Peyronie’s plaque. Cavernous nerve stimulation with changes to the intra-cavernosal pressure during those intervals will be evaluated to assess the effect of Peyronie’s plaque on erectile function. Results: Thrombojet® solution injected intra-tunically appears to stabilise the Peyronie’s plaque formation and demonstrate loss of elastic fibres, formation of a plaque and evident penile deformity. The presence of Peyronie’s plaque induced via Thrombjet will be assessed for changes in CRP levels and protein profile using Seldi-TOF-MS, immunohistochemistry and intracavernosal pressure. Conclusions: This novel technique may represent an important novel model of Peyronie’s disease, providing an opportunity for further insight into this pathogenic process. Disclosure: Work supported by industry: no. The presenter or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.

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Introduction: It is well recognized that corpus cavernosal smooth muscle (CCSM) structural changes occur after cavernous nerve (CN) injury. Evaluating these changes has been difficult without penile biopsy or animal necropsy. The development of a non-invasive means of quantifying CCSM changes would aid in the understanding of the pathophysiology of post-radical prostatectomy erectile dysfunction (ED) as well as the evaluation of strategies aimed at preventing erectile tissue damage. This series of experiments was undertaken to define if an MRI reference region contrast distribution volume model, could be used as an imaging tool for rat erectile hemodynamics. Methods: DCE scans were performed on a Bruker Biospec 4.7T MR unit (Bruker Bio-spin MRI, Billerica, MA) using a custom-made solenoid coil (ID 7 mm, length 2 cm) with Gd-DTPA (0.2 mmol/kg) injected via tail vein. 27 Sprague-Dawley rats divided into 3 groups were studied: sham group—no CN crush, no sildenafil; control group—CN crush, no sildenafil; treatment group—CN crush, 20 mg/ kg sildenafil SC daily for 28 days post CN crush. All animals were imaged first in flaccid state and were then injected intra-cavernosally with 5 mg papaverine prior to a repeat DCE MRI scan. The reference region Logan plot was used to calculate the relative distribution volume (rDV) for Gd-DTPA. rDV means and medians were computed for all three groups for both flaccid and erect states. Student’s t-test was performed for statistical comparison. Results: Sildenafil treatment resulted in significant improvement in contrast enhancement. A statistical comparison of rDV for all the groups is shown in the Figure. The post-papaverine values in the treated group had significantly greater rDV values compared with the control and sham groups (P < 0.02). In the flaccid state, the treated group also showed larger rDV compared to the other two groups, however, the difference did not reach statistical significance. Conclusion: The data show that DCE MRI is a sensitive, non-invasive imaging modality capable of detecting penile vascular volume changes. Combined with earlier data demonstrating different wash-in times in these groups, we believe DCE MRI may represent a useful tool for evaluating erectile function in post-RP patients.

Sanguinetti, H; Cao, G; Mazza, ON; Toblli, JE; Becher, EF University of Buenos Aires / Argentina

Disclosure: Work supported by industry: no.

Objective: Hypertension causes cavernous tissue damage not only by altering the smooth muscle (sm)/collagen ratio but also compromising its contractility. The objective of this presentation is to describe the ultra structural changes in cavernosal sm cells of SHR-SP rats using a semi quantitative score. Methods: The cavernous tissue of 8 SHR-SP rats was analyzed with electron microscopy. Ultra fine slices were evaluated with variable magnification between 12,500× and 40,000×. We assessed the presence of swelling, vacuolization and blurring of the mitochondrial cristae in at least 5 sm cells per animal. We scored the damage as being: Grade 0: no damage, Grade 1: lesions in half the analyzed cells and Grade 2: lesions in more than half of the analyzed cells. Results: All the animals showed Grade 2 damage in all but one sm cell of rat No. 5, where some normal mitochondria were found. We also found mitochondrial damage in adjacent endothelial cells and also fibroblast surrounding collagen suggesting active fibrosis production. Conclusions: The mitochondria of cavernosal sm cells and surrounding endothelial cells are severely damaged in SHR-SP rats. Active fibrosis production in corpus cavernosum was also found. These findings expose the cavernosal ultra structural damage found in hypertensive rats explaining the deleterious effect of hypertension in normal sexual function.

Relative Distribution Volume (rDV)

ULTRA STRUCTURAL DAMAGE OF CAVERNOUS TISSUE IN STROKE PRONE SPONTANEOUS HYPERTENSIVE RATS (SHR-SP)

Tal, R; Bennett, NE; Le, HC; Winkelman, D; Koutcher, JA; Mulhall, JP MSKCC

Disclosure: Work supported by industry: no.

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1.2 1 0.8 flaccid papaverin

0.6 0.4 0.2 0 treated

sham

control

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CGMP REGULATES CHLORIDE EFFLUX IN NORADRENALINE-INDUCED ANTIERECTILE RESPONSE IN CORPUS CAVERNOSUM Lau, LC1; Adaikan, PG1 1: Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore Objective: Calcium-activated chloride current induces depolarisation and contraction of corpus cavernosum (CC). However, the mechanistic regulation of this chloride current has not been fully understood. The present study, therefore, aimed to provide further insight on the possible involvement of NO-cGMP pathway in modulating the chloride efflux in noradrenaline-induced CC contraction. Methods: Isolated rabbit CC strips were suspended in organ baths for isometric tension recording. Chloride-free (Cf) Tyrode solution was prepared by substituting NaCl, CaCl2 and KCl with equivalent molar concentrations of the respective acetate salts. Concentration-response relationship of noradrenaline was evaluated in Cf buffer. The effects of 3-(5′-hydroxymethyl-2′-furyl)-1-benzylindazole (YC-1; guanylate cyclase activator), nitroglycerin (NO donor), Nω-nitro-Larginine (NO synthase inhibitor), sildenafil and vardenafil (PDE5 inhibitors) on peak contraction and plateau phase of noradrenaline response generated in Cf buffer were examined. The ability of nitroglycerin and vardenafil in reversing noradrenaline-induced tone in Cf medium was also compared. Results: Cf buffer augmented contractile response to noradrenaline and shifted the concentration-response curve to the left (n = 6). On the CC precontracted with noradrenaline in normal Tyrode, nitroglycerin (1–10 μM, n = 6), YC-1 (30 μM; n = 6), sildenafil (1–10 μM, n = 5) and vardenafil (1–10 μM; n = 6) induced significant relaxation of the tone. However, YC-1, sildenafil and vardenafil were capable of diminishing the peak contraction and the tonic component of the noradrenaline contraction augmented by the withdrawal of extracellular chloride. Though noradrenaline contraction in Cf buffer was enhanced by Nω-nitro-L-arginine (50 μM, n = 6), the magnitude was not statistically significant compared to that in normal buffer. Both nitroglycerin and vardenafil mediated concentration-dependent relaxation when applied during the plateau phase of the contraction induced by noradrenaline in Cf buffer. Conclusion: cGMP appears to regulate chloride movement underlying the tonic contractile mechanism characteristic of noradrenaline in CC. Nitroglycerin, which effectively reverses noradrenaline-induced tone in Cf buffer, probably acts on another intracellular target in the downstream signal transduction process. Suppression of chloride efflux by cGMP pathway may thus prime the CC for penile erection. Disclosure: Work supported by industry: no.

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INHIBITION OF RHO-KINASE PREVENTS APOPTOSIS AND ERECTILE DYSFUNCTION IN CAVERNOUS NERVE INJURED RATS Bivalacqua, TJ1; Gratzke, C2; Stief, C2; Champion, HC3; Lysiak, J4; Burnett, AL1 1: Johns Hopkins Hospital; 2: Ludwig-Maximilians-University; 3: University of Pittsburgh; 4: University of Virginia Objective: The role of RhoA/Rho-kinase (ROCK) signaling in the penis after cavernous nerve injury (CNI) has not been fully investigated. The purpose of this study was to: 1) characterize the molecular expression profiles of RhoA/ROCK signaling and apoptosis in the penis after CNI, and 2) determine the effect of ROCK inhibition on erectile function, RhoA/ROCK signaling, and apoptosis in the penis after CNI. Methods: Three groups of rats were utilized: 1) sham, 2) bilateral CNI (crush injury; BCNI), and 3) BCNI treated with Y-27632 (ROCK inhibitor, 5 mg/kg/BID). At 14 days after BCNI, groups underwent cavernous nerve stimulation to determine erectile function. Penes were

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assessed at baseline for protein expressions of neuronal nitric oxide synthase (nNOS), RhoA, ROCK1, and ROCK2 by western blot, activated RhoA-GTPase and total ROCK activities, as well as apoptotic index (Apostain) in the endothelium and smooth muscle cells of the penis. Results: Erectile function was reduced (P < 0.05) in BCNI rats. nNOS protein levels were significantly decreased (P < 0.01) whereas RhoA and ROCK2 protein levels were significantly increased (P < 0.05) in BCNI rat penes. ROCK1 protein expression was equivalent. Activated RhoA-GTPase and total ROCK activities were significantly increased (P < 0.05) in BCNI rat penes compared to sham. ROCK inhibition with Y-27632 resulted in a reduction (P < 0.05) in penile RhoA GTPase and total ROCK activities after BCNI and prevented ED in BCNI rats. Apotosis was significantly increased in the endothelium and corporal smooth muscle cells of the penis after BCNI which was prevented by ROCK inhibitor therapy. Conclusion: These data suggest that upregulation of RhoA/ROCK signaling in response to CNI contributes to penile vasculature dysfunction after nerve injury. Inhibition of ROCK prevented ED in CNI rats via a reduction in RhoA/ROCK signalling and prevention of corporal endothelial/smooth muscle apoptosis. The RhoA/ROCK pathway may thus represent a suitable target in the treatment of postradical prostatectomy ED. Disclosure: Work supported by industry: no.

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SILENCING MAXIK ACTIVITY IN CORPORAL SMOOTH MUSCLE CELLS INITIATES COMPENSATORY MECHANISMS TO MAINTAIN CALCIUM HOMEOSTASIS Calenda, G; Suadicani, S; Iglesias, R; Spray, D; Melman, A; Davies, K Albert Einstein College of Medicine/USA Objectives: The MaxiK potassium channel is a regulator of smooth muscle (SM) tone. In the corpus cavernosum (CC) misregulation can result in erectile dysfunction (ED). We have demonstrated in animal models of ED that transfer of vectors expressing MaxiK into the CC normalizes erectile function, and MaxiK gene therapy has been evaluated in Phase I clinical studies for the treatment of ED. Because of the tight functional linkage of MaxiK and calcium channel activity, we have investigated the effects of silencing and pharmacological inhibition of MaxiK on calcium homeostasis and intercellular calcium signalling in CCSM cells to better understand the role of MaxiK in erectile physiology. Materials and Methods: Silencing of MaxiK by siRNA in rat CCSM cells was confirmed by quantitative RT-PCR, western blot and electrophysiological recordings. We compared changes in the basal intracellular Ca2+ concentration ([Ca2+]i) and parameters defining intercellular calcium wave (ICW) spread in 48 h MaxiK silenced CCSM cells versus acute blockade of the channel with iberiotoxin (IBTX). We performed microarray analysis following MaxiK silencing for 48 h. Results: 48 h after siRNA treatment of rat CCSM cells, MaxiK gene expression was decreased 83+/−0.09%, resulting in significant down regulation of protein expression and activity. However, MaxiK silencing of the basal [Ca2+]i, the ICW amplitude and spread among CCSM cells were not markedly different in silenced compared to controls. In contrast, short-term blockade significantly increased the basal [Ca2+]i level and Ca2+ signalling among CCSM cells. Microarray analysis revealed that several genes with significantly altered expression are within Ca2+ homeostasis pathways. Conclusions: Ca2+ homeostasis is significantly affected by short term blockade of the MaxiK channel, while basal [Ca2+]i and ICW parameters are comparable to controls after 48 h of MaxiK silencing. Interestingly, our results suggest that compensatory mechanisms are triggered during the 48 h period following silencing of the channel that function to maintain Ca2+ homeostasis. We suggest that such modulation can only be possible if different pathways regulating the smooth muscle tone are linked through molecular crosstalk. Disclosure: Work supported by industry: no.

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using the CO2 rebreathing technique and overall cardiac function, represented by cardiac power output (CPO = CO × Mean Arterial Pressure (MAP)), was determined at rest and at maximal exercise. Differences between the groups for each variable were analysed using independent t-test. Results: Exercise duration (ExD) and peak aerobic capacity were significantly lower in men with ED (P < 0.01), there was some significant difference in peakVO2 (P = 0.05) and peak CO (P = 0.05), see Table 1. There was no significant difference noted in peak heart rate, peak MAP or peak CPO. Conclusion: Men with ED have significantly reduced exercise capability when compared to healthy controls. However, this could not be accounted for by impaired cardiac functional capacity, suggesting that other peripheral or metabolic factors may be responsible for the limitation in exercise capacity.

MEN’S ENDORSEMENT OF MODELS OF SEXUAL RESPONSE AND MOTIVATION FOR SEXUAL ACTIVITY Sand, M1; Giraldi, A2; Kristensen, E2 1: Boehringer-Ingelheim Pharma, USA; 2: Sexological Clinic, Copenhagen, Denmark Objectives: Several theoretical models of male sexual response, described as linear models [Masters & Johnson (M&J) and Kaplan], have been accepted as accurate and relevant to men, despite a lack of evidence that men endorse these models. Recently Basson described a circular model specifically addressing women. The aim of this study was to investigate the extent to which men endorse these three models of sexual response and motivations for sexual activity. Materials and Methods: A representative sample of 2004 Danish men aged 20–65 years was mailed a 91-item questionnaire that assessed their perception of models of sexual response and motivation for engaging in sex, demographic data, satisfaction with sexual life and sexual dysfunction measured by the International Index of Erectile Function (IIEF). Results: 499 (25%) men responded. Of these, 430 (86.2%) had a current partner or a partner within the last year. Of these, a majority of the men endorsed the M&J (48%), or the Kaplan model (39%), whilst a minority endorsed the Basson model (5%) or none of the models (7%). Mean IIEF score was significantly higher in men endorsing the M&J and Kaplan models than the Basson model or none of the models (P < 0.001). Significantly more of the men without ED (91%) than men with severe or moderate ED (IIEF < 17) (65%) endorsed the M&J or Kaplan model (P < 0.001). When asked about motivation for sexual activity, based on descriptions of the models, 39% indicated wanting sexual arousal,(the M&J model), 46% sexual thoughts and/or fantasies (the Kaplan model), 6% other reasons i.e the wish of intimacy (the Basson model) and 9% none of these, as motivation for sexual activity. Conclusion: These are the first data to assess the proportion of men who endorse different models of sexual response. A majority of men endorsed the M&J or Kaplan model, whilst only a small percentage endorsed the Basson model. Significantly more men with ED endorsed the Basson or no model compared to men without ED. A majority of men described their reasons for sexual activity as the wish to be sexually aroused or because of sexual thoughts and/or fantasies. Disclosure: Work supported by industry: yes, by Boehringer-Ingelheim (industry funding only—investigator initiated and executed study). The presenter or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.

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CARDIORESPIRATORY FITNESS IN MEN WITH ERECTILE DYSFUNCTION Baldo, O1; Lewis, NT2; Tan, LB2; Summers, LKM2; Eardley, I3 1: Leeds Teaching Hospitals; 2: Division of Cardiovascular & Diabetes Research, LIGHT Laboratories, University of Leeds; 3: Leeds Teaching Hospitals Introduction and Objective: Cardiorespiratory fitness (CRF) and metabolic syndrome are independent predictors for development of cardiovascular diseases. Men with erectile dysfunction (ED) have increased risk of developing metabolic syndrome. Do men with ED have reduced aerobic capacity and cardiac reserve? We aim to examine the differences in CRF and cardiac functional capacity in men ED versus potent controls. Methods: 21 men with ED and 29 potent controls were assessed using cardiopulmonary exercise testing (CPX). Both groups were matched for age and body mass index (BMI). Central haemodynamics, including peak heart rate (HR), peak mean arterial pressure (MAP) and peak oxygen uptake (VO2) as an index of CRF, were studied during maximal treadmill CPX. Cardiac output (CO) was measured non-invasively,

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Table 1

Means ± standard deviations for group differences ED Group

Exercise Duration (ExD) Peak VO2 (CRF) Peak CPO Peak CO Peak MAP

8.7 ± 2.63 min

Non-ED Group

Significance

11.55 ± 3.18 min

<0.01

31.7 ± 5.6 mls.kg.min−1

35.9 ± 9.5 mls.kg.min−1

0.05

6.0 ± 1.6 W 23.5 ± 4.7 L.min−1 113 ± 23.9 mm Hg

6.5 ± 1.3 W 25.9 ± 3.8 L.min−1 111 ± 11.7 mm Hg

0.33 0.06 0.74

Disclosure: Work supported by industry: no.

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SERUM HOMOCYSTEINE LEVELS AND SILDENAFIL 50 MG RESPONSE RATE IN YOUNG-ADULT MALE PATIENTS WITHOUT VASCULAR RISK FACTORS Basar, MM1; Ozkan, Y2; Kisa, U3; Simsek, B2 1: Univeristy of Kirikkale Faculty of Medicine, Department of Urology; 2: Gazi University, Faculty of Pharmacy, Department of Biochemistry; 3: Univeristy of Kirikkale Faculty of Medicine, Department of Clinical Biochemistry Objective: In the present study, we evaluated serum homocysteine level in young-adult males suffered from erectile dysfunction (ED) compared with healthy subjects. Material and Methods: All patients suffered from ED were evaluated in Andrology Out patients. After taking detailed history, the patients having risk factors for vascular pathologies were excluded from the study. A total of 28 men suffered from ED aged between 26–49 years old were enrolled into the study. IIEF scale was filled by all patients, and sildenafil 50 mg were given at least 4–6 doses, and IIEF scale were filled again two months later. Twenty healthy subjects in same age period were accepted as control group. IIEF scale and serum homocysteine levels in patients and healthy controls, and in patients responders and non-responders to sildenafil 50 mg were compared by using Independent- t test. Results: Average age was 40.2 ± 7.5 in patients, and 38.6 ± 8.2 in healthy controls (P = 0.632). Mean IIEF score and homocysteine levels were 11.9 ± 6.5 and 13.2 ± 4.3 μmol/L in patients, and 28.5 ± 1.5 and 10.4 ± 2.4 μmol/L in healthy subjects, respectively. There was a statistical significant difference between two groups based on compared parameters (pIIEF = 0.000, pHomocysteine = 0.037). While 13 patients (46.4%) achieved sufficient erection for sexual intercourse, 15 patients (53.6%) were not. Average age was 39.8 ± 8.5 in sildenafil nonresponder patients, and 40.5 ± 6.9 in sildenafil responders (P = 0.833). Mean IIEF score and homocysteine levels were 8.7 ± 5.6 and 13.9 ± 4.7 μmol/L in patients non-responder to sildenafil, and 15.7 ± 5.5 and 12.5 ± 3.8 μmol/L in patients sildenafil responders. There was no statistical difference between two groups based on homocysteine levels (0.393). Conclusion: Serum homocysteine levels may be a marker for the evaluation of sildenafil response in young adult male patients suffered

Proceedings from the 14th World Meeting of the International Society for Sexual Medicine from erectile dysfunction, and should be used as a predictor for the vascular status in early period even though there were not vascular risk factors. Disclosure: Work supported by industry: no.

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RESPONSE RATE AND NUMBER OF RESPONDENTS DO NOT AFFECT THE OVERALL PREVALENCE RATE OF ERECTILE DYSFUNCTION: A META-ANALYSIS OF WORLDWIDE EPIDEMIOLOGICAL LITERATURE Linn, DJ1; Laumann, EO2; Lewis, RW1; Xu, H1; Rutherford, R1; Nourparvar, P1 1: Medical College of Georgia; 2: University of Chicago Objective: In 2009, the 2nd Consultation of the World Committee on the Definition, Classification, and Epidemiology of Sexual Dysfunction recognized the need to expand the criteria for rating the level of evidence of epidemiological literature outlined by Prins et al. with regard to participants and nonresponders. To earn a point on the Prins scale of evidence-based criteria, a response rate of >70% or sufficient information on nonrespondents to demonstrate representativeness of the population must be demonstrated. The committee recommended adjusting these criteria to allow the inclusion of modern epidemiological studies that may not achieve so narrow a standard yet retain validity based upon other factors. Inclusion of female sexual dysfunction epidemiologic studies in the 2nd Consultation required a response rate (RR) of >40%. Our objective was to evaluate studies from the worldwide literature reporting the prevalence of male erectile dysfunction in order to test the association of RR and number of respondents (NR) with overall prevalence rates (OPR). Materials and Methods: Inclusion criteria included nationally or regionally representative data sets with available RR or NR and OPR data, published in peer-reviewed journals or books with at least a 10 of 15 score on the Prins scale. Seventy-two data sets met inclusion criteria for meta-analysis. The association of RR with OPR was analyzed using a two-sample t-test with 67 data sets divided into two groups based on RR (<40% n = 19; >40% n = 48). Analysis of variance in OPR was performed with data sets divided into 3 groups based on RR n = 67 (<40% n = 19; 40–69.9% n = 24; >70% n = 24) and NR n = 72 (<1000 n = 29; 1000–1999 n = 18; >2000 n = 25). Results: Average OPR in studies with RR < 40% and >40% was 23.55% and 21.07% respectively, with no statistically significant difference (P = 0.5687). Likewise, three-way analyses of variance of OPR with RR and NR averaged 23.55%; 18.05%; and 24.09% (P = 0.3616); and 20.78%; 26.76%; and 21.60% (P = 0.4411), respectively and did not achieve statistical significance. Conclusions: Our meta-analysis of male erectile dysfunction epidemiological literature does not support the use of stringent responserate or number-of-respondents criteria as requirements for evaluating otherwise internally valid epidemiologic studies. Consequently, a larger number of studies may be included when evaluating or reporting the worldwide prevalence of sexual dysfunction in the future. Disclosure: Work supported by industry: no.

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CHANGES OF SEXUAL FUNCTIONS DURING 1-YEAR TREATMENT WITH DUTASTERIDE IN BENIGN PROSTATIC HYPERPLASIA PATIENTS: COMPARISON WITH CHANGES OF VOIDING SYMPTOM SCORES AND BLOOD PROSTATE SPECIFIC ANTIGEN LEVELS Kim, SC; Chi, BH Chung-Ang University College of Medicine Objectives: This study was conducted to investigate when dutasteride, a 5andgron receptor inhibitor reduces sexual functions the most during 1-year treatment, how long the sexual dysfunctions last, and whether the dysfunctions correlate with reduction in voiding symptom scores and blood prostate specific antigen (PSA) levels. Materials and Methods: On 50 patients (62.3 ± 7.2 years) who had symptomatic benign prostatic hyperplasia (BPH) (International Prostate Symptom Score; IPSS 17.9 ± 6.6, prostate volume 49 ± 16 g), relatively good erectile function (International Index of Erectile Function- Erectile Function; IIEF-EF domain scores 22.0 ± 5.0) and sexual intercourse ≥1 per a month, changes of sexual functions were prospectively followed up using IIEF questionnaire at 1, 3, 6, 9, 12-month treatment of dutasteride and compared with reduction in IPSS scores and blood PSA levels. Results: All relative domains scores of EF (Q,1,2,3,4,5,15), orgasmic function (Q 9,10), sexual desire (Q 11,12), intercourse satisfaction (Q 6,7,8), and overall satisfaction (Q 13,14) decreased the most at 1month treatment (P < 0.01). The EF domain scores (baseline 22.0) gradually increased to 17.4, 19.0, 18.7, and 20.3 at 3, 6, 9, and 12month treatment from 15.7 of 1-month treatment. The scores of orgasmic function, sexual desire, and intercourse satisfaction statistically recovered to the baseline levels at 6-month treatment. But the scores of EF and overall satisfaction at 12-month treatment were still lower than the baselines (P < 0.05). There were no significant correlations among decrease in each domain score of IIEF, IPSS scores, and PSA levels. Conclusions: Dutasteride reduces all relative domains scores of IIEF the most at 1-month treatment. The sexual dysfunctions gradually recover to the level of baseline at 6-month treatment but EF and overall satisfaction scores remain significantly lower at 12-month treatment. The decreases in the sexual functions were not correlated with the reductions in voiding symptom scores and blood PSA levels. Disclosure: Work supported by industry: no.

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PREVALENCE OF ERECTILE DYSFUNCTION (ED) IN ASIA PACIFIC COUNTRIES Paick, JS1; Jiann, BP2; Yip, A3; King, R4 1: Seoul National University Hospital; 2: Kaohsiung Veterans General Hospital, Taiwan; 3: Kwong Wah Hospital, Hong Kong; 4: Sydney Centre for Sexual and Relationship Therapy, Australia Objective: Prevalence of erectile dysfunction (ED) among 2016 men in 13 Asia Pacific countries was determined using an online selfadministered questionnaire, in which the effect of ED on daily life was examined. Erection hardness was assessed according to the Erection Hardness Score (EHS), a validated tool. Methods and Materials: Erection hardness was categorized into 4 grades: EHS 4 = optimal erection, EHS 3 = suboptimal, EHS 2 = moderate ED and EHS 1 = severe ED. There were two separate measurements representing different levels of stress: rarely/never under stress and frequently/always under stress. Scale of importance was split into 5 categories, ranging from absolutely essential to not at all important. Satisfaction with daily life was classified into 5 categories ranging from completely satisfied to not at all satisfied.

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Result: Almost half of participants (45%) reported less than optimal erection (EHS 1-3) and this trend was fairly constant across countries. About 1 in 5 (24%) reported suboptimal erection (EHS 3) and the rates were significantly higher in several locations, such as Japan (35%), Hong Kong (34%), Malaysia (34%), South Korea (32%) and New Zealand (36%). Men with less stress (rarely/never under stress) were more likely to be satisfied with their erection hardness compared with men with more stress (46% versus 33%, respectively). They also tended to have significantly more good sex in a loving relationship than men with more stress (55% versus 34%, respectively). While men in optimal (EHS 4) and suboptimal erection groups (EHS 3) agreed that attraction to partner is important (47% and 44%, respectively), there was a significant difference in rates of satisfaction with feeling of attraction to partner (42% and 30%, respectively). Men with optimal erection were also remarkably more satisfied in daily life than those with suboptimal erection. Conclusion: In our study, the phenomenon of men with less than optimal erection was fairly common within the Asia Pacific region. Satisfaction with erection hardness for men had a significant relationship with daily stress, and was associated with satisfaction with sexual behaviour. Men with less than optimal erection were less satisfied with their attraction to their partner and less satisfied with daily life. A strong association was also observed between satisfaction with sex, and satisfaction with love and family. Disclosure: Work supported by industry: yes, by Pfizer Pharmaceuticals (no industry support in study design or execution).

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IMPROVEMENT OF INSULIN RESISTANCE AND ENDOTHELIAL FUNCTION IN PATIENTS WITH ERECTILE DYSFUNCTION BY ONCE A DAY TREATMENT WITH TADALAFIL 5 MG Kim, SC; Park, SJ Chung-Ang University College of Medicine Objectives: Recently, chronic low dosing of phosphodiesterase type 5 inhibitors has been reported to increase iNOS activity, endothelial function, and cavernosal smooth muscle/collagen ratio in men with increased cardiovascular risk or following radical prostatectomy. This study was conducted to investigate the effect of daily dosing of tadalafil 5 mg on improvement of insulin resistance and endothelial function in patients with erectile dysfunction (ED). Materials and Methods: On 73 patients with ED (57.05 ± 9.41 years, International Index of Erectile Function-erectile function domain scores; 10.79 ± 5.93) who took tadalafil 5 mg once a day for 3 months, IIEF-EF scores of baseline and post 3-month treatment were compared. Blood pressure, fasting blood levels of glucose, total cholesterol, HDL and LDL cholesterol, triglyceride, and hr-CRP, testosterone, insulin resistance (Homeostatic model assessment; HOMA-IR) and flow-mediated dilatation (FMD) of brachial artery at 3-month treatment were compared with those of baseline. Results: The IIEF-EF scores of 3-month treatment (20.81 ± 6.47) significantly increased (P < 0.001). Post 3-month treatment HOMAIR (1.06 ± 1.30, P = 0.029), C-peptide (1.06 ± 0.51), and FMD% (21.00 ± 17.42, P = 0.007) were significantly improved compared with baseline HOMA-IR (1.85 ± 1.35), C-peptide (1.31 ± 0.61), and FMD% (12.35 ± 6.52). Systolic and diastolic blood pressure dropped significantly. The other parameters were not significantly changed. The adverse effects (facial flushing, indigestion, headache in order) were tolerable. Conclusions: Daily dosing of tadalafil 5 mg for 3 months significantly improved insulin resistance and endothelial function in patients with ED. Disclosure: Work supported by industry: no.

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THE EFFECT OF DEPRESSION ON MALE SEXUAL FUNCTION Fabre, LF1; Smith, LC1; Derogatis, LR2 1: Fabre Kramer Pharmaceuticals, Inc. USA; 2: Sheppard Pratt Health Systems USA Objective: To estimate the prevalence of sexual dysfunction in men with Major Depression. Major Depression interferes with sexual function. Obtaining accurate estimates of the prevalence in the normal population with which to compare is difficult because the prevalence varies greatly in different estimates. Age, presence of diabetes, and cardiovascular illness greatly impacts the estimates. In men 18–59, various surveys have estimated prevalence: Hypoactive Sexual Desire Disorder (HSDD) 5–16%, Erectile Dysfunction 5–10%, and Premature Ejaculation 21–26%. Methods: In three studies of major depression, 430 men, 18–64 years old, average 38 y/o, were entered based on depressive symptoms, not sexual dysfunction. Additionally, these men had physical examinations, laboratory tests, and EKGs which excluded subjects with medical illnesses or taking other medications. At baseline (n = 430), before any treatment, a trained psychiatrist made diagnoses of sexual dysfunction based on DSM-IV criteria. The psychiatrist also employed a rating scale, the Derogatis Interview for Sexual Function (DISF), medical and family history records, and direct questioning. The DISF and its domains have been normed to the general population. The results here (n = 309) are presented as percentile (%ile) rank of the normal population. Results: The prevalence of DSM-IV diagnoses at baseline in this population of depressed men is: HSDD 8.8%, Sexual Aversion Disorder 0.7%, Erectile Dysfunction 7.9%, Male Orgasmic Disorder 3.7%, and premature ejaculation 3.5%. The DISF scores and %ile rank are: total DISF score 66, 12%ile; arousal domain score 13.3, 53%ile; behavior domain score 9.5, 18%ile; cognition (desire) domain score 22.7, 48%ile; drive/relationship domain score 9.0, 7%ile; and orgasm domain score 11.0, 2%ile. Conclusions: The results are surprising in that, while generally the subjects were at the low end of the normal population in terms of DISF scores, the numbers of subjects meeting criteria for DSM-IV sexual dysfunction diagnoses were small and within or below the range reported for the normal population. The rates of DSM-IV diagnoses fall within the normal range reported by others with the exception of premature ejaculation at 3.46%, which is low. The DISF scores indicate that depression affects domains of sexual function differently: desire and arousal are affected only modestly; orgasm and drive are affected severely. Disclosure: Work supported by industry: yes, by Organon (industry initiated, executed and funded study). The presenter or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.

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THE IMPACT OF PHYSICAL HEALTH AND SOCIOECONOMIC FACTORS ON SEXUAL ACTIVITY IN MIDDLE-AGED AND ELDERLY MEN Liu, CC; Juan, HC; Lee, YC; Wu, WJ; Wang, CJ; Ke, HL; Li, WM; Yeh, HC; Li, CC; Chou, YH; Huang, CH; Huang, SP Kaohsiung Medical University Hospital Objective: Sexual activity in older people has become a topic of growing interest, but few studies have been conducted in Asia because of a more conservative culture. The aim of this study is to evaluate the effect of physical health and socioeconomic factors on the sexual activity of middle-aged and elderly Taiwanese men. Materials and Methods: From August 2007 to April 2008, a free health screening for men older than 40 years was conducted by a medical center in Kaohsiung, Taiwan. At this screening, participants received detailed physical examination and answered questionnaires

Proceedings from the 14th World Meeting of the International Society for Sexual Medicine that collected demographic and lifestyle information, and medical history as well as answered items from the International Prostate Symptoms Score (IPSS) and five-item version of the International Index of Erectile Function (IIEF-5). Results: Of the 819 men who participated in this health screening, 744 were included (mean age: 57.4 ± 6.6 years; range: 43–87 years). Overall, 100 (13.4%) participants reported to be sexually inactive in previous six months especially in those over the age of 60, including 24.1% of participants aged 60–69 years and 51.2% of those aged 70 years or older. Older age, lower education levels, loss of a partner, erectile dysfunction, and increased number of comorbidities were found to be independent predictors for sexual inactivity. Conclusions: Most middle-aged and elderly Taiwanese men remain sexually active. In addition to erectile dysfunction and loss of a partner, lower education levels and increased number of comorbidities were found to be predictors for sexual inactivity. Further research would need to elucidate whether improvement of those factors could help to preserve sexual activity. Disclosure: Work supported by industry: no.

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ANALYSIS OF NATIONAL INSTITUTE OF HEALTH (NIH) GENDER-SPECIFIC RESEARCH FUNDING IN THE UNITED STATES OF AMERICA (USA) Pinkhasov, RM; Jhaveri, JK; Ghosh, P; Pinkhasov, M; Silver, D; Shabsigh, R Maimonides Medical Center Objective: Our previous studies have reported that men have a lower life expectancy than women. Men die nearly 5.2 years younger and suffer more severe chronic diseases than women. Men continue to have higher death rates in 12 out of 15 leading causes of death. Moreover, men are still less likely than women to seek medical care, and nearly half as likely to pursue preventive health visits or undergo important screening tests. There is a relative paucity of data that examines the usage of funding derived from the National Institute of Health (NIH) in the United States of America (USA). The purpose of our current study was to examine gender-specific research funding by the NIH in the USA in relation to common measures of burden of disease. Methods and Materials: We performed a cross sectional study correlating estimates of disease-specific and gender-specific research funding with measures of burdens of disease. Measures included in the study were incidence rate, prevalence, mortality rate, and disabilityadjusted life-years. Using these measures of burden of disease as explanatory variables in a regression analysis, predicted funding was calculated and compared with actual funding. Funding for mortality ratios in gender-specific disease was also subsequently calculated. Results: Mortality was weakly associated (r = 0.47, P = 0.001) and disability-adjusted life-years was strongly associated (r = 0.77, P < 0.001) with NIH research funding. For gender-specific funding, NIH breast cancer research funding continues to rise and is more than twice the amount for prostate cancer research. NIH research funding to mortality ratio is the highest for cervical cancer research (40.1:1) and lowest for uterine cancer research (6.8:1). It is also higher for breast cancer research (29.4:1) than for prostate cancer (13.6:1). When disability-adjusted life-years and mortality were used to predict expected funding, both prostate cancer and breast cancer are over funded. Over funding for breast cancer research is 3 times greater than prostate cancer research. Research funding data for testicular cancers and penile cancers were not available. Conclusions: Based on multiple measures, gender-specific research funding continues to show a pattern of under-funding for men’s health issues compared to women’s health issues. In the context of public health, addressing this gender disparity scientifically and objectively may provide an equal dispersal of research funding. Considering the cross-gender effects of burden of disease, correcting the gender disparity and providing a more equitable distribution of research funding will benefit everyone. Disclosure: Work supported by industry: no.

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ENDOTHELIAL DYSFUNCTION AND SYMPATHETIC SKIN RESPONSE IN DIABETES WITH ERECTILE DYSFUNCTION Singh, S; Patel, K; Mavuduru, RSM; Modi, M; Dutta, P; Agarwal, M; Mandal, A PGIMER Introduction: Endothelial dysfunction is a reflection of damage to the lining of arterial walls leading to impairment of nitrous oxide pathway and vasodilatation. Erectile dysfunction (ED) in diabetes is likely to be due to endothelial dysfunction and autonomic neuropathy. Methods: Participants in the study included age matched diabetes with ED (Group I n = 40) without ED (Group 2 n = 20), non diabetics with ED (Group 3 n = 16) and healthy controls (Group 4, n = 15). Participants with any cardiovascular disease, BMI more than 30, chronic kidney disease and any other cause of ED were excluded. They underwent evaluation with 11EF-5 questionnaire, biochemical tests including lipid profile, flow mediated dilatation (PMD) of brachial artery as a marker of endothelial dysfunction and sympathetic skin response (SSR). FMD was estimated using high resolution duplex ultrasound after creating flow stimulus by occluding brachial artery for 5 minutes with sphygmomanometer. FMD was expressed as maximum percentage increase in vessel diameter during the phase of reactive hyperaemia. ‘t’ test, chi-square test and pearson co-efficient of correlation were used for stastistical analysis. Results: All the four groups were comparable for their age, BMI and blood pressure. IIEF scores of Group I and Group 3 were significantly low as compared to Group 2 and Group 4. Serum cholesterol and serum LDL were significantly higher in patients with ED (Group I and Group 3). FMD was significantly low in diabetics with ED (6.1 ± 3.3%), without ED (9.9 ± 2.3%) and in non-diabetics with ED (6.9 ± 2.8%) as compared to controls (19.7 ± 6.6%). Diabetics with ED had significantly low FMD as compared to diabetics without ED (p = 0.002). Duration of diabetes was significantly more in patients having ED (8.1 ± 5.3 years vs 4.7 ± 4.8 years; P = 0.015). FMD had inverse correlation with duration of diabetes (r = −0.46; P < 0.001). Significantly high proportion of patients in group 1 had negative SSR as compared to Group 2 (18/40 vs 2/20; P = 0.007). Conclusions: Diabetic and non-diabetic patients with ED, have endothelial dysfunction and dyslipedaemia. Autonomic neuropathy may be contributory in causation of ED in diabetics. Diabetics without ED also have endothelial dysfunction which may get worsen with increasing duration of diabetes. Disclosure: Work supported by industry: no.

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OSTEOPOROSIS IN MALES WITH KLINEFELTER’S SYNDROME AND HYPOGONADOTHROPIC HYPOGONADISM Demirtaþ, A; Gökçe, A; Akýnsal, E; Ekmekçioðlu, O Erciyes University Medical Faculty/Turkey Objectives: Androgen deficiency poses males the risk of osteoporosis. In males attending with the complaint of infertility the risk of androgen deficiency is not low. Especially males with Klinefelter’s syndrome (KS) and hypogonadothropic hypogonadism (HH) have increased risk of osteoporosis. Our aims were to evaluate the degree of osteoporosis and androgen levels in these males. Material and Methods: The data of 56 males with KS and 13 males with HH without any prior androgen replacement therapy (ART) or the treatment for osteoporosis were evaluated retrospectively. Subjects were divided into subgroups as diagnosis groups (KS and HH) and according to the total testosterone (TT) levels (group I; >300 ng/dl, group II; 200–300 ng/dl, group III; 100–200 ng/dl, group IV; <100 ng/ dl. In DEXA evaluations lumbar (LBMD) and femoral (FBMD) bone mineral densities and t scores were compared between the groups. Results: In males with HH, TT levels and all DEXA parameter were significantly lower than males with KS (Table 1). When the

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comparisons were made according to the TT level groups, males in group IV had significantly lower bone mineral density levels and t scores (Table 2). Conclusions: Androgen deficiency is significant in males with KS and HH. Among them males with androgen levels less than 100 ng/dl are more prone to the risk of osteoporosis. Males attending for infertility with different syndromes should be evaluated for the risk of significant hypogonadism and osteoporosis.

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Table 1 The comparison of males with Klinefelter’s syndrome and hypogonadothropic hypogonadism

Permpongkosol, S; Veraasertniyom, O; Tongprsdit, S; Pettong, T; Putthapiban, Y; Ratana-olarn, K Faculty of Medicine, Ramathibodi Hospital, Mahidol University

KS (n:56) HH (n:13)

Total testosterone (ng/dl)

LBMD

Lumbar t score

FBMD

Femoral t score

249.7 36.1

0.94 0.70

−1.32 −3.46

0.88 0.70

−0.72 −2.39

KS : Klinefelter’s syndrome; HH: hypogonadothropic hypogonadism.

Table 2

The comparison of DEXA results according to TT levels

Total testosterone (ng/dl)

LBMD

Lumbar t score

FBMD

Femoral t score

>300 (n:18) 200–300 (n:17) 100–200 (n:14) <100 (n:20)

0.96 0.95 0.93 0.75

−1.06 −1.18 −1.35 −3.05

0.89 0.93 0.86 0.73

−0.63 −0.28 −0.99 −2.09

Disclosure: Work supported by industry: no.

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FREQUENCY OF SEX AND MASTURBATION IN JAPANESE MEN INVESTIGATED BY INTERNET QUESTIONNAIRE Nakajima, K; Nagao, K; Tai, T; Kobayashi, H; Hara, H; Ishii, N Toho University, Japan Objective: The 2005 Durex Global Sex Survey reported that the rate of intercourse among Japanese was the lowest of all countries surveyed. The present study used an internet survey to determine the rates of sexual activity (intercourse and masturbation) in Japanese men. A total of 7710 Japanese men aged 20 to 69 years responded to the survey. Material and Method: A total of 7710 random Japanese men aged 20 to 69 years responded to the survey. This survey was performed by internet since March 19th to May 31st, 2009.The questionnaire consists of seven items which are concerning presence of habit of drinking and smoking, presence of complications such as metabolic syndrome. Erection hardness score, frequency of intercourse and masturbation also includes this questionnaire. Results: A total of 71.9% of the respondents reported having had intercourse, and 91.6% reported having masturbated, during the 1year period before the survey. The respondents reported that their average frequency of intercourse leading to ejaculation was 2.0 times/ month; the frequency of ejaculation by masturbation was 5.6 times/ month. Thus, ejaculation during masturbation was more common in Japan. Regarding to marriage status, single group had high frequency of masturbation at all the ages. Regarding to child’s presence status, no child group had high frequency of intercourse than have child group at 20–29 ages. Conclusions: This survey revealed sexual activity of Japanese men is not low at all. It is as understanding from the result in which frequency of masturbation is higher than frequency of intercourse. It is thought that the factor to decrease frequency of intercourse is in a Japanese society such as the working hour is long or the time spent with the family is a little. Disclosure: Work supported by industry: no.

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THE RELATIONSHIP BETWEEN ANDROGEN RECEPTOR GENE CAG REPEATS LENGTH AND LONG TERM OUTCOME OF INTRAMUSCULAR TESTOSTERONE UNDECANOATE THERAPY IN 190 THAI LATE ONSET HYPOGONADAL MEN

Background: If Androgen receptor (AR) CAG repeat polymorphism is increased, the reduction of sensitivity of AR is occurred. Furthermore, CAG repeat length, late onset hypogonadism (LOH) and the long term effects of long-acting testosterone undecanoate (TU) in a large number of Thai LOH men have not yet been reported. Objective: We analyzed the effects of normalization of plasma testosterone (T) and CAG repeat polymorphism in such Thai men. Material and Methods: Genomic DNA was extracted from peripheral blood and the CAG repeat region was amplified by PCR. Fragment analysis and sequencings was performed. We confirmed the results with electropherogram and chromatogram (gene scan).The records of 190 men with LOH were reviewed and 133 men had used parenteral TU for >12 months. The mean duration of treatment was 110 weeks (54 to 182 weeks). Of them body mass index (BMI), waist circumference, percentage body fat, total cholesterol, HDLcholesterol, LDL-cholesterol, triglycerides, PSA and hematocrit were measured. Further the Aging Male Symptoms’ scale (AMS) and the International Index of Erectile Function (IIEF-5 and 15) were scored. Results: The repeat length CAG was between 14–31. The most CAG length was median (20–23) with low testosterone. Men with longer CAG receptor had higher levels of total T and AMS score. There was no association between repeat length and any of the anthropometric measure. Testosterone therapy was associated with a significant decline of waist circumference (P = 0.039) and of percentage body fat (P < 0.001), but no change of BMI. Total cholesterol and LDL cholesterol declined significantly (P = 0.017 and P = 0.037, respectively) and HDL cholesterol increased significantly (P = 0.009), with no significant changes of triglycerides. The scores of sub-scales of AMS (psychological, somotovegetative and sexual factors) decreased (P = 0.045, P = 0.201 and P = 0.076, respectively). The mean IIEF-5 (P = 0.016) and IIEF-15 scores (P = 0.035) improved no significantly. Erectile function domain, orgasmic function domain, sexual desire domain, intercourse satisfaction domain and overall satisfaction domain improved. Median PSA rose from 0.926 (0.591; 1.538) ng/mL to 1.42 (0.995; 2.165) ng/ mL (P < 0.001*), with 5 patients >4 ng/mL (4.01–13.21). On biopsy there was no evidence for malignancy. The mean haematocrit level increased significantly from 41.94 ± 3.53% to 46.40 ± 4.17%. Conclusions: The results suggested the AR CAG repeat length correlates with serum T of aging men. Normalizing serum T in men with LOH resulted in improvement of the metabolic syndrome, mood and sexual functions and appeared acceptably safe. Disclosure: Work supported by industry: no.

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THE SEXUAL HEALTH AND OVERALL WELLNESS SURVEY ASSESSMENTS OF AGE EFFECTS ON SEXUAL HEALTH AND SATISFACTION IN MEN AND WOMEN FROM THE ASIA-PACIFIC REGION Lee, EG Monash University, Malaysia Objective: The Asia-Pacific Sexual Health and Overall Wellness (APSHOW) survey assessed sexual satisfaction and health, including the Erection Hardness Score (EHS), in 13 Asia-Pacific countries between May and July 2008 via Internet surveys or street intercept

Proceedings from the 14th World Meeting of the International Society for Sexual Medicine interviews of 3,957 male and female participants aged 25–74 years who were sexually active (defined as intercourse ≥1 time in the past 12 months). This abstract further examines the APSHOW data, assessing effects of age on outcomes in men. Material and Methods: For 17 life priorities (sex, family life, physical health, being a spouse/partner, financial well-being, being a parent, work or career, exercise, social life, gaining wisdom, leisure time, love and romance, prestige, spirituality, hobbies, community involvement, and religious activities), 5-point Likert scales were used to categorize importance (from absolutely essential to not at all important) and satisfaction (from completely satisfied to not at all satisfied). The top 2 ratings were reported. Mean EHS scores were compared using the 2sample t-test, and proportions were compared using the z-test. Statistical significance was reached when P < 0.05. Results: Of the 2016 men, 55% were aged <40 years and 45% were aged ≥40 years. When the life priority items were scored, sex was ranked tenth of those categorized as “absolutely essential” or “very important” by the older age group (51% of men) vs seventh (60% of men) by the younger age group (P < 0.05). Fewer older men compared with younger men considered sex “absolutely essential” (17% vs 25%, P < 0.05) or were “completely satisfied” with sex (13% vs 21%, P < 0.05). Erection hardness was rated optimal (EHS 4) by 64% of younger men vs 47% of older men and rated incomplete but sufficient for penetration (EHS 3) by 20% vs 28% (both P < 0.05). Conclusion: In the Asia-Pacific region, sex was a lower life priority and less satisfying for older men than younger men. This may be a consequence of the shift of erection hardness from optimal EHS 4 to EHS 3, a suboptimal erection status. Disclosure: Work supported by industry: yes, by Pfizer Inc (industry initiated, executed and funded study).

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CORRELATION OF AGING MALE SURVEY TO TESTOSTERONE LEVELS: DETECTION OF HYPOGONADISM Jhaveri, JK; Pinkhasov, RM; Murdakhayev, M; Kashanian, J; Lee, M; Shabsigh, R Maimonides Medical Center Objective: It is well established in literature that serum testosterone levels decrease with increasing age in males. As a result, a myriad of presenting symptoms could alert patients to visit clinicians. At our program we have established a men’s health database which utilizes validated surveys to interpret symptomatology from our urological patients in Brooklyn, NY USA. The purpose of this study was to ascertain if a specific series of independent questions from the Aging Men Survey (AMS) could be used to accurately predict low serum testosterone levels. Methods and Materials: We performed a cross sectional study using ordinal logistic regression in order to correlate serum testosterone levels to severity of symptoms identified by the AMS. Odds ratios were also calculated between reference and non-reference groups. Specific questions from the AMS survey were chosen in order to determine their accuracy in predicting signs or symptoms of hypogonadism. The specific questions used were: “1—decline in your feeling of general well-being”, “9—physical exhaustion / lacking vitality”, “10—decrease in muscular strength”, “11—depressive mood”, “16—decrease in number of morning erections”, “17—decrease in sexual desire/libido.” The reference group was determined to be those without symptoms, while the non-reference group was those who did experience symptoms related to the aforementioned questions. Data was statistically analyzed using SPSS software programming. To define hypogonadism, a testosterone cutoff level value of 300 ng/dl in the presence of at least one symptom of hypogonadism was used. Results: Reviewable data were available for 59 patients. Ordinal Logistic Regression Analysis determined that in regards to muscle strength, as testosterone values decreased, the odds of the non-reference group (symptom group) of selecting “severe symptoms” [1.68 (P = 0.031)] and “extremely severe symptoms” [2.85 (P = 0.12)] were

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higher than the reference (non-symptom) group. No other variables (lacking vitality, depressive mood, decreased number of morning erections, or decrease in libido) revealed any statistically significant results. Calculating odds ratios, men who reported “moderate, severe or extremely severe decline” in “general state of well-being” had a greater than 6-fold increase [6.37 (95% CI: 1.36, 29.4)] of being hypogonadal than those who had “none or mild” symptoms. Also men who reported “moderate, severe, or extremely severe” decline in muscular strength had a greater than 4-fold increase [4.44 (95% CI: 1.22, 16.13)] of being hypogonadal when compared to those with “none or mild” symptoms. Odds ratios were computed for vitality, depressive mood, decrease in morning erections, and libido but failed to reach statistical significance. Odds ratios comparing International Prostate Symptoms Scores (IPSS) and International Index of Erectile Function Scores (IIEF) did not reveal significant findings. Conclusions: Using ordinal logistic regression analysis, muscle strength was identified as a potential symptom which could prompt the clinician to investigate the diagnosis of hypogonadism. Our data also suggests that patients’ “general state of well-being” could be a useful predictor for hypogonadism as well. All other analyses did not reveal statistically significant data. We are currently in the process of enrolling patients into our program in order to increase the power of our studies. Larger series will be required to determine whether these conclusions can be applied to larger populations. However, these data suggest that using this simple questionnaire as a screening tool during clinic visits could encourage clinicians to explore the possibility of occult hypogonadism. Disclosure: Work supported by industry: no.

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EFFECTS OF TESTOSTERONE REPLACEMENT THERAPY ON GLUCOSE HOMEOSTASIS, VISCERAL OBESITY AND SEXUAL FUNCTION IN MIDDLE-AGED MEN WITH TYPE 2 DIABETES AND ANDROGEN DEFICIENCY Cedres, S; Serra, P; Palasti, S; Dufrechou, C Introduction: Short-term studies have shown that testosterone replacement therapy (T) has a beneficial effect on visceral obesity and glycaemic control in men with diabetes and diagnosed hypogonadism. Objective: To assess the effects of testosterone supplementation therapy on glucose homeostasis, visceral obesity and sexual function in middle-aged men with type 2 diabetes and androgen deficiency. Material and Methods: Eighty-six middle-aged men, with type 2 diabetes, visceral obesity and androgen deficiency (Free testosterone ≤7,2 ng/dL), were included in this study. Forty three subjects received T (Testosterone enanthate (250 mg) in oil vehicle deep intramuscular every 2 weeks, 12 injections); 43 subjects received no treatment. Body composition was analyzed by bio-impedance. Parameters of metabolic control were determined. Symptoms of androgen deficiency were scored by selfadministered questionnaires. The non-parametric Mann-Whitney Utest was used to determine the differences between the groups. All test were done two-sided, and P < 0.05 was considered statistically significant. Statistical analyses were performed with SPSS version 15.0. Results: 6 months follow up, T had a statistically significant reduction in visceral obesity (−2,54 %) body weight (−3.72 %), and body fat (−4.58%). T significantly improved metabolic control: decrease in blood glucose values and mean glycated hemoglobin (HbA1c) (from 11.2 to 7.6%). It also improved symptoms of androgen deficiency. There was no statistically significant change in the control group. Conclusion: T treatment of type 2 diabetic men with androgen deficiency improves glucose homeostasis, body composition, and symptoms of androgen deficiency. Disclosure: Work supported by industry: no.

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and sleep recovery in both groups were analysed. For statistical analysis, Mann Whitney U-test was used. P value less than 0.05 to be statistically significant. Results: In young group, serum testosterone, LH and FSH levels continued to fall in sleep deprivation period and there were significant differences in their levels compared to the controls after 5 days of sleep deprivation (P = 0.001, 0.015, 0.010) (Table 1). In elder group, after 3 days of sleep deprivation, serum testosterone, LH and FSH concentrations reached nadir level with significant differences compared to the controls (p < 0.001, 0.031, 0.047) (Table 1). On sleep recovery, testosterone, LH and FSH levels continued to rise in sleep recovery period in both groups. In testosterone level, young group showed rapid recovery within 3 days of sleep recovery with significant increase of testosterone level (P = 0.047) (Table 2), whereas elder group showed significant increase of testosterone level after 5 days of sleep recovery (P < 0.001) (Table 2). Conclusions: Paradoxical sleep deprivation and sleep recovery had a significant influence on serum testosterone level through the effects on hypothalamic pituitary axis in both young and elder rats. However, the young group showed slow decrement of testosterone concentration during sleep deprivation and rapid increment after sleep recovery, whereas the elder group showed rapid drop of testosterone level after sleep deprivation and slow increase after sleep recovery.

EFFECTS ON SEXUAL, DEPRESSIVE AND AGEING MALE SYMPTOMS IN HYPOGONADAL MEN TREATED WITH TESTOSTERONE SUPPLEMENTATION: RESULTS FROM A RANDOMIZED, PLACEBOCONTROLLED, DOUBLE-BLIND TRIAL Saad, F1; Kalinchenko, S2; Tishova, Y2; Mskhalaya, G2; Gooren, L3; Giltay, E4 1: Bayer Schering Pharma; 2: People’s Friendship University, Moscow, Russian Federation; 3: VUMC, Amsterdam, The Netherlands; 4: Leiden University Medical Center, Leiden, The Netherlands Objectives: Low androgen levels in men are associated with the metabolic syndrome as well as with sexual, subjective somato-vegetative and psychological symptoms. The effects of testosterone administration on these symptoms have not extensively been studied. Material and Methods: In a randomized, placebo-controlled, doubleblind, phase III trial (ClinicalTrials.gov identifier: NCT00696748), 184 men suffering from both the metabolic syndrome and hypogonadism (total testosterone level <12 nmol/L) were included. They were treated for 30 weeks with either parenteral testosterone undecanoate (TU; 1000 mg testosterone undecanoate at baseline, and after 6 and 18 weeks; Nebido®) or placebo. 105 (92.9%) men receiving TU and 65 (91.5%) receiving placebo completed the trial. The International Index of Erectile Function (IIEF), Beck Depression Inventory (BDI), and Aging Males’ Symptoms (AMS) scale at baseline, 18 and 30 weeks were analysed using multilevel analysis. Results: The 184 men were aged between 35 and 70 years old, with a mean age of 51.6 (95% confidence interval [CI]: 49.8–53.4) in the TU group and 52.8 (95% CI: 50.5–55.0) in the placebo group. The body mass index ranged from 25.1 to 54.8 kg/m2. There were significant improvements in IIEF (+3.1 points; 95% CI: +1.8; +4.4; P < 0.001), the BDI (mean difference versus placebo group after 30 weeks: −2.5 points; 95% CI: −0.9; −4.1; P = 0.02) and AMS (−7.4 points; 95% CI: −4.3; −10.5; P < 0.001). The decline in body mass index was related to the improvements in the IIEF, BDI and AMS in the TU group. Conclusions: TU administration improved sexual functioning and subjective well-being in hypogonadal men with the metabolic syndrome. The strongest beneficial effects were found in obese men. Disclosure: Work supported by industry: yes, by Bayer Schering Pharma (industry funding only—investigator initiated and executed study). The presenter or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.

Table 1 Serum level of testosterone, LH and FSH according to duration of sleep deprivation Young group

Elder group

Testosterone LH Control 4.14 ± 2.20 7.42 ± 4.80 SD 3 days 2.85 ± 2.09 3.64 ± 2.02 SD 5 days 1.52 ± 0.10** 2.62 ± 2.48+

FSH

Testosterone

6.99 ± 1.75 5.70 ± 2.36 5.02 ± 1.01䉬

6.31 ± 1.67 5.59 ± 4.97 6.69 ± 1.88 1.80 ± 0.32** 2.15 ± 1.39+ 4.87 ± 1.91䉬 2.03 ± 0.09** 2.13 ± 1.26 4.37 ± 1.87

LH

FSH

**: statistically different from the control, P < 0.01. + ; statistically different from the control, P < 0.05. 䉬 ; statistically different from the control, P < 0.05. SD: sleep deprivation.

Table 2 Serum level of testosterone, LH and FSH according to duration of sleep recovery Young group

Elder group

Testosterone LH SD 3 days 2.85 ± 2.09 SD 3 days 4.75 ± 0.69* SD 5 days 4.15 ± 0.70*

FSH

Testosterone LH

3.64 ± 2.02 5.70 ± 2.36 1.80 ± 0.32 2.15 ± 1.39 3.46 ± 0.73 4.91 ± 0.11 2.67 ± 1.89 2.37 ± 1.10 10.28 ± 1.45++ 7.59 ± 0.70+ 4.10 ± 0.32** 4.11 ± 3.19

FSH 4.87 ± 1.91 5.37 ± 1.01 6.59 ± 1.07*

*: statistically different from the SD 3 days, P < 0.05. **: statistically different from the SD 3 days, P < 0.01. + ; statistically different from the SD 3 days, P < 0.05. 䉬 ; statistically different from the SD 3 days, P < 0.05. SD: sleep deprivation, SR: sleep recovery.

Disclosure: Work supported by industry: no.

039

INFLUENCE OF PARADOXICAL SLEEP DEPRIVATION AND SLEEP RECOVERY ON TESTOSTERONE LEVEL IN RATS OF DIFFERENT AGES

040

Park, MG; Nam, SG; Kim, JJ; Moon, DG Department of Urology, Korea university, College of Medicine

TESTOSTERONE ADMINISTRATION REDUCES INFLAMMATION AND MAY THUS IMPROVE LOWER URINARY TRACT SYMPTOMS

Objectives: This study was performed to assess hormonal alteration induced by sleep deprivation (SD) and to verify their replenishment during the time of sleep recovery (SR) according to different duration and ages. Materials and Methods: Wistar male rats aged 12 weeks for the young group and 20 weeks for the elder group were used. Naïve rats were randomly distributed into the control group, 3, 5 days sleep deprivation (SD) group and 3, 5 days sleep recovery (SR) group (8 rats in each group). For sleep deprivation, the modified multiple platform method, which involved placing the rats inside a tiled water tank containing 14 circular platforms with water up to 1 cm of their upper surfaces was used. The rats were sacrificed, blood was collected and centrifused to obtain serum. Testosterone, LH and FSH concentration was measured by solid-phase radioimmunoassay. Difference in testosterone, LH and FSH level according to duration of sleep deprivation

Aim of the Study: The metabolic syndrome, erectile failure and lower urinary tract symptoms (LUTS) are all associated with lower-thannormal testosterone levels, although the relationship between testosterone and LUTS appears not strong. The metabolic syndrome is associated with markers of inflammation, such as C-reactive protein (CRP), maybe signaling intraprostatic inflammation. Study Design, Materials and Methods: A large cohort of 95 middle aged to elderly hypogonadal men (testosterone levels 5.9–12.1 nmol/ L) were treated with parenteral testosterone undecanoate. Effects on the metabolic syndrome (waist circumference, cholesterol, C-reactive protein (CRP) and LUTS (residual bladder volume (RBV), Interna-

J Sex Med 2010;7(suppl 4):151–239

Saad, F1; Haider, A2; Yassin, A3; Gooren, L4 1: Bayer Schering Pharma; 2: Private Urology Practice, Bremerhaven, Germany; 3: Institute of Urology and Andrology, Norderstedt, Germany; 4: VU Medical Center, Amsterdam, The Netherlands

Proceedings from the 14th World Meeting of the International Society for Sexual Medicine tional Prostate Symptoms Score (IPSS), prostate volume (PV), PSA) were followed for 42 months. Results: (Table 1) Along with the improvements of the metabolic syndrome, there was a significant decline of the values of the IPSS and of the RBV and of CRP over the first 24 months. Thereafter values stabilized. There was a (low) level of correlation between the decline of waist circumference and residual volume of urine but not with IPSS and prostate size. Interpretation of Results: Along with the improvement of the metabolic syndrome upon testosterone administration, there was also an improvement of the IPSS and of RBV of urine and CRP. The mechanism is not immediately clear. Upon improvement of the metabolic syndrome, there may be a reduction an overactivity of autonomic nervous system. Testosterone may improve non-specific inflammation. The anatomical structures of the lower urogenital tract have testosterone receptors with a potential relation with the nitric oxide synthase system (phosphodiesterase inhibitors have a beneficial effect on LUTS). Concluding Message: future studies may prove the beneficial effects of normalization of testosterone on LUTS in testosterone—deficient men. Months

0

T nmol/L 9.3 ± 1.7 WC(cm) 107 ± 10 PV (mL) 28 ± 13 PSA ng/mL 1.7 ± 1.0 RBV mL 43 ± 20 IPPS 7.0 ± 4.1 CRP mg/dl 3.5 ± 1.2

12 19.2 103 29 1.7 34 5.1 2.4

24 ± ± ± ± ± ± ±

4.6* 9* 13 0.9 13* 2.9* 1.1*

20.3 101 30 1.8 26 3.6 1.5

36 ± ± ± ± ± ± ±

5.1 9 13 1.0 9* 2.2* 0.8*

18.4 100 31 1.7 24 3.5 1.4

42 ± ± ± ± ± ± ±

4.9 8* 12* 1.0 7 1.8 0.7

19.0 98 33 2.1 24 3.6 1.3

± ± ± ± ± ± ±

4.7 13* 12* 0.8* 5 1.5 0.8

*Compared to previous value P < 0.05.

Disclosure: Work supported by industry: no. The presenter or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.

041

SERUM ANDROGEN PROFILES IN MEN WITH SECONDARY RETARDED ORGASM Stember, DS; Logmanieh, N; Heck, M; Mulhall, JP Memorial Sloan-Kettering Cancer Center Objective(s): Besides the use of SSRI medications, penile hypothesia, chronic penile hyperstimulation and idiosyncratic masturbation, there is some evidence that low serum testosterone (T) levels may contribute to the development of retarded orgasm. This analysis was conducted to evaluate the serum androgen profiles of men presenting with secondary retarded orgasm (SRE). Material and Method(s): We compared androgen profiles of two groups of men: those with SRE without ED, and a contemporaneous group of age/comorbidity matched men with ED but no SRE. Exclusion criteria included primary RE, diabetes, prior androgen deprivation therapy, chemotherapy, abnormal biothesiometry, prior diagnosis of hypogonadism, history of T supplementation, and lack of partner for at least 12 months. Serum total and free T, SHBG, estradiol and LH levels were obtained. Result(s): 172 men had SRE and 154 ED. Mean ages were 59 ± 22 and 60 ± 19 years respectively. In the SRE group, 20% indicated that they currently experienced no orgasm during sexual encounters, 10% had an orgasm less than half the time, and 70% had an orgasm more than half the time. Total T levels were <300 ng/dl (P < 0.01) for 26% of the SRE patients and 16% of ED patients. In all age groups, except men ≤50 years, the proportion of men with total T levels < 300 ng/dl was higher in the SRE group compared to the ED group: ≤50 years (n = 36, 10% vs 8%, P = ns), 51–65 years (n = 60, 22 vs 17%, P = 0.03) and ≥65 years (n = 76, 37% vs 24%, P < 0.01). Age >65 years and never having had an orgasm predicted were predictors of low T in SRE patients on multivariable analysis. Conclusion(s): These data indicate that one quarter of men with SRE have hypogonadism. They also have a higher prevalence of hypogo-

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nadism compared to men with ED and this is most likely in older men and those men who currently are completely unable to have an orgasm with intercourse. Disclosure: Work supported by industry: no.

042

INCOMPETENT CAVERNOUS ENDOTHELIAL CELL-CELL JUNCTION IS RESPONSIBLE FOR WHY ERECTILE DYSFUNCTION IS HIGHLY PREVALENT AND PRECEDES OTHER SYSTEMIC VASCULAR DISEASES: ENDOTHELIAL CELL-CELL JUNCTION HYPOTHESIS Ryu, JK; Jin, HR; Tumurbaatar, M; Shin, SH; Yin, GN; Kwon, MH; Song, KM; Choi, MJ; Song, JS; Kim, WJ; Suh, JK National Research Laboratory of Regenerative Sexual Medicine and Department of Urology, Inha University School of Medicine, Incheon, Korea Objectives: Erectile dysfunction (ED) is highly prevalent in adult male and is regarded to act as a silent marker for serious systemic vascular diseases. Exact mechanism by which ED occurs prior to systemic vascular diseases remains to be elucidated, however, although artery size hypothesis has been suggested. In the present study, we performed biochemical, histological, and functional studies to answer to this question. Materials and Methods: Eight-week-old C57BL/6J mice were used and hypercholesterolemia or diabetes was induced by feeding a highcholesterol diet for 3 months or by intraperitoneal injection of streptozotocin (50 mg/kg for 5 days), respectively. Erectile function was measured by electrical stimulation of the cavernous nerve, and the penis was harvested and stained for endothelial cell-cell (EC-EC) junction proteins. Penis specimens from a separate group of animals were used for western blot analysis of EC-EC junction proteins. We determined vascular endothelial permeability in the penis, heart, hindlimb, brain, and testis after injection of a variety of vascular space markers (350 Da to 2000 kDa) into the jugular vein. We also investigated the effect of recombinant angiopoietin-1 (Ang1) on the cavernous endothelial permeability in diabetic mice. Results: The cavernous expression of EC-EC junction proteins, including VE-cadherin, claudin-5, and PECAM-1, was significantly lower in hypercholesterolemic or diabetic mice than in controls. These EC-EC junction proteins were more sparsely distributed in the endothelium of cavernous sinusoids than in the endothelium of cavernous artery and dorsal blood vessels. We observed a significant leakage of fluorescent tracer across the cavernous endothelium, whereas minimal leakage was noted in heart and hindlimb. No leakage was found in brain and testis. Moreover, endothelium of cavernous sinusoids was much more permeable to vascular tracers in hypercholesterolemic and diabetic condition than in normal condition, whereas endothelial layer from heart and hindlimb did not show a notable difference in permeability between the conditions. Intracavernous injection of recombinant Ang1 protein decreased cavernous endothelial permeability by restoring EC-EC junction proteins and induced recovery of erectile function in diabetic mice. Conclusions: This is the first report demonstrating that endothelium of cavernous sinusoid in normal and pathological conditions is incompetent in both structurally and functionally compared with the vasculature from other part of body, which give us an important clue to understanding why ED is highly prevalent and occurs before other systemic vascular diseases. Disclosure: Work supported by industry: no.

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043

ICP increase was the difference between the peak ICP and resting ICP. The ICP before and after electrical stimulation was compared by Wilcoxon signed rank test. The amount of ICP increase after electrical stimulation of right CN, left CN and both CN was compared by Mann-Whitney U test. P < 0.05 was considered significant. Results: Electrical stimulation of right, left and bilateral CN (5, 7.5, 10 V) elicited a significant increase of ICP from resting 8.0 ± 1.4 to peaked at 67.3 ± 9.5 mm Hg (7.5 V), 56.7 ± 5.8 mm Hg (7.5 V) and 73.5 ± 5.0 mm Hg (7.5 V), respectively. There was no significant difference of the amount of increase in ICP between electrical stimulation of right and left CN (59.3 ± 9.0 mm Hg vs. 49.8 ± 5.7 mm Hg, 7.5 V). There was no significant difference of the amount of increase in ICP between electrical stimulation of unilateral and bilateral CN (right: 59.3 ± 9.0 mm Hg, left: 49.8 ± 5.7 mm Hg vs. bilateral 65.5 ± 4.9 mm Hg). Electrical stimulation (7.5 V) of right CN after transection of left CN induced an amount of ICP increase for 41.2 ± 5.7 mm Hg, which was significantly less and accounted for 63% as compared with that after electrical stimulation of bilateral intact CNs (vs. 65.5 ± 4.9 mm Hg). Conclusions: The results suggest that there was no significant difference of ICP increase between electrical stimulation of left and right CN in the rat. Furthermore, there was no significant difference of ICP increase between electrical stimulation of unilateral and simultaneous stimulation of bilateral CN. Unilateral nerve-sparing may preserve about 63% of the amount of ICP increase after electrical stimulation of bilaterally spared cavernous nerves.

DIFFERENTIAL PROTEIN EXPRESSION OF WKY RAT PENILE TISSUE INDUCED BY CAVERNOUS NERVE RESECTION Yang, S1; Chung, H1; Kim, H1; Lee, C; Kim, B; Paick, S2 1: Konkuk University Chungju Hospital; 2: Konkuk University Hospital Objective: Cavernous nerve (CN) injury is the main cause of erectile dysfunction (ED) after radical prostatectomy. However, the clear mechanism including changes of proteome within cavernosal tissue after CN injury were not elucidated. We performed proteomic analysis to identify proteins of penile corpus cavernosum whose expression was or was not altered by cavernous nerve resection (CNR). Materials and Methods: Using 8-week-old male Wistar Kyoto rats, sham and CNR operation under a microscope were performed. Two and 8 weeks after surgery, we applied 2-DE and MALDI-TOF/TOF (AB 4700) to identify differently expressed penile proteins after CNR. 2-DE gels were stained with silver nitrate and were analyzed with PDQuest. After in-gel digestion, peptide mass spectra were obtained by MALDI-TOF/TOF mass spectrometry in the positive ion reflector mode. The obtained data were screened with a rat database from both the NCBI and the Swiss-Prot/TrFMBL home page. Results: We isolated more than 950 proteins on silver-stained gels of whole protein extracts from penile corpus cavernousum of 8-week-old male Wistar Kyoto rats. Of these proteins, 48 prominent proteins were identified using MALDI-TOF/TOF. Protein characterization revealed that the most prominent penile corpus cavernous proteins were those with antioxidant, chaperone, or cytoskeletal structure. Moreover, 11 proteins having levels elevated by CNR were annexin proteins, endoplasmic reticulum protein 29, glutathione s-transferase w-1, and others. In addition, Rho-GDP dissociation inhibitor (RhoGDI), a regulator of Rho proteins, was also increased in CNR rats compared with sham-operated rats. The apoptotic signals observed in penile tissues was greatly increased in CNR rats than in sham-operated rats. Conclusions: These results suggest that RhoGDI is one of the proteins regulated by CNR in penile smooth muscle strips, and has a crucial role in the induction of penile apoptosis. Further study is needed to elucidate the functional role of RhoGDI and related molecules in the development of ED after CNR. This work was supported by the Korea Research Foundation Grant funded by the Korean Government (MOEHRD, Basic Research Promotion Fund) (KRF-2007-521-E00089). Disclosure: Work supported by industry: no.

044

THE IMPACT OF UNILATERAL AND BILATERAL CAVERNOUS NERVE-SPARING ON THE INTRACAVERNOUS PRESSURE INCREASE AFTER ELECTRICAL STIMULATION OF CAVERNOUS NERVE IN THE RAT Chen, KK; Chang, LS Taipei Veterans General Hospital/Taiwan Objectives: To investigate the impact of unilateral and bilateral cavernous nerve-sparing on the intracavernous pressure (ICP) increase after electric stimulation of cavernous nerve (CN) in the rat. Materials and Methods: Male adult Sprague-Dawley rats anesthetized with Zoletil and xylazine were used. A 26-gauge needle was inserted into one side corpus cavernosum to measure the ICP on a polygraph. The left and right cavernous nerve was carefully identified, respectively. Three groups of study were executed as following: 1) electrical stimulation of right CN; 2) electrical stimulation of left CN; 3) simultaneous electrical stimulation of bilateral CN; and 4) transection of left cavernous nerve and then electrical stimulation of right cavernous nerve. The electrical stimulation parameters were 1-min train of 2-ms pulses, 20 Hz, 5–10 V in each of the above experiments. Amount of

J Sex Med 2010;7(suppl 4):151–239

Disclosure: Work supported by industry: no.

045

ROLE OF TNF-RELATED APOPTOSIS INDUCING LIGAND (TRAIL) AND ITS RECEPTORS IN PATHOGENESIS OF VARICOCELE INDUCED TESTICULAR DYSFUNCTION Çelik, O1; Kutlu, O3; Tekcan, M; Çelik Özenci, C; Köksal, IT2 1: Ýzmir Military Hospital Urology Clinic; 2: Akdeniz University Hospital Department of Urology; 3: BlackSea Technical University Hospital Department of Urology Aim and Purpose: We aimed that TRAIL-L and its receptors which has keyrole of apoptosis signalization and induction mechanism on the cell tissue layer effected by ethiologic factors of varicocele starting testicular dysfunction with apoptosis. Thus, inhibition of these pathways by pharmacological agents may represent a novel therapeutic approach for the medical treatment of varicocele. Material and Methods: Animals, which were 7 weeks old, were randomly separated into three groups. First group rats were used as control group (n:6), second group rats underwent a sham operation (n:6) and third group rats were used for experimental groups and underwent partial ligation of renal vein (n:6). Rats in all groups were sacrified after induction of experimental varicocele. Western blot and immunohistochemical analysis of TRAIL-L and receptors in left testicular tissues were done. TUNEL analysis was performed for apoptotic cell evaluation. Findings and Results: Immunohistochemical analysis (intensity score, immun painting score and distribution score) have confirmed that TRAIL-R1,TRAIL-R2 and TRAIL-R4 receptors expressions changed significantly; TRAIL-L and TRAIL-R3 receptors expressions unchanged significantly due to statistical analysis. In varicocele group, immun painting score changed, whereas TRAIL-R1 score was 5,00 ± 0,63, (p:0,0001) increased significantly, TRAIL-R2 score was 3,33 ± 0,81, (p:0,0141) decreased significantly and TRAIL-R4 score was 3,50 ± 0,54, (p:0,0036) increased significantly. The results of Western Blot analysis evaluated for all groups. In control and sham group TRAIL-L and its receptors proteins expressions changed, in varicocele group these proteins expressions changed statistically significant. In order to TRAIL-L, R1, R2, R3, R4 proteins expressions is (1,47 ± 0,48 p:0,9184; 0,71 ± 0,26 p:0,0026; 0,84 ± 0,74 p:0,001; 1,02 ± 0,49 p:0,9393; 1,06

Proceedings from the 14th World Meeting of the International Society for Sexual Medicine ± 0,23 P < 0,0001) measured. Especially TRAIL-R1 protein expression increased significantly, TRAIL-R2 protein expression reduced significantly and TRAIL-R4 protein expression increased statistically significant. Moreover, the ratio of apoptotic germ cells in varicocele groups were significantly higher when compared to control and sham groups. In control group apoptotic index score was 12,9 ± 2,04,sham group’s score was 12,3 ± 1,91 and in varicocele group apoptotic index score was 26,4 ± 2,5 measured. Varicocele group’s apoptotic index score increased statistically significant than other groups (P < 0,05). Conclusions: By evaluating the role of TRAIL pathway in varicocele testes, this study contributes very much to molecular mechanisms of varicocele patogenesis when compared to studies those generally evaluate the sperm cells of varicocele patients. Disclosure: Work supported by industry: no.

046

A STUDY OF RAT MESENCHYMAL STEM CELLS DIFFERENTIATED INTO PENILE SMOOTH MUSCLE CELLS IN VITRO Xiao, H1; Chen, J2; Zhang, B2; Zhang, Y1; Pu, X1; Wen, X1; Gao, X1 1: Department of Urology, the Third Affiliated Hospital of SUN Yat-sen University¬Guangzhou¬China; 2: Department of infertility and sexual medicine, the Third Affiliated Hospital of SUN Yat-sen University¬ Guangzhou¬China Objective(s): To evaluate whether rat MSC could differentiate into smooth muscle cells (SMC) in vitro and acquire potential cell fates for stem-cell-based gene therapy of ED. Material and Method(s): Rat MSC were isolated, cultured and characterized. These cells were induced to differentiate into SMCs through VEGF and b-FGF in vitro. SMC differentiation was assessed by immunofluorescence and then subjected to immunocytochemistry for specific markers of α-smooth muscle actin (α-SMA) of penile smooth muscle cells. Result(s): The differentiated cells exposed to VEGF and b-FGF media acquired the morphological features of SMC and expressed smooth muscle markers of α-SMA. They were identified to SMC by immunocytochemistry. Conclusion(s): The MSC can be induced to differentiate into SMC in vitro and have a potential source for stem-cell-based gene therapy for ED in the near future. Disclosure: Work supported by industry: no.

047

INTRACAVERNOUS DELIVERY OF A RECOMBINANT ANGIOPOIETIN-1 VARIANT AS A NOVEL THERAPEUTIC STRATEGY FOR HYPERCHOLESTEROLEMIA-INDUCED ERECTILE DYSFUNCTION Ryu, JK1; Kim, WJ1; Kok, YJ2; Piao, S1; Jin, HR1; Choi, MJ1; Shin, SH1; Yin, GN1; Tumurbaatar, M1; Song, JS1; Koh, GY2; Suh, JK1 1: National Research Laboratory of Regenerative Sexual Medicine and Department of Urology, Inha University School of Medicine, Incheon, Korea; 2: Department of Biological Sciences and National Research Laboratory for Vascular Biology, KAIST, Daejeon, Korea Objectives: Angiopoietin-1 (Ang1) is a specific growth factor functioning to generate a stable and functional vasculature. We have recently created a potent Ang1 variant, cartilage oligomeric matrix protein (COMP)-Ang1. Here, we investigated whether and how COMP-Ang1 restores penile erection in hypercholesterolemic animals. Materials and Methods: Hypercholestrolemia was induced in the C57BL/6J mouse by feeding a diet containing 4% cholesterol and 1% cholic acid for 3 months. Mice were divided into 6 groups: G1, agematched control; G2-G6, cholesterol mice, G2, no treatment; G3, a single injection of adenoviruses (ad) expressing LacZ (2 × 108 parts/ 20 μl); G4, two successive injections of BSA (days −3 and 0;

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5.8 μg/20 μl); G5, a single injection of ad-COMP-Ang1 (2 × 108 parts/20 μl); G6, two successive injections of COMP-Ang1 recombinant protein (days −3 and 0; 5.8 μg/20 μl) into the corpus cavernosum. After evaluating erectile function by cavernous nerve electrical stimulation 2 and 8 weeks after treatment, the penis was stained with antibody to PECAM1. We performed western blot analysis of phospho-eNOS/eNOS and measured cGMP concentrations. We also determined whether eNOS or NOS participated in COMP-Ang1induced cavernous angiogenesis and subsequent restoration of erectile function by using eNOS-deficient mice or wild type mice treated with L-NAME, a NOS inhibitor. Results: Intracavernous injection of ad-COMP-Ang1 or COMPAng1 protein significantly enhanced cavernous endothelial proliferation, eNOS phosphorylation, and cGMP expression in cholesterol group compared with that in the untreated control, ad-LacZ- or BSA-treated cholesterol group. Consequently, the ratio of maximal intracavernous pressure to mean systolic blood pressure during electrical stimulation of the cavernous nerve was completely restored up to 8 weeks after treatment. COMP-Ang1-induced promotion of endothelial cell content and erectile function was abolished in eNOS-deficient mice or in the presence of L-NAME. In addition, COMP-Ang1 protein significantly decreased the expression of histone deacetylase 2 (HDAC2) in the corpus cavernosum tissue of hypercholesterolemic mice and knock-down of HDAC2 using siRNA induced increase in endothelial cell-cell junction proteins, including occludin and VEcadherin, in primary cavernous endothelial cells in vitro. Conclusions: These findings constitute a new paradigm toward curative treatment of both cavernous angiopathy and ED with recombinant angiopoietin-1 protein. Disclosure: Work supported by industry: no.

048

FINGER LENGTH RATIO (2D:4D) ON FEMALE GENDER IDENTITY Hisasue, S1; Masumori, N1; Tateno, M1; Sasaki, S2; Kanaya, M1; Ikeda, H1; Saito, T1; Tsukamoto, T1 1: Sapporo Medical University, Japan; 2: Keio Advanced Research Centers Objective: Gender identity and the 2nd to 4th finger length ratio (2D:4D) are discriminative between sexes. However, it is still controversial in 2D:4D in gender identity disorder (GID). The aim of this study is to investigate the relationship between 2D:4D and gender identity scale (GIS) in female-to-male GID subjects (FtM) to study the possible influence of prenatal testosterone on gender identity. Material and Method: Thirty-six FtM with testosterone replacement therapy in our clinic were included into this study. As control, 20 male and 20 female volunteers participated from our institution. We took the photocopies of bilateral hands of the participants, and measured the 2nd and 4th finger length by one examiner with a blind manner. We investigated the gender identity with GIS which was developed and validated in Japanese by Sasaki et al. Results: The 2D:4D in male, female, FtM were 0.938 ± 0.026 (Mean ± SD), 0.999 ± 0.035, 0.954 ± 0.029 in right hand, and 0.937 ± 0.025, 0.979 ± 0.040, 0.954 ± 0.037 in left hand respectively. The 2D:4D in both hands were significantly lower in both male controls and FtM than in female controls (P < 0.05 t-test). In GIS, only “consistent gender identity” domain score was significantly correlated positively with 2D:4D (P = 0.0001, r = 0.513). Conclusions: The finger length ratio 2D:4D in FtM was significantly lower than in female controls in both hands in this study. 2D:4D showed a positive correlation with GIS score, which suggests that 2D:4D influences the gender identity which is assumed to be established in an early life with perinatal testosterone. Disclosure: Work supported by industry: no.

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049

quent contracture did occur in 7 patients. These were managed successfully by delayed excision and re-grafting. The happiest were the BXO and trauma groups where effectively extra skin had been added. An improvement in cosmesis and sexual function was reported by 83 patients with an overall satisfaction rate of 96%. Conclusion: Loss of penile skin of various causes can be reliably managed by skin grafting.

SEXUAL ACTIVITY OF BELGIAN GAY MEN Vansintejan, J; Devroey, D Vrije Universiteit Brussel Objective: Epidemiologic study of the sexual experience of Belgian men who have sexual relationships with men (MSM). Methods: A large-scale national survey was performed, using internationally and validated questionnaires, available on the “GAy MEn Sex StudieS” website (www.gamesss.be), during a 9-month study period in 2008. Participants were recruited by various audio-visual media and by the distribution of 25,000 flyers. Inclusion criteria were MSM, >18 yrs of age. Exclusion criteria were women, men under the age of 18 yrs and men who have an exclusively sexual relationship with women. Participation in this survey was voluntary and anonymous. The protocol received the approval of the Medical Ethics Commission of the University Hospital of Brussels. Results: The survey was completed by a total of 1830 Belgian MSM (mean age 35 years ± 12 SD). The average age of first sexual experience with a same-sex partner is 19 yr. Mostly the partner is 4 yr older. Conclusions: In total, 66% of the participants indicated having sexual intercourse at least once a week. A majority of 51% is satisfied with that frequency and 48% wants to have more frequently sex with their partner. Our data showed that Belgian MSM have a mean frequency of sexual intercourse of 118 times annually. The average sexual intercourse (included fore- and afterplay) lasts for nearly 49 minutes. Besides having sex with a partner, young gay men masturbate almost daily. The older population of men, who are more than 55 yr old, masturbate once every three days. Only 2% of the MSM, over the age of 55 yr, have no sexual relations anymore. Disclosure: Work supported by industry: no.

050

WITHDRAWN

051

PENILE RECONSTRUCTION FOR BENIGN DISEASE WITH THE USE OF SKIN GRAFT Garaffa, G1; Raheem, A; Minhas, S; Christopher, AN; Ralph, DJ 1: St Peter’s Andrology Objectives: The long term results of penile reconstruction for benign disease with the use of skin grafts in 86 patients are reported. Patients and Methods: The patient’s aetiologies included Balanitis Xerotica Obliterans (BXO; n = 25), traumatic amputation (n = 7), excessive circumcision (n = 12), frenular pathology (n = 8), end stage lymphoedema (n = 7), iatrogenic skin loss (n = 4), hypospadias surgery (n = 5), buried penis (n = 17) and Fournier’s gangrene (n = 1). All BXO and Lymphoedma patients had the disease area excised and grafted. The traumatic and circumcision injuries had skin added. Split skin grafts harvested from the inner thigh were used for glans and coronal pathology in 48 patients, whereas full thickness grafts from non-hairbearing areas were used on the shaft to prevent erectile dysfunction due to graft contraction in 43 patients. Results: After a median follow-up of 21.5 months (1–68), all patients were satisfied with the outcome although partial graft loss and subse-

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Disclosure: Work supported by industry: no.

052

PENILE PROSTHESIS INSERTION IN GENDER DYSPHORIA Garaffa, G1; Dente, D; Raheem, A; Christopher, AN; Ralph, DJ 1: St Peter’s Andrology Introduction: The aim of this study is to report the results of penile prosthesis implantion in patients with gender dysphoria who have had a previous phalloplasty. Materials and Methods: Between 2000 to 2010, 136 patients (age 22–59 yrs, mean 38.5 yrs) with Gender Dysphoria had a penile prosthesis inserted into their phalloplasty. The types of phalloplasty included the forearm free flap (n = 84), an abdominal phalloplasty (n = 44) and a combination of the above in 8 patients. The prostheses used were: AMS 700CX IMZ 55%, AMS 700CX IMZ preconnect 10%, AMS 700CX 29%, AMS Ambicor 6%. The resevoir component and a single testicular prosthesis had been inserted 3 months earlier. A single cylinder was used in 106 patients and 2 cylinders when the phallus was bulky in 30 patients. A vascular graft, impregnated with silver to reduce infection, was used to form a cap and sock around the cylinder to aid with anchorage to the pubis and to reduce the chance of distal erosion. A satisfaction questionaire was completed by 60 patients. Results: A prosthesis was inserted in all patients without intraoperative complications. After a mean follow up of 20 months (range 7–123 months), a successful surgical result was declared with the prosthesis in a good position and the patient being able to cycle the device. The infection rate was 4.5% necessitating removal of the implant followed by delayed reinsertion of the device. Overall, 44 patients required revision surgery (32%) for mechanical failure (n = 22), malpositioning of one component (n = 14), infection (n = 6) and erosion (n = 2). Elective device removal due to overall dislike was requested by 2 patients. The results of the questionaire showed that 46 patients (77%) had a stable partner and were having penetrative sexual intercourse. All the patients thought that the device was easy to use and were able to cycle it without discomfort. Conclusion: The insertion of a penile prosthesis into a phalloplasty allows enough rigidity to have penetrative sexual intercourse. However the patients must be informed of the short device life expectancy ad consequently high revision rate. Disclosure: Work supported by industry: no.

053

SILDENAFIL CITRATE IN TREATMENT OF ERECTILE DYSFUNCTION-ASSOCIATED DIABETES AND/OR HYPERTENSION: AN OBSERVATIONAL STUDY IN THE MIDDLE EAST El-Sakka, AI1; Anis, T2; Khadr, N3; Ismail, TA4; Hegazy, AM4; Fekry, O5; Youseif, E6 1: Department of Urology, Suez Canal University, Ismailia, Egypt, and Al-Noor Specialist Hospital, Makkah, Saudi Arabia; 2: Cairo UniversityDepartment of Andrology and Sexology, Cairo, Egypt; 3: Khadr Cardiology Clinic, Dubai, United Arab Emirates; 4: Pfizer Saudi Arabia, Jeddah, Saudi Arabia; 5: Pfizer Egypt, Cairo, Egypt; 6: Pfizer Africa and Middle East, Dubai, UAE Objectives: To evaluate the effectiveness, tolerability and sexual performance spontaneity of sildenafil citrate in a clinical practice popula-

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Proceedings from the 14th World Meeting of the International Society for Sexual Medicine tion of outpatients with erectile dysfunction (ED) associated with a diagnosis of diabetes mellitus and/or hypertension in three Middle Eastern countries. Materials and Methods: Observational analysis of men treated for ED in the outpatient clinical practices of 464 physicians in the Kingdom of Saudi Arabia, Egypt, and the United Arab Emirates. Patients who were prescribed sildenafil were observed during 12 weeks of as-needed, flexible-dose, open-label treatment with sildenafil at the recommended initial dose of 50 mg (permissible dosing range, 25–100 mg). Main Outcome Measures: A 5-item version of the International Index of Erectile Function (IIEF-5) that rates various aspects of erectile functioning on a 5-point ordinal scale; global assessment of efficacy and tolerability based on 4-point ordinal scales. Results: At baseline, patients (N = 4566) had a mean (SD) IIEF-5 total score of 13.6 (5.7). Treatment with sildenafil was associated with a significant (P < 0.001) increase in the mean (SD) IIEF-5 total score to 19.2 (4.5) at Week 4, 20.5 (4.4) at Week 8, and 21.7 (4.1) at Week 12. At endpoint, the efficacy of sildenafil was rated as good or very good by 91.4% of patients, with 93.9% rating their sexual activity on sildenafil as being “spontaneous” and 91.4% rating it as feeling “natural.” Discontinuation of sildenafil due to adverse events was very low (0.5%). The tolerability of sildenafil was rated as good or very good by 95.7% of patients. The great majority of patients (95.1%) stated that they wished to continue treatment with sildenafil beyond the initial 12 weeks of treatment. Conclusion: This analysis of a large, cross-national sample of patients in the Middle East found sildenafil to be a well-tolerated and highly effective treatment of ED in patients diagnosed with diabetes and/or hypertension. Disclosure: Work supported by industry: yes, by Pfizer Incorporation (industry initiated, executed and funded study). The presenter or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.

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EFFICACY OF FLIBANSERIN 100 MG QHS AS A POTENTIAL TREATMENT FOR HYPOACTIVE SEXUAL DESIRE DISORDER IN NORTH AMERICAN PREMENOPAUSAL WOMEN Jolly, E1; Clayton, AH2; Thorp, J3; Kimura, T4; Sand, M4; Pyke, R4 1: Shirley E. Greenberg Women’s Health Centre, The Ottawa Hospital, Canada; 2: University of Virginia, USA; 3: University of North Carolina at Chapel Hill, USA; 4: Boehringer Ingelheim Pharmaceuticals, Inc., USA Objective: To assess the efficacy of flibanserin 100 mg qhs as a treatment for generalized acquired Hypoactive Sexual Desire Disorder (HSDD) in premenopausal women. Material and Methods: Data on the efficacy of flibanserin 100 mg qhs from two 24-week randomized placebo-controlled North American trials (VIOLET, 511.71 and DAISY, 511.75) in women with generalized acquired HSDD were pooled in a pre-specified analysis. Co-primary endpoints were change from baseline to study end in the number of satisfying sexual events (SSE) and eDiary desire score. Secondary endpoints included: Female Sexual Function Index (FSFI) desire domain, FSFI total, Female Sexual Distress Scale-Revised (FSDS-R) total and FSDS-R Item 13 scores. Results: Mean (SD) baseline data were: SSE 2.8 (2.7); eDiary desire score 11.6 (9.5); FSFI desire domain score 1.8 (0.7); FSFI total score 19.6 (6.3); FSDS-R total score 30.6 (9.6), FSDS-R Item 13 score 3.2 (0.8). The mean changes from baseline to study end in the efficacy endpoints are given in the table below. Conclusions: In North American premenopausal women with HSDD, 24 weeks’ treatment with flibanserin 100 mg qhs was associated with significant improvements in the number of SSE, eDiary desire and FSFI desire domain scores versus placebo. Flibanserin was also associated with significant improvements in sexual functioning (FSFI total score), distress related to sexual dysfunction (FSDS-R score) and dis-

tress related to low sexual desire (FSDS-R Item 13 score) versus placebo. Mean change from baseline to study end in efficacy endpoints (correct to one decimal place)

Placebo (n = 693)

SSE†

eDiary desire

FSFI desire domain

FSFI total

FSDS-R total

FSDS-R Item 13

1.0

7.1

0.5

2.5

−4.8

−0.5

9.0*

0.9****

4.4**** −8.0****

Flibanserin 1.7**** 100 mg qhs (n = 685)

−0.8****

*P < 0.05, ****P < 0.0001 versus placebo. † Difference between flibanserin and placebo group in change from baseline to study end in SSE is 0.8 (correct to one decimal place).

Disclosure: Work supported by industry: yes, by Boehringer Ingelheim (industry initiated, executed and funded study). The presenter or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.

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HOW WELL DO MEASURES OF SEXUAL FUNCTION CORRELATE WITH PATIENTS’ PERSPECTIVES OF IMPROVEMENT IN HSDD? Sand, M1; Thorp, J2; Jolly, E3; Garcia, M1 1: Boehringer Ingelheim Pharmaceuticals, Inc., USA; 2: University of North Carolina at Chapel Hill, USA; 3: Shirley E. Greenberg Women’s Health Centre, The Ottawa Hospital, Canada Objective: To evaluate the relationship between Patient’s Global Impression of Improvement (PGI-I) and other measures of sexual function used in clinical trials of flibanserin in premenopausal women with Hypoactive Sexual Desire Disorder (HSDD). Material and Methods: Data on the efficacy of flibanserin 100 mg qhs in premenopausal women with HSDD from two 24-week randomized, placebo-controlled trials in North America (VIOLET, 511.71; DAISY, 511.75) were pooled in a pre-specified analysis. Co-primary endpoints were change from baseline to study end in the number of satisfying sexual events (SSE) and desire score measured using a daily eDiary. Secondary endpoints included change from baseline to study end in Female Sexual Function Index (FSFI) desire domain, FSFI total, Female Sexual Distress Scale-Revised (FSDS-R) total, and FSDS-R Item 13 scores, and PGI-I. The PGI-I question asked trial participants to evaluate the overall improvement in their condition (bothersome decreased sexual desire) since the start of treatment on a 7-point scale from 1 (very much improved) to 7 (very much worse). Pearson productmoment correlations (r) assessed the relationship of PGI-I with changes in the other measures. Results: Data from over 600 women were included in this analysis. The strongest relationship was observed between PGI-I and FSFI desire domain score (r = −0.69, r2 = 0.48). Correlations with PGI-I were also seen with FSDS-R total score (r = 0.63, r2 = 0.39), FSDS-R Item 13 score (r = 0.60, r2 = 0.36), FSFI total score (r = −0.58, r2 = 0.33), eDiary desire score (r = −0.57, r2 = 0.33), and SSE (r = −0.46, r2 = 0.21). All correlations were statistically significant (P < 0.0001). Conclusions: Analysis of data from the clinical trials of flibanserin in North American premenopausal women with HSDD shows that a women’s own perception of improvement was correlated with positive changes in all measures assessing HSDD. Change in FSFI desire domain score was the measure that was most strongly correlated with a woman’s own perception of how much her HSDD had improved. Disclosure: Work supported by industry: yes, by Boehringer Ingelheim (industry initiated, executed and funded study). The presenter or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.

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rating scale, the Derogatis Interview for Sexual Function (DISF) (309 men and 801 women), medical and family history records, and direct questioning. The DISF and its domains have been normed to the general population; normed DISF score results are a measure of severity. Results here are presented in percentile (%ile) rank of the normal population. Results: Prevalence of DSM-IV diagnoses in this population is: HSDD males 8.8%, females 17.7% (P = 0.0001); Sexual Aversion Disorder males 0.7%, females 3.4% (P = 0.009); Erectile Dysfunction 7.9%, Female Arousal Disorder 5.8% (NS); and Male Orgasmic Disorder 3.9%, Female Orgasmic Disorder 7.7% (P = 0.005). DISF scores, %ile rank are: total raw score males 68, 15%ile; females 45, 5%ile (P = 0.024); arousal domain score males 14.2, 65%ile; females 7.8, 13%ile (P = 0.0001); behavior domain score males 10.2, 20%ile, females 6.5, 13%ile (NS); cognition (desire) domain score males 23.6, 49%ile, females 12.0, 25%ile (P = 0.001); drive domain score males 11.7, 13%ile, females 8.9, 5%ile (NS); and orgasm domain score males 12.0, 7%ile, females 7.7 5%ile (NS). Conclusions: DSM-IV and the DISF results are similar, except for orgasm. Female subjects with major depression have statistically significantly higher rates of HSDD, Sexual Aversion Disorder, and Orgasmic Disorder than males, almost twice the prevalence for each, and the severity as measured by the DISF almost twice that of males. The percentage of males with erectile dysfunction is slightly, but not significantly, more than that of women with arousal disorder. Major Depression appears to affect female sexual function much more than male sexual function.

IMPLICIT AND EXPLICIT COGNITIVE SEXUAL PROCESSES IN SURVIVORS OF CHILDHOOD SEXUAL ABUSE Rellini, AH1; Ing, AD2; Meston, CM2 1: University of Vermont; 2: University of Texas at Austin Objectives: Women with a history of childhood sexual abuse (CSA) exhibit higher rates of sexual dysfunction than non abused women. Since sexual responses are affected by cognitive processes, this study investigated the implicit and explicit cognitive processing of sexual stimuli in women with (CSA; N = 34) and without (NSA; N = 22) a history of CSA. Implicit processes are involuntary or unintentional responses to stimuli. Explicit processes are intentional, voluntary, or effortful processing of sexual stimuli. Material and Methods: The definition of CSA adopted in this study was the one proposed by Finkelhor, Hotaling, Lewis, and Smith (1989): A sexual encounter where touching or penetration of genitals happened before age 16 with someone at least 5 years older. Women with and without a history of CSA were invited to a 2-hour session where they completed two Implicit Association Test (a measure of implicit processes) and a self-reported questionnaire on their view of their sexual self (a measure of explicit processes). Participants also completed questionnaires on sexual function (FSFI) and sexual satisfaction (SSS-W). Results: The results present initial evidence of between group differences in the cognitive processing of sexual stimuli. Regarding the implicit processes, women in the NSA group showed that sexual pictures were more strongly associated with positive valence (pleasure) than non-sexual pictures. For the CSA group, neutral and sexual pictures were similarly associated with pleasure. Conversely, for both groups, romantic pictures were more strongly associated with positive valence than sexual pictures. Moreover, sexual satisfaction was predicted by implicit and explicit processes, suggesting that the sexuality of women is affected by both processes independently. Conclusions: In conclusion, this study provides initial support for the presence of impairments in the implicit cognitive processes of sexual stimuli in CSA survivors. Because implicit processes are linked to physiological sexual arousal, this may help to explain why CSA survivors have been observed to have impairments in laboratory measures of physiological sexual response. Disclosure: Work supported by industry: no. The presenter or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.

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DIFFERENCES IN THE EFFECT OF MAJOR DEPRESSION ON SEXUAL FUNCTION OF MEN AND WOMEN Fabre, LF1; Smith, LC1; Derogatis, LR2 1: Fabre Kramer Pharmaceuticals, Inc. USA; 2: Sheppard Pratt Health Systems USA Objective: To compare the prevalence of DSM-IV Sexual Dysfunction diagnoses in men and women. Depression has been reported to affect sexual interest, arousal and orgasm in both men and women. The prevalence of major depression in women is almost twice that in men. There is also evidence that depression symptoms differ between sexes. Therefore, the effects of depression on sexual function may also differ between men and women. Methods: In three studies of major depression, 430 men and 920 women, 18–64 years old, average 38 y/o, were entered based on depressive symptoms, not sexual dysfunction. These subjects also had physical examinations, laboratory tests, and EKGs to exclude subjects with medical illnesses or taking other medications. At baseline, before any treatment, a trained psychiatrist made diagnoses of sexual dysfunction based on DSM-IV criteria. The number (%) with DSM-IV diagnoses is an estimate of prevalence. The psychiatrist also employed a

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Disclosure: Work supported by industry: yes, by Organon (industry initiated, executed and funded study). The presenter or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.

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GEPIRONE-ER EFFECTS ON SEXUAL DESIRE IN WOMEN WITH MAJOR DEPRESSIVE DISORDER (MDD) Goldstein, IM1; Fabre, LF2; Smith, LC2 1: San Diego Sexual Medicine Alvarado Hospital USA; 2: Fabre Kramer Pharmaceuticals, Inc. USA Objective: To determine whether the positive sexual effects of gepirone-ER are due to the antidepressant effects of gepirone-ER or due to other factors. Gepirone-ER has been shown to have a positive effect on sexual desire in women with Major Depressive Disorder, in contrast to SSRIs. Several studies have shown that gepirone-ER is an active antidepressant. Methods: In two short term (8 week) studies of gepirone-ER in major depression and their long term extensions out to 24 weeks (134006134503) or 44 weeks (134004-134502) weeks, the Derogatis Inventory of Sexual Function (DISF) was administered at baseline and at every following visit. The DISF is a comprehensive sexual scale that has multiple subscales (domains) including sexual cognition and fantasy (desire). The Hamilton Depression Rating Scale (HAMD-17) total score change from baseline at endpoint, the primary efficacy parameter, was not statistically significant in either study. A 50% decrease in HAMD-17 baseline entry scores was used to differentiate antidepressant responders from non-responders. For example, if a subject entered the study with baseline with a HAMD score of 20, an endpoint score of 10 or less would identify a responder. Results: The DISF cognition/fantasy (desire) domain shows statistically significant positive results for gepirone-ER versus placebo at many time points. The gepirone-ER responder group is statistically better than the placebo responder group; the gepirone-ER nonresponder group is statistically better than the placebo non-responder group. Both responder groups are better (often statistically significantly) than their respective non-responder groups. Conclusion: Placebo patients who are non-responders have desire domain scores below baseline, indicating that depression interferes with sexual desire. Placebo responders have desire domain scores above baseline indicating that perceived improvement in depression results in

Proceedings from the 14th World Meeting of the International Society for Sexual Medicine improved sexual function. Both gepirone-ER responders and gepironeER non-responders show desire domain scores better than baseline. Gepirone-ER responders show larger increases than gepirone-ER nonresponders. These results indicate that gepirone-ER has both antidepressant and pro-sexual effects and the effects seem to be additive. Disclosure: Work supported by industry: yes, by Organon (industry initiated, executed and funded study). The presenter or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.

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SEXUAL DYSFUNCTION IN WOMEN WITH FAMILIAL AMYLOIDOTIC POLYNEUROPATHY Silva, TO1; Farinha, R1; Pinheiro, LC2; Monteiro, LA1; Barroso, E1; Mendes, JR1 1: Curry Cabral Hospital/ Portugal; 2: New Lisbon University/ Portugal Familial Amyloidotic Polyneuropathy (FAP) is an autossomal dominant progressive disease caused by mutation of transthyretin. This protein produced mainly by the liver, when mutated deposits as amyloid in periferical nervous system (somatic sensory-motor and autonomic) and systemic organs. Death occurs 10–20 years after the initial symptoms unless a liver transplantation is made. Erectil dysfunction and retrograde ejaculation are the presenting symptoms 1\3 of cases in male patients, but nothing is known about sexual function in females. Objective(s): Characterize female FAP sexual function and understand if it correlates with their life satisfaction. Material and Method(s): We evaluated 50 women with FAP followed in your hospital (before and after liver transplantation) through phone interview and home send questionnaires including: satisfaction with life scale (SWLS), female sexual function index (FSFI), sexual practices, FAP symptoms, medication and compared the results with 43 non-FAP women. All premenopausal state and aged 20–52 years. Result(s): FAP originates sexual dysfunction in women (Pⵧ0,002), namely in arousal (pⵧ0,001), orgasm (Pⵧ0,004) and satisfaction (Pⵧ0,001). The prevalence of sexual dysfunction (SD) in female FAP were 39,5%. It was a desire problem in 79,5% of FAP, arousal problem in 70,5%, lubrification problem in 67,4%, orgasm problem in 62,8%, sexual insatisfaction in 47,7% and pain in 40,9%. Compared with non-FAP, FAP patients have more SD (odds ratio 5,1, 95% CI 1,7– 15,6), arousal problems (OR 4,6; CI 1,9–11,3), orgasm problems (OR 3,6; CI 1,5–8,8) and sexual insatisfaction (OR 5,7; CI 2–16,3). SD is related with the join presence of genitourinary and autonomic symptoms (OR 3,9; CI 1,1–13,5) and there number. With didn’t found correlation between SD and life satisfaction among FAP patients, medication or disease duration. Conclusion(s): FAP originates SD in women, namely in arousal, orgasm and sexual satisfaction. This dysfunction can not be explained by the use of medication potentially affecting sexual function (antihypertensive, antidepressive, oral anticonceptives, immunessupressive) and it doesn’t appear to be related with life satisfaction or disease duration. Instead depends on number of symptoms and organs affected by the disease, specifically genitourinary in conjunction with autonomic nervous system. Disclosure: Work supported by industry: no.

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PERSONALITY PROFILES OF UNFAITHFUL WOMEN AND THEIR HUSBANDS Aponte, R UCOSEX The aim of this study was to evaluate the personality profile of unfaithful women and their husbands. Out of 1.600 patients’ files a total of 284 who came in due to marital conflicts, we chose 100 couples, 50 were of unfaithful women and their

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husbands and 50 were of faithful women and their husbands. In order to evaluate the individuals’ personality profiles we applied the following instruments: Minnesota Multiphasic Personality Inventory, MMPI-2, Beck’s Depression Inventory, Locke & Wallace Inventory of Marital Interaction. Likert scale, and Statistical Program for the Social Sciences, SPSS were also used. We found that Psychastenia and Schizophrenia (P = 0.05, P = 0.046) were the predominant personality profiles of unfaithful women and Hypomania and Depression (P = 0.006, P = 0.047) were predominant in their husbands. In conclusion female infidelity is associated to couples integrated by psychastenic and schizophrenic women and hypomaniac and depressed men. Disclosure: Work supported by industry: no.

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SEXUAL HEALTH FUNDAMENTALS FOR PATIENT CARE: A REPORT ON 2010 CONSENSUS OUTCOMES AND GUIDANCE FOR WOMEN’S HEALTH PROFESSIONALS Krychman, M1; Kellogg-Spadt, S2; Clayton, A3 1: Hoag Memorial Hospital Presbyterian, United States; 2: The Pelvic and Sexual Health Institute of Philadelphia, United States; 3: University of Virginia Health System, United States Objectives: To address the significant practice gap in the delivery of high quality female sexual healthcare among primary care, frontline clinical professionals, the Association of Reproductive Health Professionals convened a multidisciplinary consensus panel of 16 sexuality specialists from the US and Europe. Aims: (1) Supplement expert guidelines with recommendations specifically designed to fill a practice gap for frontline women’s healthcare providers on sexual function, health, and wellness. (2) Develop open-access assessment and practice tools for professional societies and advocacy groups. Methods: The meetings utilized a modified Delphi method in combination with nominal group technique to develop consensus definitions and recommendations. To inform the meetings, a Steering Committee guided a retrospective review of PubMed research for English-language studies with acceptably rigorous study design and standards. The resulting 77 articles were made available in advance to the experts. The Committee also guided development of a web-based survey of 1,209 women aged 18–50 regarding their experiences with healthcare providers, and developed content for informal interviews with professional groups and experts. Results: The panelists concluded that frontline providers require increased medical knowledge, understanding of relevant psychosocial issues, and clinical skills on female sexual health to ensure highest-quality care. They concurred there was a strong need for expert guidance for women’s healthcare providers and that all clinicians can effectively and efficiently screen, diagnose, and initiate treatment on many common forms of female sexual dysfunction. The panelists identified specific competencies required for expert care. In 2010, the Steering Committee finalized a series of open access tools, including provider fact sheets and recommended algorithms and screening tools. ARHP plans to reconvene the consensus group in 2010 for further analysis, to develop additional tools in partnership with medical societies and professional organizations; and other activities. Conclusion: Consensus experts agree that providers need evidencebased guidance to effectively address sexual health with their female patients. Collaboratively developed expert guidance designed for the women’s healthcare team can improve the quality of patient care. Freely accessible, evidence-based guidance can fill key women’s healthcare practice gaps for primary care clinicians. Disclosure: Work supported by industry: yes, by grants from Boehringer-Ingelheim, Pfizer, Wyeth (no industry support in study design or execution). The presenter or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.

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samples analyzed differed considerably from genuine samples, containing ephedrine and unknown substances; some samples contained sildenafil instead of tadalafil. The packaging of the counterfeit drugs was extremely difficult to distinguish from the original products by appearance. Conclusions: Over half of the ED medications ordered via the Internet in Japan and Thailand were counterfeit and packaged in a manner difficult to distinguish from genuine medications. Because the ingredients of the counterfeit drugs differed substantially from their labelling, Internet-ordered medications may be hazardous. Consumers must be warned about the dangers of private Internet import of ED medication.

EFFECTS OF ICARIIN ON PREVENTIVE ERECTILE FUNCTION IN DIABETIC RATS AND ITS POSSIBLE MECHANISM Xin, ZC Peking University First Hospital, Peking University Objective: Icariin is showed to have the effects on enhancing erectile function in vasculargenic and castrated rats ED model previously, in order to realize the effects of icariin on prevention erectile dysfunction(ED), the preventive effects of icariin on DM induced rats ED were investigated. Methods: Adult male Wistar rats (n = 68) were induced hyperglycemia using streptozotocin (55 mg/kg). Rats were randomly divided into 6 groups: Group A for normal controls, Group B, C, D for oral administration of different concentration of Icariin (1 mg, 5 mg, 10 mg/kg/d) for 8 weeks. Sildenafil was used as a control (Group E). After 1 week wash out period, intracavernosal pressure (ICP) was measured for evaluating erectile function. Masson staining was used for detecting tissue’s constituents in corpus cavernosum and NOS isoforms protein expressions in corpus cavernosum were checked by Western blot and Immunochemistry stain. Results: Erectile function (ICP) in icariin treated groups(1, 5, 10 mg/ kg/d) was significantly increased compared to control Group (P < 0.01), Smooth muscle content in Icariin treated Group showed significantly higher than control Group and nNOS and eNOS protein expression in Icariin treated Group were significantly higher than that of control Group. Conclusion: Icariin showed a preventive effect on DM induced ED, it’s possible mechanism may be related to increasing NOS expression and improving muscle/fibrous proportion in corpus cavernosum, further study is recommended. Disclosure: Work supported by industry: no.

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A FOUR-COMPANY SPONSORED SURVEY ON COUNTERFEIT ERECTILE DYSFUNCTION DRUGS OBTAINED VIA THE INTERNET Sasaki, H1; Nagao, K2; Ishii, N2; Sugita, M2; Marumo, K3 1: Showa University Fujigaoka Hospital, Tokyo, Japan; 2: Toho University, Tokyo, Japan; 3: Ichikawa General Hospital, Tokyo, Japan Objective: Drugs that reach Japanese consumers through unofficial channels, including the Internet, may be counterfeit and therefore pose health hazards for users. Little information is available about the quality of Internet-ordered pharmaceutical products. We characterized a sampling of erectile dysfunction (ED) medications obtained from Internet sites claiming to conduct imports on behalf of individuals. Material and Methods: From December 2008 until April 2009, a Japanese research company was instructed to purchase 1 sample of 3 different brands (Viagra [sildenafil], Levitra [vardenafil], and Cialis [tadalafil]) at each online shopping site claiming to be a “personal import management company,” until reaching 30 samples per brand. Identical instructions were provided to a research company in Thailand (and carried out from August 2008 to December 2008) because information suggested that Japanese individuals participated in counterfeit ED drug distribution there. Samples were analyzed using Fourier transform infrared (Viagra) or near-infrared spectroscopy (Levitra) or Raman (Cialis) spectroscopy. Results: Overall, 55.4% (102/184) of the medicines distributed via the Internet were counterfeit, including 43.6% (41/94) of those obtained by the Japanese company and 67.8% (61/90) by the Thai company. Viagra samples contained 60%–149% of the indicated 100-mg sildenafil dose as well as impurities; counterfeit tablets were slightly thicker and lighter in color than genuine tablets. None of the specified active ingredient (vardenafil) was found in any Levitra sample analyzed; sildenafil and tadalafil were detected. Eleven of 36 counterfeit Cialis

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Disclosure: Work supported by industry: yes, by Pfizer Inc (industry initiated, executed and funded study). The presenter or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.

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CHEMICAL ANALYSIS OF ILLEGALLY MANUFACTURED PDE 5 INHIBITORS IN KOREA Min, KS1; Kim, SW2; Park, KS3; Lee, SW4; Hyun, JS5; Moon, KH6; Yang, DY7; Yang, SK8; Moon, DK9; Ryou, JK10; Jung, WS11; Kim, MK12; Park, JK12 1: Busan Paik Hospital, Inje University; 2: Seoul St. Mary’s Hospital; 3: Chonnam National University Hospital; 4: Samsung Medical Center; 5: Gyeongsang National University Hospital; 6: Yeungnam University Medical Center; 7: Kangdong Sacred Heart Hospital; 8: Konkuk University Chungju Hospital; 9: Korea University Kuro Hospital; 10: Inha University Hospital; 11: Ehwa Woman’s University Hospital; 12: Chonbuk National University Hospital Objectives: Since Viagra had developed at 1998, market of erectile dysfunction has been growing huge. This resulted in increasing and distributing illegally manufactured phosphodiesterase type 5 inhibitors (PDE5Is) smuggled in Korea. These drugs in the patients with erectile dysfunction could be critically harmful to them. It was aimed to analyze chemically counterfeit PDE5Is to evaluate a threat or harmfulness to the patients due to toxic materials or improper erectogenic materials. Materials and Methods: The counterfeit PDE5Is sold without prescription in private market like adult shop or on-line market in Korea were enrolled. Doses of counterfeit Viagra are 100 mg in 9 and 220 mg in 3. Counterfeit Cialis are 20 mg in 1, 50 mg in 1, 100 mg in 3, 200 mg in 1 and 220 mg in 1. Shape and color of these 19 counterfeits were compared with genuine drugs obtained free of charge from Pfizer Pharmaceuticals Korea Ltd. and Lilly Korea Ltd. Analysis of components includes erectogenic active ingredients and toxic materials like 5 heavy metals, polychlorinated biphenyls, and benzopyrenes. Erectogenic active ingredients indicate approved components of PDE5Is like sildenafil and tadalfil and 10 unapproved active materials like homo-sildenafil, hongdenafil, amino-tadalfil, xantho-anthrafil, pseudovardenafil and etc. five heavy materials are mercury, lead, cadmium, arsenic and chrome. Results: Counterfeits showed different size (32%) in tablet and different colors (42%) in tablet and solution compared to genuine Viagra and Cialis. They contained proper active ingredients including sildenafil and tadalafil in only one. Fifty eight percents contained an excess of quantity of active ingredient even by 2.4 folds compared to a genuine. Thirty seven percents showed no active ingredients at all. Ten unapproved erectogenic materials were not in all 19 drugs. Heavy materials were detected in 1 with lead and in 4 with mercury, but polychlorinated biphenyls and benzopyrenes were not. Conclusions: Counterfeit PDE5 inhibitors could not be expected consistent efficacy by lack of proper active ingredients and could be administered as over dose, which might induce serious side effects. Disclosure: Work supported by industry: yes, by Korean Society for Sexual medicine and Andrology (no industry support in study design or execution).

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A PENILE REHABILITATION PROTOCOL OF COMBINATION THERAPY FOR PDE5 INHIBITOR NON-RESPONDER WITH TDS; MONTHLY SHORT-ACTING TESTOSTERONE WITH DAILY LOW-DOSE PDE5 INHIBITOR Park, MG; Kang, JI; Chung, SM; Kim, JJ; Moon, DG Department of Urology, Korea university, College of Medicine, Seoul, Korea Objectives: The efficacy of testosterone replacement for ED after RRP or PDE5 inhibitor (PDE5I) non-responders have been reported. In this study, the efficacy of new protocol designed under the consideration of the effects and limitations of testosterone and daily low-dose PDE5I was assessed for PDE5I non-responders with low serum testosterone. Material and Methods: From January 2009, 46 ED patients of ondemand PDE5I non-responders with low serum total testosterone (<3.5 ng/dl) were followed for 36 weeks using new protocol, named KU penile rehabilitation program. KU penile rehabilitation program consists of short-acting perenteral testosterone enanthate (TE) 250 mg, every 4 weeks for 12 weeks, combination of TE with low dose daily PDE5I for the next 12 weeks and daily low-dose PDEIs or on-demand PDE5Is according to the erectile response thereafter. Serological tests (PSA, hemoglobin, testosterone, lipid profile) were performed at baseline and 24 weeks after treatment. For assessment of efficacy, the results of International Index of Erectile Function (IIEF) and Aging Male’s Symptoms Scale (AMS) were analysed at baseline, 12 and 24 weeks and the results of global assessment question (GAQ) were also analysed at 24 weeks. Statistical analysis was carried out using paired t-test. P value less than 0.05 to be statistically significant. Results: In serological tests, there was no significant change after 24 weeks of penile rehabilitation (Table 1). First 12 weeks of TE injection significantly increased total and sub-domain IIEF scores. In AMS scale, the sexual sub-scale score showed significant improvement (Table 2). After 24 weeks of treatment, total IIEF score and subdomain scores were significantly higher than the baseline (Table 2) and in AMS scale, total score and sexual sub-scale score were significantly higher than the baseline (Table 2). On GAQ, 40 of 46 patients (87.0%) stated improvement of erectile function and 32 of them (69.6%) could achieve successful sexual intercourse. For the last 12 weeks, the 32 patients were treated with on-demand PDE5Is and the rest of 14 with daily low dose PDE5Is. After completion of 36 weeks of penile rehabilitation protocol, 36 patients (78.3%) could achieve successful sexual intercourse with on-demand PDE5Is. Among 46 patients, there was no serious drug related adverse events for 36 weeks. Conclusions: In present preliminary study, the KU penile rehabilitation protocol showed a significant improvement of erectile function and the safety. Therefore, expending the application of penile rehabilitation concept could be considered and further evaluations are needed through a larger placebo controlled study. Table 1 Change of PSA, Hb, testosterone, and lipid profile after 24 weeks of treatment

PSA (ng/mL) Hemoglobin (g/dL) Testosterone (ng/dL) Total cholesterol (mg/dL) LDL (mg/dL) HDL (mg/dL) Triglyceride (mg/dL)

Baseline

6 months

P-value

1.00 ± 0.84 15.01 ± 1.34 2.24 ± 0.67 142.3 ± 44.3 105.1 ± 51.3 44.78 ± 10.27 237.8 ± 21.6

0.85 ± 0.29 15.25 ± 1.27 2.58 ± 0.73 153.9 ± 30.8 84.14 ± 29.70 44.33 ± 9.99 162.6 ± 60.3

0.484 0.396 0.137 0.287 0.132 0.838 0.282

Table 2 The results of IEF and AMS at baseline, 12 and 24 weeks after treatment Baseline

3 months

6 months

IIEF

EF OF SD IS OS Total IIEF

11.258 ± 7.488 3.742 ± 3.306 4.807 ± 2.197 4.032 ± 3.526 3.903 ± 2.181 27.742 ± 16.775

15.355 ± 7.778** 5.000 ± 3.194** 5.516 ± 2.014 6.387 ± 3.765** 4.968 ± 2.152* 37.226 ± 16.877**

16.710 ± 8.439## 5.968 ± 3.104## 5.548 ± 2.047 6.290 ± 3.752## 5.193 ± 2.257## 39.548 ± 18.053##

AMS

Psychologic Somatovegetative Sexual Total AMS

8.643 ± 3.993 15.036 ± 6.125 14.286 ± 4.206 37.964 ± 12.845

8.679 ± 4.101 14.000 ± 5.457 12.929 ± 4.936* 35.607 ± 13.031

9.071 ± 4.830 13.250 ± 6.328 12.071 ± 4.988# 34.393 ± 14.640#

*statistical significance, P < 0.05 in paired t-test between baseline and 3 months. **statistical significance, P < 0.01 in paired t-test between baseline and 3 months. # statistical significance, P < 0.05, in paired t-test between baseline and 6 months. ## statistical significance, P < 0.01, in paired t-test between baseline and 6 months. EF: erectile function, OF: orgasmic function, SD: sexual desire. IS: intercourse satisfaction, OS: overall satisfaction.

Disclosure: Work supported by industry: no.

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IS LOW INTENSITY SHOCK WAVE THERAPY A CURATIVE TREATMENT FOR ERECTILE DYSFUNCTION? A 1-YEAR FOLLOW-UP PILOT STUDY Gruenwald, IG; Vardi, Y; Appel, B; Massarwi, O Rambam Medical Center/ Israel Objectives: To evaluate the effect of low intensity extra corporeal shock wave therapy (ESWT) on erectile function, in patients with vasculogenic ED. Materials and Methods: We included 20 middle-aged patients (56.1 ± 10.7 y) with long-standing vasculogenic ED, with a mean IIEF-ED domain score (IIEF-ED) of 13.5 and an abnormal NPT. Excluded were neurogenic, psychogenic or post pelvic- surgery patients. ESWT was applied on the penile shaft and crus for 3 minutes in 5 different penile anatomical sites (intensity of 0.09 mj/mm2, 300 shocks/site). The treatment included 2 sessions/week for 3 weeks and was repeated after a 3-week no-treatment interval. Assessment of erectile function was performed at screening and at 1,3,6 months after end of treatment using validated ED questionnaires (IIEF, QEQ, SEAR, EDITS, Rigidity score). Objective hemodynamic measurements were performed in 14 patients by penile and forearm endothelial function tests before and one-month after ESWT. Results: The mean IIEF-ED increased from 13.5 at baseline to 20.6, 20.4 and 21.7 at 1, 3 and 6 months. Only 5 patients did not respond to the therapy (IIEF ED increase <5 points). QEQ improved by 23.8 points (from 32.9 to 55.3, P = 0.001) and rigidity score increased from 1.45 to 2.5 (P = 0.015). SEAR scores increased from 36 to 45.3 (P = 0.002). The EDITS final score was 23.2. A one-year follow of 9 subjects showed improvement from an average of 14.4 to 23.3 in the IIEF. Similar improvements were noted with the other ED questionnaires. Prior to our intervention all subjects were on PDE5i therapy, 5 with poor and 15 with good response. Overall 12 subjects did not require any oral therapy at 3 months. Endothelial function testing one month after treatment showed significant hemodynamic improvement in baseline and maximal penile blood flow (7.7–18.5 and 12.3–29.8 ml/ min/dl, respectively (P < 0.001). The AUC (expresses penile perfusion) increased from 369.6 to 812.2 units (P < 0.001). No pain or any other side effects were noted nor reported. Conclusions: This is the first study assessing the efficacy of ESWT for vasculogenic ED. We found this approach to be feasible and tolerable. Its main advantages are the potential to improve erectile function without the need for pharmacotherapy. Short term results are promising yet demand further evaluation using sham control and long-term follow-up that are underway. Disclosure: Work supported by industry: yes, by partially supported (device obtained from medispec) (industry funding only—investigator initiated and executed study).

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respectively. On repeat DUS: 19% (56/292) had completely normal hemodynamics, 7% (20/292) had arterial insufficiency without CVOD, while 74% (216/292) had venous leak confirmed. DIC revealed normal hemodynamics in 38% (82/216), while in 58% (126/216) CVOD was confirmed. Overall 47% (138/292) of all patients who had been given a diagnosis of CVOD had normal hemodynamics and in only 43% (126/292) was CVOD confirmed by DIC. On multivariable analysis, patient age <45 years (OR 5.2), failure to obtain a BQE during outside DUS (OR = 9.1) and <2 vascular risk factors (OR = 3.1) were predictive of a false CVOD diagnosis. Conclusions: A significant number of patients undergoing DUS in the urologic community are given a false diagnosis of CVOD. One third of men undergoing repeat DUS may again be given a false diagnosis of CVOD. Almost one half of all patients given a diagnosis of CVOD on DUS had normal hemodynamics on DIC.

CLINICALLY MEANINGFUL CHANGE IN ERECTILE FUNCTION DOMAIN SCORES Nelson, C; Balk, E; Narus, J; Atkinson, T; Mulhall, J Memorial Sloan-Kettering Cancer Center Introduction: The Erectile Function Domain (EFD) of the International Index of Erectile Function (IIEF) is considered the gold standard to measure erectile function (EF), and clinically meaningful change (CMC) has been defined as 6 points. This face-valid guideline has yet to be tested against important patient markers. We used two patient anchors (ratings of change and sexual bother) to empirically define CMC in EFD. Methods: We used two databases, both used the EFD scale. The first study assessed 95 men (mean age 59 ± 8 years) 2 months (m) and 6 m post-radical prostatectomy (RP), and included the Subjective Significance Scale (SSS), a validated measure, asking men to rate change (better or worse) in their EF. Change is graded as ‘about the same,’ ‘a little’, ‘moderate,’ or ‘very much.’ The second study assessed 437 men (mean age 59 ± 7 years) pre-RP, and then 3 m, 12 m, and 24 m postRP. This study used a validated, 3-question Sexual Bother (SB) scale. Results: For the first database, we calculated the mean increase in EFD scores from 2 m to 6 m post-RP for each category of the SSS. Men rated a significant (P < 0.05) mean increase in EFD for the following improvements in the SSS: a little = 1.9 EFD increase, moderate = 6.4 increase, very much = 18 point increase. In the second database, we calculated changes in SB and EFD scores from 3 m to 12 m, and 3 m to 24 m. We defined categories of change in SB scores using standard deviations (SD): no SB change (−1 to +1 SD), mild SB decrease (−1 to −2 SD decrease), moderate SB decrease (>2 SD decrease), mild SB increase (1 to 2 SD increase), moderate SB increase (>2 SD increase). The mean EFD change scores significantly (P < 0.05) changed for each category of SB scores: mild SB decrease = 3.1 EFD increase, moderate SB decrease = 6.7 increase, mild increase in SB = 2.9 decrease, and moderate increase in SB = 6.3 decrease in EFD. Conclusions: A 2–3 point change in EFD score appears to indicate a mild but meaningful change in EF and patient-reported SB, while a 6-point change indicates a moderate change in both. Thus a 2–3 point change is a CMC on the EFD score. This may have important implications for clinical trials and research endpoints. Disclosure: Work supported by industry: no.

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THE FALSE DIAGNOSIS OF VENOUS LEAK: PREVALENCE AND PREDICTORS Teloken, PE; Park, K; Parker, M; Guhring, P; Narus, J; Mulhall, JP MSKCC Introduction: In many centers, penile duplex Doppler ultrasound (DUS) is the sole test to investigate the existence of corporovenocclusive dysfunction (CVOD) in patients with erectile dysfunction (ED). However, methodological challenges in the performance of DUS may limit its accuracy in the diagnosis of CVOD. The present study was carried out to define the accuracy of DUS in diagnosing CVOD and seek predictors of a false diagnosis. Methods: Data were collected prospectively on patients who (i) had been given a diagnosis of CVOD based on an outside DUS (ii) elected to undergo a repeat DUS; and (iii) when the repeat DUS suggested CVOD, underwent cavernosometry (DIC). DUS and DIC were conducted using a trimix redosing schedule aimed at achieving complete corporal smooth muscle relaxation. On DUS, arteriogenic ED was defined as peak systolic velocity (PSV) <30 cm/s and CVOD as end diastolic velocity (EDV) >5 cm/s. On DIC venous leak was diagnosed when the flow-to-maintain (FTM) value at an intracorporal pressure of 90 mmHg was >5 ml/min. Results: 292 patients given a diagnosis of CVOD at an outside institution were included (Figure 1). Mean ± SD age was 44 ± 26 (range 19– 66) years. For the outside and repeat DUS, mean number of vasoactive agent injections per patient was 1.2 and 2.2 while the percentage of patients achieving penetration hardness rigidity was 34% and 74%,

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Disclosure: Work supported by industry: no.

069

A SURVEY OF ERECTILE DYSFUNCTION IN TAIWAN: USE OF THE ERECTION HARDNESS SCORE AND QUALITY OF ERECTION QUESTIONNAIRE Hwang, TIS1; Tsai, TE1; Lin, YIC1; Chiang, HS2; Chang, LS1 1: Shin Kong Wu Ho-Su Memorial Hospital; 2: School of Medicine, Fu-Jen Catholic University Objectives: To provide up-to-date data on the prevalence of ED in Taiwanese men and to validate the erection hardness score EHS and QEQ in this population. There are currently few studies in the Asia Pacific region using the erection hardness score (EHS) and quality of erection questionnaire (QEQ) to assess erectile dysfunction (ED). Material and Methods: A representative sample of 1,060 men aged ≥30 years completed a telephone interview. ED status was confirmed via direct questioning and using the abridged five-item version of the 15-item International Index of Erectile Function (IIEF-5) assessment. Responses regarding EHS, QEQ, marital and sexual satisfaction, and attitude to treatment were also recorded. Results: The prevalence of ED, as defined by IIEF-5, was 27% among all respondents and 29% among those aged ≥40 years. Although, the prevalence of ED increased with age, men of all ages tended to underestimate their erectile problems. Amongst men who indicated that they did not have ED, 25% were found to have mild to moderate ED according to the IIEF-5 assessment. An EHS of ≤3, indicating the presence of ED, was reported in 26% of men. The EHS was consistent with the QEQ: when the EHS was 4, the satisfaction of each domain of QEQ ranged from 85 to 90%. The QEQ score correlated well with the IIEF-5 score, and significantly affected both sexual and marital satisfaction (P < 0.005). Conclusions: These data indicate that EHS is a simple, practical tool for clinical use. QEQ scores appear to be independently associated with sexual and marital satisfaction and may be of value in the assessment and monitoring of patients with ED. While ED is a common health problem in Taiwan and the prevalence of ED increases with age, affected men lack awareness regarding the presence of erectile problems and the importance of initiating timely and effective treatment. Disclosure: Work supported by industry: yes, by Pfizer (no industry support in study design or execution).

070

LASER DOPPLER MICROCIRCULATION FLOUMETRY—THE NEW METHOD FOR VASCULOGENIC ED DIAGNOSIS Kurbatov, DG1; Neymark, AI2; Aliev, RT2; Kurbatov, DG3 1: Endocrinological Research Centre; 2: Altai Medical Academy/Russia; 3: Endocrinological Research Centre/Russia Objectives: Duplex Doppler ultrasonography (DDU) is the conventional test for penile haemodynamic evaluation for erectile dysfunction

Proceedings from the 14th World Meeting of the International Society for Sexual Medicine (ED) screening. We used since 2008 a new method for vasculogenic ED diagnosis—Laser Doppler Microcirculation Floumetry (LDMF). Design and Method: One hundred twenty six patients were examined—100 men (mean age 52 ± 6,4) suffered arteriovenous form of ED and 26 healthy men (mean age 26 ± 5,6) as control group. Patients with diabetes mellitus, severe arterial hypertension were excluded. Initially all men undergone DDU with pharmacological test, then tested by LDMF with laser analyzer LAKK-02 («LAZMA», Russia) and heliumneon laser of LGN-207 B-type with 0,63 microns wave length. Results: Slow rhythms with frequency of 1–10 oscillations per minute prevailed in the control group. These rhythms were accompanied with the maximum intravascular resistance and active microcirculations mechanism. We considered these blood flow parameters as a physiological norm of the peripheral microcirculation and it correlated with the dynamics fluctuations of the blood flow. The patients with ED had intravascular circulatory injuries. It characterized by abrupt decrease of the blood flow and statistically significant fluctuations of the erythrocytes velocity, decreasing of the myogenic tone and increasing of the neurogenic tone in the precapillary net. The microcirculation’s effectiveness index was also decreased. There were the decreasing of the blood perfusion intensity in cavernous tissue, blood volume reduction in the arterioles, and the congestion in venules with increasing of the erythrocytes amount. These data indicated that the patients with vasculogenic ED had the spastic form of microcirculation injure—decreasing of blood inflow due to cavernous tissue vessels spasm. In these cases the microcirculation index and sphygmic fluctuations amplitude decreased, but the slow oscillations amplitude and vasomotory activity increased. Conclusion: LDMF is a new method of vasculogenic ED diagnosis. In comparison with DDU this method allows to check the microcirculation mechanism and evaluate blood flow disturbances directly in the cavernous tissue. It helps to study the pathogenic changes caused by vasculogenic ED and thus improves the quality of diagnosis. Disclosure: Work supported by industry: no.

071

PATTERNS OF VENOUS LEAK DURING CAVERNOSOMETRY Mueller, A; Heck, M; Mulhall, JP MSKCC Introduction: While the majority of clinicians use duplex Doppler ultrasound (DUS) as the vascular evaluation investigation of choice, some question the ability of DUS to adequately measure venocclusive function, especially in the presence of low arterial inflow. This analysis was aimed at evaluating the patterns of corporo-venocclusive dysfunction (CVOD) seen on dynamic infusion cavernosometry (DIC). Methods: Patients with abnormal venocclusive parameters on DIC constituted the study population. Demographic and comorbidity parameters were recorded. Patients underwent DIC using a repeat injection protocol. Flow to maintain values were used to define CVOD. CVOD was diagnosed based on a FTM value >3 mls/min. If patients had abnormal FTM values they were monitored for 60 minutes after the procedure for the development of a delayed penetration-hardness erection. If they failed to obtain a delayed erection they were diagnosed with CVOD. Those failing to achieve a delayed erection were informed that they had abnormal FTM values resulting from high levels of intra-procedural adrenaline and were not diagnosed with CVOD. Chisquare analysis was used to detect differences in incidences of comorbidities between the two groups (delayed vs no delayed erection). Student t-test was used to define differences in DIC parameters between the two groups. Results: 102 patients were analyzed with mean age of 51 ± 16 years. Patients demonstrated two distinct patterns (Figure): a linear pattern (n = 62) and a parabolic pattern (n = 40). Statistically significant differences were demonstrated between the two groups for equilibrium pressure (P < 0.01), percentage of patients with ICP ≥60 mm Hg (P < 0.01), and FTM values (P < 0.001). There were also statistically significant differences between the 2 groups in the presence of comorbidities (P < 0.02) with lower rates of comorbidities in the parabolic

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pattern group. 89% of the linear pattern group did not develop a delayed erection (negative predictive value 97%), while 95% of the parabolic pattern group developed a delayed erection (positive predictive value 83%). Conclusions: FTM patterns can predict venous leak on DIC with an accuracy of 97%. This is superior to DUS, especially when a single dose of vasoactive agent is used for DUS. These data should encourage clinicians to monitor patients after vascular testing to minimize the risk of post-procedure priapism. Disclosure: Work supported by industry: no.

072

DA-8031, A NOVEL COMPOUND FOR PREMATURE EJACULATION, NOTICEABLY ATTENUATES THE EJACULATORY PROCESS ELICITED BY ELECTRICAL STIMULATION OF PUDENDAL AFFERENT NERVE AND P-CHLOROAMPHETAMINE Sung, JH; Ahn, GJ; Kang, KK; Ahn, BO; Kim, SH Dong-a Pharmaceutical institute Objectives: This study was undertaken to verify the efficacy of DA8031, which is being actively developed for the treatment of premature ejaculation (PE), in an animal model designed to represent pathophysiological standpoints of PE. Materials and Methods: In the first experiment, sensory branch of pudendal nerve (SnPdN) was identified in pelvic canal of spinal cordtransected rats in which supraspinal inhibition on ejaculatory process was abolished. Then electromyogram (EMG) profile of bulbospongiosus (BS) muscle was recorded during electrical stimulation of SnPdN following single i.v. dosing of DA-8031 (0.3, 1, 3 mg/kg). In the second experiment, both seminal vesicle pressure (SVP) and EMG profile of BS muscle were recorded in p-chloroamphetamine (PCA)-induced ejaculation model after applying same dosing regimen. Results: In DA-8031 treated groups, the AUC of BS muscle EMG wave during electrical stimulation of SnPdN exhibited a significant and dose-dependent reduction (p < 0.05) compared with vehicle group (0.35 ± 0.08, 1.16 ± 0.32, 2.16 ± 0.60 vs. 2.41 ± 0.44, respectively). Maximum amplitude also significantly decreased in DA-8031 1 and 3 mg/kg dose level. Consistent with these findings, SVP increase by PCA administration was significantly inhibited from DA-8031 0.3 mg/ kg dose level, and AUC of BS muscle EMG wave significantly decreased in DA-8031 1 and 3 mg/kg groups (P < 0.05) compared with vehicle group as well (0.52 ± 0.28, 0.16 ± 1.66 vs. 6.53 ± 2.10, respectively). Conclusion: On closer inspection of these results, it appears that DA8031 attributes to effective coordinated inhibition of emission phase through blocking the rise in SVP, and of expulsion phase through modulating BS muscle activity. These findings suggest that DA-8031 might be a promising PE treatment drug, but further evaluation in human must be performed. Disclosure: Work supported by industry: yes, by Dong-a Pharmaceutical institute (industry funding only—investigator initiated and executed study). The presenter or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.

073

IS INTRANASAL OXYTOCIN ADMINISTERED DURING COITUS EFFICACIOUS FOR TREATMENT-RESISTANT MALE ANORGASMIA Zappavigna, C; Shamloul, R; Gerridzen, RG; Cagiannos, I; Morash, C; Bella, AJ University of Ottawa, Canada Objectives: It was with interest that we reviewed the report by Ishak et al (J Sex Med 2008; 5: 1022–1024) demonstrating improvement in

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anorgasmia parameters with treatment by intranasal oxytocin. Oxytocin is a nine-peptide hormone originating from the posterior pituitary gland, and has been shown to impact orgasmic function; half-life is two to three minutes. There is no other series in the literature using this agent for these difficult-to-treat patients. Materials and Methods: A detailed review of anorgasmia history, potential risks and benefits of proposed treatment, and possible alternatives were reviewed for 12 patients. Baseline hormonal profiles were obtained and were within normal range. Patients did not have criteria for other DSM IV conditions. Based on the case report and on basic research findings that oxytocin increases during arousal and peaks during orgasm, patients were consented for off-label use of oxytocin spray. Formulation was 24 IU during intercourse at the point when ejaculation was sought as previously reported; one puff per nostril was utilized for drug delivery. Results: All patients attempted to modulate anorgasmia on eight different occasions using the metered-dose inhaler for delivery of 24 IU oxytocin. There were no serious side-effects; three patients complained of nasal congestion/runny nose, four had intermittent mild to moderate headache, and one repeatedly experienced an odd taste associated with treatment. Three patients noted improvement in the ability to orgasm, although for one this was inconsistent; the other nine did not demonstrate any improvement in orgasmic function. Conclusions: This report underscores the need for both positive and negative results in the medical literature to be reported. In this case series, the beneficial effects of 24 IU of intranasal oxytocin during intercourse are inconsistent and placebo effect cannot be ruled out in the initial case report. Further basic and clinical study is warranted for this potential orgasm modulator, or downstream molecular targets to oxytocin. Disclosure: Work supported by industry: no. The presenter or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.

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EJACULATORY DYSFUNCTION FOLLOWING RADIATION THERAPY FOR PROSTATE CANCER Stember, DS; Deveci, S; Akin-Olgubade, Y; Mulhall, JP Memorial Sloan-Kettering Cancer Center Objective(s): Radical prostatectomy is associated with anejaculation. Clinical experience has shown that many men after pelvic radiation therapy (RT) with time will also experience anejaculation. This analysis was conducted to define the ejaculation profiles of men after RT for prostate cancer. Materials and Method(s): As a routine part of the sexual health evaluation for post-RT sexual problems, men provided information regarding their ejaculatory function (presence/absence, semen volume, force of ejaculation) and orgasm (presence/absence, intensity, ease of achievement). Demographic data, prostate cancer factors, erectile function, ejaculation and orgasm factors were collected. Men with prior history of RP, cryotherapy, HIFU and androgen deprivation therapy were excluded. Patients completed the IIEF at follow-up visits commencing with the first post-treatment visit. Result(s): 364 consecutive patients met criteria. External beam RT was utilized in 252 and brachytherapy in 112. Mean age was 64 + 11 (42–78) years, mean follow-up after RT was 6 ± 4.5 years. Mean prostate size was 42 + 21 grams. Overall 72% were unable to ejaculate in an antegrade fashion after prostate RT by their last visit. The proportion experiencing anejaculation at 1, 3 and 5 years after RT was 16%, 69%, 89% respectively. Age >65 years, prostate size <40 grams, BT + EBRT, and IMRT were predictors of the failure to experience an antegrade ejaculate 3 years after RT. For men with at least 2 IIEF questionnaires completed, the orgasm domain scores decreased dramatically over the follow-up period: <12 months 7.4, 13–24 months 5.4, 25–36 months 3.2, >36 months 2.8 (P < 0.01). Conclusion(s): The vast majority of men after prostate RT will experience anejaculation and should be counseled accordingly prior to

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undergoing therapy. The likelihood of failure to ejaculate is increased in men with combination RT, older age, and smaller prostates at the time of RT. Disclosure: Work supported by industry: no.

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COMPARISON OF BASELINE CHARACTERISTICS OF MEN WITH LIFELONG AND ACQUIRED PREMATURE EJACULATION (PE) IN THE ASIA-PACIFIC REGION McMahon, CG1; Kim, SW2; Park, NC3; Chang, C-P4; Rivas, D5; Tesfaye, F5; Rothman, M6; Aquilina, JW5 1: Australian Center for Sexual Health, Sydney, Australia; 2: Catholic University of Korea and St. Mary’s Hospital, Seoul, Korea; 3: Pusan National University Hospital, Pusan, Korea; 4: Changhua Christian Hospital, Changhua, Taiwan; 5: Johnson & Johnson Pharmaceutical Research & Development, Raritan, NJ, USA; 6: Johnson & Johnson Pharmaceutical Services, Raritan, NJ, USA Objective: To evaluate baseline characteristics of men with lifelong and acquired PE in a phase 3 study of dapoxetine 30 and 60 mg for the on-demand treatment of PE in men from the Asia-Pacific region. Methods: Data were from a double-blind, randomized, placebocontrolled, phase 3 trial (NCT00210704) that enrolled men ≥18 years of age that met the DSM-IV-TR criteria for PE, had an intravaginal ejaculatory latency time (IELT) of ≤2 min in ≥75% of intercourse episodes, and were in a stable, monogamous sexual relationship; men and their partners did not have any other self-reported sexual dysfunction. Based on sexual history questioning at screening, investigators categorized the PE as lifelong or acquired and recorded duration of the condition, stopwatch-measured IELT, International Index of Erectile Function (IIEF) scores on 5 domains (erectile function, orgasmic function, sexual desire, intercourse satisfaction, and overall satisfaction), and patient-reported outcomes (PROs) of perceived control over ejaculation, satisfaction with sexual intercourse, and personal distress and interpersonal difficulty related to ejaculation. Results: Among men with lifelong (N = 607) and acquired (N = 460) PE, mean (standard deviation [SD]) age was 42.2 (10.0) and 40.0 (10.6) years, respectively, and mean (SD) duration of PE was 5.0 (5.2) and 14.8 (10.9) years, respectively. Baseline mean (SD) IELT was 1.0 (0.47) min and 1.1 (0.45) min in men with lifelong and acquired, respectively. Mean (SD) IIEF scores at baseline were similar for both groups for erectile function (lifelong PE, 27.4 [2.9]; acquired PE, 26.9 [3.1]), orgasmic function (8.4 [1.7]; 8.2 [1.7]), sexual desire (7.3 [1.4]; 7.2 [1.5]), intercourse satisfaction (7.2 [2.0]; 7.3 [1.9]), and overall satisfaction (4.4 [1.6]; 4.8 [1.7]). The majority of men with both groups reported “very poor” or “poor” control over ejaculation (lifelong PE, 92%; acquired PE, 88%) and satisfaction with sexual intercourse (80%; 74%), and many reported “quite a bit” or “extreme” personal distress (75%; 72%) or interpersonal difficulty (52%; 48%) related to ejaculation. Conclusions: Baseline demographic and clinical characteristics, including age, IELT, IIEF scores, and PROs were generally similar in men with lifelong or acquired PE. Disclosure: Work supported by industry: yes, by Johnson & Johnson Pharmaceutical Research & Development, L.L.C. (industry initiated, executed and funded study). The presenter or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.

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IMPROVEMENTS IN INTRAVAGINAL EJACULATORY LATENCY TIME (IELT) AND PATIENT-REPORTED OUTCOMES (PROS) IN DAPOXETINE-TREATED MEN FROM THE ASIA-PACIFIC REGION WITH LIFELONG OR ACQUIRED PREMATURE EJACULATION (PE) McMahon, CG1; Kim, SW2; Park, NC3; Chang, C-P4; Rivas, D5; Tesfaye, F5; Rothman, M6; Aquilina, JW5 1: Australian Center for Sexual Health, Sydney, Australia; 2: Catholic University of Korea and St. Mary’s Hospital, Seoul, Korea; 3: Pusan National University Hospital, Pusan, Korea; 4: Changhua Christian Hospital, Changhua, Taiwan; 5: Johnson & Johnson Pharmaceutical Research & Development, Raritan, NJ, USA; 6: Johnson & Johnson Pharmaceutical Services, Raritan, NJ, USA Objective: PE may be classified as a lifelong or acquired dysfunction, and potential differences in treatment outcomes have rarely been explored. Here we report results in men with lifelong or acquired PE from a 12week, randomized, placebo-controlled, phase 3 study (NCT00210704) of dapoxetine conducted in men in the Asia-Pacific region. Methods: Men ≥18 years of age in a stable, monogamous sexual relationship were diagnosed with PE using the DSM-IV-TR criteria, and were also required to have an IELT of ≤2 min in ≥75% of intercourse episodes during screening. Investigators classified PE as lifelong and acquired PE based on sexual history. Men received dapoxetine 30 or 60 mg, or placebo, taken on-demand for 12 weeks. Outcome measures included stopwatch-measured IELT and PROs of perceived control over ejaculation, satisfaction with sexual intercourse, and personal distress related to ejaculation. Results: Among men with lifelong PE, mean (standard deviation [SD]) IELT at endpoint was significantly (P < 0.001) greater with dapoxetine 30 and 60 mg (4.0 [4.09] and 4.0 [4.02] min, respectively) than placebo (2.3 [1.97]); similar results were observed in men with acquired PE (3.7 [3.76] and 4.5 [3.89] min, respectively, vs 2.6 [2.15]; P < 0.001). At 12 weeks, significantly more men receiving dapoxetine 30 and 60 mg reported “good” or “very good” control over ejaculation compared with placebo in both groups (lifelong PE: 32.1% and 29.3%, vs 16.8% [P < 0.001]; acquired PE: 35.2% and 39.6%, vs 21.2% [P < 0.001]). “Good” or “very good” satisfaction with sexual intercourse was also reported by significantly more men receiving dapoxetine 30 and 60 mg compared with placebo in both groups (lifelong PE: 42.8% and 38.9%, vs 28.1% [P ≤ 0.05]; acquired PE: 39.2% and 43.9%, vs 30.1% [P ≤ 0.05]). Significantly more men with acquired PE receiving dapoxetine 30 and 60 mg (49.3% and 57.6%) reported “not at all” or “a little bit” of personal distress compared with placebo (34.6%; P ≤ 0.01), as did men with lifelong PE receiving dapoxetine 30 mg (46.0% vs 34.1%; P ≤ 0.05). Conclusions: Men with lifelong and acquired PE treated with dapoxetine reported significant improvements compared with placebo in IELT, perceived control over ejaculation, satisfaction with sexual intercourse, and personal distress. Disclosure: Work supported by industry: yes, by Johnson & Johnson Pharmaceutical Research & Development, L.L.C. (industry initiated, executed and funded study). The presenter or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.

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PSYCHOLOGICAL AND INTERPERSONAL FACTORS ASSOCIATED WITH PREMATURE EJACULATION: AN EVALUATION OF DIFFERENT TREATMENT OPTIONS

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role of psychological and interpersonal factors that contribute to and maintain PE. Material and Methods: The data are drawn from a range of past studies that have evaluated the above variables. Recent data that have evaluated the impact of PE on Australian men and their partners will also be presented. The effectiveness of different treatment options in terms of improving not only the man’s PE, but also his psychological adjustment and the quality of his relationship will be presented. Results: The findings from these analyses demonstrate that the selfesteem, masculinity and quality of life of men with PE is lower than men in the general population. Further, relationship satisfaction, communication and intimacy are also lower among men with PE. The partners of men with PE are also likely to experience lower quality of life and higher levels of sexual dysfunction. Psychological and medical treatments for PE have demonstrated some success in addressing these problems. Supportfor internet-based treatment programs as well as combination therapies will be discussed. Conclusions: Research in relation to the effectiveness of various treatment options for PE demonstrate that both psychological and medical interventions demonstrate some level of effectiveness. However, patients are most likely to benefit from a combined psychological and medical treatment regime for this condition. Disclosure: Work supported by industry: no.

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RESINIFERATOXIN FOR TREATMENT OF PREMATURE EJACULATION: A NEW MEDICAL THERAPY Guan, ZC1; Shi, BT1; Wang, R2 1: Peking University Shenzhen Hospital, China; 2: University of Texas Medical School at Houston and MD Anderson Cancer Center, USA Introduction: Resiniferatioxin (RTX) can reduce the excitability and sensibility of afferent sensory nerve by blocking the C type nerve fibber through releasing P substance. There is no study available to use RTX in the treatment of premature ejaculation (PE). This study was designed to evaluate the effectiveness and the safety of RTX therapy for PE. Methods: A cohort of 21 patients with PE was prospectively enrolled into this RTX clinical trial from October, 2008 to October, 2009. The patients were instructed to soak the glans penis with 100 ml of RTX at the concentration of 100 umo1/L for 30 minutes one hour prior to sexual intercourse. The study duration was four weeks. IELT and CIPE-5 were recorded before and after the RTX treatment. The side effects with the RTX treatment were also evaluated. Results: The mean age of patients was 24 year old. Of the 21 patients, 11 men had redundant prepuce; the other 10 men were without redundant foreskin. For patients with redundant prepuce the IELT and CIPE-5 were significant increased with RTX treatment (IELT: from 1.29 ± 0.46 min to 4.55 ± 4.05 min; CIPE-5: from 11.82 ± 5.19 to 16.00 ± 4.22; P < 0.05). In patients without redundant foreskin, there were no significant changes of their IELT (0.89 ± 0.37 vs. 1.43 ± 1.44) and CIPE-5 (11.80 ± 4.52 vs. 12.40 ± 5.32) before and after the RTX treatment (P > 0.05). The IELT and CIPE-5 were significantly increased in patients with redundant prepuce when compared to that in patients without redundant foreskin after the RTX treatment (P < 0.05). The overall effective rate of RTX treatment for PE was 42.9% with 63.6% of patients with redundant prepuce reporting improvement and 20% of patients without redundant foreskin reporting efficacy. The only side effect is the bearable burning of the glans penis. Conclusion: This is the first study, to our knowledge, demonstrating the potential use of RTX in the treatment of PE, particularly, for patients with redundant prepuce. Disclosure: Work supported by industry: no.

McCabe, MP Deakin University, Melbourne, Australia Objectives: Premature ejaculation (PE) is a highly prevalent male sexual dysfunction. This paper evaluates the evidence in relation to the

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Perceived IELT. PE was diagnosed with PEDT and classified into 3 groups: PE (PEDT > 10), possible-PE (PEDT 9∼10), non-PE (PEDT < 9). IELT was asked with 5 examples: <1 min, 1∼2 min, 2∼5 min, 5∼10 min and >10 min. Results: 7,650 men were classified into 3 groups: 1,684 men in PE (22.0%), 1,117 men in possible-PE (14.6%) and 4,849 men in non-PE (63.4%). The three groups showed the significant difference between groups in the perceived IELT (Pearson’s Chi-squared test; P-value <2.2e-16). 54.1%, 19.8% and 5.6% from PE, possible-PE and non-PE groups answered their perceived IELT of <2 min, whereas 11.6%, 37.6% and 68.9% reported IELT of >5 min respectively. The three groups were also different each other in the answer of self-reported PE question. 89.3% men in PE group recognized themselves as PE. However, 58.6% in possible-PE and 21.5% men in non-PE reported self-identified PE. Conclusions: PEDT was well correlated with self-diagnosis and perceived IELT. Because men are reluctant to discuss their PE symptom with their physicians, it would be a good approach that physicians have a consultation with a man with high PEDT score (>10) about their PE symptoms even though he shows no complaint.

THE RELATIONSHIP BETWEEN LIFELONG PREMATURE EJACULATION AND MONOSYMPTOMATIC ENURESIS Gökçe, A1; Ekmekcioglu, O2 1: Mustafa Kemal University Tayfur Ata Sokmen Medical Faculty; 2: Erciyes University Medical Faculty Objectives: The underlying physiopathologies of lifelong premature ejaculation (PE) and monosymptomatic enuresis (ME) are not completely understood. The aim of the present study is to evaluate the prevalence of ME in men diagnosed with lifelong PE and relationships of these two conditions. Material and Methods: Between December 2008 and November 2009, we designed a prospective randomized study in 51 patients who had presented with lifelong PE and in age-matched 106 healthy control cases without PE. If the patient declared that he ejaculated less than 1 minute more than half of his intercourse attempts, he was enrolled in the study. All subjects included in this study underwent general and urological physical examinations and were asked about their history of ME. The frequency of enuresis was graded using the following criteria: 1–2 times/week as infrequent, 3–5 times/week as moderate and 6–7 times/week as severe. Only patients with primary ME were evaluated. Results: Of the 51 premature ejaculator men, 19 (37.2%) had a history of ME. Among these 19 men, 5 (26.3%) had severe, 6 (31.6%) had moderate and 8 (42.1%) had infrequent enuresis. Of the 106 control cases, 16 (15.1%) had a history of ME and of these 16 patients, 3 (18.7%) had severe, 5 (31.2%) had moderate and 8 (50%) had infrequent enuresis. Compared with control population (15.1%), the prevalence of ME in the premature ejaculators (37.2%) was more than 2-fold higher (P < 0.005). Conclusions: This is the first prospective study which investigated the relationship between lifelong PE and ME and we have found a significant increase in ME prevalence in lifelong premature ejaculators. A common deficiency of inhibitory signal processing in the central nervous system may underlie both inability to inhibit the ejaculation and micturition in these patients or genetic predisposition may play a significant role. Further prospective studies are needed to explain the relationship between lifelong PE and ME. Disclosure: Work supported by industry: no.

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CORRELATION OF PREMATURE EJACULATION DIAGNOSTIC TOOL (PEDT) WITH SELF-REPORTED PE AND PERCEIVED INTRAVAGINAL EJACULATORY LATENCY TIME (IELT) Lee, SW1; Park, JK2; Park, KS3; Park, NC4; Kim, SW5; Yang, DY6; Moon, KH7; Moon, DG8; Min, KS9; Hyun, JS10; Ryu, JK11; Woo, SH12; Jin, KN13 1: Sungkyunkwan University/Korea; 2: Chonbuk National University Hospital/Korea; 3: Chonnam National University/Korea; 4: Pusan National University/Korea; 5: The Catholic University of Korea/Korea; 6: Halim University/Korea; 7: Yeungnam University/Korea; 8: Korea University/ Korea; 9: Inje University/Korea; 10: Gyeongsang National University Hospital/Korea; 11: Inha University/Korea; 12: Eulji University Hospital/ Korea; 13: Dr. Jin’s urology clinic/Korea Objective(s): The Premature Ejaculation Diagnostic Tool (PEDT) was developed to apply the DSM-IV-TR criteria in diagnostic PE. The Korean version of the PEDT has been validated recently. This study has assessed the relationship of PEDT with Perceived IELT and self-reported PE. Material and Methods: We analyzed information gathered from male out-patients in 196 Korean urological clinics and hospitals during Korean Male Health Campaign Week (23∼28 Nov 2009). Each man was asked with a simple questionnaire form including PEDT and

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Disclosure: Work supported by industry: yes, by The Korean Urological Association (no industry support in study design or execution). The presenter or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.

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SURGEON IMPACT ON VARIABILITY IN PATIENT EXPECTATIONS REGARDING SEXUAL FUNCTION OUTCOMES AFTER RADICAL PROSTATECTOMY Deveci, S; Alex, B; O’Brien, K; Mulhall, JP MSKCC Introduction: It has been shown that some patients have unrealistic expectations about sexual function after radical prostatectomy (RP). We undertook this study comparing the sexual function expectations of patients treated by 7 different surgeons. Methods: Patients presenting within 3 months of their RP were questioned regarding the sexual function information that they received pre-RP. Patients were questioned about erectile function (EF), ejaculation, orgasm and penile morphology changes. Expectations were compared between 7 surgeons who had referred >20 patients over a 2 year period. Parameters assessed included: proportion of men (i) not knowing the nerve sparing (NS) status (ii) thinking average time to recover EF was <12 months (iii) thinking they would return to baseline EF after RP (iv) not knowing they would no longer ejaculate (v) not knowing about orgasmic pain (vi) not knowing about climacturia and (vii) not knowing about penile morphological changes. A 7-point scale (‘expectation score’, 0 best expectations, 7 worst) was used to grade surgeons with a point being assigned if patients did not know their NS status or when >25% of the surgeon’s patients had inaccurate expectations on each parameter. Statistical comparison was conducted for differences in outcomes between surgeons using ANOVA. Correlations were sought between surgeon factors and the expectations score. Results: 313 patients were analyzed. 3 surgeons performed open and 4 robotic RP. Patient mean age 60 ± 14 years. There were no differences in demographics, comorbidities or cancer factors between the 7 surgeons’ patients. Mean expectation score was 5 ± 2 (range 3–7). Mean score for robotic surgeons was 6 ± 1 compared to 3.6 ± 0.4 for open surgeons (P = 0.02). Expectation results are presented in the Table. There was a correlation between the number of patients referred and the expectation score (r = 0.22), with high referring surgeons having more patients with unrealistic expectations. Conclusions: These data support the previous data that many patients have unrealistic expectations. We have shown that these expectation deficiencies vary significantly between surgeons and appear to worse for high referring and possibly busier surgeons.

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Surgeon

#

Did Not Know Their Nerve Sparing Status

A B C D E F G

46 24 32 34 24 47 106

32% 40% 36% 50% 60% 22% 75%

Thought Average Time To Achieve Erection Recovery Was <12 Months

Thought They Would Get Back To Baseline Erectile Function

Did Not Know They Would Not Ejaculate

Did Not Know About Orgasmic Pain

Did Not Know About Climacturia

Did Not Know About Penile Length Changes

15% 60% 15% 11% 70% 13% 100%

50% 66% 100% 75% 66% 75% 90%

0% 15% 9% 30% 35% 50% 20%

75% 15% 75% 88% 100% 100% 100%

90% 100% 11% 13% 100% 100% 100%

100% 100% 90% 100% 100% 80% 100%

Disclosure: Work supported by industry: no.

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IMPACT OF SURGEON ON FUNCTIONAL OUTCOMES FOLLOWING RADICAL PROSTATECTOMY Vickers, A1; Bianco, F; Mulhall, JP; Sandhu, J; Guillonneau, B; Cronin, A; Savage, C; Scardino, PT 1: MSKCC Introduction: Previous studies have shown that complications and biochemical recurrence rates after radical prostatectomy (RP) vary between different surgeons to a greater extent than might be expected by chance. In this study, we examined whether such variation, known as heterogeneity, exists for the functional outcomes of potency and continence after RP. Methods: A total of 2,856 and 1,422 RP patients who were treated by one of 16 surgeons at Memorial Sloan Kettering Cancer Center were evaluated for the outcome of continence or potency one year after surgery. Multivariable random effects models were used to evaluate the heterogeneity in potency or continence between surgeons, after adjustment for case-mix (age, PSA, pathological stage and grade, comorbidities) and year of surgery. Results: We found significant heterogeneity in functional outcomes after RP (P < 0.001 for both continence and potency). Two surgeons in our series had adjusted rates of full potency of less than 25%, while another two had rates greater than 45%. For the endpoint of full continence, four surgeons had adjusted rates less than 65%, whereas three had rates better than 80%. We found significant positive associations between surgeon’s adjusted continence and potency rates (P = 0.022); better rates of functional preservation were associated with lower biochemical recurrence rates (P = 0.048). Conclusion: A patient’s risk of potency and continence may differ depending on which of two surgeons he sees. Functional preservation does not appear to come at the expense of cancer control, rather both are related to surgical quality.

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Disclosure: Work supported by industry: no.

IMPACT OF ADVANCE MALE SLING ON POST-RADICAL PROSTATECTOMY CLIMACTURIA: ROBUST PROSPECTIVE COHORT RESULTS AT ONE-YEAR FOLLOW-UP

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Saltel, ME; Gerridzen, RG; Bella, AJ University of Ottawa, Canada

WITHDRAWN

Objective: Orgasm associated incontinence has received little attention in the literature but confers significant quality-of-life and healthsystem impact post-radical prostatectomy (RP). Recent reports estimate occurrence of up to 20–48%; in Mulhall’s report of 475 RP patients (pts), 96 reported orgasm associated incontinence (J Urol 177(6): 2223-6) independent of age, nerve sparing or surgical margin status, seminal vesicle or lymph node involvement, preoperative erectile function, nocturnal erections, libido level or daytime continence. In this study, we prospectively evaluate and report the first series determining the impact of the Advance Male Sling for men with pharmacologically treatment-resistant mild-to-moderate incontinence and climacturia (CLM). Materials and Methods: Prospective data on a specific population of 15 pts with incontinence and CLM was collected. The primary endpoint was complete resolution of CLM, with concurrent evaluation of post-sling urinary control. All pts were at least 1.5 years post-RP (2 pts with adjuvant radiotherapy) prior to incontinence surgery, and underwent placement of the AdVance male sling after evaluation con-

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sisting of history, physical examination, determination of pad-per-day (PPD) incontinence, cystoscopy, and video urodynamics/pad weight tests as indicated for 3 or more ppd leakage. The pts underwent outpatient re-evaluation at 2, 6 and 12 weeks post-surgery and ongoing treatment efficacy was assessed q6 months with regards to pad-free status, flow rate, and post-void residuals in addition to yes/no of any urinary leak during sexual activity. Results: Median pt follow-up is 50 weeks (range 12–71 weeks). Age was 67 ± 6 years. Preoperative pad use ranged from 1–4 pads/day. All men had complete resolution of CLM. 13/15 (87%) pts were completely dry with no pad use, and 2/15 pts reported persistent 1 ppd incontinence; these were men initially identified with 2+ pad per day leakage and concurrent detrusor overactivity on urodynamics (one post adjuvant radiation), and were counselled regarding potential limitations of the sling approach. No sling infections or revision surgery were reported, and post-procedure transient urinary retention did not require secondary surgical intervention. Conclusions: The Advance Male Sling represents a safe and efficacious treatment for mild to moderate incontinence following RP and prospective data specific to this population supports resolution of concurrent CLM. at one-year follow-up. Disclosure: Work supported by industry: no. The presenter or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.

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SUB-SCARPA’S FACIA PLACEMENT OF THE PENILE PROSTHESIS RESERVOIR: A NEW SURGICAL TECHNIQUE Wang, R1; Lin, HC2 1: University of Texas Medical School at Houston and MD Anderson Cancer Center, USA; 2: Nanjing University School of Medicine, China and University of Texas Medical School at Houston, USA Introduction: Placement of a penile prosthesis reservoir in a patient with multiple lower abdominal/pelvic surgeries with bowel involvement (such as radical cystectomy) is a challenge in prosthetic surgery. Bowel or large blood vessel injury can be a devastating complication. We present our experience with a new technique of sub-Scarpa’s facia placement of the penile prosthesis reservoir in high risk patients to avoid these risks. Methods: The surgical technique for sub-Scarpa’s facia placement of the penile prosthesis reservoir was designed in 2007 and patients who received penile prostheses with this novel approach were prospectively studied. The 3-piece inflatable penile prosthesis implantation was performed through either a peno-scrotal or an infra-pubic incision. During placement of reservoir, the rectus facia or the external oblique aponeurosis/muscle at the external inguinal ring was identified. A space was then created in the sub-Scarpa’s facia towards the ipsilateral shoulder in either the right or the left lower abdomen with the use of rubber-coated ring forceps. A 60 or 65 cc reservoir was placed in this space and secured with purse string suture to prevent migration. Results: From January, 2007 to April, 2010 a total of 221 penile prosthetic surgeries were performed in our medical center by a single surgeon. Of those 221 surgeries, 10 patients received the 3-piece inflatable penile prosthesis implantation with sub-Scarpa’s facia placement of the reservoir. Among these 10 patients, 4 men had a history of radical cystectomy with either Studer neobladder or ileoconduit urinary diversion. Four patients had a prior history of colon cancer surgery with colostomy or colostomy take down. One patient had large pelvic scarcoma resection and one man had history of bowel necrosis with multiple abdominal surgeries. There were no intraoperative complications for penile prosthesis implantation in any of these patients. No patient complained of any discomfort at the reservoir area or reported auto-inflation. The palpable reservoirs were seen in 5 patients who had no abdominal obesity. Conclusion: Sub-Scarpa’s facia placement of the penile prosthesis reservoir is a safe and effective technique in placing the reservoir in high risk patients. Patients, particularly slender ones, should be

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informed that the reservoir can be palpable or seen in the lower abdomen. Disclosure: Work supported by industry: no.

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SIMULTANEOUS PLACEMENT OF AN INFLATABLE PENILE PROSTHESIS AND ADVANCE MALE SLING FOR ERECTILE DYSFUNCTION AND INCONTINENCE: ROBUST EFFICACY AND SAFETY DATA AT 3 YEAR FOLLOW-UP Christine, B1; Wilson, SK2; Shamloul, R3; Bella, AJ3 1: St Joseph’s, Birmingham, Alabama; 2: Little Rock, Arkansas; 3: University of Ottawa, Canada Objectives: Combined placement of a 3-piece inflatable penile prosthesis (IPP) and Advance Male Sling (MS) (American Medical Systems, MN) is a treatment option for men with treatment-resistant erectile dysfunction (ED) and mild-to-moderate incontinence, especially following treatments for prostate cancer. Medium to long-term experience of a simultaneous approach is previously unreported. Materials and Methods: Prospective data on a total of 20 patients underwent the simultaneous placement of the AdVance male sling and a 3-piece inflatable penile prosthesis was collected. The sling and prosthesis were placed using separate incisions (perineal and transverse scrotal incisions, respectively). Ongoing treatment efficacy is assessed q6 months; interval questionnaire data was supplemented by phone interviews. Results: Patient follow-up is 32 months (mdn). Operating time was 92 minutes (range 49–102). IIEF-5 increased by 18.6 ± 0.9. At this time, 19 patients are using their penile prosthesis for intercourse; 17/19 patients describe themselves as “satisfied” or “very satisfied” with the penile implant and 2/19 describe themselves as “unsatisfied”. Both of the unsatisfied patients feel so because of perceived loss of length of the erect penis. Preoperative pad use ranged from 1–5 pads/ day. 2/20 patients reported persistent incontinence requiring daily pad use; these were men with 3–5 ppd leakage prior to surgery and were counselled regarding potential limitations of the sling approach in this group. Of the other 18 patients, 17 report complete continence no longer using any pads, and 1 reports the “occasional” use of a pad (0–1 pad/week). 4/20 patients experienced urinary retention post-operatively lasting from 3–10 days, which resolved without secondary surgical intervention. No infections or revision surgery were reported. Conclusions: The simultaneous placement of a 3-piece inflatable penile prosthesis and the AdVance male sling is a safe, effective treatment combination for men suffering from post-prostatectomy urinary incontinence and erectile dysfunction. Disclosure: Work supported by industry: no. The presenter or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.

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SUPERSIZING THE PENIS FOLLOWING PENILE PROSTHESIS IMPLANTATION Shaeer, O Kasr El Aini Faculty of Medicine, Cairo University, Egypt Objectives: Following implantation of a penile prosthesis, some couples are dissatisfied with penile length, girth, shaft or glans engorgement. This may be delusional, due to the procedure per se or due to preexisting risk factors such as neglected priapism, peyronie’s disease, radical prostatectomy or overhanging suprapubic fat. In this work, we try to enhance penile size in patients dissatisfied with its dimensions following implantation of a penile prosthesis, using various augmentation techniques. Materials and Methods: Eighteen patients who have had penile prostheses implanted were enrolled in this study based on dissatisfaction with penile size. The complaint was relieved by counseling and admin-

Proceedings from the 14th World Meeting of the International Society for Sexual Medicine istration of PDE5 inhibitors in 7 patients. Two patients had elongation, girth augmentation and glans injection, six had elongation and girth augmentation and two had elongation and glans injection. Results: Average preoperative length and girth were 7.87 cm and 11.62 cm respectively. Mean post-operative length and girth were 11.62 cm and 14.07 cm. The gain in length (47.6%) and girth (21%) were statistically significant (P < 0.005). All patients and partners were satisfied with the results following surgery (Figure 10) except one who suffered graft loss. Conclusion: Implantation of a penile prosthesis may improve penile rigidity, yet may confound couple’s satisfaction with penile size to variable degrees. Sex education may alleviate those concerns. In refractory cases, penile augmentation may enhance phallic size and increase patient/partner satisfaction. Disclosure: Work supported by industry: no.

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A MULTI-CENTER EVALUATION OF A NOVEL ONE-TOUCH RELEASE PUMP INFLATABLE PENILE PROSTHESIS Brock, G1; Ohl, D2; Ralph, D3; Bogache, W4; Jones, L5; Levine, L6; Munarriz, R7; Ritenour, C8 1: Department of Surgery Division of Urology University of Western Ontario, London, ON Canada; 2: Division of Sexual and Reproductive Medicine, University of Michigan Department of Urology, Ann Arbor, MI; 3: St Peter’s Hospital and The Institute of Urology, University College London, London, UK; 4: Carolina Urologic Research, Myrtle Beach, SC; 5: Urology San Antonio, San Antonio, TX; 6: Rush University Medical Center Dept of Urology, Chicago, IL; 7: Boston Medical Center, Boston, MA; 8: The Emory Clinic, Atlanta, GA Objectives: Despite the advent and wide acceptance of oral drugs for treatment of erectile dysfunction (ED), approximately 30% of patients still fail to respond to medical therapy. For these men and their partners, surgical management with penile prosthetics represents an important therapeutic option. Interestingly, few surgical series prospectively evaluate both the patient and partner following penile prosthesis insertion. Materials and Methods: A total of 115 patients from eight centers underwent implantation of the Titan OTR inflatable penile prosthesis in this international trial. At baseline and at defined postoperative intervals (6 weeks, 3, 6, and 12 months), questionnaires were given to patients to assess their experience. Physician and partner data were also collected. The Treatment Satisfaction Scale (TSS) and the International Index of Erectile Function (IIEF) were used for assessment. At the 12-month study period, 113 subjects counted as evaluable patients. Results: The study population (mean age = 61 years) had a number of comorbidities, including diabetes (31.9%), hypertension (34.5%), and Peyronie’s disease (23.9%). Patient satisfaction score changes over baseline were significant (p < 0.05) in all domains of the TSS and IIEF at 3, 6, and 12 months. A paired analysis was completed for patient satisfaction at 6 (n = 96) and 12 (n = 90) months; overall satisfaction with the device was 90.6% and 90.0% at 6 and 12 months, respectively. Satisfaction with deflation of the device was 70.8% (12.5% neutral) and 73.3% (14.4% neutral) at 6 and 12 months, respectively. Partner satisfaction changes over baseline were significant (P < 0.05) at 6 months for all domains of the TSS. Physicians overwhelmingly reported straightforward/simple intra-operative product preparation (97.3%) and equivalent or easier training compared to their previous pump of choice (96.4%). Adverse events for all subjects (n = 113) included removal of the device in 4 cases (3.5%) for infectious complications and 1 case for chronic pain (0.8%). Conclusions: The Titan OTR represents an advancement in penile prosthetic technology that is well-accepted by patients, partners & physicians. This report of prospective surgical experience of patients and partners is unique to the prosthetic literature. The study design allowed for realistic evaluation of the learning curve associated with new technology attempting to further reduce complications and enhance clinical outcomes. Disclosure: Work supported by industry: no.

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INITIAL EXPERIENCE WITH THE NEW AMERICAN MEDICAL SYSTEMS SPECTRA MALLEABLE PENILE IMPLANT Greenspan, MB1; Shamloul, R2; Bella, AJ2 1: McMaster University, Hamilton, Canada; 2: University of Ottawa, Canada Objectives: Surgical placement of a 3-piece inflatable penile prosthesis (IPP) remains the gold standard for treatment-resistant erectile dysfunction requiring reconstruction. However, in select cases, patient factors dictate the use of a malleable penile prosthesis (MPP). The AMS (American Medical Systems) Spectra prosthesis is a newly available MPP that has several technical improvements over previous generations of MPP. Placement advantages include cylinder length adjustment, improved balance between rigidity and concealment, and simplified sizing. Erectile function is improved as the device maintains rigid erection without buckling compared to previously available MPPs, and the potential for better cosmetic results. We present initial surgical experience and technical considerations. Materials and Methods: Prospective patient and intraoperative data was reviewed for eight patients undergoing Spectra malleable penile prosthesis placement. Patients were identified as candidates for this device, as a 3-piece IPP was not the option-of-choice based on presurgical work-up. Results: Patient age range was 56–68 yrs. underlying indications for implant surgery included four first-time implants (two diabetic), two replacements for IPP, revision for previous generation MPP, and reconstructive surgery for Peyronie’s disease. Penoscrotal incision (with large corporotomies), bilateral lateral distal shaft incisions, and standard subcoronal incisions were utilized as indicated by intraoperative factors. Operative time for lateral approach was 21 minutes; median operative time for other incisional approaches is 32 minutes. IIEF-5 scores increased by 17 ± 1.9, EHS was 4 for all patients. Prosthetic infections or revision surgery did not occur at 12 month mean follow-up. All procedures were performed as outpatient surgery. Conclusions: The AMS Spectra MPP offers an improved reconstructive alternative for men not suitable for the IPP, with several technical options for placement; surgery times are approximately one-half hour, and patients are discharged day-of-surgery. Disclosure: Work supported by industry: no. The presenter or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.

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THE IMPACT OF MINIMALLY INVASIVE SURGERIES FOR THE TREATMENT OF SYMPTOMATIC BENIGN PROSTATIC HYPERPLASIA ON MALE SEXUAL FUNCTION Frieben, RW1; Lin, HC2; Hinh, PP3; Berardinelli, F4; Canfield, SE1; Wang, R5 1: University of Texas Medical School at Houston, USA; 2: Nanjing University School of Medicine, China and University of Texas Medical School at Houston, USA; 3: University of Texas Medical School at Houston, USA; 4: G. d’Annunzio University, Italy; 5: University of Texas Medical School at Houston and MD Anderson Cancer Center, USA Introduction: Minimally invasive procedures for BPH include transurethral laser procedures, transurethral microwave therapy (TUMT), transurethral needle ablation (TUNA), transurethral ethanol ablation of the prostate (TEAP) and high intensity frequency ultrasound (HIFU). Even though the effectiveness of these minimally invasive surgeries for symptomatic BPH have been established in many studies when compared with the Gold standard surgical treatment—transurethral resection of the prostate (TURP), the impact of current minimally invasive surgeries for BPH on male sexual function has not been well established. Our goal is to determine and compare the impact of these procedures with TURP on male sexual function after the treatment of BPH.

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Methods: A systematic review of randomized controlled trials and cohort studies was conducted to evaluate data for effects of minimally invasive procedures for treatment of symptomatic BPH on sexual function. The studies searched were trials that enrolled men with symptomatic BPH that were treated with laser surgeries, TUMT, TUNA, TEAP and HIFU; with comparison to traditional TURP or sham operations. A total of 72 studies were identified, of which 33 met inclusion criteria. Of the 33 studies, 21 of them concerned laser surgeries, 6 of them related to TUMT, 4 of them were for TUNA, and 2 of them were with TEAP containing information regarding male sexual function. No study is available regarding the effect of HIFU for BPH on male sexual function. Results: Our analysis shows that minimally invasive surgeries for BPH have comparable effects to TURP on male erectile function. Collectively, less than 15.4% or 15.2% of patients will have either decrease or increase, respectively, of erectile function after laser procedures, TUMT and TUNA. As observed with TURP, a high incidence of ejaculatory dysfunction is common after treatment of BPH with holmium, KTP and thulium laser therapies (more than 33%). TUMT, TUNA and ND : YAG visual laser ablation or Interstitial laser coagulation for BPH has less incidence of ejaculatory dysfunction, but these procedures are considered less effective for BPH treatment when compared to TURP. Conclusion: Available studies suggest that minimally invasive surgeries for BPH have comparable effects to TURP on male erectile function. As observed with TURP, high incidence of ejaculatory dysfunction is common after treatment of BPH with effective laser surgeries such as holmium, KTP and thulium therapy. Disclosure: Work supported by industry: no.

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AVANAFIL FOR THE TREATMENT OF ERECTILE DYSFUNCTION IN DIABETIC MEN: RESULTS OF A PHASE 3, MULTICENTER, RANDOMIZED, DOUBLE BLIND, PLACEBO-CONTROLLED TRIAL Goldstein, I1; Belkoff, L2; Bowden, CH3; DiDonato, K3; Trask, B3; Peterson, C3; Day, W 3 1: San Diego Sexual Medicine in San Diego, CA; 2: Urological Associates of Southeastern Pennsylvania in Bala Cynwyd, Pennsylvania; 3: Vivus Inc in Mountain View, California Objectives: Avanafil is a second-generation, rapidly-acting, highlyspecific, phosphodiesterase type 5 (PDE5) inhibitor under investigation for the treatment of erectile dysfunction (ED). Avanafil pharmacokinetics indicate a Tmax of 35 minutes. The objective of this study was to demonstrate safety and efficacy of avanafil in a pivotal Phase 3 trial of diabetic men with ED. Materials and Methods: A total of 390 diabetic men with ED (mean age 58) across 30 US centers were randomized to receive placebo (n = 130), 100 mg (n = 129) or 200 mg (n = 131) of avanafil for 12 weeks. Sexual function was assessed at baseline and all follow-up exams using patient diaries and the International Index of Erectile Function (IIEF). Primary efficacy endpoints included vaginal penetration (SEP 2), successful intercourse (SEP 3), and the IIEF Erectile Function (EF) Domain score. Key inclusion criteria were age ≥ 18 years, history of mild to severe ED of at least 6 months duration (EF Domain 5–25 inclusive) and documented diagnosis of type 1 or type 2 diabetes. There were no restrictions on alcohol or food and concurrent use of alpha-blockers was allowed. Results: Following 12 weeks of treatment, the two doses of avanafil were significantly superior to placebo for all 3 primary endpoints (p < 0.01). The most frequent adverse events were headache, nasopharyngitis and flushing with the majority being mild and transient. There were no drug-related SAEs. A total of 81% of study-wide sexual attempts were made in 60 minutes or less, with successful intercourse reported in as little as 15 minutes and out beyond 6 hours. Conclusions: Avanafil was studied without restriction on food, alcohol or use of alpha blocker and was found to be well tolerated and effective

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for treatment of erectile dysfunction in diabetic men. Results suggest a rapid onset of action and sustained duration of effect (success at 15 minutes or less and beyond 6 hours). All three primary endpoints were achieved at both dose levels. Disclosure: Work supported by industry: yes, Vivus (industry initiated, executed and funded study). Do you act as a consultant, employee or shareholder with this industry? Yes, Dr. Irwin Goldstein is a consultant of Vivus; Dr. Belkoff has no conflict or consulting agreement in place, and all other authors are employees of Vivus and have stock options at Vivus.

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EFFECTS OF FLIBANSERIN ON APPETITIVE AND CONSUMMATORY ASPECTS OF SEXUAL BEHAVIOR IN OVARIECTOMIZED FEMALE RATS PRIMED WITH ESTROGEN ALONE Pfaus, JG1; Greggain-Mohr, J1; Allers, KA2; Sommer, B2 1: Center for Studies in Behavioral Neurobiology, Concordia University, Montréal, QC Canada; 2: Boehringer Ingelheim, Germany Objectives: To assess the activity of flibanserin, a 5-HT1a agonist and 5-HT2a antagonist, on appetitive sexual behaviors in the female rat. Materials and Methods: Females were ovariectomised (OVX) and given 5 training tests at 4-day intervals to acquaint them with the testing apparatus and sexual behavior (with full estrogen and progesterone priming). After 14 days, female rats received treatment with two doses of flibanserin (15 and 45 mg/kg) or vehicle gavaged twice daily for a 21-day period. 48 hours before each test, rats were treated with estradiol benzoate (5 ug). For testing, females were placed into bilevel chambers with a sexually vigorous male and given 30-min tests of sexual behavior on Days 7, 14, and 21 of flibanserin treatment. Measures taken were: latency and frequency of solicitation, hops and darts, pacing, rejection, lordosis count and magnitude from females and mounts, intromissions, ejaculations, and anogenital sniffing from males. All behavioral scoring was done blind to treatment. Results: On days 7 and 14 of flibanserin treatment there were no significant differences in any behavior between vehicle and flibanserin treated female rats. On Day 21 of flibanserin treatment, female rats demonstrated increased numbers of solicitations, hops and darts, and decreased rejection of males. In contrast, on days 7 and 14, the male rats demonstrated increased anogenital sniffing of flibanserin treated females compared to vehicle treated females. Conclusions: These data indicate that a sub-chronic regimen of flibanserin treatment increases appetitive sexual behaviors in OVX rats primed with estrogen alone. These data are analogous to data indicating flibanserin improves desire in women with Hypoactive Sexual Desire disorder, and suggest that the pattern of solicitations, hops and darts, and rejection responses can be used successfully as rat models of female sexual desire. Disclosure: Work supported by industry: Yes, Boehringer Ingelheim (industry funding only—investigator initiated and executed study). Do you act as a consultant, employee or shareholder with this industry? Yes, Jim Pfaus has contract grants and consulting work with Boehringer Ingelheim, Takeda/Lundbeck, and TransTech Pharma.

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HUMAN CHORIONIC GONADOTROPIN (HCG) TREATMENT IMPROVES GONADAL FUNCTION AND PENILE GROWTH IN MALE IDIOPATHIC HYPOGONADOTROPHIC HYPOGONADISM Kim, SO; Hwang, IS; Jung, SI; Oh, KJ; Park, K Department of Urology, Chonnam National University Medical School, Sexual Medicine Research Center, Chonnam National University, Gwangju, Korea Objectives: Penile growth is dependent upon androgenic control. Human chorionic gonadotropin (hCG) has a stimulatory effect on testicular steroidogenesis and penile growth. The purpose of this study was to evaluate the effects of hCG treatment on the gonadal response and penile growth in male idiophatic hypogonadotrophic hydogonadism (IHH). Material and Methods: A total of 20 IHH patients who met the criteria of micropenis were included in this study. Basic laboratory, hormonal studies (including serum testosterone, LH levels), length of penis (flaccid and stretched) were measured before and after treatment of hCG. HCG (1500–2000 IU) was administrated intramuscularly, 3 times per week for 8 weeks. Results: Mean age of patients was 18.9 years (range from 12 to 24 years). Mean serum testosterone level was significantly increased after hCG treatment (baseline, 2, 4, 12, 24 weeks; 0.90 ± 1.35 ng/ml, 1.77 ± 1.31 ng/ml, 3.74 ± 2.24 ng/ml, 5.49 ± 1.70 ng/ml, 5.58 ± 1.75 ng/ml, respectively) (P < 0.05). Mean penile length also increased significantly (flaccid length: from 3.39 ± 1.03 cm to 5.14 ± 1.39 cm, and stretched length: from 5.41 ± 1.43 cm to 7.45 ± 1.70 cm) (P < 0.001). There was no remarkable adverse effect. Conclusions: HCG treatment in IHH patients increased serum testosterone level and penile length. This implies that hCG treatment have a beneficial effect on gonadal function and penile growth in patients with IHH presenting micropenis. Disclosure: Work supported by industry: no.

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TO INVESTIGATE THE PREDICTORS FOR IMPROVING THEIR SEXUAL FUNCTION IN HYPOGONADAL PATIENTS WITH ERECTILE DYSFUNCTION Shigehara, K1; Koh, E1; Sugimoto, K1; Ijima, M1; Fukushima, M1; Maeda, Y1; Konaka, H1; Mizokami, A1; Namiki, M1; Takashima, M2; Iwamoto, T3 1: Kanazawa University Graduate School of Medical Science; 2: Social Insurance Hospital Kanazawa; 3: International University of Health and Welfare, Reproduction Center Objectives: To investigate the predictors for improving their sexual function, we evaluated hypogonadal patients with erectile dysfunction (ED) who performed androgen replacement therapy (ART). Material and Methods: Fifty-seven hypogonadal patients with ED received ART for 12 months. Hypogonadism is diagnosed by less than 11.8 pg/ml of free testosterone (FT) according to Japanese guideline for treatment of late onset hypogonadism. Sexual function is assessed by self-reporting questionnaire using the international index of erectile function 5 (IIEF5). ART was performed by injecting testosterone 250 mg every four week. Patients were divided into two groups based on improved and non-improved their sexual function after performing ART. Parameters are the following: age, body mass index, west size, IIEF5 score, hypertention, dyslipidemia and diabetes mellitus as patients’ background, and FT, adiponectin, HbA1c, total cholesterol, triglyceride and HDL-cholesterol as laboratory data. Results: The mean age was 67.5 ± 7.1 years, and FT value of the patients was 7.79 ± 2.1 pg/ml. There was no difference between before

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and after ART in IIEF5 scores (13.9 ± 4.3 versus 13.6 ± 4.4; P = 0.68). However, the IIEF5 score of 26% (15/57) patients increased (= improved group). When we compared the parameters between improved (n = 15) and non-improved (n = 42) groups before ART, the improved group had a significant higher IIEF5 score than nonimproved group (12.7 ± 4.7 versus 9.85 ± 5.7; P = 0.048). Moreover, the value of adiponectin in improved group was significantly lower than that in non-improved group (3.93 ± 1.65 versus 7.32 ± 5.59; P = 0.02). On the other hand, the value adiponectin significantly showed no difference between before and after ART in both the improved group (from 3.93 ± 1.65 to 4.14 ± 1.69; P = 0.09) and the non-improved group (from 7.32 ± 5.59 to 6.27 ± 3.83; P = 0.489). It appears that there has been a tendency to increase adiponectin the the improved group. The other parameters showed no significant difference. Conclusions: It is worth performing ART that when hypogonadal patients with ED have higher IIEF5 score and lower adiponectin value. Disclosure: Work supported by industry: no.

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BENEFICIAL EFFECTS OF TESTOSTERONE ON GLUCOSE HOMEOSTASIS AND METABOLIC SYNDROME PERSIST AFTER ITS DISCONTINUATION Saad, F1; Heufelder, A2; Bunck, M3; Gooren, L3 1: Bayer Schering Pharma; 2: Private Diabetes Practice, Munich, Germany; 3: VU Medical Center, Amsterdam, The Netherlands Objectives: In an earlier study of 32 men with the metabolic syndrome (MetS) and newly diagnosed type 2 diabetes (T2D) with hypogonadal serum testosterone (T) (<12.0 nmol/L), all received supervised diet + exercise (D&E) but 16 also testosterone (T) gel 50 mg once daily). Serum T, HbA1c, fasting plasma glucose, HDL-cholesterol, and triglyceride concentrations, and the waist circumference improved in both treatment groups after 52-weeks of treatment. But addition of T significantly further improved these measures compared to D&E alone. All D&E+T patients reached the HbA1c goal of <7.0%, 87.5% reached an HbA1c <6.5%. Based on ATPIII, 81.3% of the patients randomized to D&E+T no longer matched the criteria of the MetS, 31.3% of the D&E alone patients did. (Heufelder et al, J Androl 2009; 30: 726–33). Research question: do these effects persist after discontinuation of T treatment? Design: After 12–18 months administration of T, T was discontinued and for the next 6 months the above variables were followed up. Results: In the group earlier treated with T for 12–18 months, there were no significant changes in waist circumference, body weight, HbA1c, fasting glucose, serum insulin, LDL- and HDL-cholesterol, and triglycerides over the 6 months after discontinuation of T while maintaining D&E. After 24 months all variables studied were significantly more favorable in the group which had received T compared to the placebo group. Conclusions: Beneficial effects of T treatment of men with diabetes and metabolic syndrome continued for at least 6 months after discontinuation of T. Disclosure: Work supported by industry: no. The presenter or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.

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PREVALENCE AND CLINICAL CHARACTERIZATION OF HYPOGONADISM IN HUMAN IMMUNODEFICIENCY VIRUS INFECTED MEN Torales, M1; Cedrés, S1; Dutra, A2; Fuentes, L1; Montes, J3; Dufrechou, C1 1: Clínica Médica “2”; 2: Pasteur Hospital; 3: Fertilab Androgen deficiency is a common endocrine abnormality among men with human immunodeficiency virus (HIV) infection. Low testoster-

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one concentrations are associated with lower CD4 cell count, advanced stage of illness, medication use, and weight loss. Signs and symptoms may be nonspecific. The most useful laboratory indicator is the serum bioavailable testosterone (BDT) concentration. Objective: To evaluate the prevalence and clinical characterization of hypogonadism (HIT) among a large number of men with HIV, and make the correlation with demographic, immunological and treatment characteristics. Methods: We performed a prospective observational study involving a well characterized cohort of 81 men with HIV infection assisted in ambulatory service of the Infection Institute, using an anonymous questionnaire, the International Index of Erectile Function-5 (IIEF-5). Non-fasting plasma was analyzed for testosterone, luteinising hormone (LH), Albumin, sex hormone-binding globulin, and hemoglobin. HIT was defined when BDT was low (<43 ng/dL for older than 60 years and <58 for younger than 60 years). We defined hypogonadotropic HIT when LH was lower than 8,6 UI/L.Regression analysis was used to determine the correlation among the variables. Results: The mean age was 43,1 (SD 13,8) years. Gonadal status: 52/81 suffer from hypogonadism (RF = 0,64). 48/52 were hypogonadotropic. 57/81 had erectile dysfunction (52/57 had hypogonadism). There was statistically significant correlation between low BDT and: age, symptomatic infection, use of tranquillizers, smokers, CD4 cell count <200 cells/mm and viral load >30.000 (P < 0.05). Conclusion: The prevalence of hypogonadism in HIV patients is higher than in the general population. Hypogonadotropism predominance in subjects with hypotestosteronemia suggests also a possible involvement of a pituitary dysfunction and/or dysregulation as the underlying cause responsable for the development of hypogonadism. It always causes erectile dysfunction and need to be treated, in order to improve the quality of life of these patients. Disclosure: Work supported by industry: no.

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PREVALENCE OF SEXUAL DYSFUNCTIONS IN MALE HIV/AIDS PATIENTS ON ANTIRETROVIRAL THERAPY—IN SOUTH INDIA Ramana, GV1; Reddy, DN2 1: Vatsayana Institute of Sexual Infections; 2: Dega Institute of Sexual Sciences Objective: To study the prevalence of sexual dysfunctions in male Hiv/Aids patients on anti-retroviral treatment. Materials and Methods: Patients of Hiv/Aids on ART, at our institutes, were selected after taking consent. After history taking, physical examination and preliminary investigations, we have excluded patients with obesity, liver, thyroid, heart and respiratory diseases, 156 male) Hiv/ Aids patients (age group of 24 years–45 yrs) on anti-retroviral therapy were administered the International Erectile Function Questionaire (iief). Results: Among the 156 patients, 36 patients scored less than 5 points in various domains of sexual response like, sexual desire, erection, ejaculation/orgasm and overall sexual satisfaction, constituting 23.07% of our enrolled patients. We have observed that the erectile dysfunction is the commonest problem with patients of AIDS on anti-retroviral therapy. Conclusions: Sexual dysfunctions are common in patients of Hiv/Aids on ART. Among the various dysfunctions Erectile Dysfunction is the commonest, followed by Early Ejaculation and Overall Sexual Satisfaction. Our results of prevalence of sexual dysfunctions are slightly less than that of COLLAZOS et al who reported 27.1%. Clearly, the diagnosis and treatment of sexual dysfunction in these patients deserve the same attention as those in the rest of the population. Early identification and treatment of sexual dysfunction, improve mood, quality of life, and therefore, adherence to treatment.

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Disclosure: Work supported by industry: no, by nil.

PREVALENCE AND PREDICTORS OF ERECTILE DYSFUNCTION IN PRIMARY CARE SETTING, MALAYSIA

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Anjang, AAR1; Low, WY2 1: University of Malaya, Malaysia; 2: University of Malaya, Malaysia Objectives: To investigate the prevalence and predictors of erectile dysfunction (ED) among men aged 40 years and above in primary care clinics and to assess help-seeking behaviour. Material and Methods: A total of 1331 men aged 40–76 years who frequented public primary care clinics in an urban district in Malaysia, participated in this analytical cross-sectional study, with a response rate of 85%. Data was collected by self-administered questionnaire. Demographic information, medical history and lifestyle factors was obtained. ED was assessed using IIEF-5. Multiple Logistic Regression was used to investigate the predictors of ED. Results: Mean age was 54.7 (±8.3). The prevalence of ED was 69.5% (95% CI: 66.9, 71.9). In terms of severity, 33.1% had mild ED, 26.6% had moderate ED and 9.8% had severe ED. The predictors of ED were age 60 years and above (OR 4.96), unemployed status (OR 4.31), diabetes mellitus (OR 7.59), hypertension (OR 2.36) and heart disease (OR 4.19). In this study, among the men diagnosed with ED by IIEF-5, only 54.8% reported having difficulty with erection. Some 67.2% reported that they would talk to someone about the problem. Many believed that ED is a natural part of the ageing process (37.9%) and some realised that ED was due to their medical illness (32.2%). Only 10.5% reported that their doctor had discussed ED with them. Only 4.4% had used treatment for ED. More than 60% used traditional and complementary medicine. Conclusion: The prevalence of ED among men aged 40 years and above at the primary care setting was high. Despite the high prevalence, ED was under reported and not often discussed with doctors. This implies that more effort is needed to screen men in primary care for ED to ensure early intervention. Disclosure: Work supported by industry: no.

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EFFECT OF STRESSFUL LIFE EVENTS AND PERCEIVED STRESS ON MEN WITH NEWLY DIAGNOSED ERECTILE DYSFUNCTION: A CASE-CONTROL STUDY Drettas, P; Eleftheriou, E; Makaroni, S; Kyratsas, C; Pallantzas, A; Strobola, M; Konstantinidis, K Andrology Institute Objectives: Stress is known to play a major role in men who develop erectile dysfunction. We conducted a case-control retrospective study to investigate the correlation between stress in the form of major stressful life events and perceived stress and the onset of erectile dysfunction (ED). Materials and Methods: 39 men with some degree of newly diagnosed erectile dysfunction were compared with 33 healthy controls. Patients in both groups completed questionnaires assessing erectile function, stressful life events and perceived stress (questionnaires IIEF5, LES and PSS, respectively). Stressful life events were evaluated for the 12 months preceding the onset of symptoms of erectile dysfunction and the degree of ED was evaluated with IIEF-5. Statistical analysis included descriptive statistics and non-parametric tests; odds ratio was also calculated. Results: Statistical analysis showed that patients with ED reported more negative stressful life events than healthy controls in the last 12 months before the onset of ED. The number of positive and neutral stressful life events did not differ between the two groups. Regarding the impact of negative stressful life events, it was found that patients with ED perceived them as more undesirable when compared to healthy controls. No difference was found between measures of total stressful life events and perceived stress (PSS) scores between the two groups. Conclusion: The study shows that men with a recent onset of erectile dysfunction experience more adverse life events in the near past, even

Proceedings from the 14th World Meeting of the International Society for Sexual Medicine though they do not perceive their impact as negative as we would expect according to their adversity. These results indicate a possible correlation between the severity of negative life events and the severity of ED. Disclosure: Work supported by industry: no.

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DEFINING THE ETIOLOGY OF ERECTILE DYSFUNCTION IN MEN WITH CHRONIC PELVIC PAIN SYNDROME Stember, DS; O’Brien, K; Mulhall, JP Memorial Sloan-Kettering Cancer Center Objective(s): CPPS is an enigmatic condition associated with significant personal distress and reduction in quality of life (QOL). Our clinical experience is that men presenting with CPPS frequently have concomitant ED. This study was undertaken to define the etiology of ED in this population. Materials and Method(s): Men presenting for evaluation of penile or ejaculatory pain who complained of concomitant ED completed the International Index of Erectile Function (IIEF) and the NIH CPPS questionnaire. Men with IIEF erectile function domain (EFD) scores <26 and CPPS scores ≥10 constituted the study population. Demographics, comorbidities and treatment history were recorded. All patients underwent duplex Doppler penile ultrasound. Normal erectile hemodynamics criteria were PSV > 30 cm/s and EDV < 5 cm/s. Correlation was sought between the IIEF EFD and CPPS scores. Result(s): 46 patients met all criteria. Mean age was 32 ± 9 years. Mean number of vascular comorbidities was 1 ± 1 (0–2). Mean (median) CPPS duration was 9 ± 12 (13) months, mean (median) ED duration was 7 ± 16 (12) months, 96% of patients had ED that post-dated the onset of CPPS symptoms. Mean EFD score was 15 ± 5 and CPPS score was 16 ± 4.5. ED severity: 15% mild, 61% moderate, 24% severe. Mean PSV was 46 ± 12 cm/s, EDV 1.5 + 1.5 cm/s, and RI 0.94 ± 0.11. PSV values were abnormal for 4% of patients (both with 2 vascular comorbidities), while none had an abnormal EDV value. The correlation between CPPS score and EFD score was moderate (r = −0.32). There was also a correlation between CPPS score and the number of injections required during penile ultrasound (r = −0.22). Conclusion(s): Men meeting the criteria for the diagnosis of CPPS that present with ED almost always have psychogenic ED. Duplex Doppler ultrasound in this population is fraught with error when a single dose of vasoactive agent is utilized. Disclosure: Work supported by industry: no.

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PRIMARY CARE DELIVERY OF MEN’S HEALTH CARE IN ONTARIO CANADA: NURSE PRACTITIONER NEEDS ASSESSMENT AND PILOT TARGETED EDUCATION FOR ERECTILE DYSFUNCTION, PEYRONIE’S DISEASE, AND LOW TESTOSTERONE/ HYPOGONADISM Bella, AJ; Zappavigna, C; Gerridzen, RG; Cagiannos, I; Morash, C; Shamloul, R University of Ottawa, Canada Objectives: Previous studies have identified several barriers to effective delivery of men’s health care; in Ontario, Canada, there is a recent shift to increased diagnostic and therapeutic decision-making by nurse practitioners, including prescribing privileges. Screening for erectile dysfunction (in the context of both enhanced quality of life and as a window into cardiovascular health), ED treatment options ranging from risk and lifestyle factor modification to pharmacologic intervention, Peyronie’s disease, and low testosterone states have not been adequately addressed in primary care nurse practitioner training. We present results from a pilot project whereby an initial needs assessment was performed, followed by trial small group teaching over 3 sessions, case-based learning, and re-evaluation of information delivery efficacy. Materials and Methods: 70 nurse practitioners in the Ottawa care network catchment area were identified. Initial needs assessment was performed by a broad 8 question (multiple subheading) web-based survey. Data were collated, and areas of interest identified pertaining to non-oncologic core men’s health issues. Results: ED, Peyronie’s disease, and low testosterone states were seen as areas of knowledge deficiency. Initial speaker curriculum underwent modification following trial small group teaching to enhance educational experience; 20–30 minute presentation followed by group discussion, facilitator provision of key information (including published peer-reviewed manuscripts), and step-wise approaches were prioritized. Permanent web-based availability of programs, and targeted references to web-based sites such as the SMSNA site, were found useful. Conclusions: The changing landscape of primary care offers an opportunity for enhanced men’s health through targeted education of nurse practitioners and implementation of simple, time-effective screening, diagnosis, and treatment implementation in everyday practice. Disclosure: Work supported by industry: yes, by Pfizer unrestricted educational grant (industry funding only—investigator initiated and executed study). The presenter or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.

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INFERTILE MAN WITH CONSANGUINEOUS MARRIAGE REPORTED PREMATURE EJACULATION AND ERECTILE DYSFUNCTION MORE OFTEN THAN NORMAL COUPLES WITH MALE FACTOR INFERTILITY Akbal, C; Mangir, N; Ozgur, O; Tinay, I; Simsek, F Marmara University School of Medicine, Department of Urology, Istanbul/Turkey Objective: We evaluated the impact of consanguineous marriage on sexual function in patients with male factor infertility. Material and Methods: 503 patients who were admitted to our andrology clinic with male factor infertility were questioned about their participation in a consanguineous marriage. The degree of consanguinity is sub-classified as close (first degree) or distant (second or third degree). Patients with or without consanguinity were compared in terms of erectile dysfunction (ED) through an IIEF-5 questionnaire

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and premature ejaculation (PE) diagnostic tool (Symonds et.al). The patients also self-assessed their psychological status with the Hospital Anxiety and Depression Scale (HADS). The mean scores of the IIEF5, PE diagnostic tool and HADS were compared using a one-way ANOVA (Tukey-Kramer) test. Results: Of those 503 patients, the degree of consanguinity was reported as close in 21 patients (4.2%, Group I) and distant in 41 (8.2%, Group II) patients. 441 patients (87.6 %) reported no consanguinity (Group III). Eight of 21 patients (38%) in Group I, fifteen of 41 patients (36.5%) in Group II and ninety-eight of 441 patients (22%) in Group III reported any degree ED, respectively. Statistically significant differences were observed in the comparison of the IIEF-5 scores of Groups I–III and II-III (P < 0,05). Of the patients, 486 selfassessed their PE status with the PE questionnaire. Five of 20 patients (25%) in Group I, eight of 38 patients (21%) in Group II and forty-six of 428 patients (10.7%) in Group III reported PE, respectively. There were no statistically significant differences between Groups I and II, but Group III patients reported less PE than patients with any consanguinity (P < 0,05). According to the interpretation of the HADS, all groups reported both depression and anxiety. Conclusions: The degree of consanguinity is an important risk factor for sexual dysfunction in patients with infertility. Patients with close consanguinity should be evaluated and treated for sexual dysfunction during an infertility work-up. Disclosure: Work supported by industry: no.

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LEVEL OF SATISFACTION WITH SEX AND ITS IMPORTANCE TO MEN AND WOMEN IN JAPAN: RESULTS OF THE GLOBAL BETTER SEX SURVEY Marumo, K Tokyo Dental College, Ichikawa General Hospital, Japan Objective: The cross-sectional Global Better Sex Survey (GBSS) examined the sexual aspirations and unmet needs of >12,500 men and women in 27 countries across 6 continents. The results from Japan are reported here. Material and Methods: Adult participants were recruited in December 2005 using street intercepts and completed paper surveys; small incentive gifts were provided. Participants must have had sexual intercourse at least once in the past 12 months and female respondents were required to have had heterosexual intercourse. Results: Japanese participants included 500 men and 500 women. Men and women shared similar views of what elements of the sexual experience are most important, ranking “feeling attracted to your partner” first; “intercourse” was ranked second among men and third among women. The majority of men (82%) and women (70%) agreed that a man’s confidence in his sexual ability is critical to having a good love relationship. Half of men and 54% of women were “somewhat” or “very” satisfied with their sex life, and 60% and 41%, respectively, derived either “much” or “great” pleasure from sex; 41% of men and 17% of women reported that their sexual frequency was less than the right amount. Sixty-one percent of men and 66% of women reported that they/their partner(s) are not “always” able to get and maintain an erection good enough for intercourse; in those aged >40 years, these percentages were 72% and 77%, respectively. As satisfaction with erection hardness increased, the percentage of men and women reporting that they were “very” satisfied with sex life, love and romance, and overall health increased; this was also true of erection duration. Men’s interest in improving their sexual experience was rated “moderate” in 23%, “high” in 18%, and “very high” in 7%; for women, respective percentages were 16%, 4%, and 4%. Seventy-one percent of men would take a prescription medication to increase satisfaction with their sex life, and 57% of women would support that decision. Conclusions: Japanese men and women agreed that feeling attracted to your partner was the most important element of the sexual experience. Approximately half of men and women were not fully satisfied with their sex life, and roughly two-thirds of respondents reported erections that were insufficient for intercourse. Although more men

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reported greater interest, both men and women expressed interest in improving their sexual experience and were willing to take prescription medications to increase their satisfaction with their sex life. Disclosure: Work supported by industry: yes, by Pfizer Inc (industry initiated, executed and funded study).

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LEVEL OF SATISFACTION WITH SEX AND ITS IMPORTANCE TO MEN AND WOMEN IN SOUTH KOREA: RESULTS OF THE GLOBAL BETTER SEX SURVEY Chul Kim, S Chung-Ang University College of Medicine, Korea Objective: The Global Better Sex Survey (GBSS) examined the sexual habits and behaviors of >12,500 men and women in 27 countries on 6 continents; here we describe findings from South Korea. Material and Methods: In this cross-sectional survey, conducted in December 2005, participants were recruited by phone to complete paper surveys. To qualify, adult respondents must have had sexual intercourse at least once in the past 12 months; female respondents were required to have had heterosexual intercourse. Male data were weighted by age, region, and education/employment; female data were weighted by age and region. Results: South Korean participants included 254 (50%) men and 255 (50%) women. Men and women shared similar views of what elements of the sexual experience are most important, ranking “intercourse” first, with “physical foreplay” and “ability to achieve orgasm” tied for second. 95% of men and 85% of women agreed that a man’s confidence in his sexual ability is critical to having a good love relationship. Half of men and 46% of women were not fully satisfied with their sex life, and only 57% and 45%, respectively, derived either “much” or “great” pleasure from sex; 38% of men and 19% of women reported that their sexual frequency was less than the right amount. Sixty-four percent of men and 59% of women reported satisfaction with their/ their partners’ erection hardness. As satisfaction with erection hardness increased, the percentage of men and women reporting that they were “very” satisfied with sex life, love and romance, and overall health increased; this was also true of erection duration. Men’s interest in improving their sexual experience was rated “moderate” in 58%, “high” in 17%, and “very high” in 8%; for women, respective percentages were 41%, 5%, and 2%. Forty-five percent of men would take a prescription medication to increase their satisfaction with their sex life, and 26% of women would support that decision. Conclusions: Intercourse, foreplay, and achieving orgasm are key elements of the sexual experience for South Korean men and women. Half of men and over half of women were not fully satisfied with their sex life and at least one-third of respondents were unsatisfied with their/their partners’ erections. Although more men reported greater interest, both men and women expressed interest in improving their sexual experience and were willing to take prescription medications to increase their satisfaction with their sex life. Disclosure: Work supported by industry: yes, by Pfizer Inc (industry initiated, executed and funded study).

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PERSPECTIVES ON MEN’S EXPERIENCE WITH SEXUAL DYSFUNCTION POST RECTAL CANCER TREATMENT: A QUALITATIVE STUDY Ball, M; Nelson, C; Shuk, E; Temple, L; Jandorf, L; Jean-Baptiste, J; Starr, T; Mulhall, J; DuHamel, K Memorial Sloan-Kettering Cancer Center Objective: About 45% of men report that their sex life is worse after treatment for rectal cancer. This qualitative study was designed to better understand men’s experience with sexual dysfunction following

Proceedings from the 14th World Meeting of the International Society for Sexual Medicine rectal cancer treatment, and to investigate barriers and promoters that would influence their participation in a sexual health intervention. Material and Methods: Thirteen male rectal cancer survivors who were treated at Memorial Sloan-Kettering Cancer Center (MSKCC) for rectal cancer participated (median time post treatment was 6.4 years). Six survivors participated in individual semi-structured phone interviews, and seven took part in focus groups. We performed standard procedures of qualitative thematic text analysis, which involved independent review of interview transcripts by several analysts followed by consensus meetings to identify key themes. Focus group themes and summaries were also reviewed. Results: Participants reported bowel dysfunction and erectile dysfunction was a chief complaint (N = 12, or 98%). The participants thought a sexual intervention post surgery would be helpful because it would provide educational information regarding the etiology of their problems and treatments to improve their sexual health (N = 8, or 62%). Most participants’ primary concern immediately after treatment was surviving their disease; improving sexual functioning became more important as time passed (N = 4, or 31%). Barriers to intervention participation included geographical distance from MSKCC (N = 3, or 23%), and the risk of embarrassment when discussing sexual issues (N = 5, or 38%). Conclusions: Men reported that a sexual intervention would be helpful to improve their sexual functioning post treatment. Discussion of bowel issues and delivery via the telephone based on men’s thoughts refined a sexual intervention. Disclosure: Work supported by industry: no.

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EXPLORING MEN’S VIEWS ON SEX AND SEXUAL PROBLEMS: A QUALITATIVE STUDY Ng, CJ1; Low, WY1; Khoo, EM1; Tong, SF2; Wong, LP1; Tan, HM3 1: University of Malaya/Malaysia; 2: University Kebangsaan Malaysia/ Malaysia; 3: Sime Darby Medical Centre/Malaysia Objectives: To explore ageing men’s views on sex and sexual problems in an urban community in Malaysia Materials and Methods: This study used a qualitative approach to capture men’s views of, attitudes towards, and practice during health and illnesses. Fifty-two married men above 40 years of age from Subang, an urban community in Malaysia, were recruited. Six focus groups were conducted by trained interviewers and a semi-structured topic guide was used to facilitate discussions. The interviews were audio-recorded and transcribed verbatim. The data were managed by using the NVivo software. The researchers extracted themes from the transcripts and categorised them into broader concepts. This paper presented parts of the findings from this study. Results: In this study, men viewed sex as (1) a way of fostering closer relationships with partners; (2) an indication of good health; and (3) part of physiological needs. Sexual problems were considered by the participants as part of ageing. Men perceived sexual difficulties as (1) a dent in their ego; (2) having a negative effect on their mental health; and (3) a potential cause of partner infidelity. Despite this, men were reluctant to seek help from healthcare professionals. They would get over-the-counter remedies or seek advice from their family and friends. Among those who sought help, many preferred the healthcare professionals to initiate the conversation and would avoid taking medications for their sexual problems. Conclusions: Healthcare professionals should initiate the discussion with men who might have sexual problem and take their views and concerns about sex and sexual problems into considerations when managing their sexual problems. Disclosure: Work supported by industry: no.

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DECREASED ANXIETY ABOUT THE NEXT INTERCOURSE ATTEMPT AND IMPROVED SCORES ON THE SELF-ESTEEM AND RELATIONSHIP QUESTIONNAIRE IN MEN WITH ERECTILE DYSFUNCTION TREATED WITH VIAGRA (SILDENAFIL CITRATE) 50 MG OR 100 MG Son, H Seoul National University Boramae Medical Center, Korea Objective: To assess the effect on event-log recorded anxiety (“Do you feel anxious about your next attempt at sexual intercourse?”) and scores on the Self-Esteem And Relationship (SEAR) questionnaire in men aged 18–65 years who were randomized to fixed-dose (50 or 100 mg) Viagra® (sildenafil citrate) or placebo for erectile dysfunction (ED) in an 8-week, double-blind, placebo-controlled (DBPC), multicenter trial. Material and Methods: Anxiety was scored on a 5-point scale from “no” to “extremely anxious”. Erectile function (EF) was assessed with the EF domain of the International Index of Erectile Function. An analysis of covariance model, including terms of baseline, center, treatment group, age, ED etiology, and ED duration was used to analyze the change in EF domain score and SEAR component scores from baseline to the end of DBPC treatment. Results: Mean ± SD age was 50 ± 10 years (placebo, n = 95), 52 ± ears (50 mg, n = 94), and 51 ± 10 years (100 mg, n = 99), respectively. Mean ED duration was 3 years in each group. The LS mean ± SE improvement in EF domain score was 2.1 ± 0.66 for placebo, 7.7 ± 0.65 for 50 mg, and 9.1 ± 0.64 for 100 mg (P < 0.0001 for both doses vs placebo; P = 0.08 for 50 mg vs 100 mg). Before treatment, most men felt moderate or high anxiety about their next intercourse attempt. At the end of treatment, anxiety about their next intercourse attempt was decreased in men treated with Viagra and eliminated in >50% of men treated with the 100 mg dose. The improvement in SEAR score was significantly greater for 50 mg vs placebo and for 100 mg vs placebo for each SEAR component (P < 0.0001 for each) and for 100 mg vs 50 mg for the total score (LS mean difference between doses = 6.9, P = 0.02), the Sexual Relationship domain (LS mean difference = 7.8, P = 0.01), and the Overall Relationship subscale (LS mean difference = 8.9, P = 0.02). The most common treatment emergent adverse events were flushing, gastrointestinal disorders, nasal congestion, and headache (all mild or moderate in severity). Conclusions: Men treated with Viagra reported less anxiety about their next intercourse attempt, with the greatest benefit occurring in the 100 mg group. SEAR component scores all significantly improved with either dose of Viagra compared with placebo, and the total score, Sexual Relationship domain score, and Overall Relationship subscale score improved significantly more in the 100 mg group compared with the 50 mg group. Disclosure: Work supported by industry: yes, by Pfizer Inc (industry initiated, executed and funded study).

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TOLERABILITY OF VIAGRA (SILDENAFIL CITRATE) 50-MG STARTING DOSE IN ELDERLY PATIENTS Jun Park, H; Yang DY; Cho KS Pusan National University School of Medicine, Korea Objective: Elderly patients often have more severe erectile dysfunction (ED) and thus may require 100-mg Viagra (sildenafil citrate) for optimal efficacy. We examined pooled data from 38 randomized, double-blind, placebo-controlled trials of fixed-dose or flexible-dose Viagra (5–200 mg) in men with ED to assess if the safety and tolerability of a 50-mg starting dose differs from that of a ≤25-mg starting dose in elderly patients.

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Materials and Methods: Most of the trials were 12 weeks in duration. 9197 men were included in the pooled analysis. Except for 367 men randomized to 5, 10, or 200 mg, all received 25 mg to 100 mg. Inclusion and exclusion criteria were consistent with the European Union summary of product characteristics for Viagra. Results: Similar percentages of elderly men (≥65 years, n = 1710) and younger men (<65 years, n = 6988) reported adverse events (AEs), regardless of whether the starting dose was ≤25 mg or 50 mg. In fact, slightly fewer elderly men starting Viagra therapy with 50 mg (54%) reported AEs than did those starting Viagra therapy with ≤25 mg (58%). The percentage of men reporting a serious AE was similar between the Viagra group and the placebo group for each starting dose in each age group. In elderly patients, the percentage of serious AEs was 4.6% in the Viagra group and 3.9% in the placebo group when the starting dose was 50 mg, and was 8.4% and 7.8%, respectively, when the starting dose was ≤25 mg. The rate of discontinuation due to AEs was low for all age and dose groups. For elderly patients, the rate of discontinuation due to AEs was similar with a 50-mg starting dose of Viagra (1.5%) or placebo (2.1%), and was lower than with a ≤25-mg starting dose of Viagra (6.0%) or placebo (3.0%). A similar profile of AEs was observed for elderly patients receiving a starting dose of either ≤25 mg or 50 mg. The profile and occurrence of AEs in elderly patients was also similar to that of younger patients for both starting doses. Conclusions: Compared with a ≤25-mg starting dose, a 50-mg starting dose does not substantially increase the rate of AEs, serious AEs, or severe AEs in elderly patients. Initiating Viagra with a 50-mg dose may more rapidly allow elderly patients to achieve successful treatment of their ED. Disclosure: Work supported by industry: yes, by Pfizer Inc (industry initiated, executed and funded study).

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PROTECTIVE EFFECT OF L-ARGININE ON OXIDATIVE STRESS IN CAVERNOUS TISSUE OF DIABETIC RATS Yun, C; Zhipeng, XU; Yutian, D 1: The Affiliated Drum Tower Hospital, Nanjing University Objective: To explore the effects of L-Arginine (L-Arg) on oxidative stress in cavernous tissue of diabetic rats. Methods: The diabetic model rats induced by streptozotocin were randomly divided into diabetes group and L-Arg treatment group. The normal rats were raised as normal control group. Eight weeks later, erectile function was assessed by measuring the rise in intracavernous pressure (ICP) of the rats following cavernous nerve eletrostimulation before sacrificed. The levels of Malondialdehyde (MDA) and the activities of superoxide dismutase (SOD) in cavernous tissue were detected. The Masson staining was used to show the structure of rat penis. Results: A significant decrease in ICP was recorded in the diabetic rats, with improvement measured in the rats receiving L-Arg. Compared with the normal control group, the levels of MDA increased remarkably and the activities of SOD decreased significantly in cavernous tissue of the diabetes group. Compared with diabetes group, the levels of MDA decreased significantly and the activities of SOD increased remarkably in cavernous tissue of the L-Arg treatment group. The Masson staining showed remarkable reduction of smooth muscle fibers and collagen fibers in DM group rats. Disrupted continuity and integrity of smooth muscles were also found. And they improved in L-Arg group rats. Conclusion: Hyperglycemia could cause oxidative stress in the cavernous tissue of diabetic rats and this impairment could contribute to diabetic erectile dysfunction; Supplements of L-Arg could attenuate oxidative stress and improve erectile function. Disclosure: Work supported by industry: no.

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ONCE-A-DAY DOSING OF TADALAFIL 5 MG IMPROVES ERECTILE FUNCTION IN KOREAN MEN INDEPENDENT OF AGE Jung, GW; Park, SJ; Ye, JW Smile Jung’s Urology Clinic/South Korea Objectives: Once-a-day (OAD) dosing of tadalafil 5 mg is currently approved only for treatment of erectile dysfunction (ED) in Korea. We report the efficacy and safety of OAD dosing of tadalafil 5 mg on erectile function in Korean men with ED according to age. Material and Methods: Patients ≥20 years of age with ED of any functional severity or etiology received tadalafil 5 mg once daily for 12 weeks. Twelve-week study enrolled 199 patients but only 139 completed the study. Analyses were performed in 139 patients divided into 3 groups according to age. Group 1 (N = 62) was in from 20’s to 40’s, group 2 (N = 49) was in 50’s, and group 3 (N = 28) was in 60’s and older. Efficacy measures included the International Index of Erectile Function (IIEF)-5, Sexual Encounter Profile diary Question 2 (SEP2: successful penetration), and 3 (SEP3: successful completion of intercourse), Global Assessment Question (GAQ: improved erection), and tolerability. Chi-square test, paired t-test, and ANOVA were used for statistical analysis. Results: Mean age was 51.0 (24–77) years old. For each group patients who took OAD dosing of tadalafil 5 mg, changes from baseline to endpoint were, respectively, 8.0, 8.5, and 7.7 for IIEF-5 (P = 0.929); 37.1, 38.8, and 57.8 for SEP2 rate; and 70.9, 63.2, and 60.7 for SEP3 rate. At endpoint, 95.2%, 85.7%, and 92.9% reported improved erections, respectively. Improvement of IIEF-5 scores, SEP2, and SEP3 from baseline to endpoint in each group were significant (P < 0.001). Eleven of the 139 patients who completed study reported recovery of erectile function and said they did not need more medication for ED 4 weeks after discontinuing tadalafil OAD. There was no drugrelated serious adverse event reported during the study. Adverse events occurred in 10.6% of study-enrolled patients. The most common adverse events reported were headache, nasal congestion, myalgia, and facial edema; 12 patients (6.0%) discontinued because of any adverse events. Conclusions: In our experience, OAD dosing of tadalafil 5 mg was well tolerated and significantly improved erectile function in Korean men with ED independent of age. Further analysis of the small subgroup of patients who had recovered normal erectile function following the 12-week ED treatment-free period may be of interest to investigation. Disclosure: Work supported by industry: no.

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A RANDOMIZED, DOUBLE-BLIND, PLACEBOCONTROLLED, PARALLEL-GROUP STUDY TO ASSESS THE EFFICACY AND SAFETY OF TADALAFIL ONCE DAILY IN SUBJECTS WITH ERECTILE DYSFUNCTION (ED) WHO ARE NAIVE TO PDE5 INHIBITORS Montorsi, F1; Aversa, A2; Porst, H3; Moncada, I4; Perimenis, P5; Shane, M6; Barker, C6; Sorsaburu, S6 1: Department of Urology, Scientific Institute Hospital San Raffaele, Milan, Italy; 2: Department of Medical Pathophysiology, Faculty of Medicine and Surgery, University of Rome, La Sapienza, Italy; 3: Private Practice of Urology and Andrology, Hamburg, Germany; 4: Department of Urology, Hospital La Zarzuela, Madrid, Spain; 5: Department of Urology, Patras University Hospital, Patras, Greece; 6: Lilly Research Laboratories, Eli Lilly, Indianapolis, IN, USA Objective: To evaluate the efficacy and tolerability of once-daily treatment with tadalafil in men who have not previously used phosphodiesterase type 5 (PDE5) inhibitors.

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Proceedings from the 14th World Meeting of the International Society for Sexual Medicine Material and Methods: This randomized, double-blind, controlled clinical trial evaluated the efficacy and tolerability of tadalafil 5 mg (with down-titration to 2.5 mg if needed) or placebo once daily for 12 weeks in European PDE5 inhibitor–naïve men with ED. Coprimary efficacy endpoints were mean changes from baseline to endpoint in the International Index of Erectile Function erectile function (IIEF-EF) domain score and the per-patient proportion of “yes” responses to questions about the ability to: 1) insert penis into vagina (Sexual Encounter Profile 2 [SEP2]); and 2) complete intercourse (SEP3). ANCOVA models were used to evaluate these endpoints in the intent-to-treat population, with significance being deduced if all three null hypotheses were rejected in favor of tadalafil. Missing data were imputed using the last observation carried forward convention. Results: Among 215 patients with available data (mean age = 52), least-square mean changes from baseline in each co-primary endpoint were significant in the tadalafil (n = 146) compared with the placebo (n = 69) group (P < 0.001). Least-square mean differences in changes between treatment groups were 3.9 (unitless) for IIEF-EF (endpoint mean tadalafil = 22.8), 11.7% for SEP2 (endpoint mean tadalafil = 83.3%), and 18.0% for SEP3 (endpoint mean tadalafil = 67.6%). Of all randomized patients (N = 217), 16.1% reported treatment-emergent adverse events: 19.0% in the tadalafil group and 10.0% in the placebo group (P = 0.114). Most subjects (tadalafil 88.4%; placebo 91.4%) completed the trial. Discontinuations because of adverse events were generally infrequent (2.7% tadalafil; 1.4% placebo), with <4% of each group reporting treatment-emergent back pain, nasopharyngitis, dyspepsia, or headache. Conclusion: Once-daily tadalafil 5 mg is efficacious in men with ED who have not previously used PDE5 inhibitors. Disclosure: Work supported by industry: yes, by Eli Lilly and Company (industry initiated, executed and funded study). The presenter or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.

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POPULATION CHARACTERISTICS ASSOCIATED WITH SATISFACTION WITH VIAGRA (SILDENAFIL CITRATE) TREATMENT IN MEN WITH ERECTILE DYSFUNCTION: COMBINED ANALYSIS OF 6 TRIALS Jun Park, H Pusan National University School of Medicine, Korea Objective: Men who are satisfied with an ED treatment are more likely to continue with treatment. Using pooled data from 6 open-label trials, each of which used the Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) to assess Viagra treatment satisfaction and was limited to a single country (Belgium, Czech Republic, Germany, the Netherlands, Russia, and the United States), we stratified results by age and by erectile dysfunction (ED) severity, duration, and etiology to more clearly define attitudes of men toward treatment of their ED and to identify population characteristics that might predict satisfaction with treatment. Materials and Methods: Men with ED, aged ≥18 years, were treated with flexible-dose Viagra (25, 50, and 100 mg). ED severity was categorized by scores on the Erectile Function (EF) domain of the International Index of Erectile Function (minimal [26–30], mild ED [22–25], moderate ED [11–21], or severe ED [≤10]). Overall treatment satisfaction was defined as an EDITS Index score >50 (out of 100) at the end of treatment. Results: 2640 men were included in the pooled analysis: mean ± SE age was 54 ± 0.22 years and ED duration was 2.5 ± 0.1 years; 71% were aged ≤60 years, 97% were white, 61% had ED for ≤2 years, and 69% had moderate or severe ED. At the end of treatment, the mean ± SE EDITS index was 74.5 ± 0.4. Overall, 86% (2265/2625) who completed the EDITS were satisfied with treatment, including: 89% aged ≤60 years and 78% aged > 60 years; 88% with ED ≤2 years, 83%

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with ED 2–5 years, and 83% with ED > 5 years; 79% with organic ED, 90% with mixed ED, and 96% with psychogenic ED; and 88% with minimal ED, 93% with mild ED, 96% with moderate ED, and 76% with severe ED. Conclusion: Although the highest rates of satisfaction were observed in men aged ≤60 years, those with ED of ≤2 years’ duration, those with ED of psychogenic or mixed etiology, and those with mild or moderate ED, the majority of men with ED who were treated with Viagra were satisfied with their treatment, regardless of their age or the duration, severity, or etiology of their ED. Disclosure: Work supported by industry: yes, by Pfizer Inc (industry initiated, executed and funded study).

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TREATMENT OF MEN WITH ERECTILE DYSFUNCTION TO A HARDNESS GOAL OF FULL RIGIDITY MAY BE OPTIMAL Lee, WS Pfizer Ltd. Korea, Korea Objective: In men with erectile dysfunction (ED), rather than a goal of improved erectile function, a hardness goal of full rigidity may be optimal for ED therapy. To better define the potential benefits of this goal, efficacy was assessed in men whose erections improved from suboptimal, hard enough for penetration but not completely hard (Erection Hardness Score [EHS] 3) to optimal completely hard/rigid (EHS 4). Material and Methods: Flexible-dose Viagra (sildenafil citrate) treatment was assessed in a 6-week double-blind, placebo-controlled (DBPC) trial with 6-week open-label (OL) extension (N = 307; 25, 50, or 100 mg) and in a 10-week OL trial (N = 107; 50 or 100 mg). Respective mean (range) age was 45 (18–55) years and 53 [20–82] years, and ED duration was 2 (<1–21) years and 4 (<1–18) years. Assessments included the International Index of Erectile Function, the Self-Esteem and Relationship questionnaire; the Quality of Erection Questionnaire; and the Erectile Dysfunction Inventory of Treatment Satisfaction. Results: 35 Viagra-treated and 3 placebo-treated men had improvements from a most frequently achieved (modal) EHS 3 at baseline to EHS 4 at DBPC end of treatment (EOT); mean ± SD EOT scores were significantly improved from baseline for all outcomes for Viagratreated patients (P < 0.0001). At OL Viagra EOT, 42 previous-Viagra and 44 previous-placebo patients who had baseline modal EHS 3 erections had achieved modal EHS 4 erections; during OL treatment their mean ± SD EOT scores were significantly improved (P < 0.05), with EOT mean scores ≥85% of maximal values. Likewise, patients improving from modal EHS 3 erections at baseline to modal EHS 4 erections at EOT in the 10-week OL Viagra study (n = 18) also achieved significant improvements from baseline in all outcomes (P < 0.01), with mean EOT scores approaching maximal values. Conclusions: In men with ED, erectile function and measures of self-esteem, confidence, and satisfaction improve to near maximal values as erection hardness increases from EHS 3 to EHS 4 hardness, suggesting ED treatment to a hardness goal of full rigidity may be optimal. Disclosure: Work supported by industry: yes, by Pfizer Inc (industry initiated, executed and funded study). The presenter or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.

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POOR BASELINE ERECTILE FUNCTION PREDICTS FOR NON-NERVE SPARING RADICAL PROSTATECTOMY

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Stember, DS; Nelson, CN; Vora, K; Mulhall, JP Memorial Sloan-Kettering Cancer Center Objective(s): Cavernous nerve sparing (NS) is critical for recovery of erectile function (EF) as well as erectile tissue preservation following radical prostatectomy (RP). Clinical experience suggests that surgeons may opt for non-nerve sparing RP in patients with baseline erectile dysfunction (ED). This study was performed to define if baseline EF is an independent predictor of NS status during RP. Materials and Method(s): Patients that underwent RP comprised the study population. Pre-operative parameters evaluated included biopsy characteristics, PSA, patient age, and EF. Baseline EF was graded on a validated 5-point patient-reported scale: 1 fully rigid, 2 diminished, but capable of intercourse, 3 occasionally satisfactory for intercourse, 4 tumescence, incapable of intercourse and 5 no tumescence. NS was graded intra-operatively by the surgeon, using a 4-point nerve sparing score (NSS) assigned to each nerve (range 2–8) where: 1 fully preserved, 2 partially preserved, 3 minimally preserved, and 4 resected. Nerve sparing surgery was defined as NSS ≤2 on at least one side, and non-nerve sparing was defined as NSS ≥3 on both sides. Univariat and multi-variable analysis were performed. Result(s): 2,323 men met criteria with a mean age of 59 + 7 years. Mean pre-treatment PSA was 6 ± 5. Mean pre-treatment EF score 1.7 + 1.1. 91% of all men had nerve sparing surgery, while 9% had bilateral non-nerve sparing. On univariate analysis, factors related to non-nerve sparing surgery included (all P < 0.01): increasing age (r = 0.16), Gleason score (r = 0.19), and EF score (r = 0.21). On multi-variable analysis, EF was a significant independent predictor of non-nerve sparing surgery. Conclusion(s): While unfavorable clinical and prostate biopsy characteristics predict less nerve sparing, we have shown that poorer baseline EF also predicts non-nerve sparing. Urologic oncologists should be educated regarding the importance of NS even in men with baseline ED. Disclosure: Work supported by industry: no.

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IMPLANTATION OF 3-PIECE INFLATABLE PENILE PROSTHESIS UNDER LOCAL ANESTHESIA Chang, HS1; Kim, DS1; Choi, HM2; Choi, HK2 1: Department of Urology, Urological Science Institute, Yonsei University College of Medicine; 2: Choi’s SS Clinic Objectives: This prospective study was designed to evaluate the feasibility of implanting AMS 700 CMX® inflatable penile prosthesis under local anesthesia only. Materials and Methods: 8 cases of penile prosthesis implantation (PPI) were performed under local anesthesia between January and February 2009 at Gangnam Severance Hospital were reviewed. The mean follow-up duration was 3 months, and the mean patient age was 64.0 years (46–74). The severity of pain was graded using visual analogue scale (VAS). Results: The average dosage of 1% and 2% lidocaine used was 9.86 mg (9–11) and 6.0 mg, respectively. The average VAS score was 1.375 (0–3) during the operation, and 2.25 (1–4), 2.125 (1–3), 1.75 (1–3) and 1.875 (1–3) at 2, 4, 6, and 8 hours of the postoperative period, respectively. No patient required general anaesthesia owing to insufficient local anaesthesia. There were no intraoperative or postoperative complications related to local anesthetic agents or injection techniques. Conclusions: Local anesthesia for performing PPI offers the advantages of minimal morbidity, preservation of patient privacy, less adverse effects of anesthesia, and shorter recovery time to activity. Our results showed that local anesthesia in performing PPI is a reliable, simple, and safe technique with excellent outcomes, especially in patients with high co-morbidities not suitable for general anesthesia. Disclosure: Work supported by industry: no.

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LONG TERM FOLLOW-UP OF INFLATABLE PENILE PROSTHESIS BY SINGLE SURGEON Choi, HK1; Choi, HM1; Kim, DS2 1: Choi’s SS Clinic, Seoul, Korea; 2: Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea Objectives: AMS 700CX/CXM inflatable penile prosthesis is increasingly applied for the treatment of ED. However, there are a few longterm survival data of the IPP over 10 years. We evaluated the long-term mechanical reliability of AMS 700CX/CXM inflatable penile prosthesis in patients with ED. Material and Methods: A total of 438 consecutive patients with ED received implantation of an AMS 700CX/CXM penile prosthesis at our institution from January 1991 to April 2009. In 397 patients (90.7%), the medical records were available and current status of penile prosthesis could be obtained by a direct telephone interview. The overall and mechanical survival rates of penile prosthesis were evalu-

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Proceedings from the 14th World Meeting of the International Society for Sexual Medicine ated using Kaplan-Meier method, and clinical factors related to survival of the CX/CXM were assessed using log-rank test. Results: Mean age of 397 patients was 63.1 years (range, 24–93) and follow-up duration was 113 months (range 1–219). 82 patients (20.6%) experienced mechanical failure at a median follow-up of 82 months. Mechanical survival rate of the penile prosthesis was 97.6%, 93.2% and 78.2% at 3, 5, and 10 years after implantation, respectively. 12 patients (3.0%) experienced nonmechanical failure including infections, tissue erosion resulting in cylinder protrusion at the meatus, and chronic discomfort. Overall survival rate of the penile prosthesis was 95.0%, 91.0% and 75.5% at 3, 5, and 10 years after implantation, respectively. Patients with neurogenic cause for ED showed lower median overall survival of penile prosthesis compared to patients with non-neurogenic cause. Patient age, obesity, and DM had no association with overall survival of penile prosthesis after implantation. Conclusions: The AMS 700CX/CXM could be accepted and applied in more patients as a reliable treatment alternative of ED. Continuous efforts for device modification are still needed to guarantee better mechanical reliability. Disclosure: Work supported by industry: no.

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TACROLIMUS (FK506) AS A NEUROMODULATOR IN THE RADICAL PROSTATECTOMY POPULATION: A MULTICENTER, DOUBLE-BLIND, RANDOMIZED, PLACEBO-CONTROLLED TRIAL Mulhall, JP1; Klein, E2; Slawin, K3; Scardino, PT1 1: MSKCC; 2: Cleveland Clinic; 3: Vanguard Urology, Houston Introduction: Cavernous nerve injury is a major cause of long-term erectile dysfunction (ED) after radical prostatectomy (RP). Data from the rat cavernous nerve injury model suggest that tacrolimus (TAC), an immunosuppressant immunophilin ligand, facilitates neural recovery with improvement in erectile function recovery in this model. This clinical trial was undertaken to define the utility of TAC in men undergoing RP. Methods: The study population consisted of men: ≤65 years of age; undergoing bilateral nerve sparing RP; with preoperative IIEF erectile function domain (EFD) scores ≥24. Patients were followed at weeks 1, 3, 5, 9 followed by months 3, 4, 6, 7, 12, 18 and 24. Patients were randomized pre-RP in a 1:1 ratio. Patients started placebo (PBO) or TAC 2 mg daily seven days prior to surgery. At discharge, TAC patients were titrated to 3 mg daily. Patients were administered the IIEF and had serum chemistries and TAC levels measured serially postoperatively. The primary efficacy end-point was the difference in EFD scores at 24 months between TAC and PBO groups. Secondary end-points included: other domain scores of the IIEF; % of patients with EFD ≥24 and the time to achieve this; % patients responding to PDE5 inhibitors (PDE5i) and the time to achieve this. Results: 131 patients were enrolled with a mean age of 55 ± 6 years. Baseline EFD score was 29 ± 2 for both groups; 24-month scores were 20 ± 10 and 17 ± 11 for PBO and TAC groups respectively (P = 0.2). 45% and 54% (P = 0.4) had 24-month EFD scores ≥ 24. No differences existed in IIEF libido, orgasm or satisfaction domain scores between groups. At 24 months, there was no difference between groups in: % of men using PDE5i (96%), % responding to PDE5i (80%) or the time to PDE5i first response (182 days). No significant adverse events were experienced. At 1 week and 3 months, no differences in serum Cr, glucose, K or estimated creatinine clearance were seen between groups. Significant, but not clinically meaningful, reductions in serum Mg was seen at 1 week (P = 0.05) and 3 months (p < 0.01) post-RP. Conclusions: These data demonstrate no significant benefit to TAC as used in this study. It is unclear at this time whether the dosing or timing strategy were inappropriate or whether the rat cavernous injury model fails to represent the human model. Disclosure: Work supported by industry: yes, by Astellas (industry funding only—investigator initiated and executed study).

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PENILE REHABILITATION AFTER LAPAROSCOPIC RADICAL PROSTATECTOMY LEADS TO IMPROVED ERECTILE FUNCTION Galiano, M; Sanchez-Salas, R; Cathala, N; Mombet, A; Praponitch, D; Barret, E; Roset, F; Cathelineau, X Institut Montsouris France Introduction: Potency is a functional concern for patients treated with radical prostatectomy (RP) and multivariable approach could be deployed to maintain/recover postoperatory function. To evaluate effect of penile rehabilitation with medical treatment on erectile function, after laparoscopic RP. Material and Methods: Prospective analysis of clinical data from patients who underwent LRP and received penile rehabilitation with tadalafil and/or intracavernous injections (ICI) between September 2003 and November 2005. All patients underwent LRP with antegrade interfasial dissection with grade of preservation stated by surgical team. Tadalafil was started on 5th post-operative day and continued every other day for one year, regardless of erectile function. ICI with alprostadil were initiated at 3 or 6 months when indicated. Follow-up included evaluations at 3-6-12-18-24 months. Oncologic and functional outcomes were systematically assessed. A self-reported IIEF questionnaire was employed for assessment. Treatment tolerance and compliance were also monitored. Results: Cohort: 1078 men mean age 60.5 years (55.5, 65.5) underwent LRP. 720 patients had inclusion criteria for our study. At a mean follow-up of 24 months, 31 (4%) patients were lost to follow-up, 43 (6%) dropped out secondary to treatment compliance and 60 (8%) patients had a PSA recurrence and required further treatment. Final analysis performed in 586 patients. Median preoperative baseline IIEF for was 22. Preoperative median IIEF for patients with unilateral nerve sparing (UNS) and bilateral (BNS) was 21 and 23, respectively. A total of 150 (26%) patients underwent UNS, while 436 (74%) patients had BNS. At follow-up of 24 months, independently of preoperatory status, 35% and 68% of patients with UNS and BNS, respectively, reported erections sufficient for intercourse without ICI. Conclusions: Adequate patient selection, meticulous surgical technique, and penile rehabilitation, allow preservation/recovering of erectile status after LRP. Disclosure: Work supported by industry: no.

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PENILE REHABILITATION IMPROVES FUNCTIONAL OUTCOMES IN PATIENTS UNDERGOING SIS PATCH GRAFTING FOR PEYRONIE’S DISEASE Rodriguez, A; Wiegand, L; Mccormick, B; Carrion, R University of South Florida Objectives: The effect of penile rehabilitation on the functional outcomes of patients undergoing surgical therapy for Peyronie’s disease (PD) is unknown. We set out to analyze the impact of penile rehabilitation in patients with PD surgically treated with plaque excision (PE) and small intestine submucosa (SIS) grafting. Material and Methods: From Jan 2005 to June 2009, 120 patients with PD were surgically treated with PE and SIS grafting (4-ply SIS, Cook, Bloomington, IN). Median age and follow-up, degree of curvature, curvature type, graft size, early complications (<3 months), and late complications (>3 months) were analyzed. The pre and post operative functional outcome were assessed using the SHIM and EPIC questionnaires for sexual function. All patients received rehabilitation education/instructions, which entailed a post-operative protocol consisting of: daily use of vacuum device, oral pentoxyphylline, and low dose PDE-5 inhibitors. Compliance with this regimen was recorded. Patients were also asked the following: 1. Are you satisfied with the surgical results (0–100%) 2. Would you be willing to undergo the surgical procedure again (Y/N) 3. How do you feel after surgery with

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respect to sexual intercourse capability, phallic length, and cosmetic effect (much better, better, the same, or worse). Results: 93 patients with a median age of 60 years (33–72) and a follow-up of 19 months (6–53) completed the analysis. 27 patients from the total were excluded due to incomplete records. All had a >60 degree of curvature. Dorsal, ventral, and pure lateral curvatures were seen in 59, 20, 2 patients, respectively. Bottle neck deformity was seen in 12 (8 of these had combined dorsal curvature). Median SIS graft size was 4 cm (1.5–7) × 4 cm (1.25–6). Median pre and post operative SHIM score were 18 (4–25) and 17 (1–24), respectively. Median pre and post operative EPIC sexual function score were 38 (29–47) and 33 (27–42), respectively. Early complications were: penile edema (16%), penile pain (8.6%), hematoma (8.6%), numbness (7.5%), and skin infection (1%). Late complications were: complaint of shorter penis (16%), numbness (4.3%), re-curvature (2.1%), and penile pain (1%). Median patient satisfaction was 70% (20–100). 63 (68%) patients reported they would be willing to go through the procedure again. 70 (75%) patients reported feeling “much better or better” about their phallus compared to their pre-operative condition. Of the 23 (25%) patients that did not feel “better,” all failed to comply with our recommended regimen for penile rehabilitation. Conclusions: Patients with PD treated surgically with PE and SIS graft can benefit from post-operative penile rehabilitation. Our series shows a relationship in penile rehabilitation with preservation of erectile function, preservation of phallic length, and overall patient satisfaction. Disclosure: Work supported by industry: no.

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SURVEY OF PATIENT SATISFACTION AND DEVICE SURVIVAL AFTER INFLATABLE PENILE PROSTHESIS IMPLANTATION FOR MEN WITH PEYRONIE’S DISEASE AND ERECTILE DYSFUNCTION Benson, JS; Levine, LA; Hoover, CRV Rush University Medical Center Objective: Erectile dysfunction (ED) frequently accompanies Peyronie’s disease (PD). Published surveys on penile prosthesis surgery for men with PD and ED have indicated a low patient satisfaction rate. This study evaluates a single center experience following placement of an inflatable penile prosthesis (IPP) in patients with PD. Material and Methods: A retrospective chart review of 91 patients with PD and ED who underwent IPP from January 1996 to February 2009 was performed. A modified erectile dysfunction inventory of treatment satisfaction (EDITS) questionnaire for Peyronie’s disease was sent to the patients. Patient reported outcomes on device and sexual satisfaction, sexual activity, residual curvature, and penile length were obtained. Multiple device related parameters were assessed including survival, infection, and measured length change. Results: Complete chart review was available on all 91 men with an average age of 57 years (range 38–75 years) and a mean follow-up of 49 months. Mean preoperative IIEF-EF score was 11. Full rigidity was not obtained in any patient during duplex ultrasound, but mean curvature at maximum erection was 53 degrees. There were 7 mechanical failures requiring device replacement, 2 revision surgeries for pump or reservoir malposition, 1 infected device removal, and 2 pending distal erosion repairs with corporoplasty. Postoperative office assessment revealed a functionally straight (i.e. <20 degrees) erect penis and a properly positioned as well as operational device in all patients. The modified EDITS questionnaire was returned by 56 (62%). Overall 84% of patients were satisfied with their outcome, yet only 73% were satisfied with their straightness. Patient perceived postoperative curvature correction was complete in less than 3 months in 84% of patients. Satisfaction with ease of inflation, deflation, and concealability was 84%, 71% and 91%. 59% noted penile length loss as a result of PD preoperatively and 54% noted length loss postoperatively. Coital activity was reported by 91% of men in this group. Conclusion: In men with PD and drug-resistant ED, inflatable penile prosthesis (IPP) placement allowed reliable and satisfactory coitus for

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the great majority of men. Mechanical failure was 7% with moderate term follow-up. Men with PD undergoing IPP placement should be counselled regarding potential penile length loss and residual curvature, neither of which appeared to interfere with coitus but may reduce satisfaction. Disclosure: Work supported by industry: no. The presenter or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.

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PENILE PROSTHESIS INSERTION FOLLOWING COMPLEX URETHROPLASTY Garaffa, G1; Raheem, A; Minhas, S; Christopher, AN; Ralph, DJ 1: St Peter’s Andrology Objectives: The long-term-results of penile prosthesis insertion following complex urethroplasty are presented. Materials and Methods: Between 1985–2009 a penile prosthesis has been inserted in 23 patients who had had a previous complex urethroplasty. A bulbo-prostatic anastamotic urethroplasty was performed in 20 patients following pelvic fracture and included corporal separation and re routing procedures. The remainder had 2 stage buccal grafting for severe BXO (n = 1), penoscrotal hypospadias (n = 1) and penile trauma (n = 1). Although severe fibrosis was present in 15 patients, dilatation of the corpora was always carried out uneventfully and a penile prosthesis was inserted in all cases (malleable n = 15; inflatable n = 8). Results: Downsized cylinders were required in 3 patients (13%) due to the fibrotic corpora. After a median follow-up of 34 months (1–120), all patients are able to have sexual intercourse. No patient had a urethral complication although 1 patient developed an infection managed by a successful salvage washout of the device (4.4%), and 2 patients needed an exchange of their prosthesis due to insufficient rigidity of the device. Overall revision was required in 4 patients (17.6%) including 1 elective exchange of malleable to an inflatable device. Conclusions: Previous complex urethral surgery is not a contraindication to the insertion of a penile prosthesis. However patients must be warned that complication and revision rates may be high due to associated fibrosis that has occurred from a combination of the original injury and the urethral surgery. Disclosure: Work supported by industry: no.

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MINIMALLY INVASIVE TECHNIQUE FOR ADULT BURIED PENIS LEADS TO LONGER PENILE LENGTH Yun, TK1; Jeon, HS1; Kim, JY1; Sohn, DW2 1: Manomedi Urologic Clinics; 2: Catholic University of Korea Objective: The aim of this study is to report a simple and minimally invasive surgical technique for adult buried penis repair. Materials and Methods: We performed penile surgery in 67 patients. All of them were underwent minimally partial circumcision. Through the partial circumcision, dartos fascia was dissected from glans to the prepubic junction. The repair is performed combination of tacking penile base to prepubic fascia and anchoring subcutaneous penile skin to base of penile shaft. The penis was wrapped up by elastic bandage evenly for 2 weeks. The outcome of the operation is evaluated by measurement of penile length before and after operation. Results: The postoperative course was uneventful with no serious complications. The mean penile length gain (flaccid penis) was 2.7 cm. There were 64 patients (95.5%) satisfied with the result and retraction occurred in 2 cases after 6 months. Conclusion: The described technique is simple and minimally invasive. In our experience, these technique may be good choice in adult buried penis and there were no additional procedures required. Disclosure: Work supported by industry: no.

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REAL PENILE LENGTHENING BY CORPOROTOMY SINGLE INCISION Kurbatov, DG; Dubsky, SA; Lepetukhin, AE Endocrinological Research Centre/Russia Objectives: In the patients having small penis and suffering ED we apply the surgical method of real penile lengthening combined with simultaneous prosthesis implantation. Design and Method: 38 men aged 43–62 (mean 53.4 ± 7.2), suffered ED and small penises, were treated from Nov. 2007 to April 2010. The etiologies of ED were cardiovascular disease (18 pts), D. Mellitus (8), radical prostatectomy (2 pts). All patients were divided at two groups. First group included 18 patients with ED and Mb. Peyronie complicated penile curvatures: dorsal (10 pts) lateral (2 pts) and complex (8 pts). 20 patients of second group suffered only severe ED and small penises but without Mb. Peyronie or any deformities. Penile length in stretched position in both groups was the similar and ranged from 7.5 to 11 cm (mean 9.5 ± 1.2). The conventional circular subcoronal incision, degloving of penile skin and mobilization of neuro-vascular bundle were performed. The single circular transverse incision of tunica except urethral plate was done. We did not mobilize urethra because it was not necessary for this type of augmentation surgery. The incision was forked at the ends for relaxation of tunica and for corpora’s lengthening. At the patients with Mb Peyronie (1st group) this incision passed through the maximal angle of curvature. At the patients without penile deformities (2nd group) we incised tunica in the middle part of penile shaft. Then we implanted malleable prosthesis by conventional technique through corporotomy defects. All these maneuvers facilitated the real lengthening of the corporal bodies in both groups. For tunica albuginea grafting we used: cadaveric dura mater (6), boving pericardium (4), Tahocomb (6), boving biocollagen (10) or scaffolds from PLGA (12). Results: The gained real penile lengthening was 2, 0–4, 2 cm (mean 3, 2 ± 0, 8). Complication occurred in 2 patients (5,2%) with ED and D. Mellitus: periprosthesis infection and partial necrosis of prepuce cutis (treated conservatively). No one patient had loss of glance sensitiveness. Conclusion: This surgical technique facilitate for gaining the real penile lengthening as to the patients with ED and penile curvatures, as to the impotent patients without any penile deformities. Disclosure: Work supported by industry: no.

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PENILE AUGMENTATION SURGERY USING AUTOLOGOUS DERMAL FAT, ALLOGENIC DERMIS OR HETEROGENIC COLLAGEN GRAFT Kim, JY Philip & Paul Medical Institute Objective: Introduction: Up to present autologous dermal-fat, fat graft and allograft have been used and xenograft is used these days in surgery. This study is to report on penile augmentation surgery using autograft, allograft, and xenograft. Material and Methods: We performed complex phalloplasty that enables simultaneous surgeries for glans augmentation, penile lengthening, and girth enhancement. Autologous dermal-fat, allogenic dermal graft or heterogenic type I collagen. The thickness of the augmented graft was about 4–6 mm. In the penile skin of the dorsal area, 1–2 cm from the subglans or circumcised scar was minimally incised at a length of 3 to 5 cm in a transverse direction Enhancement tissue was placed between the dartos and Buck’s fascia. Histologic examination was conducted for people that took penile augmentation surgery. Results: The surgery was conducted on 720 patients from January 2005 to December 2007. The thickness of the augmented graft was about 3–6 mm in a few examined cases by ultrasonography. The grafted tissues were well combined with the host penile stromal tissue with new vessel proliferation revealed.

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As for complications, in case of graft failure, the graft was removed partially or entirely. Some necrosis cases occurred but most of them were treated through conservative treatment. Conclusions: Penile augmentation surgery using the above described grafted tissues showed positive results in terms of safety, effectiveness and histologic findings. This study reports that those materials may be considered as safe materials for penile augmentation surgery. Disclosure: Work supported by industry: no.

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A NEW TECHNIQUE FOR COMPLETELY DENUDED PENIS: MODIFIED BILATERAL SCROTAL FLAP Jung, GW; Park, SJ; Ye, JW Smile Jung’s Urology Clinic/South Korea Objectives: Although worldwide incidence is not well known, foreign body injection is often attempted in order to augment the penis. Complications usually follow, such as penile deformity, skin necrosis, limited erectile function, and the ability to have intercourse. Definitive treatment of these patients includes complete removal of the involved tissue and repair of the denuded penis. We tried a new technique comprised of modified bilateral scrotal flaps to provide for reliable and stable coverage in such cases. Material and Methods: Seventy eight patients with penile foreign body granuloma underwent reconstructive surgery by author from November 2001 to December 2009. Twenty seven of them had paraffinoma and 51 patients had vaselinoma. Necrosis and ulceration of penile skin were seen in 16 patients. Foreign body granuloma partly invaded the scrotum in 7 and the infrapubic area in 18 patients. The average age of the patients was 37.2 years. Complete removal of involved skin and subcutaneous tissue was performed under spinal anesthesia. After the preoperative design, flap elevation started with a midscrotal incision. The scrotal skin flap, including Dartos fascia, was elevated from the underlying tunica vaginalis using a blunt finger dissection. Finally, the inferior sides of flaps were incised and the bilateral scrotal flaps were completely elevated. The upper angles of each side of scrotal flaps were sutured together and fixed at middorsal portion of the corona. The lower angles of flaps were also sutured at the frenulum of penis. Two large Z-plasties were inserted into the dorsal and ventral suture lines. After the completion of penile resurfacing, the remaining scrotal skin was advanced forward and sutured. All the sutures were done with 4-0 Vicryl and Nylon. Results: All the flaps survived completely. Delayed wound healing was seen in 14 patients and the wound were healed with conventional treatments, except in 5 patients who underwent surgical intervention. Fourteen patients complained of decreased scrotal size. Eight patients showed mild scar contracture at the penoscrotal junction. Urethral injury was seen in 1 patient. The part of the scrotal hair-bearing area was moved to the penile shaft. After 6-month recovery period, satisfactory sexual activity was possible for all patients. Conclusions: In our experience, penile resurfacing with modified bilateral scrotal flaps is an effective and reliable method for repair of completely denuded penis. Disclosure: Work supported by industry: no.

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REVEALING THE BURIED PENIS Shaeer, O1; Shaeer, K2 1: Kasr El Aini Faculty of Medicine, Cairo University; 2: Kasr El Aini Faculty of Medicine, Cairo University, Egypt Objective: Several surgical solutions have been proposed for resolving penile concealement with successful outcome. Those include liposuction, adhesiolysis and suprapubic lipectomy through the abdominal crease. Nevertheless, some limitations exist and compromise the results of surgical correction. This work presents our technique for

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revealing the hidden penis, addressing the limitations of existing methods for surgical correction. Materials and Methods: Sixty four adult males with buried penis were operated upon. The penis was revealed by the combination of adhesiolysis, suprapubic and lateral lipectomy, anchoring the penoscrotal and peno-pubic junctions, and skin coverage by a local flap. Results: Average post-operative length in the flaccid state was approximately 7 cm ± 1.3 (a 293% increase) and in the erect state was 18.4 cm ± 2.9 (185.7% increase), compared to pre-operative length of 1.8 cm ± 0.4 in the flaccid state and 6.4 cm ± 1.6 in the erect state. Minor complications occurred. There was no deterioration in sexual function. Conclusion: Revealing the concealed penis is a tricky procedure. The outcome may be improved by implementing a radical approach to tissue excision, providing adequate skin coverage, and anchoring the penile shaft, skin and subcutaneous tissues in the revealed state to prevent relapse. Disclosure: Work supported by industry: no.

right distal tip of his inflatable penile prostheses. He was taken to the operating room for surgical correction. Results: A distal longitudinal incision was made and the implant exposed. The deflated cylinder is deflected out of the corpora. This allows us to make an incision in the medial area of the pseudocapsule. A new space is dilated carefully. The implant is repositioned into the newly dilated space and a Tutoplast tunical patch is sewn to close the opening to the original distal corporal space. After eight weeks, the patient was given permission to resume sexual activity. At two years follow-up, there is no evidence of recurrent erosion with excellent cosmetic outcome. Conclusion: Many methods have been described for repair of distal penile prosthesis erosion. Tutoplast, used in this particular technique, can provide a barrier to prevent migration of the distal cylinder back into the original corpora and, hence, may be ideal for repair of lateral erosion. Tutoplast distal corporoplasty is a novel method for repair of these complex cases that should belong in the armamentarium of contemporary andrologists. Disclosure: Work supported by industry: no. The presenter or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.

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TOTAL URETHRAL RECONSTRUCTION WITH THE RADIAL ARTERY BASED FOREARM FREE FLAP Garaffa, G1; Raheem, A; Christopher, AN; Ralph, DJ 1: St Peter’s Andrology Objectives: The long-term-results of total urethral reconstruction with the radial-artery-based-forearm-free-flap (RAFFF) are presented. Materials and Methods: Between 2004–2009 a RAFFF-urethroplasty has been performed in 24 female-to-male-transsexuals and in a male affected by micropenis. All patients had a previous pubic phalloplasty; 2 had a failed attempt of urethral reconstruction with labial flaps. The RAFFF was raised from the non-dominant arm and tubularised around a 16-ch catheter. Arterial, venous and nervous anastomoses were performed respectively between radial and epigastric artery, cephalic and saphenous vein, antebrachial and ileoinguinal nerves. The donor site was covered with a full-thickness-skin-graft. A primary join-up of the neourethra with the native one was performed in one patient; in all other cases the join-up has been performed in 2 stages. Results: After a median follow-up of 12.4 months (2–32), two patients (8%) have lost the flap due to acute arterial thrombosis (n = 1) or venous thrombosis (n = 1). Fistulas and strictures at the level of the join-up site occurred respectively in 2 and 1 patients and required surgical correction. No complications were reported at the donor-site level. All patients who have already had the RAFF-urethroplasty joined to the native urethra void standing from the tip of the phallus and are delighted with functional and cosmetic result. Conclusions: The RAFFF-urethroplasty is a reliable technique, guarantees excellent functional and cosmetic results and patients’ satisfaction is consequently high. Disclosure: Work supported by industry: no.

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A NOVEL TECHNIQUE FOR REPAIR OF DISTAL PENILE PROSTHESIS EROSION USING TUTOPLAST 1

2

1

1

Wiegand, LR ; Carrion, H ; Kim, TJ ; Carrion, RE 1: University of South Florida; 2: University of Miami Objective: Distal penile prosthesis erosion can be a challenging repair. Multiple techniques for repair have been described. Here we describe a method for distal corporoplasty with the use of Tutoplast (Tutogen Medical, Inc., Gainesville, Florida), focusing on patients with lateral distal defects. Materials and Methods: A case report is described of a 59-year-old male with severe erectile dysfunction implanted two years prior to presentation. He was found to have impending lateral erosion of the

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AL-GHORAB SHUNT PLUS INTRACAVERNOUS TUNNELING FOR PROLONGED ISCHEMIC PRIAPISM Xin, ZC1 1: Peking University First Hospital, Peking University Objective: To investigate the efficacy and safety of corpus cavernosumcorpus spongiosum shunt (Al-Ghorab Shunt) plus intracavernous tunneling (CC-CSS+ICT) for prolonged ischemic priapism (PIP). Methods: Twelve patients with PIP were enrolled in this study. The mean age of patients was 38.3 ± 9.2 years old and the mean duration of PIP was 2.8 ± 1.0 days (range from 1.5 to 4 days). All patients were performed CC-CSS+ICT for treating PIP. The penile hardness score (PHS) and pain visual analogue score (PVAS) were used to assess the efficacy of the surgery post 1, 3, 5 days respectively. Color Duplex Doppler Ultrasonography (CDDU), International Index of Erectile Function (IIEF5) and quality of life (QOL) were used for evaluating penile morphology, erectile function, quality of life and response to Sildenafil treatment. The mean duration of follow up was 21.6 ± 10.1 months. Results: All of 12 cases successfully restored penile detumescence post surgery with the mean PHS and PVAS significantly decreased compared with that of pre surgery at different time point (post 1, 3, 5 days) (P < 0.001). The cavernosal arterial blood flow were observed with the mean PSV at 1, 3, 5 days post operation were 17.79 ± 2.04, 19.14 ± 1.58, 7.73 ± 2.02 cm/s respectively. All patients suffered from CC fibrosis and ED post operation, only 2 cases (16.7%) with short duration of PIP (1.5 days) showed response to Sildenafil treatment, 3 cases (25.0%) with severe fibrosis were satisfied with sexual life after excision of penile corpus cavernosum scar and penile prosthesis implantation (PPI). Conclusion: The CC-CSS+ICT could quickly reduce penile rigidity and pain for improving the symptoms of PIP and suggested a safe and effective therapeutic method for PIP. Disclosure: Work supported by industry: no.

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PENILE TRACTION THERAPY ADDED TO INTRALESIONAL VERAPAMIL INJECTIONS FOR PEYRONIE’S DISEASE Abern, M; Levine, L1, Hyun JA2, Kam SC2 1: Rush University Medical Center; 2: Department of Urology, Gyeongsang National University Hospital, Jinju, Korea; 3: Department of Urology, Gyeongsang National University Hospital, Jinju, Korea Objective: To compare subjective and measured efficacy, and tolerance of, the addition of penile traction therapy (PTT) to intralesional verapamil injections (IVI) combined with oral L-arginine 1 g bid and pentoxifylline 400 mg tid) in men with Peyronie’s disease (PD). Materials and Methods: 111 men with PD treated between February 2005 and April 2010 were evaluated in this prospective, non-randomized study. Penile duplex ultrasound (DU) to measure erect penile deformity (EPD), stretched penile length (SPL), physical exam and biothesiometry were performed at the beginning and end of the protocol. Patients electing to add PTT obtained a FastSize penis extender, were instructed on proper application, and were advised to wear the device for 2–8 hours daily. IVI were administered every other week for a total of 12. At each visit the patients were interviewed regarding pain, erect deformity change, ability to have coitus, girth, and rigidity. Results: 31 patients in the IVI alone group (I) vs. 40 patients in the PTT group (II) completed the protocol. There were no statistical differences between the two groups with respect to pre-treatment penile deformity, age, erectile dysfunction, vascular risk factors, and duration of disease. 53% of men in group II had 10 degrees or more reduction in EPD vs. 39% in group I (P = 0.75). Patients in group II had a mean curvature improvement of 12.0 degrees vs. 6.1 degrees in group I (P = 0.69). Men who showed improvement had a mean curvature improvement of 26.9 degrees in group II vs. 20.9 in group I (P = 0.22). Men in group II gained an average of 0.3 cm in SPL vs. a loss of 1.07 cm in group I. Mean PTT use was 3.3 hours per day, and men with >3 hours per day use gained 0.6 cm in SPL vs 0.07 cm using less than or equal to 3 hours per day (P = 0.09). Conclusions: There was a trend toward measured curvature improvement and SPL in men using the combination therapy protocol. Length improvement is likely related to duration of use of the traction device. Combined therapy is well tolerated by patients. Disclosure: Work supported by industry: no. The presenter or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.

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PEYRONIE’S DISEASE IN TEENAGERS Tal, R; Alex, B; Choi, J; Mulhall, JP MSKCC Introduction: Typically, Peyronie’s disease (PD) occurs in middleaged men, however, PD can affect men of all ages, even teenagers. PD is well recognized as a cause of distress and depression. This analysis was undertaken to review PD characteristics and associated distress in teenagers. Methods: A prospectively constructed departmental database of all subjects presenting to a sexual medicine clinic was reviewed to identify men with PD. Demographic, comorbidity and PD data were recorded. All patients with documentable plaque on examination underwent deformity assessment at the time of a duplex Doppler penile ultrasound. Comparison was made between these patients and the older PD population (aged >40 years). Chi square analysis was used to compare the two groups. Results: 32 teenagers with PD have been seen between 2000–2009 representing 2.5% of all PD patients registered in our database. All patients self-referred via internet search. Median age is 18 (17–19) years. The duration of PD at the time of presentation was 3 ± 1 month. 16% reported some form of trauma, only half of which was coital in nature. 22% had penile pain in the flaccid state. No patient had Dupuytren’s contracture. 37% developed ED after PD onset. 37% had

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multiple non-contiguous plaques. All patients had penile curvature, 22% had associated deformity (indentation, hour-glass deformity, tapering). 72% had dorsal curvature. Mean curvature at time of deformity assessment was 32 ± 12 degrees. 11% had calcification evident on ultrasound. Mean PSV 62 ± 28 cm/s, EDV 1.6 ± 0.8, RI 0.98 ± 0.16. 18% had Hb A1C > 5%. 45% had already been seen by another urologist and 28% had been told they did not have PD, 12% were treated with vitamin E and 12% with transdermal verapamil. 94% reported high distress level, 34% had sought medical consultation for anxiety/ mood disorder and 28% had had a negative encounter with a sexual partner related to their PD. Compared to the general PD population seen, the teenaged PD population was more likely to have multiple plaques (P = 0.02), have undiagnosed elevated HbA1C (p = 0.03), and present within 6 months (P = 0.01). Conclusions: PD while uncommon can occur in teenagers. In this population, the psychological effects associated with PD were great. Furthermore, more than one third were mis-diagnosed by a urologist. There need to be greater awareness among physicians, especially urologists, of the occurrence of PD in teenagers. Disclosure: Work supported by industry: no.

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SURGICAL OPTION FOR THE CORRECTION OF PEYRONIE’S DISEASE: AN AUTOLOGOUS TISSUE-ENGINEERED ENDOTHELIALIZED GRAFT Imbeault, A1; Bernard, G2; Ouellet, G2; Bouhout, S2; Carrier, S3; Bolduc, S 1: Laval University/Canada; 2: Laboratoire d’Organogénèse Expérimentale/ LOEX/Canada; 3: McGill University/Canada Objective: Surgical treatment is indicated in severe cases of Peyronie’s disease. Incision of the plaque with subsequent graft material implantation is the option of choice. Ideal graft tissue is not yet available. The aim of our study was to evaluate the use of an autologous tissueengineered endothelialized graft by the self-assembly method, for tunica albuginea reconstruction in Peyronie’s disease. Material and Methods: Two tunica albuginea models were created. Human fibroblasts were isolated from a small skin biopsy and cultured in vitro until formation of fibroblast sheets. After 4 weeks of maturation, umbilical vein endothelial cells (HUVEC) were seeded on fibroblasts sheets and wrapped around a tubular support to form a cylinder of about 10 layers. After 21 days of tube maturation, HUVEC were seeded into the lumen of the fibroblast tubes for the endothelialized tunica albuginea (ETA). No HUVEC were seeded into the lumen for the tunica albuginea model (TA). Both constructs were placed in a bioreactor for one week with an internal perfusion of endothelial cells culture medium (EGM-2). External perfusion with DME supplemented with 10% SVF was used for fibroblast culture. Fibroblast-only construct were used as controls. Histology, immunohistochemistry and burst pressure were performed to characterize mature tubular graft. Animal manipulations were also performed to demonstrate the effects of endothelial cells in vivo. Results: Histology showed uniform multilayered fibroblasts. Extracellular matrix, produced entirely by fibroblasts, presented a good staining for collagen 1 (anti-collagen 1). Some elastin fibers were present. For the TA model, anti-human von Willebrand antibody revealed the endothelial cells forming capillary-like structures. TA model reached a burst pressure of 584 mm Hg and ETA model obtained a burst pressure of 719 mm Hg. Conclusions: This tissue-engineered endothelialized tubular graft is structurally similar to normal tunica albuginea and presents an adequate mechanical resistance. The self-assembly method used and the autologous property of this model represent a real advantage comparatively to other available grafts. Further evaluation including functional testing will be necessary to characterize in vivo implantation and behavior of the graft. Disclosure: Work supported by industry: no.

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conservative attitudes toward sex, smoking and chronic diseases, and no regular occupation were more likely to suffer from FSD. Conclusions: The prevalence of FSD in Korean women was common and comparable to those reported worldwide. Sexual distress is one of the most important associated factors of FSD.

DISTAL PENOPLASTY FOR SKIN DEFECTS THAT RESULT WHILE CORRECTING PEYRONIE’S DISEASE Rodriguez, A; Wiegand, L; Keating, M; Carrion, R University of South Florida Objectives: The correction of Peyronie’s disease occasionally results in difficulty with skin closure. This occurs specifically in patients with a paucity of excess shaft skin from prior circumcision. We report our experience with distal penoplasty in patients with this shaft skin dilemma. Material and Methods: Skin deficiencies occurred in 5 patients whose Peyronie’s disease was corrected with plaque excision and patch grafting using smooth intestinal submucosa (SIS). These patients represented a subgroup of a larger series of 125 patients having similar surgery for Peyronie’s disease. Distal penoplasty was required of 4 patients with dorsal curvature and 1 with ventral curvature. The surgical technique consisted of a midline incision in the distal penile shaft skin opposite the side of the skin deficiency that resulted with the correction of corporal curvature. This facilitates the contralateral transfer of distal penile shaft skin. Two skin flaps are created that are wrapped around the shaft and meet to cover the distal skin defect. Simple 3-0 Monocryl sutures were used in each case. Results: The patient’s mean age was 44.8 (range: 39–51). All patients had a greater than 70 degree penile curvature. The mean SIS patch graft size placed was 5.5 cm × 5 cm. At a mean follow-up of 4 months (1–7) all patients had correction of penile curvature. There were no wound openings or infections. All patients received penile rehabilitation with: vacuum device, pentoxyphylline, and PDE-5 inhibitors (standard protocol). None of the patients reported penile shortening, numbness, or pain. Each was pleased with the cosmetic appearance of his penis. Conclusions: Patients with Peyronie’s disease who are surgically treated with a large plaque excision and patch grafting, experience lengthening of the corporal bodies and penile shaft. In occasional cases skin closure may be difficult to achieve without tension. Distal penoplasty is a novel technique that provides a simple and effective solution to the problem. Disclosure: Work supported by industry: no.

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THE PREVALENCE AND ASSOCIATED FACTORS OF FEMALE SEXUAL DYSFUNCTION IN KOREAN WOMEN: A COMMUNITY-BASED STUDY Yang, DO1; Lee, HS2; Oh, KJ2; Youn, G1; Park, K2; Hyun, JS3; Kam, SC3 1: Sexual Medicine Research Center, Chonnam National University, Gwangju, Korea; 2: Department of Urology, Chonnam National University Medical School, Sexual Medicine Research Center, Chonnam National University, Gwangju, Korea; 3: Department of Urology, Gyeongsang National University Hospital, Jinju, Korea Objectives: To estimate the prevalent rate and associated factors of female sexual dysfunction (FSD) in Korean women. Materials and Methods: A total of 684 married women in the Chonnam and Gwangju area were randomly included in this study. They were asked to complete a questionnaire on FSD, which consisted of the Female Sexual Function Index (FSFI), psychological, physiological, and demographic factors. Results: The mean age of the women was 40.5 years and the mean FSFI score was 23.4 out of a total score of 36. Based on the total FSFI score, 54.7% of the women had scores less then the cut-off point of 25, the assessed definition of FSD. The prevalence of FSD by age groups were; 42.0% for 20–29 year olds, 49.4% for 30–39 year olds, 53.5% for 40–49 year olds, and 72.9% for those 50 and over. A stepwise regression analysis found that those women with higher levels of sexual distress, lower frequency of sexual intercourse, lower levels of life satisfaction, menopause, less important appraisal of sex, greater

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GEPIRONE-ER IMPROVEMENT OF LOW DESIRE—DO WOMEN REGAIN NORMAL DESIRE? Goldstein, IM1; Fabre, LF2; Derogatis, LR3; Smith, LC2 1: San Diego Sexual Medicine Alvarado Hospital USA; 2: Fabre Kramer Pharmaceuticals, Inc. USA; 3: Sheppard Pratt Health Systems USA Objective: To assess whether depressed women treated with gepironeER regain normal sexual desire. In both short term (8 weeks) and long term studies, gepirone-ER has been shown to improve sexual function in women with Major Depression, but is this increase meaningful? Methods: In study 134001, female subjects with major depression had Derogatis Inventory of Sexual Function-Self Report (DISF-SR) scores recorded at baseline and at selected treatment visits. The DISF-SR total score and its individual domains have been normed to the general population. The mean of normal sexual function is denoted by the 50th percentile. The normal range extends from the 16th to 84th percentiles. In studies 134004, 134006 and 134017, a trained psychiatrist made DSM-IV diagnoses of HSDD at baseline and every patient visit. Subjects were treated with gepirone-ER, 20–80 mg/day, or placebo. Results: In study 134001, the DISF-SR cognition/drive (desire) domain score at baseline was at the bottom of normal range (rank 17%). This desire score increased statistically significantly to the middle of the normal range (rank 45%) at week 8 of gepirone-ER treatment. Placebo treated patients did not improve. This results is statistically significant compared to placebo, P = 0.013. In studies 134004, 134006, and 134017, at some visit before endpoint, 71 women randomized were diagnosed as having HSDD by DSM-IV criteria. With gepirone-ER treatment, 41 (58%) no longer met criteria for HSDD at week 8, compared to placebo 18/79 (22%) P < 0.001. At two weeks, 26 of 48 (54%) of gepirone-ER treated patients previously diagnosed with HSDD at baseline did not meet criteria for HSDD diagnosis (P < 0.001), compared to placebo 3 of 101, 3%. Conclusions: Treatment with gepirone-ER improves sexual desire into the middle range of the normal population. Of depressed women meeting DSM-IV criteria for HSDD, 54% no longer meet criteria by week 2, with 58% improving by week 8. The majority of depressed women with low sexual desire regain normal desire when treated with gepirone-ER. Disclosure: Work supported by industry: yes, by Organon (industry initiated, executed and funded study). The presenter or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.

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SAFETY AND TOLERABILITY OF FLIBANSERIN IN PREMENOPAUSAL WOMEN WITH HYPOACTIVE SEXUAL DESIRE DISORDER Jolly, E1; Clayton, AH2; Thorp, J3; Nappi, R4; Kimura, T5; Hanes, V5; Pyke, R5; Sand, M5 1: Shirley E. Greenberg Women’s Health Centre, The Ottawa Hospital, Canada; 2: University of Virginia, USA; 3: University of North Carolina at Chapel Hill, USA; 4: University of Pavia, Italy; 5: Boehringer Ingelheim Pharmaceuticals, Inc. Objective: To assess the safety and tolerability of flibanserin, a novel 5-HT1A agonist/5-HT2A antagonist being investigated as a potential treatment for generalized acquired Hypoactive Sexual Desire Disorder (HSDD) in premenopausal women.

Proceedings from the 14th World Meeting of the International Society for Sexual Medicine Material and Methods: Data on the safety and tolerability of flibanserin in premenopausal women with generalized acquired HSDD from four 24-week randomized, placebo-controlled, parallel-group trials in North America (DAHLIA, 511.70; VIOLET, 511.71; DAISY, 511.75) and Europe (ORCHID, 511.77) were pooled. Safety parameters were monitored throughout the studies. These included: adverse events (AEs); blood pressure and pulse; weight; laboratory tests; electrocardiograms; physical and pelvic examinations. Results: 4,791 women were included in this analysis (flibanserin 25 mg bid: 733; 50 mg qhs: 969; 50 mg bid: 728; 100 mg qhs: 1001; placebo: 1360). Data are expressed as the percentage of patients in the flibanserin 25 mg bid, 50 mg qhs, 50 mg bid, 100 mg qhs and placebo groups, respectively. The proportions of patients experiencing an AE were 58.7%, 64.8%, 71.0%, 69.5% and 57.7%. The proportions of patients experiencing an AE leading to discontinuation were 6.8%, 10.2%, 20.3%, 14.6% and 6.8%. The proportions of patients experiencing a serious AE were 0.5%, 0.6%, 0.4%, 0.9% and 0.6%. The following AE were reported in ≥2% of any flibanserin group and ≥ twice that of placebo: dizziness (4.2%, 6.3%, 15.3%, 12.0% and 2.5%), nausea (5.6%, 7.0%, 12.4%, 11.9% and 4.3%), fatigue (4.8%, 6.1%, 13.9%, 11.0% and 5.7%), somnolence (7.0%, 5.7%, 16.8%, 9.5% and 2.9%), insomnia (1.9%, 2.0%, 2.8%, 5.1% and 2.4%), dry mouth (0.8%, 1.2%, 1.4%, 2.3% and 0.7%) and anxiety (0.7%, 2.0%, 1.4%, 2.0% and 0.7%). Conclusions: No major safety concerns were associated with the use of flibanserin at doses up to 100 mg/day (the highest dose tested) during 24 weeks of treatment in premenopausal women with HSDD. Disclosure: Work supported by industry: yes, by Boehringer Ingelheim (industry initiated, executed and funded study). The presenter or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.

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LIVER TRANSPLANTATION IMPACT ON WOMEN WITH FAMILIAL AMYLOIDOTIC POLYNEUROPATHY Silva, TO1; Farinha, R1; Pinheiro, LC2; Monteiro, LA1; Barroso, E1; Mendes, JR1 1: Curry Cabral Hospital/ Portugal; 2: New Lisbon University/ Portugal Familial Amyloidotic Polyneuropathy (FAP) is an autossomal dominant progressive disease caused by mutation of transthyretin. This protein produced mainly by the liver, when mutated deposits as amyloid in periferical nervous system (somatic sensory-motor and autonomic) and systemic organs. Death occurs 10–20 years after the initial symptoms unless a liver transplantation is made. FAP women have more sexual dysfunction than non-FAP, namely arousal, orgasm and sexual insatisfaction. Objective(s): See if liver transplantation has impact on their sexual function and if it correlates with their life satisfaction. Material and Method(s): We evaluated 50 women with FAP followed in your hospital (19 waiting liver transplantation and 31 with more than 1 year after liver transplantation) through phone interview and home send questionnaires including: satisfaction with life scale (SWLS), female sexual function index (FSFI), sexual practices, FAP symptoms, medication and compared the results with 43 non-FAP women. All premenopausal state and aged 20–52 years. Result(s): The prevalence of sexual dysfunction (SD) in female FAP before liver transplantation (LT) was 50% and 33% after that procedure. It was a desire problem in 62,5% of FAP before LT and 75% after LT, arousal problem in 87,5% before LT and 60,7% after LT, lubrification problem in 75% before LT and 63% after LT, orgasm problem in 56,3% before and 66,7% after LT, sexual insatisfaction in 50% before and 46,4% after LT and pain in 43,8% before and 39,3% after LT. With didn’t found correlation between LT and SD or life satisfaction among FAP patients, unrelated to years of LT, immunessupressive drugs or disease duration. Conclusion(s): Although female FAP after liver transplantation appears to have less SD, it doesn’t seem to be significant, nor the time passed since the transplantation. Disclosure: Work supported by industry: no.

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A NOVEL INTRAVAGINAL ELECTRONIC PULSATILE DEVICE: NEW PROMISE FOR INDIVIDUALIZED CARE FOR VAGINAL MUSCLE DISORDERS AND DYSPARENIA Krychman, M1; Jennings, RS2 1: Hoag Hospital; 2: CTO EPD Scientific Introduction: Sexual devices and medical intravaginal stimulators do not offer programmable flexibility with location within the genitopelvic area. EPD scientific has created a new device which will allow internalized programmable stimulation either for sexual enhancement or for potential therapeutic interventions. Aim: To create a new device that can be used both for sexual novelty and enhancement and for medical therapeutics. Material and Methods: EPD Scientific, a new biotech corporation has commissioned prototype development of a Intravaginal Apparatus (IVA) which have a novel design with advanced electronic capability to program HZ from 12–200 and provide over 256 patterns of stimulation. This device will be able to be programmed to provide individualized vaginal stimulation over pre selected areas of the vaginal mucosa. It is proposed to allow the woman choose her area of increased sensitivity and pleasure and focus the vibratory stimulation accordingly. The medical device was created in order to focus vibratory sensation on specific areas within the vaginal canal which may individualize care for the patient with vaginismus or trigger point areas within the vagina. On going animal safety studies coupled with histological analysis at a variety of hertz patterns are planned. Result: Prototype 1 as demonstrated in Figure 1 is a 12.5 cm by 3.0 cm IVA with 256 programmable channels and 15 concentric Rings. Each ring can operate in isolation or computer programmable patterns of stimulation can be achieved. Conclusion: The new sexual device demonstrates novelty in design and intricate technology and may show promise for advancing individualized care for sexual complaints. It may also couple improve individualized sexual stimulation which with autonomous control. Disclosure: Work supported by industry: yes, by EPD Scientific (industry initiated, executed and funded study). The presenter or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.

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SACROSPINOUS LIGAMENT FIXATION FOR VAGINAL VAULT PROLAPSE WITH A REUSABLE SUTURING DEVICE (RSD-NEY) THROUGH A SMALL INCISION TO REDUCE DYSPAREUNIA AND PELVIC PAIN SYMPTOMS Neymeyer, J1; Abou-Dakn, M2; Ho, A3; Baecker, C1; Greiner, E1; Kassin, S1; Abdul-Wahab Al-Ansari, W4; Beer, M4 1: Franziskus-Hospital-Berlin, Department of Urology & Urogynecology; 2: St. Joseph-Hospital-Berlin, Department of Gynecology & Obsterics; 3: No.1 Hospital of Jiaxing, Department of Urology; 4: Franziskus-Hospital-Berlin, Department of Urology & Urogynecology Objective: To reduce operation time and intra- and postoperative complications we developed a new reusable suturing device (RSDNey) and to look for there follow-up results in women with sacrospinous ligament fixation. Material and Method: Between 01/2009 and 03/2010, 58 women (mean age 76.3 years, range 46 to 93 years) underwent vaginal unilateral sacrospinous ligament fixation with the RSD. All patients had had prior hysterectomy. In 32 patients sacrospinous ligament fixation was combined with the following procedures: 26 enterocele repairs, 29 anterior colporrhaphies and 9 posterior colporrhaphies. Result: All 58 patients were analysed especially for operative handling by using the RSD and intra- and postoperative complications. The

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time of secure finding and suturing the sacrospinous ligament with the RSD was 3 (2–5) min. The total mean operation time was 25 (15–36) min. Main complication registered were urinary tract infection (n = 8), temporary irritation of the sciatic nerve (n = 2) and blood loss less than 200 ml (n = 4). All occurred in the postoperative phase.We did not find any temporary partial ureteral obstruction. Recurrent cystoceles, rectoceles, enteroceles, were found in 2 cases. These patients complete recurrence of vaginal vault prolapse successfully underwent with a vaginal titanium coated mesh interposition. The mean duration of follow-up was 9 (4–13) months. Conclusion: Sacrospinous ligament fixation with the reusable suturing device is an effective and safe procedure with a low recurrence and complication rate. The procedure has the advantage of fast and secure suturing the sacrospinlous ligament, facilitating other vaginal repairs needed during the same operation, preserving vaginal function and shortening the time necessary for anesthesia and surgery. At the six month follow up period, there are far less reports of complications such as dyspareunia and pain when comparing surgery treatments. Disclosure: Work supported by industry: no.

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CHANGES IN ANDROGENS LEVELS DURING THE MENSTRUAL CYCLE AND ORGASM FUNCTIONING IN WOMEN Rellini, AH; Murray-Close, D University of Vermont Objectives: Androgens have been correlated with several aspects of sexual functioning, including frequency of orgasm and psychological experiences of orgasm. In women, higher levels of testosterone (T) have been correlated with frequency of orgasm, and orgasm has been found to increase T levels. Moreover, DHT was associated with frequency of orgasm in men. However, the relationship between orgasm and androgens remains unclear. Most studies have assessed T levels at one time during the menstrual cycle or have measured T before and after orgasm. Androgens levels vary during the menstrual cycle and hormonal contraceptives modulate these levels. In this study we investigated the relationship between orgasm functioning and changes in T and DHEA-S levels measured during the first and the last (placebo) week of a new hormonal contraceptive package (or ring). Material and Methods: 18 sexually active women (age 18–23) taking Ortho, Ortho-Lo or using the NuvaRing provided saliva samples during the first and the last week of their menstrual cycle. T and DHEA-S were derived from the saliva samples. Participants also completed the Female Sexual Functioning Index (FSFI). The Orgasm subscale of the FSFI was used in this study. Results: There were no differences in T or DHEA-S measures between women on the NuvaRing and women on Ortho and OrthoLo. Overall, there was no specific change in T and DHEA-S between day 1 and day 2 of the study, meaning that some women showed an increase in T and/or DHEA-S, some women showed a decrease, and others remained the same. T and DHEA-S levels during day 1 and day 2 did not significantly predict orgasm functioning. Conversely, changes in T, F(2,14) = 10.1, R2 = .61, P < .01, and DHEA-S, F(2,14) = 5.15, R2 = .42, P < .05, showed a strong and significant curvilinear relationship with orgasm functioning. No or small changes in T and DHEA-S were associated with higher orgasm functioning while both increases and decreases, were associated with lower orgasm functioning. Conclusions: These results suggest that stability of androgens levels throughout the menstrual cycle may be an important factor for sexual functioning, and orgasm functioning in particular. Studies with larger samples are needed to confirm these findings given the small sample size. Disclosure: Work supported by industry: no. The presenter or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.

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ANTIHYPERTENSIVE TREATMENT IMPROVES ARTERIAL PRESSURE, BLOOD GLUCOSE AND PUDENDAL ARTERY ENDOTHELIAL-MEDIATED RELAXATION IN AGED TYPE II DIABETIC FEMALE RATS Hannan, JL; Allahdadi, KJ; Ergul, A; Webb, RC Medical College of Georgia/USA Diabetic women have a two-fold greater risk of developing female sexual dysfunction (FSD). The internal pudendal artery is a key resistance vessel for peripheral manifestations of the sexual response. We have previously demonstrated that young female type II diabetic rats have impaired apomorphine-induced genital vasocongestive arousal, decreased endothelial relaxation and increased endothelin-1(ET-1) mediated constriction in the pudendal arteries. These pathological vascular changes are exacerbated with aging. Objectives: The current study examines the impact of antihypertensive treatment on blood pressure, visceral adiposity, blood glucose and mesenteric and pudendal artery reactivity. Materials and Methods: Female Goto-Kakizaki type II diabetic rats (48 weeks) were treated with enalapril (30 mg.kg) and hydrochlorothiazide (100 mg/l) for 4 weeks. Arterial pressure was assessed via tail cuff. Mesenteric and pudendal arterial segments were mounted in wire myographs and concentration response curves to phenylephrine (PE), acetylcholine (ACh) and ET-1 (+/− ETA receptor or Rho-kinase (ROCK) antagonists) were performed. Visceral adipose tissue (VAT) and hearts were excised, weighed. Protein expression of eNOS, ETA receptor and ROCK were assessed via Western blotting. Results: Treated GK had significantly lower arterial pressure (84 vs 107 mm Hg), blood glucose (142 vs 180 mg/dL) and a dramatic decrease in VAT (% VAT/body weight: 2.8 vs 7.5). Treatment did not reduce contractile responses to PE or ET-1 and expression of the ETA receptor was unchanged in mesenteric and pudendal arteries. Preincubation of treated mesenteric vessels with ROCK antagonist reduced ET-1-mediated contraction; however contraction in treated pudendals was not altered. Protein expression of ROCK was unchanged in both vessels. ACh-mediated relaxation was improved in treated pudendals (pD2: 7.1 ± 0.3 vs 6.6 ± 0.2) and both treated vessels had increased eNOS protein expression compared to untreated vessels. Conclusions: Antihypertensive treatment was able to lower blood pressure, improve blood glucose, lower visceral adipose tissue and improve endothelial-mediated relaxation in pudendal arteries of aged type II diabetic female rats. Further studies are required to determine if antihypertensive treatments can improve sexual function in aging female diabetics. (KJA: NIH HL066993-06; JLH: HSF Canada) Disclosure: Work supported by industry: no.

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THE EFFECT OF MAJOR DEPRESSION ON SEXUAL FUNCTION IN WOMEN AS MEASURED BY THE DEROGATIS INVENTORY OF SEXUAL FUNCTION (DISF) Fabre, LF1; Smith, LC1; Derogatis, LR2 1: Fabre Kramer Pharmaceuticals, Inc. USA; 2: Sheppard Pratt Health Systems USA Objective: To compare the Derogatis Inventory of Sexual Function (DISF) scores of depressed women to normative population scores with respect to DISF total score and the domains of desire, arousal and orgasm. The fact that depression interferes with sexual function has been known since Freud and Janet. Few attempts have been made to separate the effects of depression in various aspects of sexual function such as desire, arousal and orgasm. Kennedy et al. (J Affect Disord 1999 56:201–8) divided sexual function for both males and females into desire and drive, arousal and orgasm. They reported that more men

Proceedings from the 14th World Meeting of the International Society for Sexual Medicine and women have difficulty with desire and arousal than they did with orgasm. Howell et al. (J Affect Disord 1989 13:61–6), studying depressed men, found that sexual interest was most affected. Methods: The 3 studies combined enrolled 801 women. Sexual function was a secondary objective. Women were enrolled by meeting depression, not sexual function, criteria. The women, average age 38, were otherwise healthy and free of medication. Sexual function was measured at baseline before treatment using the DISF, which has been normed for the general population. The mean of normal sexual function is denoted by the 50th percentile (50%ile), with normal function ranging from the 16%ile to 84%ile (i.e., ±1σ). Results: In the 3 studies, mean total (all domains) DISF raw score was 43 (5%ile). Results for various domains were different. The cognition/fantasy (desire) raw score was 12 (27%ile); arousal raw-score was 7.9 (15%ile); behavior raw score was 6.5 (13%ile); drive raw score was 8.9 (7%ile); and orgasm raw score was 7.8 (5%ile). Conclusions: The all domains DISF raw score indicated that the sexual functioning of this population of depressed women was 2 or more standard deviations below that of the normal population. The differences between this population and other populations of depressed women that have been studied are average age 38, healthy, and free of medication. In contrast to previous reports, in this population of female patients with major depression, the most severely affected domain of sexual function was orgasm, falling at the 5%ile of the normal population. Arousal was less affected, with a mean in the 15%ile of normal population. Desire was the least affected, in the 27%ile of the normal population. These observations may be valuable in the treatment of women with depression and sexual dysfunction. Disclosure: Work supported by industry: yes, by Organon (industry initiated, executed and funded study). The presenter or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.

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THE EFFECT OF MODE OF DELIVERY ON INTRAVAGINAL PRESSURE DURING SEXUAL INTERCOURSE Cai, L1; Zhang, B2; Chen, J2; Lin, H2 1: Department of Infertility and Sexual Medicine, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China; 2: Department of Infertility ¦ Sexual Medicine, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China Objective(s): Many studies show that women chose caesarean section for the concern of postpartum sexual health. But no study about the intravaginal pressure during sexual intercourse afer delivery was reported. The effect of mode of delivery on the intravaginal pressure during sexual intercourse was determined by using a self-design vaginal pressure measuring device. Material and Method(s): A total of 95 women were included in this study in outpatient clinics. They met inclusion/exclusion criteria: 1) 25–35 years old; 2) regular sexual intercourse and stable partners; 3) term delivery with vaginal delivery (group 1, N = 18) or caesarean section (group 2, N = 33), and not given birth (group 3, N = 44); 4) Women with preterm delivery were excluded. Informed consent were obtained from these women. An experienced technician helped them to complete the procedures: Recorded the pressure right after the glans penis was totally inserted (pressure 1). Insert-out for 10 times, then recorded the pressure when the glan was inserted inward 6 cm from the outlet of the vagina (pressure 2) and the pressure right before the glans penis was taken out of the vagina (pressure 3). Result(s): Significant difference were found between group1 and group 3 for pressure 1, pressure 2 and pressure3 (P = 0.033, P = 0.009 and P = 0.013), but no significant difference between group 1 and group 2 or between group 2 and group 3. The average pressures for group 1 were 71.7+/−27.6 mm Hg, 51.9+/−22.1 mm Hg and 45.4+/−21.1 mm Hg; for group 2 were: 84.8+/−28.7 mm Hg, 62.1+/−20.1 mm Hg and 53.2+/−12.9 mm Hg; for group 3 were: 88.6+/− 27.4 mm Hg, 67.6+/−21.1 mm Hg and pressure 58.4+/−21.0 mm Hg.

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Conclusion(s): Vaginal delivery is a sinificant affecting factor for intravaginal pressure during sexual intercourse. Disclosure: Work supported by industry: no.

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MAJOR DEPRESSION, SSRIS AND SEXUAL DYSFUNCTION IN WOMEN Clayton, AH1; Fabre, LF2; Smith, LC3 1: University of Virginia USA; 2: Fabre Kramer Pharmaceuticals, Inc. USA; 3: Kramer Pharmaceuticals, Inc. USA Objective: To explore the time course of the long term effect of SSRIs on sexual function as measured by the Derogatis Inventory of Sexual Function (DISF). Major depression is a serious illness, especially in women, with almost 20% lifetime prevalence. Major depression in women results in sexual dysfunction including loss of desire, and lack of arousal. SSRIs are documented to interfere with sexual function, e.g., producing orgasmic dysfunction. If depression causes sexual dysfunction, then relief of depression should give improvement. The interplay of the antidepressant effect and adverse sexual function effects of SSRIs has not been well-described. Methods: In two short term (8 week) studies of SSRIs in major depression (134004 and 134006) and their long term extensions to 24 or 44 weeks (134503 and 134502), DISF was administered at every visit. The DISF has subscales (domains) including sexual cognition and fantasy (desire), sexual arousal, sexual behaviors and experience, orgasm and sexual drive and relationships. Fluoxetine (134004) and paroxetine (134006) were the SSRIs studied. HAMD total score change from baseline at endpoint, the primary efficacy parameter, was not statistically significant in either study. A 50% decrease in HAMD-17 score identified antidepressant responders. Results: At baseline, total DISF scores in these depressed women are 2 standard deviations below normal. Initially, SSRI treatment significantly further decreases DISF orgasm scores vs. placebo: fluoxetine wk 2 P = 0.03, wk 4 P = 0.04, wk 8 P = 0.01; paroxetine wk 2 P = 0.001, wk 4 P ≤ .001, wk 8 P = 0.002. Thereafter, DISF total scores for SSRI and placebo are not different. Antidepressant responders have better sexual function (often statistically significant) in all groups, including placebo. This represents an antidepressant effect. Placebo and both SSRI non-responders have DISF total scores below baseline. Conclusions: Both SSRIs have initial negative effects on sexual function as measured by DISF; the strongest negative effect is on the orgasm domain. The initial SSRI negative effects differ from the long term effects. Once the antidepressant effect begins, and mood improves, sexual function improves. However, the improvement with SSRIs only brings the DISF desire score back to baseline, which is still 2 standard deviations below normal. SSRI treated women (i.e., now with normal mood) do not tolerate this low desire and continue to blame it on adverse effects of SSRIs. Disclosure: Work supported by industry: yes, by Organon (industry initiated, executed and funded study). The presenter or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.

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SEXUAL FUNCTION OF ADULT WOMEN WITH CONGENITAL ADRENAL HYPERPLASIA Seyam, RM1; Bissada, NK2; Abdelally, M1; Sakati, NA1; Alkhudair, WK1 1: King Faisal Specialist Hospital and Research Center; 2: University of Arkansas for Medical Sciences Objective: Classical congenital adrenal hyperplasia (CAH) presents in early childhood with salt loosing crisis and ambiguous genitalia. Earlier detection and improvements in medical and surgical genital reconstruction have resulted in an increasing number of patients reaching womanhood. There is a paucity of data on the long term outcome in women born CAH. We set out to review the progress and sexuality of adult women treated in our hospital for CAH. Material and Method: We reviewed the medical records of women 20 years or older with the diagnosis of CAH. We recorded the marital status, sexual history, fertility and condition at last follow-up. Results: We identified 45 women with mean age 24.5 years (19.4–34.9, SE 0.6) with the diagnosis of CAH. Mean follow up was 23.2 years (11.8–33.8, SE 0.7). Patients presented in infancy and childhood mainly with salt loosing crisis, ambiguous genitalia or both. Few patients presented late with severe virilization. Prader genital grade was III-IV or higher in 37 patients. One stage clitoroplasty, vulvoplasty and vaginoplasty were performed in 21 (47%) girls at the age of 2.5 yrs (0.6–10.4, SE 0.4). A deferred vaginoplasty was carried out in 11 (24%) patients at the age of 6.1 years (0.8–24.7, SE 1.1). Revision surgery was carried out in 13 (29%) patients. Menarche occurred at 14.1 years (9.8–23.3, SE 0.6). Cosmetic genital appearance was good to excellent in 28 (62%) patients. Severe vaginal stenosis was found in 6 (13%) patients. Ten women had virilization in the form of harsh voice and or hirsutism. Three patients are treated for depression with one attempted suicide. Only 5 women were married at mean age of 23.1 years (15.9–29.9, 2.5 SE) for a period of 5.8 yrs (0.8–7.7, SE 1.3). One woman had vaginal trauma and needed surgical repair, another has dyspareunia often and 3 remain with no dyspareunia. Four women conceived, 3 unassisted and 3 delivered one normal child each by cesarean section. Conclusion: CAH has a significant impact on the sexuality of women in their adult life. Most patients in early adulthood remain single with variable virilization effects. Only a minority of these women are able to lead completely normal emotional and physical sexual life. On the other hand, the majority of those who marry are able to conceive and give birth to normal children. Disclosure: Work supported by industry: no.

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HIGH RISK SEXUAL BEHAVIOR AND REPRODUCTIVE HEALTH OF RUSSIAN FEMALE STUDENTS IN THE ERA OF HIV/AIDS Vvedenskaya, ES1; Bykova, LK1; Petrushov, PK2 1: Regional Centre for AIDS Control/Russia; 2: State Service Academy/Russia Introduction and Objectives: Risk sexual behavior places young people at risk for sexually transmitted diseases (STDs) and HIV infection which is a great burden today in Russia. The aim of the study is to provide a valid assessment of sexual behaviors and reproductive health of female students in the era of HIV- epidemic. Methods: Sexual behaviors, risk factors and HIV-related knowledge were examined among a sample of 603 female students aged 15–24. They completed a self-administered questionnaire, which included questions about sexual intercourse, number of sex partners, contraception use, STIs and HIV epidemiology and their prevention. Specialist gynecological examination was performed to identify the reproductive health abnormalities. Results: Most of the respondents had already had sexual intercourse (68.3%); Majority of students use contraception but only 34.0% does it regularly. Our respondents demonstrated rather pure knowledge in STIs and HIV epidemiology and modern methods of contraception. The gynecological diseases incidence was 185.9 per 100 students examined. The most common pathology (44.1%) are female pelvic organs inflammatory diseases, the incidence rate is 80.4 per 100 examined. The second and third ranking places—non-inflammatory female sexual and menstrual cycle disorders. The prevalence of unwilling pregnancies and the number of abortions as well as complications are high. The correlation between sexual behaviors and reproductive health of female students was assessed.

Proceedings from the 14th World Meeting of the International Society for Sexual Medicine Conclusion: Risk sexual behaviors are common among female students. Female students did not demonstrate satisfactory reproductive health and self-preservation reproductive behavior. Quality comprehensive reproductive education and self-preservation programmes should be developed and specialist centers established. Disclosure: Work supported by industry: no.

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L-CITRULLINE IN COMBINATION WITH SODIUM NITRITE PROMOTES IN VITRO RELAXATION OF HUMAN CORPUS CAVERNOSUM: CHARACTERIZATION OF THE SYNERGISTIC EFFECT Hellstrom, W; Gur, S; Kadowitz, PJ; Sikka, SC Department of Urology, Tulane University School of Medicine, New Orleans, LA Objectives: L-citrulline is the natural precursor of L-arginine, which is the substrate for nitric oxide (NO) synthase to produce NO in most cell types, including endothelial cells, neurons, and myocytes. Nitrite is a major storage entity of NO in blood and tissues. The dogma that nitrite is a metabolic waste product of NO is now being challenged, as it may initiate cytoprotective signaling in pathological conditions. We evaluated the effect of L-citrulline and sodium nitrite (NaNO2) alone and in combination to relax precontracted human corpus cavernosum (HCC) smooth muscle strips in an organ bath preparation. Material and Methods: HCC specimens were obtained from patients undergoing penile prosthesis surgery (age range 60–72 yrs., n = 6) with approval of IRB. Strips (four from each HCC, 1 × 1 × 6 mm) were suspended in an organ bath containing Krebs-Henseleit solution at 37ºC, pH 7.4 and constantly bubbled with 95% oxygen and 5% CO2. After precontraction with phenylephrine (Phe, 10 μM), dose relaxation responses were performed for (a) L-citrulline (10−8 −10−3 M); (b) sodium nitrite (NaNO2, 10−8 −10−3 M); and (c) combination of Lcitrulline (10−3 M) with NaNO2 (10−8 −10−6 M). Results: After Phe induced precontraction, the maximum relaxation response with L-citrulline at 10−3 M was (36.6 ± 7.05 %) and with NaNO2 (10−3 M) it was 60.7 ± 17.6%. The maximum relaxation response was enhanced 3 fold (97.12 ± 2.87 %, P < 0.001) when combining L-citrulline with NaNO2 (10−6 M). Similarly, NaNO2 induced relaxation (at 10−6 M, 2.12 ± 0.82%) was increased (65.22 ± 9.55, P = 0.0006) in the presence of L-citrulline (10−3 M). Conclusions: L-citrulline and nitrite have synergistic effects on release of NO in human cavernosal tissue. Further investigations using in vivo models are warranted to further delineate these pathways. Disclosure: Work supported by industry: no.

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THE ERECTOGENIC EFFECTS OF CKD-533, A NEW POTENT AND SELECTIVE PHOSPHODIESTERASE TYPE5 INHIBITOR, IN ERECTILE DYSFUNCTION INDUCED BY SPINAL CORD INJURY ON RABBITS Ha, N1; Jung, JY2; Hwang, IC1; Park, JH1; Kim, SK2; Kim, SJ2; Kim, HJ2; Yu, HS1; Kim, YM1; Kim, DH1; Lee, SS1 1: CKD Pharmaceuticals Inc.; 2: Kongju National Univ. Objective: CKD-533, a novel quinazoline derivative, is a potent and selective inhibitor of phosphodiesterase type5 (PDE5) which degrades cyclic guanosine monophosphate (cGMP). Its mechanism of action, an increased intracellular concentration of cGMP levels leads to the relaxation of the smooth muscle in the corpus cavernosum and penile arterioles. Previous preclinical experiments have showed that oral administration of CKD-533 increased penile erection in conscious rabbits. The purpose of present study was to investigate the oral efficacy of CKD-533 in an acute spinal cord injured rabbit model. Materials and Methods: In order to evaluate the efficacy of CKD-533 in inducing penile erection, two acute spinal cord injury (SCI) models

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were used. Acute SCI was induced by surgical transection of the spinal cord at the L2-L4 lumbar vertebra or ischemic-reperfusion after aortic cross-clamping. Penile erection was evaluated at 24 hours after the surgical procedures. CKD-533 (0.3, 1, 3 mg/kg) and tadalafil (3 mg/ kg) were administered orally, followed by intravenous injection of sodium nitroprusside (SNP, 0.2 mg/kg) 60 minutes later. The erections were evaluated in a time-course manner by measuring the length of the uncovered penile mucosa for up to 90 minutes after administration of CKD-533 or tadalafil. Results: CKD-533 produced penile erection in a dose-dependent manner in acute SCI models. In the transection SCI model, penile erections were induced at all doses of CKD-533 and tadalafil. And these effects were significantly increased by SNP, as a nitric oxide (NO) donor. In the ischemic reperfusion injury model, 1, 3 mg/kg of CKD533 and 3 mg/kg of tadalafil produced a penile erection. After injection of SNP, the penile erections were significantly increased in the 1, 3 mg/kg CKD-533 groups. CKD-533 demonstrated equal efficacy at doses of 0.3 to 1 mg/kg with that of 3 mg/kg of tadalafil. In addition, the onset of erection by CKD-533 was faster than that by tadalafil and response-duration time was also longer than that of tadalafil. Conclusion: In this study, we demonstrated the penile erections of CKD-533 were stronger than tadalafil in spinal cord injured rabbits. And the erectogenic effects of CKD-533 were markedly and immediately potentiated by SNP suggests that CKD-533 may enhance sexual stimulation mediated erection. These results suggest that CKD533 may be useful for treating erectile dysfunction in patients with a spinal cord injury. However further evaluation of the effects of CKD533 on humans must be performed. Disclosure: Work supported by industry: yes, by Ministry of health & welfare (industry funding only—investigator initiated and executed study).

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EFFECTS OF CKD-533, A NEW POTENT AND SELECTIVE PHOSPHODIESTERASE TYPE5 INHIBITOR, ON LUTS/BPH: REDUCTION OF IRRITATIVE SYMPTOMS AND PROSTATE ENLARGEMENT IN RATS Ha, N1; Kim, JM1; Park, JH1; Lee, S1; Kim, JC2; Park, EY2; Yu, HS1; Kim, YM1; Kim, DH1; Lee, SS1 1: CKD Pharmaceuticals Inc.; 2: The Catholic Univ. Objective: CKD-533, a novel quinazoline derivative, is a potent and selective inhibitor of phosphodiesterase type5 (PDE5) which degrades cyclic guanosine monophosphate (cGMP). PDE5 is involved in the regulation of the nitric oxide (NO)-cGMP pathway and smooth muscle tone which comprises the organs associated with lower urinary tract. Hence, this pathway is not only a possible target for pharmacotherapy to counteract the contraction of the human prostate smooth muscle, but also possibly that of the human bladder, bladder neck and urethra, either directly or indirectly. There has been reported that a PDE5 inhibitor enables the improvement of lower urinary tract symptoms (LUTS) arising from benign prostatic hyperplasia (BPH) not only by relaxing prostatic and bladder smooth muscles but by inhibiting the proliferation of human prostate stromal cells, thus suppressing abnormal enlargement of the prostate. The purpose of present study was to investigate the effects of CKD-533 for treating LUTS / BPH. Materials and Methods: The effectiveness of CKD-533 relaxing rat prostate strip was assessed in organ bath experiment. Basal prostate strip contraction was induced by phenylephrine and CKD-533 treated ranged from 100 nM to 10 μM. Then, we evaluated the effectiveness of CKD-533 in a partial bladder outlet obstruction (BOO) rat model characterized by a reduction of contraction interval (CI) and high frequency of non voiding contraction (NVC) which directly mimics the irritative symptoms of BPH in human. BOO was induced in male SD rats by tying a silk ligature around the bladder neck. At 3 weeks after inducing BOO, rats were assessed by cystometry. After stabilization, CKD-533 (1, 3, 10 mg/kg), vardenafil (3 mg/kg) and tadalafil (3 mg/kg) were injected intravenously. The results were evaluated by measuring

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cystometry for up to one hour after treatment. Values are given as percentage of CI or NVC before and after the drug treatment. In addition, the effect of the CKD-533 on experimental prostate enlargement was investigated. Prostate enlargement was induced by testosterone/17βestradiol once a day during experiment period. CKD-533 (0.3, 1, 3 mg/ kg), tadalafil (10 mg/kg), tamsulosin (10 μg/kg) and finasteride (10 mg/ kg) were concomitantly administered orally once a day. Following 6 weeks of continuous treatment, weight of the prostate was evaluated. Results: CKD-533 dose-dependently reduced the phenylephrineinduced contraction of the isolated prostate strips. In the BOO model, all doses of CKD-533 showed significant inhibitory effect on both decrease of CI and increase of NVC. CKD-533 ranging from 1 to 3 mg/ kg demonstrated equal efficacy with 3 mg/kg of vardenafil. In the experimental prostate enlargement, finasteride significantly decreased prostate size. The increase of prostate weight was lowered by administration of CKD-533, although there was no statistical significance. However tamsulosin and tadalafil were not effective on prostate hyperplasia. Conclusion: In this study, we demonstrated CKD-533 induced significant relaxation of the prostate strip and reduced the irritative symptoms of the LUTS associated with BPH in vivo. In addition, CKD-533 inhibited the prostate enlargement induced by testosterone/17βestradiol on male rats. These results suggest that CKD-533 may have potential for treating LUTS associated with BPH in human. However, further evaluation of the effects of CKD-533 on humans must be performed. Disclosure: Work supported by industry: yes, by Ministry of health & welfare (industry funding only—investigator initiated and executed study).

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ERECTILE FUNCTION DIFFERENCES BETWEEN OBSTRUCTIVE AND IRRITATIVE COMPONENTS IN RAT MODEL OF LUTS Hellstrom, W; Gur, S; Casey, SB; Kadowitz, PJ; Sikka, SC Department of Urology, Tulane University Health Sciences Center, New Orleans, LA, USA Introduction and Objective: Lower urinary tract symptoms (LUTS) and erectile dysfunction (ED) are associated conditions, but the differ-

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ences in erectile function between obstructive and irritative components have not been elaborated. The aim of this study was to separate the effects of bladder overactivity (OAB) and urethral obstruction on erectile function parameters. Methods: Eighty-four male Sprague-Dawley rats were used to induce three different animal models: (i) partial bladder outlet obstruction (PBOO) rats were subjected to 6 weeks of urethral ligation, (ii) hypertension (HTN)-induced OAB rats were treated with L-NAME (40 mg/rat/day) for four weeks, (iii) C-fiber mediated bladder overactivity was created by infusion of a low concentration of acetic acid (0.5%, AA) into rat bladders via the urethra with no surgical procedure. In vivo erectile responses were monitored by evaluating ratios of intracavernosal pressure (ICP)/mean arterial pressure. Organ-bath studies were performed on urinary bladder (UB) and corpus cavernosum smooth muscle (CCSM) strips. Neuronal nitric oxide synthase (nNOS) protein expression was determined immunohistochemically (IHC) in CCSM. Results: In vivo studies show that UB from PBOO rats displayed decreased electrical field stimulation (EFS) induced contractile response by 86% (Figure). Our results from in vitro studies show that EFS and ACh-induced relaxation responses decreased in rat CCSM by 67% and 64%, respectively. The bladder strips from HTN rats exhibited a 3- and 3.6-fold increase in EFS-induced contractions and carbachol (CCh)-evoked contractions compared with controls (P < 0.001). Maximum EFS-mediated and endothelium-dependent AChinduced relaxations in CCSM strips from HTN induced OAB group were significantly reduced by 68% and 69%, respectively, when compared with controls (P < 0.001). AA infusion evoked bladder hyperresponsiveness to CCh (2.36-fold) and EFS (2.06-fold); however, CCSM displayed no significant differences in ACh and EFS induced relaxation responses (Figure). The relaxation response to the NO donor sodium nitroprusside (SNP) in CCSM and contractile responses to KCl of UB did not change in this model. ED was manifest as reduced ICP/MAP ratio in PBOO and HTN groups, but not in the AA-OAB group (Figure). IHC analyses showed decreased expressions of nNOS in PBOO and HTN groups compared with controls, but not in the AAOAB group. Conclusions: HTN and AA induced OAB models have similar effects on erectile function. Obstruction induced LUTS appears to be different from OAB-generated LUTS in regards to causation of ED. Disclosure: Work supported by industry: no.

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NEW PARADIGM IN MALE CHRONIC PELVIC PAIN SYNDROME Davis, NPS1; Binik, MY1; Amsel, NR1; Carrier, S2 1: McGill University MUHC/Canada; 2: McGill JGH/Canada

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Introduction: Urological Chronic Pelvic Pain Syndrome (UCPPS) in men is a common complaint, and causes significant impairment in quality of life. Until recently, the focus of research has primarily been on pain symptoms or underlying prostate pathology. However, new clinical phenotyping demonstrates pelvic tenderness to be an important component of UCPPS. Unfortunately, mechanisms underlying tenderness remain to be understood, and tenderness itself has not been well quantified. Objective: To validate the use of pressure pain thresholds as a method of measuring tenderness in UCPPS and to demonstrate that tenderness extends beyond the pelvis. Material and Method: Using a digital algometer, pressure pain thresholds on 10 genito-pelvic and one control site (deltoid) were measured in 42 men diagnosed with UCPPS and 42 healthy controls matched on age and relationship status. In addition, all UCPPS men underwent urological assessment. Results: UCPPS men had reliably lower pain thresholds compared to controls in all locations, including the deltoid. UCPPS men also demonstrated consistent lower overall pain thresholds regardless of location. Furthermore, pressure pain thresholds were able to correctly distinguish patients from controls 85.5% of the time. Prostate infection did not influence pain thresholds. Conclusions: Lower pelvic and non-pelvic thresholds suggest the involvement of a central mechanism in UCPPS. Overall, the data confirms the move away from a prostate based view of UCPPS. This is supported by the failure to find threshold differences related to prostate infection. Pressure pain thresholds appear to be a promising method of assessing tenderness in UCPPS. Disclosure: Work supported by industry: no. The presenter or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.

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EFFECT OF CHUANXIONGZINE ON RABBIT INTRACAVERNOUS PRESSURE IN VIVO Xiao, H1; Liu, J2; Wang, T2; Fan, L2; Chen, J3; Gao, X1 1: Department of Urology, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China; 2: Department of Urology, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China; 3: Department of infertility and sexual medicine, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China Objective(s): To investigate the effect of Chuanxiongzine on the erectile responses after intracavernous injection of cumulative doses of it in vivo. Material and Method(s): Twelve male New Zealand White rabbits weighing 2.5 ± 0.3 kg were anaesthetized with intraperitoneal pentobarbital sodium (30 mg/kg) and were maintained with it (10 mg/kg) as needed. The carotid artery on one side was cannulated for continuous monitoring of systemic arterial pressure (SAP), mean systemic arterial pressure (MSAP) and heart rate (HR) via ML0380 pressure transducer on Powerlab polygraph (ADInstruments). A 25-gauge needle was inserted into the corpus cavernosum for pressure recording (MLT844). The needle was connected to a three-way stopcock in order to intracavernously inject administration of the drugs. The tube was filled with heparinized saline to prevent clotting. Cumulative concentrations of Chuanxiongzine (0.5∼5 mg/kg) were injected intracavernously in a volume of less than 0.15 ml and normal saline in the same volumes (0.06, 0.09 and 0.15 ml) was performed in five rabbits as a control group. Intracavernous pressure (ICP), duration of tumescence (DT) and mean blood pressure (MBp) were determined after intracavernous administration of normal saline and Chuanxiongzine of different

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volumes. In order to minimize the effect of the previous drug, the cavernous body was washed with 0.15 ml normal saline before each injection and the time interval between each injection was at least 1 h. Result(s): The baseline ICP recorded was 13.9 + 4.2 mmHg. Intracavernous injection of normal saline induced a transient rise in ICP in a volume-dependent manner. Howerver, the rising ICP soon returned to the resting level within 1∼2 min. In the Chuanxiongzine group, the erectile responses were facilitated after cumulative doses of it were administered in seven rabbits. Chuanxiongzine increased ICP during erectile responses up to 6.5∼25.8 mmHg when compared to ICP induced by intracavernous administration of normal saline. During the injection periods of 0.5∼2 mg/kg Chuanxiongzine, the SAP, MSAP and HR were unchanged. Administration of Chuanxiongzine was increased in cumulative doses (0.5, 1, 2, and 5 mg/kg) induced a dosedependent elevation in ICP. The ICP rised respectively from basal to 19.1 ± 3.7 mm Hg, 24.8 ± 2.1 mm Hg, 30.2 ± 4.8 mm Hg, 39.7 ± 6.1 mm Hg and DT ranged from 8.5 ± 2.8 min to 22.9 ± 7.3 min. Maximal ICP raised 25.8 ± 5.9 mm Hg and DT lasted 22.9 ± 7.3 min when it intracavernously injected administration of the highest dose of Chuanxiongzine (5 mg/kg). Our study showed it induced a slight and transient reduction of SAP. Conclusion(s): These studies demonstrate that Chuanxiongzine facilitates erectile responses after intracavernosal injection of it in vivo. Disclosure: Work supported by industry: no.

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DIRECT CONNECTIONS BETWEEN THE BRAIN AND THE AREA OF THE SPINAL GENERATOR FOR EJACULATION: A NEUROANATOMICAL TRACING STUDY IN THE RAT Clement, P; Laurin, M; Bernabe, J; Giuliano, F Objective: The spinal generator for ejaculation (SGE) has been recently characterized in rats and is known to be under activatory/ inhibitory influence of brain structures. However, brain descending pathways modulating SGE activity have not yet been studied. A retrograde tracing neuroanatomical study was conducted in order to identify brain nuclei with direct projections onto the spinal area where the SGE is located at the lumbar level in the rat. Material and Method: The neuronal retrograde tracer fluorogold (FG, 2%) was stereotactically injected (200 nl) in the laminae X and VII medial (1.7 mm in depth) of the third lumbar segment (L3) (Truitt and Coolen, Science, 2002) in Wistar sexually naïve adult male rats under isoflurane anaesthesia. Fifteen days after FG intraspinal injection, rats were transcardially perfused with fixative (paraformaldehyde 4%) and brains and spinal cords were removed. Tissue sections (40 μm thick) were obtained using a cryostat and processed for epifluorescence microscopy. Results: In rats correctly injected (n = 3), the same brain structures in the medulla oblongata, the pons, the hypothalamus, and the cortex were found to contain FG-labelled neurons. The highest density of FG-labelled neurons was noted in the ventral part of the gigantocellular reticular nucleus (Gi) and in the hindlimb region of the primary somatosensory cortex. A moderate density was observed in ventral medullary reticular nucleus, Gi and its alpha part, lateral vestibular nucleus, and red nucleus. A low density was found in caudal raphe nuclei (pallidus, obscurus, and magnus), dorsal and lateral parts of Gi, medial vestibular nucleus, sensory trigeminal nucleus, and lateral hypothalamus. Conclusion: Amongst the brain structures projecting to the SGE area identified in this study, Gi and raphe pallidus have previously been reported as functionally associated with ejaculation. Further research on the neuroanatomical support of the brain control exerted onto the SGE is of crucial importance to improve our knowledge of the neurophysiology of ejaculation. Disclosure: Work supported by industry: yes, by Janssen-Cilag (industry funding only—investigator initiated and executed study).

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Vardenafil was given to ligated rats of Var groups as oral administration once daily, for 20 days from 1 week after operation. Erectile function was evaluated by maximum intracavernous pressure / mean arterial pressure (Max ICP/MAP) ratios under the stimulation of cavernous nerve at 4 weeks or 6 weeks (2 weeks after the end of the treatment) after operation. Results: At 4 weeks after operation, Max ICP/MAP of Ligation group was significantly lower than that of Control group (0.25 ± 0.03 (Ligation, n = 6) v.s. 0.65 ± 0.03 (Control, n = 6), P < 0.01), and that of Var group was significantly higher than that of Ligation group (0.44 ± 0.07 (Var, n = 9) v.s. 0.25 ± 0.03 (Ligation), P < 0.05). At 2 weeks after the end of the treatment, Max ICP/MAP of Ligation group remained to be significantly lower than that of Control group (0.24 ± 0.03 (Ligation, n = 7) v.s. 0.54 ± 0.04 (Control, n = 6), P < 0.01), and that of Var group remained to be significantly higher than that of Ligation group (0.46 ± 0.10 (Var, n = 5) v.s. 0.24 ± 0.03 (Ligation), P < 0.05). Conclusions: The effect of daily vardenafil administration remained at 2 weeks after the end of the treatment for arteriogenic ED rats. Thus it might be important that patients with arteriogenic ED were treated daily with vardenafil for a certain period.

THE EFFECT OF ELECTRICAL STIMULATION OF LESSER SPLANCHNIC NERVE ON BILATERAL SEMINAL VESICAL PRESSURES IN THE RAT Chen, KK; Chang, LS Taipei Veterans General Hospital Objectives: Seminal vesicle contraction under sympathetic innervation occurs during emission, which is a part of ejaculatory process. The objective of this study was to investigate the effect of electrical stimulation of lesser splanchnic nerve (LSN) on the bilateral seminal vesical pressures (SVP) in the rat. Materials and Methods: Male adult Sprague-Dawley rats were used. A PE50 tube was inserted into the left and right side seminal vesicle to simultaneously monitor each side SVP, respectively on the polygraph. The LSN was carefully identified and was electrically stimulated with stimulus parameters (10 V, 1–160 Hz, 1 ms, 60 seconds). The SVP on left and right side was monitored simultaneously. The SVP on each side before and after electrical stimulation of LSN was compared by Wilcoxon signed ranks test, respectively. The amount of SVP increase (peak SVP minus resting SVP) between the left and right side seminal vesicle was compared with Mann-Whitney U test. A P < 0.05 was considered significant. Results: There was a significant increase of left and right side SVP, respectively after electrical stimulation of LSN with all stimulus parameters (40, 80, 120, 160 Hz) except 1 and 5 Hz. The left SVP was increased significantly from resting 3.6 ± 1.3 mm Hg and 3.4 ± 1.1 mm Hg to a peak at 64.0 ± 10.4 mm Hg (n = 5, P = 0.043) and 58.4 ± 11.7 mm Hg (n = 5, P = 0.043) after LSN stimulation with 40 Hz and 120 Hz, respectively. A simultaneous significant increase of right SVP was also noted (4.4 ± 0.7 mm Hg vs. 62.4 ± 11.7 mm Hg for 40 Hz, P = 0.043; 4.4 ± 0.7 mm Hg vs. 52.4 ± 10.5 mm Hg for 120 Hz, P = 0.043) after stimulation to LSN. The amount of SVP increase was not significantly different between left and right SVP (60.4 ± 11.2 mm Hg vs. 58.0 ± 11.9 mm Hg for 40 Hz, P = 1.00; 55.0 ± 11.9 mm Hg vs. 48.0 ± 10.4 mm Hg for 120 Hz, P = 0.69) after electrical stimulation of LSN with 40 Hz and 120 Hz, respectively. The greatest amount of SVP increase on either left or right side was induced by electrical stimulation to LSN with stimulus parameters 40 Hz, 10 V, 1 ms, 60 seconds. Conclusions: The results of this study suggest that electrical stimulation of the lesser splanchnic nerve may elicit a simultaneous significant increase of SVP on the left and right side seminal vesicle, respectively in the rat. The amount of SVP increase is not significantly different between the left and right side seminal vesicle. This implies that monitoring of SVP on either left or right side may represent SVP on both sides after electrical stimulation of the LSN. Disclosure: Work supported by industry: no.

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THE EFFECT OF DAILY TREATMENT OF VARDENAFIL REMAINED AFTER THE END OF THE TREATMENT IN RATS WITH ARTERIOGENIC ERECTILE DYSFUNCTION Hotta, Y; Ohno, R; Kataoka, T; Shiota, A; Ohno, M; Kimura, K Nagoya City University Objective: We have already reported that erectile function was improved by daily vardenafil treatment for rats with acute arteriogenic erectile dysfunction (ED) caused by ligation of bilateral internal iliac arteries. However it was unknown whether the effect of daily vardenafil administration remained after the end of the treatment for arteriogenic ED rats. Materials and Methods: 8-weeks-old male Wistar-ST rats were divided into three groups; sham operated rats (Control group), arteriogenic ED rats by ligating bilateral internal iliac arteries (Ligation group), and vardenafil treatment group (4.0 mg/kg/day; Var group).

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Disclosure: Work supported by industry: yes, by Bayer (no industry support in study design or execution).

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LOCAL DELIVERY OF A DESIGNED ANGIOPOIETIN-1 VARIANT RESCUES ERECTILE FUNCTION BY ENHANCING CAVERNOUS ANGIOGENESIS IN THE STREPTOZOTOCIN-INDUCED DIABETIC MOUSE Jin, HR1; Song, JS1; Kim, WJ1; Piao, S1; Choi, MJ1; Tumurbaatar, M1; Shin, SH1; Yin, GN1; Koh, GY2; Ryu, JK1; Suh, JK1 1: National Research Laboratory of Regenerative Sexual Medicine and Department of Urology, Inha University School of Medicine, Incheon, Korea; 2: Department of Biological Sciences and National Research Laboratory for Vascular Biology, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, Korea Objectives: Patients with diabetic erectile dysfunction (ED) often have severe endothelial dysfunction and respond poorly to oral phosphodiesterase-5 inhibitors. Therefore, cavernous endothelial regeneration is a promising therapeutic strategy for curing diabetic ED. In the present study, we examined the effectiveness of the soluble, stable, and potent angiopoietin-1 (Ang1) variant, cartilage oligomeric matrix protein (COMP)-Ang1, in promoting cavernous endothelial regeneration and restoring erectile function in diabetic animals. Materials and Methods: Eight-week-old C57BL/6J mice were used and diabetes was induced by intraperitoneal injection of streptozotocin (50 mg/kg for 5 days). Eight weeks after diabetes was induced, mice were divided into 4 groups (N = 18 per group): age-matched controls, diabetic mice without treatment, and diabetic mice receiving repeated intracavernous injections of PBS or COMP-Ang1 protein (days −3 and 0; 5.8 μg/20 μl). Two and 4 weeks after treatment, we measured erectile function by electrical stimulation of the cavernous nerve. The penis was stained with hydroethidine, TUNEL, or antibodies to PECAM-1, phosphohistone H3, phospho-eNOS, and nitrotyrosine. We also performed western blot analysis of p47phox, iNOS, and endothelial cell-cell junction proteins including VE-cadherin, zonula occludens-1 (ZO-1), occludin, and claudin-5. Penis specimens from a separate group of animals were used for cGMP quantification and vascular permeability test. Results: Local delivery of COMP-Ang1 protein significantly increased cavernous endothelial proliferation, eNOS phosphorylation, and cGMP expression compared with that in the untreated control or PBS-treated diabetic group. These changes in the group receiving COMP-Ang1 restored erectile function up to 4 weeks after treatment (85–90% of control values). Endothelial protective effects, such as marked decreases in the expression of p47phox and iNOS, in the genera-

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tion of superoxide anion and nitrotyrosine, and in the number of apoptotic cells in the corpus cavernosum tissue, were noted in COMPAng1-treated diabetic mice. Intracavernous injection of COMP-Ang1 completely restored endothelial cell-to-cell junction proteins (VEcadherin, ZO-1, occludin, and claudin-5) and decreased cavernous endothelial permeability. Conclusions: These findings support the concept of cavernous endothelial regeneration by use of recombinant Ang1 protein as a curative therapy for diabetic ED.

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Disclosure: Work supported by industry: no.

Objective: Elevated reactive oxygen species levels (ROS) in the semen are one of the potential causes for male infertility with oligoasthenoteratospermic (OATS). We aimed to evaluate seminal ROS in men with idiopathic infertility and OATS and to correlate it with other seminal plasma parameters. Methods: Between April 2009 to August 2009, 48 men with idiopathic OATS and 15 controls were prospectively evaluated for seminal ROS levels. ROS level in their semen sample was measured by chemiluminescence method with the help of Berthold Luminometer. ROS values were correlated with the age, semen volume, sperm count, sperm motility, sperm morphology, WBC count in semen and serum testosterone levels. Results: Mean age of the infertile men was 30.7 ± 4.3 years. Mean duration of infertility was 6.9 ± 4.4 years. Out of 48 men, 23 had oligospermia, 40 had asthenospermia and three patients had teratospermia. Mean ROS level in infertile men (n = 48) was 3.3 × 107 ± 1.3 × 106 RLU while in controls (n = 15) it was 498 ± 194 RLU. The levels were significantly higher in infertile men (Unpaired t test: P < .001). ROS levels in infertile men positively correlated with WBC count in the semen sample (Pearson’s correlation = .365; P = .011). No correlation was found between ROS level and age, semen volume, sperm count, sperm motility, morphology or serum testosterone levels. Conclusions: ROS level in oligoasthenoteratospermic patients was significantly higher than control group and this positively correlated with the leukocyte counts in the semen.

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ENDOGENOUS HYDROGEN SULPHIDE INSUFFICIENCY IS AN IMPORTANT PREDICTOR OF ERECTILE DYSFUNCTION IN THE AGING MALE Srilatha, B1; Muthulakshmi, P1; Jameelah, SM1; Liaw, RL1; Adaikan, PG1; Moore, PK2 1: National University Hospital, National University of Singapore, 5 Lower Kent Ridge Road, Singapore; 2: Pharmaceutical Division, King’s College London, Strand, London, WC2R 2LS, United Kingdom Objective(s): We have previously demonstrated that the endogenous hydrogen sulphide (H2S) pathway contributed to erectile function with significant vasodilatory and smooth muscle relaxant effects. In the present study, we tested the hypothesis that age-dependent changes in the bioavailability of H2S increased the risk of erectile dysfunction (ED) in the elderly. Material and Method(s): Young (3-month) and old (18-month) male Sprague-Dawley rats (n = /group) were treated daily with sodium hydrosulphide hydrate (NaHS.xH2O, stable H2S donor), cystathionine γ-lyase (CSE) inhibitor (DL-propargylglycine (PAG)), sildenafil citrate or non-specific nitric oxide (NO) synthase inhibitor L-N(G)-nitroarginine methyl ester (L-NAME) for 10 weeks. Subsequent to in vivo electrical field stimulation of cavernous nerve, the intracavernosal pressure (ICP) and mean arterial pressure (MAP) responses were determined. Samples taken from the treatment groups were processed for plasma total testosterone and oestradiol (scintillation proximity radioimmuno assay) and plasma and tissue (corpus cavernosum-CC) H2S and NO (methylene blue-H2S and Griess reaction NO assay) levels. Result(s): Aging per se significantly reduced the ICP elevation (35.9 ± 2.0 mm Hg vs. 45.2 ± 1.9 mm Hg in the young control), which was overcome by prior NaHS- (53.5 ± 6.0) or sildenafil- (52.8 ± 9.8) treatment. Both PAG and L-NAME pre-treatment inhibited the ICP response (34.8 ± 2.2 and 28.3 ± 3.2) and reduced the ICP/MAP ratio. In young and old rats (weighing 328.6 ± 5.4 g and 919.4 ± 43.7 g respectively), significant increments to total testosterone (3.04 ± 0.2 ng/ml and 1.8 ± 0.5 ng/ml) and oestradiol (53.2 ± 38.7 pg/ml and 165 ± 33.2 pg/ml) resulted following the daily NaHS administration; however, sildenafil failed to improve the hormonal parameters. Similar to the age-dependent decline in NO, the plasma and CC level of H2S was significantly lower in senescent rats when compared to young animals (P < 0.05). Conclusion(s): Our results confirm that H2S is indeed, an important gasotransmitter for the normal erectile process and ED with aging may be linked to a derangement in this pathway. It is also likely that a pharmacologic/therapeutic modulation delivering H2S will provide additional benefits to sexual function from an improved testosterone milieu. Disclosure: Work supported by industry: no.

REACTIVE OXYGEN SPECIES LEVELS IN THE SEMEN OF INFERTILE MEN AND ITS CORRELATION WITH OTHER SEMEN PARAMETERS Kumar, R; Saxena, V; Bilal, M; Venkatesh, S; Dada, R All India Institute of Medical Sciences, New Delhi, India

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THE EFFECT OF PNNOS GENE-MODIFIED ADIPOSE DERIVED STEM CELLS ON DIABETIC RATS WITH ERECTILE DYSFUNCTION Chen, J1; Zhang, B1; Cai, L1; Xiao, H2; Qi, T1 1: Department of Infertility and Sexual Medicine, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China; 2: Department of Urology, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China Objective(s): To investigate the effect of penile neuronal nitric oxide synthase (PnNOS) gene-modified adipose derived stem cells (ADSCs) on diabetic rats with erectile dysfunction. Material and Method(s): ADSCs were isolated, ex vivo expanded, transduced with lentiviral containing PnNOS. Diabetic rats with erectile dysfunction were divided randomly into four groups. 1) Group A, the PnNOS gene-modified ADSCs were injected into the penis; 2) Group B, ADSCs alone were injected into the penis; 3) Group C, the lentiviral containing PnNOS alone were injected into the penis; 4) Group D, the PBS were injected into the penis. At 3, 7, 14 and 30 days, the intracavernous pressure (ICP) in response to cavernous nerve stimulation, mean systemic arterial pressure (MAP) and heart rate (HR) were investigated. The changes of PnNOS protein expression, NOS bioactivity and cGMP level in rat’s penile tissues were also investigated. Result(s): GFP examination by microscope and western blot analysis of PnNOS confirmed the high and long-term expression of exogenous gene in ADSCs. The injection of PnNOS gene-modified ADSCs into the corpora cavernosum of the DM rat with ED significantly increased the rise in ICP in response to cavernous nerve stimulation compared with responses in PBS-treated and ADSCs-treated DM rats at 3, 7, 14 and 30 days, (P < 0.05). It was no significant effect on mean systemic

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arterial pressure (MAP) and heart rate (HR) in each group of rats. The increase in erectile function was associated with increased PnNOS protein, NOS activity, and cGMP levels. Conclusion(s): The results of the present study suggest that PnNOS gene-modified adipose derived stem cells can improve erectile function in the diabetic rats with erectile dysfunction. Disclosure: Work supported by industry: no.

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THE MECHANISM OF IMPAIRMENT AND DEFENCE OF OXIDATIVE STRESS IN CAVERNOUS TISSUE OF DIABETIC RATS Yun, C1; Xiaoxin, L1; Yutian, D 1: The Affiliated Drum Tower Hospital, Nanjing University Objective: To explore the mechanism of impairment and defence of oxidative stress in cavernous tissue of diabetic rats. Methods: Adult male SD rats were randomly divided into normal control group and experimental group, which included diabetes group induced by STZ and therapeutic group with GHS treatment. Eight weeks later, erectile function was assessed by measuring the rise in intracavernous pressure (ICP) of the rats following cavernous nerve eletrostimulation before sacrificed. The levels of Malondialdehyde (MDA) and the activities of superoxide dismutase (SOD) in cavernous tissue were detected. The morphology of mitochondria in cavernous tissue was observed with transmission electron microscope and mitochondrial transmembrane potential was detected. Results: A significant decrease in ICP was recorded in the diabetic rats, with improvement measured in the rats receiving GSH. The levels of MDA increased remarkably and the activities of SOD decreased significantly in cavernous tissue of the diabetes group. The degeneration of mitochondria in the endothelia and smooth muscle cells of penis was observed, following with the reduction of mitochondria, and mitochondria transmembrane potential was decreased. A remarkable decrease in MDA and increase in SOD was observed in GSH treatment group. Meanwhile, the morphology changes of mitochondria were ameliorated and the decrease of mitochondria transmembrane potential was inhibited, in diabetic rats with GSH treatment. Conclusion: Hyperglycemia could cause oxidative stress in the cavernous tissue of diabetic rats and this impairment could contribute to diabetic erectile dysfunction; Oxidant treatment could attenuate oxidative stress by improving the function of mitochondria in cavernous tissue. Oxidative stress plays an important role in diabetic erectile dysfunction (DMED) and our study might provide a new insight for the prevention and treatment of DMED. Disclosure: Work supported by industry: no.

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WITHDRAWN

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THE ATTITUDE OF MEN TOWARDS PREMATURE EJACULATION (PE) IN ASIA PACIFIC COUNTRIES WITH DIFFERENT ECONOMIC, CULTURAL AND RELIGIOUS BACKGROUNDS Lee, G1; McMahon, CG2; Park, JK3; Adaikan, PG4 1: University of Malaya Medical School, Kuala Lumpur, Malaysia; 2: Australian Centre for Sexual Health, Sydney, Australia; 3: Department of Urology, Institute for Medical Sciences, Chonbuk National University Medical School, Chonju, Korea; 4: Section of Sexual Medicine, Obstetrics & Gynaecology, National University Hospital, National University of Singapore, Singapore Objective: To evaluate the general attitudes regarding PE among men in 10 Asia-Pacific countries. Materials and Methods: Computer-assisted interviews and online or in-person questionnaires were conducted in a random sample of men (N = 4997) aged 18 to 65 years (mean, 39.0) who were in a sexual relationship within the past 2 years. The survey included questions in which respondents rated their agreement (1 = strongly disagree, 10 = strongly agree) with statements regarding the etiology, treatment, and prognosis of PE. Survey and recruitment methodologies varied by country. Results: Overall, men agreed that PE can be caused by a physical medical condition (mean score [range of averages for all countries], 6.4 [5.3–7.9]) or can be primarily emotional or psychological (6.6 [5.6– 8.0]), and can be effectively treated with prescription medications (6.3 [5.3–7.2]) and behavioral techniques or counseling (6.4 [5.4–7.2]). The perceived effectiveness of erectile dysfunction (ED) medications for PE differed between countries. Men in China, Taiwan, Hong Kong, Australia/New Zealand, South Korea, and Thailand disagreed that PE and ED are similar problems (range, 4.3–4.8) whereas men in Malaysia, Indonesia, and the Philippines agreed (range, 5.3–5.9). Men in Malaysia, Indonesia, and the Philippines agreed that PE would resolve over time (range, 5.3–5.5), while those in other countries did not (range, 3.9–4.8). Men from Australia/New Zealand, Thailand, and Malaysia agreed that there is no effective treatment for PE (range, 5.3–6.0), while men from other countries disagreed (range, 4.1–4.7). Conclusion: Perceptions of PE were generally similar across AsiaPacific countries, although differences in the perceived effectiveness

Proceedings from the 14th World Meeting of the International Society for Sexual Medicine of treatment and the relationship between PE and ED were observed. These differences may be associated with differences in socioeconomic, cultural, or religious backgrounds among countries. Men in this region may benefit from additional education about PE. Disclosure: Work supported by industry: yes, by Janssen-Cilag (industry initiated, executed and funded study). The presenter or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.

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THE OWN PERCEPTION OF PREMATURE EJACULATION Abdo, CHN1; Afif-Abdo, J2; Machado, AC1 1: Program of Studies in Sexuality, University of São Paulo, Medical School, São Paulo, Brazil; 2: Urology Department of Santa Cruz Hospital, São Paulo, Brazil Objective: To evaluate the impact of premature ejaculation (PE) on sexual performance, couple’s satisfaction, and treatment expectations. Methods: An instrument to access the objective has been developed. Men with PE aged >18 years were recruited. Chi-square and Fisher’s exact tests have checked the associations between PE and categorical variables. Student’s t-test has compared the continue variables means. P values ≤0.05 have been considered statistically significant. Results: The sample comprised 32 subjects, 46.9% with Lifelong PE (LPE), mean age 42.7 (±12.6); 53.1% with acquired PE (APE), mean age 42.2 (±11.7). For them, PE is characterized by: lack of control (100.0% of those with LPE; 70.6% of those with APE), short intravaginal latency time (66.7% and 52.9%) and concern in satisfying the partner (33.3% and 64.7%). The following issues impact the patient’s quality of life: lack of control over ejaculation for 100.0% of those with LPE and 94.2% of those with APE (P = 0.53); short intravaginal latency time 93.4% and 88.2% (P = 0.63); personal distress 86.7% and 94.1% (P = 0.45); dissatisfaction with sexual intercourse 86.7% and 76.5% (P = 0.76); partner’s dissatisfaction 86.7% and 88.2% (P = 0.99). Medication associated with psychotherapy was the preferred treatment for 40.0% (LPE) and 35.3% (APE). More control over ejaculation, intravaginal latency time and partner’s satisfaction are the main treatment expectations (respectively 100.0%, 86.7%, 93.3% for men with LPE; and 88.2%, 88.2%, 70.6% for men with APE). Conclusion: Control and intravaginal latency time are the most important PE characteristics for LPE patients, while control and partner’s satisfaction are more important for those experiencing APE. Both groups prefer the combined treatment (medication and psychotherapy), although this preference is not a consensus. Disclosure: Work supported by industry: no.

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PREMATURE EJACULATION (PE) AND ITS ASSOCIATED CONDITIONS IN KOREAN MALE SEXUAL HEALTH SURVEY Park, JK1; Lee, SW2; Park, KS3; Park, NC4; Kim, SW5; Min, KS6; Moon, KH7; Yang, DY8; Moon, DG9; Hyun, JS10; Ryu, JK11; Woo, SH12; Jin, KN13 1: Chonbuk National University Hospital/Korea; 2: Sungkyunkwan University/KOREA; 3: Chonnam National University/Korea; 4: Pusan National University/Korea; 5: The Catholic University of Korea/Korea; 6: Inje University/Korea; 7: Yeungnam University/Korea; 8: Hallym University/Korea; 9: Korea University/Korea; 10: Gyeongsang National University Hospital/Korea; 11: Inha University Hospital/Korea; 12: Eulji University Hospital/Korea; 13: Dr. Jin’s urology clinic Objective(s): To investigate the prevalence of PE and its associate condition. Material and Methods: We analyzed information gathered from male out-patients in 196 Korean urological clinics and hospitals during Korean Male Health Campaign Week (23∼28 Nov 2009). A simple

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questionnaire was used to collect data. Its first section, including PEDT, life habits and basic demography, was to be filled in by male patients. The other section of questions which focused on medical condition of urology was reported by physicians. PE was diagnosed with PEDT and classified into 3 groups: PE (PEDT > 10), possible-PE (PEDT 9∼10), non-PE (PEDT < 9). Odds ratios (OR) and the corresponding 95% confidence interval (CI) were computed by using unconditional multiple logistic regression. Results: 7,650 men were classified into 3 groups: 1,684 men in PE (22.0%), 1,117 men in possible-PE (14.6%) and 4,849 men in non-PE (63.4%). The risk of PE slightly increased with aging. Men who had experienced a divorce showed significantly increased risk. Men with more exercise and less life stress had relatively low risk. Education, occupation, smoking and drinking were not related with PE. Concerning medical history, a decreased risk of PE emerged in men with treated urethritis, whereas increased risk in men with low libido or erectile dysfunction. No association was found with prostatitis, benign prostatic hyperplasia, overactive bladder and pelvic trauma. Conclusions: The prevalence of PE diagnosed by PEDT (>10) was 22.0% and Subjects with PE have experiences stress-related problems (divorce and life stress). Disclosure: Work supported by industry: yes, by The Korean Andrological Association (no industry support in study design or execution). The presenter or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.

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CAN METABOLIC SYNDROME AFFECT THE EJACULATORY FUNCTION IN MEN? Koo, JM; Yoon, HN; Chung, WS Ewha woman hospital/ Korea Purpose: Premature ejaculation is the most common sexual disorder, affecting about 20% to 25% of males. Although some biological and psychological conditions have been proposed to cause PE, the exact pathogenesis of PE remains to be clarified. Recently it was reported that metabolic syndrome is also known to decrease male sexual dysfunction. However co-relationship between metabolic syndrome and ejaculatory dysfunction has not yet been fully established. We examine the relationship between ejaculatory dysfunction and metabolic syndrome and its components in men who were visiting health screening center. Method: 517 men who were visiting Ewha Women’s Hospital General Health Care Center entered the study. We measured blood pressure and checked cholesterol profile of all subjects and trained interviewers using the structured Male Sexual Health Questionnaire (MSHQ) collected the information on ejaculatory function. We excluded the men who were receiving any kind of medication or diagnosed of any urologic disease. Metabolic syndrome was defined using National Cholesterol Education Programme Adult Treatment Panel III (NECEP-ATPIII). All men completed MSHQ short form questionnaire, which evaluates ejaculatory function. Multiple regression analysis was used to analyze the association between metabolic syndrome components and ejaculation functional directory. Results: Mean ± SD age was 48.4 ± 5.4 (range 36.9–64.9). Out of 517, 104 men (20.1%) were diagnosed as metabolic syndrome. Average of total MSHQ score was 35.0 ± 4.6 (3.0–40.0) and no significant difference was found between metabolic syndrome and normal men in total score (P = 0.325). However men with metabolic syndrome scored significantly higher than normal group in delayed ejaculation (4.52 ± 0.9 vs 4.73 ± 0.8, P = 0.020). Multiple regression analysis showed that the function of ejaculation significantly decreases with age and increasing blood sugar(P < 0.001). Conclusion: Metabolic syndrome was associated with delayed ejaculation. Furthermore among the component of metabolic syndrome blood glucose level shows strong negative co-relationship with ejaculatory function. We should consider the effect of metabolic syndrome on male ejaculatory function. Disclosure: Work supported by industry: no.

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Conclusion(s): This is the first prospective study which investigated the relationship between lifelong PE and obesity, and we found that patients with lifelong PE were leaner than the healthy control cases.

EJACULATORY DUCT OBSTRUCTION, AN IMPORTANT CAUSE OF EJACULATORY DISORDERS Abdel Raheem, A1; Garaffa, G1; Walkden, M1; Allen, C1; Azizy, H2; Atteya, A3; Ralph, DJ1; Anis, MT3 1: St. Peter’s Department of Andrology, The Institute of Urology, London, UK; 2: Radiology Department, Cairo University Hospitals, Egypt; 3: Andrology Department, Cairo University Hospitals, Egypt Objective: Ejaculatory duct obstruction (EDO) is a recognized and correctable cause of male infertility. However, EDO is also associated with ejaculatory dysfunction that may be the presenting symptom. This study looks in the prevalence of ejaculatory disorders in patients with EDO. Material and Methods: Evaluation of the ejaculatory disorders in 23 male patients with EDO diagnosed by trans-rectal ultrasonography (TRUS) and confirmed by TRUS guided seminal vesicle aspiration and seminal vesiculography. Results: Out of the 23 patients with confirmed EDO, 11 (48%) had disorders of ejaculation. The presenting symptoms included: painful ejaculation in 7 patients (30%), low volume ejaculate in 5 (22%), weak force of ejaculation in 3 (13%), watery ejaculate in 1 (4%) and haemospermia in 1 patient (4%). Eight of the 11 patients with ejaculatory dysfunction (73%) had more than one ejaculatory symptom. Ejaculatory dysfunction was the reason for referral in 5 patients (45%), while the other 6 (55%) were mainly referred for infertility, however, these patients also complained of ejaculatory symptoms. Conclusion: Ejaculatory disorders are common in patients with EDO. Thus patients with ejaculatory symptoms should be investigated for the presence of EDO which is a correctable condition. Disclosure: Work supported by industry: no.

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INSIGHT ON PATHOGENESIS OF LIFELONG PREMATURE EJACULATION: INVERSE RELATIONSHIP BETWEEN LIFELONG PREMATURE EJACULATION AND OBESITY Gökçe, A1; Ekmekcioglu, O 1: Mustafa Kemal University Tayfur Ata Sokmen Medical Faculty Objective(s): Although both biological and psychological factors are important in the etiology, the exact pathogenesis of lifelong premature ejaculation (PE) remains to be clarified. Obesity is a worldwide epidemic that contributes to many chronic diseases. Obesity is associated with erectile dysfunction, but the relationship between obesity and PE has not yet been specifically investigated. The aim of the present study is to evaluate the relationships of these two conditions. Material and Method(s): Between January 2008 and December 2009, we evaluated consecutive patients with lifelong PE in the urology outpatient clinic. Control cases without lifelong PE were selected randomly among cases attending the department of internal medicine for a checkup procedure. The age and sex of control group were matched to that of the study group. Body mass index (BMI) of each case was calculated using the WHO criteria by the measurements of the physician instead of relying on verbal expressions. Result(s): The mean (±SD) age of the premature ejaculators was 31.7 ± 5.7 (range 21–51) years and in the control cases it was 32.3 (±6.7) (range 22–54) years. The comparison of the mean (±SD) weight between the study (74.1 ± 11.2 kg) and control groups (81.9 ± 6.4 kg) revealed a significant difference (P < 0.001). The mean BMI of premature ejaculators (24.9 ± 3.4 kg/m2) were lower than the mean BMI of control (27.5 ± 3.6 kg/m2) (P < 0.001). As the BMI increased, the number of patients decreased in the PE group. The number of the obese cases in the control group (n: 26, 24.1%) was three times greater than the obese premature ejaculators (P < 0.005) and the number of PE patients were approximately two times greater than the control cases in the normal weight class (P < 0.001).

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Disclosure: Work supported by industry: no.

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PERCEIVED INTERVAL OF INTERCOURSE (IOI) IN MEN FROM ASIA-PACIFIC COUNTRIES WITH DIFFERENT SOCIOECONOMIC, CULTURAL AND RELIGIOUS BACKGROUNDS Lee, G1; McMahon, CG2; Park, JK3; Adaikan, PG4 1: University of Malaya Medical School, Kuala Lumpur, Malaysia; 2: Australian Centre for Sexual Health, Sydney, Australia; 3: Department of Urology, Institute for Medical Sciences, Chonbuk National University Medical School, Chonju, Korea; 4: Section of Sexual Medicine, Obstetrics & Gynaecology, National University Hospital, National University of Singapore, Singapore Objective: To characterize men’s expectations of IOI in 10 AsiaPacific countries with different socioeconomic, cultural, and religious backgrounds. Material: A random sample of men (N = 4997) aged 18 to 65 years (mean, 39.0) and in a sexual relationship within the past 2 years completed a 48-question survey in which they were asked to estimate their own IOI, their perception of the “average” IOI in the population, and their perception of the “ideal” IOI. Additionally, men were asked questions regarding the impact of IOI on their relationship with their partner. The survey (computer-assisted interview and online or in-person questionnaires) and recruitment methodologies varied by country. Result: The overall mean self-estimated IOI was 10.3 minutes and ranged from 4.7 to 12.1 minutes across countries. The mean perceived normal and ideal IOIs were 9.8 and 13.4 minutes and ranged across countries from 5.6 to 12.3 minutes and from 7.9 to 17.7 minutes, respectively. Men in Australia/New Zealand, Hong Kong, Taiwan, and Indonesia reported self-estimated IOIs that were greater than the perceived normal IOIs in their respective countries. Men in the Philippines reported the lowest mean self-estimated, normal, and ideal IOIs, and the highest mean self-estimated, normal, and ideal IOIs were reported by men in Hong Kong, Thailand, and Malaysia, respectively. The majority of men in each country reported an interest in increasing their IOI (range, 57%-90%), and 63% and 68% of all men indicated that this would improve their overall and sexual relationships with their partner, respectively. Conclusion: Men’s perceptions of their self-estimated, normal, and ideal IOIs varied by country across the Asia Pacific region, which may be associated with differences in socioeconomic, cultural, or religious backgrounds; however, men from all countries expressed a desire to increase their IOI. Disclosure: Work supported by industry: yes, by Janssen-Cilag (industry initiated, executed and funded study). The presenter or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.

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EJACULATORY DYSFUNCTION IN PATIENTS AFTER SALVAGE RETROPERITONEAL LYMPH NODE DISECTION FOR NONSEMINOMA GERM CELL TUMOR Zachoval, R1; Jarabak, J1; Donatova, Z1; Abrahamova, J1; Krhut, J2 1: Thomayer Teaching Hospital; 2: Teaching Hospital Ostrava Objective: To evaluate ejaculatory function in patients after salvage retroperitoneal lymph node disection for non-seminoma germ cell tumor. Material and Methods: To evaluate functional (presence and quality of ejaculatory function before and after procedure) and oncological

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Proceedings from the 14th World Meeting of the International Society for Sexual Medicine results (PET CT and tumor markers before and after procedure) of salvage retroperitoneal lymph node disection in all patients operated from January 2008 to January 2010. The procedure was performed in case of suspicious tumor residuum or reccurence in retroperitoneal area after chemotherapy in patients with a non-seminoma germ cell tumor. Results: Salvage retroperitoneal lymph node disection was performed in 11 patients with normal ejaculatory function. Average age of patients was 30,7 years (range 27–35). Oncological stage was T1-3, N2, M0, S1 in 9 patients, T3 N3, M0, S1 in 1 patient and T1, N2, M0, S2 in 1 patient. Average tumor mass number was 1,8 (range 1–3) and average tumor mass size was 5,5 cm (range 2–10 cm). Chemotherapy was performed in all patients in average 7 cycles (range 4–10). In the histological specimen teratoma was found in 10 patients and non-maignant fibrosis in 1 patient. Normal ejaculatory function was preserved in 10 patients (91%), anejaculation occurred in 1 patient (9%). With followup of 18 months in average (range 4–28) no tumor reccurence has been observed. Conclusions: There is a small risk of ejaculatory dysfunction after salvage retroperitoneal lymph node disection for non-seminoma germ cell tumors and oncological outcome in short term follow-up is very good.

Table 1. Correlations between subject and partner measures with PEPQ in whole group (PE and non-PE) Subject measures in PEPQ Subject measures in PEPQ

IELT

Perceived Satisfaction control over with sexual Personal Interpersonal ejaculation intercourse distress difficulty

IELT 1.0 0.51* Perceived control 0.51* 1.0 over ejaculation Satisfaction with 0.46* 0.64* sexual intercourse Personal distress −0.53* −0.66* Interpersonal −0.49* −0.61* difficulty

0.46* 0.64*

−0.53* −0.66*

−0.49* −0.61*

1.0

−0.73*

−0.70*

−0.73* −0.70*

1.0 0.83*

0.83* 1.0

0.71*

−0.70*

−0.69*

−0.66* −0.65*

0.77* 0.74*

0.74* 0.76*

Partner measures in PEPQ Satisfaction with 0.51* 0.65* sexual intercourse Personal distress −0.47* −0.59* Interpersonal −0.45* −0.58* difficulty

*Correlation is significant at the <0.01 level (2- tailed).

Disclosure: Work supported by industry: no.

Disclosure: Work supported by industry: no.

185 184

THE APPLICABILITY OF A PREMATURE EJACULATION PROFILE QUESTIONNAIRE FORMS IN OUR COUNTRY

THE DEMOGRAPHY AND PARTNER’S RELATIONSHIP OF PREMATURE EJACULATION IN TURKEY: MULTICENTER STUDY

Can, E1; Demir, O2; Gumus, B3; Degirmenci, T4; Bolukbasi, A5; Basar, M6; Akbal, C7; Ozgur, GK8; Alici, B9; Inci, K10; Aridogan, A11; Erol, H12; Akdeniz, F1; Zeren, F3; Esen, AA2 1: Tepecik Trainig Hospital/Turkey; 2: Dokuz Eylul University/Turkey; 3: Celal Bayar University/Turkey; 4: Bozyaka training Hospital/Turkey; 5: Atatürk Training Hospital/Turkey; 6: Kýrýkkale University/Turkey; 7: Marmara University/Turkey; 8: Karadeniz Teknik University/Turkey; 9: Istanbul University Cerrahpasa Medicine Faculty/Turkey; 10: Hacettepe University/Turkey; 11: Cukurova University/Turkey; 12: Menderes University/Turkey

Can, E1; Demir, O2; Gumus, B3; Degirmenci, T4; Bolukbasi, A5; Basar, M6; Akbal, C7; Guner, GK8; Alici, B9; Inci, K10; Aridogan, A11; Erol, H12; Akdeniz, F1; Zeren, F3; Esen, A A2 1: Tepecik Trainig Hospital/Turkey; 2: Dokuz Eylul University/Turkey; 3: Celal Bayar University/Turkey; 4: Bozyaka training Hospital/Turkey; 5: Atatürk Training Hospital/Turkey; 6: Kýrýkkale University/Turkey; 7: Marmara University/Turkey; 8: Karadeniz Teknik University/Turkey; 9: Istanbul University Cerrahpasa Medicine Faculty/Turkey; 10: Hacettepe University/Turkey; 11: Cukurova University/Turkey; 12: Adnan Menderes University/Turkey

Objectives: In clinical studies premature ejaculation (PE) is commonly evaluated by intravaginal ejaculatory latency time (IELT). However, the difficulties to use this one, there is necessity to alternative evaluation methods. Reliability and applicability of a premature ejaculation profile questionnaire (PEPQ) among Turkish couples were aimed in the study. Material and Methods: Study was conducted in 12 different urologic centers in Turkey. Initial establishment of the PE diagnosis was constructed on DSM-4 definition and stop-watch measurements were also asked from each couple to record intra-vaginal ejaculation latency time (IELT). Subjects were evaluated with IELT and four items PEPQ which was derived from literature based on patient reported outcome measures (PRO) related to the ejaculation. Results: Among 316 eligible subjects and their partners’, mean age was 36.2 ± 8.9 years and mean partner age was 32.8 ± 8.7 years. Following the initial evaluation 244 subjects recruited to PE group based on DSM-4 TR definitions. Geometric mean IELT of the subjects was significantly differed between PE and non PE group (65.4 ± 72.5 vs. 455.6 ± 405.0 seconds, P < 0.001). All of the PEPQ domain scores were also differed between groups. Subjects in the PE group gave poor ratings than non-PE subjects. Partner responses were similar pattern. Correlation analyses of the PEPQ scores demonstrated significant positive correlations between “perceived control over ejaculation” and “satisfaction with sexual intercourse” domains of the PEPQ and with IELT (Table 1). At the same time there were found negative correlations in “personal distress” and “interpersonal difficulty” scores with IELT, “perceived control over ejaculation” and “satisfaction with sexual intercourse” domain scores of the couples. Conclusions: Four items PEPQ is reliable and applicable at the diagnostic approach to the PE in our country. Genetic and sociocultural aspects should be considered while diagnosing and studying on PE.

Objectives: The aim of this multicentre, observational study was to evaluate the demography of patients with Premature Ejaculation (PE) and their relations with partners using the PE Profile Questionnaire (PEPQ) questionnaire form in Turkey. Material and Methods: Total of 244 patients with PE who have not any treatment history for PE and 72 patients without PE according to DSM-IV-TR criteria and their partners were enrolled to study. After detailed sexual anamnesis all couples were asked for filling the PEPQ. Stop-watch measurements of intravaginal ejaculatory latency time (IELT) performed by patient or partners of them were assessed. Stopwatch recordings for four times were asked from subjects in the period of first 4 weeks. At the final visit couples again filled PEPP forms for second four weeks. All data were collected in Access data base and performed statistical analyses. Results: Mean age of PE (lifelong; n = 173; acquired; n = 72) and control groups was 37.1 ± 9.1 years (lifelong; 35.8 ± 8.4 and acquired; 40.5 ± 10.0 years; P < 0.001) and 32.9 ± 7.0 years, respectively (P < 0.001). Demographic characteristics of the groups are summarized in Table 1. Marriage duration was significantly higher in patient with PE than controls (P < 0.01). Also marriage duration was significantly different between patients with lifelong PE and acquired PE (10.3 ± 8.8 vs. 14.5 ± 10.5 years, P < 0.01). There were no statistically correlation was determined between patient’s age, partner’s age, education level and IELT in both groups. Correlation analyses of the PEPQ scores demonstrated significant positive correlations between “satisfactions with sexual intercourse”, “Personal distress related to ejaculation” and “Interpersonal difficulty related to ejaculation” domains of the PEPQ with education level in PE group. Conclusions: This study demonstrated that all parameters of PE patients’ and partners’ should be questioned in the evaluation of PE in urology clinics.

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210 Table 1

Proceedings from the 14th World Meeting of the International Society for Sexual Medicine Patient demographics Premature Ejaculation Yes (n = 244)

Patient’s age (years) Partner’s age (years) Marriage duration (years) Monthly frequency of sexual intercourse Average IELT (sec)

Table 2

37.1 ± 9.1 33.4 ± 9.2 11.6 ± 9.5 8.7 ± 4.8 58.6 ± 65.7

No (n = 72) 32.9 ± 7.0 30.5 ± 6.5 7.6 ± 6.6 10.7 ± 3.5 409.9 ± 337.8

The distribution of educational level

Education level

Premature Ejaculation Yes (n = 244)

No (n = 72)

Primary school (%) High school (%) University (%)

55.2 33.0 11.8

33.7 35.3 31.0

Disclosure: Work supported by industry: no.

it brings some difficulties. It might disrupt the naturality of sex for the partner and some cuples do not want to use or can not use the chronometer. Our aim was to create a very little device for the measurement of ELT in laboratory setting and afterwards in the real environment. Material and Methods: A little device with one cm diameter and three mm thickness which can measure the pressure applied on it was connected to a recorder. Pressure sensor was placed on the pubis of a healthy male volunteer. During audiovisual sexual stimulation he masturbated with an artificial vagina when he had rigid erection. When the subject ejaculated he stopped masturbation. Every hit of the vagina to the sensor was recorded. The record was downloaded as a graphic showing the pressure and duration of pressure measurement. Results: Ejaculation latency time could be successfully measured in a laboratory setting. The graphic of the record is shown in the figure. Conclusions: Our intention is to devolop a smaller one piece compact device to record ejaculation latency time in every environment. The pitfall might be that the recorder gets all the impulses during lovemaking. But it will not disrupt the naturality of sex. If we can realize what we want to do, our device might be used to calculate ELT for research purposes.

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CLINICAL CHARACTERISTICS OF THE PATIENTS WHO HAVE SEVERE LIFELONG PREMATURE EJACULATION THAT ALWAYS OCCURS BEFORE OR WITHIN 10 SECONDS OF THE BEGINNING OF INTERCOURSE Kim, JY Philip & Paul Medical Institute Objectives: Few clinical researches has been done on lifelong premature ejaculation that ejaculates before or immediate after the insertion of the penis. This study reports clinical characteristics of the patients who have severe lifelong premature ejaculation. Methods: The subjects were those who repeated ejaculation before or immediate after the insertion and did not have any other sexual dysfunction. Their sexual behavioral patterns were researched accompanied by penile sensitivity, blood test, and prostatitis test. Results: The study was conducted on 25 patients and average age was 35.5 years. Among of them, 18 were singles. The threshold of biothesiometry was 4.6 ± 1.2 and 8(33.3%) of them showed less then 4. In the prostatitis test, they were all negative. The average PSA was 1.0 ng/ml. The results of thyroid function tests, LH and FSH were in the normal scope. The total testosterone and free testosterone were 491 ± 144 ng/ dl and 13.6 ± 4.9 pg/ml. 1 of them showed increase in testosterone. Leptine was 3.5 ± 1.6 ng/mL. 81.8% responded that they had prolongation of the ejaculatory latency after applying anesthetic cream. On the question asking “What do you think of the reason of your premature ejaculation?”, 60% responded to penile hypersensitivity Conclusions: Though the patients group was small in number, this study was meaningful for reference in treating patients with very severe premature ejaculation. Not only the neurobiological access using SSRIs drug, but also the method to decrease penile sensitivity can be considered for treating the patients with severe premature ejaculation according to circumstances. Disclosure: Work supported by industry: no.

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A NEW WAY AND DEVICE TO EVALUATE EJACULATION LATENCY TIME IN LABORATORY Ekmekçioðlu, O1; Gökçe, A1; Tokmakçý, M2; Akýnsal, E1; Demirtaþ, A1 1: Erciyes University Medical Faculty/Turkey; 2: Erciyes University Faculty of Engineering/Turkey Objectives: In the definition of premature ejaculation the duration till ejaculation is a mjor component. To measure ejaculation latency time (ELT) with a chronometer is accepted as the best method. However,

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Figure 1 Graphic showing the duration of applied pressure (x axis) in seconds and the amplitude of the pressure (y axis). Disclosure: Work supported by industry: no.

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IS SELF REPORT OF ERECTILE DYSFUNCTION ASSOCIATED WITH SEVERITY, CARDIOVASCULAR RISK FACTORS, AND DEPRESSION? Park, HJ; Ahn, JH; Lee, SS; Park, NC; Moon, KH; Kil, NJ Pusan National University School of Medicine Objective(s): The aim of this study was to evaluate whether cardiovascular risk factors and depression are associated with frequency of self-report in patients with ED. Materials and Methods: A total of 459 patients who visited the urology clinics between January 2005 and July 2008 were analyzed. All patients were at least 40 years old. The group with unreported ED was defined as men with an IIEF-5 score of ≤21 who did not self report ED. The group with self-reported ED was defined as men with an IIEF-5 score of ≤21 who self reported ED. Symptoms of depression were assessed by the Center for Epidemiological Studies-Depression Scale (CES-D). Results: Overall frequency of ED was 39.8%; 25.9% were assigned to the unreported ED group, and 13.9% were assigned to the selfreported ED group. The average age was 54.9 ± 7.6 years for the unreported group and 51.4 ± 8.1 years for the self-reported ED group (no difference). The incidence of presenting with subjective ED symptoms was higher in the younger generation; however, it was not statistically significant. The incidence of patients with hypertension, diabetes, and BMI (≥25 kg/m2) was significantly higher in the selfreported ED group. Similarly, the incidence of abnormal results for fasting glucose level, triglyceride, HDL, and total cholesterol value in

Proceedings from the 14th World Meeting of the International Society for Sexual Medicine the self-reported group was significantly higher. The incidence of severe ED (≤10 IIEF-5 score) was significantly higher in the selfreported group. The incidence of patients with depression (>17 points CES-D) was significantly higher in the self-reported ED group. Conclusion: Our results suggest that men with self-reported ED had a higher frequency of cardiovascular risk factors and symptoms associated with depression compared to men with unreported ED. Furthermore, ED was more severe in men with self-reported ED than in those with unreported ED. Disclosure: Work supported by industry: no.

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GEPIRONE-ER SHORT TERM TREATMENT OF SEXUAL DYSFUNCTION IN DEPRESSED MEN Clayton, AH1; Fabre, LF2; Smith, LC2 1: University of Virginia, USA; 2: Fabre Kramer Pharmaceuticals, Inc. USA Objective: To examine the effect of gepirone-ER treatment on sexual dysfunction in clinically depressed men. Men with depression have sexual dysfunction. PDE5 inhibitors improve erectile function, but do not help with desire and orgasm. Gepirone-ER improves sexual function in women, and could have similar effects in men. Methods: In gepirone-ER depression study (134017), measurement of sexual function used the Changes in Sexual Functioning Questionnaire (CSFQ). Inclusion and exclusion criteria selected depressed, but not sexually dysfunctional, subjects. The population was men average age 38 that were otherwise healthy and not taking concomitant medications. CSFQ was evaluated at every visit for effects of gepirone-ER and placebo on sexual function in depressed men. HAMD17 responders (n = 40), who experienced an antidepressant effect (>50% decrease from baseline), and HAMD17 non-responders (n = 56) were also analyzed for effects on CSFQ scores. Results: For the total population at wk 2, CSFQ total score change from baseline (CFB) trended toward significance (P = 0.10). At wk 4, CSFQ total score CFB and all individual domains except desire/interest showed statistical significance or trends (total score P = 0.014, pleasure P = 0.048, desire/frequency P = 0.026, and orgasm P = 0.09). At the wk 8 (EOT) evaluation, orgasm (P = 0.04) and total score (P = 0.07) reached or approached significance. Gepirone-ER did not show an antidepressant effect in this study. Non-responders (gepirone-ER n = 27, placebo n = 29) were statistically significantly better than placebo or trended to significance on CSFQ total score (CFB) at weeks 2, 4 and 8, and on all CSFQ domains except desire/interest at week 4. Responders (gepirone-ER n = 15, placebo n = 25) did not show statistical separation from placebo in sexual functioning; although the CSFQ means for total score and the domains CFB for the gepironeER treated group were generally greater than for the placebo treated group. Conclusions: Short term gepirone-ER treatment of men with sexual dysfunction is positive for total score and most individual domains of the CSFQ, including domains for desire and orgasm. Statistical significance in the antidepressant non-responder group indicates a prosexual effect of gepirone-ER. Lack of statistical significance in the antidepressant responder group is likely a statistical aberration due to the small numbers of patients. Future studies of gepirone-ER in nondepressed subjects for treatment of male sexual dysfunction are warranted. Disclosure: Work supported by industry: yes, by Organon (industry initiated, executed and funded study). The presenter or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.

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GEPIRONE-ER LONG TERM TREATMENT OF LOW SEXUAL DESIRE IN DEPRESSED MEN Goldstein, IM1; Fabre, LF2; Smith, LC2 1: San Diego Sexual Medicine Alvarado Hospital USA; 2: Fabre Kramer Pharmaceuticals, Inc. USA Objective: To examine the long term effects (up to one year) of gepirone-ER in depressed males with sexual dysfunction, including low desire. Short term, eight week gepirone-ER treatment of sexual dysfunction in depressed men has shown improvement in total score and the sexual domains including the desire/frequency domain as measured by the Changes in Sexual Function Questionnaire (CSFQ). Gepirone-ER studies of depressed females with sexual dysfunction have shown positive results up to one year. Methods: In study 28709, a placebo substitution study of gepirone-ER in major depressive disorder, one hundred thirty depressed males (HAMD-17 20 or greater) received open label treatment with gepironeER. Responders at 4 to 8 weeks (HAMD-17 8 or less) entered into a double-blind placebo substitution study: 33 gepirone-ER and 48 placebo subjects. The Derogatis Inventory of Sexual Function-Self Report (DISF-SR) was measured at weeks 16, 28, and 52 (EOT). Results: Gepirone-ER treated patients showed statistically significant improvement in total DISF score at week 16 (P = 0.022), week 28 (P = 0.05), and week 52 (EOT) (P = 0.01). At week 28, The DISF domain for desire, cognition/fantasy, trended toward significance P = 0.07, and at week 52 (EOT) the desire domain was significantly superior to placebo at P = 0.01. Conclusions: Gepirone-ER treatment improves sexual desire in men. The effect lasts as long as the study continued, i.e., week 52. In female and short term male studies, gepirone-ER has been shown to be effective in both antidepressant responders and antidepressant nonresponders demonstrating both pro-sexual and anti-depressant effects. In this study, subjects were selected as antidepressant responders, precluding study of non-responders. The magnitude of the effect in this long term study of depressed men suggests that both antidepressant and pro-sexual mechanisms are occurring. Disclosure: Work supported by industry: yes, by Organon (industry initiated, executed and funded study). The presenter or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.

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THE EFFECT OF VACUUM DEVICE ON THE CELL APOPTOSIS IN PENIS OF DIABETIC RATS WITH ERECTILE DYSFUNCTION Zhang, B; Chen, J; Qi, T; Jin, M Department of Infertility and Sexual Medicine, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, China Objective(s): To study the effect of vacuum device on the cell apoptosis in penis of diabetic rats with erectile dysfunction.. Material and Method(s): There were total 25 experimental rats, out of which 5 were selected as normal control group (group C), and the rest ones we used Streptozotocin (STZ) and Apomorphine (APO) to establish type II diabetic rat models with erectile dysfunction. Then the established ED model rats were randomly divided into vacuum device group (group A) and diabetic ED group (group B). Vacuum aspiration operations were carried out on the rats in group A. after treatment all the rats were killed and the penile tissues were paraffin—embedded. The cell apoptosis in penis was tested with TUNEL method. Result(s): There were statistical significances among the cell apoptotic rate in penis in three groups (P < 0.001), in which the cell apoptotic rate in Group C was less than that in Group A and Group B

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(both P < 0.001), and that in Group A was less than Group B (P < 0.001). Conclusion(s): Vacuum device might reduce the cell apoptosis in penis of diabetic rats with erectile dysfunction. Disclosure: Work supported by industry: no.

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THE EFFECT OF NEFERINE ON THE RABBIT’S PENILE ERECTILE RESPONSES IN VIVO Chen, J1; Zhang, B1; Xiao, H2 1: Department of Infertility and Sexual Medicine, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, China; 2: Department of Urology, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, China Objective(s): In our previous study, we found that neferine possesses a relaxant effect on rabbit corpus cavernosum tissues in vitro. The mechanism is manifested by the fact that tetrandrine reduces the intracellar free Ca2+ level of corpus carvernosum smooth muscle cells by means of the following three ways: (1) the inhibition of extracellular Ca2+ infux from the extracellular site via voltage-activated Ca2+ channel and α1-adrenoceptor-operated Ca2+ channel, (2) the inhibition of release of intracellular stored Ca2+, and (3) the inhibition of activities of phosphodiesterase and then enhancement of the concentration of cAMP in rabbit corpus carvernosum tissue. In the present study, the effect of neferine on the rabbit’s penile erectile responses in vivo was further investigated. Material and Method(s): Twenty-four male New Zealand white rabbits were divided in two groups: Neferine group (twelve) and control group (twelve). Rabbits were anaesthetized, and then the carotid artery on one side was cannulated for continuous monitoring of mean blood pressure (MBP). A 25-gauge needle was inserted into the corpus cavernosum for measuring intracavernous pressure (ICP). Cumulative concentrations of neferine were injected intracavernously and normal saline in the same volumes was performed in the control group. ICP, MBp and heart rate (HR) were determined after intracavernous administration of normal saline and neferine. Result(s): The baseline ICP recorded was (14.6 + 3.7) mm Hg. Neferine increased ICP in a concentration-dependent manner. However, the MBP and HR were unchanged during the injection periods of neferine. Conclusion(s): The results of the present study suggest that neferine enhances rabbit’s penlie erection after intracavernosal injection, and it needs further pharmacological research and Toxicology test in vivo to clarify whether neferine can be developed into the drug for ED. Disclosure: Work supported by industry: no.

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PENILE VEINS ARE THE DETERMINING CONTRIBUTOR FOR ERECTION: THE HEMODYNAMIC EVIDENCE FROM THE STUDY IN DEFROSTED HUMAN CADAVERS Hsu, GL1; Huang, YP2; Tsai, MH3; Hsu, CY4; Chen, KL5; Chang, CH5; Wu, HC5 1: Microsurgery Potency Reconstruction & Research Center, China Medical University/Taiwan; 2: Department of Physiology, China Medical University/ Taiwan; 3: Department of Anatomy, China Medical University/ Taiwan; 4: neuroscience, CEO China medical University/Taiwan; 5: Department of Urology, China Medical University/ Taiwan Objective: Penile venous surgery for treating erectile dysfunction (ED) is currently considered experimentally and the venous factor is not included as a contributor for penile erection. We sought to conduct a hemodynamic study in order to elucidate what the extent is of the actions of penile veins in penile erection, and possibly being an important contributor to impotence.

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Materials and Methods: From March 2009 to March 2010, nine male defrosted human cadavers were used for this study mimicking a refined penile venous stripping surgery in clinical use. Among the 9 subjects 6 had no sexual activity for at least 6 months prior to death and the remaining three were deceased from acute accidents in an active sexual period. Using 10% colloid four sets of infusion cavernosometry were carried out with a flow rate 14.0–94.0 ml/min before and after the deep dorsal vein (DDV), cavernosal veins (CVs) and para-arterial veins (PAVs) were removed respectively. The maintenance flow at ICP 90 mm Hg was attempted at every occasion. Results: The data of one cadaver was excluded due to inconsistency resulting from postmortem change and the last one who died of acute cardiac infarction at the age of 87 years using infusion rate of 35.0 ml/ min failed to induce erection, subsequently this cadaver was subject to mere inquiring the flow rate for maintaining ICP 90 mmHg after DDV, CVs and PAVs were removed respectively. The ICP can be reached up to 708.2 mmHg while the maintenance flow at ICP 90 mmHg was significantly improved (P = 0.018, >16.2 vs 7.1 ml/min) in all subjects after removal of DDV, CVs, and PAVs respectively. Similarly, there were significant in pressure built up (P = 0.018, 124.39 vs 230.01 vs 323.02 mm Hg or P = 0.028), shorter time of reaching base pressure (P = 0.018, 3′44″ vs 3′4″ vs 2′56″) and perfusion volume (P = 0.018, 90 vs 71 vs 65 ml). Although in some subjects infusion rate were too low to reach rigid erection preoperatively, in all cadaveric penises, after the removal of erection-related veins a rigid erection was readily attainable. Conclusion: We may conclude that penile vein is categorically the determinant in penile erection since none of the current contributors of penile erection can be expressed in cadavers such as intracavernosal, hormonal, arterial, neurological, drugs effect, chronic systemic diseases, and psychogenic factors. Disclosure: Work supported by industry: no.

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WITHDRAWN

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A NEW ANTHROPOMETRIC MEASUREMENT OF PENILE LENGTH AND ITS RELATION TO SECOND AND FOURTH DIGITAL LENGTHS Davarcý, M; Gökçe, A; Yalçýnkaya, FR; Kaya, YS; Turhan, E; Tutanç, M; Doðramacý, Y; Balbay, MD Mustafa Kemal University Tayfur Ata Sokmen Medical Faculty/Turkey Objectives: The developments of digits are under the control of Homebox or Hoxa genes, which also control the differentiation of the urogenital system. In the present study we evaluated the association between penile length and those of the second and fourth digits. Material and Methods: A total of 1028 Turkish male primary school children in Hatay (province in southern Turkey) region were included in this study, between May-June 2009. Weight and height measurements were taken in order to calculate body mass index (BMI). Flaccid and stretched length of the penis was measured. The lengths of the second and fourth digits were measured of the right hand. Statistical analyses were performed with descriptive statistics and Pearson correlation analysis. Results: A significant correlation was found between the following comparisons: the length of the second digit with flaccid and stretched length of the penis (r = 0.166 and r = 0.276, respectively; P < 0.01); and the length of the fourth digits with flaccid and stretched length of the penis (r = 0.174 and r = 0.287, respectively; P < 0.01). A significant correlation was not found between 2D:4D ratio with flaccid and stretched length of the penis (r = −0.013; P = 0.668 and r = −0.018; P = 0.565 respectively). Conclusions: Based on the positive correlations in the present study, we believe that the relation between digit and penile length could be a novel developmental data and may have clinical applications.

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median longitudinal incision associated with a semi-circumferential incision was made from the retrocoronal sulcus to the pubic region in order to facilitate vascular access. Two #19 scalp needles were inserted and firmly fixed in place with 4-0 silk sutures at the 3 and 9 o’clock positions respectively. One needle was connected to an infusion pump and used to inject 10% colloid solution into the corpora cavernosa, whereas the other needle was used to monitor the intracavernosal pressure. Each corresponding set of infusion cavernosometry was subsequently made with an infusion flow while the intracavernosal pressure (ICP) of the corpora cavernosa was fixed at 90 mmHg before and after the deep dorsal vein, cavernosal veins and para-arterial veins was removed subsequently. Each drainage proportion of respective veins was derived from 100% minus X where X was calculated after logistic transformation of data and subdivided to the global one in percentage. Results: The drainage proportion of each separated venous system was 49.8%–66.3% (average 62.3), 23.7%–35.8% (average 30.1) and 5.5–8.1% (average 5.7) to the DDV, CVs and PAVs respectively. Conclusions: The result in this study signifies the important contribution of each venous system which is much more complex than that of traditional ones. This implies why recurrence is susceptible on surgery for penile venous leakage because residual veins is easily ensued. Disclosure: Work supported by industry: no.

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Disclosure: Work supported by industry: no.

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THE DRAINAGE PROPORTION OF THE CORPORA CAVERNOSA VIA SEPARATED VEINS: A HEMODYNAMIC STUDY FROM DEFROSTED HUMAN CADAVERS AND THEIR CLINICAL IMPLICATIONS Hsieh, CH1; Hsu, GL2; Huang, YP3; Tsai, MH4; Chen, KL5; Chang, CH5; Wu, HC5 1: Department of Urology, Buddhist Tzu Chi General Hospital, Taipei Branch; 2: Microsurgery Potency Reconstruction & Research Center, China Medical University; 3: Department of physiology, China Medical University and Hospital, Taichung; 4: Department of Anatomy, China Medical University and Hospital, Taichung; 5: Department of Urology, China Medical University and Hospital, Taichung Objectives: In addition to commonly agreed mere one deep dorsal vein, one paired of cavernosal veins, and two pairs of para-arterial veins was reported in early 2001, an investigative cavernosometry had been made in clinical patients who underwent penile venous stripping in between July 2003 and March 2004. Although its results was not reliable, this pilot study prompted us to conduct a hemodynamic study on human cadavers in order to explore what is the drainage proportion of separate veins. Material and Methods: In late 2009 seven adult human male defrosted cadavers whose penis is intact were used for this study. A dorsally

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IMPLANTATION OF AUTOLOGOUS BONEMARROW-DERIVED CELLS RECOVER ERECTILE DYSFUNCTION IN SPONTANEOUSLY HYPERTENSIVE RATS Ishikawa, M; Imamura, T; Aizawa, N; Kurizaki, Y; Ishizuka, O; Igawa, Y; Nishizawa, O Shinshu University School of Medicine/Japan Objective(s): In many clinical cases, hypertensive men show a high prevalence of erectile dysfunction (ED). We investigated to determine if autologous bone-marrow-derived cells (BMC) implanted into the cavernous bodies of penis in spontaneously hypertensive rats (SHRs) have therapeutic effects on ED.

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Material and Method(s): Six male SHRs at postnatal week 25 were anesthetized, and then two bone marrow needles were inserted into their femurs. We flashed saline through the one side, and harvested BMC from the other side. The cells were cultured on collagen-coated flask for 7 days. At 5 days of culture, the cells were labeled with fluorescence materials (Qtracker®, Invitorogen) for identification in tissues. Seven days after of the culture, the 1 × 105 autologous BMCs were implanted into the cavernous bodies of penis (n = 6). For controls, the cell-free solution was injected (n = 16). At 7 days after the implantation, intracavernous and blood pressures of the experimental animals were measured with and without administration of apomorphine (0.1 mg/kg s.c.) in awake. In this study, we evaluated the reactions of peak pressure within 30 min (PP30) and tonic peak pressure (TPP) of the intracavernous pressures. After the mesurements, those the cavernous bodies of penis were analyzed by histochemistry investigations. Prior to this study, the intracavernous and blood pressures of the six male Wistar Kyoto (WKY) rats and fifteen male SHRs without the cell-implantation were also analyzed as above. Result(s): The reactions of PP30 of the SHRs significantly decreased compared to the WKY rats, while the TPP of the SHRs having the reaction of PP30 were as same level as that of WKYs. The blood pressures and TPP of the cell-implanted SHRs had no significant differences compared to the control SHRs. The five in the sixteen of the cell-free injected ones did not the reactions of PP30. However, the five in the six of the cell-implanted SHRs showed the PP30-reactions. The implanted BMC were survived in the cavernous bodies of penis. Conclusion(s): The implantation of autologous BMC has a potential to be effective therapy for ED. Disclosure: Work supported by industry: no.

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ANALYSIS OF BLADDER FUNCTION BY THE APPLICATION OF A WIRELESS BLADDER VOLUME SENSOR IN RATS Kim, SJ1; Lee, DS1; Sohn, DW1; Choi, BK2; Lee, MK2; Lee, SJ2; Kim, SW1; Yoon, BI1; Cho, HJ1; Hong, SH1; LEE, JY1; Hwang, YK1 1: Department of Urology, the college of Medicine, the Catholic University of Korea; 2: Department of Mechanical Engineering, Sogang University Object: By the observation of the real-time change of bladder volume in laboratories in parallel to the measurement of intravesical pressure, information about bladder function could be collected more accurately. We examined the accuracy and usefulness of the measurement of bladder volume using an in vivo bladder volume sensor. Materials and Methods: The urodynamic study to measure bladder pressure was performed in rat. At the same time, mini electrodes were placed symmetrically on the both lateral walls of bladder to sense the change of the distance between the two electrodes, and assuming as a sphere shape, the expanded bladder volume was calculated. Results: The change of the bladder volume measured by attaching a bladder volume sensor statistically highly correlated to the volume of saline injected to the bladder (P < 0.01). Conclusion: In vivo bladder volume sensors could detect the accurate change of bladder volume. Therefore, when the bladder function test is performed with rats, it is thought that the accuracy of the test could be elevated by using an in vivo bladder volume sensor in parallel. Furthermore, it may have a role to develop wireless bladder volume sensor clinically. Disclosure: Work supported by industry: yes, by the Ministry of Health & Welfare (no industry support in study design or execution).

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COMPARISON OF THE EFFECT BETWEEN DAILY AND WEEKLY ADMINISTRATION OF SILDENAFIL ON INTRACAVERNOUS PRESSURE INCREASE AFTER ELECTRICAL STIMULATION OF CAVERNOUS NERVE IN THE RAT Chen, KK; Chang, LS Taipei Veterans General Hospital Objectives: To investigate and compare the effect of daily or weekly (on-demand) administration of sildenafil on intracavernous pressure (ICP) increase after electrical stimulation of cavernous nerve in the rat. Materials and Methods: Male adult Sprague-Dawley rats (300–350 g) anesthetized with Zoletil and xylazine were used. Three groups of experimental animals were designed. Group 1: no administration of sildenafil, group 2: daily oro-gastric administration of sildenafil 0.13 mg for 4 weeks, and group 3: oro-gastric administration of sildenafil 0.5 mg every week for 4 weeks. A 26-gauge needle was inserted into the corpus cavernosum to monitor the ICP. The cavernous nerve (CN) was identified and was electrically stimulated with parameters (5 and 10 V, 20 Hz, 2 ms, 1 minute) on the 28th day for the rats in each group. The ICP before and after electrical stimulation of CN was compared by Wilcoxon signed ranks test. The amount of ICP increase (peak ICP minus resting ICP) among different groups was compared with Kruskal-Wallis test. A P < 0.05 was considered significant. Results: There was a significant increase of ICP from resting 13.3 ± 2.1 mm Hg to a peak at 48.0 ± 6.0 mm Hg and 52.7 ± 6.8 mm Hg after CN stimulation with parameters 5 V and 10 V, respectively in group 1 rats. A significant increase of ICP from resting 11.3 ± 2.2 mm Hg to a peak at 70.3 ± 5.6 mm Hg and 67.2 ± 4.3 mm Hg after CN stimulation with parameters 5 V and 10 V, respectively was also noted in group 2 rats. There was a significant increase of ICP from resting 11.0 ± 2.1 mm Hg to a peak at 74.0 ± 7.1 mm Hg and 66.3 ± 5.3 mm Hg after CN stimulation with parameters 5 V and 10 V, respectively in group 3 rats. The amount of ICP increase was 34.7 ± 4.8 mm Hg, 59.0 ± 5.3 mm Hg, and 63.0 ± 6.4 mm Hg at group 1, 2 and 3, respectively after CN stimulation with 5V, and was 40.2 ± 5.6 mm Hg, 58.5 ± 3.2 mm Hg, and 57.5 ± 4.7 mm Hg at group 1, 2 and 3, respectively after CN stimulation with 10 V. There was a significantly greater amount of ICP increase in group 2 and group 3 rats as compared with group 1 rats after electrical stimulation of CN with 5 V or 10 V. No significant difference of amount of ICP increase was noted between group 2 and group 3 rats. Conclusions: The results of this study suggest that there is a significant greater amount of cavernous nerve stimulation-induced ICP increase in the rats with daily or weekly oral administration of sildenafil than those without sildenafil administration. No significant difference of cavernous nerve stimulation-induced amount of ICP increase was noted between daily and weekly administration of sildenafil. Disclosure: Work supported by industry: no.

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PNNOS GENE TRANSFECTION IN ADIPOSE DERIVED STEM CELLS USING LENTIVIRAL VECTOR Chen, J1; Zhang, B1; Tao, X1; Cai, L1; Xiao, H2 1: Department of Infertility and Sexual Medicine, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 510630, China; 2: Department of Urology, the Third Affiliated Hospital of Sun YatSen University, Guangzhou, Guangdong 510630, China Objective(s): To construction penile neuronal nitric oxide synthase (PnNOS) gene-modified adipose derived stem cells (ADSCs) for treating erectile dysfunction. Material and Method(s): (1) generation of PnNOS gene recombinant lentiviral vector, (2) isolation and ex vivo expansion of ADSCs,

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Proceedings from the 14th World Meeting of the International Society for Sexual Medicine (3) lentiviral gene transfer of PnNOS into ADSCs, (4) the expression of PnNOS were determined by GFP examination and Western Blot test. Result(s): The cDNA of a tissue specific PnNOS gene from SD rat was amplified, and a PnNOS gene recombinant lentiviral vector were also constructed successfully. The GFP-fusion expression of PnNOS was confirmed by Western blot analysis in 293 cells, and the titer of lentivirus enveloped in 293T cells was 2 × 106 TU/ml measured by qPCR test. The high and long-term expression of exogenous PnNOS gene in ADSCs was confirmed by GFP examination by microscope and western blot analysis. Conclusion(s): Recombined lentivirus is feasible for introduction of PnNOS long-term and high over-expression in ADSCs. Disclosure: Work supported by industry: no.

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A NEW INSIGHT INTO PENILE TUNICAL, VENOUS ANATOMY, ERECTION PHYSIOLOGY AND THEIR CLINICAL IMPLICATIONS Hsu, GL1; Hsieh, CH2; Huang, CH3 1: Microsurgery Potency Reconstruction & Research Center, China Medical University/Taiwan; 2: Buddhist Tzu Chi General Hospital/Taiwan; 3: Buddhist Tzu Chi General Hospital and En-Chu-Kong Hospital/Taiwan Objective: Has the human penile anatomy been well studied and informative? Could it provide a foundation for dictating medical strategies and evolution evidence? Deliberation of the human penile anatomy and erection physiology will benefit in treating male sexual dysfunction. We will provide scientific evidence of penile anatomy and erection physiology. Materials and Methods: Dissecting, light, scanning and transmission electron microscopy, special stains and hemodynamic cavernosometry were used for studying the penile anatomy of human beings, representative quadrupeds and human penile erection physiology when appropriate. Results: The tunica albuginea of the corpora cavernosa is a bi-layered structure with a complete inner circular layer and an incomplete outer longitudinal coat. The outer cover is absent between the 5 and 7 o’clock positions where two triangular ventral thickenings radiate from the anterior fibers of the bilateral bulbospongiosus respectively. On the dorsal aspect, between the 2 and 10 o’clock positions, the thickening originates from the ischiocavernosus and continues into the distal ligament which serves as a spine within the glans penis. It is equivalent to os penis consistently found in quadrupeds. Evolution of the penile structures from quadrupeds to human is evident because this structure shares the same anatomical location and histology. In the corpora cavernosa, skeletal muscle contains and supports smooth muscle. This chamber design meets the requirements for rigid erection. Using normal saline 150 ml/min and 10% colloid 35 ml/min for a cavernosometric study in fresh and defrosted male human cadavers respectively a rigid erection is unexceptionally attainable, in particular venous removal mimicking a penile venous stripping. In the corpus spongiosum, a paper thin tunica albuginea encircles the sinusoids, skeletal muscle partially entraps the smooth muscle in order to allow ejaculation when rigid erection. The deep dorsal vein, a couple of cavernosal veins, and two pairs of para-arterial veins are located between Buck’s fascia and the tunica albuginea. Conclusions: With this penile anatomical knowledge, a sustainable foundation can provide for medical strategies, surgical solutions, and evidence for species evolution. Should the penile veins play a pivotal role in attaining rigid erection since there is no other contributors of penile erection can be expressed in cadavers such as psychogenic factors?

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BONE MARROW STEM CELL TREATMENT FOR THE ERECTILE DYSFUNCTION IN SPONTANEOUS HYPERTENSIVE RATS Ishikawa, M; Ishizuka, O; Imamura, T; Kurizaki, Y; Nakayama, T; Nishizawa, O Shinshu University School of Medicine Objectives: Spontaneous hypertensive rats (SHR) have a high prevalence of erectile dysfunction (ED). To evaluate if autologous bone-marrow-derived mesenchymal stem cells (BMSC) have therapeutic effects due to hypertension, we transplanted BMSC into the corpus cavernosum of SHR. Material and Methods: To evaluate the presence of increase of the pressure (erection), intracavernous pressures were recorded after administration of apomorphine (0.1 mg/kg, s.c.) in awake condition. We also harvested BMSC from SHRs for transplantation. The cells were cultured, and transfected with Qtracker cell labeling. After one week culture, the BMSC was injected into the corpus cavernosum of the same SHRs. Cell-free medium (CFM) were injected into the other SHRs as control. One week after injection, intracavernous pressures of each group rats were recorded. The corpus cavernosum tissues were also evaluated by immunohistochemical staining. Results: There were the erections in 8 out of 10 sham-operated Wistar Kyoto rats. And there were the erections in 5 out of 6 cultured BMSC transplanted SHRs, while in 5 out of 15 CFM injected SHRs. By Immunohistochemical staining, the transplanted cells were detected in the BMSC transplanted corpus cavernosum tissues (Fig. 1). Conclusion: These results imply that transplantation of autologous BMSC may be a potential therapy for ED.

Figure 1 Labeled transplanted BMSC in corpus cavernous tissues (muscles and vessels, vessels, smooth muscles) Disclosure: Work supported by industry: no.

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WITHDRAWN

Disclosure: Work supported by industry: no.

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Proceedings from the 14th World Meeting of the International Society for Sexual Medicine International Index of Erectile Function (IIEF), International Prostate Symptom Score (IPSS), and the Aging Male Survey (AMS). Pertinent results are presented in the following tables. Results: 130 men were enrolled, age range 25–79 with a mean of approximately 53 years.

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SPOUSE’S BODY IMAGE AND PSYCHOLOGICAL FACTORS AS PREDICTORS OF MEN’S MARITAL SATISFACTION Low, WY1; Yusoff, N2; Yip, CH3 1: University of Malaya; 2: Universiti Sains Malaysia; 3: Universiti Malaya Introduction: Body deformity due to the removal of breast in breast cancer treatment may have a negative effect on one’s marital relationship. Objective: This paper examined the possibility of the spouses’ body image and psychological factors as predictive of men’s marital satisfaction following breast cancer surgery of their spouses. Method: One hundred and fifty seven men completed various standardized scales at three different phases of treatment: (i) prior to starting adjuvant chemotherapy at approximately seven weeks after diagnosis; (ii) during adjuvant chemotherapy at approximately 14 weeks after diagnosis and (iii) after the completion of chemotherapy at approximately 23 weeks after diagnosis. Scales used were the modified version of Body Image Scale (higher scores indicate higher negative view on spouse’s body image), Dyadic Satisfaction (higher scores indicate higher marital satisfaction) and Hospital Anxiety and Depression Scale (higher scores indicate higher anxiety and depression). Results: Eighty percent of the women had mastectomy. The stepwise method for regression analysis was performed. Men’s marital satisfaction at post-chemotherapy was modeled as a dependent variable, whereas spouse’s body image at prior-chemotherapy, men’s depression and anxiety at prior-chemotherapy, men’s and spouse’s age, and duration of marriage were chosen as independent variables. Men’s depression prior to chemotherapy explained 0.2% of the variance of men’s marital satisfaction at post-chemotherapy (P = 0.049). However, spouses’ body image at prior-chemotherapy, men’s anxiety at priorchemotherapy, age and duration of marriage did not predict men’s marital relationship at post-chemotherapy. Conclusion: Healthcare professionals should address men’s depression as it affects marital satisfaction with spouses who are diagnosed with breast cancer. Disclosure: Work supported by industry: no.

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ANALYSIS OF MEN’S HEALTH: DESCRIPTIVE DATA FROM THE PROSPECTIVE MEN’S HEALTH STUDY, BROOKLYN NY Jhaveri, JK; Pinkhasov, A; Horan, P; Hakimian, P; Lindsay, GK; Shabsigh, R Maimonides Medical Center Objective: “Men’s Health” is a broad general topic that is not fully understood by clinicians or patients. Research studies are being performed in order to identify gender specific disease as well as isolate preventive measures to improve quality of life. Using a variety of validated questionnaires, we sought to assess the severity of different symptoms on quality of life in men in New York, USA. Methods and Materials: A men’s health database was established in order to gather pertinent information from urological patients in Brooklyn, NY, USA. Data domains assessed included: sexual function, urinary function, and mental behavior. Questionnaires employed were:

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IPSS Score

N (%)

Overall Satisfaction

N (%)

0–7 Mildly Symptomatic 8–19 Moderately Symptomatic 20–35 Severely Symptomatic

72 (55.4) 44 (33.8)

0–2 Severe Dysfunction 3–4 Mod Dysfunction

30 (24.2) 23 (18.5)

14 (10.8)

5–6 Mild-Mod Dysfunction

21 (16.9)

Erectile Function 0–6 Severe Dysfunction 7–12 Moderate Dysfunction 13–18 Mild-Mod Dysfunction 19–24 Mild Dysfunction 25–30 No Dysfunction

N(%) 33 (26.4) 33 (26.4)

7–8 Mild Dysfunction 9–10 No Dysfunction No Data=

37 (29.8) 13 (10.5) 6 (4.6)

30 (24)

Total AMS Sum-Score***

N (%)

21 (16.8) 8 (6.4)

0–26 No Impairment 27–36 Little Impairment

54 (43.5) 42 (33.9)

No Data=

5 (3.8)

37–49 Moderate Impairment

23 (18.5)

Orgasmic Function 0–2 Severe Dysfunction 3–4 Moderate Dysfunction 5–6 Mild-Mod Dysfunction 7–8 Mild Dysfunction 9–10 No Dysfunction No Data=

N (%) 76 (61.3) 20 (16.1) 12 (9.7) 9 (7.3) 7 (5.6) 6 (4.6)

50+ Severe Impairment No Data=

5 (4.0) 6 (4.6)

***The Total AMS Sum-Score represents a composite score of multiple subscales from the Aging Male Survey including somato-vegetative (somatic), sexual, and psychological subscales.

Conclusions: Men’s health disorders are prevalent and could be under-diagnosed if clinicians are not prompted to evaluate them. This could serve to benefit patients by ascertaining their state of health through simple questionnaire utilization, which may alert physicians to diagnose a masked disease. In order to isolate gender-specific disease phenomena, more data acquisition and analysis will be required. Disclosure: Work supported by industry: no.

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YOUTH SEXUAL ISSUES FROM THE KEY INFORMANTS’ PERSPECTIVES: COMPARISON OF IRAN AND MALAYSIA Fazli Khalaf, Z1; Low, WY1; Merghaty Khoei, E2; Ghorbani, B3 1: Medical Education and Research Development Unit, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; 2: School of Public Health, Iran university of Medical Sciences, Tehran, Iran; 3: Avicenna Research Institute, ACECR, Tehran, Iran. Objectives: Socio- cultural changes in developing countries have affected people’s daily lives especially, young people’s behaviours and values. This study aimed to explore the attitudes of local key professionals towards youth sexuality issues in Iran and Malaysia. This paper is the preliminary findings of a large study for the PhD program. Material and Methods: This qualitative study involved in-depth faceto-face interview of Iranian and Malaysian key informants. The study involved 19 Iranians where the interviews were carried out in Tehran, whereas the 11 Malaysians were interviewed in Kuala Lumpur. NVIVO v8 software was used for data analysis. Results: There were similarities in sexual related matters in both countries; despite the religious and cultural opposition to premarital and extra marital sexual relationships. It was felt that there was a growing proportion of young people, particularly young men who involve in sexual relationships. Comparing with the previous generation, due to social and educational progress of women, girls of both countries played a more active role in their intimate relationships; however, a male dominancy still prevails in sexual relationship. Risky sexual behaviours were common among young people and developing a more strategic prevention program is suggested by the key infor-

Proceedings from the 14th World Meeting of the International Society for Sexual Medicine mants. According to the female respondents of both countries, most of the young women are not aware of their sexual rights and often, intimate violent behaviours of male partners affects women’s emotional and psychological health. Comparing to the unspoken situation in Iranian governmental system, Malaysian governmental system has considered the sexuality education of youth and has recently finalized a school based curriculum in this regard. Conclusion: Findings of this study illustrated the need for considering the sexuality related matters in the school curriculum. Regarding the social and religious similarities between these two Islamic countries, exchanging the experiences of the key informants and community leaders between them is recommended. Disclosure: Work supported by industry: no.

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SEXUAL OFFENDERS AGAINST CHILDREN— INTEGRATING COMMON FEATURES WITH TARGETS FOR TREATMENT AND PREVENTION Lew-Starowicz, M1; Lew-Starowicz, Z2; Heitzman, J3; Pacholski, M3 1: Institute of Psychiatry and Neurology, Department of Psychiatry; 2: Medical Center for Postgraduate Education, Department of Sexual Medicine and Psychotherapy; 3: Institute of Psychiatry and Neurology, Department of Forensic Psychiatry Objective(s): Establishing targets for treatment and prevention for the perpetrators of acts of sexual abuse against minors designed for out- and inpatient health care. Material and Method(s): A detailed analysis has been made of documentation from forensic sexological examinations (conducted between 1980–2008 at the Institute of Sexology of Polish Sexological Society) and information from the records of the proceedings (if available) concerning individuals suspected and accused of acts of sexual abuse against minors. The analysis was based on the authors’ designed template including i.a. demographic data, interview on psychosexual development, interpersonal and emotional relationships, sexual activity, medical examination and information concerning the alleged acts. Result(s): The documentation analyzed encompasses data from studies on 257 individuals (256 men and 1 woman). The individuals under study were mostly adults after 21 years of age (92,6%) with a primary education (38,2%) or vocational one (37,8%), working (62,7%), coming from two-parent families (83,7%) with good relationships with parents (74,4%) and peers (73%). The majority were heterosexual (91%), with no history of sexual abuse in family or apart (98,3%, 90%, respectively), having their own children (56,2%), but less than half of which being in formal relationships (39,8%) or informal ones (9,1%). 20,6% offenders were diagnosed with mental disorders—personality disorders most of the time (20,6%). The prevalence of reported sexual dysfunctions was relatively low (with 8,6% for hypoactive desire, 3,5% for erectile dysfunction, 3,1% for hyperlibidemia and 2,4% for ejaculatory dysfunction). 27% was diagnosed as pedophile (20,4% heterosexual pedophilia) and 23,1% as psychosexually immature. 58,75% pedophiliac behaviours were of substitute nature, 64,6% were planned, 53,8% involved physical violence, 29,5% resulted in physical injuries, or their death—7,3%. The data were discussed in order to develop the objectives of the program of treatment and prevention of perpetrators of sexual abuse against minors. Conclusion(s): In handling perpetrators of sexual crimes against minors, the authors propose an approach taking into account both the psychopathological and paraphilic context, and the structured assessment of re-offense risk. The continuation of research and discussion is aimed at developing therapeutic and preventive algorithms. Disclosure: Work supported by industry: no.

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THE PROGRESS ON THE RESEARCH OF DIABETIC ERECTILE DYSFUNCTION Yutian, D; Yun, C; Weidong, Z The affiliated drum tower hospital, Nanjing University Erectile dysfunction is a common complication of diabetes mellitus. The pathogenesis of diabetic erectile dysfunction (DMED) is very complicated, involving neuropathy, neurotransmitters, vasculopathy, vasoactive mediators, metabolism, endocrine and so on. Neural Factor: Hecht’tests indicating neuropathy showed abnormalities in men with diabetic ED as frequently as in men with neuropathic ED. The findings support the hypothesis that neuropathy contributes significantly to the pathophysiology of DMED. We found 4 neurotrophins (NGF, BDNF, NT-3, and NT-4) in cavernous tissue of diabetic ED rats changed. And our results showed that exogenous administration of NGF or using adenoviral vector–mediated NGF could partly revise the erectile function of diabetic ED rats, which might promote the recovery of injured nerves. Vascular Factor: In the development of diabetic vasculopathy, some vasoactive mediators undergo conspicuous changes, such as ET-1, VEGF, VIP, which are also correlated with the development of DMED. Besides, there are local renin–angiotensin aldosterone systems (RAS) in the penis. Our primary study showed that the Ang II level of diabetic ED rat penises was significantly higher than those of normal control rats. And angiotensin receptor blockage (ARB), such as valsartan, had significant effect on improving the erectile function of diabetic ED rats. Metabolism: Deposition of advanced glycation of end products (AGEs) due to the hyperglycemic situation also promotes the development of DMED. We found that AGEs can attenuate the activity of cNOS in cavernous tissue of diabetic rats and the joint effect of AGEs and RAGE may elevate the activity of ET-1. These changes might affect erectile tissue introducing increased contraction and decreased smooth muscle relaxation. Oxidative Stress: Oxidative stress is also playing an important role in the pathogenesis of DMED. Antioxidant treatment could improve erectile function of diabetic rats due to attenuating oxidative stress by increasing the activities of SOD and decreasing the levels of MDA. Their morphology changes were relived, apoptosis of smooth muscle and endothelial cells were suppressed and endothelia function was improved after supplements of antioxidants, such as GSH, L-Arg, ALA and melatonin. We also found these antioxidants could ameliorate the function of mitochondrion of cavernous tissue of diabetic rats. Stem Cells: Nowadays, stem cell treatment of DMED is paid much attention to. Maurice et al found autologous adipose tissue-derived stem cells (ADSCs) injected into the penis of diabetic rats were effective to improve erectile function. We used rat mesenchymal stem cells (MSCs) inject into the penis of diabetic rats and also found that intracavernous administration of MSCs improved erectile function of rats. Immunofluorescence analysis demonstrated that MSCs could differentiate into smooth muscle and endothelial cells. MSCs improved erectile function of diabetic rats also by paracrine effects. MSCs secreted lots of growth factors such as VEGF, bFGF, TGF β-1 and IGF-1. The content of these factors increased after MSCs injection. In our basic researches and clinical work, we should use combined therapy according to the multifactorial and complex pathogenesis of DMED, in order to elevate the therapeutic effect. Disclosure: Work supported by industry: no.

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THE FEATURES OF FORMING OF RESISTANCE TO ANTIBIOTICS OF N. GONORRHOEAE IN ASSOCIATION WITH MRSA AT NOT COMPLICATED GONORRHEA Singur, O Vladivostok State Medical University Objective: There is a steady growth of resistance N. gonorrhoeae to variety of antibiotics over the world, the frequency of associations N.

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gonorrhoeae with other agents of STIs increases. All it reduces efficiency of therapy, promotes disease relapses, development of such complications as prostatitises, epididimites, potentiality infringement, infertility and conducts to the further selection of gonococci strains with resistance to antibiotics. The aim of research is monitoring of resistance N. gonorrhoeae and the allocated microorganisms at mikstforms to antibiotics applied for treatment. Materials and Methods: We observed 70 patients with gonorrhea in age 18–45 year old. The sensitivity to antibiotics was spent by minimal inhibitory concentration (MIC) using agar dilution method. For definition the determinant of resistance is used method PCR by technique T. Nishijima, Y. Saito et al (1999) with primers to gene mecA (5-AACAGG-TGA-ATT-ATT-AGC-ACT-TGT-AAG-3, 5-ATT-GCT-GTT-AAT-ATT-TTT-TGA-GTT-GAA-3). Results: Over the last 5 years (2005–2009) we observed the decreasing of gonorrhoea as by a monoinfection to 32% of cases and we noted the growth of mikst-forms from 40% to 68%. More than in 32% of cases N. gonorrhoeae is fixed in association with S. aureus. Among all isolated S. aureus 60% had in structure of genome a gene of resistance mecA (MRSA). During 5 years we noted direct correlation between increasing number of associations N. gonorrhoeae and S. aureus and their resistance to antibiotics. In 2005 N. gonorrhoeae were resistant to doxycycline in 27% cases, and reached 68% in 2009. Increasing resistance to ciprofloxacin is noted from 6% to 24% in 2009, to spectinomycin—2% in 2009, the resistance to penicillin is fixed 100 %. Isolated MRSA strains show high resistance to all investigated antibiotics. So, 75% of isolated MRSA are resistant to doxycycline, to ciprofloxacin—83,3%, to spectinomycin—91% and 100% of MRSA strains have resistance to penicillin and ceftriaxone. Conclusion: For last five years the sensitivity of N. gonorrhoeae to antibiotics has decreased almost in 2 times. It has possibly a talk with the expressed adaptable abilities of N. gonorrhoeae, directed on kind preservation from one side, and increasing of frequency of occurrence in association with MRSA from another. Therefore, it is necessary to lead monitoring for resistance to antibiotics of N. gonorrhoeae and MRSA strains for the control over spreading of gonococcal infections and preventions of development of complications. Disclosure: Work supported by industry: no.

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CORRELATION OF ERECTILE DYSFUNCTION WITH LOWER URINARY TRACT SYMPTOMS IN ELDERLY PERSONS Yutian, D; Zhipeng, X; Yun, C The affiliated drum tower hospital, Nanjing University Objective: To investigate the degree of lower urinary tract symptoms (LUTS) in elderly persons with erectile dysfunction (ED) and evaluate the correlation between erectile dysfunction (ED) and lower urinary tract symptoms (LUTS). Methods: Total 67 patients were divided into mild group, moderate group and severe group according to international prostate symptom score (IPSS). Every patient took a 5-item version of the international index of erectile function (IIEF-5) test. The peak systolic velocity (PSV) and end diastolic velocity (EDV)of cavernosal artery were measured by color doppler ultrasonography. Then the results were statistically analyzed. Results: The means of IIEF-5 scores and PSVs decreased along with the progression of LUTS and significant differences were found when mild group comapared with moderate and severe group (P < 0.05). There was no significant difference of EDVs among three groups (P > 0.05). Conclusions: The sexual life quality in elderly persons with ED decreased along with the progression of LUTS and hemodynamic effect may be the etiological factor. Disclosure: Work supported by industry: no.

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ANALYSIS OF THE INFORMATIONAL CONTENT REGARDING THE KEY WORD BALGIBUJEON AS ERECTILE DYSFUNCTION IN ENGLISH USING DAUM VIEW INTERNET BLOG THROUGH AN RSS FEED Kang, DH1; Lee, JY1; Lee, SW2; Choi, HY1; Park, HY1; Moon, HS1 1: Hanyang University College of Medicine; 2: Eulji University School of Medicine Objectives: The emergence of Web 2.0 has changed the use of big portal sites to the integration of individual information as the center of internet information. Blogs and Twitter exist at the center of this change, through which health information is usually created and posted. Therefore, this study was conducted to analyze the content and quality of health information on balgibujeon as erectile dysfunction (ED) in English retrieved from a domestic blog. Material and Methods: Data regarding ED was retrieved from Daum view internet, the biggest metablog site (http://view.daum.net/) that provides information through an RSS feed. The search period was between January 24 and February 23 of 2010. The data obtained were analyzed by a single urologist and 2 residents at the Department of Urology in terms of the content and relevance of the information and the popularity of the post. The content of the information was classified as medical information, oriental medical information, non-medical information, daily life issue, news, advertisement or others. The relevance of the content was divided into 4 categories; (1) complete agreement, (2) partial agreement, (3) near non-agreement and (4) complete non-agreement. The preference of the post was rated according to the View On score that was provided by Daum view internet. Results: A total of 1,475 xml documents, which were created between March 2009 and Feb 2010, were obtained by retrieval through the aforementioned database. As for the content of the information, medical information was obtained in 363 (24.6%) of the 1,475 xml documents, oriental medical information in 128 (8.7%), non-medical information in 396 (26.8%), daily life issue in 315 (21.4%), news in 178 (12.1%), advertisement in 80 (5.4%) and others in 15 (1.0%). As for the relevance of the information, complete agreement was observed in 125 documents (34.5%), partial agreement in 98 documents (27.0%), near non-agreement in 100 documents (27.5%) and complete nonagreement (11.05%). These results were not statistically different from those of previous studies (P < 0.001) (Figure 1). The mean View On score of the individual content for the information was 2.96 (range, 0–128) for medical information, 2.13 (range, 0–27) for oriental medical information, 3.99 (range, 0–158) for non-medical information, 10.27 (range, 0–1107) for daily life issue, 3.30 (range, 0–172) for news, 2.16 for advertisement (range, 0–36) and 1.07 (range, 0–6) for others. The mean View On score of all content of the information in all xml documents was 4.71 (range, 0–1107). Conclusions: Although information on ED has increased year by year, medical information has occupied only 25% of the information, and the relevance of the information showed an agreement rate of 9.8%. However, the preference of the post was higher in non-medical information and daily life issue as assessed by the View On score. Taken together, it is necessary to provide correct information based on urological knowledge of ED by using blogs. Disclosure: Work supported by industry: no.

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IMPACT OF LOWER URINARY TRACT SYMPTOMS, OVERACTIVE BLADDER AND URINARY INCONTINENCE ON SEX LIFE: RESULTS OF THE CHINESE EPIC STUDY Yang, Y1; Lin, TL2; Chan, CK3; Yan, B4 1: Capital Medical University Affiliated Beijing Chaoyang Hospital, Beijing, China; 2: Taipei Veterans General Hospital and National Yang Ming University, Taipei, Taiwan; 3: Prince of Wales Hospital, Hong Kong SAR, China; 4: Pfizer Inc., New York City, USA Objective: To evaluate the impact of lower urinary tract symptoms (LUTS), overactive bladder (OAB) and urinary incontinence (UI) on the sexual aspects of quality of life in Chinese patients. Methods: This was a cross-sectional population-based survey of subjects aged ≥ 18 years old living in China, Hong Kong and Taiwan. Patients were recruited from June 2008 to August 2008 using a number of approaches, including street intercepts at hospital/clinic areas and patient referrals. Six hundred patients with OAB or stress UI symptoms (case group) and 600 patients without these symptoms (control group) were selected for the study. In each group there were 236 males and 364 females. The 2002 International Continence Society definitions were used to classify symptoms associated with LUTS, OAB and UI. Results: The proportions of sufferers who were currently sexually active (males 63.6%, females 60.7%) were comparable to the proportions of sexually active controls (males 54.2%, females 47.3%). Among respondents who were currently sexually active, urinary symptoms had a negative impact on sexual activity (decreased frequency or cessation) in both control subjects (12.7%) and sufferers (7.3%). Patients with urinary symptoms were significantly less satisfied with their sex life compared with controls (9.2% vs 5.0%, P < 0.05), particularly male sufferers when compared with male controls (14.0% vs 5.5%, P < 0.05). Female sufferers (5.9%) were less satisfied with their sex life compared with female controls (4.7%), but not significantly so. Conclusion: In this Chinese population, the presence of lower urinary tract symptoms, overactive bladder and urinary incontinence had a negative impact on sex life, in particular on sexual satisfaction. Disclosure: Work supported by industry: yes, by Pfizer Inc. (industry initiated, executed and funded study). The presenter or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.

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cally significant correlation between IIEF-5 scores and: age, serum testosterone, IPSS scores, BPH (P < 0.05). Serum testosterone did not correlate to IPSS score. Conclusion: Results of this study suggest that age, serum testosterone, BPH and LUTS are risk factors of sexual function, and sexual dysfunction is closely related to the severity of LUTS. This makes a direct association between male ED and BPH, supports the theory that the association between the two pathologies could be due instead to the common link of ageing.We recommend further studies, preferably of a longitudinal and/or qualitative character, to gain a more profound understanding of the interaction, probably multifactorial, between them. Disclosure: Work supported by industry: no.

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THE CLINICAL CHARACTER OF ERECTILE DYSFUNCTION IN AGING MALE Weidong, Z; Yun, C; Yutian, D The affiliated drum tower hospital, Nanjing University Objective: To investigate the principal amd clinical characteristics of erectile dysfunction (ED) in male elderly by retrospective study. Methods: All patients were divided into two groups, elderly patients with ED (group A) and non-elderly patients with ED (group B). The data of age, course of disease, past medical history, International index of erectile function (IIEF-5), nocturnal penile tumescence and intracavernous injection, were analyzed. Results: Compared to patients of group B, the patients of group A had a long course of disease (2.4 ± 2.5 years) and higher incidence of diabetes, hypertension and hyperlipemia (61%, 78%, 37%). Compared with group B, the mean score of IIEF-5 of group A was significantly reduced while the ratio of severe ED was significantly increased. The frequency, duration and ratio of penile volume and baseline of nocturnal erection of patients in group A were all decreased. After injection of alprostadil, the PSV and RI of group A were significantly lower than those of group B, but EDV was higher. Conclusion: Structural ED is the main type of elderly patients with ED with longer course of disease and more severe, especially vessel disease. The deficient of corporal blood supply and veno-occlusive caused by vasculopathy might play the key role in the pathogenesis of elderly patients with ED. Disclosure: Work supported by industry: no.

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PROSTATIC HYPERPLASIA AND SEXUAL FUNCTION

PREVALENCE OF LATE ONSET HYPOGONADISM IN LATVIA: A PRELIMINARY STUDY

Cedres, S1; Arroyo, C2; Dufrechou, C1 1: Clínica Médica “2”, Uruguay; 2: Servicio de Urología—Hosp. Pasteur

Pozarskis, A1; Erenpreiss, J2; Pozarska, J1 1: Private Practice; 2: Riga Stradins University, Latvia

Multiple studies have demonstrated a true relationship between benign prostatatic hyperplasia (BPH) and erectile dysfunction (ED). Objective: To evaluate the degree of sexual dysfunction in a population of men with benign prostatic hyperplasia (BPH) accompanied by lower urinary tract symptoms (LUTS), and to assess the correlation between sexual dysfunction and urinary symptoms and age. Methods: Hospitalized men >55 years were evaluated.They all received digital rectal examination by urologist and were evaluated through the International Prostate Symptom Score (IPSS), International Index of Erectile Function-5 (IIEF-5), and serum testosterone. ED was classified into five groups according to the scores: severe (1–7), moderate (8–11), mild-moderate (12–16), mild (17–21) and no ED (22–25). Regression analysis was used to determine the correlation among the variables. Results: 52 patients were included. The prevalence of benign prostatic hyperplasia was 41/52 (RF = 0,92). The mean age of the patients was 68.23 years, the mean IPSS score was 19,2, and the mean IIEF-5 was 8.45. There were 45 cases of erectile dysfunction. There was statisti-

Background: Life expectancy of Latvian men is one of the lowest in Europe: 67.3 years. Hereby we aimed to: a) investigate the prevalence of late onset hypogonadism (LOH) in Latvia; b) to elaborate an algorithm for screening LOH in men of the age 40 and older. Objectives and Methods: 169 men attending general practitioner office were asked to fill in the Aging Male Symptom (AMS) score form. 52 of these men, take testosterone and sex hormone building globulin level in serum. Results: 66% of all men showed impairment according to the AMS score. 39% of these men have serum testosterone deficiency or LOH. Conclusions: 1. LOH symptoms were found in 2/3 of Latvian men in the age group of 40 years and older among those attending general practitioners. Testosterone deficiency were found 39% of these men. 2. AMS score form is not ideal for LOH screening.Continuing the study, it will be elucidated which of these men can benefit from the testosterone replacement therapy. Disclosure: Work supported by industry: no.

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it was significantly less in those infused with Selenium-rich hot spring water (P < 0.05). Also, the serum IGF-1 levels (pg/ml) were 1247.72 ± 53.85 and 933.03 ± 113.69 in groups 1 and 2, respectively, which again, illustrated the significant lower level in those mice that were given Selenium-rich hot spring water (P < 0.05). Conclusion: Significantly decreased serum levels of leptin and IGF-1 were observed in mice which drank Selenium-rich hot spring water, and thus, we were able to deduce the role of Selenium-rich hot spring water on prostate cancer prevention. A long-term effect of Seleniumrich hot spring water on prostate cancer prevention is necessary; if it is indeed proven to have long-term effects, we believe it will become valuable in clinical practice.

PREVALENCE OF OSTEOPOROSIS IN MALE AGE-RELATED HYPOGONADISM Goñi, M1; Cedrés, S1; Montes, J2; Dufrechou, C1 1: Clínica Médica “2”, Uruguay; 2: Laboratorio Fertilab Men clinically diagnosed with hypogonadism consistently have low bone density. Measurements of testosterone in men with hip fractures show low levels of free testosterone. Bone biopsies from hypogonadal men with osteoporosis show a high bone turnover rate, as compared with eugonadal osteoporotic men. All men with hypogonadism should have their bone mineral density (BMD) measured, because it is known that it is low in this men. However, the rate and sites of bone loss following testosterone deficiency are not known. Objectives: Review the BMD in hypogonadal men that consulted for sexual dysfunction. Methods: BMD measurements were performed in the lumbar spine (LS) and femoral neck (FN) using Osteodensitometry Equipment DXA Fan-Beam, GE Lunar Prodigy Advance, Software 9.0 version, results compared with same age not hypogonadal men with T-score and Standard Deviations (SD). Hypogonadism was defined by calculating Free Serum Testosterone (FT). Results: 88 patients were included. The mean age was 54. All of them had hypogonadism as the only risk factor for osteoporosis. There was a relation between reduction of FT with reduction of BMD. 16/88 had T-Score ≥1.0 SD (normal BMD), 33/88 had T-Score between −1 and −2,5 SD (osteopenia) and 39/88 had T-Score ≤2.5 SD (osteoporosis). The observed reduction in BMD in the LS and FN did reach statistical significance (P < 0.005). Conclusion: These findings demonstrate a significant loss of bone in men with hypogonadism and suggest that the femoral neck and lumbar spine are the preferred sites for monitoring bone loss in older men. In addition, markers of bone resorption may be helpful. Further studies are needed to demonstrate whether testosterone administration affects BMD in these subjects. Disclosure: Work supported by industry: no.

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THE ROLE OF SELENIUM-RICH HOT SPRING WATER ON PREVENTION OF PROSTATE CANCER IN RAT

Disclosure: Work supported by industry: no.

Kim, SJ; Yoon, BI; Ha, US; Cho, HJ; Hong, SH; Lee, JY; Hwang, TK; Kim, SW The college of Medicine, the catholic University of Korea

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Objectives: There have been reports that a higher serum level of Selenium is related to a lower incidence of prostate cancer. Also, there are many studies relating prostate cancer to metabolic syndromes, and Selenium is known to be related to steroid melabolism through several mechanisms. Serum leptin and IGF-1 are factors related to metabolic syndromes which are also known to be related to prostate cancer, and the higher their levels, the higher the possibility of prostate carcinogenesis. Thus, we measured the serum levels of leptin and IGF-1 in rats that were given Selenium-rich hot spring water to drink in an attempt to elucidate the role of Selenium on prostate cancer prevention. Materials and Methods: A total of twelve white mice was included in the study, and they were further divided into a control group (group1, n = 6) induced to drink normal saline, and those mice that drank Selenium-rich hot spring water diluted to 10% (group 2, n = 6). The hot spring water that we used was from Kum-jin region which is composed of rich minerals such as Selenium, Vanadium, Calcium and Magnesium. The concentration of Selenium in hot spring water was 480 ug/L. After daily for four weeks, the two groups were each given normal saline and Selenium-rich hot spring water 50 mg/day. After the four weeks of experiment, we drew blood samples from both groups and measured serum leptin and IGF-1 levels using ELISA. Results: The serum leptin level (pg/ml) was 964.04 ± 127.77 in group1, and 531.92 ± 151.04 in group 2, allowing us to confirm that

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PREVALENCE OF HYPOGONADISM IN MALE PATIENTS WITH HEMODIALYSIS Valiño, J1; Cedrés, S1; Campeas, G2; Nuñez, M1; Montes, J3; Dufrechou, C4 1: Clínica Médica “2”, Uruguay; 2: NEPHROS; 3: Fertilab; 4: CEDIR—Rivera. Background: Men with renal failure have high incidence of Hypogonadism. It is thought to contribute to the sexual dysfunction experienced by these patients. However, the association between hypogonadism and different degrees of renal dysfunction is not well characterized in our country. Methods: We performed a prospective observational study involving a well characterized cohort of 56 men treated with HD to examine the relationship between testosterone concentration and renal failure. Non-fasting plasma was analysed for testosterone, luteinising hormone (LH), Albumina, sex hormone-binding globulin, and haemoglobin. Serum bioavailable testosterone (BDT) concentrations was classified as low (<43 ng/dL for older than 60 years and <58 for younger than 60 years). We defined hypogonadotropic hypogonadism when LH was lower than 8,6 UI/L. Results: The mean age was 64,6 (SD 13,8) years. Gonadal status: mean bio disponible testosterone (BDT) was 42,5 (SD 4,05) and mean LH 6,3 UI/l (SD 2,03). 60/65 (RF = 0,92) patients had significantly

Proceedings from the 14th World Meeting of the International Society for Sexual Medicine low BDT levels. All of them suffer from sexual dysfunctions and most of them had no sexual activity from 6 months ago. Gonadal status was correlated with diabetes, smoking, alcoholism and dialysis duration. Conclusion: Most of the patients with renal failure in dialysis phase have low levels of testosterone, which causes sexual dysfunction. The pituitary response is not adequate (low LH) and it is well related to the co morbid variables analyzed. Disclosure: Work supported by industry: no.

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INTRAMUSCULAR TESTOSTERONE UNDECANOATE FOR SUBSTITUTION IN MALE HYPOGONADISM—THE EXPERIENCE OF 12.4 YEARS ELUCIDATES BENEFICIAL EFFECTS ON THE NEWLY DEFINED METABOLIC SYNDROME AND REVEALS A HIGH DEGREE OF SAFETY Saad, F1; Zitzmann, M2 1: Bayer Schering Pharma; 2: Center for Reproductive Medicine and Andrology, University of Muenster, Muenster, Germany Background: A reliable form of androgen substitution therapy in terms of favorable kinetics and tolerance as well as effective restoration of androgenicity is paramount for hypogonadal men. The intramuscular injection of the long-acting ester testosterone undecanoate (TU) offers a convenient modality for testosterone substitution. Methods: We report data from 227 patients (117 with primary, 79 with secondary hypogonadism and 31 with late-onset hypogonadism) aged 15 to 71 years (mean 38 ± 12 years) receiving altogether 3692 intramuscular injections of 1000 mg of TU during a maximal treatment time of 12.4 years. Results: The medication was well tolerated and local irritation at the injection site was rare and moderate and did not exceed a duration of 3 days. Serum trough levels of testosterone were generally within the low normal range, indicating sufficient substitution. Individual dosing intervals ranged from 10 to 14 weeks. The proportion of men fulfilling the new joint consensus criteria of the International Diabetes Federation and the National Cholesterol Education Program for definition of the Metabolic Syndrome decreased from initially 86% to 45% (Chisquare for trend: P < 0.001). Regarding the single components of this clinical entity, especially waist circumference decreased from 106.0 ± 10.1 to 94.9 ± 8.7 cm (P < 0.001) within a time frame of 8 injections. Concentrations of lipoprotein subfractions, blood pressure and fasting glucose levels were positively influenced in a similarly significant manner. PSA concentrations did not exceed 4.0 μg/L, except for two measurements (each 5.5 μg/L) in cases of subsequently confirmed prostatitis. Hematocrit was significantly elevated under treatment but remained within the normal range, except for occasional measurements (maximal value 54.4%). Conclusion: Intramuscular injections of testosterone undecanoate represent a feasible, safe and well tolerated modality of androgen substitution in hypogonadal men of a wide age-range, substantiated by more than one decade of experience, facilitating a decrement of metabolic/cardiovascular risk factors. Disclosure: Work supported by industry: no. The presenter or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.

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PREVALENCE OF HYPOGONADISM IN TYPE 2 DIABETES Cedres, S1; Pupo, D1; Serra, P2; Montes, J3; Dufrechou, C1 1: Clínica Médica “2”, Uruguay; 2: Cátedra Endocrinología; 3: Fertilab

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panies significant weight loss and the improvement in body composition that results from androgen replacement therapy indicate that these changes in testosterone levels in diabetic patients are potentially reversible. Objective: Study the prevalence of hypogonadism (HIT) in this population, evaluate the pituitary response and define the relation between HIT and: age, chronic illness, habits, drugs, and metabolic diabetes control. Methods: We performed a prospective observational study involving a well characterized cohort of 82 type II diabetic men. Non-fasting plasma was analyzed for free testosterone (FT), luteinising hormone (LH). We defined hypogonadism (HIT) when TL ≤6,9 ng/dL (55–60 years) and ≤4,7 ng/dL (>60 years) We defined hypogonadotropic HIT when LH was lower than 8,6 UI/L. Regression analysis was used to determine the correlation among the variables. All of the patients filled the ADAM questionnaire. Results: The mean age was 64,1 (19–88, SD 13,8) years. Gonadal status: mean FT was 6,9 for patients between 55 and 60 years old, and 4,7 for patients older than 60 years. 58/82 suffer from hypogonadism (RF = 0,71). 19/58 were hypogonadotropic (RF = 0,33). 71/85 presented erectile dysfunction. FT correlated strongly with chronic illness (renal failure and liver disease), anemia, smokers and poor diabetic metabolic control (P < 0.05). Conclusion: Hypogonadism occurs commonly in type 2 diabetes. Pituitary function seems to be adequate to the FT level. It causes erectile dysfunction in most of this patients. This important aspect requires further investigation. Disclosure: Work supported by industry: no.

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ORAL TESTOSTERONE USE BEHAVIOR AMONG 254 SYMPTOMATIC LATE-ONSET HYPOGONADAL MEN Permpongkosol, S; Rata-Olarn, K Faculty of Medicine, Ramathibodi Hospital, Mahidol University Purpose: The objective of the study was to evaluate oral testosterone use behavior among symptomatic late-onset hypogonadal men (LOH). Materials and Methods: From March 1999 to November 2008 (9 years and 9 months), a total of 254 men aged 37–82 years documented LOH receiving an oral testosterone replacement therapy at a men’s health clinic. An oral testosterone use behavior questionnaire was posted to all patients and 169 were returned giving a response rate of 66.5%. Results: The LOH symptoms more frequently reported were decrease in morning erections (59.2%), erectile dysfunction (52.7 %) and decrease of sexual desire (49.7). For most of the LOH, the main medical histories were dyslipidemia (48.5%), hypertension (37.9%) and benign prostate hyperplasia (30.8%). The median of the total period of using oral testosterone was 2.18 years (0.1–10 years, 0.94; 3.91). At the end of our study, sixty-six patients (39%) were still on hormonal replacement therapy. One hundred and three cases (61%) responded that the main reason for ceasing the treatment were clinical improvement (33%), lower urinary tract symptoms (18%), and advised to stop using male hormone (10%) by the doctor treating other illness. Four patients expressed fear of developing cancer or other long term complications (2.4%). Four percent of patients stopped using oral male hormone supplements because of side effects, such as weight gain or edema (0.6%), oily and pimpled face (0.6%) and headaches or dizziness (2.4%). The percentage of patients who would recommend oral testosterone supplements to friends who are LOH was 40%, with undecided 30%, would not recommend 22%, and unspecified 8%. Conclusions: This study found that practice guidelines regarding oral testosterone therapy in LOH were needed and should cover the risks and benefits of the long-term use of hormonal therapy. Disclosure: Work supported by industry: no.

Type 2 diabetes is associated with lower total and free testosterone levels in cross-sectional studies, and Obesity and aging seem to be the common factors. The increase in total testosterone levels that accom-

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Hormonal examination revealed adrenal deficiency due to an undetectable ACTH value. They dramatically recovered after steroid replacement immediately following diagnosis. They are currently in good condition as a result of steroidal maintenance without side effects. Conclusions: IAD is one of the diseases of that should be considered in differential diagnosis of various diseases in an LOH syndrome clinic.

EFFECT OF TANKYRASE 1 ON AUTOPHAGY IN THE CORPUS CAVERNOSAL SMOOTH MUSCLE CELL FROM AGED ERECTILE DYSFUNCTION RATS AND POTENTIAL MECHANISM Xin, ZC Peking University First Hospital, Peking University Objectives: To compare Tankyrase 1 and autophagy difference between ED and non-ED rats’ corpus cavernosum smooth muscle cells (CSMCs), and to explore the effect and possible mechanism of Tankyrase 1 on autophagy and cell proliferation in aging ED rats’ CSMCs. Methods: 24-month-old ED and 8-month-old male Wistar rats were checked by intracavernous pressure/mean systematic arterial pressure measurement. The rats’ corpus cavernosum smooth muscle cells (CSMCs) were isolated and cultured by enzyme digestion, in which Tankyrase 1 expression and autophagy quantity were compared. Tankyrase 1 overexpression was performed with plasmid transfection by LipofectamineTM. The effect of Tankyrase 1 overexpression on proliferation, autophagy and mTOR pathway in 24-month-old ED rats’ CSMCs was checked by methyl thiazoly tetrazolium assay, cell cycle analysis in flow cytometry, transmission electron microscopy, Monodansylcadaverine staining, GFP-LC3 fluorescence and Western-blot. Results: The primary CSMCs were confirmed by immunofluorescence and the purity was 99.2% in flow cytometry. Compared to that of 8-month-old rats, Tankyrase 1 expression and autophagy quantity significantly decreased in 24-month-old ED rats’ primary CSMCs. In 24-month-old ED rats’ CSMCs with Tankyrase 1 overexpression, it significantly increased growth rate and increased S phase from 6.61% to 15.11%, furthermore, the autophagosome quantity was remarkably increased, together with LC3-I/II, Beclin 1 up-regulation and pp70S6K down-regulation. Conclusion: Tankyrase 1 and autophagy decrease with aging, and Tankyrase 1 may have a positive effect on proliferation through enhancing autophagy and regulating mTOR signaling pathway.

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WITHDRAWN

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IS ISOLATED ACTH DEFICIENCY A SIGNIFICANT DISEASE IN DIFFERENTIAL DIAGNOSIS FOR LOH SYNDROME? TWO CASE REPORTS Yoshikazu, S; Hitoshi, T; Hisao, N; Toshikazu, N; Keigo, A; Tatsuo, H; Musashi, T; Kazunori, H; Kousuke, U; Ichiya, H Sanjukai Hospital, Japan Objectives: We experienced two cases of isolated ACTH deficiency (IAD) in late onset hypogonadism (LOH) outpatient clinic. IAD is a secondary adrenal deficiency that may lead to a life-threatening condition. It is difficult to diagnose this rare disease properly, although the number of case reports is increasing. Its symptoms such as general malaise overlap those of LOH syndrome. IAD is a possible disease of those referred for LOH syndrome. Material and Methods: The clinical courses of two patients and points of differential diagnosis between IAD and LOH syndrome are reported here. Results: 54 y.o. and 51 y.o. male patients with severe general malaise and appetite loss and hypotension visited our clinic for evaluation of possible LOH syndrome. They had been diagnosed with different diseases and received other treatments. Their symptoms were not changed by the previous treatments. Their aging male symptom scores showed high somatovegatative and normal other subscale scores. According to their severe physical symptoms (malaise, muscle weakness, appetite loss, body weight loss and hypotension) without psychological distress, we considered adrenal insufficiency for them.

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THE EFFECTS OF ANTHOCYANIN EXTRACTED FROM BLACK SOYBEAN ON BENIGN PROSTATIC HYPERPLASIAINDUCED RAT MODEL Kim, SJ; Jang, H; Ha, US; Yoon, BI; Cho, HJ; Hong, SH; Lee, JY; Hwang, TK; Kim, SW Tthe college of Medicine, the catholic univerity of Korea, South Korea Purpose: Anthocyanin is a natural plant pigment and potent antioxidant. We investigated its actions and antioxidant properties on benign prostatic hyperplasia using a rat model. Materials and Methods: thirty male rats were divided into 5 experimental groups: the control, BPH-induced, BPH induced and oral anthocyanin (40 mg/kg, 80 mg/kg, 160 mg/kg) ingestion groups. For exclusion of intrinsic testosterone influence, bilateral orchiectomy was done except the control group. An experimental prostate hyperplasia

Proceedings from the 14th World Meeting of the International Society for Sexual Medicine was induced by the administration of testosterone propionate, 3 mg/kg SC, for 4 weeks except the control group. Anthocyanin ingestion was done in last 4 weeks in anthocyanin ingestion groups. After 8 weeks, the prostates were removed, and analyzed for their prostatic weight, his histological examination. Then TUNEL stain was done in each group specimens and analyzed for their apoptotic body counts. Results: The mean prostate weight were found to be 674.17 ± 28.24 mg, 1098.33 ± 131.31 mg, 323.00 ± 22.41 mg, 324.00 ± 26.80 mg, 617.50 ± 31.08 mg in the control, BPH-induced, and oral anthocyanin ingestion (40 mg/kg, 80 mg/kg, 160 mg/kg) groups. The BPH induced group showed statistically increases in their prostate weights compared with control group (P < 0.05) and anthocyanin ingestion groups showed significant decreases than BPH-induced group statistically (P < 0.05). Histologically injected testosterone lead to prostatic hyperplasia, but anthocyanin ingestion groups decreased this change. Apoptotic body counts in 5x400/HPF were found to be 3.67 ± 0.86, 1 ± 0.94, 15.67 ± 2.36, 28.33 ± 1.71, and 11.00 ± 0.66 in each groups. Anthocyanin ingestion groups showed statistically significant increases in apoptotic body counts compared with BPH induced Group (P < 0.05). Conclusion: These results suggest that anthocyanin may be effective in decreasing volume and suppressing proliferation of prostate. And we believed that these results were due to the antioxidant properties of anthocyanin. Disclosure: Work supported by industry: yes, by Rural development administration (no industry support in study design or execution).

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THE ASSOCIATION BETWEEN THE SEVERITY OF TYPE 2 DIABETES AND ERECTILE DYSFUNCTION Gosyanto, JF1; Bandaso, R2; Lawrence, GS3 1: Practicing Sexual Physician; 2: Andrologist, Dept of Pathology, Faculty of Medicine Hasanuddin University; 3: Vascular Research Unit, Dept of Pathology, Faculty of Medicine Hasanuddin University Introduction: Type 2 diabetes causes myriads of complications through several pathological mechanisms, such as oxidative stress, endothelial dysfunction, vascular inflammation, and glycosilation of interstitial matrix. Aim: To find out the correlation between the severity (controlled and uncontrolled) of type 2 diabetes and erectile dysfunction. Main Outcome Measures: International Index of Erectile Function5 (IIEF-5), laboratory measures of glycemic states, and endogenous ADMA. Methods: All participants completed the IIEF-5 questionnaires and undergone laboratory examination (Fasting Plasma Glucose, HbA1c and ADMA); cross-sectional study design was conducted in 46 controlled and 62 uncontrolled diabetic Indonesian male adults, aged 40–60 yrs. Results: There is a strong negative correlation between fasting plasma glucose and IIEF-5 score (r = −0,370, P = 0,000); between HbA1c and IIEF-5 score (r = −0,592, P = 0,000). However, there is no significant correlation between ADMA and IIEF-5 score (r = −0,185, P = 0,134). There is a better erectile function in patients with better diabetic control as indicated by A1c < 7% as compared to A1c ≥7% (18,98 ± 4,7 vs 12,68 ± 4,92). Conclusions: We have demonstrated that better type 2 diabetes mellitus management brings about lesser degree of erectile dysfunction. Disclosure: Work supported by industry: no.

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AGE, DURATION, COMPLICATIONS AND VIBRATION PERCEPTION THRESHOLD ARE SIGNIFICANT INDICATORS FOR ERECTILE DYSFUNCTION IN PATIENTS WITH DIABETES MELLITUS Amano, T1; Seki, M1; Imao, T1; Takemae, K1; Ohta, Y2; Sakai, S2; Ohta, H2 1: Nagano Red Cross Hospital/Japan; 2: Ohta DM clinic/Japan Objectives: Diabetic mellitus (DM) is one of the most important risk factors of erectile dysfunction (ED). However, only few patients with DM eager to treat their ED conditions. The objects of this study are to find out indicators to define ED situation in DM patients. Material and Methods: (1) The DM parameters, including age, serum levels of blood sugar (BS), hemoglobin A1c (HbA1c), duration of DM, number of DM complications were obtained from 135 patients at general DM clinic. (2) The peripheral neuropathy examinations by vibration perception threshold (VPT: measured at inner ankle using a tuning fork, decline of VRT: <10 seconds) and Achilles tendon reflex were also performed in 86 DM patients. Erectile functions in DM patients were evaluated by international index of erectile function (IIEF 5). These DM patients’ parameters were compared with IIEF 5 scores. Results: (1) The data obtained from 135 DM patients, showed IIEF 5 scores were significantly correlated with patients’ age, duration of DM and number of DM complications (P < 0.0001, P = 0.0051 and P = 0.0002; paired t-test), respectively. (2) The mean VPT time were 10.7 ± 3.2 (0∼17.5) seconds. IIEF 5 scores were significantly correlated with VPT time (P = 0.0024). However, no significant relationship was not obtained between IIEF 5 scores and BS (P = 0.1154), HbA1c (P = 0.5421), Achilles tendon reflex (P = 0.1513). Conclusions: The severity of ED in DM patients depended on patients’ age, duration of DM, number of DM complications and VPT. These parameters were considered to be significant indicators for predicting ED in DM patients. Especially, the measurement of VPT is considered to be a simple and useful examination to diagnose ED in patients with DM. Disclosure: Work supported by industry: no.

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ERECTILE DYSFUNCTION IN MEN TREATED FOR TESTIS CANCER Tal, R; Logmanieh, NE; Narus, J; Mulhall, JP MSKCC Introduction: Testis cancer is most commonly diagnosed in young men. The diagnosis of a cancer and orchiectomy are stressful events. Minimal data exist on sexual dysfunction in the testis cancer population. This study was undertaken in men who developed erectile dysfunction (ED) after testis cancer treatment. Methods: All men treated for testis cancer who presented for sexual function evaluation were included in an institutional database. All men underwent standard evaluation including history/physical examination, completion of the International Index Of Erectile Function (IIEF) questionnaire, androgen/gonadotropin measurement and a duplex Doppler ultrasonography (DUS). Results: 76 men constituted the population. Mean age was 29 ± 8 years. 25% were partnered. 39% had seminoma (S) and 61% NSGCT (NS). 66% of S patients had radiation. 79% of NS had chemotherapy, 18% primary RPLND and 20% post-chemotherapy RPLND. The mean time to seek sexual medicine consultation was 12 ± 7 months after treatment completion. Median number of vascular risk factors was 0 (range 0–2). Mean remaining testis size = 16 ± 8 mls. Mean total testosterone, LH, FSH levels were 312 ± 186 ng/dl, 9 ± 7 IU/ml, 17 ± 12 IU/ml. 26% had total T levels <300 ng/dl. 84% complained primarily of loss of erection sustaining capability. 24% had had prior episodes of transient ED. Mean IIEF erectile function domain score

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was 18 ± 6. 100% of patients had a normal DUS. Median number of injections for the DUS was 2. Mean peak systolic and end diastolic velocities were 48 ± 16 cm/s and 2.2 ± 1 cm/s. 88% responded with penetration hardness erection to PDE5 inhibitor (PDE5i) use (mean EFD score 27 ± 5), however 12% did not (mean EFD score 17 ± 6). No difference in hemodynamics existed between those men with and without hypogonadism. Conclusions: Men with testis cancer presenting with erectile dysfunction after treatment appear to uniformly have normal erectile hemodynamics, suggesting adrenaline mediated ED. Endocrine factors do not appear to play a role. While the majority respond successfully to PDE5i, a significant minority do not. Disclosure: Work supported by industry: no.

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HIGH DOSE VARDENAFIL IS EFFECTIVE AND WELL-TOLERATED FOR TREATING ERECTILE DYSFUNCTION IN AGING MEN Sasaki, H; Yamamoto, K; Morita, JUN; Aoki, K; Ota, M; Oshiomi, K; Shichijo, T; Ogawa, Y 1: Urology, Showa University Fujigaoka Hospital, Japan Objectives: To assess the efficacy and safety of vardenafil in the treatment of erectile dysfunction in men of different age groups. Patients and Methods: We evaluated 144 patients received vardenafil treatment. We assessed the efficacy and safety of 10 mg vardenafil and 20 mg vardenafil, among three age groups (<44 years, 45–64 y, >65 y). Results: In the vardenafil 10 mg group, the number of patients of <44 are 36 cases, 45–64 are 46 and >65 are 21. On the other hand, in the vardenafil 20 mg group, the number of patients of <44 are 18, 45–64 are 23 and >65 are 22. The efficacy in the men aged < 44 are 61.1%, 45–64 are 80.4% and >65 are 47.6% in 10 mg group. And the efficacy in the men aged <44 are 72.2%, 45–64 are 69.6% and >65 are 81.8% in 20 mg group. Only one case discontinued treatment due to headache and flashing in the 10 mg vardenafil, but there was no case to discontinue in the 20 mg group. In both groups, there were no moderate or severe adverse events. Conclusion: Vardenafil is effective and well-tolerated for treating erectile dysfunction in a broad population of men, especially high dose vardenafil is effective both <44 years group and >65 years group.

American physician, J. King for the first time mentioned the use of a vacuum-device in the treatment of ED by applying vacuum to the penis although not combining it with the principle of constriction. On February 14th in the year 1913, Dr. O. Lederer took out a patent on ‘a device for the artificial erection of the penis’. His device for the first time combined the principles of using vacuum for initiating an erection by applying a glass suction-bell to the penis and constriction of the penile base by using a rubber ring in order to maintain erection after the suction-bell has been removed. Unfortunately, no medical publication referring to that device could be found and therefore it remains unclear, if the device ever reached series production. Dr. O. Lederer lost his Life in 1944 in the concentration camp in Auschwitz-Birkenau. It took a long time until the VCD was developed to series production and approved by the FDA later by G. D. Osbon in 1982 and it is still used in ED treatment until now. The VCD was recommended to 40 patients with ED from 01/2006 until 01/2010 in our practiceclinic. 17 pat. suffered from ED due to radical prostatectomy (RP), 10 pat. due to other treatment for prostate cancer (radiation etc). 10 pat. suffered from organic ED, 3 were found to have psychogenic ED. All off them were non-responders to PDE5-inhibitors and penile injection therapy or denied injections. All patients have been contacted be telephone, performing a semistructured interview. Results: 25 pat. were satisfied with VCD-treatment, 7 were not satisfied due to not reaching enough rigididy of the penis with the device and 4 admitted, not to have used the device at all after prescription. 4 patients were lost to follow-up. Conclusion: Based on the reviewed literature, the VCD is an acceptable treatment option with satisfaction rates up to 70 % or higher. Our results support the use of VCD in PDE-5/SKIT-non-responders even in 2010. Nevertheless some patients do not use the device, even if it is reimbursed in Germany by most insurance companies. In order to keep that rate as low as possible, pat. have to be informed before prescription about the exact way to use the device and should talk to their partner before prescription in order to make sure, the female partner will accept that treatment method especially in the older population. Disclosure: Work supported by industry: no.

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EFFICACY OF LOW-DOSE TADALAFIL ADMINISTRATION ON PATIENTS WITH ARTERIAL ERECTILE DYSFUNCTION

Disclosure: Work supported by industry: no.

Yutian, D; Zhipeng, X; Yun, C; Weidong, Z The affiliated drum tower hospital, Nanjing University

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Objective: To evaluate the effect of low-dose administration of phosphodiesterase type 5 inhibitor tadalafil on patients with arterial erectile dysfunction. Methods: Forty-three patients with arterial erectile dysfunction were requested to take 5 mg tadalafil after supper on alternate days for 4 weeks. Every patient took a 5-item version of the international index of erectile function (IIEF-5) test first and then the peak systolic velocity (PSV) of cavernosal artery were measured by color doppler ultrasonography after intracavernous injection with 10 μg prostaglandin E1. Results: IIEF-5 scores and PSVs were higher after the treatment when compared with baseline, respectively (P < 0.01). Conclusion: Low-dose administration of tadalafil demonstrated clinically meaningful and statistically significant efficacy in patients with arterial erectile dysfunction.

HISTORICAL EVOLUTION OF THE VACUUM CONSTRICTION DEVICE (VCD) IN THE TREATMENT OF ERECTILE DYSFUNCTION (ED) FROM 1874 UNTIL NOW—OBSOLETE OR DOES IT STILL HAVE A MEANING IN ED-TREATMENT? Ju, M1; Schenck, M2; Thomas, M3; Schneider, T1 1: University Hospital of Essen, Germany and PURR-Clinic Muelheim, Germany; 2: University Hospital of Essen, Germany; 3: PURR-Clinic Muelheim, Germany Introduction and Objectives: The historical evolution of the VCD from 1874 until now is one of the most interesting developments in ED treatment besides the invention of PDE-5-inhibitors. Therefore, its way from first prototypes, only built to treat the producer himself, until its position as a worldwide accepted treatment option for ED as well as the importance and results of the VCD in our urological practice clinic in 2010 have been investigated. Material and Methods: Vacuum has been discovered to be useful for medical treatment as early as in 1837 by M. Junod. Although the beneficial effect of vacuum was known for a long time, ED belonged to the sexual disorders and therefore it took a long time until 1874 the

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Disclosure: Work supported by industry: no.

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INTRACAVERNOUS INJECTION (ICI) OF PGE1 FOR TREATMENT OF ED WHEN PDE5INHIBITOR THERAPY IS INEFFECTIVE OR CONTRAINDICATED Tai, T1; Nagao, K1; Nakajima, K1; Ishiwatari, T1; Kobayashi, H1; Ishii, N1; Fujime, M2 1: Toho University School of Medicine; 2: Juntendo University School of Medicine Objectives: Although PDE5 inhibitors are the first-line treatment for erectile dysfunction (ED), approximately 30% of patients are nonresponders. Moreover, PDE5 inhibitors (PDE5Is) are contraindicated in patients taking any form of nitric acid, eg, in the treatment of angina. In such cases, external negative-pressure devices and intracavernous injection (ICI) therapy are the standard treatments. In this study, we evaluated the safety and effectiveness of ICI therapy at our center. Material and Methods: At our center, in patients for whom PDE5I therapy was ineffective or contraindicated, erection was induced by ICI of 20 μg of prostaglandin E1 (PGE1). A type II or III response was classified as effective, as per the standards of the International Society for Sexual Medicine, and a self-injection regimen was begun. The study was approved by the Toho University Omori Hospital Ethics Committee, and all patients provided written informed consent for inclusion in the study. Results: A total of 98 patients with ED were tested with an ICI of 20 μg PGE1, excluding those for whom the test was done for diagnostic purposes. Two patients with a type III response were restarted on a PDE5I, 50 patients with a type II or III response chose penile selfinjection therapy (51%), and 46 patients with a type I or II response chose another treatment. There were no cases of type IV response; however, 2 patients developed protracted erections, which were treated by venesection and phenylephrine injection. Adverse drug reactions during the test included the 2 cases of protracted erection and 2 cases of penile pain. Six patients with a type II response selected another treatment (surgery for prostatitis: 3, external negative-pressure device: 3). Adverse drug reactions due to self-injection included penile pain in 2 patients, both of whom were able to continue self-injection. Overall, 12% of patients selected another treatment or described the treatment as ineffective; 88% had satisfactory results. Conclusions: Among patients for whom PDE5I therapy was ineffective or contraindicated, 51% selected self-injection therapy; 88% of these were able to successfully continue treatment. Our results indicate that self-injection with PGE1 is safe and effective for the treatment of ED. Disclosure: Work supported by industry: no.

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THE STANDARD OF DIFFERENT DOSES OF TADALAFIL ADMINISTRATION ON PATIENTS WITH ED Yun, C; Yutian, D; Zhipeng, X The affiliated drum tower hospital, Nanjing University Objective: In order to provide the suitable choice for clinical doctor, we observed the effect of two different doses administration of tadalafil (5 mg and 10 mg) on alternate days for 4 weeks on patients with ED. Methods: Every patient took a 5-item version of the international index of erectile function (IIEF-5) test and the peak systolic velocity (PSV) of cavernosal artery were measured by color doppler ultrasonography after intracavernous injection with 10 μg prostaglandin E1. According to the value of PSV, 136 patients randomly divided into four groups. Group A: PSV > 15 cm/s, 10 mg tadalafil; Group B: PSV > 15 cm/s, 5 mg tadalafil; Group C: PSV < 15 cm/s, 10 mg tadalafil; Group D: PSV < 15 cm/s, 5 mg tadalafil. Results: The scores of IIEF-5 and the values of PSVs were significantly higher after the treatment when compared with baseline, respectively (P < 0.01) and the same tendency the scores and values of

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Group C were significantly higher campared with Group D (P < 0.01). But there are no significant difference between group A and group B. Conclusion: Different doses administration of tadalafil both effect on ED patient. To reduce drug side effect and medicine cost, the patients with PSV > 15 cm/s can choose 5 mg on alternate days. But the patients with PSV < 15 cm/s can choose 10 mg or more on alternate days as far as possible to get more effective. Disclosure: Work supported by industry: no.

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EXTENT OF IMPROVEMENT IN SELFESTEEM, CONFIDENCE, AND RELATIONSHIP INCREASES WITH EXTENT OF IMPROVEMENT IN ERECTILE FUNCTION IN MEN TREATED WITH VIAGRA (SILDENAFIL CITRATE) Jun Park, H; Moon KH Pusan National University School of Medicine, Korea Objective: In 2 similarly designed double-blind, placebo-controlled trials from the United States and Brazil, Mexico, Australia, and Japan, successful treatment of erectile dysfunction (ED) with Viagra was associated with improved self-esteem, confidence, and relationship as measured with the Self-Esteem And Relationship (SEAR) questionnaire. Here, the relationship between these outcomes is further analyzed, using pooled data. Materials and Methods: Men with ED, aged ≥18 years, with low self-esteem (per the SEAR Self-Esteem subscale) were randomized to flexible-dose Viagra (25, 50, and 100 mg) or placebo. Outcomes were the change from baseline to week 12 in scores for the SEAR components (Sexual Relationship domain, Confidence domain [ie, the SelfEsteem and Overall Relationship subscales], and Overall score) and in ED severity categorized by scores on the Erectile Function (EF) domain of the International Index of Erectile Function (normal EF [26–30], mild ED [22–25, near-normal], mild-to-moderate ED [17– 21], moderate ED [11–16], or severe ED [≤10]). Results: The placebo (n = 274) and Viagra (n = 279) groups were well balanced for demographics, ED duration, and ED etiology. In the Viagra group compared with the placebo group, EF was normal or near-normal (EF domain score of ≥22) in ≤5% of men at baseline (9/256 vs 13/254), increasing to 72% (184/256) vs 36% (91/254) at week 12 (P < 0.0001, Chi-square), with improvement by ≥1 EF severity categories in 85% (217/256) vs 46% (118/254; P < 0.0001, Chi-square). SEAR scores showed minimal or negative changes in men whose EF did not improve but increased in men whose EF improved. In the Viagra group, SEAR scores improved 8–20 units in men whose EF improved by 1 EF severity category and by 34–42 units in men whose EF improved by ≥1 EF severity category. Conclusion: Viagra treatment results in normalization or near normalization of EF in most men with ED. Improvements in EF are accompanied by substantial improvements in self-esteem, confidence, and relationship. Disclosure: Work supported by industry: yes, by Pfizer Inc (industry initiated, executed and funded study).

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IMPROVED ERECTILE FUNCTION AND SUCCESESFUL SEXUAL INTERCOURSE CORRELATE WITH IMPROVED SEXUAL RELATIONSHIP IN MEN WITH ERECTILE DYSFUNCTION RECEIVING VIAGRA (SILDENAFIL CITRATE) Son, H; Gye MC; Park HJ Seoul National University Boramae Medical Center, Korea Objective: In men aged ≥18 years who were treated with flexible-dose (25, 50, and 100 mg) Viagra® (sildenafil citrate) for erectile dysfunc-

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tion, this 10-week open-label, multicenter trial sought correlations between both erectile function (EF) and successful sexual intercourse (SSI), and satisfaction with sexual relationship (SR). Material and Methods: Assessments were made with the SR domain of the Self-Esteem And Relationship questionnaire, the EF domain of the International Index of Erectile Function, SSI as a percentage of event-log recorded attempts at sexual intercourse, and global efficacy questions (“Has treatment improved your erections?”; “Has treatment improved your ability to have sexual intercourse?”). Mean ± SD changes from baseline to week 10 were analyzed using the paired t test, which was 2-sided and performed using the 5% significance level. For correlations, a 95% confidence interval (CI) was constructed using a back-transformation of a 95% CI based on Fisher’s z transformation of Pearson’s correlation coefficient. Results: 382 men were enrolled and treated: mean ± SD age, 55 ± 13 years; mean ED duration, 4 years. At the end of treatment, most patients were taking 100 mg (61%) or 50 mg (37%). There was a significant improvement in SR domain score (from 45.8 ± 18.5 to 73.4 ± 21.7), EF domain score (from 14.2 ± 6.7 to 24.2 ± 8.2), and the percentage SSI (from 27% ± 34% to 82% ± 32%); P < 0.0001 for each. At week 10, 88% (95% CI, 83%–91%) of men reported improved erections and 86% (95% CI, 82%–90%) reported improved ability to have intercourse; P < 0.0001 for each. The improvement in SR domain score correlated positively with all other measures (P < 0.0001 for each): improvement in EF domain score (r = 0.64) and percentage SSI (r = 0.53), and percentage of men reporting improved erections (r = 0.48) and improved ability to have sexual intercourse (r = 0.49). Conclusions: Sildenafil treatment significantly improves EF, the likelihood of SSI, and SR. The positive correlation between these measures suggests that as EF improves and the likelihood of SSI increases, a couple’s satisfaction with their SR may also improve. Disclosure: Work supported by industry: yes, by Pfizer Inc (industry initiated, executed and funded study).

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INCREASED FREQUENCY OF SUCCESSFUL INTERCOURSE CORRELATES WITH IMPROVED SELF-ESTEEM AND SEXUAL RELATIONSHIP REGARDLESS OF AGE IN MEN WITH ERECTILE DYSFUNCTION TREATED WITH VIAGRA (SILDENAFIL CITRATE) Son, H; Lee CH Department of Urology, School of Medicine, Kyung Hee University, & Boramae Medical Center, Seoul, Korea Objective: To determine the relationship between a successful sexual experience and psychosocial outcomes. Material and Methods: In this 10-week, open-label, Viagra (sildenafil citrate), multicenter trial, event log measures of erectile function/intercourse success were an erection lasting long enough for successful intercourse, an erection hard enough for intercourse, ejaculation and/ or orgasm, and a second erection hard enough to attempt intercourse within 24 hours. The Self-Esteem subscale and Sexual Relationship domain of the Self-Esteem And Relationship (SEAR) questionnaire are the psychosocial outcomes used in this analysis. Mean ± SD changes from baseline to week 10 were analyzed using the paired t test, which was 2-sided and performed using the 5% significance level. Correlations were sought, overall and within age groups (<50 years, 50–65 years, and >65 years), between the increase in percentage occurrence of event log outcomes (as a percentage of occasions of sexual activity) and the improvement in scores on the SEAR components. Results: 382 men were enrolled and treated: mean ± SD age, 55 ± 13 years; mean ED duration, 4 years. At the end of treatment, most patients were taking 100 mg (61%) or 50 mg (37%) Viagra. Scores for the SEAR components (Self-Esteem subscale and Sexual Relationship domain) improved and the percentage occurrence of event log outcomes increased (P < 0.0001 for each). For each of the two SEAR components, score improvement correlated significantly with increased

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percentage occurrence of each event log measure, overall, in the men aged 50–65 years, and (except for the Self Esteem subscale with erection hard enough for intercourse and with ejaculation and/or orgasm) in the men aged > 65 years (P < 0.05). In the men aged < 50 years, the only significant correlations were for the Sexual Relationship domain with erection lasting long enough for successful intercourse and with ejaculation and/or orgasm. Conclusions: Increased frequency of erectile function/intercourse success associated with Viagra treatment correlated with improved self-esteem and improved sexual relationship, with no significant difference between age groups, and may result in a more satisfying sexual experience. Disclosure: Work supported by industry: yes, by Pfizer Inc (industry initiated, executed and funded study).

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THE INITIAL EXPERIENCE OF GENITAL NEUROPATHY TREATMENT BY PHOSPHODIESTERASE-5 INHIBITORS IN THE PATIENTS WITH DIABETES MELLITUS Kurbatov, DG; Lepetuchin, AE; Dubsky, SA; Rozhivanov, RV Endocrinological Research Centre/Russia Objective: Genital neuropathy is characterized by ED which is appeared in progressive decline of penis rigidity, prolonged prelude period, penis’s paresthesia and decline of sensitivity. We evaluated the role of phosphodiesterase-5 inhibitors in the treatment of diabetic genital neuropathy. Materials and Methods: 16 male subjects 27 y.o. [25; 29] with medical history of Diabetes Mellitus type 1, erectile dysfunction (ED) and symptoms of genital neuropathy were included in the study. Examination consisted of survey by IIEF-5 and evaluations of local sensitivity. We administrated udenafil 100 mg daily during 3 months. Statistic analysis of data was calculated from Wilcoxon test. Statistically significant considered differences was P < 0,05. Results: The subjects duration of Diabetes Mellitus were 9 [7;11] years. Duration of ED was 3 [2;4] years, total score of ED were 15 [14;17] before and 21 [21;22] after the treatment (P < 0,001). The level of HbA1c was 8,3 [8,9;9,1]% before treatment and 8,7[8,3;9,1]% after treatment (P = 0,3). All patients experienced progressive decline of penis exertion before the treatment and marked improvement after the treatment. 15 pts experienced prolonged prelude period before the treatment and marked improvement after the treatment. 9 pts experienced penis’s paresthesia before the treatment and only 2 pts—after the treatment. 13 pts experienced disturbance of temperature sensitivity before the treatment and 3 pts—after the treatment (P < 0,05). There were no any significant adverse events and nobody was excluded from the study. Conclusion: Udenafil demonstrated safety and efficacy action on ED and decrease of genital neuropathy symptoms, that could be considered as the result of enhance of endoneural blood supply. Disclosure: Work supported by industry: no.

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CLINICAL FEATURES AND TREATMENT OPTIONS FOR CHINESE PATIENTS WITH SEVERE PRIMARY ERECTILE DYSFUNCTION Xin, ZC Peking University First Hospital, Peking University Objectives: To investigate clinical features of Chinese patients with severe primary erectile dysfunction (S-PED) and to identify the ideal treatment options for this population. Methods: Patients with PED were screened for enrollment in our study. Sexual history, marital status, and erectile function were evaluated by inquiry including International Index of Erectile Function-5. Individuals with severe PED (defined as refractory to management

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with phosphodiesterase type 5 inhibitor [PDE5i]) underwent serum hormone analysis, penile color duplex Doppler ultrasound, neuroelectromyogram, and cavernosography as appropriate. Long-term treatment results were determined. Results: Among 220 PED patients, 72 (32.7%) suffered from severe PED (PDE5i nonresponse). Mean age was 31.5 ± 4.5 years and mean duration of attempts at sexual activity was 2.4 ± 3.2 years, Sixty-eight men (94.5%) had organic etiologies for erectile dysfunction, including arteriogenic (n = 13), venogenic (n = 35), endocrinologic (n = 6), neurologic (n = 9), and cavernosal fibrosis (n = 5). Sixteen men (22.2%) had been divorced. Mean erectile function and quality of life were significantly improved (P < .001) in the 25 men (34.7%) who were treated by penile prosthesis implantation, at a mean follow-up of 5.6 years. Satisfaction with penile prosthesis for patients and partner was 93.4% and 92.3%, respectively. Conclusions: Severe PED has a major impact on young couple’s life quality. Venous leak is the most common cause of severe PED. Penile prosthesis implantation is safe and effective for severe PED.

catheter (Group 2, n = 10). Drainage in group 2 was operatively placed in the scrotum. Follow-up included patient’s evaluations in the perioperative period and at 3, 6 and 12 months, postoperatively. A comparison of complications was performed between the two groups. Quality of life scores and visual analog pain scale questionnaires were applied for both groups. Results: Twenty patients with a mean age of 63 years (53–74) were operated. Penile implants were successfully inserted in all patients without any operative complication. Mean operative time was 65 min (45–120). Mean drainage period for group 2 was 72 hours (48–96); mean blood drainage was 78 cc (50–180). Two hematomas were identified in each group. A long term infection was verified in group 2. Quality of life scores were significantly impacted in patients featuring hematomas. Median follow-up for the series was 12 months (6–18). Conclusions: Our initial experience shows that perhaps catheter drainage is not mandatory in penile prosthetic surgery. Tachosil® represents a potential feasible option to prevent perioperative hematomas for penile prosthetic implantation in selected patients.

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Disclosure: Work supported by industry: no.

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A SURVEY OF PENILE PROSTHESIS IMPLANTATION FOR TREATING SEVERE ERECTILE DYSFUNCTION IN CHINESE PATIENTS—SATISFACTION OF PATIENT AND PARTNER

EVALUATION OF AMS LGX™ CYLINDERS FOR MAINTAINING PENILE LENGTH—12 MONTH OUTCOMES

Xin, ZC Peking University First Hospital, Peking University

Objective: A single arm, prospective, bi-center study was conducted to evaluate the effectiveness of the American Medical Systems (AMS) 700™ LGX™ cylinders in maintaining penile length 12 months postimplantation in patients treated for erectile dysfunction (ED). Materials and Methods: Twenty-six (26) patients from the existing population experiencing ED without previous prosthetic implantation were enrolled and implanted at two sites. The standard operating procedure was followed during implantation and a max-inflate technique was incorporated 6 months post-procedure. A paper ruler calibrated to the nearest 0.5 cm was used to measure a patient’s flaccid and stretch penile length, penile circumference, width, and depth of prepubic fat at follow-up. A paired t-test was used to evaluate the change in each dimension at 12 months compared to baseline for all subjects. Results: Twenty-two (22) patients were available for follow-up at the 12 month time point. Increases in average measurements were seen in flaccid length, penile circumference, penile width and depth of prepubic fat. Flaccid length increased from 9.8 cm at baseline to 10.0 cm at 12 months (P = 0.761). Penile circumference and width both increased significantly from 9.2 cm to 11.6 cm and 2.8 cm to 3.9 cm respectively (P < 0.0001). Depth of prepubic fat increased from 2.7 cm to 3.1 cm (P = 0.3761). A decrease was seen in stretched penile length from 12.5 cm at baseline to 11.2 cm at 12 months (P = 0.0028). At 12 months, 6 patients (27.3%) showed maintenance or an increase in stretched penile length and 10 patients (45.5%) showed an increase in flaccid penile length. All 22 (100%) patients showed an increase in penile circumference. Conclusions: The AMS LGX cylinders were able to maintain stretched penile length in 27.3% of patients with an increase in penile girth in 100% of patients, comparable to published literature. Defining a max-inflation protocol is essential for maintaining or increasing penile length. A scheduled max-inflation technique should be recommended to all patients soon after AMS LGX implantation.

Objective: To evaluate the outcome of penile prosthesis implantation (PPI) for sever erectile dysfunction (SED) in Chinese patients. Methods: Patients who underwent PPI over than 6 months were retrospectively evaluated using IIEF5, QOL, and satisfaction questionnaires. Surgical data, postoperative complications and information from a survey on satisfaction of patient and partner were investigated. Results: Among 158 cases of PPI, during March 2001 to May 2009, the mean aged 34.6 ± 11.2 y (20∼73 y), implanted AMS650 51 (33.3%) and AMS 700 CXM 103 (66.7%). All the operations were successful without severe surgical complications and infection. The IIEF5 scores in pre and post PPI was 6.29 ± 1.5 and 20.02 ± 2.32 respectively QOL score in pre and post PPI was 5.28 ± 0.76 and 2.13 ± 0.84 respectively, both of them had significantly improved (P < 0.01). The overall satisfaction of patients was 93.4%, and of partner was 92.3%. The mechanical failures were 2 cases (1.3%) in AMS 700 CXM group, without severe complications such as infection and erosion. Mild complications were 6 cases (3.9%) with mild pain of 4 cases and STD of 2 cases. Conclusions: PPI was safe and effective for the treatment of severe erectile dysfunction. The AMS 700 CXM penile prosthesis is better than AMS 650 in patient’s overall satisfaction and complication incidence. Disclosure: Work supported by industry: no.

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DRAINAGE IN PENILE PROSTHETIC SURGERY: IS IT ALWAYS NECESSARY? Galiano, M; Sanchez-Salas, R; Cathala, N; Mombet, A; Valancien, G Institut Montsouris France Introduction: Penile reconstructive surgery holds a high risk of bleeding. To report our initial experience with Tachosil® in penile prosthetic surgery. Material and Methods: Prospective evaluation of twenty patients with the diagnosis of severe organic erectile dysfunction undergoing penile prosthetic surgery at our institution. Three piece Titan OTR prostheses were employed for all cases. The surgical technique deployed hemostatic adjuvant Tachosil® (Group 1, n = 10) or a drainage

Henry, G Regional Urology, USA

Disclosure: Work supported by industry: yes, by American Medical Systems (industry funding only—investigator initiated and executed study). The presenter or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.

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CORRELATION OF PRE-OP AND POST-OP PENILE MEASUREMENTS WITH THE TITAN® INFLATABLE PENILE PROSTHESIS (IPP)

CORRELATION OF PRE-OPERATIVE AND POST-OPERATIVE STRETCHED VERSUS ERECT PENILE MEASUREMENTS WITH THE TITAN® INFLATABLE PENILE PROSTHESIS (IPP)

Henry, G1; Wang, R2; Carrion, R3 1: Regional Urology, USA; 2: University of Texas Health Science Center at Houston, USA; 3: University of South Florida, USA Introduction: It is well documented that after IPP placement, patients are dissatisfied with their perceived penile length. This study explores the use of a Max Inflate regimen along with sizing the cylinders to correlate with intra-operative penile measurements to maintain or increase penile length. The following data represents baseline to postoperative change in penile length after Titan IPP placement. Patients and Methods: This ongoing multi-center prospective clinical study implanted 40 pts at 3 sites. All patients received a Titan IPP with distribution amongst core sizes 16 cm, 18 cm, 20 cm, 22 cm, 24 cm at 10%, 20%, 32.5%, 35%, 2.5%, respectively. Patients are followed at 6 w, 6 m, 12 m and 24 m. Ten penile measurements were collected at pre-operative baseline and immediately post-operatively. Results: A total of 40 pts were implanted at 3 sites (Table 1). All flaccid penile measurements, width and circumference increased while all stretched penile lengths showed no significant change after implantation of the IPP (Table 2). Conclusions: The increase in flaccid penile length, width and circumference is minimal; however, it does indicate that flaccid penile shortening may not be an issue post-operatively with the Coloplast Titan IPP. Furthermore, stretched penile length does not change significantly suggesting that the corpora length is maintained during the implant procedure. Prospective follow-up measurements and patient satisfaction will be reported when available. Table 1

Mean +/− SD or n (%)

Age (years) Primary indications (not mutually exclusive) Vascular disease Diabetes mellitus Post-cancer treatment Pelvic surgery Neurogenic Psychological causes Pelvic trauma Iatrogenic Other

66.9 +/− 11.4 13 (32.5%) 11 (27.5%) 20 (50.0%) 4 (10.0%) 1 (2.5%) 0 (0.0%) 2 (5.0%) 0 (0.0%) 4 (10.0%)

Table 2 Change in Penile Measurement from pre-op to postimplantation of IPP Meaurements

Change (cm) ± SD

Pubopenile skin junction to proximal end of corona Flaccid 1.11 ± 1.31 Stretched 0.04 ± 1.10 Pubopenile skin junction to meatus Flaccid 1.20 ± 1.20 Stretched −0.02 ± 1.24 Pubic bone to proximale end of corona Flaccid 1.12 ± 1.31 Stretched 0.32 ± 1.75 Pubic bone to meatus Flaccid 1.13 ± 1.72 Stretched −0.07 ± 1.40 Width of penis 0.60 ± 0.44 Penile circumference 1.71 ± 1.52

p-value 0.001 0.826 0.001 0.919 0.001 0.258 0.001 0.754 0.001 0.001

Disclosure: Work supported by industry: yes, by Coloplast (industry funding only—investigator initiated and executed study). The presenter or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.

J Sex Med 2010;7(suppl 4):151–239

Introduction: It is well documented that after IPP placement, patients are dissatisfied with their perceived penile length. This study explores the use of a Max Inflate regimen along with sizing the cylinders to correlate with intra-operative penile measurements to maintain or increase penile length. The following data represents the correlation of post-operative erect versus pre and post-operative stretch penile measurements. Patients and Methods: This ongoing multi-center prospective clinical study implanted 40 pts at 3 sites. All patients received a Titan IPP with distribution amongst core sizes 16 cm, 18 cm, 20 cm, 22 cm, 24 cm at 10%, 20%, 32.5%, 35%, 2.5%, respectively. Patients are followed at 6 w, 6 m, 12 m and 2 4 m. Four stretched penile measurements were collected pre-operatively and immediately post-operatively as well as four erect measurements post-operatively. Results: A total of 40 pts were implanted at 3 sites (Table 1). There is a significant correlation in all pre and post-operative stretched measurements versus erect post-operative measurements (Table 2). Conclusions: The correlation of pre and post-op stretched measurements as compared to post-op erect measurements indicates that the post-operative length of the penis can be predicted by performing pre-operative measurements. This may help physicians consult patients on their penile length prior to and after the surgery. Table 1

Pt Demographics (N = 40)

Characteristic

Wang, R1; Henry, G2; Carrion, R3 1: University of Texas Health Science Center at Houston, USA; 2: Regional Urology, Shreveport, LA, USA; 3: University of South Florida, USA

Pt Demographics (N = 40)

Characteristic

Mean +/− SD or n (%)

Age (years) Primary indications (not mutually exclusive) Vascular disease Diabetes mellitus Post-cancer treatment Pelvic surgery Neurogenic Psychological causes Pelvic trauma Iatrogenic Other

66.9 +/− 11.4 13 (32.5%) 11 (27.5%) 20 (50.0%) 4 (10.0%) 1 (2.5%) 0 (0.0%) 2 (5.0%) 0 (0.0%) 4 (10.0%)

Table 2 Correlation of pre-op and post-op stretched vs erect measurements Measurements

Correlation (r-value)

Pubopenile skin junction to proximal end of corona Pre-op stretched vs Erect 0.92 Post-op stretched vs Erect 0.094 Pubopenile skin junction to meatus Pre-op stretched vs Erect 0.90 Post-op stretched vs Erect 0.96 Pubic bone to proximale end of corona Pre-op stretched vs Erect 0.81 Post-op stretched vs Erect 0.89 Pubic bone to meatus Pre-op stretched vs Erect 0.84 Post-op stretched vs Erect 0.86

p-value 0.0001 0.0001 0.0001 0.0001 0.0001 0.0001 0.0001 0.0001

Disclosure: Work supported by industry: yes, by Coloplast (industry funding only—investigator initiated and executed study). The presenter or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.

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PROXIMAL MIGRATION OF PENILE PROSTHESES: A RARE COMPLICATION

TECHNICAL FEASIBILITY AND PATIENT SATISFACTION REGARDING CONCOMITANT IMPLANT OF NON BONE-ANCHORED MALE SLING AND PENILE PROSTHESIS

Wiegand, LR; Kim, T1; Carrion, RE University of South Florida Objective: Proximal penile prosthesis migration or extrusion is a rare event. Few cases have been reported in the literature. Here we present three cases with contributing factors, surgical correction, and review of the literature. Materials and Methods: Over four years, three cases of proximal penile prosthesis migration were identified, one associated with extrusion. All had been implanted at outside institutions and were seen in consultation. The patients’ presentation, demographics, initial implantation procedures, and repair techniques are catalogued and analyzed. Results: Two cases were inflatable prostheses and one was a semi-rigid prosthesis. Per operative report, all prostheses were implanted successfully, without concern for proximal perforation. One patient from the inflatable prostheses group had multiple prior revisions. All patients were satisfied with their implants prior to any clinical changes. The time from implantation to migration was 3, 4, and 23 years. Two patients reported vigorous sexual activity prior to their clinical presentation. All patients related new-onset prosthesis pain and uneven distal tips. One patient presented with extrusion of his prosthesis through the peri-rectal fat that was thought to be an abscess. Two patients had revision with inflatable penile prostheses with the suture sling technique. At over two years follow-up, the two revised patients are very satisfied with their results. Conclusion: Proximal penile prosthesis migration is a rare event associated with a predictable clinical picture. Conceptually, migration seems to be more associated with the semi-rigid prosthesis. Further analysis is warranted to fully elucidate the risk factors that would predispose this complication. Revision can be safely and effectively performed with corporoplasty and/or suture sling techniques. Disclosure: Work supported by industry: no. The presenter or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.

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PENILE PROSTHESIS SURGERY PRESERVED CAVERNOUS SMOOTH MUSCLE Nagao, K; Nakajima, K; Tai, T; Kobayashi, H; Hara, H; Ishii, N Toho University, Japan

George, VK1; Pacha, T2 1: Michigan Institute of Urology; 2: Michigan State University Purpose: To demonstrate the feasibility and report patient satisfaction regarding concomitant non bone- anchored sling and penile prosthesis (IPP) post prostatectomy under one anesthetic. To our knowledge there has been no similarly published reported technique to date. Materials and Methods: Five patients post prostatectomy with mildmoderate urinary incontinence (less than 5 pads) and erectile dysfunction refractory to nonsurgical treatment undergo simultaneous implantation of a male sling and penile prosthesis under one anesthetic from a single surgeon. Patients were phone interviewed using a validated questionnaire regarding their satisfaction of the procedure and if they would recommend it to a friend. Results: No perioperative complications. Combo procedure had a 40 minute decrease in operative time vs. each procedure done in turn. All patients were discharged on post op day 1 without a Foley. All patients were completely dry except one who had an occasional dribble upon exertion at most recent follow up (average followup: 16 months (range 2–29 months). All men were having intercourse. All patients were completely satisfied with the sling and all except one were completely satisfied with the IPP. This patient had a mechanical failure that was replaced with a malleable prosthesis. All men would recommend to a friend. Approximate cost savings to each patient $9,400. No infections or erosions to date. Conclusions: Simultaneous implant of non bone anchored male sling and IPP in the appropriately selected patients have the following benefits: safe, feasible, effective, economical, and reduced operative time. Disclosure: Work supported by industry: no.

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BOTULINUM TOXIN A (BOTOX) FOR RELIEVING PENILE RETRACTION Shaeer, O1; Shaeer, K2; Shaeer, A3 1: Kasr El Aini Faculty of Medicine, Cairo University; 2: Kasr El Aini Faculty of Medicine, Cairo University, Egypt; 3: Kamal Shaeer Hospital, Egypt

Objective(s): The perforation of noninflatable penile prostheses to skin or urethra mainly occurred because the corpus cavernosum is narrower in Asian men. This study compared the safety and satisfaction rates for single and dual noninflatable penile prostheses. Material and Method(s): The 62 patients investigated in the present study received noninflatable penile prosthesis implants and were followed up for at least 10 months. Dual-implant AMS600 and AMSDuraII prostheses were implanted in 43 patients, and single-implant AMS600 and Genesis prostheses were implanted in the remaining 19 cases. In the single-implant procedures, the tip of the penile prosthesis was secured to the septum of the corpus cavernosum with 4-0 Tyclon to prevent dislocation. Result(s): Among dual-implant, 10 (23%) developed complications within 1 to 168 months postoperatively (average: 10 years 9 months). When single-implant were used, the complication rate was 0% after 10 months to 15 years (average: 2 years 8 months). Satisfaction rate of single-implant (95%) was higher than dual-implant (75%). Potential problems of single-implant regarding implant dislocation and limited penile width can be successfully addressed by the use of appropriate countermeasures. Conclusion(s): Single-implant surgery can preserves cavernous smooth muscle, have no complication and have high satisfaction rate in Japanese men.

Objectives: The flaccid penis undergoes retraction upon contraction of the Dartos muscle. These contractions are most pronounced in the situations of cold, stress, and upon exercising, and can be the source of embarrassment to those who have a hyper active retraction reflex, especially when exposed to their partners or to others in showers and dressing rooms, despite a normal and satisfactory length in the erect state. In this work, we propose an alternative to surgery and penile extenders for alleviating penile retraction, by injection of Botulinum toxin into the Dartos to induce muscle relaxation. This is the first report of the technique. Materials and Methods: Ten male patients complaining of a short penis exclusively in the flaccid state, despite normal and satisfactory erect and outstretched lengths were selected for the study. 100 units of BOTOX® were injected into the Dartos muscle. Results: Seven out of ten cases (70%) subjectively reported a decrease in the frequency and amplitude of penile retraction, as well as improvement in flaccid length. Clinical measurements were less pronounced but still showed an improvement that was mainly in terms of less retraction rather than more length. No side effects were reported. Improvement faded completely by the 6th month. Conclusion: This preliminary report of Botulinum toxin A (Botox) injection into the Dartos muscle shows that Botox may have a potential effect in temporarily decreasing penile retractions in terms of frequency and amplitude.

Disclosure: Work supported by industry: no.

Disclosure: Work supported by industry: no.

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COMPARISON OF VOIDING PARAMETERS ACCORDING TO THE CLASSIFICATION OF SS-PENOGRAM IN PATIENTS WITH ED AND LUTS

AN IMPROVEMENT OF BOTH VOIDING AND SEXUAL DYSFUNCTION IN 313 THAI MEN WITH LOWER URINARY TRACT SYMPTOMS AFTER A UROSELECTIVE ALPHA1-BLOCKER TREATMENT

Choi, HM1; Choi, HK1; Chung, BH2; Kim, CE3 1: Choi’s SS clinic, Seoul, Korea; 2: Department of Urology, Yonsei University College of Medicine, Seoul, Korea; 3: Department of Applied Statistics, Yonsei University, Seoul, Korea Objectives: Sexual Stimulation (SS)-penogram is a non-invasive, simple and physiologic test using radioisotope for evaluation of erectile function (EF) before and after oral administration of PDE-5 Inhibitors. We evaluated the results of voiding parameters according to the sub-classification of audiovisual stimulation (AVS) and SS-penogram in patients with both erectile dysfunction (ED) and lower urinary tract symptoms (LUTS) and assessed whether NOS/NO thery could support the correlations betweent ED and LUTS. Methods: A total of 66 patients with ED and LUTS were included in this investigation. EF was evaluated by international index of erectile function (IIEF)-5, AVS-penogram, and SS-penogram. SS penogram was performed 30 minutes after taking mirodenafil 100 mg orally. Voiding function was evaluated by international prostatic symptom score (IPSS), quality of life score (QoL), urinary flow rate (UFR), residual urine volume (RV), and transrectal ultrasonography (TRUS). The results of AVS-penogram categorized the patients into 3 groups: l-responsive, b-borderline, a-nonresponsive. According to the responses to mirodenafil, patients were classified into 4 groups: A-a very excellent response group, B-a good response group, C-a borderline group and D-inhibited, non-response group. Results: 1) In AVS-penogram study. The responses were: l–12 (18.2%), b-32 (48.5%), a-22 (33.3%). From the Analysis of Variance, UFR and RV showed marginally significant differences of means with both p-values are 0.08, and other variables showed no statistical significance. From the Multiple Comparison with Duncan test at 5% significance level, for both UFR and RV, l and b, b and a are grouped together. The means of UFR for l, b, and a groups are 18.92, 15.47, and 13.45 respectively. The means of RV for l, b, and a groups are 15.76, 29.69, and 54.18 respectively. If we drop the borderline group b from the analysis, the two-sample t test results significant for UFR with p-value 0.03 and marginally significant for RV with p-value 0.096. Other variables do not show the statistical significance. The means of IIEF scores for l, b, and a groups are 14.42, 10.06, and 8.18 respectively. The Analysis of Variance for the IIEF scores results significant with p-value 0.01 and Duncan test separates l from b and a group. 2) In SS-penogram study. The responses were: A-34 (51.5%), B-7 (10.6%), C-10 (15.2%), D-15 (22.7%). For the SS-penogram groups, IPSS, QOL, UFR, RV, and TRUS do not show any statistically significant differences of means. The mean of IPSS scores of the combined group of A and B is 15.61. And the means of C and D are 15.00 and 13.64 respectively. The Analysis of Variance results nonsignificant. If we compare the combined group of A and B with the group D dropping the C group, then the difference of the means is marginally significant with p-value 0.058. Conclusion: We found some evidences to support NOS/NO theory. The UFR correlates with AVS-penogram. RV marginally correlates with AVS-penogram. The high IIEF scores are related to responsive group of AVS-penogram. We don’t find any variable that relates to SS-penogram. The IPSS scores marginally relates to SS-penogram. However the preliminary analysis indicates that there are age effect to AVS and SS-penogram. Further study is needed to remove the age effect and to check the evidence to support NOS/NO theory. Further study is needed to clarify the NOS/NO role in the ED and LUTS correlation. Disclosure: Work supported by industry: no.

Permpongkosol, S Faculty of Medicine, Ramathibodi Hospital, Mahidol University Introduction: Lower urinary tract symptoms (LUTS) are a common problem in aging men and are accompanied by erectile dysfunction (ED). Aim: To study the relationship between ED and LUTS and analyze the effect of a uroselective α1-blocker on the sexual function of Thai male patients with benign prostate hypertrophy (BPH). Methods: Of the 488 Thai men with LUTS and treated with alfluzosin monotherapy at a men’s health clinic, 313 men (64%) with LUTS completed 8 months of the treatment, and the two questionnaires: (1) the International Prostate Symptom Score (IPSS) and (2) the International Index of Erectile Function (IIEF)-5 questionnaires. Main Outcome Measures: For the comparisons at baseline and changes from baseline in the overall population, a chi-square or Fisher’s exact test was used for qualitative variables and a t-test for quantitative variables, with P < 0.05 taken to indicate statistical significance. Results: Of the 313 men were treated with alfuzosin 10 mg for 35.6 ± 2.2 week follow-up (ranged 32.1–42.3). LUTS were categorized by IPSS score as moderate 100 (31.9%), severe 231(68.1%) and ED were graded according to the IIEF-5 as normal 51 (16.3%), mild 27 (8.6%), mild to moderate 78 (24.9%), moderate 47 (15.0%), severe 110 (35.1%). Men considered ED were with a strong influence of LUTS severity. After 8 months of alfuzosin treatment there was a significant improvement from baseline in mean total IPSS and IIEF-5, from 19.95 ± 6.4 to 11.13 ± 4.6 (P < 0.001) and from 11.5 ± 6.9 to 14.9 ± 5.7 (P < 0.001), respectively. However, IIEF-5 score did not have a statistically significant improvement in the patients who had the severe symptom score of IPPS. Conclusion: Treatment with alfuzosin is safe, and in this pilot study it was the most effective therapy to enhance both voiding and sexual function in Thai men with LUTS and sexual dysfunction Disclosure: Work supported by industry: no.

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PRODUCING PENILE MOLD Gökçe, A1; Demirtaþ, A1; Akýnsal, E1; Kadýoðlu, A2; Ekmekçioðlu, O1 1: Erciyes University Medical Faculty/Turkey; 2: Istanbul University Medical Faculty/Turkey Objectives: In the education of surgical treatment of Peyronie’s disease or penile curvature penile molds might be useful. Our purpose was to create penile molds using rapidly hardening silicone used in dentistry. Material and Methods: Silicone materials used in dentistry for preparing palatine molds were selected. Erections were obtained with intracavernosal injection of vasoactive drugs in males with Peyronie’s disease or penile curvature. Following erection penis was wrapped with rapidly hardening silicone material. In 2–3 minutes the mold hardens. This mold is used as outer mold and with a different kind of silicone inside of the outer mold is covered. The inner mold seems the same with the patient’s penis with its curvatures. Results: The molds mimicking the penis could be prepared. Outer mold might be used more than once to create inner mold. Some examples will be shown near the poster. Conclusions: Prepared silicone penile molds might be used for educational purposes. These molds might be scanned with reverse engineering techniques. The resultant images might be remodelled and straight penis models could be obtained with special programs. This might help in pre-planning the operation and the shape of the graft which will be used during surgical correction. Disclosure: Work supported by industry: no.

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NICARDIPINE VERSUS SALINE INJECTION AS TREATMENT FOR PEYRONIE’S DISEASE: A PROSPECTIVE, RANDOMIZED, SINGLEBLIND TRIAL Soh, J; Kawauchi, A; Kanemitsu, N; Naya, Y; Ochiai, A; Naitoh, Y; Fujiwara, T; Kamoi, K; Miki, T Japan Introduction: Various conservative treatments for Peyronie’s disease (PD) have been attempted over the years. Intra-lesional verapamil injection has been tested in prospective randomized studies, but the effect of this treatment seems insufficient. Nicardipine is a calcium antagonist alternative to verapamil and is reportedly more effective in vitro. Aim: The objective of our study was to evaluate the usefulness of intra-lesional nicardipine injection as a conservative treatment for PD in the transition period of acute and chronic phase. Mean Outcome Measure: The subjects were assessed by IIEF-5 and international pain scale. The plaque size was measured by ultrasonography after 20 μg intra-cavernosal injection of alprostadil (prostaglandin E1). The penile curvature was also measured by taking a photograph at maximum rigidity. Methods: 86 patients (age: 38–72 years, mean: 52) were enrolled in this study. A total of 74 patients were assigned randomly to nicardipine group (10 mg diluted in 10 ml of distilled water daily, n = 37) and control group (10 ml of saline water, n = 37). A total of 6 injections were administrated biweekly. Results: A reduction of pain score was seen throughout the course of treatment in both groups with a significant difference between the nicardipine and control groups (MANOVA test, P = 0.019). A significant improvement of IIEF-5 score occurred only in the nicardipine group at 48 weeks after the initiation of treatment (P < 0.01). The plaque size was significantly reduced at 48 weeks only in the nicardipine group (12 points, P = 0.0004 by paired t-test). The penile curvature was significantly improved in both groups (P < 0.01) without significant difference between them (P = 0.14). There were no severe side effects, such as hypotension or other cardiovascular events. Conclusion: Our findings indicate that intra-lesional nicardipine injection is clinically effective as a conservative treatment for PD in the transition period of acute and chronic phase. Disclosure: Work supported by industry: no.

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PATIENT SATISFACTION AFTER NON TENSILE TUNICA ALBUGINEA PLICATION FOR THE CORRECTION OF PENILE CURVATURES Zahran, AR Urology department, faculty of medicine Introduction: Penile curvatures can be either congenital or acquired secondary to peyronie’s disease. Severe curvatures (angle of deviation more than 30 usually necessitate surgical corrections. Objective: To evaluate the efficacy of non tensile tunical albuginea placation using non absorbable sutures (NTTAP) in the correction of congenital and acquired penile curvatures and determine key points for a successful outcome of this procedure and consequent patient satisfaction. Materials and Methods: From June 2004 to March 2009, 86 patients having penile curvature (70 congenital and sixteen secondary to Peyronie’s disease) underwent surgical correction by NTTAP. Indications were difficult or impossible penetration, cosmetically unacceptable penis. For TAP we used non-absorbable sutures (ticron2/0) using the 16 dot procedure previously described by Lue etal 2002. Circumcising incision was used for the ventral curvatures and a midline ventral incision was used for dorsal curvatures where the sutures were placed on

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tunica albuginea on both sides of the corpus spongiousum&a lateral penile incision for those having lateral penile curvatures. Results: At mean follow-up of 36 months, full subjective and objective success (straight penis, penile shortening, normal erection, penetration and sensation) was achieved in all patients. There no single failure to date in the studied patients, However the post operative penile shortening was present in 50% of the cases, it didn’t exceed 1 cm in length and no significant interference with the intercourse. postoperative complications were mild and reversible as penile superficial skin necrosis after the circumcising incisions (in early cases secondary to massive pressure effect of the dressing) & post operative pain upon nocturnal erection which subsides after few weeks and with the frequent usage of the ice compressors. The overall satisfaction rate was nearly 98%. Conclusions: NT TAP is a simple and effective method for the correction of congenital and acquired penile curvatures. Key points for successful outcomes are to clearly identify the line of maximum curvature, adequate preoperative evaluation and counseling of the patients to meet their expectations, careful preparation of suture sites, No need for neither mobilization of urethra or neurovascular bundle is carrying a great advantage for this easy and simple technique(minimal dissection was needed in cases of lateral curvatures). As well as no cutting through the tunica albuginea this alleviates any suspicion of postoperative erectile disabilities. The main disadvantage of this procedure is that it can’t correct the hour glass deformity as all other placation surgeries. Disclosure: Work supported by industry: no.

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THE ROLE OF PDE5 INHIBITOR IN SEPTAL SCAR REMODELLING: ASSESSMENT OF THE CLINICAL AND RADIOLOGICAL OUTCOMES Chung, E; Brock, GB St Joseph Health Care London Objective: Effective oral medication for use in men with Peyronie’s disease has been an area of interest of the medical community and lay public for decades. Initially Potaba, colcichine and vitamin E have been investigated without evidence of significant efficacy. In this study, we assess the efficacy of PDE5 inhibitor in septal scar remodelling among men with Peyronie’s disease. Material and Methods: All men who underwent penile Doppler ultrasound between December 2007 and December 2009 were enrolled in this study. Of the 60 men with ultra-sonographic confirmed septal scar, 30 men received Tadalafil 2.5 mg daily over a 6 months period. The clinical outcomes between the 2 groups were compared using IIEF-5 score and 6 months penile Doppler ultrasound follow up. Results: Preliminary analysis showed similar demographics between the 2 groups with a mean age of 43.2 (20–65) years in Tadalafil and 44.2 (34–72) years in the control groups. The length of time from onset to presentation was 22 (6 to 40) months. The majority of ultrasonographic proven septal scar was not clinically palpable and complaint of decreased penile rigidity was the predominant feature. Treatment with low dose daily Tadalafil did not result in any significant side effects (such as headache and flushing) or discontinuation. The Tadalafil group reported higher IIEF-5 score (pre-treatment 11/25 to post-treatment 18/25) (P < 0.01) and resolution of septal scar were recorded in 24 patients (80%). Conclusion: Low dose daily Tadalafil is a safe and effective treatment option in septal scar remodelling. Disclosure: Work supported by industry: no. The presenter or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.

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precipitating PD are inconclusive. Interestingly, while the testes have a similar tunica albuginea covering to that of the penis, testicular injury (direct trauma) does not seem to result in tunical scarring. The aim of this study was to clarify the prevalence of penile injury in a large contemporary cohort of patients diagnosed with PD. Materials and Methods: Patients were evaluated between January 2008 and October 2009 and diagnosed with PD based on history, genitourinary examination and high resolution penile ultrasound (US). Penile US was used to confirm the penile plaques sites, size, and presence/absence of calcification. If erectile function was compromised, color penile US was done. Patients were questioned for injury events (self and/or partner stimulation) to the erect penis prior to the development of penile deformity. Institutional approval was obtained. Results: The 400 consecutive patients included in this study had a mean age of 52 y and duration of disease prior to presentation of 1.1 y. Plaque distribution was primarily dorsal or dorso-lateral. Calcification of the penile plaques was present in 18% (n = 72) of patients, while only 15% (n = 60) of patients reported history of penile injury. There were no significant differences between the patients with and without history of penile injury regarding age, penile plaque size, site and presence of calcification. Conclusions: This large prospective series solidifies recent evolving data that penile injury does not appear to be the primary cause of PD; potential causes may include immunological or inflammatory disorders, or as yet unidentified causes.

EXPERIENCE ON SALVAGE PENILE CURVATURE CORRECTION SURGERY Hsieh, CH1; Hsu, GL2; Huang, CH3; Chen, KL4; Chang, CH4 1: Department of Urology, Buddhist Tzu Chi General Hospital Taipei Branch; 2: Microsurgery Potency Reconstruction & Research Center, China Medical University; 3: Department of Urology, En-Chu-Kong Hospital; 4: Department of Urology, China Medical University and Hospital, Taichung Objectives: It is commonly believed that coarser suture materials should be used to provide sufficient tenacity in tunical surgery for penile curvature correction. We report our 15-year experience of fine sutures in a second operation in 33 patients who underwent prior curvature correction elsewhere with coarser sutures, resulting in resumption of penile curvature associated with erectile dysfunction. Materials and Methods: From February 1993 to November 2009, unsatisfactory postoperative outcomes prompted 45 patients, aged 19 to 37 (mean age = 29), to consult our institutes after previous tunical surgery at other institutions. These patients were remarkable for normal erectile function prior to the first tunical surgery in which 2/3-0 nylon sutures were used. They frequently presented with recurrence of penile curvature resulting from herniation/weakening of a tunical region or even crateriform tunical defects associated with gradual loss of erectile capability and palpable lumps. In this series, 33 patients underwent a revised Nesbit procedure at the level of the collagen bundles using finer sutures which is optimal for approximation of collagen bundle. Prior to July 1998, 10 men underwent salvage surgery using 4-0 polyglactin sutures. Thereafter, we have adapted 6-0 nylon sutures for another 23 patients. These were categorized into the polyglactin and nylon groups respectively. Overall, 31 patients were available for a follow-up while using the abridged five-item version of the International Index of Erectile Function (IIEF-5) scoring system with 22 patients in the nylon group. Results: The follow period ranged 0.6 to 16.0 years with an average of 6.9 ± 2.5 years. The penile morphology both subjectively and objectively was excellent in all patients, except for one in each group. Erectile function restoration showed a trend of satisfaction in the polyglactin group and based on IIEF-5 was significantly improved in the nylon group (14.2 ± 3.5 vs. 21.8 ± 2.2, n = 22, P < 0.001). We have found that cavernosography is a practical and reliable method to objectively assess penile morphology and probably erectile function in these patients. Conclusion: We may suggest that in penile tunical surgery, fine sutures such as 6-0 nylon may be an ideal suture material for resulting better penile morphology and functional outcomes since it has been sustainable in salvaging tunical surgery. Disclosure: Work supported by industry: no.

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SINGLE CENTER RESULTS FOR 400 CONSECUTIVE CANADIAN MEN EVALUATED FOR PEYRONIE’S DISEASE (2008–2009) DO NOT SUPPORT INCIDENT TRAUMATIC EVENT AS UNDERLYING ETIOLOGY Shamloul, R; Bella, A University of Ottawa Objective: The most widely-accepted explanation for the development of abnormal collagen deposits in the tunica albuginea covering of the penis, known as Peyronie’s disease (PD) is that it follows aberrant wound healing after penile injury. It is suggested that following trauma to the erect penis, probably during sexual intercourse, microscopic tears develop in the tunica albuginea. Contemporary data suggests incidence in 5–9% of men, as “tunical scarring” results in development of penile plaques and subsequent penile curvature or other deformity during erection and in some, erectile dysfunction. On the other hand, data to support the involvement of penile trauma in

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IS CONGENITAL PENILE DEVIATION ASSOCIATED WITH PEYRONIE’S DISEASE? Coombs, PE; Akhavan, A; Alex, B; Choi, J; Mulhall, JP MSKCC Introduction: Risk factors for Peyronie’s disease (PD) are poorly delineated but in the literature have included hypertension, cigarette smoking, diabetes and radical prostatectomy. Clinical experience suggests that a significant proportion of men with PD report prior congenital penile deviation (CPD). We undertook this analysis to define whether is associated with PD. Methods: Patients presenting for evaluation of sexual problems were routinely asked about penile curvature including CPD. A retrospective review of our sexual medicine database was conducted to define the incidence of CPD in the PD-only and ED-only populations. Demographic and comorbidity parameters were recorded. The study population consisted of men ≥50 years of age that had undergone duplex Doppler ultrasound with a rigid erection. Men with ED-only were required to have no palpable or ultrasonographically defined plaque. Comparison of comorbidity profiles was assessed use chi-square analysis. Multivariable analysis was used to define factors associated with PD development. Results: 636 PD-only patients and 932 ED-only patients were compared. Mean age of both groups was 59 ± 7 (50–72) years and 62 ± 11 (50–76) years respectively (P = 0.03). Mean curvature for the PD patients was 47 ± 24 degrees. 5.9% (n = 38) PD patients gave a prior history of CPD (47 ventral, lateral 23, dorsal 6). At penile ultrasonography, 1.2% (n = 11) men with ED without PD had CPD (16 ventral, 6 lateral). No significant difference in reported prior trauma rates was seen between those PD patients with and without a history of CPD (6.6% vs 8.4%; P = 0.085). There were significant differences in comorbidity profiles (hypertension, cigarette smoking) between the ED and PD groups (higher in ED group), but no difference in comorbidities in the PD patients with and without a history of CPD. The multivariable analysis of predictors of PD in the total population (n = 1568) is presented in the Table. Conclusions: While this is not a cross sectional population-based study, in the population studied, the reported incidence of CPD is approximately 5 times higher in men with PD compared to men with ED without PD, raising the question as to whether CPD may represent a risk factor for PD development. This potential link warrants further and more extensive evaluation.

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OR

95% CI

P value

Diabetes (Y/N) CPD (Y/N) Caucasian vs Other

1.4 4.1 8.2

1.1–4.1 2.2–13.6 4.4–23.9

<0.01 <0.01 <0.001

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A CASE OF ISCHEMIC PRIAPISM WITH RECOVERY OF ERECTILE FUNCTION EVALUATED BY AUDIO-VISUAL SEXUAL STIMULATION Suetomi, T1; Kawai, K1; Oikawa, T1; Onozawa, M1; Miyazaki, J1; Sekido, N1; Akaza, H2; Shimazui, T1 1: University of Tsukuba/Japan; 2: University of Tokyo/Japan

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augmentation using injection of autologous fat between the penile skin and the corpora cavernosa of the penile shaft, under local anesthesia, by one surgeon. Penile circumference measurements on proximal and distal one third points, penile length without stretching, volume of injected fat, pre- and postoperative International Index of Erectile Function (IIEF) domain 5 score, and complications were analyzed. At 3 months postoperatively, the patients were asked to classify their satisfaction level for sexual function, morphology and global state as very satisfied, satisfied, so-so, dissatisfied, or very dissatisfied. Both ‘very satisfied’ and ‘satisfied’ were scored as satisfied. Results: The average volume of injected fats was 42.2 g (range 24– 60 g). Penile circumferences were measured at the proximal and distal third points of the penis at pre- and post-operation. Penile circumferences at the proximal and distal third points were 8.13 ± 0.89 cm and 8.14 ± 0.85 cm before treatment and 10.51 ± 1.07 cm and 10.00 ± 1.05 cm after treatment. All of them were significantly increased after surgery (P = 0.000 and 0.000). Penile length was 7.37 ± 1.31 cm before treatment and 8.34 ± 1.18 cm after treatment. Penile length was significantly increased after surgery (P = 0.000). IIEP domain 5 scores were significantly increased after surgery (19.2 vs 20.2, P = 0.000). There were six complications during the short-term follow-up, with 6 cystic fat nodules. Fat nodules were controlled by needle aspiration. The satisfaction rate for sexual function, morphology and global state were 79.8% (87/109), 78.9% (86/109), and 91.7% (100/109). Conclusions: Penile girth augmentation using injection of autologous fat shows very effective short-term outcomes and patient’s satisfaction without serious complications.

Background: Ischemic priapism is a urologic emergency that requires immediate intervention, with the goal of achieving detumescence while preserving erectile function. However, the period for recovering erectile function after management is unclear. We report a case of ischemic priapism in which recovery of erectile function was evaluated by audio-visual sexual stimulation (AVSS). Case Report: A 38-year-old man visited our hospital complaining of painful complete erection that had begun 24 h previously on 11 May 2003. Gas analysis of the cavernous blood showed a PO2 of 4.3 mm Hg and a PCO2 of 99.5 mm Hg, which indicated ischemic priapism. We performed therapeutic aspiration with saline irrigation, and injection of phenylephrine, and the penis gradually softened. The priapism continued the next day, so an emergency operation (distal shunt) was performed according to Al-Ghorab’s procedure. However, 4 hours after resolution, the priapism recurred as an incomplete erection without pain. We recommended observation, but the patient hoped for complete detumescence, so a proximal shunt was performed according to Quackels’ procedure. As intraoperative findings, the surgeon palpated a sclerotic lesion at the tip side of the cavernous body, and it was thought to be fibrosis. The penis gradually detumesced, but the patient continued to suffer from erectile dysfunction. At 3 months post-operation, 50 mg of sildenafil was administered. After follow-up for 18 months, the patient was able to perform intercourse. AVSS tests with a Rigiscan-Plus were done at 3, 12, 24, and 36 months postoperation. The maximum rigidity was 6%, 17%, 85%, and 83% at the penile base, and 0%, 29%, 34%, and 73% at the penile tip, respectively. On the other hand, the IIEF-erectile function domain scores were 3, 26, 28, and 29, respectively. The mean penile circumference of the tumescence was 10.9 cm and 10.9 cm at the penile base, and 7.3 cm and 7.4 cm at the penile tip, at 24 and 36 months post-operation, respectively. Conclusion: To the best of our knowledge, ischemic priapism observed with AVSS has not been reported before in the literature. The patient showed clinical improvement in erectile function more than 2 years after surgical management. We consider that combined assessment using AVSS and IIEF may be more useful for accurately evaluating erectile function in such cases.

Objectives: To evaluate the effect of compound lidocaine cream on the treatment of primary premature ejaculation. Methods: 51 patients with primary premature ejaculation were requested to use compound lidocaine cream to glans pre-intercourse and washed clean 5 to 10 minutes later, 10 times for one treatment course. Then evaluations were made on the changes of the intravaginal ejaculatory latency time (IELT). Chinese index of sexual function for premature ejaculation-5 (CIPE-5) score—the penile vibration threshold (PVT) and adverse events after three treatment courses. Results: After the treatment, IELT is significantly prolonged (P < 0.01). CIPE-5 score is increased than the base line (P < 0.01). And PVT is significantly increased (P < 0.01). No serious adverse events were recorded. Conclusion: Compound lidocaine cream has satisfactory curative effect for the patients with primary premature ejaculation and improves the quality of their sex life.

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EFFICACY OF COMPOUND LIDOCAINE CREAM ON THE TREATMENT OF PRIMARY PREMATURE EJACULATION Yutian, D; Zhipeng, X; Yun, C The affiliated drum tower hospital, Nanjing University

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SHORT-TERM RESULTS OF PENILE GIRTH AUGMENTATION USING INJECTION OF AUTOLOGOUS FAT

PREMATURE EJACULATION IN PATIENTS WITH MALE FACTOR INFERTILITY DOES NOT OCCUR MORE OFTEN IN THE NORMAL POPULATION AS ERECTILE DYSFUNCTION DOES

Cho, SH; Lee, HN; Chang, TH Gilman Urology Hospital Objectives: Penis size has been a source of anxiety for men throughout history, and still men often feel a need to enlarge their penises. We report our short-term results of penile girth augmentation using injection of autologous fat. Material and Methods: Between April 2009 and November 2009, 109 men (mean age 40 years, range 21–58 years) received a penile girth

Akbal, C; Ozgur, O; Mangir, N; Sekerci, C; Simsek, F Marmara University School of Medicine, Department of Urology, Istanbul/Turkey Introduction: We attempted to find the prevalence and related conditions of PE with the help of the two different validated PE diagnostic tools (PEDT) in infertile patients.

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Materials and Methods: Two PEDT validated and filled out by the infertile patients. Group I filled out only one of the PEDT, which consisted of 5 questions, and Group II filled both PEDTs, which consisted of 5 questions and 4 questions, respectively. The ages of patients and partners, duration of marriage, presence of azoospermia, presence of consanguinity, smoking, presence of varicocele, and presence of erectile dysfunction (ED) were analyzed and compared in both groups. Results: Group I consisted of 334 patients, and Group II consisted of 86 patients. According to PEDT I and PEDT II 13.2% and 31.4% of infertile males reported PE, respectively. 323 patients self-assessed their ED status. 3 (0.9%) patients reported severe ED, 4 (1.2%) reported moderate ED, 24 (7.4%) reported mild-moderate ED, 91 (26.9%) reported mild ED, and 212 (63.5%) patients reported no ED. In Group I ED reporting infertile males also reported 3.3 times higher a likelihood of having PE. There were no statistically significant differences between PE and non-PE patients with respect to patients’ and partners’ ages or duration of marriage, presence of azoospermia, consanguinity, varicocele, or smoking. Conclusion: Infertile males reported having PE in the same ratio as fertile males. The current study revealed that both questionnaires could be used for diagnosis of PE in patients with male factor infertility. Disclosure: Work supported by industry: no.

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TREATMENT OF MALE ORGASM DISORDER BY RULING-OUT ATTENTION-DEFICIT DISODER: A CASE STUDY Banner, LL Objectives: The incidence of male orgasm disorder is pervasive and creates distress to the patient, and sometimes his partner, experiencing this disorder. Men, presenting with this disorder, report “being distracted” during intimacy causing a loss of erections and orgasm, so the connection to men with undiagnosed or untreated attention-deficit disorder (ADD) was difficult. Materials and Methods: This is a preliminary report of a clinical observation and testing of a methodological hypothesis. It includes a review of the literature and realization that this is a novel area of research in sexual medicine. When a detailed psychological history and sex history was taken, a light came on to rule-out the undiagnosed and untreated ADD to evaluate its impact on men with orgasm disorder. Three men, age 28 to 61 years of age who presented with orgasm disorder, were evaluated for ADD and given a regimen of either Stratera, Vivance, or Adderall on a daily basis. Additionally, patients were taught to use guided relaxation to help them stay relaxed during physical intimacy. Results: The anecdotal results indicate that the men were able to maintain their erections and have an orgasm on a frequent basis. All of the men reported that they felt better about themselves because of their sexuality “working” and because they were able to stay focused on a daily basis. Conclusions: This is a very small sample of men and clearly not generalizable. However, the initial results are promising and indicate there is a benefit to ruling-out ADD as a potentially undiagnosed and untreated source of male orgasm disorder. Disclosure: Work supported by industry: no.

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A SINGLE CENTER EXPERIENCE: OPERATIVE MANAGEMENT OF TESTICULAR TORSION IS ORCHIECTOMY OR ORCHIOPEXY? Xiao, H1; Zhang, Y1; Liao, J1; Zhou, X1; Zhan, H1; Pu, X1; Huang, W1; Chen, J2; Qi, T2; Zhang, B2; Gao, X1 1: Department of Urology, the Third Affiliated Hospital of SUN Yat-sen University, Guangzhou 510630, China; 2: Department of infertility and sexual medicine, the Third Affiliated Hospital of SUN Yat-sen University, Guangzhou 510630, China Objective(s): To report our experience and evaluate the appropriate surgical intervention to treat testicular torsion. Material and Method(s): The clinical data of 15 cases with testicular torsion were analyzed retrospectively. The age group ranged from 16 to 46 years (mean 23 years) and the time of testicular torsion lasted 8 h to 5 days (2 cases less than 12 h, 3 cases during 12–24 h and 10 cases more than 24 h). Result(s): All the 15 patients were confirmed testicular torsion according to color Doppler uhrasonography. A median of 540 degrees of testicular rotation was noted (3 cases during 180–360, 11 cases during 360–720 and 1 case for 1,080) in the surgical exploration. Orchiectomy was performed in 11 cases and 4 patients with the time of testicular torsion less than 24 h in 3 cases and degrees of testicular rotation less than 360 in 1 cases were underwent by surgical detorsion and orchiopexy. Nine to sixty months’ followup is warranted to assess the incidence of subsequent testicular atrophy after the management of orchiopexy. Testicular atrophy occurred in 1 of those 4 patients who were underwent by orchiopexy of the better perfused gonad during surgical exploration. Conclusion(s): The diagnosis of testicular torsion is not always straightforward because many acute scrotal pains may have a similar clinical presentation as epididymo-orchitis or incarcerated inguinal hernia. Color flow Doppler sonography can serve as a chief adjuvant method for detecting the perfusion of the testis. Early exploration was recommended to perform in the presence of strong suspicion of torsion. Those which degrees of testicular rotation were less than 360 or the time of testicular torsion was less than 24 h have a chance to preserve the testis by surgical detorsion and orchidopexy. Disclosure: Work supported by industry: no.

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APOPTOSIS IN TESTICULAR TISSUE OF RATS AFTER VASECTOMY: CHANGES OF ENOS, INOS IMMUNOREACTIVITY AND THE EFFECTS OF OZONE TREATMENT Alpcan, S1; Aydos, TR2; Basar, H1; Kul, O3; Basar, MM1 1: Univeristy of Kirikkale Faculty of Medicine, Department of Urology; 2: Baskent University, Faculty of Medicine, Department of Pharmacology; 3: Univeristy of Kirikkale, Veterinary Faculty, Department of Pathology Objective(s): The aim of the study is to investigate of the eNOS and iNOS immunoreactivity changes and developing of apoptosis in rat testicular tissue after vasectomy, and the effects of ozone therapy on these changes. Material and Method(s): The study was applied on 60 adult male Wistar rats weighing 352.5 ± 37.67 g. Rats were divided into 10 working groups mentioned below: Group I (n = 6): not made any pre-intervention (Control) Group II (n = 6): surgical control group for 4 weeks (Sham). Group III (n = 6): surgical control group for 6 weeks (Sham). Group IV (n = 6): left vasectomy and testis isolation at the 4th week of vasectomy Group V (n = 6): left vasectomy and testis isolation at the 6th week of vasectomy Group VI (n = 6): double-sided vasectomy and testis isolation at the 4th week of vasectomy

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Proceedings from the 14th World Meeting of the International Society for Sexual Medicine Group VII (n = 6): double-sided vasectomy and testis isolation at the 6th week of vasectomy Group VIII (n = 6): left vasectomy and intraperitoneal (ip) application of ozone therapy, testis isolation at the 6th week Group IX (n = 6): double-sided vasectomy and ip ozone therapy, testis isolation at the 6th week Group X (n = 6): ip ozone therapy Apoptotic index was investigated by TUNEL methods, the immunoreactivity of eNOS and iNOS were evaluated with immunohistochemical staining Result(s): Left testicular apoptotic indices (mean ± SD) were 0.4 ± 0.3; 0.7 ± 0.3; 0.9 ± 0.4; 2.1 ± 0.6; 2.5 ± 0.4; 2.3 ± 0.7; 2.7 ± 0.9; 1.4 ± 0.6; 1.4 ± 0.5; 3.2 ± 0.7, respectively. Analysis of eNOS in groups (right/left testis) were 5 ± 2.7/4.5 ± 2.9; 7.5 ± 2.2/6.8 ± 2.9; 7.2 ± 1.8/11.8 ± 2.3; 11.3 ± 2.4/17.5 ± 6.2; 8.5 ± 2.8/16.8 ± 7.4; 17 ± 3.1/21.8 ± 5.2; 25.2 ± 3/23.2 ± 2.8; 16.2 ± 0.8/9.8 ± 6; 9.2 ± 2.6/7.8 ± 3.8; 30.7 ± 5.1/29 ± 5.2, respectively. Additionally, iNOS immunoreactivity in groups (right/left testis, respectively) were 5.2 ± 3.8/3.2 ± 1.3; 6.8 ± 4.5/6.8 ± 3.6; 6.5 ± 1.4/7.7 ± 2; 7.7 ± 3.1/13.5 ± 5.2; 10.8 ± 1.9/13.5 ± 3.7; 21.3 ± 2.9/18.5 ± 5; 17.5 ± 2.7/16.8 ± 2.3; 6.3 ± 1.2/12.7 ± 3.5; 5.7 ± 1.6/5.3 ± 2.7; 20.1 ± 7.1/19.7 ± 3.4 Conclusion(s): We concluded that while ozone therapy led to an increase to apoptosis and eNOS and iNOS immunoreactivity in rat testicular tissue, it was to block those changes in rat which expose to oxidative stress depending vasectomy. Disclosure: Work supported by industry: no.

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INTERRELATION OF LEFT VARICOCELE WITH HEIGHT, BODY MASS INDEX AND SOME SPERM PARAMETERS Gökçe, A; Demirtaþ, A; Öztürk, A; Þahin, N; Ekmekçioðlu, O Erciyes University Medical Faculty/Turkey Objectives: Some studies argued that as the man becomes taller he will be posed to more enhance of having varicocele. Although there are conflicting data in the literature regarding the relationship between varicocele and somatometric parameters, some studies have reported an inverse relationship between body mass index (BMI) and the presence of a varicocele. Thus we evaluated interrelation of left varicocele with height, body mass index and some sperm parameters. Material and Methods: We retrospectively evaluated the data of all patients who consulted for infertility at a tertiary academic referral center. Patient’s height, weight, body mass index (BMI), semen analysis, presence or absence of varicocele, and varicocele side and grade were evaluated. In statistical evaluations chi-square, Student’s t, MannWhitney U, ANOVA and logistic regression analyses were performed. Probability of less than five percent was considered significant. In ANOVA analyses, Bonferroni posthoc test were performed when needed. Results: Following strict exclusion criteria, of totally 2780 males presenting for infertility the data of 1842 males included the study. There were 587 males (31.9%) with left varicocele and 1255 (68.1%) males without varicocele. Two hundred seventy-two males (14.8%) had grade I or II, and 315 males (17.1%) had grade III varicoceles. Mean height was 174.3 + 6.7 and 172.5 + 7.0 in males with and without varicocele, respectively (P < 0.001). The presence of varicocele increased as the height increased. The constant for each cm increase was 1.039 (B = 0.038, P < 0.001). The mean BMI of cases without varicoceles (25.8 kg/m2) was greater than varicocele group (24.9 kg/cm2) (P < 0.001). Varicocele ratio was the highest in moderately oligozoospermic males and significantly higher than the males with normal sperm count. Conclusions: We found that as the height increased, the probability of having varicocele increased, the diverse is true for BMI. Patients with varicocele were taller and leaner than males without varicocele. The prevalence of varicocele was the lowest in azoospermic and severely oligozoospermic infertile population. Disclosure: Work supported by industry: no.

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PENILE KAPOSI´S SARCOMA IN AN HIVNEGATIVE PATIENT—5 YEARS FOLLOW UP Afif-Abdo, J Santa Cruz Hospital—São Paulo—Brazil Objectives: Kaposi’s sarcoma is a malignant vascular tumor, usually seen in elder and immunodepressed patients. The aim ofthis paper is to present a case report and its evolution. Material and Methods: A homosexual, 59 year-old patient, presented a penis lesion appeared 3 weeks earlier. The patient was submitted to: Hemogram, Kidney function, serum Glucose, TSH, free T4, Thyroglobulin, Lactate dehydrogenase test, Antinuclear antibody test, Serology for Herpesvirus, Syphilis, HIV 1–2, Cytomegalovirus, Hepatitis types B and C, Auxiliary and Suppressor CD4 T cell count, and Chest and Abdominal CT. Subsequently he was submitted to postectomy and the penis lesions were excised for anatomo-pathological and Immunohystochemical laboratory tests. Results: Three small papular, elevated, violet, painless lesions were found at the balanopreputial area by macroscopy. The anatomopathological test disclosed Kaposi’s sarcoma. The immunohystochemical test revealed HHV8 (Human Herpes Virus type 8) antibodies in the tumors cells. Among serology tests: HIV 1–2, B and C Hepatitis and Cytomegalovirus were negative, G and M immunoglobulin were positive to Herpesvirus infection. CD3+, CD4+, CD8+ T cells count were normal and CD4+/ CD8+ ratio was 2.13. Chest and abdominal CT were normal. Four months after the excision of the penis lesions, the patient presented the first recurrence. He was submitted again to a excision and to four (4) sessions of systemic chemotherapy with doxorubicin. After that he was oriented to apply imiquimod cream. He presented a second and a third recurrence respectively (9) nine and twelve (12) months later the inicial lesion. In all theses times the excision of the penis lesion was made and Kaposi sarcoma was confirmed. In the second recurrence enlarged bilateral inguinal ganglions were found and the biopsy was negative. After one year he started with acyclovir 200 mg twice a day, the recurrence were decreased e and when appeared they were submitted to cauterization of all suspected lesions with 50% tricloroacetic acid. Conclusion: This is an exclusive penile Kaposi’s sarcoma in negative—HIV and immunocompetent patient, a very rare report with a follow up of 54 months. Disclosure: Work supported by industry: no.

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SERUM GHRELIN AND OREXIN LEVELS IN INFERTILE MALE HAVING VARICOCELE Basar, MM1; Kisa, U2; Sipal, T1; Dogan, OC2 1: Univeristy of Kirikkale Faculty of Medicine Department of Urology; 2: University of Kirikkale Faculty of Medicine Department of Clinical Biochemistry Objective: The aim of the present study was to investigate serum ghrelin and orexin levels in patients with varicocele and compare these levels with the ones observed in idiopathic infertile male and healthy control cases. Material and Methods: A total of 24 adult men with varicocele and 24 male having idiopathic infertility were enrolled into study. Additionally, a total of 21 voluntary fertile cases without any scrotal pathology were accepted as control group Hormonal analyses including gonadotropins, prolactin, sex steroids, ghrelin and orexin levels were measured in serum samples. Semen was analyzed after 2 and 5 days of sexual abstinence and evaluated according to WHO guidelines and Kruger strict criteria. Results: Serum ghrelin levels were found statistically different among three groups (P = 0.015), and it was due to statistically lower level in group-1 than level in the control cases (P = 0.012). On the other hand, serum orexin levels were lower than healthy subjects in infertile groups with/without varicocele, but there was no difference (P = 0.685) among three groups. While serum ghrelin level showed negative and signifi-

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cant correlation only with sperm motility (r = −0.646, P = 0.005), there were no correlation with other parameters. On the other hand, serum orexin level did not showed significant correlation with seminal parameters. Conclusion: Both of the new investigated peptides ghrelin and orexin have regulatory effects on testicular function. However, ghrelin has a more evident and complex effect on spermatogenesis. Impaired seminal parameters, especially motility were associated with increased serum ghrelin levels in infertile patients, especially with varicocele. Disclosure: Work supported by industry: no.

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ZOLEDRONIC ACID INDUCES AUTOPHAGIC CELL DEATH IN HUMAN PROSTATE CANCER CELLS Lin, YC; Lin, JF; Tsai, TF; Chen, HE; Chou, KY; Hwang, T I-Sheng Shin Kong WHS Memorial Hospital Objective: Bisphosphonates are potent inhibitors of bone resorption frequently used for breast cancer and myeloma-induced done disease. Zoledronic acid (ZA) has been recently shown to also reduce skeletal morbidity from prostate cancer. In vitro studies also showed that ZA inhibit prostate cancer cell growth by activating caspase cascade which leading to apoptosis cell death. In this study, we investigate whether ZA also inhibit prostate cancer cell growth by type-II programmed cell death, autophagy. Material and Methods: MTT assay was introduce to investigate the biological effects of ZA on PC-3 and DU-145, androgen-independent human prostate cancer cell lines, as well as LNCaP and CRW22Rv1, androgen-sensitive cell lines. The formation of LC3-II protein, a marker protein involved in the formation of autophagosome during autophagic cell death, was detected by Western blot. Formation of acidic organelles was detected by acrindine orange staining. LC3-II incorporation into autophagosome was detected by Immunoflorescent (IF) staining. Results: ZA exhibited dose and time-dependent growth inhibition on four human prostate cancer cell investigated. Apoptosis was demonstrated by caspase-3 activation. Autophagic cell death was detected by the formation of LC3-II protein as early as 24 hours exposure to 100 nM of ZA. Acidic organelles were detectable by acridine orange staining and IF showed round-up and condensed staining of LC3-II, suggesting the formation of autophagosome in the cytoplasm during autophagic cell death. The rescue of cell growth occurred only by administration of both apoptosis and autophagy inhibitor during ZA treatment suggesting ZA induces prostate cancer death by either apoptosis or autophagic cell death. Conclusion: This is the first study showed that ZA markedly inhibit human prostate cancer cells growth thought autoghagic cell death. ZA can exhibit its anti-cancer activity via both apoptosis and autophagy. These findings could potentially contribute to the beneficial effect of ZA in prostate cancer treatments. Disclosure: Work supported by industry: no.

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REVISIT OF AMERICAN UROLOGICAL ASSOCIATION SYMPTOM SCORE AND INTERNATIONAL PROSTATE SYMPTOM SCORE: ARE THEY THE SAME? Lu, CC Chi Mei Medical Center, Liouying / Taiwan Objective: American Urological Association symptom score (AUASS) and International Prostate Symptom Score (IPSS) were published in 1992, and 1995 respectively. Does IPSS equal to AUASS? Both of them could be found as tools for assessment of prostatism in the literature. AUASS and IPSS were found to be used interchangeably. But there are 7 questions in AUASS and 8 questions in IPSS.

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Materials and Methods: A PubMed survey with a period from 2006 to 2008 was done. Key words were “International Prostate Symptom Score”. The search was accessed in October 2009. Review articles were excluded. The articles which defined 7 questions as “total IPSS” with score range 0 to 35 or quality of life, the eighth question in IPSS, as another independent tool were classified as inappropriate use (IU) of IPSS. The appropriate use (AU) was defined as 100% minus percentage of IU by the journals. Results: Three hundred and forty published papers were available in the search. Many qualified articles mentioned IPSS containing 8 question items with clear definition. Inappropriate use of “total IPSS” in the paper was an actual application of AUASS. Excluding the edition for online in advance and review articles, the journals with more than 20 original articles applying IPSS were selected. There were British Journal of Urology International (BJUI, with 38 articles), European Association Urology (EAU, 23), International Journal of Urology (IJU, 23), Journal of Urology (JU, 38), and Urology (36) were qualified. The ranking of AU, from high to low, was JU (89.5%), Urology (88.9%), EAU (73.9%), IJU (60.9%), and BJUI (57.9%). A trend of lessen inappropriate use of IPSS also has been noted. Conclusions: AUASS is not identical to IPSS. For accurate clinical and academic use, the urologists and the medical journal editorial board are encouraged to be aware of the differences. Disclosure: Work supported by industry: no.

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‘4X4 VASOVASOSTOMY’: A SIMPLIFIED TECHNIQUE FOR VASECTOMY REVERSAL Kumar, R All India Institute of Medical Sciences Objective: An ideal vasovasostomy procedure requires precise mucosal approximation with a water-tight anastomosis. This is often difficult due to discrepancy in the lumen size between the dilated proximal and normal distal end of the vas deferens. The standard two-layer microdot technique requires multiple sutures within each layer and is a technically difficult operation to perform. In this video, we demonstrate a two-layered technique which adheres to the principles of tubular anastomosis but is simpler and affords excellent results. Materials and Methods: The 4 × 4 vasovasostomy is a two-layered anastomosis using 4 sutures in each of the two layers. Suture sites in the two layers are staggered so as to provide a water-tight anastomosis. The proximal and distal ends of the ligated vas are identified. Distal patency is confirmed using saline infusion and proximal presence of sperms is demonstrated under light microscopy. Two 8-0 polyamide sutures are placed at 5 and 7 o’clock positions in the sero-muscular layer to approximate the two ends of the vas. Next, four double-armed, 10-0 polyamide sutures are sequentially placed, inside out in the mucosa of the vasal ends, at 3,6,9 and 12 o’clock positions and tied. Two additional sero-muscular sutures are placed at 1 and 11 o’clock positions to complete the anastomosis. A third layer of supportive sutures are placed into the adventitia or peri-vasal tissue to enhance security of the anastomosis. Results: Between February 2008 and December 2009, nine men underwent vasectomy reversal using the 4x4 technique. The procedure was performed bilaterally in seven men while two patients underwent a two-suture, longitudinal intussusception vasoepididymostomy on the second side due to absence of sperms in the proximal end of the vas deferens. Mean operative time was 92 minutes per patient. All men had sperm in the ejaculate at the first semen analysis, performed six weeks after the surgery. There were no complications. Conclusions: The ‘4x4’ modified two-layer vasovasostomy is a simple technique that can be performed quickly with excellent outcomes. It may allow a common ground between the complex microdot double layer technique and the over-simplified single layer procedure. Disclosure: Work supported by industry: no.

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PENILE MONDOR’S DISEASE CAN EFFECTIVELY BE TREATED WITH THE USE OF ACETYL SALICYLIC ACID AND PENTOXYPHYLLINE COMBINATION Davarci, M; Güven, EO; Gökçe, A; Yalçýnkaya, FR; Kiper, AN; Balbay, MD Mustafa Kemal University Tayfur Ata Sokmen Medical Faculty/Turkey Objectives: Since penile Mondor’s disease is a rare condition, different treatment choices are used uptill now. Therefore we recommended a new treatment strategy with acetylsalicylic acid and pentoxifylline in 14 patients with penile Mondor’s disease. Material and Methods: Fourteen patients with the clinical presentation of penile Mondor’s disease were included. Patients were given acetylsalicylic acid (ASA) 500 mg qid and pentoxifylline 600 mg bid for 14 days. Physical examinations were performed to all patients. In addition ultrasonic examinations were done before the treatment and in the 7th and 14th days of the treatment to evaluate dorsal vein thrombosis. Results: Physical examination revealed lesions parallel to the coronal sulcus in 9 patients and in the dorsal aspect of proximal penis in 5 patients. All patients had painful induration of the penis. In the 7th day, hyperechoic structures were still observed in eight patients and no thrombus was seen in six patients. Ultrasonographic measurements were repeated 14 days after treatment and a hyperechoic structure was observed in four patients. No side effects were encountered during follow-up period. Conclusions: We believe that ASA and pentoxyphylline protocol; a protocol that is also used for the treatment of thrombotic events occurred in the other parts of the body; helps resolving Penile Mondor’s disease in a shorter period of time compared to previous treatment protocols. Further randomised controlled studies are needed for a definitive decision. Disclosure: Work supported by industry: no.

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OREXIN EXPRESSION IN PROSTATE Basar, MM1; Han, U2; Cakan, M3; Alpcan, S1; Basar, H1 1: University of Kýrýkkale, Faculty of Medicine, Department of Urology; 2: Ankara Yýldýrým Beyazýt Education and Training Hospital, Department of Pathology-Ankara; 3: Ankara Yýldýrým Beyazýt Education and Training Hospital, Deparment of Urology, Ankara, Turkey Aim: The aim of this study was to evaluate orexin receptors expression in different prostate pathologies including Prostate Adenocarcinoma (PCa), Benign Prostate Hyperplasia (BPH) and chronic prostatitis (CP). Material and Methods: A total of 90 patients (mean age 64.01 ± 7.2 years-old) were enrolled into the study, and they were divided into three groups including equal number patients based on their histopathologic findings, which were as follows: PCa (Group-1), BPH (Group-2) and CP (Group-3). All the tissues were incubated with Orexin R-1/2 primary antibody. Specific cytoplasmic immunoreactivity of Orexin R1/2 was scored semiquantitativeley on a grading-scale for intensity and distribution. Staining intensity and orexin expression were evaluated by using Pearson χ2 test. Results: Expression of Orexin R1/2 was not observed homogeneous staining pattern in the groups. Expression of Orexin R1/2 rates were 90% (27/30) in Group-1; 53.3% (16/30) in Group-2 and 26.7% (8/30) in Group-3. While 5 patients (9.3%) showed strong staining in Group1, all samples showed only weak staining in other two groups. There were statistical difference between three groups based on staining intensity. Expression and distribution of orexin R1/2 was more widespread in group-1 than the others and higher in poor differentiation group. However, there was no statistical difference based on Gleason score. Conclusion: Orexin receptors found in human prostate tissues, and were widespread in PCa and in higher Gleason score. Therefore, we

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believed that Orexin immunoreactivity might be considered as poor prognostic criteria for poor differentiate PCa. Disclosure: Work supported by industry: no.

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PARENTAL CONSANGUINITY IN INFERTILE MALES Demirtaþ, A; Gökçe, A; Þahin, N; Sofikerim, M; Ekmekçioðlu, O Erciyes University Medical Faculty/Turkey Objectives: There is not enough knowledge if parental consanguinity of infertile male has an effect on infertility. Aim of this study was to investigate the effect of males’ parental consanguinity on some infertile subgroups and some semen and hormone parameters. Material and Methods: The charts of 2221 infertile males were retrospectively evaluated for first degree parental consanguinity ratios, sperm counts, motility parameters and FSH values at a tertiary care academic center. Detailed medical and surgical conditions and consanguinity status of the parents were evaluated. Some patients were grouped according to sperm counts. Some were grouped if they had some conditions related with infertility. If they had medical or surgical conditions which might be related or effect fertility status, their data were excluded. The ratios of the parental first degree consanguinities were compared among the groups. Statistical analyses were performed with independent sample t and chi square tests. Results: In 1049 eligible males the first degree parental consanguinity ratio was 22.7%. In 100 nonobstructive azoospermic (NOA) and in 300 normozoospermic males the ratios were 35% and 19.7%, respectively (P = 0.002). In NOA group the parental consanguinity ratios were 28.8% (19/66) and 47.1% (16/34) in males with the FSH values of >8.5 and <8.5, respectively (P = 0.07). In normozoospermic group if the parents were first cousins, both sperm counts and motility parameters were significantly reduced when compared with the others. Conclusions: To our knowledge, this is the first study of consanguinity ratios among some infertile subgroups. Our observations suggest that first degree parental consanguinity might have some deleterious effects. In males with parental consanguinity lower sperm counts and motility ratios in normozoospermic males and lower FSH levels in NOA group might show the relation with some genetically transmitted defects. Disclosure: Work supported by industry: no.

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THE DETERMINATION OF CHROMOSOMAL ABNORMALITIES IN AZOOSPERMIC MALES USING ARTIFICIAL NEURAL NETWORK Kalýnlý, A1; Demirtaþ, A2; Gökçe, A2; Akýnsal, E2; Ekmekçioðlu, O2 1: Erciyes University Faculty of Engineering/Turkey; 2: Erciyes University Medical Faculty/Turkey Objectives: In azoospermic males it is difficult to determine which males must undergo cytogenetic evaluation to find out any chromosomal abnormality in general practice. Genetical evaluation is time and money consuming and brings stress to the couple. Our aim was to develop an artificial neural network (ANN) model and to evaluate whether this model works to distinguish males who need genetical counselling. Material and Methods: Pellet negative azoospermic 345 males with chromosomal, complete hormonal, physical and seminal evaluation were enrolled in the study. They all had two testicles and had not undergone any prior surgical or medical conditions which might relate with infertility. Among 345 males, the data of 252 were analyzed with binary and multiple logistic regression analyses to differentiate which parameters were significant in decision making. With selected significant parameters a neural network was created and the education of the system was performed. The other 93 males were tested with the educated system.

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Results: The selected parameters with logistic regression analyses were height, total testicular volumes, FSH, LH, total testosterone and ejaculate volume. In multiple logistic regression analysis the final diagnosis was true in 93.5% of the males whether they had chromosomal abnormality or not. In 93 test cases the diagnosis was true in the ratio of 92.5%. Conclusions: Artificial neural network is a novel era in diagnosis making in especially andrology. It might help general practitionars of urology or other health care providers in selecting patients whether they need chromosomal evaluation. Neural networks do not need statistical evaluation and might show the direction for a new patient. However, statistical analyses need a pool of patients for a decision.

chial asthma, allergic rhinitis and neuro-dermatitis. All laboratory results; CBC, Blood Sugar, Total Testosterone, DHEA, T3, T4, TSH, Cortisol, Prolactin and Prostatic Smear were normal. Only elevated ALT and AST due to fatty liver. Trials of treatment by non-steroidal anti-inflammatory drugs, selective serotonin re-uptake inhibitor-es-citalopram-and tramadol were ineffective. Conclusion: Data on POIS are very few. Cases are mostly misdiagnosed. Much attention must be given to this syndrome from the clinicians, researchers, and the scientific meetings of the interested societies. Atopy in this patient may point to allergic reaction as a cause. Trials of treatment by corticosteroids may be worthy. Further investigations are mandatory.

Disclosure: Work supported by industry: no.

Disclosure: Work supported by industry: no.

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A NEW TREATMENT PARADIGM FOR FEMALE ORGASM DISORDER: A PILOT STUDY Banner, LL Objectives: Many women, aged 18 to 59 in the United States, report difficulty experiencing orgasm with physical intimacy with a male partner. Frequently, brief cognitive-behavior sex therapy (CBST) methods are applied with some success. However, the frequency of success and time to success can be overwhelming for some women and the need for a new integrative treatment method is evident. Materials and Methods: Seven women, aged 24 to 37 years old, were recruited to evaluate this integrative treatment method of female orgasm disorder. The signed the Informed Consent, completed the FSFI, BDI, and BAI, prior to beginning the four week study. They attended weekly CBST sessions, used guided relaxation, watched the Becoming Orgasmic DVD, and used the Synergy vibrator for the four weeks of treatment. Results: At the end of the four-week session, five women completed the study and two women dropped out due to pregnancy and moving out of the area. The five women who completed the study, reported an improvement on the FSFI, no significant changes on the BDI and BAI, and overall sense of well-being by learning to relax and experience orgasms with their partner during physical intimacy. Conclusions: While this is a very small study to evaluate efficacy of this method for treating female orgasm disorder, it clearly indicates a positive potential for an effective, brief treatment for this disorder. Disclosure: Work supported by industry: no.

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POSTORGASMIC ILLNESS SYNDROME “POIS”: CASE REPORT Attia, A1; Al-Ziny, M2; Yasien, H1 1: Faculty of Medicine Menofia University; 2: Faculty of Medicine Ain Shams University Introduction: POIS is a newly described syndrome. The reported cases worldwide are few. It presents by cognitive and/or flu-like manifestations that start within seconds of orgasm and may continue for days after. It is of unknown etiology and no treatment till now. Aim: To report a case of POIS in an Egyptian engineer and to draw the attention for such cases which may be misdiagnosed. Methods: This case documents POIS presentations, investigations and trials of treatment. Results: Apart from his POIS manifestations; he is sexually normal. His general health is fair except; life-long atopic manifestations; bron-

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Krychman, M; Kellogg, S 1: Hoag Hospital; 2: Pelvic and Sexual health Institute Objective: Orgasmic complaints are common for women and include changes in latency and frequency with respect to orgasmic potential.To date no treatment paradigm exists that offers the health care provider some guidance in order to manage these troublesome issues. Methods and Materials: Presented here is a proposed paradigm for the treatment of orgasmic complaints that affect latency and intensity of orgasm. Phase 1 a) Bibliotherapy, Sexuality Education, Self Stimulation, Use of Vibrator/Stimulator- Begin sexual response educational program which includes education about anatomy and physiology of sexual response. Phase 2 a) Topical Neutriceuticals; Products that may enhance genital sensitivity and increase sexual satisfaction includes Zestra® Feminine Arousal Fluid. b) Topical Hormonal Agents. Minimally absorbed local vaginal estrogen creams may be beneficial. Post menopausal women who realize substantial benefit who demonstrates vuvlovaginal and clitoral atrophic changes, including architectural changes and phymosis, topical compounded testosterone cream may

Proceedings from the 14th World Meeting of the International Society for Sexual Medicine be added for added benefit. Phase 3 a) Identify Medications that may negatively impact sexual orgasmic response. And attempt to change, decrease or alter dose. If selective serotonin reuptake inhibitor (SSRI) is the offending agent, consider adding a dopamine agonist to the SSRI regimen or changing to a new antidepressant. Also consider adding a phosphodiesterase inhibitor “antidote” precoitally. b) Phosphodiesterase Inhibitors (PDE5I) Agents: medications like phosphodiesterase inhibitors may prove to be helpful for SSRI induced orgasmic changes as well as for selected women who have orgasmic changes. Compounded PDE5I applied to clitoral tissues or 25–50 mg of oral Sildenafil 40–60 minutes prior to intercourse with improved sexual response. Results: Presented is a treatment paradigm to help ameliorate the issues related to changes in orgasmic latency and frequency. The paradigm shifts from minimally invasive to more systemic therapeutic options which can minimize potential side effects. This model has proven beneficial in over 100 women in two large busy sexual medicine practices on two coasts of the USA. Conclusions: Female orgasmic Disorder is complex and multifaceted and further research is needed to confirm its utility of proposed paradigms in large scale populations. Disclosure: Work supported by industry: no. The presenter or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.

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WOMEN’S VIEW OF MALE SEXUAL PROBLEMS: A QUALITATIVE INQUIRY Low, WY1; Ng, CJ1; Khoo, EM1; Tong, SF2; Wong, LP1; Tan, HM1 1: University of Malaya, Malaysia; 2: Universiti Kebangsaan Malaysia Background: Research on men’s health has always been focusing on men’s perspective of the issue. Research on women’s perception of male sexual problem, however, is lacking. Objective: The qualitative study aimed to explore women’s views on male sexual problems. Methods: Six focus group discussions were conducted in Klang Valley based on a semi-structured interview guide. A total of 62 women aged between 40–60 years participated. A qualitative data management software, NVIVO was utilized. Content analysis was used to exemplify the emerging themes. Results: Participants felt that sex was important for men and was men’s prime concern in terms of their bodily function as it ‘proves’ their manhood and masculinity. Some participants felt that sex drive declined in men after 50 years old but a few disagreed. Women on the other hand felt there were other ways to being close besides having sex. However, participants felt men should seek medical help if they had erectile dysfunction (ED) because it might indicate other health; some felt ED was an indicator of poor health. Most participants believed men would not tell their wives if they had ED. It was regarded a taboo and a loss of their ‘manliness’. Nevertheless, women viewed it important for wives to understand ED. They wished to be acknowledged if their husbands had ED and be able to talk about it.

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Conclusion: Women were well informed about male sexual health and could potentially help their spouses in improving their health. Disclosure: Work supported by industry: no.

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CROSS-SECTIONAL SURVEY OF SEXUAL HEALTH AND VAGINAL LAXITY FOLLOWING VAGINAL DELIVERY Millheiser, L1; Kingsberg, S2; Chen, B1; Lukes, A3; Pauls, R4, Pope, K 1: Stanford University School of Medicine, USA; 2: Case Western Reserve University School of Medicine, Pennsylvania, USA; 3: Carolina Women’s Research and Wellness Center, North Carolina, USA; 4: Good Samiritan Hospital, Cincinnati, Ohio, USA Objective(s): To examine the prevalence of vaginal laxity and its impact on women’s sexual function as well as assess OB/GYN’s attitudes and practices regarding sexual health and physical changes after childbirth. Material and Method(s): Two non-randomized cross-sectional surveys were administered on-line. An OB/GYN Alliance database was utilized to identify 524 OB/GYNs in US private practices. A national database of on-line registrants was used to survey 421 women (25– 55 yrs) who had experienced at least one vaginal delivery. Anonymity was maintained for all respondents. Result(s): Descriptive statistics were used to analyze all survey data. Among the 635 women who received the on-line questionnaire, 421 completed the survey representing a 69.8% response rate. Surveys were collected from women in every state of the continental US. Nearly 90% of the women were married with a median of two children. Among the 524 OB/GYN respondents, 58.5% were male and 57.9% reported seeing 50–100 patients per week. Most of the OB/ GYNs (98%) reported discussing sexual health with patients; although 52% spent less than five minutes on the topic. Common physical changes observed by them after vaginal delivery included vaginal laxity (88%), weight gain (83%), and urinary incontinence (75%). Forty percent of OB/GYNs felt that nearly 25% of their patients experienced undesirable physical changes and would be interested in treatments for vaginal laxity. In the female survey, the prevalence rate of vaginal laxity or “looseness” was found to be 48%. Many of the respondents (62%) had never discussed it with anyone; while only 20% discussed the topic with their OB/GYN. Approximately 50 % of the women felt that improving the tightness of their vaginal introitus would enhance their own sexual satisfaction and that of their partners’. Conclusion(s): Both surveys confirm a high prevalence of vaginal laxity as a physical change experienced after vaginal delivery and that dialogue between patients and their OB/GYNs on sexual health is limited. Although vaginal laxity is a significant concern to women, it is rarely discussed with health professionals. Both patient and physician are interested in treatments aimed at improving sexual quality of life. Disclosure: Work supported by industry: yes, by Viveve, Inc. (industry initiated, executed and funded study). The presenter or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.

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