Friday 10 October 2014

Session type:
Person:
Clear filters

Morning

08:30 - 09:00
Master lecture 4 - Is there an increased CV risk in patients on TRT?

Location: Comandatuba Room 2+3
Chairs: John Dean (United Kingdom) & Luiz Otavio Torres (Brazil)

Is there an increased CV risk in patients on TRT

Mario Maggi (Italy)


09:00 - 09:30
Master lecture 5 - Sexual issues in SCI women

Location: Comandatuba Room 2+3
Chairs: Kwangsung Park (Korea) & Lucia Pesca (Brazil)

Sexual issues in SCI women

Michal Lew-Starowicz (Poland)


09:30 - 10:00
Master lecture 6 - Nitric oxide in the penis: Scientific discoveries and clinical applications

Location: Comandatuba Room 2+3
Chairs: Ganesan Adaikan (Singapore) & Juza Chen (Israel)

Nitric oxide in the penis: Scientific discoveries and clinical applications

Arthur Burnett (USA)


10:00 - 10:30
Coffee break

Location: Comandatuba Room 1

10:30 - 11:00
Point counterpoint 3 - 90 degree penile curvature: Patch or corporoplasty?

Location: Comandatuba Room 2+3
Chairs: Guillermo Gueglio (Argentina) & Sudhakar Krishnamurti (India)

Patch

Arthur Burnett (USA)

Corporoplasty

Wayne Hellstrom (USA)


10:30 - 11:30
Moderated posters 4 - Psychotherapy

Location: São Paulo Room
Chairs: Chris Nelson (USA) & Sharon Parish (USA)

Military sexual trauma in male military personnel (#134)

S. Wilcox (USA)
show abstract

134

Military sexual trauma in male military personnel

Wilcox, S1; Schuyler, A1; Campbell, S1; Redmond, S1

1: University of Southern California, United States

Objective: To assess the rate of military sexual trauma (MST) in a nation-wide sample of male military personnel and evaluate the impact of MST on psychosocial functioning and quality of life (QOL). Research on sexual trauma and victimization has historically focused on women, who have been more likely to report such experiences. While rates of sexual trauma and victimization are lower in men, it still exists and the subsequent impact on psychological and physical functioning can be severe. Military personnel often under report psychological problems and the sensitive nature of MST in men is predicted to further reduce reported rates in military personnel, in addition to the complexities of assessing MST. Further, men with MST are more likely to report comorbid mental health diagnoses and are nearly three times more likely to report PTSD than men without MST.

Material and Methods: This exploratory study used data from a larger study on sexual functioning problems in military populations age 40 and younger. This sample consisted of 367 male military personnel aged 18-40 years. Process modeling was performed to examine the psychosocial processes by which MST can influence QOL. We predicted that MST would be associated with reduced mental health outcomes, which would be associated with lower QOL.

Results: Results show high rates of MST in male military personnel and indicate the negative association MST can have on mental health outcomes and QOL.

Conclusions: This study underscores the importance of assessing MST in men (in addition to women). While men are less likely to report MST, there may be many unreported cases that are significantly impacting psychosocial functioning and QOL. Strategies aimed at reducing MST in both men and women can significantly improve the readiness of military populations.

Disclosures:

Work supported by industry: yes, by California Community Foundation - Iraq Afghanistan Deployment Impact Fund (industry funding only - investigator initiated and executed study).

Sexuality and depression among pregnant women with recurrent spontaneous abortion (#135)

M. Francisco (Brazil)
show abstract

135

Sexuality and depression among pregnant women with recurrent spontaneous abortion

Francisco, M1; Mattar, R1; Nakamura, M1

1: UNIFESP, Brazil

Objective: To analyze, among pregnant women with a history of recurrent spontaneous abortion (RSA), symptoms of depression, sexual behavior, emotional support from the partners and the interrelationships between these factors.

Methods: This was a prospective case-control study, being the first group of RSA and the second by primigravidae. It has been used the Beck Depression Inventory (BDI), the Female Sexual Function Index (FSFI) and two more questionnaires, one about emotional aspects resulting from sexual intercourse during pregnancy and another about the emotional and social support offered by the partner. To compare quantitative variables with normal distribution, it has been used the Student t test, and categorical variables were compared using the chi-square test or Fisher's exact test. The statistical significance was set at p <0.05.

Results: The BDI showed approximately twice the incidence of depression in the group RSA. Regarding sexual function, the average scores of the FSFI were lower for the group RSA, and only under the desire (average 3.4 ± 1.3 for the RSA group and 3.7 ± 1.1) was not statistically significant (p = 0.003). We have realized that, regardless of the pregnant woman having or not having RSA history, the higher the depression score, the lower the sexuality score.

Conclusions: RSA pregnant group often experience depression twice and more impaired sexual function. There is an inverse association between depression and sexual function / emotional support from the partner and direct association between emotional support and sexual function.

Disclosures:

Work supported by industry: no.

show poster

Comparison of traditional female sexual function Index score versus adapted score for postmenopausal Latin-American women (#136)

G. Silva (Brazil)
show abstract

136

Comparison of traditional female sexual function Index score versus adapted score for postmenopausal Latin-American women

Silva , G1; Lima, S1; Reis, BF2; Bernardo, B2; Macruz, C2

1: Santa Casa de São Paulo Medical School, Brazil; 2: São Paulo Medical School, Brazil

Introduction: When using the FSFI, the currently acceptable cutoff value for diagnosing Sexual Dysfunction (SD) in women between 18 and 74 years of age is ≤ 26.5. Nevertheless, this index can yield SD rates varying from 22 to 50% in fertile women, which would then lead to the inappropriate conclusion that the majority of fertile and healthy women in their fourth decade of life have SD. For this reason, there has been some debate about considering the ideal total score as ≤ 23. In fact, in a study with pre-menopausal women of Latin origin not using oral contraceptives, an FSFI score ≤ 23 was considered as the cutoff value for diagnosing them as having SD. Therefore, considering studies and the fact that we have also been evaluating a post-menopausal female cohort of Latin origin, we used as a cutoff value FSFI ≤ 23 and we also calculated the SD rates in our study considering the traditional cutoff value of FSFI ≤ 26.5.

Objective: To compare the traditional Female Sexual Function Index versus adapted score for postmenopausal Latin-American women.

Methods: This is a case-control study. The group consisted of post-menopausal women that usually seek treatment at the Endocrine Gynecology Clinic at the Santa Casa de São Paulo Medical School at and at the Basic Health Units (Vila Barbosa, Vila Dionísia and Vila Santa Maria) participating in the Family Health Program promoted by the local municipal health authorities in São Paulo, in the period between February 2011 and February 2013. The study was conducted in accordance with the Declaration of Helsinki. All patients signed a voluntary informed consent form that was approved by the Medical Ethics Committees at the Faculty of Medical Sciences at Santa Casa de São Paulo .The women considered as being post-menopausal were those with amenorrhea ≥ 1 year and FSH ≥30mUI/mL. The MetS diagnosis was determined by the ATP III. The sexual function was performed by using the FSFI. These are indicative of  SD risk when their values are less than or equal to 26.5 points – in post-menopausal women, the cutoff value FSFI <23 was also considered. We used the cutoff value ≤23, and we also calculated the SD rates while considering a cutoff value of FSFI ≤26.5.

Results: When we used a cutoff value of FSFI < 23 for determining the presence of SD, we observed that 18.4% of the patients in the Control Group and 57.4% in the MetS Group showed that disorder. When we used a cutoff value of 26.5, 48.2% of the patients in the Control Group and 83.3% in the MetS Group were diagnosed with SD. The prevalence of SD was greater in the MetS Group than in the Control Group, either when using cutoff values of 23 or 26.5(57.4% versus 18.4%; FSFI <23: 83.3% versus 48.2%).

Conclusion: As proposed in previous studies, we believe that a less rigorous cutoff value is more appropriate for the Brazilian population, considering that the percentage of the population affected by SD is very high and incompatible with what we observed during the interviews. An important hypothesis would be the existence of socio-cultural and religious variables, which are difficult to measure statistically. New studies are needed in order to demonstrate the reason why the total FSFI score obtained from our sample was lower than expected, similarly to what was observed in the studies mentioned in the literature. Althought the FSFI is the most widely used scale to assess SD in women, adaptation to other cultures is necessary.

Disclosures:

Work supported by industry: no.

show poster

Sexual function in schizophrenia (#137)

D. Lin (USA)
show abstract

137

Sexual function in schizophrenia

Lin, D1; Snyder, C; Concepcion, E; Colon-Vilar, G

1: Mount Sinai Beth Israel, United States

Objective: This study surveys patients with schizophrenia or schizoaffective disorder, to understand the relationship between sexual function and treatment with antipsychotic medication. The study compares patients on single versus multiple antipsychotics as well differences between first and second generation agents.

Material and Method: Patients diagnosed with schizophrenia or schizoaffective disorder at Beth Israel Medical Center are eligible. Once patients are evaluated to ensure they meet enrollment criteria and are consented, they are administered the Positive and Negative Syndrome Scale (PANSS), Abnormal Involuntary Movement Scale (AIMS), and either the International Index of Erectile Function for men, or the Female Sexual Function Index for women. Inclusion criteria include age 18-65, able to participate in a structured interview, fulfill DSM-IV criteria for Schizophrenia or Schizoaffective disorder, and on stable doses of one or more antipsychotic medications for at least six weeks. Exclusion Criteria include patients taking Selective Serotonin Reuptake Inhibitors (SSRIs), and inability to provide informed consent.

Results: Presently, data suggests sexual function is impaired secondary to antipsychotic use. Further extrapolation of data is pending further enrollment.

Conclusions: Preliminary results point to better sexual function with certain second generation antipsychotics. It also appears that patients on single antipsychotic may have better sexual function than patients on multiple agents.

Disclosures:

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

Attachment styles, sexual concerns and their relation to sexual behavior (#138)

K. Brenk-Franz (Germany)
show abstract

138

Attachment styles, sexual concerns and their relation to sexual behavior

Brenk-Franz, K1; Strauß, B2

1: Institute of General Practice & Family Medicine, University Hospital Jena, Germany; 2: Department of Psychosocial Medicine and Psychotherapy, University Hostpital Jena, Germany

Background: Attachment Theory provides a useful view on human sexuality. It affords the reflection of different facets of human sexuality from a developmental perspective and offers approaches of explanation for interindividual differences in sexual concerns and behavior.

Purpose: The purpose of the study was the question, whether different styles of attachment are associated with interindividual differences in sexual concerns and behavior.

Methods: The relations between adult attachment and sexuality were examined in a sample from Germany. Participants completed self-report scales of Attitudes Related to Sexual Concerns Scale (ASC-Scale, Cowden & Koch 1995; German: FSB; Brenk-Franz, Strauß, 2014), Multidimensional Sexuality Questionnaire (MSQ, Snell, Fisher & Walters, 1993; German: MFS; Brenk-Franz & Strauß, 2014) and Questionnaire on Sexual History and Sexual Behavior (FSGSV; Brenk-Franz & Strauß, 2014). The Attachment styles were measured by the Bielefeld Partnership Expectations Questionnaire (BFPE, Höger & Buschkämper, 2002).

Results: 261 women and men at the age of 16 to 68 were included in a German cross-sectional study. There were significant differences in kind of sexual concerns in dependence of the attachment styles. Adults with insecure attachment reported higher sexual concerns with body image, commitment, sexual communication, performance and sexual self-understanding than persons with secure attachment. Adults with secure attachment reported a higher trust in close relationships, a higher sexual-esteem and internal-sexual control, a minor preference for one-night-stands or extra-relationship sexuality. In contrast, adults with an insecure dismissing attachment reported the earliest sexual maturity and the earliest time in sexual intercourse. Adults dismissing attachment preferred more one-night-stands and sexual activities in extradyatic relationships, but reported a minor sexual satisfaction Ambivalent attachment was associated with more aversive sexual feelings and cognitions.

Discussion: These findings support the strong association between attachment and sexuality. The sexual relationships of ambivalent attached individuals tend to be organized around the hyperactivation of their attachment system, which causes them to be chronically dependent on others. They use sex to reduce insecurity and establish intense closeness, while also having feelings of external-sexual control. On the other hand, in line with their goal of deactivating attachment concerns, dismissing individuals find close sexual relationships uncomfortable. Based on their general discomfort with intimacy and a desire to avoid closeness they prefer sexual relationships without commitment and have the tendency to focus on their own sexual needs.

Disclosures:

Work supported by industry: no.

The binomial sexuality and childbirth: Mutual repercussions (#139)

M. Madi (Brazil)
show abstract

139

The binomial sexuality and childbirth: Mutual repercussions

Madi, M1; Nakamura, M2; Vieira, T2

1: Universidade Federal de São Paulo, Brazil; 2: Universidade Federal de São Paulo

Objective: Assess sexual function of pregnant women during the first prenatal consultation and correlate with their opinion about impacts of vaginal birth (with or without episiotomy) or cesarean on sexuality.

Method: Cross-sectional study with low-risk pregnant women conducted by Universidade Federal de São Paulo/UNIFESP, during their first prenatal consultation. Data collection included 30 pregnant women in the 2nd or 3th trimester, over 18 years old, and in a relationship with the same partner for at least 6 months. Pregnant women with clinical/obstetrical complications that contraindicated sexual activity were excluded. The questionnaire applied contained 35 questions, including socioeconomic profile, opinion on the possible pelvic floor and sexuality modifications due to childbirth, and the Sexual Coefficient female version (QS-F) - a validated instrument to evaluate sexual satisfaction. Pregnant women were divided into 3 groups (G1/G2/G3) according to QS-F and the results were compared (G1: excellent; G2: good; G3: null to regular sexual satisfaction). To compare means and the homogeneity of the proportions the non-parametric test of Kruskal-Wallis and Fisher's extract test were used respectively. The significance level used for the tests was 5%.

Results: Average age was about 29.3 (± 5.1), they had 2.1 (± 1.2) pregnancies (considering the current) and 1.2 (± 1.4) previous births. In G1, 75% had at least 11 years of education, higher than the G2 and G3 (p=0, 003). Unlike G2 and G3, where the partner takes more initiative to sex, in G1 58,6% of the initiative comes from both in the same proportion (p=0, 041). 56.7% had never talked about sex with any health professional. The next results had no statistical difference between the groups: only 10% considered that vaginal birth with episiotomy could interfere with sex after the postpartum period, 3.3% would request cesarean to avoid vaginal changes. Grading assignments considering a 0 to 10 scale: fear of labor pain was 5.7 (± 3.4); concern about parturition and newborn vitality: 5.6 (± 3.8); fears of episiotomy: 3.3 (± 3.3) and fear of vaginal structural changes: 3.1 (±3.6).

Conclusions: Results underscore a maternal concern centered on childbirth and newborn vitality. The fact that 56,7% had never talked about sex with health professional, even those with more schooling and better sexual satisfaction, makes the prenatal consultations an even more important and essential moment, not just to inform and clarify pregnancy changes and childbirth itself but also for the obstetricians to expose the topic of sexuality.

Disclosures:

Work supported by industry: no.

show poster

Preliminary data on the efficacy of psychoeducational intervention on sexual health and sexual difficulties in individuals with psychotic or mood disorder (#140)

M. Scanavino (Brazil)
show abstract

140

Preliminary data on the efficacy of psychoeducational intervention on sexual health and sexual difficulties in individuals with psychotic or mood disorder

Vieira, J1; Silva, G1; Carmo, I1; Neto, M1; Amaral, M1; Sant, R1; Scanavino, M1

1: Hospital das Clinicas - FMUSP, Brazil

Objectives: To assess the effectiveness of psychoeducational intervention on sexual health and sexual difficulties in individuals with psychotic or mood disorders in an experimental model of day hospital.

Methods: This interventional study in an experimental model of day hospital, comprising three group approaches (sexual psychoeducational, neurocognitive rehabilitation, fitness) with minimal crossed effect between them, twice a week, unchanged drug regimens and without exposure to other interventions, along 10 weeks. In this work, we analyzed data on sexual health. The first nine patients diagnosed with psychotic or mood disorder according to the Structured Clinical Interview for DSM-IV (SCID-CV), formed the first group who underwent assessments before and after the intervention, with the measure Knowledge about Human Sexuality and Sexual Health and the measure Arizona Sexual Experience. The sexual psychoeducational approach consisted of 10 sessions of 60 minutes weekly, on sexual health.

Results: Seven men and two women, whose the mean age was 39.6 (SD = 11.0) years and 14.9 years of education (SD = 5.0), whose two completed the high school and seven started the college but did not finish. There were seven singles and two divorced. Six met criteria for schizophrenia and three for mood disorder. Regarding knowledge about sexuality, there was no difference (p> 0.05) when comparing the mean score at time 2 vs. time 1 in total sample, nor in the group diagnosed with schizophrenia and the group diagnosed with mood disorder. For symptoms of sexual dysfunction, the comparison of mean scores at time 2 vs. time 1 showed no difference in the total sample, but showed a trend towards difference (p = 0.06) among those diagnosed with mood disorder (M = 21.7, SD = 2.1 vs. M = 25.0,. SD = 3,6).

Conclusions: The intervention was not effective for changing the sexual knowledge, which can be explained by the difficulty in acquiring new information by individuals with schizophrenia. The improvement in sexual difficulties after the psychoeducational intervention is consistent with previous studies.

Disclosures:

Work supported by industry: no.

show poster

Fears and myths during pregnancy and their impact on sexual activity: a systematic review of the literature (#141)

M. Ribeiro (Brazil)
show abstract

141

Fears and myths during pregnancy and their impact on sexual activity: a systematic review of the literature

Ribeiro, M1; Mattar, R2; Nakamura, M3; Torloni, M2; Scanavino, M4; Horta, A2

1: São Paulo Federal University, Brazil; 2: São Paulo Federal University (UNIFESP), Brazil; 3: São Paulo State University Medical School (FMUSP), Brazil; 4: University of São Paulo Medical School (FMUSP), Brazil

Objectives: Myths and fears about potential harms of sexual activity on the pregnancy or the fetus may affect the couple’s sexuality and relationship. We conducted a systematic review of the literature to assess fears and myths related to sexual activity during pregnancy in different cultural contexts.

Patient and Methods: Medline electronic database was searched from 2004 to 2014, without language restrictions for publications on fears or myths related to sexual activity during pregnancy. The following key-words were used: “sexual behavior” or “coitus” or “sexuality” and “pregnancy” or “pregnant women” or “gestation”. A specific data extraction form was created to extract the following information from each included study on i) design, ii) participant characteristics, iii) fears and myths. The search was completed by screening the reference lists of publications selected for full text reading. The process of study selection and extraction was performed by two independent reviewers; disagreements were discussed until consensus was reached.

Results: The search strategy yielded 594 references. After primary screening of titles and abstracts, 18 studies were selected for full text reading, 11 were excluded because they lacked information about sexual myths in pregnancy and 7 were included. Three additional studies were identified in the reference lists of the included manuscripts. In total, ten studies (conducted in Nigeria, China, Thailand, Egypt, Iran, Portugal and Croatia) were included. Fears of harming the fetus, of abortion, of preterm labor or rupture of membranes were reported by women and their partners as reasons to avoid sexual activity, in all ten studies. Additional reported reasons to forgo sexual intercourse during pregnancy included: fear of sin due to perception of the fetus as a third person; avoidance of adultery and of rupturing the hymen of a female fetus, as well as blindness and suffocation of the baby (Iran); bleeding and infection (Nigeria, China, Thailand, Iran, Croatia) as potential results of coitus and the belief that breast massages can lead to preterm labor (Egypt). Reported reasons to increase or maintain sexual activity in pregnancy included to keep the husband, to maintain marital harmony (Nigeria) and to facilitate labour in late pregnancy (Nigeria and Egypt).

Conclusion: Our findings indicate that myths and fears may affect the couple’s sexual life and vary in different cultures.

Disclosures:

This study was funded by a grant from FAPESP – Fundação de Amparo à Pesquisa do Estado de São Paulo. Process n. 12/03670-4 and 12/50225-6

show poster

The features of motivational sphere in infertile women (#142)

N. Stenyaeva (Russia)
show abstract

142

The features of motivational sphere in infertile women

Stenyaeva, N1; Chritinin, D2; Sukhikh, G1

1: Federal State Budget Institution "Research Center for Obstetrics, Gynecology and Perinatology" Ministry of Healthcare of the Russian Federation, Russia; 2: I.M. Sechenov First Moscow State Medical University

Objective: To study the features of value-motivational sphere in women with infertility.

Subjects and Metods: 157 women (average age 33.38 ± 4.96) had primary infertility, and 53 fertile women (average age 32.26 ± 34.86) were studied as the group of comparison. Criteria for exclusion were mental diseases (schizophrenia, schizotypical and delusional disorders, affective mood disorders, epilepsy, etc.). Motivational orientations in interpersonal communication were investigated, as well as the features of value orientations, and motivational-require mental sphere area.

Results: According to the Test of humorous phrases (THP), 69.8% of women with infertility demonstrated social motives. They were characterized by paying high personal importance to "gender relationship" and decreased importance to the motive of self-preservation. The Rokich technique revealed in this group the leading value of the physical and mental health (U = 34.5, p < 0.05), indicating the motivations shift towards the goal to become healthy. Among the values – goals specific material values and values of personal life were prevailing. Among the most important instrumental values in women with infertility there were social values of communication and acceptance of other people.  The results of studies showed domination of need to reach a certain result, as well as high scores on the scales of "altruism" and "friendship" demonstrating the needs for communication, assistance and help to other people. Women in the two groups showed statistically significant differences in motivational orientations to communication (U = 45.5, p ≤ 0.01). The infertile women were focused more on the "compromise" in their interpersonal communications, as well as on the harmony in relationship in general.

Conclusion: Infertility leads to disruption of normal social functioning of a woman and her emotional state, which affects the value-motivational sphere of personality and leads to the shifts of motives, needs and values. Infertile women’s motives are shifted to the goal of "health". These women are characterized by the social orientation of values and needs; apparent need for physical and emotional affinity with the beloved and family; low motivations for high social or career status and self-affirmation; motivational orientation towards compromise and communicational harmony; and by unsatisfied need for safety.

Disclosures:

Work supported by industry: no.

show poster

Prevalence of zoophilia in Czech sado-masochistic community (#143)

K. Bártová (Czech Republic)
show abstract

143

Prevalence of zoophilia in Czech sado-masochistic community

Binter, J1; Schejbalova, A1; Bártová, K1; Varella Vanletova, J2; Krejcova, L1; Weiss, P3; Kleisner, K4; Keil, P5; Klapilova, K1

1: Faculty of Humanities, Charles University in Prague, Czech Republic; 2: Center for Theoretical Studies, Chares University & the Academy of Sciences of the Czech Republic, Prague, Czech Republic; 3: 1st Medical Faculty, Charles University, Prague, Czech Republic; 4: Department of Philosophy and History of Science, Charles University, Prague, Czech Republic; 5: Department of Ecology and Evolutionary Biology, Yale University

Sexual contact with animals – zoophilia has been rarely studied. The most famous are studies by Kinsey (1948, 1953) who identified 8% and Hunt (1974) who identified 2-5% prevalence of zoophilic behavior. Williams & Weinberg (2003) reported that in the USA the prevalence is around 5%. Sandabba (2002) focused on the prevalence in Sado-Masochistic (S-M) community and identified prevalence of 7,5% (12 of 164 respondents).

We have analyzed data from dating questionnaires available online from 3,734 members of the largest Czech S-M community (altogether more than 17 thousand members) divided into four categories: dominant men (N = 1,496; mean age = 34.7, ± SD ± 9.0), submissive men (N = 1,572; 32.2 ± 8.9), dominant women (N = 140; 30.6 ± 8.9), and submissive women (N = 526; 29.9 ± 9.2). The questionnaires were not designed by researchers but by members of the community to find an appropriate partner. The questionnaire had two parts A) yes/no questions about general dimensions of preferences and practices (e.g., beating, bestiality) and B) specific activities for each general dimension (e.g., beating by hand, oral sex with a horse) scaling form 1 = never wanted even to try, to 5 = insisting on such practices.

The prevalence of the general dimension of zoophilia among all groups together was 7.32%. In dominant men it was 6.1% (91 out of 1,496), in submissive men 9.1% (143 out of 1,572), in dominant women 3.6% (5 out of 140), and in submissive women 10.6% (55 out of 526). Also we have found that submissive members tended to be more likely to perform bestiality than dominants (χ²=9.882, p=0.002). Also, we have found a positive correlation between preferences for zoophilia and dominance in dominants (r = 0.061, p = 0.005) and submissiveness in submissive members (r = 0.146, p < 0.001). Preference for bestiality was also associated with activities that include contact with waste products of human metabolism – urine, excrements and vomit. Therefore, we suggest the reason to have sexual contact with animals in S-M community is related to induction of negative emotions (disgust, fear, shame) that can, in some cases, increase sexual excitement, as lately suggested by de Jong (2012, 2013) and others.

Disclosures:

Work supported by industry: no.

show poster


10:30 - 11:30
Podium 5 - Epidemiology

Location: Transamérica Auditorium
Chairs: Emmanuele Jannini (Italy) & Juan Uribe (Colombia)

Weaker masturbatory erection may be a sign of early cardiovascular risk associated with erectile dysfunction in young men without sexual intercourse (#025)

Y. Huang (China)
show abstract

025

Weaker masturbatory erection may be a sign of early cardiovascular risk associated with erectile dysfunction in young men without sexual intercourse

Huang, Y1; Chen, B1; Ping, P1; Chen, X1; Wang, H1; Huang, Y1

1: School of Medicine, Shanghai Jiao Tong University, China

 

Objectives. To evaluate the young men presenting weaker masturbatory erection with no sexual intercourse (WME-NS) and verify if this cohort have early cardiovascular risks associated with ED.

Material and Methods. Male subjects aged 18-40 years with WME-NS were screened by analyzing detailed sexual intercourse and masturbatory history. The age-matched ED and non-ED population were identified by using International Index of Erectile Function-5 (IIEF-5). All subjects with acute and/or chronic diseases (including diagnosed hypertension and diabetes) and long-term pharmacotherapy were excluded. Nocturnal penile tumescence and rigidity (NPTR), systemic vascular parameters and biochemical indicators related to metabolism were assessed. Comparison analysis and logistic regression analysis were conducted among WME-NS, ED and non-ED population.

Results. In total,78 WME-NS cases (mean 28.99±5.92 years), 179 ED cases (mean 30.69±5.21 years) and 43 non-ED cases (mean 28.65±4.30 years) were screened for analysis. Compared with non-ED group, WME-NS group had higher prevalence of early ED risk factors including endothelial dysfunction, insulin resistance, high level of glycosylated serum protein and abnormal NPTR. Multivariable-adjusted logistic regression analysis showed endothelia dysfunction (odds ratio: 8.83 versus 17.11, both P<0.001) was the independent risk factor for both WME-NS and ED.

Conclusions. Weaker masturbatory erection may be a sign of early cardiovascular risk associated with ED in young men without sexual intercourse. More studies are warranted to elucidate the clinical benefits by targeting these formulated strategies.

Disclosures:

Work supported by industry: no.

Factors correlating with sexual interest and function in long-term colorectal cancer survivors (#026)

H. Ayoub (USA)
show abstract

026

Factors correlating with sexual interest and function in long-term colorectal cancer survivors

Ayoub, H1; You, Y2; Cao, H1; Hu, C1; Bailey, C3; Chang, G1; Feig, G1; Rodriguez-Bigas, M1; Skibber, J1; Westney, L1

1: MD Anderson Cancer Center, United States; 2: MD Anderson Cancer Center, United States ; 3: MD Anderson Cancer Center

Purpose:  Long-term sexual dysfunction after multimodality treatment of rectal cancer occurs in roughly 40% of patients, irrespective of gender. We sought to evaluate the factors influencing the quality of sexual function as reported on a colorectal cancer specific quality of life instrument.

Materials and Methods: Colorectal Cancer (CRC) patients alive > 5 years from their diagnosis were identified from our Tumor Registry. Demographics, tumor characteristics and treatment details were extracted. Patients were mailed a standardized survey - European Organization for Research and Treatment of Cancer (EORTC) CRC disease specific module (CR29). Responses to items in the CR29, generic sexual interest and gender specific sexual function (impotence and dyspareunia), were extracted and analyzed. Univariate and multivariate analysis (logistic and linear) was performed to examine the relationship between clinical treatment factors [extent/location of surgical resection (abdominal, distal rectal or anus), lifetime chemotherapy, lifetime XRT and presence of an ostomy] and sexual interest/function.  A two tailed p < 0.05 was considered statistically significant.

Results: Of 830 responders, 671 (81%) completed the sexual items.  The mean age was 55.9 (SD, 11.6) years with a mean time from diagnosis of greater than 10 years.  In males, decreased sexual interest correlated with younger age (p<0.001). Impotence was associated with a permanent ostomy (p=0.0045), radiation (p=0.0003), current cancer (p=0.0103) and younger age at cancer diagnosis (p=<0.001).  In female survivors, sexual interest was negatively impacted by permanent ostomy, radiation and younger age of diagnosis but positively related to marriage (0.0001). In univariate analysis, dyspareunia was associated with surgery type (0.0012), permanent ostomy (0.0025), history of radiation therapy (0.0025), prior chemotherapy (0.0061), older age (0.0405) and marital status (<0.0001).  Marriage was predictive of dyspareunia (p=0.001). 

Conclusion:

Both permanent ostomy and radiation correlated with impotence and dyspareunia.  Determinants of sexual interest varied tremendously based on gender.  Younger patients had more complaints regarding level of sexual interest.  Due to the cross-sectional nature of this study, we cannot determine the relationship to baseline.  Additionally, historical and present frequency of sexual activity is unknown.

Disclosures:

Work supported by industry: no.

Sexual function recovery in kidney transplant donors and receptors after a year of follow-up (#027)

J. Herrera-Caceres (Mexico)
show abstract

027

Sexual function recovery in kidney transplant donors and receptors after a year of follow-up

Magaña-Rodríguez, J1; Herrera-Caceres, J1; Davila, F1; Rodríguez-Covarrubias, F1; Gabilondo-Pliego, B1; Castillejos-Molina, R1

1: INCMNSZ, Mexico

Objective: The study aims to analyze the change in sexual function among men before and up to one year after a renal transplant. Secondary analysis aims to compare sexual function dynamics to donor nephrectomy patients.

Material & Methods: We prospectively included renal transplant patients and kidney donors from July 2011 until March 2014. A basal evaluation of sexual function was performed as well as a monthly follow-up up to one year from surgery. We used the IIEF questionnaire for sexual evaluation. We also obtained demographic information from patients.

Results: We included 52 male kidney transplant patients and 12 male donors. Transplanted kidneys were either form living or cadaveric donors. Mean age was 34.48 (SD 12.97) years old for receptors and 37.82 (SD 9.15) years old for donors.

Abstract 027

Before transplantation, all IIEF domains except for overall satisfaction were worse in the receptors. One year after surgery none of the individual domains showed a statistically significant difference. It is important to mention that since the first month (p= 0.55) and after a year from transplantation, there was no difference in glomerular filtration rate (p= 0.85)

Conclusions: Before the transplant, kidney receptors have a worse sexual function in comparison to healthy individuals, such as kidney donors. Interestingly, just after a month after the surgery the difference among groups disappeared. By one year receptors seems to have a better improvement, although this did not reach statistical significance, perhaps due to the sample size.

Disclosures:

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

Exploration of the association between chronic periodontal disease and erectile dysfunction from a population based view point (#028)

C. Tsao (Taiwan)
show abstract

028

Exploration of the association between chronic periodontal disease and erectile dysfunction from a population based view point

Tsao, C1; Liu, C2; Cha, T1; Hsu, C3

1: Depertment of Surgery, Division of Urology, Tri-Service General Hospital, Taipei, Taiwan; 2: Department of Nutritional Science, Fu Jen Catholic University, New Taipe, Taiwan; 3: Graduate Institute of Biomedical Informatics, Taipei Medical Unversity, Taipei, Taiwan

Objective:

Several cross-sectional studies have indicated an association between chronic periodontal disease (CPD) and cardiovascular disease and metabolic syndrome. Erectile dysfunction (ED) also shares pathological mechanisms with these diseases. Using a nationwide population-based dataset, we examined the association between ED and CPD, and assessed the effect of dental extraction (DE) on ED prevalence in different aged CPD populations in Taiwan.

Material and Methods:

The study population and matched controls for this case–control investigation were taken from the Longitudinal Health Insurance Database (LHID2000). The LHID2000 includes all the original claims data and registration files for 1,000,000 individuals randomly sampled from the 2000 Registry for Beneficiaries (n = 23.72 million) of the Taiwan National Health Insurance (NHI) program. A matched case–control study of ED was conducted in Taiwan. Cases included ED patients ≥ 20 years of age and < 80 years of age diagnosed with ED for the first time (International Classification of Disease, 9th edition, Clinical Modification (ICD-9-CM code 607.84) during visits to ambulatory care centers (including the outpatient departments of hospitals or clinics) between 1996 and 2008. DE procedures (ICD-9-CM codes 23.0, 23.09 & 23.19) were traced prior to the ED diagnosis date.

Result:

We identified 5,105 patients with ED and randomly selected 10,210 patients as controls. Of these patients, 2,617 (17.09%) were diagnosed with CPD according to the index data: 1,196 (23.43%) in the ED group and 1,421 (13.92%) in the control group. After adjusting for comorbid factors, patients with ED were more likely to have been diagnosed with prior CPD than controls (OR = 1.79, 95% CI = 1.64-1.96, p < 0.001). Moreover the association was much stronger in the populations aged less than 30 years (OR = 2.13, 95% CI = 1.23-3.70, p < 0.001) and more than 59 years (OR = 2.27, 95% CI = 1.99-2.59, p < 0.001).

Conclusion:

Dental extraction (DE) seems attenuate damage to the penile endothelial beds caused by CPD-related inflammation, and overcame the process of ED in the middle-aged and older populations.

Disclosures:

Work supported by industry: no.

Female sexual dysfunction risk factors in diabetic women (#029)

A. Mahran (Egypt)
show abstract

029

Female sexual dysfunction risk factors in diabetic women

Moubasher, A1; Mahran, A1; Asham, R1; Zakaria, M1; Abdel Rahman, G1

1: Assuit University Hospital, Egypt

Objective: To assess the risk factors of developing female sexual dysfunction (FSD) among women with diabetes mellitus (DM).

Material and methods: This study included 100 sexually active diabetic women and age matched 100 healthy women served as control. All participants underwent full history taking, general and genital examination and glycated hemoglobin (HbA1c) level. Sexual function was evaluated by the Arabic version of the Female Sexual Function Index (FSFI).

Results: FSFI score was significantly lower in patients (25.39 ± 3.25) compared to control (28.84 ± 4.26) (P=0.000). There was a significant negative correlation between FSFI score and HA1c (P=0.016, r=-0.239). HA1c level was negatively correlated to arousal (P=0.000, r=-0.383) and lubrication (P=0.05, r=-0.197). As regards the type of DM, FSFI full score was significantly lower in patients with type II DM (25.02 ± 3.21) compared to type I DM (26.51 ±3.19) (P=0.047). Desire domain score in type II DM patients (3.50 ± 0.61) was significantly lower than type I DM patients (3.96 ± 0.57) (P=0.001). Similarly, arousal domain score was significantly lower in type II group (4.01 ± 0.84) compared to type I group (4.48 ± 0.76) (P=0.016). On the contrary, no significant correlation was detected between FSFI score and age (P=0.813, r=-0.024), duration of DM (P=0.808, r=0.025), waist circumference (P=0.292, r=-0.106) and Body Mass Index (P=0.292, r=-0.106).  As regards DM complications, patients with nephropathy or retinopathy had lower FSFI score compared to those without (P=0.008, P=0.042 respectively). Moreover, patients with associated hypertension showed lower FSFI compared to those without hypertension (P=0.014).

Conclusion: Poor glycemic control in diabetic women is a risk factor for developing FSD. Type II DM seems to have a greater negative impact on female sexual function than type I DM.  Patients with diabetic nephropathy or retinopathy are at  risk of developing FSD. Hypertension is a risk factor for FSD in diabetic women.

Disclosures:

Work supported by industry: no.

The impact of genital image and sexual anxiety on erectile dysfunction among male military personnel (#030)

S. Wilcox (USA)
show abstract

030

The impact of genital image and sexual anxiety on erectile dysfunction among male military personnel

Wilcox, S1; Latham Davis, T2; Redmond, S1

1: University of Southern California, United States; 2: Emory University, United States

Objective: To assesses the relationships between male genital image satisfaction (MGIS), sexual anxiety (SA), and erectile dysfunction (ED) in a sample of male military personnel between 18 and 40 years of age. In military populations under 40, rates of ED are as high as 15.7% in those without posttraumatic stress disorder (PTSD) and over 80% in male veterans with PTSD. Both physical and psychological (body image, sexual anxiety) factors contribute to sexual functioning problems (SFP), including ED. Body image concerns are associated with more SFPs in both men and women. The military culture is masculine in nature and young male military personnel are at risk for SFPs, which can negatively impact quality of life. Over a third of young military personnel (age 40 and younger) report experiencing some level of ED. Preoccupation with body image, particularly genitals, is a distraction that can influence SA and impact SFPs. The purpose of this study is to determine wither sexual anxiety mediates the relationship between male genital image satisfaction and erectile dysfunction in male military personnel aged 18 to 40 years.

Material and Methods: This exploratory study used data from a larger study on SFPs in military populations age 40 and younger. This sample consisted of 367 male military personnel aged 18-40 years. Process modeling using mediation analysis was performed to examine the effects of MGIS on ED with SA as an intermediate variable. We predicted that SA would mediate the relationship between MGIS and ED.

Results: There were significant direct effects of MGIS on ED (b=-.14, CI[-.23, -.04], p<.01) and SA (b=-.23, CI[-.34, -.12], p<.001). There was a significant direct effect of SA on ED (b=.29, CI[.20, .39], p<.001). There was a significant indirect effect of MGIS on ED through SA (b=-.07, CI[-.14, -.01] p<.01). Analyses controlled for age, marital status, education, and race.

Conclusions: This study underscores the complex etiological basis for SFPs and highlights the importance of considering psychological contributors to SFPs, such as SA and MGIS. Those with ED may benefit from psychological interventions to address MGIS and SA. Furthermore, interventions addressing MGIS and SA may also be preventative. Strategies aimed at reducing SA may be useful in improving ED in young military populations and are worth considering as compliments to strategies that improve sexual functioning.

Disclosures:

Work supported by industry: yes, by California Community Foundation - Iraq Afghanistan Deployment Impact Fund (industry funding only - investigator initiated and executed study).


10:30 - 11:15
Workshop 6 - Sexual side effects of psychotropic meds

Location: Ilhéus + Una Room
Chair: Fernando Bianco (Venezuela)

Antidepressants and human sexual response

Eusebio Rubio-Aurioles (Mexico)

Antipsychotics and human sexual response

Michal Lew-Starowicz (Poland)


11:00 - 11:30
Point counterpoint 4 - Sexual (erectile?) dysfunction: can it be prevented?

Location: Comandatuba Room 2+3
Chairs: Alejandro Carvajal (Colombia) & Ira Sharlip (USA)

Pro

Sidney Glina (Brazil)

Con

John Mulhall (USA)


11:30 - 12:30
Podium 6 - Androgens

Location: Comandatuba Room 2+3
Chairs: Mohit Khera (USA) & Ernani Rhoden (Brazil)

Cardiovascular risk associated with testosterone boosting medications: a meta-analysis of the available evidence (#031)

Mario Maggi (Italy)
show abstract

031

Cardiovascular risk associated with testosterone boosting medications: a meta-analysis of the available evidence

Corona, G1; Maseroli, E2; Rastrelli, G2; Isidori, A3; Maggi, M2

1: Endocrinology Unit, Italy; 2: Sexual Medicine and Andrology Unit, University of Florence, Florence, Italy; 3: 3Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy

Introduction. Recent reports significantly halted the enthusiasm regarding androgen boosting, suggesting that testosterone supplementation (TS) increases cardiovascular (CV) events. The aim of this study is to meta-analyze all available evidence on the effect of TS on male CV events.

Methods An extensive Medline Embase and Cochrane search was performed. All randomized controlled trials (RCTs) comparing the effect of TS vs. placebo on different CV outcomes were included

Results Out of 2747 retrieved articles, 75 were included in the study. In addition, one completed but still unpublished study was also considered. Retrieved trials included 3040 TS treated and 2468 placebo treated men for a mean duration of 34 weeks. Our analyses, performed on the largest number of studies collected so far, indicate that TS is not related to any increase in CV risk even when composite (HR=1.01[0.58;1.78]; p=0.97]) or single adverse events were considered. In RCTs performed in subjects with metabolic derangements a protective effect of TS on CV risk was observed (HR=0.19[0.04;0.85]; p=0.03).

Conclusion Present systematic analysis does not support a causal role between TS and  adverse CV events. Our results are in agreement with a large body of literature from the last twenty years supporting TS of hypogonadal men as a valuable strategy in improving a patient's metabolic profile, reducing body fat and increasing lean muscle mass, which would ultimately reduce the risk of heart disease.

Disclosures:

Work supported by industry: no.

Treatment of male hypogonadism with injectable testosterone undecanoate: outcome meta-analysis study (#032)

Mario Maggi (Italy)
show abstract

032

Treatment of male hypogonadism with injectable testosterone undecanoate: outcome meta-analysis study

Corona, G1; Maseroli, E2; Maggi, M3

1: Endocrinology Unit, Italy; 2: Sexual Medicine and Andrology Unit, University of Florence, Florence, Italy ; 3: Sexual Medicine and Andrology Unit, University of Florence, Florence, Italy

Objective. Injectable testosterone undecanoate (TU) is a long acting testosterone (T) (from 10 to 14 weeks) formulation available for the treatment of male hypogonadism since 2003 in several countries. The aim of this study is io assess the efficacy and safety of injectable TU by meta-analyzing available evidence.

Methods An extensive Medline Embase and Cochrane search was performed. All uncontrolled and placebo-controlled randomized clinical trials (RCTs) evaluating the effect of injectable TU on different outcomes were included.

Results Out of 98 retrieved articles, 33 were included in the study. Among those, 11 were placebo-controlled RCTs. Injectable TU was significantly associated with a reduction of fat mass and HbA1c in both controlled and uncontrolled trials, in particular when hypogonadal subjects were enrolled. Similar results were observed for the improvement of sexual function. In addition, TU ameliorated several other outcomes including blood pressure, lipid profile, waist circumference and BMI in uncontrolled studies but these data were not confirmed in placebo-controlled trials. The treatment was well tolerated and no risk of prostate cancer or cardiovascular disease observed. 

Conclusion Injectable TU is a safe and effective treatment for male hypogonadism. The possibility of a four time a year, therapeutic intervention frees the patient, at least partially, from having a chronic condition, maintaining a positive, active role in self-caring and helping hypogonadal men to keep his condition in long-way perspective.

Disclosures:

Work supported by industry: no.

Use of a novel subcutaneous Needle-Free technique to deliver testosterone in hypogonadal men (#033)

J. Marotte (USA)
show abstract

033

Use of a novel subcutaneous Needle-Free technique to deliver testosterone in hypogonadal men

Marotte, J1; Stout, R2; Alobuia, W3; Frazier, R1

1: Conway Urology, United States; 2: Bioject Inc., United States; 3: University of Arkansas for Medical Sciences, United States

Objectives: A proof-of-concept study was performed to assess the potential and efficacy of needle-free injection as a modality for Testosterone Replacement therapy (TRT). We hypothesize that needle-free delivery of testosterone in TRT would address the major limitations of the currently marketed modalities while providing a normal range of blood testosterone level with very minimal to no fluctuations in levels.

Methods: Fourteen men were confirmed to have had at least two prior blood levels documenting hypogonadism (T <300ng/dl) were enrolled in an IRB-approved prospective trial of a needle-free injection of testosterone cypionate for TRT. All subjects were instructed on the correct way to use the needle-free device to administer 25mg of the commercially available 100mg/ml testosterone cypionate in cottonseed oil daily, via subcutaneous delivery in the abdominal area. Blood level of testosterone was taken by the clinical staff at 6 hours post injection on Day 1, days 2, 7, 14 and 30. After successfully increasing and maintaining testosterone levels at physiologic levels in all 14 subjects throughout the first 30 days, the study was continued to determine efficacy at day 60 and day 120 using a 50mg every other day dosing with weekends off. Primary endpoints were testosterone levels, with secondary endpoints determined using subjective clinical improvement by the Aging Male Score (AMS) questionnaire.

Results: The study data are extremely promising. 12 of 14 subjects had normal T levels by day 4 (mean 487ng/dL), with all 14 subjects having normal levels with a mean of 658ng/dL at day 14. Mean testosterone levels at day 30 were 842ng/dL for all 14 participants.  At days 60 and 120, mean testosterone levels in the 12 men who continued the study were 707ng/dL and 549ng/dL respectively with no supra or sub-physiologic levels at day 120. No adverse events were recorded and very low pain scales were reported throughout the study period. All the subjects had a greater than 50% objective improvement in their AMS scores, and were very pleased with their treatment.

Conclusion: We report the first study to demonstrate that needle-free delivery of testosterone is efficacious and maintains normal ranges of testosterone blood levels during TRT, while eliminating the potential for the many risks and side effects associated with the currently available treatment modalities. The elimination of adverse side effects and risks of interpersonal transfer and toxicity, coupled with the advantages of self administration, consistent maintenance of normal blood testosterone levels and pain-free delivery are evidence of the efficacy and great potential afforded by this novel design/use of needleless delivery of testosterone in testosterone replacement therapy.

Disclosures:

Work supported by industry: .

Beneficial effects of long-term testosterone replacement therapy (TRT) with testosterone undecanoate (TU) in hypogonadal men with cardiovascular diseases (CVD) in an observational registry study (#034)

F. Saad (Germany)
show abstract

034

Beneficial effects of long-term testosterone replacement therapy (TRT) with testosterone undecanoate (TU) in hypogonadal men with cardiovascular diseases (CVD) in an observational registry study

Saad, F1; Haider, A2; Doros, G3; Traish, A4

1: Bayer Pharma AG, Germany; 2: Private Urology Practice, Germany; 3: BU School of Public Health, USA; 4: BU School of Medicine, USA

Objective: To assess effectiveness and safety of long-term treatment with testosterone undecanoate (TU) injections in hypogonadal with a history of cardiovascular diseases.

Material and Methods: 68 hypogonadal men with a previous diagnosis of coronary artery disease (CAD; n=40) and/or a myocardial infarction (MI; n=40) and/or stroke (n=6) received TU injections for up to 7.

Results: Mean age was 60.76±4.94 years. 68 men were included for 3 years, 59 for 4 years, 54 for 5 years, 44 for 6 years, and 28 for 7 years. Declining numbers reflect the nature of the registry (patients are included after receiving 1 year of TRT) but not drop-out rates. Testosterone levels rose from 10.21±1.43 nmol/L to trough levels (measured prior to the following injection) between 15 and 19 nmol/L. Weight (kg) decreased progressively from 115.07±13.71 to 92.5±9.64. Waist circumference (cm) decreased from 112.07±7.97 to 99.89±6.86. BMI (kg/m2d) decreased from 37.27±4.45 to 30.14±3.21 (p<0.0001 for all). Weight loss was 17.05±0.57%. Fasting glucose decreased from 108.74±17.08 to 96.0±1.92 mg/dl, HbA1c from 7.81±1.17 to 6.2±0.62% (p<0.0001 for both). Lipids (mg/dl): Total cholesterol (TC) decreased from 304.66±34.09 to 189.32±9.68, LDL from 184.28±37.51 to 134±27.91, triglycerides from 308.38±56.3 to 187.71±8.67 (p<0.0001 for all), and HDL increased slightly. The TC:HDL ratio declined from 5.16±1.55 to 3.15±0.87 (p<0.0001).

Systolic BP decreased from 167.82±11.01 to 142.36±10.62, diastolic BP from 102.28±8.23 to 81.25±8.07 mmHg (p<0.0001 for both). Pulse pressure declined from 65.54±5.24 to 61.11±4.66 (p<0.0001). Liver transaminases (IU/L): Aspartate aminotransferase (AST) decreased from 42.18±14.11 to 22.14±3.23, alanine aminotransferase (ALT) from 42.62±15.49 to 20.18±2.72 (p<0.0001 for both). C-reactive protein (CRP) declined from 4.08±4.73 to 0.44±0.6 mg/L. IIEF-EF increased from 21.25±4.69 to 25.93±3.55, change from baseline: 4.21±0.33. Minimum number of injections was 13, maximum 30. In no patient TRT was discontinued or interrupted. No cardiovascular events were reported during the observation time.

Conclusions: All changes were more pronounced with increasing obesity grade. All changes were in a clinically meaningful magnitude and sustained for the full observation period. T therapy seems to be an effective approach to achieve sustained weight loss in obese hypogonadal men, thereby potentially reducing cardiometabolic risk.

Disclosures:

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

Testosterone replacement therapy in men undergoing active surveillance for prostate cancer (#035)

John Mulhall (USA)
show abstract

035

Testosterone replacement therapy in men undergoing active surveillance for prostate cancer

Berookhim, B1; Krishnan, R2; Nelson, C1; Mulhall, JP2

1: Memorial Sloan Kettering Cancer Center, United States; 2: Memorial Sloan Kettering Cancer Center

Objective: With increasing experience with testosterone replacement therapy (TRT) for men undergoing prostatectomy for prostate cancer (CaP), attention has turned to TRT in patients undergoing active surveillance (AS). We report our experience with TRT in patients on AS.

Material and Methods: An IRB approved retrospective review was performed on all patients with a prior diagnosis of CaP opting for AS and presenting with signs and symptoms consistent with hypogonadism (HG) to a single urologist specializing in andrology. All patients had final surgical pathology reports available for review and had baseline testosterone (TT) labs performed before 11 A.M., with repeat lab testing performed to confirm initial results. Patients with low or borderline TT levels (<300 ng/dL) and the presence of symptoms of hypogonadim were offered TRT after extensive counseling. Patients with LH levels in the normal laboratory range were offered clomiphene citrate (CC). Those who failed to achieve therapeutic TT levels (goal 600 to 800 ng/dL) on CC, or who opted against CC were offered transdermal testosterone (TDT) or intramuscular testosterone (IMT). Repeat hormonal evaluation, PSA, hemoglobin and hematocrit values were obtained at 6 weeks after initiation of therapy, and TRT doses were titrated as needed.  Labs were monitored every 3 months for the 1st year, 6 month for 2 years and then annually.

Results: A total of 11 patients met inclusion criteria. Mean age at start of TRT was 66 years. Mean PSA at baseline was 3.7 ng/mL (range 0.4-8.2).  All patients had Gleason 6 CaP. CaP stage was cT1c in 10 patients and cT2c in 1. Mean TT prior to initiating TRT, and while on treatment, was 237 ng/dL (range 93-396) and 603 ng/dL (range 463-807) , respectively.  2 patients were on CC, 8 on TDT, and 1 on IMT. Mean follow up on TRT was 26 months (range 6-101). Mean PSA at last follow-up was 5.6 ng/mL (range 1.1-11.4).  No patient had grade or stage progression of CaP on TRT. 2 patients discontinued TRT, either on advice of outside physician or due to anxiety.

Conclusion: In a small population of patients, TRT is safe in patients on AS for CaP, with no evidence of grade or stage progression noted on approximately 2 year follow up. Further study with longer follow up is necessary to confirm safety of TRT in selected men with untreated CaP.

Disclosures:

Work supported by industry: no.

Prevalence and characteristics of low serum testosterone levels in men with type 2 diabetes mellitus naïve to injectable therapy (#036)

F. Borges Dos Reis (Brazil)
show abstract

036

Prevalence and characteristics of low serum testosterone levels in men with type 2 diabetes mellitus naïve to injectable therapy

Polzer, P1; Ni, X1; Borges Dos Reis , F2

1: Eli Lilly and Company, United States; 2: Eli Lilly and Company, Brazil

Objectives: Male hypogonadism is defined by low serum testosterone (T) levels and associated clinical symptoms, and observed at elevated prevalence among men with type 2 diabetes mellitus (T2DM). This post hoc study assessed the association of low T levels with baseline characteristics of diabetic men in a phase 3 randomized clinical trial of the once weekly GLP-1 receptor agonist dulaglutide versus metformin.

Materials and Methods: Men were ≥18 yrs of age with T2DM, treatment naïve or on 1 oral antihyperglycemic medication at ≤50% of the recommended maximum daily dose, and had screening HbA1c 6.5% - 9.5%. Low total T (TT) was defined as <300 ng/dL. Free T (FT) was calculated using the Vermeulen equation. Two-sample t-test and Fisher’s exact test were used to compare T subgroups.  Pearson’s correlation coefficients were calculated between T and continuous variables. Men receiving T replacement (n=3) were not analyzed.

Results: 101 men (32.4%) had low TT and 211 (67.6%) had normal TT; mean age was 56.7 and 56.0 years, respectively (p=.82), and HbA1c was 7.6% in both groups (p=1.0). Men with low TT had higher BMI (34.6 vs. 30.8 kg/m2, p<.001), higher weight (107.1 vs. 92.7 kg, p<.001), and lower insulin sensitivity (HOMA2-%S, 40.8 vs. 52.8, p=.008). Among men reporting a lack of energy, mean energy levels were lower among men with low TT (p=.044). Statin use was more prevalent among men with low TT (52.5% vs. 28.0%; p<.001) and a history of cardiovascular disease was more prevalent in men with low TT (17.8% vs. 10.9%; p=.107). Both TT and FT correlated negatively with BMI, weight, and lack of energy, and positively with HOMA2-%S (all p<.05)

Conclusions: In men with T2DM naïve to injectable therapy, approximately one-third (n=101) had untreated low TT, with 3 additional men receiving T replacement. Men with low TT were of similar age and had comparable HbA1c relative to men with normal TT, but had higher BMI and weight, and reduced insulin sensitivity. Low T correlated with patient-reported lack of energy. These data support Endocrine Society Guidelines for measuring T levels in men with T2DM. Further study is needed to evaluate the role of T replacement in T2DM.

Disclosures:

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


11:30 - 12:30
Moderated posters 5 - ED medical, diagnosis and epidemiology

Location: São Paulo Room
Chairs: Irwin Goldstein (USA) & Andrea Salonia (Italy)

Adjuvent Tadalafil polytherapy in Tamsulosin nonresponders with LUTS/BPH (#144)

V. Bhatia (UAE)
show abstract

144

Adjuvent Tadalafil polytherapy in Tamsulosin nonresponders with LUTS/BPH

Bhatia, V1

1: Al Ain Cromwell Hospital, Al Ain, UAE, United Arab Emirates

Objective: Alpha 1 adrenoreceptor antagonists including Tamsulosin have been used as a safe and effective first line therapeutic option for vast majority of patients with Lower urinary tract symptoms/Benign Prostate Hypertrophy(LUTS/BPH).A minority of these patients may not have satisfactory clinical response to these drugs.Daily Tadalafil has been approved for the treatment of patients with LUTS/BPH with or without Erectile Dysfunction (ED).This study evaluates the role of daily Tadalafil & Tamsulosin polytherapy in Tamsulosin monotherapy non responders.

Material & Methods: The study comprised 36 males above 50 years of age with LUTS/BPH who had previously received daily Tamsulosin 0.4mgm for 8 weeks or longer with unsatisfactory clinical response. Additional inclusion criteria were International Prostate symptom score (IPSS) of 15 or higher, QoL score of 3 or greater, Qmax from 5-15ml/sec, prostate volume on transrectal ultrasound exceeding 20ml and post void residual urine less than 100 ml. Twenty one patients had coexisting ED with median International Index of Erectile Function (IIEF-5) score of 14.2.Patients were prescribed daily oral Tadalafil 5mgm (9am) and Tamsulosin 0.4 mgm(9pm) for 8 weeks.

Results: Thirty one patients completed the study. The median reduction in IPSS was 5.8 with greater reduction in storage symptoms over voiding symptoms (3.4/2.1) .The average increase in IIEF-5 score was 5.6 with reduction in QoL of 1.4. After 2 months of combined therapy none of the patients wanted to discontinue therapy either due to lack of efficacy or adverse effects.

Conclusion: Patients with LUTS/BPH showing poor response to daily Tamsulosin monotherapy may benefit from additional daily Tadalafil polytherapy with improvement in both LUTS and ED with no additional side effects.

Disclosures:

Work supported by industry: no.

Salvage penile linear shock wave therapy for poor responders to conventional erectile dysfunction management (#145)

V. Bhatia (UAE)
show abstract

145

Salvage penile linear shock wave therapy for poor responders to conventional erectile dysfunction management

Bhatia, V1

1: Al Ain Cromwell Hospital, Al Ain, UAE, United Arab Emirates

Objective: Erectile dysfunction(ED) is a widespread malady and conventional treatment options include oral Phosphodiesterase 5 inhibitors(PDE5i), Intracavernosal vasoactive agent injection(ICI),Vacuum Constrictive Device(VCD) and intraurethral alprostadil   (MUSE). It is estimated that 25-30 % of ED patients may have an unsatisfactory erectile response to these modalities. Penile linear shock wave therapy (LSWT) is a recent noninvasive therapy utilizing low intensity shock waves to stimulate penile angiogenesis and improve erectile function.This study evaluates the safety and efficacy of LSWT by Renova device in ED patients with poor response to PDE5i,ICI,VCD and MUSE.

Material & Methods: The study comprises 26 males above 50 years with moderate to severe ED with mean International Index of Erectile Function (IIEF) score of 13.6.Coexisting comorbidities included Diabetes (32%), Hypertension (38%) and Dyslipidemia (42%). Duration of ED ranged from 10-18 months. The previous treatments used by these patients included on demand PDE5i(19),ICI with Alprostadil(4),VCD(2) and MUSE(1).All these patients opted to discontinue these regimen due to unsatisfactory erectile improvement or side effects, These patients were treated with LSWT by Renova device with four weekly outpatient sessions without any analgesia or preparation. LSWT was applied to four anatomical sites (right, left crura, and right,left corpus cavernosum) at 300 shocks per minute ,total 5000 shocks per session. Patients were followed up at 1 and 3 months after the last session.

Results: At one month follow up statistically significant improvement in IIEF was recorded in 19 patients (73%) from mean score of 13.6 at baseline to 19.2.The improvement was maintained at 3 months .No side effect was noted. Overall 92% patients expressed satisfaction with LSWT irrespective of the clinical outcome.

Conclusion: LSWT appears to be a safe and effective non invasive, office based therapy in the management of difficult to treat poor responders to prior treatment of ED .

Disclosures:

Work supported by industry: no.

Screening for metabolic syndrome and hypogonadism in men with erectile dysfunction (#146)

Bang-Ping Jiann (Taiwan)
show abstract

146

Screening for metabolic syndrome and hypogonadism in men with erectile dysfunction

Jiann, B1

1: Kaohsiung Veterans General Hospital, Taiwan

 

Objectives: Erectile dysfunction (ED) is a portal to men’s health. We assess the prevalence of metabolic syndrome (MetS) and testosterone levels in men presenting with erectile dysfunction (ED).

Methods and Materials: The information of ED patients was collected by Kaohsiung Veteran Hospital from Dec. 2010 to Jul. 2011. Male subjects presenting to urological outpatient clinics with ED were screened for MetS. Blood sampling was used for quantifying total testosterone (TT) level, fasting glucose (FBG), triglycerides (TGs), total cholesterol, high-density lipoprotein-cholesterol (HDL-C), low-density lipoprotein-cholesterol (LDL-C). Criteria for MetS followed the rules set by International Diabetes Federation (IDF). Erectile function was assessed by the Sexual Health Inventory for Men (SHIM). All the participants signed the written inform consent to join the study. The Independent Review Board reviewed and approved the study.

Results: A total of 1640 subjects completed the study with data eligible for analysis from 2009 to 2013 with a mean age of 52.4 ± 13.5 yrs (19–88) and a mean TT of 4.4 ± 1.9 ng/mL (0.2–15.4). Of 1640 subjects with ED, 27.2% (447/1640) met the criteria of MetS. The prevalence of MetS increased with the increase of age and reached plateau after age group of 40-49. Subjects with MetS had a higher BMI, a higher prevalence of hypogonaidsm and worse lipid profiles and erectile function than those without MetS. Of 1383 subjects with T levels, 36.5% (505/1383) had hypogonadism (defined by TT <3.48 ng/mL). Serum TT levels decreased as the number of MetS components increased after adjustment for age. Compared with eugonadal subjects, hypogonadal subjects were older in age and had a higher prevalence of MetS and its individual components. The TT levels had significantly negative correlation with age, waist circumference and TGs in multiple logistic regression analysis.

Conclusions: Mets is commonly seen in men with ED and is associated with low TT levels. Of metabolic syndrome components, central obesity and TGs have negative correlation with TT levels in ED subjects in multivariate analysis.

Disclosures:

Work supported by industry: no.

show poster

Correlation between erectile function and endothelial function evaluated using finger artery stiffness (#147)

K. Kobayashi (Japan)
show abstract

147

Correlation between erectile function and endothelial function evaluated using finger artery stiffness

Kobayashi, K1; Tanaka, G1; Takayanagi, A1; Matsuda, Y1; Masumori, N1

1: Sapporo Medical University School of Medicine, Japan

Objective(s): Previous reports have suggested that erectile dysfunction and cardiovascular disease should be regarded as two different manifestations of the same systemic disorder. A dysfunctional endothelium contributes to cardiovascular events. Vasculogenic erectile dysfunction is also associated with impaired endothelial function. Clinical manifestations of these events rarely appear simultaneously because the arteries supplying various areas have different sizes. For example, the finger artery is smaller than the penile artery. Therefore, impaired endothelial function of the finger artery may predict erectile dysfunction (ED). We investigated the correlation between erectile function and endothelial function evaluated using little finger arterial stiffness.

Material and Method(s): We assessed erectile function and endothelial function in 43 male participants. Erectile function was using the 5-item version of the International Index of Erectile Function (IIEF-5). ED severity was classified into five categories based on the IIEF-5 scores. Endothelial function was assessed by little finger arterial stiffness. The novel finger arterial elasticity index was calculated based on the compliance index from the finger photoplethysmogram while occluding the finger. Spearman’s rank correlation coefficient was used to identify the relationship between erectile function and endothelial function.

Result(s): The median age of the participants was 65 years (range: 50-75). The degree of ED was severe, moderate, mild to moderate, mild and no ED for 14 (32.6%), 11 (25.6%), 3 (7.0%), 10 (23.3%) and 5 (11.6%) participants, respectively. There was a correlation between erectile function and endothelial function (correlation coefficient=0.402, p<0.01).

Conclusion(s): Erectile function was correlated with endothelial function by assessing little finger arterial stiffness. Little finger arterial endothelial dysfunction might be considered an early marker of erectile dysfunction.

Disclosures:

Work supported by industry: no.

show poster

Association of serum testosterone with erectile function in young ED men without androgen deficiency (#148)

Y. Huang (China)
show abstract

148

Association of serum testosterone with erectile function in young ED men without androgen deficiency

Huang, Y1; Chen, B; Ping, P; Chen, X; Wang, H; Huang, Y

1: School of Medicine, Shanghai Jiao Tong University, China

Objective. The aim of this study was to examine the association of erectile function with serum testosterone in young ED patients without androgen deficiency.

Material and Methods. Consecutive men aged 20-40 years presenting with the complaints of erectile problem were included in this study. General health questionnaire and demographic data were collected in all subjects. International Index of Erectile Function-5 (IIEF-5) and Erection Hardness Grade Scores (EHGS) were used to assess erectile function. Androgenic profile (total (TT), free (FT) and bio-available (BT) testosterone and sex hormone binding globulin (SHBG)), inflammation factor, lipid profile and glycometabolic indicators were tested in fasting blood sample. Linear regression analyses were used to analyze the association of testosterone as independent factors with erectile function as dependent factor.

Results. A total of 140 cases (mean age 30.56±4.81 years) were enrolled for analysis. In all regression models (age-adjusted to multivariable), FT was associated with IIEF-5 (r=0.202 to 0.204) and EHGS (r=0.224 to 0.213); and TT (r=-0.299 to -0.257), FT(r=-0.214 to -0.205), BT(r=-0.229 to -0.221), and SHBG(r=-0.222 to -0.148) were significantly inversely correlated with hs-CRP values. TT (r=0.179) and BT (r=0.170) positively correlated with EHGS in age-adjusted model but not in multivariable model. TT, BT and SHBG were not related with IIEF-5 in any regression models.

Conclusions. Only free testosterone level positively correlated with erectile function in young ED men and androgen levels were significantly inversely associated with hs-CRP in this population. Young men with ED should be screened for free testosterone level and inflammation markers.

Disclosures:

Work supported by industry: no.

show poster

Erectile dysfunction and its relation with risk factors for vascular disease (#149)

S. Cedres (Uruguay)
show abstract

149

Erectile dysfunction and its relation with risk factors for vascular disease

Cedres, S1

1: Uruguay

Background: The prevalence of erectile dysfunction (ED) and associated risk factors has been described in many clinical settings (1), but there is little information regarding men seen by internal medicine physicians.

Objectives: To evaluate erectile dysfunction (ED) using a validated self-administered 5-item questionnaire (5-item version of the International Index of Erectile Function [IIEF-5]) in the internal medicine practice, to correlate it with risk factors for vascular disease an to determinate the sildenafil use and its effectiveness.

Materials and Methods: We studied patients consulting internal medicine physicians for 3 months. Participants completed a full medical history including alcohol consumption, smoking, physical activity, hypertension, physical examination for calculation of BMI, and measurement of fasting blood glucose and lipid levels. ED was defined by the 5-item version of the International Index of Erectile Function (IIEF-5). It was stratified as complete (4 or less), severe (5 to 10), moderate (11 to 14), mild (15 to 18), or none (19 to 20). Men were also asked about use of Sildenafil.

Results: A total of 132 men responded to the questionnaire. 81% of men < 50 years were sexually active compared with 16% of men > 80 years. 62% sexually active men reported severe (34,5%), or moderate (51,6%) or mild (13,9 %) ED. The prevalence of complete ED increased with age, rising from 32.2 % in the 40-49 age group to 67.9% in the 70-79 age group. Only 19.3 % of men with ED had received treatment. The response to sildenafil deteriorated with age and increasing degree of ED. Odds ratios for having DE were significantly higher in men with smoking (1.96), physical inactivity (1.28), hypertension (2.04) and abnormal fasting blood glucose.

Conclusions: This study confirms the strong correlation between ED and some comorbidities. With an ageing population, erectile dysfunction may become a significant health problem. Health care providers should plan their resources accordingly.

Disclosures:

Work supported by industry: no.

show poster

Lifestyle and erectile dysfunction: A meta-analysis of population-based studies (#150)

J. Qi (China)
show abstract

150

Lifestyle and erectile dysfunction: A meta-analysis of population-based studies

Cui, R1; Wu, Y1; Qi, J1; Bai, Q1; Fu, Q2

1: XinHua Hospital, China; 2: Shanghai 6th Hospital, China

Objectives: Erectile dysfunction (ED) is defined as the inability to attain and/or maintain an erection sufficient for sexual intercourse. Smoking, alcohol, and exercise have long been regarded as risk factors for ED. The aim of this meta-analysis was to evaluate the associations between smoking, alcohol intake, and exercise with the incidence of ED.

Material and Methods: Relevant articles, up to December 2012, were searched using the Medline, PubMed, and the Cochrane Library database. The search combined randomized, controlled clinical trials that were performed on healthy populations and that assessed smoking, alcohol, or aerobic exercise for men with ED. ED was defined using the International Index of Erectile Function Index-5 (IIEF-5) or a single question about each patient’s ability to maintain an erection. Data on participants’ age, bad habits, drug use, and concomitant diseases (such as hypertension) were also collected and analyzed.

Results: Six randomized controlled studies were identified and reviewed. The combined population included 17,893 patients. Results showed that smoking is an important risk factor for ED [odds ratio (OR) = 1.21 (95% CI 1.11-1.31)], low or moderate drinking may reduce ED [OR = 0.82 (95% CI: 0.72-0.93)], and a lack of exercise can increase the risk of ED [OR = 1.34 (95% CI: 1.12-1.60)].

Conclusions: Sexual function may benefit from exercise and low or moderate drinking, while it might be adversely affected by both current and past smoking habits. Large amounts of drinking are associated with increased ED incidence. More randomized controlled studies in this area are warranted.

Disclosures:

Work supported by industry: no.

show poster

Prevalence of erectile dysfunction in Egyptian men with metabolic syndrome (#151)

A. Swidan (Egypt)
show abstract

151

Prevalence of erectile dysfunction in Egyptian men with metabolic syndrome

Hatem, A1; Eid, A2; Swidan, A2; Salama, N3

1: Faculty of medicine, university of alexandria, Egypt; 2: Faculty of medicine, University of Alexandria, Egypt; 3: Faculty of Medicine, University of Alexandria, Egypt

Objectives: Determination of the potential effect of metabolic syndrome (MetS) on erectile function in Egyptian men and description of the sociodemographic characteristics of these men.

Material and Methods: A cohort of 220 patients presenting to Alexandria urology department ages between 30 and 75 years were prospectively assessed and divided into two groups. Group I (n=110) diagnosed with MetS and mean age of 55.4 years. Group II controls (n=110) subjects with no MetS and mean age 53.5 years. Patients filled the International Index for Erectile Function (IIEF) questionnaire, Medical, personal history and BMI data were tabulated. Presence of metabolic syndrome was determined when three or more of the five risk factors were present according to the National Cholesterol Education Program (NCEP) Adult Treatment Panel (ATP)-III.

Results: In the study groupI 82(74.5%) of the patients had ED. Of these, 19 (17.3 %) had mild, 25 (22.7%) had moderate and 38 (34.5 %) had severe ED. and 38(34.5%) of patients without metabolic syndrome had ED. Of these, 22 (20 %) had mild, 10 (9.1 %) had moderate and 6(5.5 %) had severe ED. (P < 0.001; odds ratio 5.549; 95% CI 3.101 –9.928). Patients with metabolic syndrome had lower IIEF-EF domain scores than controls. Logistic regression analysis for the study group revealed that abnormal FBG was the most important criteria for ED (OR 1.013, 95% CI 1.004-1.022; P = 0.007) while on T Ed positively correlated to FBG, HDL, triglycerides and blood pressure (p<0.001).

Conclusions: Metabolic syndrome is a potential risk factor for ED in Egyptian men. Patients with metabolic syndrome should be questioned about ED. The diabetic patients are the most risky for ED.

Disclosures:

Work supported by industry: no.

show poster

The relationship of carotid artery plaque with erectile dysfunction (#152)

J. Lee (Korea)
show abstract

152

The relationship of carotid artery plaque with erectile dysfunction

Lee, J1

1: National Police Hospital, Korea, South

Objective: Erectile dysfunction (ED) and carotid artery disease are known predictors of cardiovascular disease. However, little is known regarding the relationship of carotid artery disease with ED. Elucidation of the relationship of ED with carotid plaque would be helpful in comprehensive and detailed management in ED patients. Therefore, we evaluated the relationship of carotid artery disease with and ED.

Material and Methods: We enrolled 799 men who had participated in a health examination. During this examination, they received an international index of erectile function-5 (IIEF), a carotid duplex ultrasound, and a full metabolic work-up. The plaques were classified into three groups according to the severity of plaque size (absence: ≤1 mm, mild: 1.1–2.0 mm, and moderate to severe: ≥ 2.1 mm). Additionally, we classified ED as normal, mild, mild to moderate, moderate, and severe for IIEFs of > 21, 16–21, 11–16, 7–11, and ≤ 7, respectively. We investigated the relationship between carotid artery plaque with ED using the Spearman correlation test, the Mantel-Haenszel Extension test, and logistic regression analyses.

Results: The median age was 57 years, and the median IIEF were 15. The IIEF showed a significant negative linear correlation with maximum intima-media thickness (max IMT) (correlation coefficient = -0.132, P < 0.001). Additionally, there was a significant increase in the severity of ED with increased the severity of plaque size (P trend < 0.001). There was a greater likelihood of having moderate ED in the moderate and severe plaque size groups when compared to the absence of plaque group, after adjusting for age and components of metabolic syndrome (odds ratio [OR] = 1.672, P = 0.021).

Conclusions: In this study, the IIEF were significantly correlated with increased plaque size. Our data indicates the potential role of ED as predictors of carotid artery plaque.

Disclosures:

Work supported by industry: no.

Detection of a tadalafil analogue as an adulterant in a dietary supplement for erectile dysfunction (#153)

Edgardo Becher (Argentina)
show abstract

153

Detection of a tadalafil analogue as an adulterant in a dietary supplement for erectile dysfunction

Ulloa, J1; Sambrotta, L1; Redko, F1; Mazza, O1; Garrido, G1; Becher, E1; Muschietti, L1

1: University of Buenos Aires, Argentina

Introduction: Cases of adulteration of dietary supplements with tadalafil, sildenafil and vardenafil, or their unapproved analogues have been reported worldwide. Mainly, the presence of the latter represents a serious health risk to consumers as their efficacy and toxic effects have not been assessed and may result in unpredictable adverse effects.

Aim: To investigate the suspected adulteration with synthetic PDE-5 inhibitors in a dietary supplement marketed in Argentina for the treatment of erectile dysfunction (ED).

Methods: The content of the capsules of the dietary supplement (Sample A) was analysed by Thin Layer Chromatography (TLC) and High Performance Liquid Chromatography (HPLC-DAD). From the organic extract of sample A, a major compound was purified by column chromatography (CC).  The isolated compound was identified by proton nuclear magnetic resonance (1H NMR) and carbon NMR (13C NMR), heteronuclear single quantum correlation (HSQC), distortionless enhancement by polarization transfer (DEPT 135), Electrospray ionization-Mass Spectrometry (ESI-MS); and Ultraviolet (UV) and Infrared (FT-IR) spectroscopy.

Main Outcome Measure: Proof of adulteration of herbal products with synthetic PDE-5 inhibitors.

Results: By TLC and HPLC analysis, a major compound was detected in sample A organic extract.  The purification of this extract by CC led to the isolation of a pure compound which was identified according to its spectral data as (6R,12aR)-2-amino-6-(1,3-benzodioxol-5-yl)-2,3,6,7,12,12a-hexahydropyrazino [1’,2’:1,6] pyrido [3,4-b] indole-1,4-dione or aminotadalafil.

Conclusions: An unapproved PDE-5 inhibitor analogue, which was identified as aminotadalafil, has been detected in a dietary supplement. This study represents the first report in Latin America and one of the few independent studies of an adulteration with an unapproved PDE-5 inhibitor of an herbal product for ED treatment.

Disclosures:

Work supported by industry: no.

show poster


11:30 - 12:30
Podium 7 - Sexual pain, identity & relationship

Location: Transamérica Auditorium
Chairs: Alessandra Graziottin (Italy) & Raquel Simone Varaschin (Brazil)

Development and validation of the PROMIS vulvar discomfort with sexual activity scales (#037)

K. Weinfurt (USA)
show abstract

037

Development and validation of the PROMIS vulvar discomfort with sexual activity scales

Flynn, K1; Weinfurt, K2; Lin, L3; Jeffery, D4; Reese, J5; PROMIS Sexual Function Domain Group,

1: Medical College of Wisconsin, United States; 2: Duke University; 3: Duke Clinical Research Institute; 4: Department of Defense; 5: Johns Hopkins University

Objective: Vulvar discomfort can severely compromise women’s sexual function and satisfaction, but there are no well-recognized comprehensive self-report measures that include assessment of vulvar discomfort. We sought to address this gap in version 2.0 of the PROMIS® Sexual Function and Satisfaction (SexFS) measure.

Material and Methods: Seventeen candidate items were first generated from literature review, patient focus groups and clinician input; cognitive interviews with patients then evaluated comprehension of the question stems and response options. After modifications to define labia and clitoris within each item, items were administered online to a random sample of 1686 English-speaking adult women in the U.S. through GfK’s KnowledgePanel®. Psychometric analyses included assessing unidimensionality using confirmatory factor analysis (CFA) and item response theory (IRT) modeling (Graded Response Model).

Results: Based on individual item frequencies, of all adult women in the U.S. who were sexually active in the past 30 days, 13% had experienced labial discomfort, 10% had experienced clitoral discomfort, and 11% were bothered by labial or clitoral discomfort during sexual activity. While some CFA fit statistics were acceptable for a unidimensional model, there was a significant amount of local dependence (LD) suggesting that items referencing labial discomfort were distinct from those referencing clitoral discomfort. To further inform our decision regarding dimensionality, we sought input from several clinicians who treat sexual dysfunction in women, who advised that the specificity of the 2-factor approach had greater utility. The final 2 scales each included 4 items, with 2 items assessing pain and 2 items assessing discomfort. In the full sample, the two scales were highly correlated (Pearson’s r= 0.77), but among women reporting any vulvar discomfort, these domains were moderately correlated (Pearson’s r=0.50), supporting the notion that these are empirically unique dimensions.

Conclusion: The PROMIS SexFS Vulvar Discomfort With Sexual Activity–Clitoral and Vulvar Discomfort With Sexual Activity–Labial scales had excellent psychometric properties and are brief enough for a range of clinical and research uses. These measures are important complements to existing vaginal discomfort and lubrication scales to allow a comprehensive assessment of female sexual function.

Disclosures:

Work supported by industry: no.

Group therapy focused on psychodrama for patients with genito-pelvic pain/penetration disorders: a qualitative study (#038)

A. Fanganiello (Brazil)
show abstract

038

Group therapy focused on psychodrama for patients with genito-pelvic pain/penetration disorders: a qualitative study

Fanganiello, A1; Lordello, M1; Ambrogini, C1; Zaneti, M1; Araújo, T1; Veloso, L1; Piccirillo, L1; Crude, B1; Silva, I1

1: Unifesp, Brazil

Main: Assess the effectiveness of a group therapy using psychodrama techniques in women with Genito-pelvic Pain/Penetration Disorders, who can't have penetration, seeking outpatient care for treatment.

Methods: This qualitative study selected 20 women between 23 and 45 years of age who could not have penetration for psychological reasons, selected by International Classification Diseases, tenth edition (ICD 10) criteria. They went  through 12 weekly psychodrama group therapy treatment sessions and four monthly maintenance sessions.

Results: From 20 women, 5 (25%) reached total penetration, 2 (10%) reached partial penetration, 6 (30%) had penetration with finger or dildos, 3 (15%) could touch their exterior genitalia and 4 (20%) dropped out before the end of the 12 sessions.

Conclusion: The Group Therapy focused on psychodrama was effective for women with penetrations difficulties raising emotional issues relevant to the management of this sexual dysfunction. Except for those 4 patients who abandoned the treatment, all participants had improved their sexual condition, even those who have not obtained as a result total vaginal penetration.

Disclosures:

Work supported by industry: no.

Effectiveness of physiotherapy treatment in disorders of vaginal penetration (#039)

C. Ambrogini (Brazil)
show abstract

039

Effectiveness of physiotherapy treatment in disorders of vaginal penetration

Veloso, L1; Bentes, L1; Laviola, B1; Ambrogini, C1; Lordello, M1; Embiruçu, T1; Zaneti, M1; Fanganiello, A1; Silva, I1

1: Unifesp, Brazil

Objective: Verify the effectiveness of physical therapy treatment in patients with disorders of penetration.

Material and Methods: This is a retrospective study analyzing the charts of patients attending at the physiotherapy sector of Female Sexuality Ambulatory in the period 2010-2013. In the present study were included that patients whose main complaint was unable to have vaginal penetration during  sexual intercourse. Werw collected data as: marital status, length of union, educational level, incidence of psychological disorder, history of sexual trauma, religion, number of physical therapy sessions and treatment outcome. The treatment of physiotherapy was based on the desensitization of the pelvic and perineal areas, digital vaginal introduction, and manual techniques of myofascial release and stretching of the pelvic floor musculature. The success of treatment was verified by the ability of the patient to be able to complete sexual intercourse including penetration of the penis.

Results: The sample consisted of 20 patients. The mean age was 31 (± 10.8) years; 95% of patients were in a stable relationship with a mean time of union of 6 (± 6.9) years; 40% of patients had college education; the predominant religions were catholic (45%) and evangelical (40%); 25% of patients had a history of depression and 30% reported some type of trauma or sexual abuse. The average number of sessions was 14.9 (± 9.4). In this study, 70% of patients were satisfied with the treatment and were considered cured, two of them became pregnant. On the other hand, 30% of the sample had their treatment discontinued by several issues, therefore, it was not possible to assess the final outcome of the treatment.

Conclusion: The physiotherapy treatment can be effective in treating patients with complaints of inability to vaginal penetration, but more studies assessing physiotherapy interventions and with representative samples are needed.

Disclosures:

Work supported by industry: no.

Outcomes of gender dysphoria treatment for trans men and trans women in the UK National Health Service (#040)

John Dean (United Kingdom)
show abstract

040

Outcomes of gender dysphoria treatment for trans men and trans women in the UK National Health Service

Quick, L1; Morris, R1; Morris, M1; Dean, J1

1: Devon Partnership NHS Trust, United Kingdom

Objectives: To assess treatment outcomes for trans men and trans women who complete a Gender Dysphoria Care Pathway based upon World Professional Association for Transgender Health (WPATH) Standards of Care, Version 7 (SoC v7), 2011.

Material and Methods: The Laurels Clinic of Gender and Sexual Medicine is a multi-disciplinary clinical service commissioned by the UK National Health Service (NHS). It delivers a range of interventions for the treatment of gender dysphoria directly, or commissions them from other providers. The care pathway is based upon the WPATH SoC v7. For trans men, this typically includes assessment, psychological therapies, virilising endocrine therapies, male chest reconstructive surgery and genital reconstructive surgery with phalloplasty. For trans women, this typically includes assessment, psychological therapies, epilation of facial hair, speech and language therapy, feminising endocrine therapies, augmentation mammaplasty and genital reconstructive surgery with vaginoplasty. Treatment is state-funded through the NHS. All patients completing the care pathway at least six months earlier and who had genital surgery (trans men and trans women) or chest surgery only (trans men) were identified from a database of all previous service users; the total study population comprised 37 trans men and 65 trans women. They were sent an invitation to complete an on-line questionnaire. This was completed by 20 (54%) trans men and 23 (35%) trans women. Trans people may avoid contacts that remind them of their gender past, affecting the study response rate.

Results: Improved psychological and emotional well-being was reported by 100% of trans men and 89% of trans women. Improved social well-being was reported by 100% of trans men and 89% of trans women. Stable or improved physical health was reported by 91% of trans men and 74% of trans women. 96% of trans men and 71% of trans women were in employment, training or had permanently retired.

Conclusions: There are very few studies of gender dysphoria treatment outcomes; most studies focus on regret following surgery. This survey demonstrates that trans people experienced improved psychological, emotional and social well-being, and stable or improved physical health after participation in a WPATH SoC v7-based care pathway; the great majority live productive lives, integrated within society, after treatment.

Disclosures:

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

The efficacy of a sexual health education Intervention for male rectal cancer patients (#041)

Chris Nelson (USA)
show abstract

041

The efficacy of a sexual health education Intervention for male rectal cancer patients

Nelson, C1; Schuler, T1; Philip, E1; Mulhall, J1; Jandorf, L2; Reiner, A1; Baser, R1; DuHamel, K1

1: Memorial Sloan Kettering Cancer Center, United States; 2: Mount Sinai School of Medicine, United States

Objective(s): Male rectal cancer patients show high rates of sexual dysfunction following treatment. We pilot tested a sexual health education intervention and hypothesized that the intervention would improve sexual function and psychosocial adjustment compared to usual care (UC).

Material and Method(s): Patients who had completed treatment for rectal cancer were randomized to (1) UC: consisted of a referral to a sexual medicine clinic and supplying the American Cancer Society booklet, “Sexuality for the Man with Cancer” and (2) Intervention: composed of UC plus four 1-hour sexual health education sessions and three follow-up telephone calls with a psychologist who discussed strategies to maximize compliance with treatment, reduce anxiety, and increase partner communication. Assessments were completed at baseline (pre-intervention), 4 months (m), and 8m. Outcome variables included: International Index of Erectile Function (IIEF), Sexual Self-Esteem and Relationship Questionnaire (SEAR), Sexual Bother Questionnaire (SB), and Impact of Events Scale (IES-R). Considering the pilot nature of this data, if differences were not significant, treatment effects were assessed by Cohen’s d effect size (d=0.2, small effect; d=0.5, medium effect; d=0.8, large effect).

Result(s): 71 men were randomized. Most were diagnosed with Stage III cancer. Treatment included surgery, chemotherapy, and radiation. Men in the intervention group improved compared to UC in: IIEF Erectile Function Domain at 4m (p=0.02) and 8m (p=0.04); Sexual Desire Domain at 4m (p=0.001) and 8m (p=0.03); and Overall Satisfaction Domain at 4m (p=0.04) and 8m (p=0.06). Effect sizes ranged from d=0.59 to d=1.37. These men also improved compared to UC on SB at 4m (p=0.02, d=-1.44) and 8m (d=-0.20), for SEAR Total scores at 4m (d=0.25) and 8m (d=0.56), and for the IES-R Total scores at both 4m (d=-0.33) and 8m (d=-0.65).

Conclusion(s): In the male rectal cancer population, pilot data support the utility of a brief sexual health education intervention in improving erectile function, libido, sexual satisfaction, while reducing sexual bother.  

Disclosures:

Work supported by industry: no.

Acceptance and commitment therapy for adherence to an erectile rehabilitation program (ERP) after radical prostatectomy (RP) (#042)

Chris Nelson (USA)
show abstract

042

Acceptance and commitment therapy for adherence to an erectile rehabilitation program (ERP) after radical prostatectomy (RP)

Nelson, C1; Pessin, H1; Mulhall, J1

1: Memorial Sloan Kettering Cancer Center, United States

Objective(s): Intracavernosal injection therapy (ICI) is the cornerstone of many erectile rehabilitation programs (ERP). However, compliance with ICI is historically low. This RCT tested a novel psychological intervention based on Acceptance and Commitment Therapy (ACT) to help men overcome barriers to using ICI.

Material and Method(s): Men were recruited when starting an ERP and randomized to ERP+ACT or ERP+Enhanced Monitoring (EM).  ERP+ACT received ERP plus 7 ACT sessions. ERP+EM received ERP plus 7 calls from a nurse practitioner. Assessments were at entry, 4 months (m), and 8m. The primary outcomes were feasibility, number of penile injections/week (verified by syringe count), and compliance (≥2 injections/week). Secondary outcomes were: ED treatment satisfaction, sexual self-esteem, sexual bother, and prostate cancer treatment regret. If differences were not statistically significant, effect sizes (d) are reported (d=0.2, small effect; d=0.5, medium effect; d=0.8, large effect).  

Result(s): 63 subjects were randomized (ACT n=32, EM n=31). The mean age was 60±7 years. The acceptance rate was 72%. At 4m, the ACT group utilized more injections/week vs. the EM group (1.73 vs. 0.95, p<0.01). Subjects in the ACT group were more compliant with ICI vs. the EM group (50% vs. 10%, p=0.01).  The ACT group reported greater satisfaction with ED treatment (d=1.01, p=0.09), greater sexual self-esteem (d=0.72, p=0.02), lower sexual bother (d=0.48, p=0.20) and lower prostate cancer treatment regret (d=1.21, p=0.02). At 8m, the ACT group continued to utilize more injections/week vs. the EM group (1.20 vs. 0.70, p=0.03). The ACT group also continued to report greater satisfaction with ED treatment (d=0.61, p=0.15), greater sexual self-esteem (d=0.69, p=0.05), and lower prostate cancer treatment regret (d=0.93, p=0.02).

Conclusion(s): Data suggest ACT is feasible, while increasing ICI use and compliance with an ERP. Data also indicate ACT increases ED treatment satisfaction and sexual self-esteem, while reducing sexual bother and prostate cancer treatment regret.

Disclosures:

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


11:30 - 12:30
Instructional course 4 - Premature ejaculation: Update on management

Location: Ilhéus + Una Room
Chair: Amr El-Meliegy (Saudi Arabia)

Etiology and diagnosis

Ege Can Serefoglu (Turkey)

Psychological treatment

Stanley Althof (USA)

Pharma treatment

Chris McMahon (Australia)


Afternoon

12:30 - 14:00
Lunch break

Location: Comandatuba Room 1

12:45 - 13:45
Sponsored lunch symposium

Location: Comandatuba Room 2+3

14:00 - 15:30
Round table 3 - New pharma compounds for FSD

Location: Comandatuba Room 2+3
Chairs: Gerson Lopes (Brazil) & Sharon Parish (USA)

The evolution of the concepts and treatment of female sexual dysfunctions

Carmita Abdo (Brazil)

Central acting agents

Annamaria Giraldi (Denmark)

Peripherally acting agents

Irwin Goldstein (USA)


14:00 - 15:30
Moderated posters 6 - Other aspects of sexual medicine 2

Location: São Paulo Room
Chairs: Alejandro Carvajal (Colombia) & Eusebio Rubio-Aurioles (Mexico)

Perceptions and attitude towards the treatment of PE with traditional medication vs western medication: The result of SCOPE (Sexual Concerns On Premature Ejaculations) (#154)

M. Lam (United Kingdom)
show abstract

154

Perceptions and attitude towards the treatment of PE with traditional medication vs western medication: The result of SCOPE (Sexual Concerns On Premature Ejaculations)

Lam, M1; Loh, J2; Siaw, M3; Lim, L3; Razack, A4; Ong, T4; Lee, E3

1: University of Leicester, United Kingdom; 2: University of Southampton, United Kingdom; 3: Monash University, Malaysia; 4: Department of Surgery, University of Malaya, Kuala Lumpur

Objective: Premature Ejaculation (PE) is a commonplace medical condition affecting both men and their sexual partners in approximately 30% of the general population. The objective of this study aims to identify the perceptions and attitudes of treatment seeking preference between traditional and western medications in a rapidly developing and diverse socio-economic Asian country.

Methods: The study population was obtained primarily from both urological and non urological clinics in an urban tertiary hospital. Convenience sampling was employed and the participants completed a non-validated questionnaire which recorded their perception towards PE and the different treatment modalities. Demographical details of age, gender, income brackets and education backgrounds were also identified.

Results: A total sample population of 1541 subjects (792 males and 749 females) were enrolled into this study. Of which, 80.1% of the sample population agreed that PE is a condition treatable with medications. A huge majority of participants (95.5%) would readily accept any treatment interventions offered to them as they view it as necessary (92.2%). Despite such perception, only 79.5% of subjects would accept western medicine as their first line choice of therapy with only 88% believing it to be effective. It is noteworthy that 63.4% of the respondents would also readily accept traditional medications as an alternative remedy for PE.

Conclusion: This study has identified that majority of the respondents are keen and accepting in seeking medical treatment for PE. The general consensus agrees that western medication would yield promising results and is viewed as the first choice in PE management. As with most Asian communities, most of the participants are also open to the idea of using traditional medications as an alternative or adjunct in the treatment of PE. As such, further studies should be done to examine the different compounds that have been used traditionally and clinicians should address the risk of drug interactions and adverse effects through focused patient education.

Disclosures:

Work supported by industry: no.

show poster

Effect of chronic skin diseases on female sexual function in upper Egypt (#155)

H. Abdel Hafez (Egypt)
show abstract

155

Effect of chronic skin diseases on female sexual function in upper Egypt

Abdel hafez, H1; Abdel Motalab, A1; Ismail, S1

1: Assiut University Hospital, Egypt

Objectives: Female sexual dysfunction in chronic diseases has become a popular and important health concern in recent years.  Dermatological diseases can have a significant impact upon sexual function. The aim of this study was to investigate sexual function in females with chronic dermatologic diseases in upper Egypt, for the first time to the best of our Knowledge.

Material and Methods: A total of 100 female patients with chronic dermatological problems and 100 healthy volunteers as age-matched control group were enrolled in the study. The validated Arabic version of Female Sexual Function Index (FSFI) was used to assess female sexual function. The cut-off score to define sexual dysfunction on the total FSFI score was obtained from a validation study that determined a total score below 26.55 to denote sexual dysfunction.

Results: This study included 100 patients (71 with vitiligo and 29 with psoriasis), their age ranged from 18 to 50 years with mean ± SD 36.11 ± 9.12 and 100 healthy control their age ranged from 18 to 50 years with mean ± SD 33.79 ± 8.17. Mean duration of the disease was 6.21 ± 6.50. Percentage of involvement ranged from 3-90% with mean ± SD 39.51 ± 28.11. Fifty two percent of the patients proved to have sexual dysfunction. Total FSFI score was not significantly decreased in patients versus control. However, there was statistically significant difference in some of its domains as lubrication, satisfaction and pain (p<0.05). Age of the patients showed negative correlation with desire, arousal, lubrication, orgasm, satisfaction and the total FSFI. Also,  the duration of the disease showed negative correlation with arousal, orgasm, satisfaction and total FSFI. However, the percentage of involvement of the disease showed no correlation with total FSFI or individual domains.

Conclusion: Sexual health is affected in female patients with chronic dermatological diseases. These patients need for physicians to implement attention on the impact of their diseases on sexual health in order to provide a better quality of life.

Disclosures:

Work supported by industry: no.

show poster

Association between alexithymia and sexual self-efficacy in patients with erectile dysfunction and premature ejaculation (#156)

Itor Finotelli Jr. (Brazil)
show abstract

156

Association between alexithymia and sexual self-efficacy in patients with erectile dysfunction and premature ejaculation

Finotelli Jr., I1

1: Paulista Institute of Sexuality (InPaSex), Brazil

Introduction: Alexithymia is characterized by the difficulty in identify and describe emotions, lack of fantasies and cognitive style externally oriented. Researches associate negative influences of this condition in the sexual function. The objective for this study was to investigate such influences in the men sexual self-efficacy.      

Methods: Fifty-six (56) patients, who have been treated in a private clinic in Sao Paulo, Brazil, were assisted and, thirty-one (31) patients were diagnosed with premature ejaculation (PE) and twenty-five (25) with erectile dysfunction (ED). The ages vary between twenty (20) and fifty-eight (58) years old (M=32.61; SD=9.87), fifty-seven percent (57%) were single, thirty-six percent (36%) married and seven percent (7%) divorced. The majority of seventy-five percent (75%) of the participants had a Bachelor degree or equivalent. For this measurement, the Toronto Alexithymia Scale (TAS-26) and Sexual Self-Efficacy – Erectile Function (SSES-E) that evaluate the sexual function and dimensions denominated as obtaining and maintaining an erection, were used.

Results: No differences in the score for TAS-26 were found among subjects with PE and ED. For the SSES-S, the subjects with PE had higher scores compared to the subjects with ED in the total score and in the obtaining dimension. No differences were found in the maintaining dimension, which was expected because none of the dysfunctions is capable of providing favorable states for the erectile maintenance. For association between the instruments, moderate negative correlations were found only in the dimensions. In this case, the ability of sexual self-efficacy in behaviors on the erectile maintenance was compromised due to the high scores in the TAS-26 dimensions related to the difficulty in identify/describe feeling and distinguish bodily sensations, and the inability of expressing and understand emotions. This situation can compromise behaviors for the continuity of the erection, i.e. the communication about the way to stimulate; the capability of sexual attraction; the diversity of stimuli, besides penetration; the non-anxiety or fear during sexual activity; among others.

Conclusions: Related to alexithymia, the inability to identify feelings and the lack of ability to express emotions keep the negative association in the self-efficacy connected to erectile maintenance behaviors. This association can implicate in the clinical management of male sexual dysfunctions.

Disclosures:

Work supported by industry: no.

show poster

The influence of marital myths when comparing clinical and non-clinical subjects (#157)

Itor Finotelli Jr. (Brazil)
show abstract

157

The influence of marital myths when comparing clinical and non-clinical subjects

Finotelli Jr., I1

1: Paulista Institute of Sexuality (InPaSex), Brazil

Introduction: Different social instances estipulate to a subject how one should act socially. These expectations are described by beliefs and attitudes connected to different social practices. Such beliefs may influence the way an individual behaves. The objective was to compare influences of marital beliefs in individuals with and without relationship complaints.

Methods: The sample was composed by sixty (60) participants, who have been treated in a private clinic and sixty (60) participants from a private university, both in Sao Paulo, Brazil. The clinical sample was composed by patients with marital complaints. The ages vary between twenty-one (21) and sixty-two (62), (M=30.30; SD=10.11), gender and type of sample do not vary according age. In order for the data to be collected, a questionnaire based in the book Marital Myths, from Arnold A. Lazarus, which contains twenty-four (24) myths related to marital practices. These myths were transformed in items and the score of the questionnaire was designated the greater the amount of claims, the higher one's belief.

Results: Differences were found in the score of the samples, in this case, the clinical participants confirm more myths compared to the university ones. Comparing items, two (2) had significant differences. In the search for dimensions, factorial analysis for main components and varimax rotation extracted three (3) dimensions which were denominated as Crisis Situation, Relationship Maintenance and Trust. Only the Relationship Maintenance dimension presented significant differences in the score of the sample, presenting higher score for the clinical participants.    

Conclusions: To assess the beliefs of an individual regarding marital relationship may represent an aspect to be intervened in people who seek processes of marital psychotherapy. In the research, the clinical sample presented higher frequency of the myths compared to the sample of individual without any marital complaints. These myths were connected to aspects of relationship maintenance. The results also presented the feasibility of using and the construction of scales to assess the beliefs of the individual regarding marital relationship.

Disclosures:

Work supported by industry: no.

show poster

Comprehensive care for rape victims: Adherence to HIV/STD prophylaxis and to laboratory follow up at the Rape Victim Care Center, School of Medicine, University of São Paulo, Brazil (#158)

I. Nisida (Brazil)
show abstract

158

Comprehensive care for rape victims: Adherence to HIV/STD prophylaxis and to laboratory follow up at the Rape Victim Care Center, School of Medicine, University of São Paulo, Brazil

Nisida, I1; Boulos, M2; Atui, F3; Diegoli, C4; Segurado, A5

1: Rape Victim Care Center, Division of Infectious diseases, Hospital das Clínicas da FMUSP, Brazil; 2: Rape Victim Care Center, Division of Infectious Diseases,Hospital das Clínicas da FMUSP, Brazil; 3: Colorectal Surgery, Hospital das Clínicas da FMUSP, Brazil; 4: Gynecology, Hospital das Clínicas da FMUSP, Brazil; 5: Division of Infectious Diseases, Hospital das Clínicas da FMUSP, Brazil

Objective: To identify factors associated with completion of prophylactic interventions for rape victims in a tertiary university care setting. 

Methods: We conducted a retrospective medical chart review of patients who attended NAVIS (Rape Victim Care Center, School of Medicine, University of São Paulo) from 2001 to 2009. All patients were referred to NAVIS after having showed up at the emergency room of a tertiary university hospital in São Paulo, up to 72 hours after SA. All eligible patients were prescribed HIV/STD chemoprophylaxis (anti-retroviral drugs, ceftriaxone, metronidazole, azithromycin), hepatitis B immunization and submitted to a laboratory screening and follow-up (lab FU) that consisted of detection of anti-HIV, hepatitis B and C and syphilis antibodies. The study outcome – adherence to chemoprophylaxis and lab FU was classified as: incomplete (G1); complete chemoprophylaxis (G2) (patients treated as recommended for more than 30 days); and complete prophylaxis and lab FU (G3) (patients who completed chemoprophylaxis and hepatitis B immunization, and underwent 2 lab screenings on days 60 and 180 after SA. Using the Chi-square test patients from G2 and G3 were compared to those in G1 in regard to independent variables of interest that included: age, gender and SA characteristics [(known or unknown perpetrator), anatomical site (vaginal, oral or anal penetration)].

Results: 136 of 274 patients were eligible for HIV/STD prophylaxis: 109 (80.2%) female and 27 (19.8%) male; 103 (75.7%) over 14 years old. As far as the study outcome is concerned, 42 patients (30.9%) were classified in G2 and 59 patients (43.4%) in G3. Oral penetration was associated with complete chemoprophylaxis (p<0.001), whereas anal and oral penetration (p<0.001) and report of ejaculation (p<0.001) with completion of both chemoprophylaxis and lab FU. No patient tested positive for HIV infection on day 180.

Conclusion: Our results highlight factors associated with complete adherence to chemoprophylaxis, hepatitis B immunization and lab FU in rape victims assisted in a university care center in São Paulo. Special attention in future studies is warranted to the assessment of multidimensional barriers to completion of these prophylactic interventions, in order to enhance their effectiveness.

Disclosures:

Work supported by industry: no.

show poster

Long-term erectile function outcomes in patients submitted to either trans-urethral resection (TURP) or holmium laser enucleation of the prostate (HoLEP) (#159)

P. Capogrosso (Italy)
show abstract

159

Long-term erectile function outcomes in patients submitted to either trans-urethral resection (TURP) or holmium laser enucleation of the prostate (HoLEP)

Capogrosso, P1; Boeri, L1; Serino, A1; Colicchia, M2; Ventimiglia, E1; La Croce, G2; Castagna, G1; Russo, A1; Damiano, R3; Montorsi, F1; Salonia, A1

1: Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; 2: Division of Oncology/Unit of Urology; URI; IRCCS Ospedale San Raffaele, Milan, Italy; 3: Research Doctorate Program in Urology, Magna Graecia University, Catanzaro, Italy

Objectives: Assess long-term predictive factors of erectile function (EF) outcomes in patients treated with HoLEP vs TURP for bladder outlet obstruction associated with benign prostate hyperplasia (BPH).

Methods: Data from 99 patients submitted to HoLEP and 102 patients submitted to TURP with a minimum 5-yr follow-up (FU) were analyzed. All patients completed a remembered (= targeting EF related to a date preceding surgery) and a real-time (= targeting EF over the 4 weeks prior to survey)IIEF-EF domain. Both a remembered and a real-time IPSS were also completed. Logistic regression models tested the association among potential clinical predictors and postoperative IIEF-EF scores [also considering Minimal Clinically Important Differences (MCIDs) criteria] in both groups.

Results: HoLEP patients showed higher preop prostate volumes than TURP patients [65.7 (34.3) vs 56.6 (23.3) ml; p=0.03). At long-term FU, post IPSS significantly improved after HoLEP [23.1 (7.5) vs 6.3 (5.4)] and after TURP [22.1 (6.2) vs 7.39 (5.5)], respectively (all p=0.001). A significant improvement was observed for irritative and obstructive symptoms in both groups (all p<0.001), without inter-groups differences. IIEF-EF values were significantly lower after surgery, without inter-groups differences [HoLEP: 24.27 (7.4) vs 17.1 (10.7); p=0.001; and, TURP: 22.6 (8.9) vs 13.6 (10.7); p=0.001]. Conversely, as a whole only 14 (7%) patients improved their EF after surgery, irrespective of type of surgery [7 (7.1%) vs 7 (7.0%)]. A significant improvement according to MCIDs criteria was observed in 12 (5.9%) patients. At MVA, preop IIEF-EF emerged as an independent predictor for either a postop improvement or a decrease of IIEF-EF for TURP patients (OR: 0.83; p=0.02; OR:1.1; p=0.01, respectively). Conversely, age at FU (OR:1.19; p<0.01) and preop IIEF-EF (OR:1.14; p=0.01) were associated with a decrease of postop IIEF-EF in HoLEP patients. TURP patients showed higher rates of overall postop complications than HoLEP patients [23.2% vs 6.1%; p=0.001].

Conclusions: Long-term FU data showed no differences between HoLEP vs TURP in terms of EF and urinary symptoms improvements after surgery. Preoperative EF emerged as an independent predictor of EF maintenance after both types of procedures.

Disclosures:

Work supported by industry: no.

show poster

Autoimmune diseases are highly comorbid in patients with Peyronie's disease - Results of a cross-sectional real life study among caucasian-european men (#160)

P. Capogrosso (Italy)
show abstract

160

Autoimmune diseases are highly comorbid in patients with Peyronie's disease - Results of a cross-sectional real life study among caucasian-european men

Ventimiglia, E1; Colicchia, M2; Capogrosso, P2; Serino, A2; Boeri, L2; Castagna, G2; La Croce, G2; Russo, A1; Castiglione, F2; Montorsi, F1; Salonia, A2

1: Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; 2: Division of Oncology/Unit of Urology; URI; IRCCS Ospedale San Raffaele, Milan, Italy

Objectives: We sought to investigate autoimmune diseases’ prevalence in a cohort of patients seeking medical help for sexual dysfunction, focusing on those complaining of Peyronie’s disease (PD).

Methods: Complete sociodemographic and clinical data from 1140 consecutive patients presenting for new-onset sexual dysfunction (Jan 2010 – June 2013) were analysed. Health-significant comorbidities were scored with the Charlson Comorbidity Index (CCI) as a continuous or a categorized variable (0 vs 1 vs ≥2). Categorized measured body mass index (BMI) cut-offs were used as proposed by the NIH. All patients completed the International Index of Erectile Function (IIEF) domains. Autoimmune diseases were assessed through a comprehensive history examination and stratified according to ICD-9 classification.

Results: Of 1140, ED and PD were diagnosed in 665 (58.3%) and in 148 (13%) men, respectively. Of all, 34 (3%) patients had a confirmed diagnosis of  autoimmune disease. Among PD patients, 14 (9.5%) presented with an autoimmune disorder; conversely, non-PD patients did present an autoimmune disease in a significantly lesser amount of cases [20/992 (2%); c2: 24.7; p <0.001]. Patients with PD were older (mean (SD) age: 57.2 (13.1) vs 47.5 (15.6) years; p<0.001) as compared with non-PD individuals. Conversely, the two groups did not differ in terms of CCI, continuous or categorized BMI. At univariable analysis, cigarette smoking (OR: 1.54; p=0.04) was significantly correlated with PD. At multivariable analysis, age and a history of autoimmune disease achieved independent predictor status for PD (OR: 1.05; p<0.01, and OR: 5.74; p<0.001), after accounting for patient age, CCI, BMI and autoimmune diseases.

Conclusions: Autoimmune diseases emerge as highly comorbid with PD in a large cohort of individuals seeking medical help for sexual dysfunction in the real life setting.

Disclosures:

Work supported by industry: no.

show poster

A geometric model of plaque incision and graft for Peyronie’s Disease with geometic analyses of different techniques (#161)

A. Miranda (Brazil)
show abstract

161

A geometric model of plaque incision and graft for Peyronie’s Disease with geometic analyses of different techniques

Miranda, A1; Sampaio, F2

1: Ipanema Federal Hospital, Brazil; 2: Urogenital Research Unit, State University of Rio de Janeiro, UERJ, Rio de Janeiro, Brazil

Objective: To analyze the geometric and mechanical consequences of plaque incision and graft (PIG) on penile rectification surgery.

Material & Methods: A tridimensional penile simile model with a curvature of 85o was created to test all of the most common PIG techniques. PIG with double-Y, H-shape and Egydio techniques were used to rectify the curved penile model. The results that differed from a rectified cylinder shape were highlighted.

Results: All of the analyzed techniques created a geometric distortion that could be linked to poor surgical results. We suggest a new technique to resolve these abnormalities.

Conclusions: Current techniques designed to correct penile deviation using PIG present geometric and mechanical imperfections with potential consequences to the postoperative success rate. The new technique proposed in this report could be a possible solution to solve the geometric distortion caused by PIG.

Disclosures:

Work supported by industry: no.

show poster

Efficacy of extended intralesional verapamil therapy for Peyronie's disease in early responders (#162)

John Mulhall (USA)
show abstract

162

Efficacy of extended intralesional verapamil therapy for Peyronie's disease in early responders

Berookhim, B1; Larish, Y 1; Chevinsky, M 1; Jakubowski, C 1; Jamzadeh, A 1; Nelson, C1; Mulhall, J1

1: Memorial Sloan Kettering Cancer Center, United States

Objective: To report our experience using a total of 12 intralesional verapamil injections (ILVi), among men with a good response following the initial 6 ILVi for treatment of Peyronie’s disease.

Methods: The study population consists of men (i) with palpable penile plaque (ii) uniplanar penile curvature and (iii) who underwent 6 ILVi (10 mg verapamil in 5 ml saline) every 2 weeks. All patients were evaluated with a penile injection assisted deformity assessment (DA) at baseline. Those reporting improvement after 6 ILVi had a repeat DA within 2 weeks, and when clinical improvement was documented were offered an additional course of 6 ILVi. ILVi 7-12 were administered identically to the first 6 ILVi. A final end of treatment DA was conducted 3 months after last ILVi (number 12).

Results:  123 men had 6 ILVi. Mean duration of PD was 4±3 months. There was a non-significant mean 2.1 degree increase in curvature from baseline (35.0±18.3) to 6 injections (37.2±20.1, p=0.19). 30 (24%) had a >10 degree decrease, 53 (43%) were unchanged (<10 degrees increase/decrease), 40 (33%) >10 degree increase.

17 patients (10%) had documentable improvement after 6 injections and proceeded to 12 ILVi. Mean age = 51±12 years and the mean number of months with PD at the time ILVi was commenced = 4±4 (range 2-14) months. Following 6 ILVi, there was a significant reduction in mean degree curvature (41 to 30.0, p=0.05).  9 (53%) had a >10 degree decrease, 5 (29%) were unchanged (<10 degrees increase/decrease), 3 (18%) >10 degree increase. There was a mean reduction in curvature between 6 and 12 treatments of 3.8 degrees (30 to 26.2, p=0.28). 6 (35%) had a >10 degrees decrease, 7 (41%) were unchanged (<10 degrees increase/decrease), 4 (24%) >10 degree increase. Overall, among those patients who opted for 12 ILVi, there was a significant reduction in curvature from baseline to 12 injections (41 to 26.2, p=0.01, mean reduction=14.7).  9 (53%) had a >10 degree decrease, 4 (24%) were unchanged (<10 degrees increase/decrease), 4 (24%) >10 degree increase.

Conclusions: Among patients with demonstrated improvement following an initial course of 6 ILVi, one third will appear to experience further improvement with an additional 6 ILVi. Consideration should be given to a longer course of treatment for those men considered early responders to ILVi.

Disclosures:

Work supported by industry: no.

show poster

International multicenter psychometric evaluation of patient reported outcome data for the treatment of Peyronie’s disease (#163)

V. Kueronya (Austria)
show abstract

163

International multicenter psychometric evaluation of patient reported outcome data for the treatment of Peyronie’s disease

Kueronya, V1; Miernik, A2; Kojovic, V3; Hatzichristodoulou, G4; Egydio, P5; Tosev, G6; Falcone, M7; Djordjevic, M3; Schoenthaler, M2; Fahr, C2; De Luca, F8; Kuehhas, F9

1: Medical University of Vienna, Department of Obstetrics and Gynecology 2 Medical University of Freiburg, Department of Urology; 2: Medical University of Freiburg, Department of Urology; 3: School of Medicine, University of Belgrade; 4: Technical University of Munich, Rechts der Isar Medical Center, Department of Urology; 5: Centre for Peyronie’s Disease Reconstruction, Sao Paulo; 6: Medical University of Heidelberg, Department of Urology; 7: Medical University of Turin, Department of Urology ; 8: Institute of Urology, University College London; 9: Medical University of Vienna, Department of Urology

Objective: To compare patient reported outcomes for the Nesbit procedure, plaque incision and grafting, and the insertion of a malleable penile implant following surgical correction of the penile curvature.

Material and Methods: A retrospective review was performed regarding men who underwent surgical correction of PD between January 2010 and December 2012 at six international centres. Patient functional outcomes and satisfaction were evaluated with a non-validated questionnaire. Furthermore, clinical data were retrospectively analyzed.

Results: The average response rate to the questionnaire was 70,9%, resulting in a study cohort of 206 patients. The Nesbit procedure, plaque incision with grafting, or implantation of a malleable penile prosthesis was performed in 50, 48, and 108 individuals, respectively. Overall, 79.1% reported a subjective loss of penile length due to PD (range 2.1-3.2 cm), preoperatively. Those patients treated with a malleable penile implant reported the greatest subjective penile length loss, due to PD.  A subjective loss of penile length of >2.5 cm resulted in reduced preoperative sex ability. Postoperatively, 78.0%, 29.2% and 24.1% patients in the Nesbit, grafting, and implant groups reported a postoperative, subjective loss of penile length (range, 0.4-1.2cm), with 86.3%, 78.6%, and 82.1% of the patients in each group, respectively, being bothered by loss of length.

Conclusion: Penile length loss due to PD affects the majority of patients. Further penile length loss due to the surgical correction leads to bother among the affected patients, irrespective of the magnitude of the loss. The Nesbit procedure was associated with the highest losses in penile length. In patients with PD and severe erectile dysfunction, a concomitant lengthening procedure may be offered to patients to help overcome the psychological burden caused by the loss of penile length.

Disclosures:

Work supported by industry: no.

The Nesbit procedure for Peyronie’s Disease: Six year follow up (#164)

F. De Luca (United Kingdom)
show abstract

164

The Nesbit procedure for Peyronie’s Disease : Six year follow up

Yap, T1; Raheem, A1; Spilotros, M1; De Luca, F1; Handalage, C1; Lucky, M1; Imbeault, A1; Muneer, A1; Christopher, N1; Garaffa, G 1; Ralph, D1

1: University College Hospital, United Kingdom

Objective: When treating Peyronie’s disease by plaque incision and grafting, the initial results are favourable, but at 5 years up to 67% of patients have deteriorated, usually due to erectile dysfunction (ED). Is this due to the type of operation or the disease itself? To answer this question we have therefore evaluated the six year outcome of the Nesbit procedure for Peyronie's Disease.

Material & Methods: Between 2006 and 2008, 116 patients underwent the Nesbit procedure (90 patients with Peyronie's disease and 26 controls with congenital curvature). Data was collected for risk factors of ED including diabetes, hypertension & hypercholestrolemia and the presence of residual curvature, penile shortening and sexual function (using the IIEF-5 questionnaire and objective use of PDE5 inhibitors).  The congenital group was used as controls as they had no pre-operative ED or risk factors. Fisher's exact test and unpaired t-tests were used to compare scores between groups as appropriate.

Results: Median follow-up was 78 months for all patients. Mean age of the Peyronie’s group was 57 (range 29 - 75), and 24 (range 16 -36) in the congenital group. Penile shortening > 1cm and residual curvature (> 30 degrees) was reported in 61% and 6% of Peyronie's patients (no significant difference with control group, p = 1.0). Pre-operative ED was present in 16% of Peyronie’s patients and new-onset ED requiring PDE5 inhibitors occurred in a further 7% at 3 months and 16 % at 6 years post op. At 6 years, 14% of men with pre-op and new onset ED had progressed from medication to injectables. The most significant risk factor in Peyronie’s patients for developing pre & post-op ED was hypertension (p < 0.05 compared to non ED patients). At 6 years, the mean IIEF-5  in the Peyronie’s patients was 16 and significantly lower than the controls at 25 (p <0.05).

Conclusion: The Nesbit operation may cause penile shortening and result in a residual curvature, but this occurs equally in both Peyronie’s Disease and controls. However, erectile dysfunction is common in Peyronie’s disease and deteriorates with time. As the control patients did not develop ED, the disease and not the type of operation is the likely cause. This difference is likely due to associated co-morbidities especially hypertension in the older Peyronie's group. This long term data will help with counselling and decision-making in men requiring surgical intervention.

Disclosures:

Work supported by industry: no.

show poster

Medical sex therapy: A novel certification program that incorporates both sexual medicine and sex therapy training and didactic learning (#165)

Michael Krychman (USA)
show abstract

165

Medical sex therapy: A novel certification program that incorporates both sexual medicine and sex therapy training and didactic learning

Krychman, M1; Lee, S2

1: OBGYN, United States; 2: Sex Therapist, USA

Objective: Sexual Medicine is considered a multidisciplinary field of study. Many organizations focus on either the psychological training or medical expertise yet the integration of both facets to adequately train sexual health care specialists is often lacking.

Materials/Methods. The Florida Postgraduate Sex Therapy Training Institute of has developed an integrated program entitled, “Medical Sex Therapy.” The course consists of two 60 -hour courses which include didactic and interactive learning from an experienced sex therapist and a sexual medicine physician. The core curriculum is comprehensive and covers both male and female sexual function and dysfunction as well as paraphilia, sexual compulsivity, gender and orientation and unconventional sexual practices. Case presentation and hands on study is an integral part of the course work. The participant is required to review current sexual medicine and sex therapy research literature and preform detailed case study supervision with an expert accredited supervisor.  Once completion of the program, the participant may be certified in the state of Florida as a certified Sex Therapist. Medical Sex Therapy credits and supervision hours are fully accredited towards certification by the American Association of Sex Educators, Counsellors and Therapists (AASECT).

Results: To date, fifty-three health care professionals, from the following specialties: Ob/GYN, nurse practitioners, psychiatry, psychology, psychotherapy, marital counselling have attended the program, twenty have completed certification and ten are completing additional hours to fulfil AASECT certification. 

Conclusion: In order to best serve the client with sexual problems a multifaceted approach is often warranted. Didactic learning, case training, education and supervision in sexuality are necessary for comprehensive care of these complex patients.

Disclosures:

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

show poster

Risk factors for diseases sexually transmitted infections (STIs) and its association with sexual behaviors in students of the Faculty of Medicine of the Universidad Autonoma de Queretaro (UAQ) (#166)

P. González Ortega (Mexico)
show abstract

166

Risk factors for diseases sexually transmitted infections (STIs) and its association with sexual behaviors in students of the Faculty of Medicine of the Universidad Autonoma de Queretaro (UAQ)

González Ortega, P1; Villaseñor Cuspinera, N1; García Gutiérrez, M1; Ávila Morales, J1; Leo Amador, G1

1: Universidad Autonoma de Queretaro, Mexico

Objective: To determine risk factors for diseases sexually transmitted infections (STIs) and its association with sexual behaviors in students of the Faculty of Medicine of the Universidad Autonoma de Queretaro(UAQ).

Material and Method: Observational study, involving students of medicine and Dentistry of the UAQ on a voluntary basis and with informed consent. The determination of the risk factor for STDs was made with the application of a questionnaire which evaluates sexual risk factors, consists of 9 items: homosexuality, multiple partners of the participant and his/her respective partner, sex with sex workers, exercising prostitution, bisexuality, use of the sharps, injecting drug user and the frequency of the use of the condom, and their theoretical basis is the standard official Mexican 003-SSA2-1993 criteria of opt-out for blood and organ donation. In addition, Hidalgo-San Martin et.al. 2003 validated instrument is used to measure social and personal sexual behaviors. The dimensions evaluated for social sexual behaviors: fantasy, search, image, casual dating and formal courtship. For social sexual behaviors were analyzed: external contact, Self-eroticism sensations, not genital intimate contact and intimate genital contact. The data processing was performed using SPPS, presenting the information in descriptive statistics and contingency tables. The association between variables was analyzed with Chi-square test and logistic regression was done.

Results: 648 students, of whom 445(68.6%) of medicine and 203 (31.4%) of dentistry. The average age was 20.6 years. Women represented by 374(57.7%) and the male 274(42.3%). Risk factors were assessed by gender, by determining Odds Ratio (OR) and Chi square. The significant results were:  multiple couples OR 2.92, CL (1.84-4.63) p =. 000; Prostitution OR 8.35, CL (1-185.12), p =. 019 and bisexuality OR. 2.90, CL (1.36-6.27), p =. 002. The significant social sexual behaviors were: Fantasy OR 2.53, CL (1.20-3.46), p =. 004; Image OR 6.47, CL (3.57-11.93), p=0.000; Dating casual OR 1.75, CL (1.05-2.92), p = .022.  Significant body sexual behaviors: Contact external OR 1.6, CL (1.02-2.77), p =. 030; Auto sexual sensations OR 4.5, CL (2.58-8.23), p =. 000 and intimate genital contact OR 1.56, CL (1.11-2.20), p =. 007.

X 2 test (Statistically significance p value <0.05) and 95% CL.

The risk factors for STDs were associated with: fantasy, image, casual dating, external contact, and genital contact.

Conclusions: There are differences in sexual behaviors between men and women, which should be considered for the design and implementation of educational strategies in sexual health focus to STD prevention.

Disclosures:

Work supported by industry: no.

show poster

Proposal for an instrument for characterization of sexual experiences in childhood and / or adolescence (ICSECA) of individuals with compulsive sexual behavior (#167)

M. Scanavino (Brazil)
show abstract

167

Proposal for an instrument for characterization of sexual experiences in childhood and / or adolescence (ICSECA) of individuals with compulsive sexual behavior

Dos Reis, S1; Scanavino, M1

1: Institute of Psychiatry (IPq) of the Clínicas' Hospital of the University of São Paulo Medical School (FMUSP), Brazil

Objectives: One of the etiological factors of Compulsive Sexual Behavior (CSB) is Child Sexual Abuse (CSA). The consequences on mental health are directly related to the type of violence, the victim's reaction, characteristics of the abuse (duration, frequency, time, age, onset of abuse, type of kinship, type of sexual experiences, number of abusers), but there is a lack of measures to specific evaluation of individuals with CSB who suffered CSA in childhood. We aim to develop an instruments for the characterization of sexual experiences suffered in childhood and / or adolescence to specific evaluation in adults with CSB.

Method: A literature search was performed in the following databases: Pubmed, Lilacs and Scielo, with keywords: compulsive sexual behavior, sexual addiction, child sexual abuse, measures, scale and instruments, all of 1985/2014, in English and Portuguese. After deleting those papers unrelated to the topic, 25 articles were analyzed for the development of the instrument.

Results: The following aspects were considered most relevant: quantitative aspects (number of episodes, number of abusers, period in childhood and / or adolescence); qualitative aspects (age of victim, age of the abuser, bond, type of abuse (without contact or penetration)); experiential aspects ( past sexual experiences, past and present feelings  about the episode; if it was revealed; if it was the host family, if it was a traumatic experience; or involving seduction). All these aspects were investigated if the participant reported has had sexual experience before age 13 with someone at least 5 years older; and / or has had between 13 and 18 years with someone at least 10 years older. Based upon those aspects we drafted o the Instrument consisting of 25 closed questions for self-fulfillment.

Conclusion: There is a diversity of qualitative, quantitative and experiential aspects that should be investigated in order to characterize the experience of CSA in a sample of individuals with CSB. The characterization of CSA may facilitate investigations on the connections between sexual experiences in childhood and adolescence and mental and sexual health in adulthood of individuals with CSB.

Disclosures:

Work supported by industry: no.

show poster

Neuropsychological aspects about decision-making and cognitive flexibility of 25 patients with compulsive sexual behavior (CSB) and 25 controls (#168)

M. Scanavino (Brazil)
show abstract

168

Neuropsychological aspects about decision-making and cognitive flexibility of 25 patients with compulsive sexual behavior (CSB) and 25 controls

Messina, B1; Scanavino, M1

1: IPQ-HCFMUSP, Brazil

Objectives: There are few studies on Neuropsychological aspects of patients with compulsive sexual behavior (CSB), and the results are controversial. We aim to investigate through the Iowa Tests Gambling Task (IGT) and Wisconsin Card Sorting Test (WCST), respectively, the Decision Making and Cognitive Flexibility, of 25 patients with CSB and 25 controls.

Methods: 25 men with CSB, after being diagnosed to 52.7 F Excessive sexual appetite (ICD-10), and sexual addiction (Goodman), underwent to neurocognitive assessment by neuropsychologist who applied the IGT and the WCST. They also answered the Sexual Compulsivity Scale (SCS).

Results: The patients presented higher scores (M = 28.4, SD = 7.07) than controls (M = 15.8, SD = 5.8) (P . <0.001) in the SCS. Regarding Decision Making (IGT), patients had lower scores (M = 13.2, SD = 25.81) than controls (M = 25. 12, SD = 24.0) (P = 0.04) in the variable Trend General (TG), as well as the first block of the analysis by segments (5 blocks), patients presented a tendency to scoring lower (M = -5.28 ; SD = 5.4) than controls (M = -1.12, SD = 5.8) (P = 0.006); suggesting an initial process of taking more impulsive decision.

Conclusions: The results suggest more impulsive decision making in patients with CSB when comparing with controls.

Disclosures:

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

show poster


14:00 - 15:30
Instructional course 5 - Patient selection and monitoring of TRT

Location: Transamérica Auditorium
Chairs: Ernani Rhoden (Brazil) & Luiz Otavio Torres (Brazil)

Laboratory diagnosis of testosterone deficiency

Jacques Buvat (France)

Metabolic and vascular risk factors

Miguel Rivero (Argentina)

TRT in the obese patient

Mario Maggi (Italy)

CV safety issues

Abraham Morgentaler (USA)


14:00 - 14:45
Workshop 7 - A step by step tutorial on PD surgery

Location: Ilhéus + Una Room
Chair: Guillermo Gueglio (Argentina)

A step by step tutorial on PD surgery: Incision and grafting

Wayne Hellstrom (USA)

New insights into tunical plication strategies

Laurence Levine (USA)


14:45 - 15:30
Workshop 8 - Penile duplex ultrasound

Location: Ilhéus + Una Room
Chair: Lawrence Hakim (USA)

How to diagnose penile vascular disease by duplex Doppler ultrasound

Chris McMahon (Australia)

Penile Duplex Doppler Ultrasound (PDDU) – keys to proper diagnosis, standardization and success

Suresh Sikka (USA)


15:30 - 16:00
Coffee break

Location: Comandatuba Room 1

16:00 - 17:00
Round table 4 - History of ISSM

Location: Comandatuba Room 2+3
Chairs: Sidney Glina (Brazil) & Chris McMahon (Australia)

The surgeon, the organizer,and the scientist

Ronald Lewis (USA) & Ira Sharlip (USA)

Jurassic Park in Latin America: the lost meetings

Edgardo Becher (Argentina)


16:00 - 17:00
Podium 8 - ED surgical

Location: São Paulo Room
Chairs: Rafael Carrion (USA) & Claudio Teloken (Brazil)

The Carrion Cast: An update on the usage of the intracorporal antimicrobial doped spacer for the treatment of penile implant infection (#043)

D. Martinez (USA)
show abstract

043

The Carrion Cast: An update on the usage of the intracorporal antimicrobial doped spacer for the treatment of penile implant infection

Martinez, D1; Alhammali, E1; Emtage, J1; Parker, J1; Carrion, R1

1: University of South Florida, United States

Objectives: Since the inception of the penile prosthesis, infection has always been a significant risk. With the advent of antibiotic coated implants the rate has decreased to 1-3%, and with the “no touch technique”, 0.7%. Despite this, infection is still a reality, and a devastating complication; resulting in a decrease in penile size, increase in pain, and loss of sexual function. We present our updated series of the “Carrion Cast”, antimicrobial spacer that maintains size while treating infection, bridging the gap between explantation and reimplantation.

Materials and Methods: From May 2012 to February 2014, 9 cases have been performed using high purity CaSO4 mixed with antimicrobials for the management of infected penile prosthesis in patients who are not candidates for immediate salvage. All cases had either already failed an immediate salvage and/or presented with bacteremia/septicaemia. 5 were Coloplast Genesis Semirigid Penile Prosthesis (SRPP), 2 were Coloplast Titan Inflatable Penile Prosthesis (IPP), and 2 were narrow SRPP’s, sizes ranging from 17cm to 23cm. All cases underwent complete removal of prosthetic material and modified “Mulcahy Salvage” wash. The amount of CaSO4 used varied, depending on the volume of corpora (20-30cc, split between the two corpora). Serum calcium, vancomycin and tobramycin levels remained stable while the cast was palpable within the corpora.

Results: Time to reimplantation varied (6-18 weeks), but most at 6 weeks, the time it takes for the cast to dissolve. All patients were able to have a prosthesis replaced: 1 SRPP, 3 IPP’s, 2 narrow SRPP’s, and 1 narrow IPP, with sizes ranging from 17cm to 20cm; 2 cases are still pending reimplantation. The mean loss of penile prosthesis length was only 1.1cm, meaning the average percent of penile length maintenance was 95%.

Conclusions: Penile prosthesis infection is devastating. Thanks to the “Mulcahy Salvage Protocol”, most cases can be immediately reimplanted. These cases, however, can be technically challenging, carry a higher rate of reinfection, and some patients are too sick for an immediate salvage. Thus, many infected implants undergo explantation and are left with a scarred, severely shortened penis, and inability to perform coitus. Thanks to the “Carrion Cast”, our small, yet growing series shows that they can be bridged with this antimicrobial-doped spacer, and reimplanted at 6 weeks, maintaining their penile length by 95%. Albeit a small series at this time, the “Carrion Cast” provides hope to this subset of patients that would otherwise be left in a terrible predicament.

Disclosures:

Work supported by industry: no.

“Just the tip”: Closed suction drain cultures after penile implant surgery with prolonged drains (#044)

D. Martinez (USA)
show abstract

044

“Just the tip”: Closed suction drain cultures after penile implant surgery with prolonged drains

Martinez, D1; Wallen, J1; Kongnyuy, M1; Emtage, J1; Carrion, R1; Parker, J1

1: University of South Florida, United States

Objectives: Closed suction drains have been used in penile prosthesis surgery for some time to prevent hematoma formation. Among some surgeons, there is a concern that these foreign bodies may increase the risk of infection by allowing retrograde migration of bacteria from the skin into the wound.  We present the culture results of these to assess for bacterial colonization after 72 hours of drain placement

Materials and Methods: In the past, we have presented our series of drains status post placement of an inflatable penile prosthesis. It consisted of approximately 100 drains left in for at least 72 hours, and none have experienced an infection to date. The last 5 drains removed have had two portions sent for anaerobic and aerobic culture, the distal tip and a section 1cm deep to the skin. An alcohol pad was first used to sterilize the skin, and all drains were removed in standard fashion.

Results: All 5 patients had their drains in place for 72 hours. None had any evidence of a hematoma at the time of drain removal. All 5 distal drain tips showed no evidence of bacterial growth. Only one of the four distal drain sections, 1cm from the skin, showed 2 colony forming units (CFU) of Staphylococcus (coagulase negative). The other 4, at 1cm from the skin, showed no growth after 48 hours.

Conclusions: Hematoma formation after penile prosthetic surgery can cause patient discomfort, prolonged postoperative recovery time, and may even act as a medium for potential bacterial proliferation. Postoperative drain placement for only 24 hours has been shown to decrease the rate of hematoma formation while not increasing the risk of infection. In our series of prolonged drainage of at least 72 hours, none have developed infections. Opponents of drain placement endorse the argument that there exists a hypothetical risk that the longer the drain is left in place, the higher the likelihood that bacteria may contaminate the surgical site possibly compromising the implant. We now present our initial series of drain sections, at different distances from the skin, sent for culture. Even after a prolonged period of time, the drain portions within the surgical site, in close contact with the prosthetic, do not show any evidence of bacterial colonization, even the sections close to the skin. While drain placement is still a surgeon preference, these results further supports the safe usage of closed suction drains in penile prosthetic surgery for the prevention of hematoma formation.

Disclosures:

Work supported by industry: no.

Improved infection outcomes after mulcahy salvage procedure and replacement of infected IPP with malleable prosthesis (#045)

M. Gross (USA)
show abstract

045

Improved infection outcomes after mulcahy salvage procedure and replacement of infected IPP with malleable prosthesis

Gross, M1; Eid, J2; Yang, C3; Simon, R3; Martinez, D3; Carrion, R3; Perito, P4; Levine, L5; Greenfield, J6; Munarriz, R1

1: Boston University Medical Center, United States; 2: Advanced Urological Care, United States; 3: University of South Florida, United States; 4: Perito Urology, United States; 5: Rush University Medical Center, United States; 6: Urology Associates of North Texas, United States

Objective: Since its introduction in 1996, Mulcahy salvage has significantly improved outcomes for removal and replacement of infected IPPs. Long-term follow-up data of Mulcahy salvage shows an infection-free rate of 82%. Since 2002, 55 patients have undergone Mulcahy salvage with IPP removal and replacement with malleable prosthesis at our institutions. Of these patients, 51 (93%) have remained infection free postoperatively. Additionally, 14 of these 55 patients have undergone subsequent malleable replacement with IPP. Our objective was to review the successful outcomes of this innovative variant of the salvage procedure.

Materials & Methods: This is a retrospective multi-institution study of 55 patients who underwent Mulcahy salvage with IPP removal and replacement with malleable prosthesis. Patients’ operative notes and charts were extensively reviewed to compile study data.

Results: Between 2002 and 2014, 55 patients underwent infected IPP removal and replacement with malleable prosthesis via Mulcahy salvage. Average age was 58, range 26 to 79. Average operative time was 169 minutes, range 79 to 264. Postoperative follow-up ranged from 2 weeks to 84 months. Forty-one of 55 patients retained malleable prosthesis, 14 patients subsequently underwent replacement with IPP. This occurred on average 7.7 months after Mulcahy salvage, range from 2 to 29 months. Four patients had persistent infection after Mulcahy salvage with malleable and underwent explant.

Conclusion: Mulcahy salvage procedure and replacement of IPP with malleable prosthesis has an improved infection-free rate of 93% when compared to the 82% infection-free rate after IPP removal and replacement. Additionally, 14 of the 55 patients who remained infection free were able to successfully undergo subsequent removal of malleable prosthesis and replacement with IPP an average of 7.7 months later.

Disclosures:

Work supported by industry: no.

Key factors and influencers impacting the penile implant decision (#046)

Chris Nelson (USA)
show abstract

046

Key factors and influencers impacting the penile implant decision

Nelson, C1; Hill, R2; Hakim, L3; Burnett, B4; Mulhall, J1

1: Memorial Sloan Kettering Cancer Center, United States; 2: American Medical Systems, United States; 3: Cleveland Clinic, United States; 4: Johns Hopkins Medical Institutions, United States

Objectives: For men with erectile dysfunction (ED), the decision to have penile implant surgery can be a difficult one. However, little is known about how men make this decision. We conducted two quantitative studies to explore the primary factors and relative influencers in the decision to move forward (or not move forward) with a penile implant.  

Material and Methods: Two separate IRB approved patient research studies were conducted. The first study was a quantitative survey of 257 men who had attended American Medical System (AMS) sponsored Patient Education Seminars on ED. The research assessed men at three time points: 1-2 months post-seminar (n=43), 3-6 months post-seminar (n=80), and 12-16 months post-seminar (n=134).  Survey length was approximately 30 min. Respondents answered questions on their ED history, the seminar itself, activities since the seminar, therapies tried and relative satisfaction, and potential barriers to penile implants.  The second study was also a quantitative survey of approximately 30 min in length. This study sample (n=61) consisted of men who had a recommendation from a urologist to receive a penile implant.  Half of this sample (n=31) had implant surgery, while the other half (n=30) decided not to receive an implant. The primary purpose of the study was to better understand the differences between these two groups.

Results: The primary factors across both study which lead to an implant were: 1) belief that it is the best solution for them, 2) trust and confidence in their urologist, and 3) a supportive spouse/partner.  Factors deterring patients from an implant included: 1) hope that a better solution exists, 2) concern about pain and other surgical side effects, and 3) concern about the reaction of their partner. Interestingly, the relative influence of key players in the decision was similar when comparing implanters vs. non-implanters: urologist (36% vs. 29%), the spouse/partner (23% vs. 27%), and the patient himself (34% vs. 29%).       

Conclusions: It is important for physicians treating ED to understand the dynamics behind a patient’s decision related to a penile implant. Both the urologist and the spouse/partner hold about the same relative influence as patient in this decision.   

Disclosures:

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

MRI analysis of architectural changes of the retropubic space and relevant structures post radical prostatectomy: Implications for penile prosthesis reservoir placement (#047)

John Mulhall (USA)
show abstract

047

MRI analysis of architectural changes of the retropubic space and relevant structures post radical prostatectomy: Implications for penile prosthesis reservoir placement

Sullivan, JF1; Foran, P1; Nelson , C1; Akin , O1; Mulhall, J1

1: Memorial Sloan Kettering Cancer Center

Objective: Insertion of a three-piece inflatable penile prosthesis (IPP) is commonly performed in men post radical prostatectomy (RP). The traditional reservoir placement in the space of retzius can result in damage to bladder, bowel and femoral vessels. In this study using pre and post operative magnetic resonance imaging (MRI) we aimed to assess the effects of RP on pertinent retropubic anatomy with respect to IPP placement.

Methods and Materials: Endorectal MRI studies in men with prostate cancer were reviewed. Inclusion criteria: (i) availability of pre and post operative MRI from single institution, (ii) post RP MRI (>6 months), (iii) no pre or post RP pelvic surgery or radiation. All scans were performed on a 3 Tesla system with T1 and T2 weighted images reviewed using axial and sagittal planes. Pertinent landmarks were evaluated by 2 independent readers, blinded to clinical and pathological data. All measurements were defined by an experienced radiologist. Measurements included (i) distance from external inguinal ring (EIR) to external iliac vein (EIV) (ii) superior aspect of pubic symphysis (PS) at midline to bladder and (iii) EIR to nearest bladder point. Correlation was measured between bladder volume and (iii). For distances (i) and (iii) bilateral measurements were obtained and data averaged as no significant differences were observed. Maximal post operative scar thickness in the retropubic space was quantified. Repeated measure t-test was used to assess differences in pre and post operative values.

Results: 22 patients were included in the analysis. Operative approach: open retropubic 64%, laparoscopic / robotic  36%. Both pre and post operative scans were reviewed. Mean pre and post operative measurements are reported (cm): (i) EIR to EIV: pre op 3.00 (1.94-3.83); post 2.95 (1.94-3.76), (ii) EIR to the nearest point of the bladder: pre op 2.62 (1.47-3.92); post 2.75 (2.10-4.10), superior aspect of PS to nearest point of bladder (midline): pre op 1.05 (0.56-1.82); post 1.09 (0.69-1.62). No significant differences were observed. Post operative midline retropubic scar thickness range 0.55-1.01cm. A significant difference was observed in mean scar thickness in open 0.55cm vs laparoscopic 0.28cm approaches (p=0.04)

Conclusions: In this study we have attempted to highlight the changes in the architecture of the retropubic space post RP. Patients undergoing a laparoscopic procedure have significantly less post operative scarring in this region. Although not currently routine, reviewing MRI prior to IPP placement may aid in pre operative planning, selection of appropriate prostheses and reservoir placement location.

 

Disclosures:

Work supported by industry: no.

Utilization of pre-operative penile stretch test as a predictor of erection and total implant length (#048)

H. Ayoub (USA)
show abstract

048

Utilization of pre-operative penile stretch test as a predictor of erection and total implant length

Ayoub, H1; Westney, O1; Perito, P2

1: MD Anderson Cancer Center, Houston, USA; 2: Perito Urology, Florida, USA

Objectives: Prediction of the erection and total corporal length prior to inflatable penile prosthesis (IPP) surgery is of great benefit to both the surgeon and the patient. For the patient, estimation of the post-operative result is helpful in creating realistic expectations. The ability to accurately calculate the range of the total implant length utilizing a penile stretch test could focus the amount of inventory shipped for an individual procedure.   Thus, we sought to determine whether a formula based on the pre-operative stretch length could reliably predict the total corporal length.

Methods: Fifty-three consecutive virgin IPP patients were performed by a single surgeon over 30 days. All patients received a Coloplast Titan® IPP through an infrapubic approach. In all patients, a pre-operative stretch test was performed using Furlow along the dorsal aspect of the penis from the mons pubis to the tip of the glans. Intraoperatively, the same measurements were repeated after induction of normal saline artificial erection and after implantation and inflation of the device. Formulas based on the stretch test were constructed to predict the total device length [stretch test + (x%) stretch test].  Descriptive statistics, paired significance testing and linear regression were performed using Stata 13.

Results: In comparing the three penile measurements, the stretch test and the post-implant measurement were not statistically different (p-value=0.3878). The artificial erection length was statistically different from both penile stretch and post-implant lengths (p< 0.0001). On linear regression, all measurements demonstrated a significant linear relationship with the overall implant length with inflated post-implant length having the highest correlation. The linear formula, stretch test + (0.35) stretch test, predicted the total device length within the range [stretch test (cm) to calculated value (cm)]  in 96% of cases. (Table I) Rear tip extenders, primarily 1 cm, were utilized in 25 cases (47.2%). No total implant length was less than the pre-operative stretch test. 

Conclusion: The preoperative stretch test demonstrated a high correlation with post-implant erection length and total IPP device length in this pilot dataset.  The formula for estimating total device length will need to be verified prospectively to determine its reproducibility. 

Table I: Correlation between predictive formulas and final implant length

Abstract 048

Disclosures:

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


16:00 - 17:00
Round table 5 - Hormones and womens sexuality: Contraception and sexuality, menopausal women and HRT

Location: Transamérica Auditorium
Chairs: Annamaria Giraldi (Denmark) & Monica Lijtenstein (Uruguay)

Contraception

Susan Kellogg-Spadt (USA)

Menopause

Victoria Bertolino (Argentina)

Hormones, menopause and oncology

Alessandra Graziottin (Italy)


16:00 - 16:45
Workshop 9 - ICI program: Drugs and combinations

Location: Ilhéus + Una Room
Chair: Eduardo Bertero (Brazil)

Intracavernous injection therapy for ED: Indications and contra-indications, complications and treatment

Hossein Sadeghi-Nejad (USA)

Intracavernous injection therapy for ED: What is the best dose and mixture (combination) for my patient? How I manage the medication in my practice? Drop out rates and complications

Ricardo Munarriz (USA)


17:00 - 18:30
ISSM business meeting

Location: Comandatuba Room 2+3