Saturday 11 October 2014

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Morning

07:45 - 08:30
Sponsored breakfast symposium

Location: Comandatuba Room 2+3

08:30 - 09:00
Master lecture 7 - Hypersexuality/Sexual addiction

Location: Comandatuba Room 2+3
Chairs: Romulo Aponte (Venezuela) & Eli Coleman (USA)

Hypersexuality/Sexual addiction

Kevan Wylie (United Kingdom)


09:00 - 09:30
Master lecture 8 - Postorgasmic illness syndrome

Location: Comandatuba Room 2+3
Chairs: Stanley Althof (USA) & Juan Uribe (Colombia)

Postorgasmic illness syndrome

Chris McMahon (Australia)


09:30 - 10:00
Master lecture 9 - Permanent adverse effects after 5ARI treatment

Location: Comandatuba Room 2+3
Chairs: Sharon Parish (USA) & Lucia Pesca (Brazil)

Permanent adverse effects after 5ARI treatment

Mohit Khera (USA)


10:00 - 10:30
Coffee break

Location: Comandatuba Room 1

10:30 - 11:00
Special lecture - The road to ICSM 2015

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

The road to ICSM 2015

Gerald Brock (Canada)


10:30 - 11:30
Moderated posters 7 - Basic science 2

Location: São Paulo Room
Chair: Ronald Lewis (USA)

Efficacy of pioglitazone on erectile function recovery in a rat model of post-prostatectomy erectile dysfunction (#169)

Ronny Tan (Singapore)
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169

Efficacy of pioglitazone on erectile function recovery in a rat model of post-prostatectomy erectile dysfunction

Aliperti, L1; Tan, R1; Lasker, G1; Hagan, S2; Hellstrom, JA1; Gokce, A1; Trost, L3; Kadowitz, P1; Sikka, S1; Hellstrom, W1

1: Tulane University School of Medicine, United States; 2: Tulane University School of Medicine, United States School of Medicine; 3: Mayo Clinic, United States

Objectives: To examine the effect of pioglitazone on erectile function (EF) in a rat model of post-prostatectomy erectile dysfunction (ED).

Methods: Twenty adult rats were divided into four groups: a) sham, b) control - bilateral cavernosal nerve crush injury (BNCI), c) BNCI + low-dose pioglitazone (PioL) and d) BNCI + high-dose pioglitazone (PioH). Sham and control rats were administered phosphate buffered saline, while PioL and PioH rats received 0.65 and 6.5 mg/kg of pioglitazone, respectively. All treatments were administered by oral gavage for 14 days.  Following treatment, animals underwent surgery for endpoint cavernosal response to define hemodynamic parameters of erectile function reported as the ratio of intracavernosal pressure to mean arterial pressure (ICP/MAP). Corporal tissue was retrieved for histologic and molecular analysis.

Results: Animals treated with pioglitazone experienced dose-dependent improvements in ICP/MAP, with PioH achieving results similar to sham:  sham 0.774; BCNI 0.421; PioL 0.616; PioH 0.758 (p=0.0006). PioH animals demonstrated increased expression of eNOS and nNOS, while both PioL and PioH had increased staining for anti-smooth muscle actin antibody and non-significant increases in cGMP.

Conclusion: Pioglitazone improves EF in rats undergoing BNCI via a nitric-oxide mediated pathway.

Disclosures:

Work supported by industry: no.

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Peripheral effects of opiates agonist in isolated corpus cavernosum (#170)

R. Rodrigues (Brazil)
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170

Peripheral effects of opiates agonist in isolated corpus cavernosum

Rodrigues, R1; de Oliveira, M2; Antunes, E1; De Nucci, G1; Mónica, F1

1: UNICAMP, Brazil; 2: UNIVAP, Brazil

Objective: The peripheral effects of opiates in the corpus cavernosum (CC) are controversial, since both detumesce and priaprism were observed. To date, there are no studies that evaluated the role of opiate system in isolated CC. The aim of this work was to assess the peripheral effects of opiates in isolated CC from rats (RCC).

Material and Methods: Concentration-response curves to fentanyl,  loperamide and endomorphin-1 were carried out in the absence and presence of the non-selective opiate antagonist (naloxone 10 µM), selective µ-opiate antagonist (ciprodime 100 nM), soluble guanylyl cyclase inhibitor (ODQ 10 µM), nitric oxide synthase inhibitor (L-NAME, 100 µM) or potassium channel blockers (glibenclamide 10 µM, tetraetylammonium 1 uM, apamine 100 nM and charybdotoxin 100 nM) in tissues pre-contracted with phenylephrine (PE, 10 µM). In vivo assay was realized by determining basal and stimulated intracavernous pressure (ICP) before and after intracavernosal infusion of fentanyl (4 µg/kg, 5 min). Immunohistochemical analysis for µ and δ- opioid receptors was also carried out.

Results: Immunohistochemical analysis revealed the expression of µ and δ- opioid receptors in nerve fibers of RCC. The µ-opiate agonists (n=5) fentanyl, loperamide and endomorphin-1 produced concentration-dependent relaxation with values of Emax of 110 ± 3%; 105 ± 3%; 57 ± 2% and pEC50 of 5.81±0.06; 4,94±0.04; 5,57±0.07 (n=5), respectively. Naloxone did not alter the relaxation induced by µ-opiate agonists, while the selective µ-opiate antagonist ciprodime caused a 1.7-fold and 1.5-fold (P<0.05) on the relaxation induced by fentanyl and loperamide. The potassium channel blockers significantly reduced the values of pEC50 relaxation of fentanyl 5.57 ± 0.03 and loperamide (4.39 ± 0.04). Neither L-NAME nor ODQ altered the relaxation induced by opioids agonists. Intracavernosal infusion of fentanyl increased the basal ICP on 3.8 ± 0.5 mmHg and stimulated ICP (from 36,5 ± 2,8 to 48,6 ± 4,5, P<0.05).

Conclusions: Opioids receptors are expressed on RCC and their agonists induced relaxation. However, further studies should be carried out in order to verify whether these receptors have any role on the neurotransmitters release and thus on erectile function.

Disclosures:

Work supported by industry: no.

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Nonalcoholic steatohepatitis as a novel player in metabolic syndrome-induced erectile dysfunction: An experimental study in the rabbit (#171)

Mario Maggi (Italy)
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171

Nonalcoholic steatohepatitis as a novel player in metabolic syndrome-induced erectile dysfunction: An experimental study in the rabbit

Vignozzi, L1; Filippi, S2; Comeglio, P1; Cellai, I3; Sarchielli, E4; Morelli, A4; Rastrelli, G1; Maneschi, E3; Galli, A5; Vannelli, G4; Saad, F6; Mannucci, E7; Adorini, L8; Maggi, M1

1: Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Italy; 2: Interdepartmental Laboratory of Functional and Cellular Pharmacology of Reproduction, Department of Experimental and Clinical Biomedical Sciences and Department of NEUROFARBA, University of Forence, Italy ; 3: Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences University of Florence, Italy; 4: Section of Anatomy and Histology, Department of Experimental and Clinical Medicine, University of Florence, Italy; 5: Gastroenterology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Italy; 6: Global Medical Affairs Men’s Healthcare, Bayer Pharma AG, Berlin, Germany; 7: Diabetes Section Geriatric Unit, Department of Critical Care, University of Florence, Italy; 8: Intercept Pharmaceuticals, New York, USA

Objectives: A pathogenic link between erectile dysfunction (ED) and metabolic syndrome (MetS) is now well established.  Nonalcoholic steatohepatitis  (NASH),  the hepatic hallmark of MetS, is regarded as an active player in the pathogenesis of MetS-associated cardiovascular disease. The aim of this study was aimed at evaluating  the relationship between MetS-induced NASH and penile dysfunction.

Material and Methods:  We used a non-genomic, high- fat diet (HFD)-induced  rabbit model of MetS, and treated  HFD  rabbits with testosterone (T), with the farnesoid X receptor agonist obeticholic acid (OCA), or with the anti-TNFa mAb infliximab. Rabbits fed a regular diet were used as controls.

Results:  Liver histomorphological and gene expression analysis demonstrated NASH in HFD rabbits. Several genes related to inflammation  (including TNFa), activation of stellate cells, fibrosis, lipid metabolism  parameters were negatively associated to maximal acetylcholine (Ach)-induced–penile relaxation. When all these putative  liver  determinants of penile Ach responsiveness were tested as covariates in a multivariate model, only the association between hepatic TNFa expression and Ach response was confirmed. Accordingly, circulating levels of TNFa were increased in HFD  rabbits. T and OCA in HFD  rabbits  both  reduced TNFa liver expression and plasma levels, with a parallel increase of penile eNOS expression  and Ach-responsiveness. Also neutralization of TNFa with  infliximab treatment normalized HFD-induced hypo-responsiveness to Ach, as well as responsiveness to vardenafil, a PDE5 inhibitor.

Conclusions: MetS-induced NASH in HFD rabbits plays an active role in the pathogenesis of ED, through TNFa,  as indicated by treatments reducing liver and circulating  TNFa  levels, or neutralizing TNFa action, which improve Ach-penile responsiveness in HFD rabbits.

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.

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Metformin in vitro and in vivo increases adenosine signalling in rabbit corpora cavernosa (#172)

Mario Maggi (Italy)
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172

Metformin in vitro and in vivo increases adenosine signalling in rabbit corpora cavernosa

Vignozzi, L1; Filippi, S2; Comeglio, P1; Cellai, I3; Morelli, A4; Rastrelli, G5; Maneschi, E 1; Mannucci, E6; Maggi, M3

1: Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Italy; 2: Interdepartmental Laboratory of Functional and Cellular Pharmacology of Reproduction, Department of Experimental and Clinical Biomedical Sciences and Department of NEUROFARBA, University of Forence, Italy ; 3: Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences University of Florence, Italy; 4: Section of Anatomy and Histology, Department of Experimental and Clinical Medicine, University of Florence, Italy; 5: Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences University of Florence,Italy; 6: Diabetes Section Geriatric Unit, Department of Critical Care, University of Florence, Italy

Objective: In subjects with erectile dysfunction responding poorly to sildenafil, metformin was reported to improve erections. The aim of this study was to investigate metformin's mechanism of action on erectile function, focusing on adenosine  (ADO) and nitric oxide  (NO) signaling in an animal model of high fat diet (HFD)-induced metabolic syndrome.

Material and Methods: In vitro contractility studies were used to investigate the effect of in vivo and ex vivo metformin administration on ADO-or acetylcholine  (Ach)-induced relaxation of penile strips from HFD, as compared  to animals fed a regular diet (RD). We evaluate also the expression of genes related to penile smooth muscle relaxation and contractility.

Results:  Expression of ADO receptor type 3 (A3R), ADO deaminase  (ADA), AMP deaminase type 1 (AMPD1)  and 2 (AMPD2)  was decreased in HFD, as compared to RD. Accordingly, in HFD the ADO relaxant effect was potentiated as compared to RD. In vivo metformin treatment in both RD and HFD significantly increased the ADO relaxing effect, although to a different extent. In penile strips from HFD, in vivo metformin normalized  A3R,  ADA  and  AMPD1, further decreased  AMPD2, increased dimethylarginine-dimethylamino-hydrolase and restored impaired Ach-induced relaxation. Ex vivo metformin time-and dose-dependently increased the relaxant effect of ADO in RD. The potentiating effect of metformin on ADO-induced relaxation was significantly reduced by pre-incubation with NOS inhibitor L-NAME.  Interestingly, in vivo testosterone supplementation in HFD rabbits increased penile expression of eNOS, AMPD2 and  restored metformin’s potentiating effect on ADO induced relaxation, up to RD level.

Conclusions:  In conclusion, metformin in vivo and ex vivo increases ADO signalling in CC, most probably interfering with NO formation and ADO breakdown.

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.

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Excessive fructose administration from childhood may induce oxidative stress via the AGE-NADPH oxidase pathway, resulting in erectile dysfunction in adult rats (#173)

Y. Hotta (Japan)
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173

Excessive fructose administration from childhood may induce oxidative stress via the AGE-NADPH oxidase pathway, resulting in erectile dysfunction in adult rats

Hotta, Y1; Nakamura, D1; Yahagi, R1; Kataoka, T1; Maeda, Y1; Kimura, K1

1: Nagoya City University, Japan

Objective: Fructose is widely used in many sweets and beverages. Excessive fructose administration induces oxidative stress via the activation of NADPH oxidase by advanced glycation end products (AGE). However, it is unknown how excessive fructose administration from childhood affects erectile function in adulthood. In this study, we investigated the relationship between excessive fructose administration and erectile dysfunction in rats.

Materials and Methods: Four-week-old male Wistar-ST rats were divided into three groups: control, 5% fructose, and 10% fructose. Control rats were given normal water, while those in the treatment groups were given 5% or 10% fructose water to drink at libitum for eight weeks. After eight weeks, the levels of blood glucose (BG) and serum bioavailable testosterone (bio-T) were measured, and erectile function was assessed. Serum bio-T levels were measured by UPLC/MS/MS. Erectile function was evaluated by gauging changes in the intracavernous pressure (ICP)/mean arterial pressure (MAP) ratio under stimulation of the cavernous nerve. mRNA expression of receptor for AGE (RAGE) and NADPH oxidase 1, 2, and 4 in the corpus cavernosum (CC) of the animals was measured by real-time PCR analysis. ANOVA and Bonferroni’s multiple t-test were used for statistical analysis.

Results: No intergroup difference was observed in the body weight of the animals. BG levels in the 5% and 10% fructose groups were higher than those in the control group. ICP/MAP ratios of the fructose-treated animals were significantly lower (p < 0.05) than those of the control animals. Bio-T levels in the fructose-treated animals were lower (in a dose-dependent manner) than those in the control animals ( p < 0.05; 10% fructose group). Moreover, mRNA expression of RAGE and NADPH oxidase 1, 2, and 4 in the CC of the fructose-treated animals was dose-dependently higher than that in the control animals.

Conclusions: Excessive administration of fructose from childhood may induce erectile dysfunction in adult rats because of the production of oxidative stress via the AGE-NADPH oxidase pathway.

Disclosures:

Work supported by industry: no.

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Decreased basal levels of neurotrophic factors and impaired neurite outgrowth in major pelvic ganglia from type 2 diabetic rats with erectile dysfunction (#174)

Trinity Bivalacqua (USA)
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174

Decreased basal levels of neurotrophic factors and impaired neurite outgrowth in major pelvic ganglia from type 2 diabetic rats with erectile dysfunction

Hannan, J1; Musicki, B1; Liu, X1; Burnett, A1; Bivalacqua, T1

1: Johns Hopkins School of Medicine, United States

Objectives: Type 2 diabetes is a common disorder that causes progressive damage to the autonomic nervous system leading to erectile dysfunction (ED).  Furthermore, obese diabetic men have significantly worse ED outcomes following radical prostatectomy (RP) than men without diabetes. This study aimed to characterize the basal levels of neurotrophic factors and neurite outgrowth in the major pelvic ganglia (MPG) of a high fat diet/low dose streptozotocin (STZ)-induced type 2 diabetic rat model. 

Material and methods: Male Sprague-Dawley rats were fed a high-fat diet (60% Kcal) for two weeks followed by 2 low dose injections of STZ (20 mg/kg) to induce diabetes.  Rats were continuously fed the high fat diet and assessed at 3 and 5 weeks after diabetes induction.  Control rats were fed a normal chow diet.  Blood glucose was recorded and erectile function was assessed by measuring the ratio of intracavernosal pressure to mean arterial pressure (ICP/MAP) after cavernous nerve stimulation.  MPGs were collected and gene expression analysis by qPCR was performed for neurotrophic factor 3 (NT3), nerve growth factor (NGF), glial-derived neurotrophic factor (GDNF) and brain derived neurotrophic factor (BDNF).  Additional MPGs (n=4/group) were cultured in reduced growth factor matrigel for 48h and neurite growth was measured. 

Results: Blood glucose was elevated 3 and 5 weeks following diabetes induction compared to controls (215±13, 223±12, 76±1.8 mg/dl, respectively; p<0.05). Erectile function was significantly decreased in all diabetic rats compared to controls (6V, ICP/MAP: 3wk 0.55±0.093; 5wk 0.51±0.088; Con 0.84±0.027; p<0.05). There was a slight decrease in the gene expression of NT3, NGF, GDNF and BDNF after 3 weeks of diabetes. After 5 weeks of diabetes, NT3, NGF and BDNF was significantly lower than controls (p<0.05). MPG neurite outgrowth was significantly decreased in type 2 diabetic rats after 3 and 5wks compared to controls in sham (3wk: 224±19μm; 5wk: 190±24μm; Con: 315±8μm, p<0.05).  

Conclusions: Neurotrophic factors are significantly decreased in MPGs from early type 2 diabetic rats and may contribute to decreased neuronal outgrowth. These deficits in neurotrophic factors may help explain why diabetic men have less erectile function recovery following RP and increasing neurotrophic growth factors may have therapeutic benefit in the treatment of diabetic peripheral neuropathy.

Disclosures:

Work supported by industry: no.

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Lower gap between ideal and actual partners (GIAP) in relationship and sexual hierarchy predicts relationship satisfaction in heterosexuals, but in homosexals only sexual GIAP matters (#175)

J. Varella Valentova (Czech Republic)
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175

Lower gap between ideal and actual partners (GIAP) in relationship and sexual hierarchy predicts relationship satisfaction in heterosexuals, but in homosexals only sexual GIAP matters

Varella Valentova, J1; Varella, M2

1: Charles University in Prague, Czech Republic; 2: University of Brasilia, Brazil

Objectives: Sexual and romantic relationships are usually initiated through mutual attraction, which is, at least to some point, set by individual partner preferences. Nevertheless, ideal partner preferences and actual mate choices can differ to some degree. In general, it is expected that higher Gap between Ideal and Actual Partner (GIAP) can negatively influence relationship satisfaction, regardless of gender and sexual orientation. We tested whether the level of dominance in actual relationship and sexual activity, and also whether the GIAP in dominance influences the current relationship quality.

Material and Methods: Coupled Czech and Brazilian 514 women (459 heterosexual), and 297 men (168 heterosexual) between 18 and 40 years filled in online questionnaires, where they reported their age, length of the current relationship, sexual orientation, Dyadic Adjustment Scale (DAS), their ideal preferences for dominance in relationship and sex, and their actual dominance in relationship and in sex with the current partner. We computed absolute differences between preferred and actual dominance and regressed them on DAS.

Results: In heterosexual men, lower GIAP in relationship and sex and also lower actual dominance predicted increased relationship satisfaction. In heterosexual women, controlled for age, lower GIAP in both relationship and sex, and also lower relationship duration predicted increased DAS. In both homosexual men and women, only lower GIAP in sexual dominance predicted increased DAS.

Conclusions: As predicted, smaller GIAP in relationship and sexual dominance increased perceived overall relationship quality in heterosexual men and women. However, in homosexuals only GIAP in sexual dominance did so, which suggests that how they resolve the same-sex intercourse is more decisive for them than relationship hierarchy. Thus, sexual orientation matters when it comes to sexual dominance and relationship satisfaction. Furthermore, more submissive heterosexual men but heterosexual women in shorter relationships reported greater relationship satisfaction. These results held across the ethnically distinct populations, which adds support to a more universal pattern in romantic relationship dynamics.

Disclosures:

Work supported by industry: no.

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Spider venom toxin Tx2-6 from Phoneutria nigriventer induces priapism even after cavernousal denervation in mice (#176)

L. Troncone (Brazil)
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176

Spider venom toxin Tx2-6 from Phoneutria nigriventer induces priapism even after cavernousal denervation in mice

Ravelli, K1; Ramos, A1; Gonçalves, L1; Magnoli, F1; Troncone, L1

1: Instituto Butantan, Brazil

The Phoneutria nigriventer spider toxin Tx2-6 causes priapism in humans and mice. NO-Synthase inhibitors abolish toxin-induced priapism as well as all the other symptoms of intoxication.

Objectives: to investigate if cavernousal denervation abolishes the toxin-induced priapism, the role of NO signaling in this process using the NO-sensitive fluorescent dye DAF-FM, and nitrite assay method of Griess;

Methods: mice penis samples were incubated in the presence of the NO-sensitive fluorophore DAF-FM and observed with a confocal fluorescence microscope before and after the addition of Tx2-6 toxin as well as L-NAME and Sodium Nitropruside (SNP) controls; total nitrites were assayed by the Griess method in control and toxin-exposed penile sections and controls; cavernosal nerve excision/denervation performed in mice was confirmed by histological assessment of fibrosis (Mason’s trichromic staining) immunohistochemical staining for synaptophysin, and failure in fertilizing female mice; toluidine blue staining was also performed;

Results: normal tissues controls treated with L-NAME, SNP and saline showed a steady increase in fluorescence and tissue incubated with toxin showed the same trend as well; production of nitrites assayed by the Griess method also failed to detect toxin-induced increases while NPS caused a dose-dependent increase and L-NAME a small decrease. Denervated mice showed intense fibrosis of the cavernousal tissue as well as absence of synaptophysin IHC staining; surprisingly mice showed toxin-induced priapism when tested 30 or 60 days after denervation; while sham-operated mice presented full priapism denervated animals showed partial priapism possibly due to the fibrosis.

Discussion: confocal DAF-FM imaging showed remarkable NO-related staining of mastocytes (confirmed by toluidine blue staining) but failed to show NO-related fluorescence in cavernousal tissue (possibly given to the high auto-fluorescence of this tissue) but the absence of nitrite accumulation after toxin cast doubts on the involvement of NO signaling; most importantly, these results reveal that erection caused by Tx2-6 toxin might not be depend on penile nerves integrity and opens a new perspective for the treatment of erectile dysfunction.

Disclosures:

Work supported by industry: no.

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Open comparative cross-sectional study of frequency and structure of sexual dysfunction in patients of the gynecological clinic and women with infertility (#177)

N. Stenyaeva (Russia)
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177

Open comparative cross-sectional study of frequency and structure of sexual dysfunction in patients of the gynecological clinic and women with infertility

Stenyaeva, N1; Chausov, A1; 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 assess the features of sexual function in fertile women routinely visiting gynecological clinic, and women suffering from infertility.

Material and Method: In this open-label, cross-sectional study in 2 cohorts we compared the features of sexual function in patients in the gynecological clinic and women with infertility. The inclusion criteria were the reproductive age and the presence of sexual partner. The group 1 included 829 fertile women at the age of 31.42 ± 6.37. The group 2 included 157 patients with infertility at the age of 33.38 ± 4.96 years. They were assessed with the Female Sexual Functioning Index (Russian version) (FSFI). P values of less than 0.05 were significantly considered. Additionally, women answered the questions: Do you think that you have a sexual problem? Are you ready to consult a doctor to solve sexual problems?

Results: There was no significant difference between two groups in desire, lubrication, pain and the sum domains scores of the FSFI. We found significant difference between the two groups of FSFI arousal component score (4,34+1,19 vs 4,71+0,85), orgasm (4,38+1,31 vs 4,80+1,49), and satisfaction (4,48+1,73 vs 4,72+1,30). 17.78% in the group 1 vs. 11.46% in the group 2 believed that they had sexual dysfunction, 26.78% in the group 1 vs. 22.93% in the group 2 were not sure with their answers. 25.75% vs. 12.10% were ready to consult a sexologist, 26.54% vs. 22.93% doubted with their answers.

Conclusion: It is known that the notion of normal sexual function varies widely. Personal satisfaction of sexual needs and sexual function are not always comparable with the results of its assessment with the questionnaires. The infertility in marriage creates a long stressful situation for the spouses, causes severe mental trauma resulting in personal, family, social maladjustment and promotes the formation of borderline mental disorders and sexual dysfunction. However, our study showed that women, who are actively struggling with infertility, are better adapted to the sexual life in comparison with another patients of gynecological clinic. The study allowed to reveal latent sexual dysfunction, which manifests with disturbances of sexual function components, but a woman does not fully realize the problem and is not ready to actively attempt to solve it. Interestingly, infertile women showed normal sexual function which seems a compensatory answer to reproductive disorders.

Disclosures:

Work supported by industry: no.

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Effect of soluble guanylate cyclase modulators, BAY 60-2770 and BAY 41-2272 in isolated corpus cavernosum from normotensive and spontaneously hypertensive rats (#178)

C. Estancial (Brazil)
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178

Effect of soluble guanylate cyclase modulators, BAY 60-2770 and BAY 41-2272 in isolated corpus cavernosum from normotensive and spontaneously hypertensive rats

Estancial, C1; Antunes, E1; Rodrigues, R1; Barbosa, A1; Mónica, F1

1: UNICAMP, Brazil

Objective: This study is aimed to verify the effect of soluble guanylate cyclase (sGC) modulators, BAY 60-2770 (activator) and BAY 41-2272 (stimulator) in isolated corpus cavernosum (CC) from normotensive (WKY) and spontaneously hypertensive rats (SHR).

Material and Methods: Concentration-response curves to BAY 60-2770 (0.01-10 µM) and BAY 41-2272 (0.01-10 µM) were carried out in the absence and in the presence of sGC inhibitor (ODQ, 10 µM) in tissues pre-contracted with phenylephrine (PE, 10 µM). Potency (pEC50) and maximal response (Emax) values were calculated. In vivo assay was realized by determining basal and stimulated intracavernous pressure (ICP) before and after intracavernosal injection of BAY 60-2770 (350 ng/Kg) or BAY 41-2272 (350 ng/Kg). Protein expression for α1 (Anti-sGC  α1 –subunit, 1:500 and beta-1 Anti-sGC β1-subunit, 1:1000) subunits were also assessed. The experimental protocols were approved by the Animal Ethical Committee of UNICAMP (2721-1).

Results: BAY 60-2770 and BAY 41-2272 produced concentration-dependent relaxation in isolated CC from WKY (pEC50: 7.01± 0.45 and 6.05 ± 0.10; Emax: 99± 13 and 76 ± 4 %, n=5-7, respectively) and SHR (pEC50: 6.99 ± 0.15 and 6.11 ± 0.16; Emax: 95 ± 5 and 87 ± 6 %, n=5- 7, respectively). Whereas the addition of ODQ produced a 7-fold rightward shift (P<0.05) in BAY 41-227-induced relaxation, the pEC50 values of BAY 60-2770 was shift by 5-fold to the left. Protein levels for α1 and β1 subunits of sGC did not differ between WKY and SHR. BAY 60-2770 augmented ICP by  25,9 % at 16 Hz only in CC from WKY. BAY 41-2272 did not alter ICP in CC from WKY or SHR.

Conclusion: BAY 41-2272 and BAY 60-2770 relaxed corpus cavernosum from hypertensive rats and may constitute a therapeutic option for the treatment of erectile dysfunction. Soluble guanylate cyclase modulators have been proposed as pharmacological tools to differentiate the oxidative state of sGC. In the present study we may speculate that sGC is not oxidized in CC from SHR, as the relaxing response induced by BAY 41-2272 or BAY 60-2770 in CC from SHR did not differ from that of WKY.

Disclosures:

Work supported by industry: no.

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10:30 - 11:30
Podium 9 - ED epidemiology

Location: Transamérica Auditorium
Chairs: Eduardo Bertero (Brazil) & Luiz Otavio Torres (Brazil)

256-slice spiral CT angiography in arterial erectile dysfunction: A penile hemodynamic study (#049)

M. Shen (China)
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049

256-slice spiral CT angiography in arterial erectile dysfunction: A penile hemodynamic study

Shen, M1; Sun, Y2; Pu, J2; Qin, Y1; Jiang, Z3; Yu, J1; Wang, X1

1: Department of Andrology,Second Affiliated Hospital of Kunming Medical University, Kunming 650101, Yunnan Province, China; 2: Department of Radiology,Second Affiliated Hospital of Kunming Medical University, Kunming 650101, Yunnan Province, China; 3: Department of Andrology, Second Affiliated Hospital of Kunming Medical University, Kunming 650101, Yunnan Province, China;

Objective: To investigate the diagnostic significance of 256-slice spiral CT angiography in arterial erectile dysfunction.

Methods: Thirty-two adult male patients suspected with arterial erectile dysfunction (study group) and twenty adult male subjects with normal erectile function (control group) underwent 256-slice spiral CT angiography of the lower abdomen. Three-dimensional images of the penile vessels were reconstructed from 256-slice spiral CT angiography data. Perfusion parameters of the arteries in bilateral cavernous bodies of the penis, including time-to-peak (TTP; the time from the start of injection until maximum contrast enhancement is reached), blood flow (BF; measured blood flow per 100 grams of penile cavernous tissue per minute), and blood volume (BV; measured volume of blood per 100 grams of penile cavernous tissue) were recorded and statistically analyzed.

Results: There were no significant differences in TTP, BF and BV between bilateral cavernous body arteries of the penis in the control group (P > 0.05). The continuity of bilateral cavernous body arteries was traceable on 256-slice CT angiography images. The continuity of bilateral cavernous body arteries was also observed on the reconstructed three-dimensional images of the penile vessels. Unilateral cavernous body artery stenosis was observed on CT images of 26 cases from the study group (among them left side were 16 cases and right side were 10 cases). Discontinuous or incomplete unilateral cavernous body artery was observed on the reconstructed three-dimensional images of the penile vessels of these 26 cases. There were significant differences in TTP, BF and BV between bilateral cavernous body arteries in these 26 cases (P < 0.01). TTP, BF and BV were also significantly different between stenotic cavernous body arteries of the study group and the control group (P < 0.01). Other there were 6 cases bilateral cavernous body artery stenosis was observed in the study group. Noncontinuity or incompleteness of bilateral cavernous body arteries was also traceable on reconstructed three-dimensional images of the penile vessels of these 6 cases.

Conclusion: The use of 256-slice spiral CT perfusion imaging technique three-dimensional image reconstruction and analysis of the relevant parameters of the blood vessels of the penis is a new `diagnosis method for arterial erectile dysfunction.

Disclosures:

This work is supported by the National Natural Science Foundation of China, No. 81160080 (industry funding only - investigator initiated and executed study).

Association of catechu nut chewing with risk of erectile dysfunction (#050)

Bang-Ping Jiann (Taiwan)
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050

Association of catechu nut chewing with risk of erectile dysfunction

Jiann, B1

1: Kaohsiung Veterans General Hospital, Taiwan

Objectives: Catechu nut chewing is a common habit in Taiwan and is reported to increase the risk for oral malignancy and diabetes and metabolic syndrome. Our study was the first study to investigate the association between catechu nut chewing and the risk of erectile dysfunction (ED).

Methods and Materials: Male subjects with age between 40 to 70 years were screened for the habit of catechu nut chewing when they visited the Provincial Public Health Centers for a routine physical checkup from 2010 to 2011 in Taiwan. Erectile function was assessed by the Sexual Health Inventory for Men (SHIM).

Results: A total of 1581 subjects completed the study with data eligible for analysis. Among the 1581 subjects, 712 (45.0%) reported a history of catechu nut chewing and 869 (55.0%) subjects did not who served as the control group. Subjects who reported a history of catechu nut chewing were younger in age, had a higher body mass index, were associated with a higher frequency of smoking and drinking, and had a higher prevalence of DM and hypertension (p < 0.05). ED was reported in 62.4% (444/712) of subjects with a history of catechu nut chewing, significantly higher than that in 51.4% (447/869) of controls (p <0.001). Subjects who had chewed catechu nut for > 3 yrs reported a higher prevalence of ED (65.8% [373/567]) than those for ≤ 3 yrs (51.5% [34/66]) (p = 0.022). In the receiver operating characteristic (ROC) curve, the risk of ED significantly increased when cumulative exposure of catechu nut chewing reached 27.5 (p = 0.001) Subjects with a history of catechu nut chewing had an increased risk for ED (OR = 1.72; 95% CI: 1.36–2.18), diabetes mellitus (OR = 1.60; 95% CI: 1.10–2.33), hypertension (OR = 1.46; 95% CI: 1.12–1.89) and obesity (OR = 1.31; 95% CI: 1.00–1.71), after adjustment for age, smoking and drinking habit (p <0.05).

Conclusion: Our results showed that catechu nut chewing is an independent risk factor for ED, diabetes mellitus, hypertension and obesity with a dose-dependent effect.

Disclosures:

Work supported by industry: no.

Subsequent cardiovascular diseases and mortality in men presenting with erectile dysfunction (#051)

Bang-Ping Jiann (Taiwan)
show abstract

051

Subsequent cardiovascular diseases and mortality in men presenting with erectile dysfunction

Jiann, B1

1: Kaohsiung Veterans General Hospital, Taiwan

 

Objectives: Erectile dysfunction (ED) is seen as a precursor of cardiovascular diseases (CVD). The aim of this study was to investigate the incidence of CVD in men presenting with ED and their cause of mortality.

Methods and Materials: Consecutive patients who presented with ED and did not have CVD from 1999 to 2011 were enrolled into the study. A telephone structured interview by a trained nurse was conducted to collect the information. Besides, chart review was done for all participants. The Institutional Review Board at our institution reviewed and approved the study protocol.

Results: From 1999 to 2011, a total of 4713 patients presented with ED at our institution. Of 4713 patients, 7.4% (347) had CVD with a mean age of 66.1 yrs and 92.6% (4366) did not have CVD with a mean age of 58.4 ± 14.1 years. Response rate of telephone interview was 43.0% (1475/3427). After excluding subjects with an age <40 years (N = 484) and who did not have any follow-up visit or could not reach by interview (N = 409), a total of 3473 subjects’ data eligible for analysis who had a mean age of 62.2 ± 11.2 years (40-91) and a mean follow-up of 82.5 ± 51.8 months (1-173). Of 3473 subjects, 9.1% (316) developed with subsequent CVD with an incidence of 3.3%, 7.3%, 10.3% and 12.4% for the age group of 40-49, 50-59, 60-69, and ≧70 age group, respectively. The ED-CAD temporal relationship was 58.7 ± 36.4 months (1-170). Independent risk factors for CAD in ED patients include age, diabetes, hypertension and dyslipidemia. Of the 3801 subjects, 7.7% (293) expired and the major causes of mortality in ED patients were malignancy (2.7%), infection (1.5%) and CVD (1.0%).

Conclusion: Of the cohort, the incidence of subsequent CVD in men with ED was 9.1% with an interval of 58.7 months. The independent risk factors for developing CVD in men with ED include an older age, DM, hypertension and dyslipidemia. Malignancy, infection and CVD constitute the main cause of mortality in men with ED.

Disclosures:

Work supported by industry: no.

Sexual dysfunction in cirrhotic male and female patients (#052)

J. Herrera-Caceres (Mexico)
show abstract

052

Sexual dysfunction in cirrhotic male and female patients

Herrera-Caceres, J1; Nava-Sanchez, J1; Flores-Rodríguez, J1; Magaña-Rodríguez, J1; Villeda-Sandoval, C1; Torre-Delgadillo, A1; Castillejos-Molina, R1

1: INCMNSZ, Mexico

Objectives: The aim of the study is to analyze de the prevalence of sexual dysfunction in men and women with different stages of liver cirrhosis as well as the related risk factors for such condition in this population

Material & Methods: We did a prospective evaluation including patients from the "Liver and Urology Clinic" from our institution. Evaluation included demographics, a sexual function assessment (IIEF and IFSF) and a depression questionnaire (Beck Questionnaire). We analyzed prevalence and associated risk factors.

Results: We included 145 patients (65% female), mean age was 50 (range 20-80) years old. Mean IIEF score was 42.46 (22% no-ED, 18% mild-ED, 16% mild-moderate ED, 14% moderate ED, 30% severe ED), IFSF 29.71 (55.9% score less than 26.55, with sexual dysfunction), 75% were married or in a stable relationship and 43.4% had a negative Beck score for depression. Male patients without a stable partner had lower scores in IIEF (p=0.029), in female it was the other way around (p=0.017). Presence of depression showed no statistical difference. Child-Pugh scores (ChP), either ChP A or B as cut-offs were not statistically different. On the other hand, patients with a MELD score of less than15 had higher IIEF scores (56.5 vs 29.6, p=0.004). Neither viral nor alcoholic etiology had statistical differences. Albumin <3 gm/dl (45.3 vs. 16.5, p=0.002) and creatinine <1.2 were associated with lower IIEF scores (43.8 vs. 23.5, p=0.033). Neither bilirrubin levels, ascites, history of liver encephalopathy, coagulopathy nor thrombocytopenia showed an association that reached statistical significance. Individual domains analyses showed that patients with a ChP <7 (ChP A) had better performance in terms of intercourse satisfaction (p=0.001), orgasm (p=0.05), desire (p=0.03) and erectile function (25.2 vs. 13.1, p=0.002), but not in overall satisfaction (p=0.503). For female patients, the only individual domain with statistical difference was orgasm, favoring patients with a ChP >7 (0.24 vs. 1.6, p=0.012).

Conclusions: Factors associated with lower IIEF score in cirrhotic patients are a non-stable relationship (58 vs. 39.9), MELD >15 (56.5 vs. 29.6), albumin <3 and creatinine >1.2 (43.8 vs. 23.6). Only 22% of patients did not have ED. For female patients, a stable partner was associated with higher IFSF scores (35.2 vs. 20.6). For individual domains, ChP scores had significant repercussion in intercourse satisfaction, orgasm, sexual desire and erectile function, but not in overall satisfaction.

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.

Radiotherapy for stage I-II testicular seminoma: a prospective evaluation of short-term effects on body image and sexual function (#053)

Luca Incrocci (The Netherlands)
show abstract

053

Radiotherapy for stage I-II testicular seminoma: a prospective evaluation of short-term effects on body image and sexual function

Wortel, R1; Ghidey Alemayehu, W1; Incrocci, L1

1: Erasmus MC, The Netherlands

Objective: Orchiectomy followed by infradiaphragmatic radiotherapy is a commonly used treatment for Stage I-II testicular seminoma. Long-term effects on body image and sexual function have been reported, however few  data are available on the short-term effects of orchiectomy and radiotherapy for testicular seminoma. These patients are usually of reproductive age and are frequently sexually active, therefore prospective data on the short-term effects of treatment on body image and sexual function are also needed. The aim was to prospectively evaluate the short-term effects of orchiectomy and radiotherapy on body image and sexual function in testicular seminoma patients.

Materials and Methods: Questionnaires on body image and sexual function were prospectively distributed to all patients treated between 1999-2013. The baseline questionnaire prior to radiotherapy was returned by 161 patients; 133(82%) returned the second after 3 months, 120 (75%) completed the questionnaire after 6 months.

Results: Median age was 36 years (range 18-70), median follow-up was 55 months (range 3-148). After orchiectomy 61% found their body had changed, 48% expressed concerns about fertility. Six months after radiotherapy the quality of erections was significantly decreased compared to prior radiotherapy (p=0.016). At six months, 23% reported a decrease in sexual interest, -activity and pleasure and 45% reported adverse effects on their sexual life. Changes in body image were significantly associated with a decrease in sexual interest, -pleasure and erectile function. The number of sexually active patients remained stable at 91%.

Conclusions: Short-terms effects of treatment included fertility concerns and changes in body image. Also reported erectile rigidity was significantly decreased after six months, as were sexual interest, -activity and –pleasure. Changes in body image were associated with sexual dysfunction and the disease and the treatment had adverse effects on sexual life. Body image and these aspects of sexual functioning should be addressed at an early stage after treatment for testicular seminoma in order to offer adequate treatment and counselling.

Disclosures:

Work supported by the Dutch Society for Sexual Medicine (NVVS) (funding only - investigator initiated and executed study).

What a difference a decade makes: analysis of factors influencing urinary symptoms and erectile function from data collected during prostate cancer awareness weeks in 2003 versus 2011/2012 (#054)

N. Stone (USA)
show abstract

054

What a difference a decade makes: analysis of factors influencing urinary symptoms and erectile function from data collected during prostate cancer awareness weeks in 2003 versus 2011/2012

Poage, W1; Stone, N2; Leapman, M3; Crawford, E1; Tawari, A3

1: Prostate Conditions Education Council / University of Colorado HSC, United States; 2: Prostate Conditions Education Council / Mount Sinai, United States; 3: Mount Sinai, United States

 

Objective:  To investigate changes in clinical and demographic characteristics influencing urinary symptoms and erectile function from a large prostate cancer screening cohort in 2003 vs. 2011/2012.    

Materials and Methods:  We analyzed data obtained from questionnaires completed during the nationwide Prostate Cancer Awareness Week (PCAW) initiative.  We compared baseline serum testosterone, PSA, AUASS, SHIM and significant clinical covariates between the cohort of patients screened in 2003 and those in 2011-2012.  Men with incomplete or missing AUASS or SHIM were excluded.   Analysis of variance (ANOVA) was utilized to investigate differences for continuous variables, and Chi-square analyses were conducted for dichotomous covariates.  Linear and multivariate binary regression models were constructed to assess significant predictors of changes in urinary, sexual function, and serum testosterone levels.

Results: Among 25,390 men screened in 2003 and 2011/2012, 16,808 were included in this analysis.   8,133 men were screened in 2003 (mean age 59.5 versus 61.8 years, p<0.001) compared with 8,675 in 2011/2012; proportion of African-American respondents increased from 14.6% to 17.9% (p<0.001).  Mean PSA increased from 1.72 ng/mL in 2003 to 2.83 ng/mL (p=0.011) in 2011 and 2012, while serum testosterone decreased from 419.4 ng/dL to 359.8 ng/dL (p<0.001). In a linear regression model incorporating age and significant clinical and demographic covariates, increasing BMI (p<0.001), serum HDL, LDL and total cholesterol (p<0.001), dietary fat content (p<0.027), and type II diabetes (p=0.003) independently influenced serum testosterone levels.  The mean AUASS was unchanged between 2003 and 2011/12 (6.87 versus 6.97, p=0.258) while mean SHIM declined in this interval from 18.1 to 16.3 (p<0.001).  In a linear regression model, SHIM was influenced by BMI (p<0.001), frequency of exercise (p=0.039), AUASS (p<0.001), and age (p<0.001). 

Conclusion: Changes in testosterone and erectile function were observed in the 2003 vs. 2011/2012 screening interval that may reflect the contribution of obesity and lifestyle-related factors. 

Disclosures:

Work supported by industry: no.


10:30 - 11:15
Workshop 10 - Medical sexual issues for non-medical therapists

Location: Ilhéus + Una Room
Chair: Hossein Sadeghi-Nejad (USA)

Drug interventions for sexual problems; integrating sex therapy and pharmacotherapy

John Dean (United Kingdom)

Latrogenic sexual dysfunction - what non medical therapist should know

Yacov Reisman (The Netherlands)


11:00 - 11:30
Point counterpoint 5 - Sex rehab after RP: Is it really justified?

Location: Comandatuba Room 2+3
Chairs: Anthony Bella (Canada) & Raanan Tal (Israel)

Pro

John Mulhall (USA)

Con

Landon Trost (USA)


11:30 - 12:30
Podium 10 - ED medical therapy

Location: Comandatuba Room 2+3
Chairs: Guillermo Gueglio (Argentina) & Ricardo Munarriz (USA)

Empirical vs risk-based approach to intracavernosal injection therapy: A prospective study (#055)

Trinity Bivalacqua (USA)
show abstract

055

Empirical vs risk-based approach to intracavernosal injection therapy: A prospective study

Segal, R1; Le, B2; Burns, K2; Burnett, A2; Bivalacqua, T2

1: Chesapeake Urology, U.S.A.; 2: Johns Hopkins Hospital Brady Urological Institute, U.S.A.

Objectives: Intracavernosal injection (ICI) therapy is widely used for ED. Employing it in practice is largely empirical and has not been validated with evidence-based approaches.  This study compares two strategies for ICI to determine whether a risk-based approach is more efficacious, increases satisfaction and/or results in fewer treatment complications.
Methods: After obtaining IRB approval, a prospective database of patients enrolled in the ICI program at the Johns Hopkins Hospital from May 2012-present was amassed. Demographic information, treatment outcomes and subjective patient evaluations of sexual function (IIEF, QEQ, SQoL and EDITS questionnaires) were obtained at baseline, 3 and 6 months. Two approaches were compared. Group 1 consisted of empiric ICI treatment.  Patients were treated with Prostaglandin E1 10mcg, irrespective of ED etiology or severity, and only if poor response noted at test injection, then initiated on bimix or trimix. Group 2 was a risk-based approach, where using an algorithm that factored in: organic vs. neurogenic ED, number of ED risk factors, prostatectomy, nerve-sparing status, time from surgery and radiation status, patients were treated with either bimix, low- or high-dose trimix.  Dose titration was permitted in both groups.  Statistical analysis was carried out using t-test and chi-squared analysis.

Results: 175 patients were enrolled (57 in Group 1, 118 in Group 2) with 3 and 6 month f/u at 57% and 35% respectively, and similar between groups.  Baseline patient characteristics and sexual function questionnaire responses were similar between groups 1 and 2, (mean age 61.9 vs. 61.3 p=0.66, IIEF-EF 8.1 vs. 6.9 p=0.28, and SQoL 37.7 vs. 39.2 p=0.71), though Group 1 reported higher quality erections at baseline (QEQ 14.3 vs. 7.3 p=0.05) and had a lower proportion of post-prostatectomy patients 54.4% vs. 74.6% (p=0.02).  In both groups, quality of erections (QEQ) improved with treatment (mean 10.78 vs. 56.76, p<0.05), SQoL improved (38.41 vs. 50.25, p<0.05), and IIEF-EF improved (7.51 vs. 18.48, p<0.05).  However, between groups at 3 and 6 months, there were no statistically significant differences in responses for IIEF, QEQ, SQoL or EDITS, and no difference in failure or medication switch rates. There were no significant differences in complication rates, though at 3 months group 2 reported a higher incidence of priapism and pain (23% vs. 7.4% p=0.08).

Conclusions: Both approaches resulted in significant improvements across multiple domains of sexual function. Complications rates, satisfaction and efficacy overall were similar between both approaches.

Disclosures:

Work supported by industry: no.

Initial clinical experience of linear focused, low intensity shockwave for treatment of ED patients with different severity symptoms (#056)

Natalio Cruz Navarro (Spain)
show abstract

056

Initial clinical experience of linear focused, low intensity shockwave for treatment of ED patients with different severity symptoms

Cruz, N1; Martin Morales, A2

1: Andromedi Sevilla, Spain; 2: IUAMS Malaga, Spain

Objective: The aim of this clinical experience was to assess the feasibility of   the application of Linear-Focused Low Intensity Shockwaves (Renova Direx Group) as an alternative or complementary treatment for Vascular ED patients with different degrees of symptom severity.

Material and methods: The treatment was offered in a routine natural way in 2 medical centers: 46 patients in Malaga (Serie A), and 35 in Seville (Serie B). The treatment is composed of 4 weekly sessions (20 minutes each), in which shockwaves were applied, into 4 areas; right and left crura, and right and left corpus cavernosum, with 900 shockwaves in each site (Total 14400). No need for anesthesia, sedation or painkillers. The evaluation was done using the IIEF-EF, SEP and GAQ at baseline visit and 1and 3 months post treatment.

Results: Average IIEF-EF increased significantly from 19.94 and 14,03 at baseline to 23.92 and 18.53 at 3 months post treatment. A number of patients stopped using PDE-i: 30,77 % and 23,53 % respectively. SEP 2 increased from 88,89 % and 43,48% to 100% and 66,67%. SEP 3 increased from 38,89 % and 27,59 % to 78,75% and 57,89%. Use of PDE5-I for sexual intercourses was reduced from 77,78 % and 85,19 %  to 53,85 and 35,29 % at 3 months post treatment. No side effects were recorded.

Conclusions: The results of both series at 3 months show a consistent and global improvement in IIEF-EF, SEP 2 and SEP 3 parameters. The outcome of the treatment is related to the baseline symptoms severity, meaning that in average, patients with more severe ED symptoms will improve, but will not reach the final level of improvement that can be obtained by mild to moderate patients .In our experience the Linear-Focused Low Intensity Shockwave treatment is a valid alternative or complement to current available treatments.

Disclosures:

Work supported by industry: no.

Safety and efficient duration of linear focused shockwave treatment for erectile dysfunction – A 12 months follow-up pilot study (#057)

Yacov Reisman (The Netherlands)
show abstract

057

Safety and efficient duration of linear focused shockwave treatment for erectile dysfunction – A 12 months follow-up pilot study

Reisman, Y1

1: Dutch Center Sexual Medicine, Netherlands

Objective: The aim of this pilot study was to assess the safety, effectiveness and sustainable results of the Linear Focused Shockwave system Renova, for the treatment of Vascular Erectile Dysfunction patients.

Material and methods: Renova is a system that uses a Linear Low Intensity Shockwave technology. We have treated 20 patients with Vasculogenic ED; with an averaged International Index of Erectile Function (IIEF-EF) score of 12.35±3.16 (Range 7-18). The protocol consisted of 4 weekly sessions, in which a total of 3600 shockwaves were applied, divided into 4 areas; right and left crura, and right and left corpus cavernosum, 900 shockwaves in each site. The following questionnaires were used: IIEF-EF, Sexual Encounter Profile (SEP) and Global Assessment Question (GAQ), at baseline visit and 1, 3, 6 and 12 months post treatment. Success was defined as an increase in score from baseline to the 6 months post treatment follow-up, according to Minimal Clinical Improvement Criteria (Rosen et al.).

Results: At the 6 months follow-up, 18 patients out of 20 showed success (90%). Out of these 90%, 83.3% (15 patients) sustained the positive outcome for a period longer than 12 months after the end of treatment. The average IIEF-EF increased significantly from 12.35±3.16 at baseline to 20.65±2.64 at 6 months post treatment, and was 18.65±2.56 at the 12 month follow-up. Four patients (20%) who were non-responsive to Phosphodiesterase type 5 Inhibitors (PDE5i) at baseline became responsive after the treatment, and 2 patients (10%) successfully stopped using PDE5i. Majority of patients completed the last follow-up with an average of 14.5±1.08 months duration from the end of treatment. Among the successful patients, the average IIEF-EF score increase was 8.3 points. No side effects were reported.

Conclusions: With a success rate of 90% after 6 months, and an 83.3% sustainable positive effect after 1 year, the results of this pilot study suggest that this treatment is probably effective for at least 1 year. No anaesthesia or analgesia was needed, and no adverse effects were recorded, making it a potential good alternative for current available treatments.

Disclosures:

Work supported by industry: yes, by Direx (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.

The role of early patient tailored penile rehabilitation in patients post radical prostatectomy (#058)

A. Bazo (United Kingdom)
show abstract

058

The role of early patient tailored penile rehabilitation in patients post radical prostatectomy

Goodall, P1; Campain, N1; Bazo, A1

1: Nottingham City Hospital, United Kingdom

Objectives: Erectile dysfunction (ED) post-radical prostatectomy (RP) is a well-acknowledged complication, which varies widely from 20-90% according to the literature. This is despite advances with nerve sparing and robotic techniques. With the detection of prostate cancer in younger men, there is a greater emphasis on appropriate management of ED post RP. It is well documented that early intervention of ED with appropriate management results in a better functional outcome. Despite this there are no national guidelines regarding penile rehabilitation following RP. We retrospectively reviewed patients who had undergone a RP and had been followed-up for a period 2 years with penile rehabilitation to assess their erectile function (EF).

Materials and Methods: 117 patients were retrospectively identified as having undergone a radical RP irrespective of nerve sparing status and open or laparoscopic surgery. All patients were followed-up for at least 2 years in the erectile dysfunction clinic and initially counselled prior or shortly after their surgery. Patients were initially offered vacuum erection device therapy (VED) and trialled on a phosphodiesterase type-5-inhibitor (PDE5-I) if appropriate and followed-up on a 4 monthly basis with management altered accordingly to EF. Patient satisfaction with EF was noted at the time of discharge from clinic.

Results: All patients were started on VED therapy and 107 patients (91.5%) commenced a PDE5-I. Over 2 years 40 patients (34.2%) had stopped using the VED, 65 patients (60.7%) were changed to a different PDE5-I or dose. 60 patients (51.3%) were commenced on penile injection therapy and 4 patients (3.4%) on medicated urethral system for erection (MUSE) therapy. 2 patients (1.7%) underwent penile implant surgery. 23 patients (19.7%) were getting erections without any treatment compared with 73 patients (62.4%) able to get an erection with treatment.

Conclusion: Patients who underwent a period of early patient tailored penile rehabilitation post RP and adhered to treatment for a sustained period had significantly improved EF.

Disclosures:

Work supported by industry: no.

Frequency of intracavernosal injections (ICI) improves erectile function recovery (EFR) following radical prostatectomy (RP) (#059)

Chris Nelson (USA)
show abstract

059

Frequency of intracavernosal injections (ICI) improves erectile function recovery (EFR) following radical prostatectomy (RP)

Nelson, C1; Pessin, H1; Mulhall, J1

1: Memorial Sloan Kettering Cancer Center, United States

Objective(s): Penile rehabilitation (PR) is frequently used following RP and intracavernosal injections (ICI) play an important role at many centers. While there is data suggesting participation in a PR program improves long term EFR post-RP, there is little research investigating if frequency of ICI is associated with EFR.

Material and Method(s): Patients included in this analysis started PR using ICI ≤6 months (m) post-RP, had ICI frequency recorded and had erectile function (EF) data available for 12-30m post-RP. ICI frequency was assessed by patient self-report. Nerve sparing was surgeon graded for each nerve on a validated 1-4 point scale: 1-complete preservation, 2-near complete preservation, 3-partial resection, 4-complete resection (score 2-8). Pre-RP EF was graded on a validated 5-point patient-reported scale: 1 (fully rigid) to 5 (no tumescence).  EF post-RP was graded on a percentage patient-reported scale (100% = fully rigid, 60%= adequate for penetration, 0%= no rigidity).  Post-RP response to ICI, PDE5i, and spontaneous erectile rigidity (SER) was assessed. Very poor ICI responders (rigidity ≤ 40%) and excellent PDE5i responders (rigidity ≥ 80%) were excluded.

Result(s): 99 men with a mean age of 59±7 years met eligibility. The mean number of ICI/week was 1.6±0.8. On average, men started ICI 4±2m post-RP. Men reported good EF pre-RP (mean=1.6±1). Mean follow-up time post-RP EF was 22±5m. At follow-up, mean PDE5i EF was 50±26% and mean SER was 31±24%. On univariate analysis, PDE5i EF was related to age (r=-0.33, p=0.001) and ICI/week (r=0.39, p=0.001). SER was related to age (r=-0.24, p=0.02), NSS (r=-0.28, p=0.01) and ICI injections/week (r=0.24, p=0.02).  On multivariable analysis, ICI/week was a strong predictor of PDE5i EF (beta=0.48, p=0.001).  For an increase of 1 injection/week, PDE5i EF increased by 16 percentage points. ICI/week was also a strong predictor of SER (beta=0.31, p=0.01).  For an increase in 1 injection/week, SER increased by 11 percentage points.

Conclusion(s): In those patients pursuing PR, frequency of ICI was a significant predictor of EF recovery. Men in a PR program should be encouraged to inject as frequently as possible.

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.

Adipose derived stem cell therapy for treatment of refractary ED (#060)

A. Skupin (USA)
show abstract

060

Adipose derived stem cell therapy for treatment of refractary ED

Skupin, A1; Herandez-Serrano, R2; Alvarez, N1; Zevallos, B1

1: 3Med Health Institute; 2: WAS, FLASSES, AISM, UCV, WPA

Backround: ED is a sexual pathology caused by numerous comorbidities. In Latin America according to DENSA study, 54 % of the patients in Colombia, Ecuador and Venezuela, were diagnosed with this pathology. The USA National Institute of Health reports that 30 million men experience chronic ED and the incidence of the disorder increased with age. Transient ED and inadequate erection affect as many as 50 % of men between ages of 40-70. Several studies done in rats have shown the effectiveness of mesenchymal stem cells in the treatment of ED. In this study we are working with adipose derived stem cells (ADSc) which are multipotent and exhibit capabilities of differentiation and regeneration of myogenic, neurogenic and vascular cells as well as repair mechanisims that increase the synthesis of NO in the penis.

Methods: A retrospective survey of 82 patients that were treated with ADSc for ED between 2012 and 2014 was done. All of the patients had comorbidities including diabetes, hypertension, coronary artery disease, obesity and consumption of alcohol and tobacco. The StemProCell Protocol was used to harvest, isolate and re-inject the stromal vascular fraction (SVF) into the corpus cavernosum of the men treated. Platelet rich plasma was also isolated and injected with the SVF.

Results: Of the 82 patients that were treated in the clinic, we followed up with 30 patients, of which 42% showed improvement of sexual function of more than 51% after the treatment with ADSc. Of the patients that reported improvement, 60% had hypertension, 36% had DM Type II, 20% were smokers, 53% consumed alcohol and 6% had coronary artery disease.

Conclusions: ADSc is an innovative and new alternative to treat patients with ED, even those with comorbidities. The stem cells can regenerate tissue that has been injured due to vascular disease or compromised by surgical procedures in the penis. There is a surge to create a multicenter prospective study of new cases with an established protocol and classification system that will allow standard research criteria and valid and reliable results.

Disclosures:

Work supported by industry: no.


11:30 - 12:30
Moderated posters 8 - Androgens

Location: São Paulo Room
Chairs: Jacques Buvat (France) & Abraham Morgentaler (USA)

Testosterone replacement therapy in hypogonadal men for improvement of sexual function (#179)

K. Drasa (Albania)
show abstract

179

Testosterone replacement therapy in hypogonadal men for improvement of sexual function

Drasa, K1; Dani, E1; Rusi, R2

1: Central Polyclinic, Albania; 2: Privat Clinic, Albania

Objectives: Testosterone (T) is the most important endogenous sex hormone in the male.Clinical  T deficiency or male hypogonadism can be seen  from puberty until old age. Our study was undertaken to gain insights into improvement in sexual function(SF) and mood in hypogonadal(HG) on T replacement therapy (TRT),based on whether they reached the prespecified threshold of serum T - 300ng/dl.

Materials and Methods: In this DBP controlled 30 weeks(wks) study, enrolled 56 men, aged 38-70Y(mean 52.6+-9.9Y),with T deficiencies (T<300ng/dl).They were screened for morning T .Due to the DB nature of the study the interval injection was 12 wks ,was used according to SPC of the drug and this product through levels of T by 30 wks. Depot T  undecaonate (TU) as NEBIDO  or matching placebo was administered at wk 0,6,8and30.SF and mood changes were assessed by the Psychosexual Daily Questionnaire(PDQ),IIEF-EF,PSA. Analysis of covariance (ANCOVA)with adjustments for baseline PDQ score, age and body mass index (BMI),was used to evaluate change in PDQ scores from baseline as wk 6,18 and 30.

Results: T level improved markedly in the 12 month. TU significantly made numerical improvement  in all PDQ scores(sexual desires ,sexual activity ,percent full erection, erection maintained and positive and negative mood).There was also significant improvement in BMI(0.7kg/m2)and all domains in the IIEF, specially the EF domain of 7.75 point by the end of the 52wk. There was a 25-30%increase in PSA by 30 wks but no rise thereafter. There was only one case of prostate cancer in the placebo cohort.

Conclusion: These data show that symptoms in HG men receiving TRT improved by day15 and continued until day120,even in men with T<300ng/dl, after treatment. Men in TU group achieved maximal effect by 12wk,especially improvement in erectile function, which continued to improved at wk 30 and associated with favorable changes in body( and presumably penile)composition.

Disclosures:

Work supported by industry: no.

Association of vitamin D status, diabetes type 2 and hypogonadism in men with erectile dysfunction: A cross-sectional study (#180)

C. Alvarenga (Brazil)
show abstract

180

Association of vitamin D status, diabetes type 2 and hypogonadism in men with erectile dysfunction: A cross-sectional study

Alvarenga, C1; Guglielmetti , G1; Cezarino , B1; Regina dos Santos, A1; Cury , J 1; Srougi, M 1

1: HCFMUSP, Brazil

Objective: Increasing numbers of men are being diagnosed with low levels of testosterone, associated with erectile dysfunction, loss of sexual desire and decrease of morning erections. The Interrelationships between hormones of the hypothalamic-pituitary-testicular (HPT) axis, hypogonadism, vitamin D, erectile dysfunction and low libido remain unclear. We investigated in this study whether HPT axis hormones, diabetes type 2 and hypogonadism are associated with serum levels of 25-hydroxyvitamin D (25(OH)D) in men with erectile dysfunction.

Design and Methods: A total of 352 men aged 38-84 years are followed at the urological division of the Hospital das Clínicas da USP, from 2012 to 2013, complaining of erectile dysfunction and/ or low libido. Of these 352 men, 52 men presented with hypogonadism (Testosterone (T) levels <300 nmol/l). Testosterone (T), estradiol (E(2), LH, FSH, sex hormone binding globulin (SHBG), 25(OH)D were measured. Free T was calculated from total T, SHBG and albumin. Gonadal status was categorised as eugonadal (normal T/LH), secondary (low T, low/normal LH), primary (low T, elevated LH) and compensated (normal T, elevated LH) hypogonadism. Associations of HPT axis hormones with 25(OH)D were examined using linear regression and hypogonadism with vitamin D using multinomial logistic regression.

Results: The prevalence of hypogonadism among all study participants was 14.7%. Among the diabetic and non-diabetic men the prevalence was 28.3% and 9.4%, respectively (P<0.005) and symptomatic androgen deficiency was associated with diabetes and age (P<0.005). The general prevalence of 25(OH)D deficiency among men with erectile disfunction was 15,6% and among men with hypogonadism men was 34.3% (P<0.005). Among men with hypogonadism, the mean (SD) total testosterone concentration of diabetic and non-diabetic was 192 ng/ml and 242 ng/ml, respectively (P<0.005). In univariate analyses, total T levels were lower (P=0.018) and E(2) and LH levels were higher (P<0.05) in men with vitamin D deficiency (25(OH)D<30 nmol/l). Vitamin D deficiency was also significantly associated with secondary hypogonadism (RRR=1.18, P=0.05). After 6 months of testosterone replacement (injections) median serum testosterone (T) levels increased from pre-treatment levels in all men (T=224 to 804 ng/dL, p<0.05). Despite different serum T levels after 6 months, 44 of 52 men with therapy (84%) reported similar satisfaction levels (qADAM=38).

Conclusion: Hypogonadism is a prevalent disorder among diabetic population with erectile dysfunction. Symptoms of androgen deficiency should be corroborated with testosterone level to establish a multidisciplinary approach for management of hypogonadism. Secondary hypogonadism were associated with vitamin D deficiency. The clinical significance of this relationship requires further studies.

Disclosures:

Work supported by industry: no.

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Weight loss and and reduction of waist size in 237 hypogonadal men with obesity grades I-III under long-term treatment with testosterone undecanoate (TU): Observational data from a registry study (#181)

F. Saad (Germany)
show abstract

181

Weight loss and and reduction of waist size in 237 hypogonadal men with obesity grades I-III under long-term treatment with testosterone undecanoate (TU): Observational data from a 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 changes in anthropometric parameters in hypogonadal men under long-term treatment with testosterone undecanoate (TU) injections.

Material and Methods: Single-center, prospective, cumulative registry study of 340 hypogonadal men. 237 men with obesity grade I-III were selected. All men received TU injections for up to 7 years. Measures were taken at each three-monthly visit.

Results: Grade I (n=103, mean age: 58 years): Weight decreased from 102.79 to 85.41 kg. Changes were statistically significant vs. previous year for six years. Change from baseline was -17.27 kg, percent change from baseline -16.81%. Waist circumference (WC) decreased from 104.74 to 95.24 cm. Changes were statistically significant vs. previous year for six years. Change from baseline was -8.93 cm. BMI decreased from 32.85 to 27.65 kg/m2, mean change from baseline -5.5 kg/m2.

Grade II (n=97, mean age: 60 years): Weight decreased from 116.67 to 92.19 kg. Changes were statistically significant vs. previous year for six years. Change from baseline was -25.15 kg, percent change from baseline
-21.52%. WC decreased from 111.97 to 100.96 cm. Changes were statistically significant vs. previous year for five years. Mean change from baseline was -12.53 cm. BMI decreased from 37.33 to 29.88 kg/m2, mean change from baseline –8.06 kg/m2.  

Grade III (n=36, mean age: 60 years): Weight decreased from 128.92 to 100.75 kg. Changes were statistically significant vs. previous year for six years. Change from baseline -29.3 kg, percent change from baseline
-22.79%. WC decreased from 117.56 to 103.63 cm. Changes were statistically significant vs. previous year for six years. Mean change from baseline was -12.93 cm. BMI decreased from 41.99 to 33.23 kg/m2, mean change from baseline -9.59 kg/m2.

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.

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Long-term treatment with testosterone undecanoate injections sustainably improves metabolic control and erectile function in hypogonadal men with type 2 diabetes (#182)

F. Saad (Germany)
show abstract

182

Long-term treatment with testosterone undecanoate injections sustainably improves metabolic control and erectile function in hypogonadal men with type 2 diabetes

Saad, F1; Haider, A2; Doros, G 3; 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 effects of long-term treatment with testosterone undecanoate (TU) injections in hypogonadal with type 2 diabetes.

Material and Methods: Cumulative, prospective, observational registry study of 340 hypogonadal men from a single urological practice. 120 men (35.3%) had T2D. All men received testosterone undecanoate injections for up to 7 years. All men were treated for their T2D by their respective family physician.

Results: Mean age was 60.36±5.02 years. 4/120 men (3%) had normal weight, 9 (8%) were overweight, and 107 (89%) were obese. Testosterone levels rose from 10.0±1.28 nmol/L to trough levels (measured prior to the following injection) between 15 and 18 nmol/L. Weight decreased progressively from 110.37±14.28 to 89.38±9.33 by 21.36±0.73 kg. The proportion of weight loss was -18.24% in the obese, -13.64% in the overweight, and the men with normal weight gained 2.82%. Waist circumference decreased from 109.34±7.97 to 99.89±6.48 by 11.34 cm, BMI (kg/m2d) from 35.57±4.5 to 29.09±2.91 (p<0.0001 for all).

Fasting glucose decreased from 113.45±14.53 to 95.93±2.56 mg/dl, HbA1c from 8.02±0.86 to 5.9±0.45% (p<0.0001 for both). At baseline, 11% of patients were within an HbA1c target of 7%, at the end of the observation time, all patients completing 7 years of treatment had an HbA1c ≤ 7%.  At baseline, 4% of patients were within an HbA1c target of 6.5%, at the end of the observation time, all but one patients completing 7 years of treatment had an HbA1c ≤ 6.5%.  

The lipid pattern improved. The TC:HDL ratio declined from 4.9±1.18 to 2.52±0.56, the TG:HDL ratio from 4.84±1.34 to 2.49±0.54, non-HDL cholesterol from 6.14±0.76 to 2.85±0.41 (p<0.0001 for all).

Systolic BP decreased from 160.48±13.89 to 137.41±7.37, diastolic BP from 96.03±10.65 to 77.17±5.98 mmHg (p<0.0001 for both). IIEF-EF increased from 19.63±4.83 to 26.31±1.54, change from baseline: 5.38±0.31.

Conclusions: All changes were in a clinically meaningful magnitude and sustained for the full observation period. T therapy seems to be highly effective in hypogonadal men with type 2 diabetes, improving both metabolic parameters and erectile function.

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.

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Experience with testosterone undecanoate treatment of hypogonadal men for up to 17 years in an academic andrology setting (#183)

F. Saad (Germany)
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183

Experience with testosterone undecanoate treatment of hypogonadal men for up to 17 years in an academic andrology setting

Zitzmann, M1; Saad, F2

1: Centre of Reproductive Medicine and Andrology of the University, Germany; 2: Bayer Pharma AG, Germany

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

Material and Methods: Cumulative, prospective, observational registry study of 422 patients (188 with primary [including 56 Klinefelter’s patients], 125 with secondary hypogonadism and 109 with late-onset (“mixed” or “metabolic” hypogonadism) aged 15 to 72 years (mean 41±12 years) receiving intramuscular injections of 1000 mg of TU during a maximal treatment time of 17 years..

Results: Individual dosing intervals ranged from 10 to 14 weeks Serum T concentrations increased from 5.2 nmol/L to stable trough levels of 12.8 nmol/L within the first year of treatment and further on to levels between 15 and 16 nmol/L thereafter. The proportion of men fulfilling the new Harmonized Criteria for definition of the Metabolic Syndrome decreased from initially 86% to 68% within the first year and further on to 43% within 5 years (Chi-square for trend: p<0.001). During the maximal duration of treatment, an overall favourable change from baseline was visible for a multitude of parameters related to androgen effects/metabolic risk, especially lipid parameters, blood pressure and fasting glucose levels (all with p<0.001 in ANOVAs). Body weight decreased within the first year from 100.9±11.7 to 97.8±10.6 kg and continued to decrease progressively to 86.6±9.3 kg. Prostate size increased from 16.8±5.0 to max 21.2±5.4 ml (p<0.001), PSA levels changed moderately (baseline 1.5±0.4 to max 2.3±0.6 µg/l, p=0.001). No case of prostate cancer was observed. Haematocrit increased significantly during treatment but remained within the normal range (40.5±2.1% to max 47.2±2.5%, p<0.001), except for occasional measurements (maximal value 56.7%). One patient suffered from deep vein thrombosis, one from stroke, two from myocardial infarction. These events were considered unlikely to be directly related to testosterone replacement therapy, as the patients had a respective cardiovascular risk profile but haematocrit was not elevated.

Conclusions: Intramuscular injections of testosterone undecanoate represent a feasible, safe and well tolerated modality of testosterone therapy in hypogonadal men of a wide age range, substantiated by a long experience, facilitating a decrement of metabolic/cardiovascular risk factors.

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.

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Weight loss and reduction of waist size in 362 hypogonadal men with obesity grades I to III upon long-term treatment with testosterone undecanoate (TU): Observational data from two registry studies (#184)

F. Saad (Germany)
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184

Weight loss and reduction of waist size in 362 hypogonadal men with obesity grades I to III upon long-term treatment with testosterone undecanoate (TU): Observational data from two registry studies

Saad, F1; Haider, A2; Yassin, A 3; Doros, G 4; Traish, A5

1: Bayer Pharma AG, Germany; 2: Private Urology Practice, Germany; 3: Institute for Urology and Andrology, Germany; 4: BU School of Public Health, USA; 5: BU School of Medicine, USA

Objective: To assess changes in anthropometric parameters in hypogonadal men under long-term treatment with testosterone undecanoate (TU) injections.

Material and Methods: From two cumulative registry studies, 362 men with obesity grade I (BMI 30-34.9), grade II (BMI 35-39.9) and grade III (BMI ≥ 40 kg/m2) were selected. All men received TU for up to 6 years. 

Results: Grade I (n=185, mean age: 58.4±8.0 years): Weight (kg) decreased from 101.88±6.2 to 89.34±6.7. These changes were statistically significant for all six years compared to the previous year. Mean change from baseline was -12.55±0.44 kg, percent change from baseline -12.25±5.76%. Waist circumference (cm) decreased from 107.07±7.57  to 97.09±6.95. These changes were statistically significant for five years compared to the previous year and approached significance at the end of six vs. five years. The mean change from baseline was -9.24±0.3 cm. BMI (kg/m2) decreased from 32.51±1.39 to 28.63±1.92, mean change from baseline -3.99±0.14 kg/m2. Grade II (n=131, mean age: 60.6±5.6 years): Weight (kg) decreased from 117.02±6.99 to 96.78±7.47. These changes were statistically significant for all six years compared to the previous year. Mean change from baseline was -20.67±0.51 kg, percent change from baseline -17.03±5.02%. Waist circumference (cm) decreased from 114.23±7.51 to 102.52±6.5. These changes were statistically significant for all six years compared to the previous year. Mean change from baseline was -12.29±0.33 cm. BMI (kg/m2) decreased from 37.39±1.46 to 31.05±2.02, mean change from baseline -6.58±0.16 kg/m2. Grade III (n=46, mean age: 60.3±5.4 years): Weight (kg) decreased from 129.02±5.67 to 103.33±4.17. These changes were statistically significant for all six years compared to the previous year. Mean change from baseline -27.15±0.74 kg, percent change from baseline -20.99±3.16%. Waist circumference (cm) decreased from 118.41±5.69 to 106.48±4.91. These changes were statistically significant for all six years compared to the previous year. Mean change from baseline was -12.44±0.36 cm. BMI (kg/m2) decreased from 41.93±1.5 to 33.62±1.58, mean change from baseline -8.79±0.23 kg/m2.

Conclusions: All changes were meaningful and sustained for the full observation time. TRT seems to be effective to improve MetS and cardiovascular risk profile in obese hypogonadal men.

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.

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Biochemical clomiphene citrate response in men with hypogonadism based on baseline LH level (#185)

John Mulhall (USA)
show abstract

185

Biochemical clomiphene citrate response in men with hypogonadism based on baseline LH level

Deveci, S1; Mazzola, C2; Logmanieh, N2; Mulhall, J2

1: Medical School of Acibadem University, Turkey, Memorial Sloan Kettering Cancer Research Center, New York; 2: Memorial Sloan Kettering Cancer Research Center, New York

Objectives: Clomiphene citrate (CC) is being increasingly recognized as an effective treatment for men with HG. Prior data suggests men with elevated baseline LH levels may be poor candidates for CC therapy. This analysis was undertaken to analyze response to CC based on baseline LH level.

Materials and Methods: Men with a diagnosis of HG, (2 separate early morning total T levels <300 ng/dl) opting for CC therapy constituted the study population. Patients were sub-divided based on baseline LH level: <5 IU/ml (A), 5-10 (B), >10 (C). Demographic, comorbidity data, physical and laboratory characteristics were recorded. TT and LH levels ≥6 months after commencing CC were used for this analysis. Responders were defined as those achieving a 200 ng/dl increase in TT on treatment combined with a post-treatment TT level ≥400 ng/dl.

Results: 112 patients were included with a mean age = 58±21 years. Mean pre-treatment testicular volume = 15±7.5 mls. Mean baseline and post-treatment T and LH levels are listed in Table 1. The mean change in LH for each group was: A 4.8 (1.2-8.5); B 1.1 (0.5-3.8); C 0.3 (0-1.4) (p<0.01). The mean change in TT for each group was: A 225 (165-622); B 148 (115-322); C 25 (12-110) (p<0.01). 78% in group A were responders, 49% in group B and 12% in group C.

Conclusion: These data indicate that the best biochemical response to CC is in men with baseline LH levels below 5 and that men with baseline LH levels above 10 are generally poor responders.

Abstract 185

Disclosures:

Work supported by industry: no.

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Testosterone replacement therapy (TRT) infrequently used in hypogonadal men (#186)

W. Poage (USA)
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186

Testosterone replacement therapy (TRT) infrequently used in hypogonadal men

Poage, W1; Nelson, N2; Crawford, E1; Miner, M3

1: Prostate Conditions Education Council / University of Colorado HSC, United States; 2: Prostate Conditions Education Council / Mount Sinai, United States; 3: Brown University, United States

Objectives: Urologists are the primary prescribers of TRT in men with hypogonadism (HG). HG (T<300 ng/dL) is associated with obesity, cardiovascular disease risk factors, diabetes and ED. There are no large population studies that have assessed the use of TRT in these individuals although data is emerging about its benefits in improving lean body mass and decreasing waist circumference.

Materials and Methods: 11,584 men from the general population participated in the Prostate Cancer Awareness Week (PCAW) in 2011 and 2012, a nationwide health screening program, and completed health assessments. Testosterone (T) levels were determined in 4849 (41.9%). Associations for T were compared by ANOVA and chi-square for age, race, fat in diet (FID), exercise amount (Ex), degree overweight (Over), presence of erectile dysfunction (ED) and diabetes, heart disease (HD), heart attack (HA), and increased body mass index (BMI over 30). The effect of multiple variables on T<300 was tested by linear regression.

Results: Mean and median T and age were 358.8 and 326 ng/dL and 61.6 and 62 years, respectively. Lower mean T was associated with older age group (p=0.001) and race, higher FID, low Ex, Over, ED, HA, HD, diabetes, and higher BMI (all p<0.001). On regression analysis only race (p=0.05), FID (p=0.006), BMI (p<0.001), diabetes (p<0.001) and Ex (p<0.001) remained significant. HG was present in 42.8% (table). TRT was used by 304 of the 11,584 participants (2.6%). Mean T for men on TRT was 352 compared to 226.4 ng/dL for HG men not on TRT (p<0.001). TRT was more commonly used in men over 65 years (3.3% vs. 2.6%, p=0.046), BMI ≥ 30 (4.5% vs 2.3%, p<0.001) and ED (6.2% vs. 2.1%, p<0.001). There was no difference in TRT use in diabetic vs. non-diabetic men. TRT use by race was white 3.2%, AA 1.5% and Hispanic 3.9% (p<0.001). Men with HG and higher BMI had mean weight of 241 lbs. compared to 232 lbs for those taking TRT (p=0.001). Diabetes was also less common in HG men on TRT (12% vs. 15.2, p=0.221).

Conclusions: Despite the high frequency of HG (42.8%) in this screening population, TRT was reported to be used only 2.6% of the time. Men with ED had the highest reported use of TRT (6.2%), while use in diabetic men was no different than non-diabetic men. Use of TRT in AA men was half that of others. Urologists involved in men’s health should be aware of the high prevalence of HG and consider the potential benefits of TRT in men, especially those with high BMI, high fat diet, minimal exercise and the presence of diabetes.

Disclosures:

Work supported by industry: no.

Characteristics associated with low testosterone levels in men with type 2 diabetes mellitus previously treated with insulin (#187)

F. Borges Dos Reis (Brazil)
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187

Characteristics associated with low testosterone levels in men with type 2 diabetes mellitus previously treated with insulin

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

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

Introduction: Male hypogonadism is defined by low serum testosterone (T) levels and associated clinical symptoms, and has elevated prevalence in men with type 2 diabetes mellitus (T2DM). This post hoc analysis examined baseline associations between low T levels and demographic and disease characteristics in diabetic men previously treated with insulin entering a phase 3 trial of once weekly GLP-1 receptor agonist dulaglutide.

Methods and Materials: Men were ≥18 yrs of age with T2DM, had screening HbA1c 7.0% - 11.0%, and received insulin alone or with oral antihyperglycemic medications (OAMs). Low T was defined as total T (TT) <300 ng/dL or free T (FT) <65 pg/nL, calculated using the Vermeulen equation. A two-sample t-test and Fisher’s exact test were used to compare between T subgroups. Men receiving T replacement (n=11) were not analyzed.

Results: 33.9% of men (n=151) had low TT and 66.1% had normal TT (n=294); mean age was 60.3 and 59.3 yrs (p=.59), and HbA1c was 8.6% and 8.4% (p=.31), respectively. Men with low TT differed from men with normal TT for mean BMI (33.9 vs. 31.0 kg/m2, p<.001), weight (103.8 vs. 93.7 kg, p<.001), proportion with HbA1c >9.5% (21.2% vs. 12.9%, p=.028), and proportion using a phosphodiesterase 5 inhibitor (9.3% vs. 3.4%, p=.014). Men with low versus normal FT (26.4% [n=117] vs. 73.7% [n=327]) were older (63.4 vs. 58.3 years, p<.001), had higher BMI (34.0 vs. 31.3 kg/m2, p<.001), weight (103.1 vs. 95.0 kg, p<.001), and history of cardiovascular disease (40.2% vs. 22.9%, p<.001). Mean HbA1c (8.5% vs. 8.4%, p=.95) and proportion with HbA1c >9.5% (17.1% vs. 15.3%, p=.66) were similar between men with low versus normal FT.

Conclusion: In men with T2DM previously treated with insulin and OAM, about 1/3 had untreated low TT; 11 additional men were receiving T replacement therapy. Men with untreated low TT had greater BMI and weight, and a greater proportion had HbA1c >9.5%. The approximately 1/4 of men with low FT had greater age, BMI, and weight, but similar HbA1c versus normal men. These data support Endocrine Society Guidelines for measuring T levels in men with T2DM, and highlight the need for further study 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.

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Clomiphene citrate and human chorionic gonadotrophin are good alternative therapy to testesterone in hypogonadal men seeking fertility (#188)

John Mulhall (USA)
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188

Clomiphene citrate and human chorionic gonadotrophin are good alternative therapy to testesterone in hypogonadal men seeking fertility

Habous, M1; Elhadek, W1; Shamndy, M1; Mahmoud, S1; Abdelwahab, O2; Abdelrahman, Z1; Muir, G3; Mulhall, J4

1: Elaj medical centers, Saudi Arabia; 2: Benha university, Egypt; 3: King's College Hospital; 4: Sexual and and reproductive medicine program, Memorial Sloan Kettering cancer center, NY USA

Introduction: Secondary, or late onset, hypogonadism (LOH) is a common problem in the ageing male population. It is significantly associated with various co morbidities such as obesity, type 2 diabetes, hypertension, osteoporosis and metabolic syndrome. The standard therapy for hypogonadism is testosterone replacement therapy (TRT) which is not suitable for men seeking fertility – a major problem in many men from the Gulf States

Objectives: We wished to compare the efficacy of single agent clomiphene citrate(CC),human chorionic gonadtrophin (HCG), and a combination of the two in  symptomatic patients of LOH wishing to preserve fertility

Patients&Methods: In this unblinded multicentre RCT, a total of 287 hypogonadal patients were randomly enrolled 2:2:1 into 3 groups. Group A (n= 88) were given HCG 5000 international units (i.u) intramuscularly once a week; group Group B (n=82) took CC 50 mg daily, and group C (n=41) took both HCG&CC (our previous standard treatment) A non-randomized control group of consecutive patients (D: n=76) who did not wish to preserve fertility were commenced on Testosterone undecanoate (TU.) All patients had physical examination, T measurements & glycosylated haemoglobin(HbA1c)  at baseline,1 month and 3 months, as  were Quantitative ADAM questionnaire (qADAM) scores. LH and FSH levels were checked at baseline and three months.

Results: The average age of patients were 42 being 47 for TU group, 40 for HCG, 38 for CC and 41 for combination group. The mean body mass index (BMI) of all patients was 30,9 All three treatments increased serum testosterone levels as shown in table 1:

Abstract 188

Significant improvements were seen in the qADAM score in all groups. Improvements were seen in HbA1c and BMI in all groups, although not always reaching significance. The increases in all metrics, while not directly comparable, were similar to those seen in the TU group.

Conclusion: CC and HCG alone or in combination are good alternative therapy in LOH with comparable results and rapid onset subjectively and objectively in hypogonadal men irrespective of their age but the outcome is less in obese patients. These results would suggest a larger RCT between CC, HCG and TRT.

Disclosures:

Work supported by industry: no.

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11:30 - 12:30
Podium 11 - Ejaculation and its associated problems

Location: Transamérica Auditorium
Chairs: Chris McMahon (Australia) & Ana Puigvert Martinez (Spain)

Thyroid dysfunction, serum testesterone and prolactin levels don’t seem to be risk factors in men complaining of premature ejaculation (#061)

John Mulhall (USA)
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061

Thyroid dysfunction, serum testesterone and prolactin levels don’t seem to be risk factors in men complaining of premature ejaculation

Habous, M1; Mahmoud, S1; Abdelwahab, O2; Elhadek, W1; Shamndy, M1; Abdelrahman, Z1; Nelson, C3; Mulhall, J4

1: Elaj medical centers, Saudi Arabia; 2: Benha university, Egypt; 3: Sexual & Reproductive Medicine Program, Memorial Sloan Kettering Cancer Center; 4: Sexual and and reproductive medicine program, Memorial Sloan Kettering cancer center, NY USA

Introduction: Most epidemiological studies suggest that premature ejaculation (PE) also referred to as early ejaculation and rapid ejaculation, may be the most common male sexual disorder. The exact etiology of PE is unknown. Psychological/behavioristic and biogenic etiologies have been proposed.

Objectives: Initial reports indicate that there are hormone differences between men with primary (lifelong) and secondary (acquired) PE.  This study was designed to investigate hormone profiles of these two subgroups.

Methods & Patients: Men who presented to our outpatient clinic with PE were enrolled in this study.  The diagnosis and classification (primary or secondary) of PE was based on patient medical and sexual history according to guidelines of international society of sexual medicine (ISSM) and European association of urology (EAU). Complete physical examination was done and we measured thyroid stimulating hormone (TSH), testosterone (T), and prolactin (P) for all patients. Statistical analyses included descriptive statistics and independent-measures t-test for univariate analyses.  Analysis of covariance was used for multivariable analyses.

Results: 506 men were included in this analysis. The average age of these men was 44±12 years old and the mean body mass index (BMI) was 26.7±5.5. The mean levels of T, TSH, and P for the entire sample was 4.38±1.69, 2.31±3.56, and 10.56±11.04, respectively.  There were 267 men in the primary PE group and 239 men in the secondary PE group. The men with primary PE were significantly younger than those with secondary PE (37±11 vs. 52±12, p=0.001). There were no significant differences in BMI between the groups. On univariate analyses, there was no differences between the primary PE and secondary PE groups in T (4.39±1.66 vs. 4.38±1.84, p=0.94), TSH (2.31±4.89 vs. 2.20±2.07, p=0.76), and P (10.65±8.13 vs. 10.46±13.46, p=0.86).  When controlling for age in multivariable analyses, there continued to be no differences between the two groups (p values ranging from p=0.56 to 0.81).

Conclusion: hormonal profile including T, TSH and P seem to be in the normal range in men with PE and there is no statistical difference in these hormones between primary and secondary PE

Disclosures:

Work supported by industry: no.

“Glass half empty or glass half full". Does the ejaculated volume really matter? (#062)

M. Osta (Brazil)
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062

“Glass half empty or glass half full". Does the ejaculated volume really matter?

Da Silva, E1; Osta, M1; Damião, R1; Real, A1; Barboza, R1

1: Rio de Janeiro State University, Brazil

Objective: Despite the reproductive aspect, ejaculation can be considered as a human sexual behavior and the man’s perception plays an important role on quality of life. We aim to access the impact of the perceived ejaculated volume (PEV) on sexual satisfaction and quality of life.

Material and Methods: Seventy men were invited to answer a quality of life (WHOQoL-Bref) and satisfaction about perceived ejaculated volume (SAPEV) questionnaires. The SAPEV questionnaire is composed of four questions evaluating the self-perception about their normality, changes with aging, satisfaction with PEV, and objective volumetric perception (OVP). Patients were categorized by question 3 (satisfaction), age group, OVP and SAPEV Score (SS) which is composed by 3 questions of the SAPEV. Men with history of prostate or urethral surgeries, diabetes, hypogonadic men or under uroselective alpha-blocker therapy were excluded.

Results: Ten men (14.3%) referred with dissatisfaction about PEV. The mean OVP was 25.3±33.6mL (ranging from 1 to 200mL) and there was no significant difference (p=0.629) between unsatisfied and satisfied groups (17.7±29.5mL, 25.1±35.0mL, respectively). Relationships domain score was 59.3±21.4 and 73.0±22.6 (p =0.01) and the psychological domain score was 70.1±13.1 and 78.9 ±12.4 (p=0.02) for those, respectively. In Group with referred OVP ≥100mL (Group A), the risk to be unsatisfied about PEV was 1.56 (RR, CI 95%) comparing to the 5mL OVP population (group B). The mean age were 43±11 years old and 52±14 years old (p=0,213) and the psychological domain score was 67.6±7 and 80.9±11.1 (p=0.024) for groups A and B respectively. In men aged ≥ 60 years old the OVP mean was 12.69±12.2mL  in contrast with 28.68±36.92mL (p=0.088) of younger population, and the SS 10.0±2.58 vs. 8.81±1.39 (p=0.018). Men with negative perception about the ejaculate (SS ranging from 12 to 15) were significantly older (p<0.05) than the group with positive perception (SS ≤ 9) (mean age 57.7±13.5, 44.2±12.2, respectively). The relationships domain score was 61.57±21.28 and 72.61±24.72 (p=0.16), and the OVP mean was 7.14 ± 5.49 and 26.72 ± 38.54 (p=0.076) for those, respectively.

Conclusion: Men have a propensity to overestimate the ejaculated volume. Perception about ejaculated volume plays an important role on sexual satisfaction and overall quality of life. Furthermore, men over 60 years old are at risk to be dissatisfied regarding their ejaculated volume.

Disclosures:

Work supported by industry: no.

Perceptions and attitude towards PE and treatment seeking behavior: The result of SCOPE (Sexual Concerns On Premature Ejaculations) (#063)

M. Lam (United Kingdom)
show abstract

063

Perceptions and attitude towards PE and treatment seeking behavior: 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 common medical condition affecting men and their sexual partners, affecting up to 30% of general population. The objective of this study is to identify the level of knowledge on PE and the treatment seeking behavior of population in a socio-economically diverse nation in Asia.

Methods: Subjects from both urological and non-urological clinics are recruited to complete non-validated part questionnaires on their perception towards PE and the treatment modalities. The age, gender, income and economic backgrounds were identified.

Results: A total of 1541 subjects (792 men and 749) completed the study, of which 77% believed PE is common and 61% consider it to be a medical condition. More than 80% of the respondents agree PE can negatively affect the quality of life of the sufferers and their partners. A third of the participants find it difficult to discuss issues of PE and 28% would avoid the discussion mainly due to embarrassment (42%). Of the population studied, more than 90% would discuss the dysfunction with their doctors and 80% would accept medicine as the first line treatment.

Conclusion: Sexual dysfunction is a taboo subject in many Asian cultures, and this may lead to poor treatment seeking behavior. Although many understand PE is a prevalent sexual dysfunction with negative impact of sufferers and partner quality of lives, our study revealed embarrassment, avoidance and difficulties in the discussion of the subject matters. We also identify the willingness of subjects to approach physicians and accept medications and the therapeutic modality. Sub-analysis of the population studied may ensure targeted patient educations for clinicians.

 

Disclosures:

Work supported by industry: no.

Silodosin, a highly selective α1A-adrenoceptor antagonist, as a new treatment option for Premature Ejaculation (#064)

Y. Sato (Japan)
show abstract

064

Silodosin, a highly selective α1A-adrenoceptor antagonist, as a new treatment option for Premature Ejaculation

Sato, Y1; Nakajima, H1; Nitta, T1; Akagashi, K1; Hanzawa, T1; Tobe, M1; Haga, K1; Uchida, K1; Honma, I1; Otani, T2; Amano, T3; Araki, T4

1: Sanjukai Hospital, Japan; 2: Chibu Rosai Hospital, Japan; 3: Nagano Red Cross Hospital; 4: Araki Kidney & Urology Department Clinic

Objective: We evaluated silodosin, a highly selective α1A-adrenoceptor antagonist, as a new treatment option for PE. Silodosin that is widely used for LUTS, has strong suppressive action on ejaculation. This suppression action may have potential for treating PE. Our preliminary study demonstrated that silodosin had potential for PE treatment (Sato et al. Int J Urol 2012). As a next step, we compared efficacy of silodosin and naftopidil (weak suppressive action for ejaculation among α1-adrenergic receptors) on PE.

Material and Method: Twelve patients who suffered with PE were involved in this study. Definition of PE was “persistent or recurrent ejaculation with minimal stimulation before, on, or shortly after penetration and before the person wishes it” and “Within 3 minute of Intravaginal ejaculatory latency time (IELT)”. Subjects had a mean age of 43 years (range 29-59), reported having had PE for an average of 7.0 years (range 5-15years). Six patients (50%) suffered with ED and had received treatment by phosphodiesterase type 5 inhibitors. Patients administrated silodosin 4 mg and naftopidil 25 mg (1 hours before intercourse) in turn at least 3 times each. IELT, premature ejaculation profile (PEP) item, clinical global impression change (CGIC) in PE and systemic adverse events were evaluated.

Results: 1) IELT: Mean average IELT at baseline, during naftpidil and silodosin-administration were 1.9±1.1, 4.2±3.1 and 9.2±5.7 min, respectively. IELT during silodosin-administration was significantly longer than those at baseline (p=0.0007) and at naftpidil-administration (p=0.005 ). 2) CGIC: Improve rate for PE-related problems compared to pre-treatment condition at silodosin and naftopidil-administration were 83.3% and 41.6 %, respectively. Silodosin significantly improved PE-related problems compared to naftopidil (p= 0.03 by χ2-test). 3) Premature ejaculation profile: Among PEP measure, ejaculation control and satisfaction of sexual intercourse during silodosin-treatment were significantly improved compared to those at base line (p <0.01 for all). 4) Reduced semen volume and orgasm: Eight patients (67%) experienced reduced semen volume at silodosin-administration. However, only three patients (25%) considered reduced semen volume with silodosin as a significant problem.  5) Systemic adverse events: No systemic adverse effects at silodosin and naftpidil-administarion were reported.

Conclusion: Silodosin significantly improved PE-related problems than naftpidil. Silodosin’s safety and clear mechanism for efficacy on PE (suppression for seminal emission but not retrograde ejaculation) are confirmed by large clinical studies for LUTS and well designed-studies with volunteers. According to these favorable aspects and current results suggest the potential of off-label silodosin as a new treatment option for PE.

Disclosures:

Work supported by industry: no.

Controlled clinical study of the effectiveness and adverse effects of imipramine and amoxapine for treatment of retrograde ejaculation (#065)

T. Tai (Japan)
show abstract

065

Controlled clinical study of the effectiveness and adverse effects of imipramine and amoxapine for treatment of retrograde ejaculation

Tai, T1; Nagao, K1; Kobayashi, H1; Tanaka, N1; Nakajima, K1

1: Toho University, Japan

Objective Retrograde ejaculation (RE) is an ejaculation disorder that can cause male infertility. It is defined as a pathological condition in which some or all semen is not emitted despite orgasm. The main cause of RE is believed to be decreased function of the bladder neck due to conditions such as diabetes, pelvic surgery, and drug resistance. Currently imipramine is the drug of choice for treatment of RE, but side effects such as drowsiness sometimes develop. In this controlled clinical study we evaluated the effectiveness and adverse effects of imipramine and amoxapine for treatment of RE.

Material and Methods Eleven men were randomly assigned to one of two groups. We gave amoxapine to group I and imipramine to group II during the first 2-week period and examined adverse effects and semen volume. After a 1-week washout period, the drugs were switched for a second 2-week period. Mean age was 41.0 years (range, 30-52). Disease duration was 3 months to 5 years (average, 1.6 years). The main causes of RE were diabetes (n=8), surgery for rectal cancer (n=2), and retroperitoneal lymph node dissection for testicular cancer (n=1); cause was unknown in four cases. Male infertility was the reason for consultation in 13 cases. The men were provided with a 2.5-cc syringe for self-measurement of semen volume during ejaculation.

Results ED was observed in three patients, but erection hardness was greater than EHS3 after use of PDE5I. In six cases, sperm was found in urine after orgasm. With amoxapine treatment, 14 (77.8%) men were able to ejaculate (average volume, 0.9 [0.1-1.5] cc). Mild drowsiness was noted in four cases. With imipramine treatment, 11 (61.1%) men were able to ejaculate (average volume, 0.57 [0.3-2.0] cc). Mild drowsiness was noted in three cases and severe drowsiness in one case. All men who reported semen emission with imipramine were also able to ejaculate while receiving amoxapine. Semen volume was significantly greater with amoxapine than with imipramine (p <0.001). The incidence of adverse effects was similar for amoxapine and imipramine. Amoxapine was effective for all men who had positive results with imipramine.

Conclusions In the treatment of RE, amoxapine was much more effective than imipramine, and equally safe.

Disclosures:

Work supported by industry: no.

Dapoxetine for premature ejaculation: A rapid evidence assessment (#066)

F. Feys (Belgium)
show abstract

066

Dapoxetine for premature ejaculation: A rapid evidence assessment

Feys, F1; Devroey, D1

1: Vrije Universiteit Brussel, Belgium

Introduction: Premature ejaculation mostly causes a transitory inconvenience for the young, sexually active male. Sometimes, a simple sexological intervention can provide definitive solace. Recently, dapoxetine was approved by the European Medicines Agency (EMA) as an pharmacological agent for the treatment of PE.  The objective of this study was to systematically review the efficacy and harm of dapoxetine.

Methods: We included RCTs that investigated the efficacy of dapoxetine for male PE by comparing to placebo. We searched for both published and unpublished relevant trials using PUBMED, EMBASE, the Cochrane Central Register of Controlled Trials, a clinical trials register (clinicaltrials.gov), the EMA and the FDA websites through december 2013. We evaluated the blinding status of trials with the Cochrane Risk of Bias (ROB) Tool, using the domains of allocation sequence concealment, blinding of participants, healthcare providers and outcome assessors. For the latter 3 ROB domains, we applied additional criteria. Across these domains, studies that scored low risk of bias were judged to be adequately blinded and the remaining studies were judged to be inadequately blinded.

Results: We included 8 studies that involved 6,954 randomized participants; Seven studies had a short duration (6 to 12 weeks). Information on study blinding was mostly absent, many participants dropped out of studies (short (21%) vs long (47%) duration studies) and many conflicts of interests were found. One adequately blinded study reported an orgasm delay with 42 [95% confidence interval (CI) -8, 76] seconds.  For inadequately blinded studies the reported orgasm time was 2.29 [CI 1.37, 3.21] and 1.70 [CI 0.50, 2.90] minutes on dapoxetine and placebo respectively. Risk ratios for the most common adverse events (AEs) were: nausea RR 5.93 [CI 4.31, 8.18], headache RR 1.21 [CI 0.94, 1.55], dizziness RR 3.17 [CI 2.25, 4.47], diarrhoea RR 3.18 [CI 2.06, 4.92]. One study reported substantially more headache RR 5.16, more dizziness RR 7.22 and more diarrhoea RR 11.35.

Conclusions: There is no evidence that dapoxetine is effective. Any irrelevant small ejaculation-time delaying effects seem to result from a placebo effect. The data suggest that dapoxetine may add around 30 seconds to postpone an man's orgasm, but this was not statistically confirmed. Unfortunately, dapoxetine comes with its risks. It has adverse effects and a significant proportion of patients quit dapoxetine early. After quitting, patients may relapse and suffer PE again. Dapoxetine's overall risk/benefit profile is unfavourable.

Disclosures:

Work supported by industry: no.


11:30 - 12:30
Round table 6 - Sexual issues in gay-lesbian patients

Location: Ilhéus + Una Room
Chairs: Michael Krychman (USA) & Ralmer Nochimówski Rigoletto (Brazil)

Assessment and sexual concerns of gay men and lesbian women in a sexual medicine setting

John Dean (United Kingdom)

Prevalence of FSD and MSD in the gay and lesbian population

Alan Shindel (USA)

Promoting sexual health among gay and lesbian Individuals: Treatment considerations

Eli Coleman (USA)


Afternoon

12:30 - 14:00
Lunch break

Location: Comandatuba Room 1

12:45 - 13:45
ISSM journals - Lunch symposium

Location: Comandatuba Room 2+3

14:00 - 15:30
Round table 7 - Managing difficult cases with PP

Location: Comandatuba Room 2+3
Chairs: Gerald Brock (Canada) & Lawrence Hakim (USA)

Saving the cavernous spaces after infection

Rafael Carrion (USA)

SMSNA sponsored lecture: Implant after priapism

Arthur Burnett (USA)

Alternative reservoir placement

Run Wang (USA)

Finding the space in scarred tissue

Steven Wilson (USA)


14:00 - 15:30
Podium 12 - Other aspects of sexual medicine

Location: São Paulo Room
Chairs: Jacqueline Brendler (Brazil) & Alan Shindel (USA)

Improved erectile function recovery after nerve-sparing radical prostatectomy by ink-marked intraoperative frozen section monitoring of the prostate: Results of a prospective single-surgeon series (#067)

G. Hatzichristodoulou (Germany)
show abstract

067

Improved erectile function recovery after nerve-sparing radical prostatectomy by ink-marked intraoperative frozen section monitoring of the prostate: Results of a prospective single-surgeon series

Hatzichristodoulou, G1; Wagenpfeil, S; Weirich, G; Herkommer, K; Kübler, H; Gschwend, J

1: Technische Universität München, Klinikum rechts der Isar, Germany

Objectives: Intraoperative frozen sections (IFS) of the prostate during nerve-sparing radical prostatectomy (nsRP) have been demonstrated effective in reducing positive surgical margins (PSM), and biochemical recurrence. However, its effect on erectile function (EF) recovery has not been assessed so far. The aim of our study was to report for the first time results on EF recovery in patients undergoing IFS of the prostate during nsRP.

Materials and Methods: Patients with organ-confined prostate cancer (PCa) were included in this prospective study independent from other adverse prognostic factors (Bx cores, Gleason, PSA). All pts underwent standardized open nsRP by a single high-volume surgeon (JEG, >2500 RP). Upon prostatectomy, the prostate was ink-marked and both postero-lateral parts (from apex to base) sent for IFS analysis after en-bloc preparation. In case of PSM, additional tissue was partly resected from the prostatic bed along the neurovascular bundles (NVB) corresponding to the PSM. EF recovery was the endpoint and defined as IIEF-5 ≥17. The impact of IFS on EF recovery rates was analyzed with Kaplan-Meier analysis (NCSS version 9, NCSS, Kaysville, Utah, USA).

Results: From April 2008 to May 2012, n=500 consecutive pts were included. Seven and 22 patients were excluded because of neoadjuvant treatment and lymph node positive disease, respectively. PSM in IFS were detected in 137/471 patients (29.1%). After secondary resection 127/137 patients (92.7%) converted to negative surgical margins (NSM). Ten patients (7.3%) showed persistent PSM. EF recovery rates after 12 months were 65.7% vs. 56.1% in pts with primarily and converted NSM, respectively (p=0.786).

Conclusions: IFS of the prostate is highly effective in reducing PSM in pts undergoing nsRP for PCa, independent of adverse pathologic factors. Moreover, secondary partial resection along the NVB does not compromise EF recovery rates when compared to pts with primarily NSM. IFS may be recommended in order to reduce PSM, while increasing the rate of ns procedures and consequently optimizing EF recovery rates.

Disclosures:

Work supported by industry: no.

Frequency of citation errors among male sexual medicine publications in high-impact urology journals (#068)

Landon Trost (USA)
show abstract

068

Frequency of citation errors among male sexual medicine publications in high-impact urology journals

Trost, L1; Mulhall, J2

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

Objective: Peer-reviewed publications are currently the optimal method for communicating research findings.  Despite critical appraisals performed by reviewers and editors of manuscript texts, reference citations are frequently under-evaluated.  Our objective was to determine the frequency and types of citation errors present in high-impact urology journals. 

Material and Methods: Recent publications in the area of male sexual medicine from high impact-factor, peer-reviewed urology journals were reviewed to assess the accuracy of citations.  Two articles each were selected from recent issues of the following journals: European Urology, Journal of Urology, BJU International, and Journal of Sexual Medicine. Only original research or meta-analytic studies were included.  All citations within the manuscript text were critically assessed to determine accuracy, relevance to statement referenced, and congruence of reference and textual findings.  Errors in citations were classified as: incorrect (duplicate reference, unrelated reference, unverifiable statement, wrong reference); errors of interpretation (discrepant data or conclusions, overstatement/understatement of findings); or suboptimal (inappropriate reference, reference to review article in lieu of source publication, indirect/inactive website link). 

Results: A combined 468 citations were reviewed from eight articles (March-October 2013). Citations were distributed in the introduction (I-26%), methods (M-19%), results (R-11%), and discussion (D-44%) sections. 145 (31%) errors were identified.  Among errors, suboptimal reference utilization was most common (44%; 64/145), followed by incorrect references (37%; 54/145), and errors of interpretation (19%, 27/145). Error distribution occurred least frequently in the M section with errors in D section commonest (I-30%, M-10%, R-13%, D-47%). No difference in error rates between journals was identified.

Conclusions: Citations errors are common among high impact-factor urology journals.  Although incorrect and suboptimal references are most commonly identified, errors of source data misinterpretation/misrepresentation are not uncommon.

Disclosures:

Work supported by industry: no.

Development and preliminary validation of the PROMIS SexFS version 2.0 (#069)

K. Weinfurt (USA)
show abstract

069

Development and preliminary validation of the PROMIS SexFS version 2.0

Weinfurt, K1; Flynn, K2; Bruner, D3; Cyranowski, J4; Dombeck, C1; Hahn, E5; Jeffery, D6; Lin, L1; Luecht, R7; Magasi, S8; Porter, L1; Reese, J9; Reeve, B10; Shelby, R1; Willse, J7

1: Duke University, United States; 2: Medical College of Wisconsin, United States; 3: Emory University, United States; 4: University of Pittsburgh, United States; 5: Northwestern University, United States; 6: Health Affairs, Department of Defense, United States; 7: University of North Carolina at Greensboro, United States; 8: University of Illinois at Chicago, United States; 9: Johns Hopkins University, United States; 10: University of North Carolina, United States

Objective: To develop version 2.0 of the Patient-Reported Outcomes Measurement Information System® (PROMIS®) Sexual Function and Satisfaction measure (SexFS). The revision was needed to (1) ensure the SexFS was valid across a broad range of patient groups, (2) develop scoring metrics centered around U.S. population norms, (3) expand and improve on the concepts being measured, and (4) minimize differential item functioning (DIF) across important subgroups of respondents.

Material and Methods: Building off version 1.0, version 2.0 included review of extant items, clinical expert discussions (n=15), patient focus groups (11 groups, including diabetes, heart disease, anxiety, depression, LGBT, aged 65+), cognitive interviews (n=48), and psychometric evaluation in a random sample of U.S. adults (2281 males, 1686 females). We examined DIF by gender and sexual activity. We evaluated concurrent validity with the IIEF and FSFI as well as known groups validity by comparing SexFS scores between people who had and had not talked to a doctor about sexual problems in the past year.

Results: The final set of 17 domains includes 11calibrated item banks, and 6 non-calibrated item banks. All domains were reevaluated and improved. New domains included Vulvar Discomfort with Sexual Activity-Clitoral, Vulvar Discomfort with Sexual Activity-Labial, Orgasm-Ability, Orgasm-Pleasure, Oral Discomfort with Sexual Activity, Oral Dryness with Sexual Activity, and Bother Regarding Sexual Function. Several domains (Interest in Sexual Activity, Orgasm, and Satisfaction) had significant DIF, but we were able to identify items in these domains without DIF. Concurrent and known groups validity was supported.

Conclusion: SexFS version 2.0 has several improvements over version 1.0: (1) expanded validity, (2) score norms for sexually active U.S. adults, (3) new domains, and (4) items that statistically work interchangeably for both genders and for individuals across levels of sexual activity. A U.S. Spanish translation is underway.

Disclosures:

Work supported by industry: no.

Impact of transobturator tape surgery on sexual function in female with stress urinary incontinence (#070)

O. Abdelwahab (Egypt)
show abstract

070

Impact of transobturator tape surgery on sexual function in female with stress urinary incontinence

Abdelwahab, O1; Habous, M2; Soliman, T1; Sherif, H1; Gehad, M1; Shamndy, M2; Mulhall, J3

1: Benha university, Egypt; 2: Elaj medical centers, Saudi Arabia; 3: Sexual & Reproductive Medicine Program, Memorial Sloan Kettering Cancer Center

Introduction: Sexual dysfunction is a common condition in females with stress urinary incontinence (SUI). The use of transobturator tape (TOT) has shown favorable clinical outcomes for treatment of SUI, however, the effect on female sexual function remains unclear.

Objectives: To study the effect of TOT used for treatment of female SUI on female sexual function.

Patients and Methods: From 2011-2013, 130 females with SUI underwent TOT surgery (outside in technique). Patients underwent history and physical examination, routine laboratory investigations and complete urodynamic study. All patients were evaluated using the Urogenital Distress Inventory Questionnaire (UDI6) and female sexual function index (FSFI) questionnaire (Arabic versions). 99 patients were sexually active and 31 were not. All patients were evaluated preoperatively and 6 months after TOT. All data collected, tabulated and statistically analyzed.

Results: The mean age of study group was 43.4 years. The mean duration of SIU was 2.5 years. The success rate, defined as cure and improvement was 96.2% (121 cured, 4 improved). Significant improvement in UDI-6 was observed (see Table). 91% of sexually active women achieved significant improvement in the sexual life and FSFI (see Table). No woman experienced postoperative dyspareunia.

Abstract 070

Conclusion: SUI has negative impact on the female sexual life and correction of SUI by TOT had a significant positive impact on sexual life.

Disclosures:

Work supported by industry: no.

Sickle cell disease in priapism: Disparity in care? (#071)

Trinity Bivalacqua (USA)
show abstract

071

Sickle cell disease in priapism: Disparity in care?

Joice, G1; Kates, M1; Sopko, N1; Hannan, J1; Bivalacqua, T1

1: Johns Hopkins School of Medicine, United States

Objectives: To determine the impact of sickle cell disease (SCD) on hospital outcomes among patients admitted for priapism.

Materials and methods: Using the Nationwide Inpatient Sample (NIS), a weighted sample of 12,547 patients was selected with a primary diagnosis of priapism from 2002 – 2011.  Baseline differences for patient demographics and hospital characteristics were compared between SCD and non-SCD patients.  Multivariate analysis was performed to identify the impact of SCD on length of stay (LOS), utilization of penile operations, blood transfusion, and cost.

Results:  The proportion of SCD patients was 21.5%.  SCD patients were younger, more often black, more likely to have Medicaid insurance and treated more frequently in Southern urban teaching hospitals.  SCD was a significant predictor of having a blood transfusion (OR 16.3, p <0.001), and an elongated LOS (OR 1.42, p <0.001).  SCD was associated with less penile operations (OR 0.40, p <0.001).  When SCD patients did have an operation, it was performed later in the admission (mean 0.87 days vs. 0.47 days, p <0.001).  SCD was not a significant predictor of increased cost (OR 1.02, p = 0.869).

Conclusions:  SCD patients represent a demographically distinct sub-group of priapism patients with different courses manifested by longer hospital stays and more blood transfusions.  Moreover, despite evidence that immediate treatment of priapism results in improved erectile function outcomes, SCD patients had less surgical procedures for alleviation of acute priapism events.

Disclosures:

Work supported by industry: no.

Erectile function and health-related quality of life after stroke (#072)

S. Cedres (Uruguay)
show abstract

072

Erectile function and health-related quality of life after stroke

Cedres, S1

1: School of Medicine, UDELAR, Uruguay, Uruguay

Background: Sexual problems and poor quality of life have been a common finding in chronically ill and physically disabled patients such as those with strokes. Previous studies have supported the association between stroke and erectile dysfunction (ED) (1).

Objective: To investigate the health related quality of life (HRQoL) and characteristics of sexual function in patients with stroke 6 month after the hospitalization and to look for the relation with: gender, marital status, severity and nature and topography of stroke, disability, depression and cognitive status.

Methods: Patients were evaluated 6 month after the stroke. HRQoL was measured through the SF-36 questionnaire. ED by the 5-item version of the International Index of Erectile Function . Severity of stroke through Canadian Stroke Scale, Nature and topography according to tomography findings, disability through Bartel Index, Depression according to Hamilton Scale and Cognitive Status through the Mini Mental State Examination de Foldstein.

Results: A total of 31 patients ages from 55 to 78 years were involved The severity of sexual dysfunction increased as the scores of the scales of the SF-36 decreased (chi(2)-test statistic; p<0.001). It was demonstrated a statistic relation (chi(2)-test statistic; p<0.001). between erectile dysfunction and the following characteristics: isquemic stroke, dominant lobule, depression (mild, moderate or severe) and disability (moderated or severe).

Conclusion: Our study findings revealed a great prevalence of ED in stroke patients. We found a clear pattern of negative association between self-perceived sexual function and HRQoL. Post-stroke rehabilitation care helps to improve it.

Disclosures:

Work supported by industry: no.

The reduction corporoplasty: The answer to the unlikely question, “Can you make my penis smaller?” (#073)

D. Martinez (USA)
show abstract

073

The reduction corporoplasty: The answer to the unlikely question, “Can you make my penis smaller?”

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

1: University of South Florida, United States

Objectives: Large and/or deformed phalluses secondary to hyperplastic/aneurysmal corpora can occur as a result of different pathological states. This is most commonly seen in recurrent priapism. It occurs secondary to blood pooling in the cavernous sinusoids with resultant hypoxemia, acidemia, and eventual cavernous smooth muscle necrosis with fibroblast proliferation, plaque formation, and collagen deposition. We present a surgical technique for the management of this morphologic sequela, the reduction corporoplasty.

Materials and Methods: A 17-year-old male with a history of sickle cell disease presented with a phallus that was “too large for intercourse”. The patient reported normal erectile function with masturbation, but inability to penetrate his partner due to the size and shape of his phallus. He had a history of three priapismic episodes since 10 years of age, each treated with irrigations in the emergency department. These episodes progressively led to the aneurysmal deformity of his phallus.  Further evaluation included an MRI, which revealed true aneurysmal dilatation of bilateral corpora cavernosa distally, with diffusely hyperplastic tunica. 

Results: The patient was taken to the operating room, and the penis degloved via a circumferential incision. Elliptical cuts were made over the lateral aspects of both corpora, incising a longitudinal ellipse of the aneurysmal corpora. These elliptical wedges of aneurysmal corpora were then removed, and healthy bleeding smooth muscle surrounded by a thick collagen rind was noted. The edges of the elliptical incisions were transversely closed, with 3-0 vicryl sutures in an interrupted, watertight fashion, with the aid of Allice clamps. The phallus was inspected for symmetry, cosmesis, and adequate reduction. The circumcision incision was closed and drains left in place. At the latest follow up of 6 months the patient reports normal erections and successful coitus.

Conclusions: Reduction corporoplasty was performed, and the patient reported intact erectile function without aneurysmal recurrence at 6 months postoperatively. We present this case, the subsequent successful treatment of this debilitating pathology with the surgical technique, reduction corporoplasty. The literature is currently scarce in providing a protocol for managing patients with corporal enlargement. Reduction corporoplasty can optimize sexual function while improving the cosmetic appearance of a deformed phallus such as the one discussed here. 

Disclosures:

Work supported by industry: no.

Preliminary validation of a new measure of oral discomfort with sexual activity: PROMIS-SA (#074)

K. Weinfurt (USA)
show abstract

074

Preliminary validation of a new measure of oral discomfort with sexual activity: PROMIS-SA

Bruner, D1; Flynn, K2; Lin, L3; Reese, J4; Weinfurt, K3; PROMIS Sexual Function Domain Group

1: Emory University, United States; 2: Medical College of Wisconsin, United States; 3: Duke University, United States; 4: Johns Hopkins University, United States

Objective: To develop and begin validation of a measure of oral discomfort with sexual activity (SA). A recent survey indicated that 84% of US adults engage in oral SA.  Some diseases, such as HPV+ head and neck cancers, are related to oral SA, and therapies to treat the disease have the potential to interfere with oral SA.  However, there is a dearth of research in this area, due in part to lack of validated measures.

Material and Methods: The psychometric characteristics of the PROMIS® Sexual Function and Satisfaction Measures were evaluated using data collected from the GfK KnowledgePanel®, a probability-based online panel designed to be statistically representative of the US population. Participants were administered an online survey of ~170 items, which included 11 items on oral discomfort (degree of physical discomfort in the mouth, including pain and/or irritation, during SA) and dryness (lack of saliva in the mouth during SA). Higher scores indicated greater discomfort/dryness. The overall sample was drawn in two phases: first, a nationally representative sample of adults (n=3967; 2281 men, 1686 women), and second, an oversample of individuals (men n=94; women n=133) with mouth discomfort during SA. Analysis of item response included only those who answered something other than “Never” to the item: “In the past 30 days, how often have you had any of the following during SA: dryness, pain, irritation, or other discomfort in your mouth?”

Results: 615 respondents fit inclusion criteria (376 males, 239 females). The unidimensional model fit well, except for significant local dependence among the 3 items about dry mouth—items that also had the lowest factor loadings in the 11-item set. Because dry mouth is an important aspect of oral problems, we created separate subdomains for oral discomfort (6 items) and oral dryness (3 items). The correlation between the subdomains was r = .60, p<.0001.  Cronbach’s Alpha for oral discomfort and dryness were .92 and .85, respectively.  Comparative Fit Index and Tucker-Lewis Index were .99 and .054 for the discomfort subdomain, and >0.99 and <0.01 for the dryness subdomain.

Conclusion: Both oral discomfort and dryness with sexual activity subdomains had excellent model fit.  The final 9-item PROMIS oral sexual activity measure may help fill an important gap in the science by facilitating assessment of an understudied issue.

Disclosures:

Work supported by industry: no.

Learning sexual medicine during undergraduate medicine course contribute to medical professionalism behaviour in medical students (#075)

José Carlos Riechelmann (Brazil)
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075

Learning sexual medicine during undergraduate medicine course contribute to medical professionalism behaviour in medical students

Riechelmann, J1; Castilho, F1; Cavanha, L1

1: Universidade Cidade de Sao Paulo (UNICID), Brazil

Objective: To evaluate the impact on medical education of students submitted to the first course of sexual medicine inserted into an official undergraduate medical curriculum in Brazil.

Method: Quali-quantitative analysis of discourse, by Lefevre’s “Collective Subject Discourse” (CSD) technique, applied on 154 written responses by 77 students chosen randomly from 400 students who completed the course of sexual medicine between August 2008 and December 2011, offered in the Medical Skills Module, in the sixth semester of a problem-based learning (PBL) medicine course. The module objective was to develop interdisciplinary clinical reasoning skills, taking the context of sexuality as a trigger. Each student answered two questions about their inner perceptions on skills to listening and talking: 1) about the sexuality of the patient, and 2) about their own sexuality. The answers were processed using appropriate software (Qualiquantisoft ®) for the quali-quantitative analysis of discourses and construction of the CSD.

Results: About the ability to listen to patients shall speak about their sexual problems, only 7 students (9.10%) expressed indifference, while 70 (90.9%) showed increased skill. Increased capacity to understand (diagnosis) and talk about the patient's sexual problem was reported by 65 (84.42%). Increased ability to speak about their own sexuality was perceived by 50 (64.94%). Qualitatively, the CSD obtained from central ideas of discourses shows: reduction of afraid to listen and talk about sex and decreased anxiety of working with the sexuality of patients after replacement of sexual myths by scientific knowledge. There was no reports of emotional troubles caused by the course. Feelings of rejection to the course and/or to the teacher were perceived by 4 students (5.19%).

Conclusion: The pioneering experience of learning sexual medicine during an official undergraduate degree in medicine in Brazil has produced at least two major impacts in medical education: 1) significant decrease in anxiety with sexual issues, including own sexuality, and 2) gains medical communication skills, improving the doctor-patient relationship, especially the ability to listen with empathy (not just hearing), the sexual discourse of the patient. This leads us to conclude that learning about sexuality during undergraduate medicine course can contribute significantly to the construction of medical professionalism behaviour in medical students.

Disclosures:

Work supported by industry: no.


14:00 - 15:30
Instructional course 6 - Sexual aspects of incontinence surgery in women

Location: Transamérica Auditorium
Chairs: Sue Goldstein (USA) & Gerson Lopes (Brazil)

Incontinence and overactive bladder

Irwin Goldstein (USA)

Fecal incontinence and sexual dysfunction

Susan Kellogg-Spadt (USA)

The effect of stress urinary incontinence and it's treatment on sexual function

Lior Lowenstein (Israel)


14:00 - 14:45
Workshop 11 - Management of priapism

Location: Ilhéus + Una Room
Chair: Fernando Facio (Brazil)

Epidemiology, physiopathology and diagnosis

Ricardo Munarriz (USA)

Management (medical/surgical) and outcomes

Fernando Facio (Brazil)


14:45 - 15:30
Workshop 12 - Building a prosthetics practice in the social media era

Location: Ilhéus + Una Room
Chair: Carlos Eurico Cairoli (Brazil)

Building a prosthetics practice in the social media era

Andrew Kramer (USA)


15:30 - 16:00
Coffee break

Location: Comandatuba Room 1

16:00 - 17:30
Round table 8 - How does the Pca risk factors affect TRT?

Location: Comandatuba Room 2+3
Chairs: Ernani Rhoden (Brazil) & Andrea Salonia (Italy)

TRT after radiation therapy for prostate cancer

Luca Incrocci (The Netherlands)

Why we must do TRT in symptomatic men after treatment of prostate cancer?

Abraham Morgentaler (USA)

When we should start TRT after a radical

Andrea Salonia (Italy)

How do I control (monitor) patients receiving TRT after prostate cancer treatment

Anthony Bella (Canada)

Is TRT safe to the prostate health?

Luiz Otavio Torres (Brazil)


16:00 - 17:30
Moderated posters 9 - Women's sexual medicine

Location: São Paulo Room
Chairs: Annamaria Giraldi (Denmark) & Sue Goldstein (USA)

Treatment paradigm for women with arousal and orgasmic complaints (#189)

Michael Krychman (USA)
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189

Treatment paradigm for women with arousal and orgasmic complaints

Krychman, M1; Kellogg, S2; Damaj, B3; Hachicha, M3

1: OBGYN, United States; 2: PHD,CRNP, CST, USA; 3: Innovous Pharmaceuticals

Objective:  Changes in latency and frequency with respect to orgasmic potential are common complaints for women with malignancies and or medical illness.  There is a lack of consensus with respect to treatment paradigm for FSAD and we attempt to present a comprehensive stepwise treatment protocol for FSAD.  

Methods & Materials: Presented here is a revised proposed paradigm for women with changes in arousal intensity and latency.  All patients undergo a comprehensive history and physical examination coupled with a psychosexual and relationship assessment. Hormonal laboratory testing is not mandatory and often done to confirm physical findings.  Patients with orgasmic intensity and latency changes are placed on the sexual arousal paradigm. The paradigm includes: monitoring and modification of potentially offending medications (SSRI, anti-hypertensive) education about sexual anatomy and physiology, self-stimulation with vibrators and Zestra® Feminine Arousal Oils. ZestraÒ has 3-5 minutes onset time and 45 minutes duration of efficacy. Topical hormonal agents including minimally absorbed local vaginal estrogen and testosterone creams may utilize as secondary agents, if not contraindicated. Identify Medications that may negatively impact sexual orgasmic response.    If medication induced FSAD is suspected, a dopamine agonist maybe added or one may suggest changing to a new antidepressant. A pre-coital “antidote” Phosphodiesterase Inhibitors (PDE5I) may also be considered.  Advanced compounded medications including a variety of combinations of: PDE5I, aminophylline, arginine, phentolamine and nitroglycerine maybe applied to clitoral tissues. Aggressive treatment of 5mg daily or precoital 10 mg dose of oral Tadalafil 30-45- minutes prior to coitus.  

Results: Presented is a comprehensive assessment and treatment paradigm to help address orgasmic latency and frequency.   

Conclusions: Orgasmic Intensity and latency are challenging sexual concerns and creative paradigms are needed to address these complex dilemmas

Disclosures:

Work supported by industry: yes, by Innovous Pharmaceuticals (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.

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A look at female masturbation: a cross sectional study in university women of the metropolitan area of Bucaramanga, Colombia (#191)

A. Mujica Rodriguez (Brazil)
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191

A look at female masturbation: a cross sectional study in university women of the metropolitan area of Bucaramanga, Colombia

Guarin Serrano, R1; Mujica Rodriguez, A2; Cadena Afanador, L1; Useche Aldana, B1

1: Colombia; 2: Brazil

Objective: Evaluate the prevalence of female masturbation in college students in the metropolitan area of Bucaramanga, Colombia.  

Material and Methods: A cross sectional study using a self-report questionnaire in a sample of college women, stratified by the size of the institution. We performed a descriptive and inferential analysis. The significance level was established at p<0.05.

Results: We surveyed 1038 women, whose median age was 20, IQR 4. The prevalence of masturbation was of 32.2% and only the 73.1% of them reach an orgasm by this stimulation. One in three women who do not masturbate reported anorgasmia. The activity of masturbation was more frequent in women over 35 years old, with a high socioeconomic strata, who studies and works independently, not religious, or catholic with a low or zero level of religiosity and who auto-identified as bisexual.

Conclusion: It is important to provide education to women from their self-knowledge of the body; with the purpose of improved their awareness about their sexuality and can fully enjoy it.

Disclosures:

Work supported by industry: no.

Risk factors for low sexual interest in young women in stable relationships (#192)

H. Fleury (Brazil)
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192

Risk factors for low sexual interest in young women in stable relationships

Fleury, H1; Abdo, C1

1: ProSex - Program of Studies in Sexuality, University of Sao Paulo Brazil

Objective: The aim of this study was a systematic review of sexual interest in young women in stable relationships.

Material and Method: A systematic literature review of publications reported on MEDLINE via Pubmed, from 1977 to 2013, was performed with the search terms: libido; sexual dysfunctions, psychological; and marital relationship.

Results: The literature search resulted in a total of 884 references. The filter “Adult: 19-44 years” limited to 553 references. Of these, 521 publications were excluded on the basis of their titles and abstracts. A total of 32 publications were included. Most of the articles reported high prevalence of low sexual interest in women from all ages. Younger women presented less sexual difficulties but more sexual distress (personal and relational) than older women. Relationship stability was inversely associated with sexual initiative frequency and partners’ satisfaction. Women dissatisfied with sexual frequency were also more likely to report lower sexual and relationship satisfaction. In stable relationships, sexual satisfaction was negatively correlated with conflict in the relationship, and women engaged in sex with no sexual interest more often than those in short-term relationships. Risk factors for this condition are: relationship stability, low affective satisfaction, and lower valuation of sexual life, medical conditions and their treatments. Some articles pointed that desire discrepancy between partners predicted women lower sexual satisfaction, and this discrepancy is more related to partners’ interaction than an individual problem. These women with low interest report distress because they perceive that this sexual interest decrease affects the partner. Some women attribute this decrease to the marriage institutionalization, over-familiarity with the partner and the de-sexualization of wife, mother, and professional roles.

Conclusions: Physiological, emotional, and sociocultural conditions and relational stability influence sexual interest in young woman in long-term relationships. The knowledge of risk factors for these aspects can contribute for successful treatment and counseling of the young couple.

Disclosures:

Work supported by industry: no.

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Association between alexithymia and female sexual self-efficacy in patients with sexual dysfunctions (#193)

Itor Finotelli Jr. (Brazil)
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193

Association between alexithymia and female sexual self-efficacy in patients with sexual dysfunctions

Finotelli Jr., I1

1: Paulista Institute of Sexuality (InPaSex), Brazil

Introduction: Alexithymia is characterized by the difficulty in identifying and describing 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 women sexual self-efficacy.      

Methods: Thirty (30) patients with sexual dysfunction, who have been treated in a private clinic in Sao Paulo, Brazil, were assisted. The ages vary between eighteen (18) and fifty-six years old (M=30.87; SD=9.28), fifty-seven percent (57%) were single, forty percent (40%) married and three percent (3%) divorced. The majority of eighty-seven percent (87%) of the participants had a Bachelor degree or equivalent. For this measurement, the Toronto Alexithymia Scale (TAS-26) and Sexual Self-Efficacy Scale - Female (SSES-F) that evaluate the sexual function and dimensions denominated as desire-arousal, penetration ability, solitary pleasure and sexual assertiveness, were used. The instruments were individually applied in the initial assessment observing the ethical compliance demanded in the research.       

Results: For associations between the instruments, moderate negative correlations were found for the total score and dimensions. It was observed that the ability to fantasize was the only dimension which was negatively connected in three dimensions to the sexual self-efficacy, in this case, desire-arousal, solitary pleasure and sexual assertiveness. This meant that the ability to fantasize creates favorable states for the manifestation of behaviors related to the expression of desire, openness to sexual stimuli and orientation of such stimuli, further on the possibility of obtaining sexual response in a solitary way.      

Conclusions: Related to alexithymia, the inability to fantasize maintains negative associations in the sexual self-efficacy in behaviors of expression of desire-arousal, both in dyadic sexual practices as in solitary ones. This association demonstrated an important influence of alexithymia in the sexual function, essentially in the initial stages of the tree-phase model of this function. This association can implicate in the clinical management of female sexual dysfunctions.

Disclosures:

Work supported by industry: no.

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Dyspareunia and sexual dysfunction following vaginal delivery in Thai primiparous women with second degree perineal tear: a prospective cohort study (#194)

C. Chayachinda (Thailand)
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194

Dyspareunia and sexual dysfunction following vaginal delivery in Thai primiparous women with second degree perineal tear: a prospective cohort study

Chayachinda, C1; Ungkanungdecha, A1; Veeragul, J1; Jisabai, J1

1: Faculty of Medicine Siriraj Hospital, Thailand

Female sexual dysfunction is increasingly prevalent throughout the whole pregnancy and declines after the delivery. Dyspareunia or sexual pain, a domain of sexual function, is very common among parous women; however, its role remains elusive. 

Objectives: To examine prevalence and associating factors of dyspareunia and to study sexual dysfunction at 3 months, 6 months, 12 months following vaginal delivery among Thai primiparous women with second degree perineal tear.

Materials and Methods: A total of 190 primiparous women with second degree perineal tear were invited into the study on Day 2 post-partum. Dyspareunia and sexual function were assessed among 93 women who came for 3-month visit by using the Thai version of Female Sexual Function Index (FSFI) and visual analogue scale (VAS). FSFI at ≤ 26.55 is considered as having sexual dysfunction. The 6-month and 12-month evaluations were performed by telephone interview. 

Results: The prevalence of dyspareunia at 3-month visit is 30.1% (mild degree 17.2%, moderate to severe degree 12.9%); and those of sexual dysfunction at 3- , 6- and 12-month visits are 66.6%, 28.7% and 14.9%, respectively. Among underweight women (BMI < 18.5 kg/m2), less weight gain appears to be associated with dyspareunia (11.8 ± 4.1 vs 15.4 ± 4.0 kg, p 0.020). After adjusting for age, husband’s age and partnership length, a maternal weight gain of < 14.5 kg (median weight gain) associates with reporting dyspareunia (aOR 3.64, 95% CI 1.33-9.98, p 0.012). Women without dyspareunia at 3-month visit tend to resume normal sexual function quicker than the other group.

Conclusion: Dyspareunia and sexual dysfunction are common conditions among Thai primiparous women with second degree perineal tear. A total weight gain of < 14.5kg appears to be a predictor of the dyspareunia at 3-month visit; and the occurrence is negatively predictive for the resumption of normal sexual function. Despite the spontaneous improvement of both conditions over time, intervention to minimize the sexual pain during the first 3 months may facilitate the return of sexual quality among this population.

Disclosures:

Work supported by industry: no.

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5 Alpha-reductase enzyme deficiency: A new pathophysiology of female hypoactive sexual desire disorder (#195)

Irwin Goldstein (USA)
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195

5 Alpha-reductase enzyme deficiency: A new pathophysiology of female hypoactive sexual desire disorder

Cohen, S1; Gagnon, C1; Minton, J1; Goldstein, I2

1: San Diego Sexual Medicine, United States; 2: Alvarado Hospital, United States

Objectives: Women with testosterone deficiency syndrome, as defined by the 2001 Princeton Consensus Conference, have persistent symptoms in mood, libido and fatigue in the presence of a low free testosterone with adequate estrogen status. Use of testosterone for treatment of hypoactive sexual desire disorder (HSDD) in women pre-supposes that cytoplasmic enzyme 5 alpha-reductase is functioning and converts free testosterone to the more active androgen dihydrotestosterone (DHT). This study examined a sub-group of women diagnosed with testosterone deficiency syndrome and HSDD who underwent 6 months of testosterone treatment, resulting in increases in total and calculated free testosterone values to the mid to upper tertile range.  These women, however, failed to have their symptoms of testosterone deficiency syndrome ameliorated, with persistent bothersome HSDD, and had no adverse events related to the increased testosterone, such as acne, facial hair or scalp hair loss. Dihydrotestosterone values were measured before and after testosterone treatment.

Methods: An IRB approved retrospective chart review was performed in 31 women examined between 2007-2014 presenting with persistent sexual symptoms despite being treated with testosterone.  Data collected included DHT, testosterone, sex hormone binding globulin and calculated free testosterone values, duration of use and of persistent side effects, and parametric data analysis of psychometrically validated questionnaires.

Results: Mean age was 47 +/- 16 years; mean pre-treated testosterone values were 18+/-6 ng/dl (range 6-82 ng/dl), mean free testosterone values 0.2+/-0.1 ng/dl (ideal value 0.8 ng/dl) and mean DHT values <5 ng/dl (range 4–22 ng/dl). After initial treatments with testosterone, sexual dysfunction persisted with mean treated testosterone values increased to 78+/-17 ng/dl and mean free testosterone values 0.9+/-0.2 ng/dl but mean DHT values remained low at 8+/-4 ng/dl.

Conclusions: A small subset of patients identified with persistent sexual dysfunction while on testosterone treatment, with normal or elevated total and free testosterone values had low DHT values.  The mechanistic hypotheses include persistent endocrine and epigenetic gene expression alterations of the 5AR enzyme. Symptoms have improved by increasing the serum DHT levels to the upper tertile of normal using low dose topical DHT (Andractim). Testosterone treatment is more complicated than just measuring total testosterone.

Disclosures:

Work supported by industry: no.

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Sexual practices and sociodemographic predictors: A population-based study in young women (#196)

V. Piassarolli (Brazil)
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196

Sexual practices and sociodemographic predictors: A population-based study in young women

Piassarolli, V1; Giraldo, P1; Bardin, M1; do Amaral, R1; Mira, T1; Benetti Pinto, C1; Beghini, J1; Polpeta, N1; Miranda, A2; Rett, M3

1: UNICAMP, Brazil; 2: UFES; 3: UFSE

Objective: The present study investigated the prevalence of  dyspareunia in a Brazilian community sample. In addition, the authors assessed the role of sociodemographic predictors in women's sexual practices.

Methods: Population-based study involving 474 Brazilian women with 18-44 years of age, living in Vitória – ES. The sample was stratified by the five regions and the respective Basic Health Units and randomized from the registry of the Family Health Program. After the draw, the residences were located by community health workers and together with research assistants previously trained invited women in their own homes after study objectives were explained. For data analysis we used the Fisher exact test considering significant with p values <0.05.

Results: The average age of participants was 31 years (SD ± 7.68), mostly working out (67%), Catholic (42%), 46% white and 37.3% married or living together with their partner. The frequency of vaginal intercourse 1 to 3x/week was 72.2% with no significant differences between categories of age, education level and family income. The prevalence of receiving oral sex was 67.5%, being statistically significant in younger women (<0.0001), low education level (<0.0001) and low income (<0.0002). In this same profile of women the frequency of dyspareunia was 47.7% and more significant in the group of women with low income and low education levels (0.0042, 0.0306), with 24.6% of penetration pain and 30.6% of deep dyspareunia. There was a minority of women practicing anal sex (23.3%) and no difference between the categories of sociodemographic variables was found.

Conclusions: Significant differences were found when comparing the sexual practices and sociodemographic characteristics among categories of age, education level and family income. Results also indicated that symptoms of dyspareunia and some sexual practices are a significant health concern in Brazil, suggesting that public policies should be developed to promote sexual health.

Disclosures:

Work supported by industry: yes, by FAPESP - São Paulo (no industry support in study design or execution).

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Profile of the female adolescents in use of combined oral contraceptives (#197)

D. Maranhão (Brazil)
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197

Profile of the female adolescents in use of combined oral contraceptives

Maranhão, D1; Bardauil, V1; Marina, M1; Cardoso, F1; Aldrighi, J1; Coelho, J2; Ribeiro, S2

1: Faculdade de Ciências Médicas da Santa Casa de São Paulo, Brazil; 2: Faculdade de Ciências Médicas da Santa casa de São Paulo

Objective: This study evaluated the profile of adolescents in use of combined oral contraceptives (COCs) through questionnaires and correlation of the acquired data.

Material and Method(s): A cross-sectional, descriptive, prospective and observational study was conducted through questionnaire answering with 41 girls, aged 12 to 17 years old, which had follow-ups in the Clinic of Pediatric and Adolescent Gynecology of Santa Casa Hospital in São Paulo, Brazil. All the questions made were concerning general characteristics of contraceptive use, knowledge of its functions, dialoguing with parents about sexuality and using barriers methods for prevention of sexually transmitted diseases (STDs). In addition, data such as age, adverse effects, time of administration and frequency of forgetfulness were also evaluated.

Result(s): From analysis, the reason for initiating the use of pill was menstrual irregularities in 55% of the patients. As for side effects (SE), 61% reported suffering negative SE and the classification of SE discomfort level  was directly proportional to age increase (r = 0,340 e p = 0,030).

93% of girls said to be true the sentence “There is a correct way for using COCs”, showing knowledge about the need of a proper use of hormone therapy. However, 76.2% of them had forgotten to take the pill at least once and 60% had reported they do not trust the usage of pill, alone, as a reliable contraceptive method.

The majority of parents was aware and was in favor of COC usage; therefore, omissions were rarely reported. Still, approximately 50% of patients denied receiving sexual orientation from parents, and among those receiving, almost half were exclusively maternal. Simultaneously, results showed that adolescents whose parents participated in sexual orientation showed statistically higher knowledge about the function of COCs (p = 0,042). Out of the total, 32% did not know that COC does not protect against STDs, and approximately 55% were unaware of its function.

Conclusion(s): The lack of knowledge by adolescents regarding the contraceptive function, despite and regardless of the broad access to media they have, arouses questions about the need for greater intervention of health professionals propagating information to this community during its crucial learning stage, promoting health care through prevention.

Disclosures:

Work supported by industry: no.

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The prevalence of dyspareunia in female urology clinic (#198)

Y. Sekiguchi (Japan)
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198

The prevalence of dyspareunia in female urology clinic

Sekiguchi, Y1; Maeda, Y2; Azekosh, Y1; Kinjo, M2; Fujisaki, A2; Nakamura, R2

1: Womens Clinic LUNA Group, LUNA Pelvic Floor Total Support Clinic, Japan; 2: Womenfs Clinic LUNA Group, LUNA Pelvic Floor Total Support Clinic, Japan

Objective: Integra theory 1) which is the development basis of Tension free Vaginal Tape (TVT) by P.P.Petros referred pelvic floor disorders were one of causes of dyspareunia. Pelvic floor disorders consist of stress urinary incontinence, overactive bladder and pelvic organ prolapse and so on which are treated in female urology clinic.  We conducted a study of the prevalence of dyspareunia in female urology clinic for researching the relation between pelvic floor disorders and dyspareunia.

Material and Method: 747 patients visited first between July 2010 and January 2014. They took the questionnaire included dyspareunia, chronic pelvic pain and lower urinary symptoms. .

Results: There were 105 patients (14%) had dyspareunia. The disease of the initial motive to come the clinic were chronic pelvic pain syndrome/ interstitial cystitis 37 (35.2%), urinary incontinence 15 (14.3%), acute cystitis 14 (13.3%), overactive bladder 12 (11.4%), pelvic organ prolapse 11 (10.5%), female sexual dysfunction 10 (9.5%), hematuria 3 (2.9%), nocturnal enuresis 2 (1.9%) and urinary calculi 1 (1%). Additionally people complained of back pain were 26 (24.8%), that of abdominal pain were 40 (38.1%) and that of pain in the vulva were 49 (46.7%).

Conclusions: 14% of dyspareunia in our study is same as the prevalence of dyspareunia in Europe. 2) It suggested that there were many potential patients with female sexual dysfunction in Japan. The 36.2% of pelvic floor disorders patients included stress urinary incontinence (14.3%), overactive bladder (11.4%) and pelvic organ prolapse (10.5%) has dyspareunia. It was equivalent the probability of dyspareunia with chronic pelvic pain syndrome/interstitial cystitis (35.2%).Therefore dyspareunia related to pelvic floor disorders may exist as same as that of chronic pelvic pain syndrome.

Disclosures:

Work supported by industry: no.

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Does parity affect the sexual function of pregnant women? Preliminary results (#199)

M. Ribeiro (Brazil)
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199

Does parity affect the sexual function of pregnant women? Preliminary results

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

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: Several factors may affect female sexual function during pregnancy. Our aim was to evaluate and compare the sexual function of nulliparous versus multiparous pregnant women.

Patient and Methods: Cross-sectional study conducted between March 2012 and June 2014 at the antenatal clinic of a public teaching hospital. Up to the present, 114 healthy women between 14 and 40 weeks´ gestation were recruited:  55 were nulliparous and 59 were multiparous. The Female Sexual Function Index (FSFI) was used to assess sexual function. Women scoring ≤ 26 were classified as having sexual dysfunction symptoms. The Chi-square and Student’s t tests were used to compare variables between the two groups. P < 0.05 was considered significant.

Results: There were 71 2nd (14-28 weeks) and 43 3rd trimester (28 – 40 weeks) participants. The mean (standard deviation) gestational age of nulliparous and multiparas were similar for 2nd trimester (22.1 ± 2.1 and 21.9 ± 4.5 weeks, respectively) and 3rd trimester (34.5 ± 3.3 and 34.2 ± 3.6 weeks, respectively) participants. Socio-demographic characteristics were also similar. Mean final FSFI scores did not differ significantly between the two groups: 20.5 ± 11.0 vs 22.3 ± 10.1 (p=0.475) for nulliparous and multiparous 2nd trimester participants and 22.1 ± 10.7 vs 25.5 ± 9.6 (p=0.280) for nulliparous and multiparous 3nd trimester participants. A total of 32 nulliparous women had sexual dysfunction symptoms (FSFI score ≤ 26) compared to 23 multiparous pregnant women (58.2% x 40.0%, p=0.060).

Conclusion: According to our preliminary results, the prevalence of sexual dysfunction symptoms, as measured by the FSFI questionnaire, is similar among nulliparous and multiparous pregnant women during the 2nd and 3rd trimesters of pregnancy.

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

Disclosures:

Work supported by industry: no.

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Evaluation of sexual function and mood in women with stress urinary incontinence (#200)

Lucia Lara (Brazil)
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200

Evaluation of sexual function and mood in women with stress urinary incontinence

Romão, A1; Lara, L1; Brito, L1; Franceschini, S1; Yamaguti, E1; Rosa-e-Silva, A1; Gorayeb, R1

1: Faculty of Medicine of Ribeirão Preto, Brazil

Objectives: To evaluate the sexual function and mood of women under treatment for urinary incontinence (UI).

Material/Methods: This was a pilot study conducted at the Urogynecology Outpatient Clinic of the University Hospital of Faculty of Medicine of Ribeirão Preto, São Paulo University. Forty five incontinent women were included. Records of sociodemographic data were obtained. The Female Sexual Function Index (FSFI) was used to assess Sexual Function, with a score ≤ 26.55 considered to indicate a risk for sexual dysfunction. The Hospital Anxiety and Depression Scale (HAD) was used to assess mood, with a score > 8 indicating a risk for anxiety and a score > 9 indicating a risk for depression.

Results: All 45 women with a mean age of 48±12.54 years (24-79) completed the two instruments. The mean education level was 7 ± 3.94 years. The analysis of social variables indicated that most women, 29 (64.5%), were Catholic, 23(51%) had no type of remuneration, the mean family income was $ 739.6± 456.5, and 35 (77.8%) were married. The mean relationship time was 21.36 ± 14.83 years (0-56), and the mean number of children was 2.9±1.7.  Regarding sexual function, 33 (73%) had FSFI scores < 26.55. Regarding the type of sexual dysfunction, 18 (40%) reported hypoactive sexual desire, 27 (60%) had arousal dysfunction, 19 (42%) had lack of lubrication, 24 (53%) reported anorgasmia, 22 (49%) had difficulty in engaging in sex, and 27 (60%) had pain during intercourse. Thirty-one women (69%) were at risk to develop anxiety and 23(51%) were at risk of depression.  There were positive correlations for depression with age (p=0.01) and arousal with schooling time (p=0.01). A negative correlations was observed for depression and schooling time (p=0.03), orgasm with income (p=0.006), anxiety and lubrication (p=0.005), and anxiety and satisfaction with the relationship (p=0.02).

Conclusion: Women with UI were at high risk to develop sexual dysfunction and mood disorders. A characterization of these disorders is necessary, as well as multidisciplinary approach for the treatment of these women.

Disclosures:

Work supported by industry: no.

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Sexual function of women under treatment for infertility (#201)

Lucia Lara (Brazil)
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201

Sexual function of women under treatment for infertility

Salomão, P1; Romão , A1; Reis, R1; Navarro, P1; Lerri, M1; Rosa-e-Silva, A1; Ferriani, R1; Lara, L1

1: Faculdade de Medicina de Ribeirão - Universidade de São Paulo (FMRP-USP), Brazil

Objectives: This study aimed to investigate the impact of infertility and the process of assisted reproduction (ART) on female sexual function and to assess the emotional state of infertile women.

Methods: Female sexual function was assessed by the female sexual function index (FSFI) and the Anxiety and Depression Scale (HAD) was used to assess the emotional state of these women.

Results: A total of 109 women aged on average  34.62±4.04(22-42) years participated in this study. Eighty- one (74.30%) were married and 28(25.70%) were in a stable relationship. Eighty-eight (80.73%) were employed. The average length of relationship was 12.03±4.66(2-24) years. The average age at first intercourse was 18.01±3.41(13-33) years, and 69(63.30%) had sexual intercourse 2-3 times/week. Primary infertility was diagnosed in 79(72.48%), and 30(27.52%) had secondary infertility. Seventy-six (69.72%) were nulliparous and 33(30.28%) had had one or more pregnancies. Only 6(5.51%) were receiving psychotherapy. The total score for FSFI was less than 26,55 for 41 (37.62%)  women. The analysis of each FSFI domain showed 37(33.94%) women with hypoactive sexual desire, 21(19.26%) with arousal dysfunction, 13(11,92%) with lack of lubrication, 15(13.76%) with orgasmic dysfunction, 10(9.17%) with lower satisfaction, and 14(12.84%) reported coital pain. Concerning psychological aspects, 38(34.87%) were at risk of anxiety, and 16(14.68%) at risk of depression. Both excitation and lubrication were negatively correlated with the length of the relationship (p=0.004 and p=0.006, respectively). There was a positive correlation between pain and length of relationship (0.004); age (p=0.005), and lubrication and also a positive correlation between excitation and age at first intercourse (p=0.005).

Conclusion: The prevalence of sexual dysfunction in this sample is lower than in the general Brazilian population (49%), suggesting that the diagnosis and treatment of infertility did not impact on sexual function in this population. However, sexual desire disorder was more prevalent in this population. A long-term relationship is a causal factor for lubrication and arousal disorder. This work may guide health professionals to assist infertile couples so that they have a better quality of life.

Disclosures:

Work supported by industry: no.

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Sexual complaints of women diagnosed with breast cancer (#202)

Lucia Lara (Brazil)
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202

Sexual complaints of women diagnosed with breast cancer

Tiezzi, M1; Romão, A1; Tiezzi, D1; de Andrade, J1; Carrara, H1; Lara, L1

1: Faculty of Medicine of Ribeirão Preto, Brazil

Background / Aims: Breast cancer is a malignancy that affects more women in the population. The quality of life can be affected in a general way, involving psychological, sociological, emotional and sexual. Therefore, the objective of this study is to evaluate the sexual complaints and mood in women diagnosed with breast cancer treated at a general hospital.

Material / Methods: This is a pilot study, which evaluated 54 women diagnosed with breast cancer. For evaluation of the Sexual Function was used Female Sexual Function Index (FSFI) with scores ≤ 26.55 regarded risk to sexual dysfunction and mood report used the Hospital Anxiety and Depression Scale (HAD) is the score> 8 meant risk for anxiety and > 9 meant that risk for depression and protocol epidemiological and clinical data.

Results: The mean age of patients was 47.5 ± 8.75 [38-67] years, 48 (88,9%) were white. The average years of education was 7.15 ± 3.83 [2-18] years, the median of family income was $ 1,109.84 ± 1,217.39 [869.50-2,321.33-], the average length of relationship was 20.69 ± 13,23 [0-52] years, the average number of children was 2.3 ± 1,33 [0-6]. Regarding sexual functioning, 43 (79,6%) showed FSFI score ≤ 26,55. Among women who scored FSFI ≤ 26,55, the hypoactive sexual desire disorder was prevalent in 15 (27,8%), 17 (31,5%) had arousal dysfunction, 5 (9,3%) showed lack of lubrication, 12 (22,3%) had anorgasmia, 29 (64,4%) showed difficulties in sexual relationship, and 8  (14,8%) had pain. Considering all sample, 10 (18,5%) women had HAD scores > 9 for the depression domain and 21 (38,9%) women were at a risk for anxiety.

Conclusion: In this pilot study, women with breast cancer are at high risk for sexual dysfunction and anxiety as well as difficulties in sexual relationship. This condition may negatively impact interpersonal relationship and quality of life.

Disclosures:

Work supported by industry: no.

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Prevalence of sexual complaints and epidemiological profile of women with polycycstic ovary syndrome (#203)

Lucia Lara (Brazil)
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203

Prevalence of sexual complaints and epidemiological profile of women with polycycstic ovary syndrome

Lara, L1; Romão, A1; Gorayeb, R1; Tiezzi, M1; Reis, M1; Pandochi, H1; Rosa-e-Silva, A1

1: Faculty of Medicine of Ribeirão Preto, Brazil

Introduction/Objectives: Sexuality is a complex process involving biological, psychological and interpersonal determinants. Impairment of any of these dimensions may interfere with sexuality. Patients with Polycystic Ovary Syndrome (PCOS) presenting biopsychosocial changes may have impaired sexual function. Thus, the objective of the present study was to assess the prevalence of sexual and mood complaints and the epidemiological profile of women under treatment for PCOS at a Teaching hospital in the interior of the state of São Paulo.

Material/Methods: The Female Sexual Function Index (FSFI), Hospital Anxiety and Depression Scale (HAD) and a protocol involving epidemiological and clinical data were used to evaluate the women. The instruments were analyzed according to the criteria established by the authors of the Portuguese version.

Results: A total of 101 women were evaluated. Mean age was 31.41 ± 8.32 years [19-50], mean schooling was 11 years ± 4.48 [4-18], mean family income was US$ 763.00 ± 383.90 [173.91 - 1,739.13], mean duration of relationship was 7 ± 8.21 years [0-31], mean number of children was 0.9 ± 1.09 [0-4], and mean BMI was 28.35 ± 7.67 [16.87-49.72]. Most women, 73 (72%) were catholic, and 67 (66.4%) were married. Sixty-six (65%) had a paid job. Fifty six (55%) women had a total FSFI score with a cut-off point of < 26.55. The results for the specific domains were as follows: 40 (39%) had hypoactive sexual desire, 45 (44%) had arousal dysfunction, 32 (32%) had lack of lubrication, 37 (37%) reported anorgasmia, 34 (34%) had difficulties with sexual relations, and 35 (35%) had pain.  Regarding mood disorders, 63 (62%) of the women were at risk for anxiety and 41 (41%) were above the cut-off point 9 for depression.

Conclusion: Results of this study provide evidence that PCOS women are at high risk to develop sexual dysfunction and mood disorder.

Disclosures:

Work supported by industry: no.

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16:00 - 17:30
Instructional course 7 - Non surgical, non pharmacological treatment of ED

Location: Transamérica Auditorium
Chairs: Julio Ferrer (Colombia) & Hartmut Porst (Germany)

Future targets

Arthur Burnett (USA)

Neuromodulating agents

Arthur Burnett (USA)

Vacuum erection therapy: 2014 update or simply vacuum erection therapy

Hossein Sadeghi-Nejad (USA)

LiSWT

Ilan Gruenwald (Israel)


16:00 - 16:45
Workshop 13 - Treatment paraphilias

Location: Ilhéus + Una Room
Chair: Veronica Delgado-Parra (Mexico)

Paraphilias: New concepts, cassification and treatment options

Eli Coleman (USA)

Paraphilic behavior complains to diagnostic claims

Oswaldo Rodrigues Jr. (Brazil)


16:45 - 17:30
Workshop 14 - Practical aspects of vaginal dilators

Location: Ilhéus + Una Room
Chair: Jacqueline Brendler (Brazil)

Practical aspects of vaginal vibrators and dilators

Annamaria Giraldi (Denmark)

Clinical implications for vibrators, dilators

Michael Krychman (USA)