Thursday 9 October 2014

Session type:
Person:
Clear filters

Morning

07:45 - 08:30
Sponsored symposium

Location: Comandatuba Room 2+3

08:30 - 09:00
Master lecture 1 - Delayed ejaculation/Anorgasmia

Location: Comandatuba Room 2+3
Chairs: Miguel Rivero (Argentina) & Ege Can Serefoglu (Turkey)

Delayed ejaculation/Anorgasmia

Emmanuele Jannini (Italy)


09:00 - 09:30
Master lecture 2 - Sexual consequences of STI's

Location: Comandatuba Room 2+3
Chairs: Adrian Momesso (Argentina) & Yacov Reisman (The Netherlands)

Sexual consequences of STI's

Philip Kell (United Kingdom)


09:30 - 10:00
Master lecture 3 - Infertility and sexuality: Effect on the couple

Location: Comandatuba Room 2+3
Chairs: Victoria Bertolino (Argentina) & Natalio Cruz Navarro (Spain)

Infertility and sexuality: Effect on the couple

Lucia Lara (Brazil)


10:00 - 10:30
Coffee break

Location: Comandatuba Room 1

10:30 - 11:00
Point counterpoint 1 - Is there a true association between BPH/LUTS and ED?

Location: Comandatuba Room 2+3
Chairs: Edgardo Becher (Argentina) & Archimedes Nardozza (Brazil)

Pro

Anthony Bella (Canada)

Con

Andrea Salonia (Italy)


10:30 - 11:30
Moderated posters 1 - ED surgical

Location: São Paulo Room
Chairs: Laurence Levine (USA) & Ronny Tan (Singapore)

Does early insertion of a malleable prosthesis still allow later upsizing of cylinders in patients with ischaemic priapism? (#101)

F. De Luca (United Kingdom)
show abstract

101

Does early insertion of a malleable prosthesis still allow later upsizing of cylinders in patients with ischaemic priapism?

De Luca, F1; Zacharakis, E2; Kuehhas, F1; Spilotros, M1; Garaffa, G1; Raheem, A1; Ralph, D1; Muneer, A3

1: St. Peter's Andrology Centre and Institute of Urology, University College London, London, United Kingdom; 2: Guy’s Hospital, King’s College London; 3: University College London, London, United Kingdom

Objective: The aim of this study was to assess whether a delayed exchange to an inflatable implant allows upsizing of the cylinders in patients who have undergone early insertion of a malleable prosthesis for refractory ischaemic priapism

Material and Methods: Over a 30 month period 10 patients with ischaemic priapism underwent an early (within 2 weeks) insertion of a malleable (Coloplast Genesis®) penile implant. The mean age was 41.3 years (range 26-58yr) and the mean duration of priapism was 188 h (range 98-336 h). The aetiology was sickle cell disease (2 patients), idiopathic (4 patients), intracavernosal injection(1 patient) and antipsychotic agents (3 patients). Following a median period of 130.5 days (range 85-157 days) all of these patients underwent exchange of the malleable implant to a 3 piece inflatable (AMS 700® or Titan Coloplast®) prosthesis. The size of the cylinders was recorded at each operation and compared.

Results: At the time of exchanging from a malleable to inflatable, a median upsize in the length of the cylinders of 1 cm in either one or both corporal bodies (range 0-3 cm) was recorded. Although 5 patients had deliberate downsizing at the initial operation due to a previous Winter or T shunt or both. The mean IIEF-5 score prior the first operation was 24 (range 20-25). Three months after the initial insertion of malleable penile implant the satisfaction rate according to the IIEF-5 score was 80%. Three months following the exchange the patient satisfaction rate increased to 90%.

Conclusion: Insertion of a malleable penile prosthesis is an acceptable option for patients with refractory ischaemic priapism. Upsizing of the cylinders is still possible regardless of deliberate cylinder downsizing or whether the cylinders have been sized to the corporal tips.

Disclosures:

Work supported by industry: no.

Concomitant IPP and Virtue® Male Sling placement utilizing a single incision (#102)

H. Ayoub (USA)
show abstract

102

Concomitant IPP and Virtue® Male Sling placement utilizing a single incision

Ayoub, H1; Wang, R2; Westney, O1

1: MD Anderson Cancer Center, Houston, USA; 2: UTHealth, Houston, USA

Purpose: We sought to describe an alternative technique for placement of an inflatable penile prosthesis (IPP) and a quadratic male bulbourethral sling (Virtue®) through single perineal incision. Our group previously reported on concomitant implantation of an IPP and two-arm transobturator male sling through a single perineal incision. We herein report on a technique adapted to the Virtue® male sling for the treatment of post prostatectomy incontinence and erectile dysfunction.

Methods: IPP insertion proceeds through a 4cm perineal incision with dissection of the perineal-scrotal fat until both corpora cavernosa are identified and Buck’s fascia is uncovered bilaterally. A 1.5 cm vertical corporotomy is performed between four 2-0 PDS pre-placed stay sutures in each corporal body. Proximal and distal dilation followed by corporal measurements are completed in the standard fashion and the corresponding cylinders are implanted. After closure of the corporotomies, the transversalis fascia at the external inguinal ring is perforated inferior and medial to the spermatic cord with Metzenbaum scissors through the same perineal incision, which can be further extended should the external ring prove difficult to reach. The reservoir is then placed with a rubber-coated ring forceps in the space of Retzius which is developed bluntly with an index finger with the aid of a baby Dever retractor. The pump is then placed in the left dependent scrotal dartos pouch, with standard tube connecting. 

The Virtue® sling placement then follows after adequate exposure of the bulbospongiosus muscle is completed. While preserving the muscle, dissection is carried bilaterally to identify the inferior rami. 2-0 Prolene figure-of-eight afferent limb anchoring stitches are placed into the periosteum of the inferior rami bilaterally.  The transobturator arms are passed using a J hook introducer to a previously marked location 2 cm inferior to the adductor longus tendon. The pre-pubic arms are brought through skin 2 cm above the symphysis pubis and lateral to the midline bilaterally.  The afferent limb sutures are brought through the mesh just superior to the intersection of the mesh body and afferent limbs. The sling is then tensioned under cystoscopic guidance providing both direct compression and urethral elevation.

Conclusions: Concomitant placement of an IPP and virtue male bulbourethral sling is an efficient and safe for the simultaneous treatment of post prostatectomy incontinence and impotence. The utilization of a single incision is a novel approach for dual implantation of these devices and may decrease the recovery time by eliminating the penoscrotal incision.

Disclosures:

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

show poster

Venous leakage treatment revisited-pelvic venoablation using aethoxysclerol under air block technique and valsalva maneuver (#103)

R. Herwig (Austria)
show abstract

103

Venous leakage treatment revisited-pelvic venoablation using aethoxysclerol under air block technique and valsalva maneuver

Herwig, R1; Sansalone, S2

1: Vienna International Medical Clinic, Vienna, Austria; 2: Dept of Experimental Medicine and Surgery University Tor Vergata, Rome, Italy

Objective: We evaluated the effectiveness of pelvic vein embolisation with aethoxysclerol in aero-block technique for the treatment of impotence due to venous leakage in men using sildenafil for intercourse. The aim of the procedure was to reduce or eliminate the use of sildenafil.

Methods: A total of 49 patients with veno-occlusive dysfunction, severe enough for the need of PDE5 inhibitors for vaginal penetration, underwent pelvic venoablation with aethoxysklerol. The mean patient age was 53.5 years. Venous leaks were identified by Color Doppler Ultrasound after intracavernous alprostadil injection. Under local anesthesia a 5F-Angioport was inserted antegrade into the deep dorsal penile vein. The pelvic venogram obtained with deep dorsal venography was included. Aethoxysklerol 3% as sclerosing agent was injected after air-block under valsalva manoeuver in three consecutive steps. A 5F-angiography catheter was placed in the vein of major outflow from the penis. Success was defined as the ability to achieve vaginal insertion without the aid of any drugs, vasoactive injections, penile prosthesis, or vacuum device. Additionally, a prae- and posttherapeutical IIEF-5 score was performed.

Results: At a 12 month follow-up 40 out of 49 patients (81.63%) reported to have erections sufficient for vaginal insertion without the use of any drug or additional device. 4 (8.16%) patients did not report any betterment.

Follow up Color Doppler Ultrasound revealed a new or persistant venous leakage in 8 (16.33%) of the patients. No serious complications occurred.

Conclusions: Our new pelvic venoablation technique using aethoxysklerol in air-block technique was effective, minimally invasive, and cost-effective. All patients were able to perform sexual intercourse without the previously used dosage of their PDE5 inhibitor. This new method may help in patients with contra-indications against PDE5 inhibitors, in patients who can not afford the frequent usage of expansive oral medication or those who do not fully response to PDE5-inhibitors.

Disclosures:

Work supported by industry: no.

Initial experience with inverted-Y reduction scrotoplasty: A technique for management of the excess scrotum during placement of inflatable penile prosthesis (#104)

D. Martinez (USA)
show abstract

104

Initial experience with inverted-Y reduction scrotoplasty: A technique for management of the excess scrotum during placement of inflatable penile prosthesis

Emtage, J1; Martinez, D1; Yang, C1; Baumgarten, A1; Hakky, T1; Parker, J1; Carrion, R1

1: University of South Florida, United States

Objectives: Erectile dysfunction is common and placement of inflatable penile prosthesis (IPP) is a urologic surgery that dramatically aids in the management of this condition. A number of individuals undergoing IPP placement have a severely redundant scrotum that can cause functional discomfort, pain or even limited cosmetic outcome post-operatively. We present our initial experience with a novel technique entitled ‘Inverted-Y reduction scrotoplasty’ for the management of the excess scrotum during simultaneous placement of IPP.

Materials & Methods: We perform IPP placement via a penoscrotal approach. A ventral phalloplasty is performed using our previously described method in order to remove the redundant penoscrotal web invariably found in these patients. The IPP is inserted using the standard, widely described protocol. We position the pump for the prosthesis in the most dependent portion of the scrotum after making a longitudinal incision through the dartos layer. For closure, we begin by performing an inverted-Y re-approximation of the dartos. The overlying skin is closed in the same fashion. The result is cephalad retraction of the scrotum and a resultant reduction in overall scrotal sac dimensions.

Results: At our institution, we have performed inverted-Y reduction scrotoplasty with simultaneous placement of IPP in a total of seven patients. After several months follow up, all patients have excellent cosmetic and functional outcomes. To date, there have been no known complications associated with the inverted-Y reduction scrotoplasty.

Conclusions: Inverted-Y reduction scrotoplasty is a safe and feasible technique that can be performed with simultaneous IPP placement to improve cosmesis and decrease functional discomfort and pain post-operatively. The added surgical time is minimal and our outcomes to date have been excellent. When added to IPP placement, this procedure can lead to improved quality of life for patients with concurrent erectile dysfunction and a redundant scrotum.

Disclosures:

Work supported by industry: no.

show poster

Surgeon selection for penile implant procedure remains internet driven (#105)

Andrew Kramer (USA)
show abstract

105

Surgeon selection for penile implant procedure remains internet driven

Kramer, A1

1: University of Maryland School of Medicine, United States

Objective: The goal of the study is to understand the evolving patient-centered selection process of penile implant surgery. Patients with erectile dysfunction who are considering implant surgery increasingly utilize internet, phone consultation, referrals, word of mouth, and logistical considerations, but the priority placed in each of these methods remains to be studied and analyzed.

Materials and Methods: Surveys were used with 300 consecutive patients in one practice between 1/7/10 and 6/1/14 to consider their choices with regard to surgeon preference. They were asked a series of questions to assess their decision process in choosing where to get the implant done, and asked whether they assessed one surgeon, or “shopped” and considered multiple surgeons. If several surgeons were considered, they were queried as to how the decision was made, and what was most influential in making that decision.

Results: Among survey respondents, 24% of patients considered one surgeon, overwhelming due to referral patterns and proximity to that practice. 76% considered multiple surgeons. Internet was the decisive factor in 68%, the most cited resource was Google, then YouTube as search engines. Forums were a 2nd internet influence, the most utilized were FrankTalk.com, then HealthBoards.com. The 3d largest internet influence was physician-rating sites, such as Healthgrades, Vitals, Wellness, and UCompareHealth.com. Next in importance to patients was physician personality based on phone consultation, in 16%. For the remainder, cost was a decisive factor in 8%, location in 6%, and word of mouth for 4%.

Conclusion: Physician selection is evolving as information is more accessible via the internet. The ability to create an internet presence and create patient comfort with phone calls remains most influential to patients in choosing an implant surgeon.

Disclosures:

Work supported by industry: no.

Maximal penile length and girth restoration combined with penile prosthesis implantation without grafting: “the modified sliding technique” (#106)

F.E. Kuehhas (Austria)
show abstract

106

Maximal penile length and girth restoration combined with penile prosthesis implantation without grafting: “the modified sliding technique”

Kuehhas, FE1; Egydio, P2

1: Medical University of Vienna, Austria; 2: Centre for Peyronie’s Disease Reconstruction, Sao Paulo

Objective: To present a modification of the so called “sliding technique” for the restoration of penile length and girth for patients suffering from penile shortening and erectile dysfunction.

Material and Methods: Between January 2013 and January 2014, 143 patients underwent our modified “sliding technique“ for penile length and girth restoration with concomitant penile prosthesis implantation without any graft. . All patients had severe ED associated with penile shortening with or without curvature, inability to have sexual intercouse and consecutive dissatisfaction with their sexual life.

Results: The mean age at the time of surgery was 56 years (range, 40- 72). The etiology of penile shortening and narrowing were: Peyronie´s disease, post radical prostatectomy, post brachytherapy and external radiotherapy, post intracavernous injection therapy, post penile fracture, post redo-hypospadias repair and post priapism in 53.8%, 14.7%, 7%, 21%, 2.1%, 0.7% and 0.7% of cases. Mean deviation of the penile axis was 45° (range, 0- 100). Postoperative hematoma were seen in 24.5% on the base of penile shaft however spontaneous absorption resolved without any additional drainage. Laminar superficial hematoma on pubic area was seen in the majority of the cases and absorption was seen in 2 to 3 weeks. Temporary partial glans numbness was reported in 5%, however it vanished with the course of the follow-up. Glans sensitivity, ability to achieve orgasm and ejaculation were preserved. The penile axis was straightened in all cases. Our approach led to a mean penile length gain of 3.1 cm (range, 2-7).  All patients resumed sexual intercourse and were able to perform satisfactory sexual intercourse. No penile prosthesis infection was observed.

Conclusion: Our modification of the “sliding technique” is safe and effective and are associated with reduced operative times, less cost and low infection rate.

Disclosures:

Work supported by industry: no.

Surgical technique for removal of retained rear tip extenders (#107)

M. Bickell (USA)
show abstract

107

Surgical technique for removal of retained rear tip extenders

Khurgin, J1; Bickell, M2; Garber, B3

1: Johns Hopkins Hospital, USA; 2: Einstein Medical Center, USA; 3: Hahnemann University Hospital, USA

Objective: Retained rear tip extenders (RTE) during inflatable penile prosthesis (IPP) explantation can be a problematic portion of the surgery. RTE removal remains an imperative step, as failure to remove all foreign material can compromise the success of future implantation. In an infected IPP, failure to remove a RTE may lead to continued infection. We review several techniques for RTE extraction, including the preferred technique of a high volume implant urologist at our institution.

Material and Methods: A thorough review of the literature was carried out, using keywords “Rear Tip”, “Rear Tip Extender(s)”, “Retained Component(s)” and “Technique” with “Penile Prosthesis” and “Penile Prosthetic”. We compared the findings in the literature to the surgical experience of a high volume implant urologist at our institution.

Results: Several surgical techniques have been described in the literature for the removal of RTE. These include: blind extraction with a Kelly forceps or similar instrument; cavernosal endoscopy with a flexible or semirigid cystoscope and alligator graspers; and use of a Brooks corporal dilator or similarly elliptically-shaped instrument to create a suction effect with the RTE. Our preferred technique uses a long nasal speculum deployed into the corporotomy, allowing direct visualization of the RTE. A long Kocher forceps is then used to extract the RTE. This technique has proved to be successful when other techniques have failed. In addition, it does not rely on a specific orientation of the RTE as other techniques do and causes minimal trauma to the surrounding tissue.

Conclusion: Removal of retained RTE during IPP explantation surgery is imperative. Several surgical techniques have been described in the literature. We detail our preferred technique, using a long nasal speculum for direct visualization and use of a Kocher clamp to grab and extract.

Disclosures:

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

The ED care pathway for patients considering penile implants (#108)

Chris Nelson (USA)
show abstract

108

The ED care pathway for patients considering penile implants

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

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

Objectives: The typical treatment algorithm for erectile dysfunction (ED) starts with a trial of phosphodiesterase type 5 inhibitors (PDE5i), followed by one or more “second line” therapy options such as Vacuum Erection Devices (VED) and/or injection therapy. Often it is only after all of these options fail that penile implants are given serious consideration. We conducted two patient research studies, in part, to explore the typical care pathway of patients exploring the option of a penile implant.

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

Results: On average, patients receiving a penile implant had been suffering from ED for 6-7 years.  Similarly, those patients considering an implant but not yet receiving one had been suffering for 5-6 years. The vast majority of men had tried a PDE5i (95%) and a second line treatment (65%), while reporting significant dissatisfaction with both a PDE5i (55%) and a second line treatment (75%).  Those men who had not received an implant tended to utilize more second line therapies. In the group of men in the second study who had implant surgery (n=31), 42% stated that they should have had the implant surgery earlier.

Conclusions: The ED care pathway can be a long and frustrating journey for patients and their partners.  It is important for physicians to recognize the risk of treatment fatigue as patients move through a series of less than satisfying options before deciding on the more permanent and invasive implant solution.

Disclosures:

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

show poster

The prognostic factors for the efficacy of low-intensity shock wave therapy for erectile dysfunction (#109)

S. Hisasue (Japan)
show abstract

109

The prognostic factors for the efficacy of low-intensity shock wave therapy for erectile dysfunction

Hisasue, S1; China, T1; Ide, H2; Shirai, M1; Abdelhamed, A1; Matsushita, K1; Yamaguchi, R2; Muto, S2; Wakumoto, Y1; Tsujimura, A1; Horie, S1

1: Juntendo University, Japan; 2: Teikyo University, Japan

Objective; Phosphodiesterase type 5 inhibitors (PDE5i) revolutionized the treatment of erectile dysfunction (ED). However, even in vasculogenic ED patients, one fifth of them showed poor response to PDE5i. Recently low-intensity shock wave therapy (LI-SWT) has been reported to be effective in 60% of patients. The goal of this study is to evaluate the efficacy of LI-SWT and the prognostic factors for its efficacy for ED patients in Japan.

Material and Method; This study included 58 patients with ED history for more than 6 months, sexual health inventory for men (SHIM) score of ≤ 12 without PDE5i, erection hardness score (EHS) grade 1 or 2, mean penile circumferential change (MPCC) by erectometer assessing sleep related erection of <25mm, and non-neurological pathology. Patients were treated by a low energy shockwaves generator (ED1000, MEDISPEC, MD, USA); 3-minute application of 300 shock waves (intensity of 0.09 mJ/mm2) in 5 different anatomical sites of penis. After the baseline assessment, treatment was done twice a week for 3 weeks (6 times), no treatment for 3 weeks, and twice a week for 3 weeks (6 times) again. Total of 12 shock wave treatments were applied. SHIM score and EHS with or without PDE5i, MPCC were assessed at baseline, 1, 3, and 6 months following the termination of LI-SWT. Student’s t-test was used to assess the improvement of erectile function. Logistic regression analysis was done for the multivariate analysis for the efficacy of LI-SWT using the parameters of age, free testosterone level, body mass index, ED history, baseline MPCC, and comorbidities.

Result(s); Of 57 patients who assigned for LI-SWT trial, 56 patients were analyzed. Median age was 64 years and median ED duration was 3 years. One, 3 and 6 months after LI-SWT, each of SHIM and EHS with and without PDE5i were significantly increased (p<0.001). MPCC was also improved increased from 13.1 mm to 20.2 mm after LI-SWT (p<0.001). In the multivariate analysis, age and concomitant comorbidities number were the statistically significant predictors for the efficacy of LI-SWT.

Conclusion; The current study showed the efficacy and feasibility of LI-SWT for ED patients in Japan. The multivariate analysis for the efficacy of LI-SWT showed that age and concurrent comorbidities were significant predictors. Older ED patients with several comorbidities should be informed about the less responsiveness to LI-SWT before the treatment.

Disclosures:

Work supported by industry: no.

show poster


10:30 - 11:30
Podium 1 - Basic science

Location: Transamérica Auditorium
Chairs: Ganesan Adaikan (Singapore) & Julio Ferrer (Colombia)

Icariside II ameliorates erectile function in a rat model of bilateral cavernous nerve injury: Implications for activation of endogenous stem cells (#001)

Zhong Cheng Xin (China)
show abstract

001

Icariside II ameliorates erectile function in a rat model of bilateral cavernous nerve injury: Implications for activation of endogenous stem cells

Xu, Y1; Guan, R1; Lei, H1; Li, H1; Gao, Z1; Xin, Z1

1: Andrology Center, Peking University First Hospital, Peking University, Beijing, China

Objective: Activation of endogenous stem cells (ESCs) might help conservation intrinsic healing capacity of a healthy organism as well as rejuvenation of damaged erectile function. The aim of this study is to investigate the feasibility and mechanism of incariside II (ICA II) in the treatment of ED in a rat model of bilateral cavernous nerves (CN) injury.

Methods: sixty newborn male rats were intraperitoneally injected with 5-ethynyl-2-deoxyuridine (EdU; 50 mg/kg) for the purpose of tracking putative ESCs. Eight weeks later, forty-eight rats underwent CN crush injury and were randomized into gavage feeding of solvent (vehicle group), ICA II 0.5, ICA II 1.5 or ICA II 4.5 mg/kg/day. Twelve animals underwent sham surgery, received vehicle treatment and served as sham group. Treatment was continued for 4 weeks followed by a wash-out period of 72 h.

Results: Daily gavage feeding of ICA II resulted in a significant improvement of erectile function compared to vehicle group. ICA II treatment partially prevented schwann cell demyelination, SMC loss and collagen deposition in the penis. More EdU-positive cells differentiated into Schwann cells and MSCs in ICA II treated rats than in vehicle controls. In addition, the trend of p38 mitogen activated protein kinase (MAPK) MAPK activaty between groups was similar as that of EdU-positive cells. All these changes were caused by ICA II in a dose-dependent manner.

Conclusion: ICA II can ameliorate ED following CN injury by promoting regeneration of nNOS-positive nerves and SMCs in the penis. The underlying mechanism might be due to p38 MAPK activation which could prevent schwann cell demyelination and promote EdU-positive cells (putative ESCs) differentiation.

Disclosures:

Work supported by industry: no.

Cell stretching – The putative mechanism of penile traction; An in-vitro cellular analysis (#002)

L. De Young (Canada)
show abstract

002

Cell stretching – The putative mechanism of penile traction; An in-vitro cellular analysis

De Young, L1; Chung, E 2; Brock, G1

1: Canada; 2: Australia

Introduction: Penile traction therapy (PTT) has gained considerable popularity as a non-invasive treatment option in Peyronie's disease (PD), used to improve penile curvature and maintain penile length. The exact mechanism of action of penile traction devices remains unknown. Previously, work on penile plaque cells has shown that stretch induces a decrease in smooth muscle alpha-actin and an increase metalloproteinase 8 (MMP8). The effect of the stretching on extracellular matrix (ECM) components may play an important role on plaque remodeling.

Methods: The third passage of primary cell cultures derived from Peyronie's plaques were sub-cultured on BioFlex-ProNectin plate and the sub-confluent cells were exposed to A Flexecell FX-500 tension plus system sinusoidal strain of 18% at 1 Hz for 48 hours. Cell culture medium and cellular extracts were analyzed by enzyme-linked immunosorbent assay (ELISA) and Western blot for inflammatory cytokines, collagen, metalloproteinase, and tissue inhibitors of metalloproteinases (TIMPs) expression.

Results: The alteration of inflammatory cytokines IL-6, TGF-B, VEGF was measured among the stretched compared to non-stretched cells. Clear evidence of a treatment effect on these cytokines was measured, supporting a cellular basis to its action. Most striking was the alterations in MMP-8 and other MMP levels consistent with tissue remodeling.

Conclusion: This unique dynamic study of penile plaque-derived cells cultured in a mechanical environment provides strong evidence for the use of penile traction devices in Peyronie's disease appearing to facilitate plaque remodeling. Further work to define time course, extent of stretch and other parameters optimizing traction use, is currently ongoing.

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.

Hemolysis contributes to PDE5 dysregulation and priapism in sickle cell bone marrow transplanted mice (#003)

H. Matsui (USA)
show abstract

003

Hemolysis contributes to PDE5 dysregulation and priapism in sickle cell bone marrow transplanted mice

Matsui, H1; Sopko, N1; Hannan, J1; Hsu, L2; Berkowitz, D1; Champion, H3; Burnett, A1; Bivalacqua, T1

1: Johns Hopkins School of Medicine, United States; 2: University of Illinois, United States; 3: University of Pittsburgh Medical Center, United States

Objectives: Mechanisms responsible for “nitric oxide (NO) imbalance" in reference to deranged NO signalling, in sickle cell-associated priapism are not fully elucidated. We have hypothesized that reduction in endothelial-derived NO causes phosphodiesterase type 5 (PDE5) dysregulation and thus enhanced corporal smooth muscle relaxation and priapism.  Hemolysis that occurs in sickle cell anemia is associated with steady state increases in plasma cell-free haemoglobin, overproduction of reactive oxygen species (ROS) and endothelial dysfunction. Our objective was to determine if acute hemolysis would result in NO/cGMP/PDE5 dysregulation, overproduction of ROS, and thus cause priapism in a sickle cell bone marrow transplanted mice. 

Material and methods: Three groups were used: 1) wild type (WT), 2) sickle cell homozygotes (Sickle), and 3) WT mice transplanted with bone marrow (BMT) from Sickle mice which is known to cause direct hemolysis of blood and cause the mice to have a Sickle phenotype.  All groups underwent cavernous nerve stimulation (CNS) to assess erectile function. The frequency of erectile responses (erections/hr) pre- and post-stimulation was determined.  Penile constitutive nitric oxide synthase (NOS), protein kinase G (PKG) and PDE5 activities as well as ROS (luminol activity) generation were determined. 

Results: Erectile responses to CNS were significantly enhanced (P<0.05) in Sickle and BMT Sickle mice when compared to WT.  Sickle and BMT Sickle mice demonstrated spontaneous erections pre- and post-stimulation that were significantly (P<0.05) increased. Sickle and BMT Sickle mice had significant reductions in penile constitutive NOS, PKG, and PDE5 activities at a time when ROS generation was significantly increased (P<0.05) compared to values obtained in WT mice penes.  

Conclusions: The priapic activity in BMT Sickle mice can be attributed to NO/PDE5 dysregulation and is consistent with data obtained from transgenic Sickle mice.  The present data suggest that direct hemolysis of Sickle hemoglobin and thus overproduction of ROS generation may be an etiological causes of endothelial NO imbalance with direct effects on PDE5 regulation in the penis.  These molecular findings in a new animal model of BMT Sickle mice suggest that global dysregulation of endothelial-derived NO occurs in sickle-cell disease related priapism, further highlighting the importance of NO in maintaining penile vascular homeostasis.

Disclosures:

Work supported by industry: no.

Injection of BDNF transfected MSCs is a potential therapeutic measure for neurogenic erectile dysfunction (#004)

X. Wang (China)
show abstract

004

Injection of BDNF transfected MSCs is a potential therapeutic measure for neurogenic erectile dysfunction

Wang, X1; Shen, H2

1: Huashan Hospital, Fudan University, China; 2: Shanghai Key Laboratory of Forensic Medicine, Institute of Forensic Science, Ministry of Justice, Shanghai, China

Objective: To investigate the effect of intracavernosal injection with brain-derived neurotrophic factor (BDNF) transfected mesenchymal stem cells (MSCs) on the nerve regeneration and recovery of erectile function after cavernous nerve injury (CNI).

Material and Method: We established a stable MSC cell line that overexpresses BDNF. The expression levels of BDNF and Vascular endothelial growth factor A (VEGF-A) in the BDNF-MSC and MSC cell lines were detected by western blot. Elisa kits were used to estimate the BDNF and VEGF-A concentration in the cell supernatant. 120 SD rats of 3-month-old were divided randomly into 4 groups. Group1 had a sham operation without cavernous nerve manipulation. The other 3 groups underwent bilateral CNI. Group 2 (Control group) had no further manipulation. Group 3 (MSC group) and Group 4 (BDNF-MSC) were treated by intracavernosal injection with MSCs or BDNF transfected MSCs respectively before the abdomen was closed. Erectile function was assessed by cavernosal nerve electrostimulation 12 weeks after operation. The penile tissues were then collected for immunohistochemical staining to detect inducible nitric oxide synthase (iNOS) expression levels.

Results: The MSCs demonstrated a spindle-shaped morphology and green fluorescence detection showed that BDNF overexpression MSC cell line was successfully established. Western blot analysis indicated that both BDNF and VEGF-A increased in the BDNF-MSC cell line compared with MSC cell line. Compared with MSC, higher concentration of BDNF and VEGF-A was also detected in BDNF-MSC supernatant by enzyme-linked immunosorbent assay (ELISA). After nerve crushing, the functional evaluation of the control group at 3 months showed a lower mean maximal intracavernous pressure (ICP) with CN stimulation, at 35.47±13.16 cmH2O, than that of the sham group, at 102.20±15.61 cmH2O. Meanwhile, the ICP of BDNF-MSC group was significantly higher than the controls, at 66.04±15.33 cmH2O. Histological analysis with staining of iNOS showed a significant change in the morphology of penile smooth muscle cells. The number of positively stained penile smooth muscle cells tended to increase after treatment with BDNF-MSC.

Conclusion: Our study validates that intracavernous injection with BDNF-transfected MSCs can enhance the therapeutic effect of MSCs for the treatment of erectile dysfunction in an animal model.

Disclosures:

Work supported by industry: no.

Tadalafil ameliorates metabolic syndrome-induced alterations in visceral adipose tissue and liver: An experimental study in the rabbit (#005)

Mario Maggi (Italy)
show abstract

005

Tadalafil ameliorates metabolic syndrome-induced alterations in visceral adipose tissue and liver: An experimental study in the rabbit

Vignozzi, L1; Cellai, I 1; Comeglio, P1; Filippi, S2; Mello, T3; Morelli, A4; Galli, A3; Bani, D5; Maggi, M6

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 NEUROFARBA and of Experimental and Clinical Biomedical Sciences, University of Florence, Italy; 3: Gastroenterology 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: Department of Experimental and Clinical Medicine, University of Florence, Italy; 6: Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences University of Florence, Italy

Objective: Development of “brown-like” adipocytes within white visceral adipose tissue (VAT) has potential antiobesity effects. Genetic manipulation of cGMP formation suggests a role for this pathway in preadipocytes (PAD) commitment towards a brown phenotype. The aim of this study was to investigate the effect of tadalafil on metabolic syndrome (MetS)-induced VAT dysfunction.

Material and Method: We used a non-genomic, high- fat diet (HFD)-induced  rabbit model of MetS, with or w/o tadalafil  Rabbits fed a regular diet were used as controls.

Results: In HFD-induced rabbit model of MetS, in-vivo treatment with the PDE5 inhibitor, tadalafil (by increasing cGMP signaling), completely normalized HFD-induced increase of VAT mass and morphological alterations (adipocyte hypertrophy and hypoxia), triglycerides levels. Tadalafil also significantly increased brown adipocyte marker, UCP1, expression in VAT. HFD-induced increase in circulating level and liver expression of TNFα were also decreased by in-vivo tadalafil dosing. We then studied the adipogenic capacity of VAT preadipocytes (rPADs) isolated from rabbits fed a HFD (with or w/o tadalafil). Comparative gene expression analysis in rPADs demonstrated that in vivo tadalafil dosing dramatically increased the expression of genes related to brown-differentiation (UCP1, TMEM26, PGC 1β, BMP4, CIDEA) and mitochondrial biogenesis (TFAM, NRF1) in rPAD, whilst genes related to white adipocytes differentiation (HOXC9) were significantly reduced. Also in-vitro treatment with tadalafil, in HFD-rPAD induced the expression of genes related to brown differentiation  (UCP1, TMEM26). By using transmission electron microscopic images analysis in rPAD, we found that HFD-induced mitochondrial morphological abnormalities (reduced size, loss of mitochondrial cristae, an increased matrix density) were all counteracted by in-vitro tadalafil dosing.

Conclusions: Tadalafil dosing in a MetS rabbit model ameliorates liver and VAT MetS-induced alterations. This could reflect the ability of tadalafil to restore insulin sensitivity in VAT unable to finalize its storage function, counteracting MetS-induced liver alterations.

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.

Androgens positively regulate no-mediated relaxant pathway in rat clitoris (#006)

Mario Maggi (Italy)
show abstract

006

Androgens positively regulate no-mediated relaxant pathway in rat clitoris

Vignozzi, L 1; Filippi, S2; Cellai, I3; Comeglio, P 3; Corno, C3; Corcetto, F3; 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 Florence, Florence, Italy; 3: Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy

Objectives: Female sexual response is the result of a complex interplay between central and peripheral mechanisms . Hormonal regulation of female sexual excitement is poorly understood. To evaluate sex steroid regulation of the NO-dependent relaxant and RhoA/ROCK contractile pathways in clitoris.

Material and Methods: Subgroups  of  ovariectomized  rats were or left untreated or supplemented with estradiol, progesterone, testosterone (T) and T plus the aromatase inhibitor, letrozole. mRNA expression (qRTPCR)  of  genes of the relaxant NO-signaling,  and  genes of the contractile RhoA/ROCK pathway in clitoris.

Results:  In- vivo treatment with T increased clitoris eNOS, nNOS, sGC1a3, sGC1b3, PDE5, PKG1 mRNAs, that were all further increased by cotreatment with letrozole. T also increased ROCK2mRNA. E2-supplementation increased RhoA and ROCK2 expression. All NO-signaling genes, and ROCK2 resulted positively associated with T plasma level , while E2 level was positively associated with RhoA, ROCK2  and sGC1a3. When T and E2 (ROCK2 determinants at univariate analysis) were introduced as covariates in a multivariate model, only the association between E2 and ROCK2 was confirmed. To further investigate the effect of T and E2, in isolated rat clitoris smooth muscle cells (clitSMC) we studied migration, as a read-out of RhoA/ROCK activity. E2 increased clitSMC migration, and the selective RhoA /ROCK inhibitors. Also T increased clitSMC migration. Letrozole pretreatment abrogated T-induced migration. The non aromatizable androgen, DHT, reduced clitSMC chemotaxis even below untreated cells.

Conclusions: Our data demonstrate that T improves the NO-mediated signaling, whilst E2 stimulates the contractile RhoA/ROCK signaling in clitoris .

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.


10:30 - 11:15
Workshop 1 - Maximizing the potential of your abstracts and papers

Location: Ilhéus + Una Room
Chair: John Mulhall (USA)

How to write an attractive paper

John Mulhall (USA) & Alan Shindel (USA)

How to write an attractive abstract

Alan Shindel (USA)


11:00 - 11:30
Point counterpoint 2 - Persistent genital arousal disorder in women: Mental or Body

Location: Comandatuba Room 2+3
Chairs: Carmita Abdo (Brazil) & Annamaria Giraldi (Denmark)

Mental

Agnes Kocsis (United Kingdom)

Body

Irwin Goldstein (USA)


11:30 - 12:30
Podium 2 - Desire & arousal

Location: Comandatuba Room 2+3
Chairs: John Dean (United Kingdom) & Shari Goldfarb (USA)

Persistent genital arousal disorder (PGAD): Experience with management in 35 consecutive cases (#007)

Irwin Goldstein (USA)
show abstract

007

Persistent genital arousal disorder (PGAD): Experience with management in 35 consecutive cases

Gagnon, C1; Minton, J1; Goldstein, I2

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

Objectives: Persistent genital arousal disorder (PGAD) is a rare, unwanted and intrusive sexual dysfunction associated with excessive and unremitting genital arousal and engorgement without sexual interest, with no recognized safe and effective evidence-based treatment. Characteristics of women with PGAD were assessed. 

Methods: A retrospective clinical chart review was performed on the last 35 women assessed for PGAD.

Results: Women (age 46+/-18) had symptoms of PGAD for 17+/-16 years, appearing secondary to increased peripheral sensory afferent input and an under inhibited central sexual arousal reflex center falsely interpreting excess peripheral sensory information as sexual arousal, leading to spontaneous arousal, orgasm and a short refractory period post-orgasm. Conditions resulting in increased peripheral sensory afferent input: altered pre-menopausal hormone integrity, hormonally mediated provoked vestibulodynia; altered menopausal hormone integrity, genitourinary syndrome of menopause; increased nerve fiber density, genetic susceptibility with elevated levels of nerve growth factor substances; injury to or irritation of pudendal nerves transmitting pain and other sensations; abnormal response of tissues to Candida infection, recognized or non-specific allergies; lichen sclerosus or lichen planus; vulvar granuloma fissuratum; peri-urethral glans pathology; clitorodynia; pelvic congestion syndrome; S2 Tarlov cyst; high tone pelvic floor dysfunction. Reducing excess peripheral sensory input with sex therapy/counseling, pelvic floor, pharmacologic, device and surgical treatments, and increasing inhibitory regulation of the uninhibited central sexual reflex center kept the PGAD manageable.

Conclusions: PGAD is not so rare: an estimated 20% of healthcare providers at numerous sexual meetings have claimed caring for individuals with PGAD.  PGAD can be managed so that afflicted women have normal life quality. Patients diagnosed with PGAD and managed successfully are no longer suicidal or bothered/distressed after treatment(s).  PGAD seems to be caused by a combination of excess peripheral afferent stimulation from irritated genital, pudendal nerve, pelvic floor tissues or sacral nerve roots and a central sexual reflex that has limited central inhibition.  PGAD may be lifelong, some women do not know any other form of sexual arousal, or acquired after living many years with no hint of PGAD symptoms. The persistent genital arousal usually does not resolve with orgasm.  PGAD can also occur and be managed successfully in men.

Disclosures:

Work supported by industry: no.

Open cross-sectional study of the clinical types of sexual dysfunction, personality traits and psychological status in women with infertility (#008)

N. Stenyaeva (Russia)
show abstract

008

Open cross-sectional study of the clinical types of sexual dysfunction, personality traits and psychological status in 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 clinical types of sexual dysfunction, personality traits and psychological status in infertile women.

Material and Methods: A cross-sectional study of mental and sexual health was conducted in women with infertility. The inclusion criteria were primary infertility and the presence of sexual partner. The data of 157 patients within the main treatment group of infertility were assessed according to the ICD-10. Patients completed the Symptom Checklist 90-R (SCL-90-R), the Munich Personality Test (MPT) and the Female Sexual Functioning Index (Russian version) (FSFI). The control group consisted of 53 healthy women.

Results: There were revealed significant inverse correlation between association the pairs of domains the FSFI questionnaires and SCL-90-R: Desire – Obsessive-Compulsive (r = -0,2, p = 0,04), Desire - Interpersonal Sensitivity (r = -0,2, p = 0,045) , Desire - Depression (r = -0,3, p = 0,003), Desire - Psychoticism (r = -0,3, p = 0,004), Arousal - Obsessive-Compulsive (r = -0,2, p = 0,04) , Arousal - Depression (r = -0,2, p = 0,015), Arousal - Psychoticism (r = -0,2, p = 0,03), Orgasm - Depression (r = -0,2, p = 0, 04). There were revealed in the clinical group significant inverse correlation between associations of the pairs of domains the FSFI questionnaires and the MPT Desire – Extraversion (r=-0,2, p=0,049), Desire – Esoteric Tendencies (r=-0,3, p=0,003), Arousal - Frustration Tolerance (r=0,4, p=0), Arousal - Esoteric Tendencies (r=-0,2, p=0,036), Lubrication - Esoteric Tendencies (r=-0,3, p=0,003), Orgasm - Esoteric Tendencies (r=-0,3, p=0,005), Satisfaction - Esoteric Tendencies (r=-0,2, p=0,03), Pain - Orientation towards Social Norms (r=-0,2, p=0,045). There were also revealed significant direct correlation between associations of  the pairs of domains Desire - Frustration Tolerance (r=0,4, p=0), Arousal - Extraversion (r=0,24, p=0,01), Lubrication - Frustration Tolerance (r=0,2, p=0,03), Satisfaction – Extraversion (r=0,3, p=0,03).

Conclusions: The study showed that sexual dysfunction in the form of reduced desire, arousal, orgasm disorders in patients with infertility were associated with symptoms of depression, obsessive-compulsive, interpersonal isolation, or sensitivity, as well as with personal characteristics as esoteric tendencies, introversion, reduced tolerance to frustration. Dyspareunia phenomena were more pronounced at low orientation to social norms.

Disclosures:

Work supported by industry: no.

Sexual function in gender match after kidney transplantation (#009)

J. Herrera-Caceres (Mexico)
show abstract

009

Sexual function in gender match after kidney transplantation

Magana, J1; Herrera, J2; Gabilondo, B1; Hernandez, M1; Castillejos, R2

1: Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico; 2: Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán , Mexico

Objectives: To analyze sexual function among men and women after kidney transplantation by gender match in patients who received grafts from living donors.

Materials and Methods: Prospective study from March 2012 to May 2014. Using the Female Sexual Function (FSF) and the International Index of Erectile Function-15 (IIEF-15) questionnaires, sexual function was assessed in patients who received a kidney allograft from a living donor the day before surgery and every month after surgery for 6 months.

Results: After a 2 year follow up 54 patients were included.  At six months, we saw a significant difference in satisfaction (p=0.003) and excitation (p=0.055) in 16 women who received an allograft from men; they seem to have a better score in these areas when compared with other gender match groups.

Conclusions: Women who received a kidney allograft from men seem to have better satisfaction and excitation from baseline and compared with other gender match groups six months after surgery.

Disclosures:

Work supported by industry: no.

A randomized, single center, single-blind, crossover thermographic study to evaluate the effect of 1000 mcg of topical alprostadil cream compared to an over-the-counter marketed lubricant (#010)

Sue Goldstein (USA)
show abstract

010

A randomized, single center, single-blind, crossover thermographic study to evaluate the effect of 1000 mcg of topical alprostadil cream compared to an over-the-counter marketed lubricant

Goldstein, I1; Gagnon, C2; Minton, J2; Morris, D3; Goldstein, S2

1: Alvarado Hospital, United States; 2: San Diego Sexual Medicine, United States; 3: WebbWrites, United States

Objectives: Women have more sexual dysfunction than men, yet there are no FDA-approved drugs for bothersome sexual desire, arousal  or orgasm disorders.  Study drug efficacy for the treatment of peripheral genital arousal may be assessed by measuring improvement in genital blood inflow using a non-invasive technique such as Forward Looking InfraRed (FLIR) thermography.  Alprostadil is a vasoactive compound, increasing intracellular cAMP and activation of protein kinase A, resulting in genital smooth muscle relaxation, vulvovaginal vasodilation and enhanced genital secretion.  A prospective, randomized, single center, single-blind, crossover thermographic study was performed to evaluate the effect on peripheral genital arousal of 1000 mcg of topical alprostadil cream (Femprox) compared to an over-the-counter (OTC) lubricant.

Methods:  In this proof-of-concept study, 10 healthy premenopausal women (mean age 32+/-12 years) were topically administered study drug to their clitoris and anterior vaginal wall.  Continuous temperature monitoring of the vestibule, clitoris and vulva was conducted for 30 minutes before and 60 minutes post-application in subjects watching a non-sexual (travel) film. After each application subjects completed questionnaires assessing genital sensations and maximum intensity and duration of effect; adverse events were recorded.

Results: In all subjects topical alprostadil cream induced a statistically significant increase in temperature of the vestibule, clitoris and vulva relative to the OTC lubricant.  Sustained statistically significant treatment differences occurred at 11 minutes post-application for the vestibule, 19 minutes for the clitoris and 9 minutes for the vulva and maintained for the duration of the assessment.  Six of the ten women reported being aware/conscious of genital sensations with the topical alprostadil cream and not the OTC lubricant, consistent with concordance of physiological and subjective assessments.  Discordence was noted in 30% who reported being aware/conscious of genital sensations with both treatments and 10% who reported not being aware/conscious of genital sensations with either.  No adverse events were reported.

Conclusion: Topical alprostadil cream administered to healthy premenopausal women induced statistically significant sustained increases in genital temperatures of the vestibule, clitoris and vulva within 20 minutes relative to OTC lubricant.  Further studies are planned.

Disclosures:

Work supported by industry: yes, by Apricus Biosciences (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.

Female arousal and orgasmic complaints in a diverse cancer population treated with Zestra®: A topical applied blend of botanical oils (#011)

Michael Krychman (USA)
show abstract

011

Female arousal and orgasmic complaints in a diverse cancer population treated with Zestra®: A topical applied blend of botanical oils

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

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

Objective: Arousal and orgasmic changes are as a result of cancer treatments. Presently, there is no Food and Drug Administrative approved products presently available for female sexual orgasm dysfunction (FSOD) many troubled women opt for over the counter (OTC) products in an attempt to enhance orgasmic responsivity and improve sexual satisfaction.

Materials/Methods: We present a case series of 10 women who presented with self reported delayed arousal and poor orgasmic response and decreased orgasmic intensity.

Results: Patient demographics included median age of 55.4 years. The following malignancies were represented in this small case series: Breast, rectal, uterine, and ovarian  and lung. One woman was single and another was divorced whereas 8 were married. All women were sexually active with a functional partner. All patients were diagnosed with vulvar vaginal atrophy and were placed on local moisturizers and lubricants to help mitigate these symptoms. Four patients were on concurrent minimally absorbed local vaginal hormones (3 Estradiol cream, 1 DHEA suppositories). Seven out of 10 women had laboratory blood testing. Most women had normal hormones though the majority had testosterones in the lower one third. All women had estradiol levels in the menopausal range.  Patients were evaluated and assessed using a standardized protocol (previously described by a sexual medicine gynecologist. All patients reported efficacy with respect to improved intensity of orgasmic response, and decreased latency of time to orgasms after use of the non-prescription product, Zestra®, a proprietary blend of botanical oils and extracts, with subjective improvement in orgasmic intensity and decreased latency to orgasm for select patients. In addition all reported improved sexual satisfaction at the 4-week follow up visit.

Conclusion: Treatment for malignancy affects the genital arousal and orgasmic function. There are several OTC products that purport to improve sexual satisfaction for women. All women treated in this case series reported increased intensity of orgasmic response and decreased latency to orgasm with the use of Zestra ®, a mixture of arousal oils and extracts. Further randomized clinical trial study with standardized screeners and questionnaires with set endpoints is necessary to establish the generalizability of these preliminary case findings.

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.

The Viveve system is a non invasive treatment for vaginal introital laxity that improve sexual function in adult female subject (#012)

Michael Krychman (USA)
show abstract

012

The Viveve system is a non invasive treatment for vaginal introital laxity that improve sexual function in adult female subject

Krychman, M1

1: OBGYN, United States

Objective/ Introduction:  Many women suffer from sexual complaints as a direct result of changes in the integrity of vaginal introitus. The Viveve System is a safe effective treatment of the Vaginal Introital laxity that demonstrates improved sexual function in adult female subjects.

Material and Methods:  The Viveve System is a monopolar radiofrequency system that uses surface cooling and radiofrequency (RF) energy delivery to provide a non-surgical and minimally invasive approach to create heat within the submucosal layers of vaginal tissue while keeping the surface cool. During the Viveve Procedure™, coolant is delivered to the membrane of the Viveve treatment tip. The RF technology creates a reverse thermal gradient, which heats the deeper tissue at a higher temperature while the coolant protects the surface epithelium. The Viveve System consists of the following components: A Console containing the Radiofrequency Generator, a Cooling Module with Cryogen Canister Port, a Hand piece Assembly with attached cables, Treatment Tip, a Return Pad Electrode and a Cable. 

Results:  To date, over 414 tips have been sold, and over 300 procedures performed in approved areas (Canada, Japan and Hong Kong). In addition the procedure has CE mark and European approval.  Eight additional machines are presently on back order.  Initial clinical studies have shown safety and efficacy and further randomized sham controlled research  is  planned for this office based 20-30 minute  outpatient procedure  which is gaining popularity amongst health care professionals and women 

Conclusions:  The Viveve Procedure remains a viable treatment for women who have sexual complaints as a result of vaginal introital changes in the genitopelvic matrix.

Disclosures:

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


11:30 - 12:30
Moderated posters 2 - Basic science 1

Location: São Paulo Room
Chairs: Kwangsung Park (Korea) & Ricardo Reges (Brazil)

Hypoactive sexual desire disorder: Tibolone and Tribulus terrestris are really effective? (#110)

G. Silva (Brazil)
show abstract

110

Hypoactive sexual desire disorder: Tibolone and Tribulus terrestris are really effective?

Silva , G1; Lima, S1; Guazzelle, R1; P, S1; Yamada, S1; Martins, C1

1: Santa Casa de São Paulo Medical School, Brazil

Introduction: The hypoactive sexual desire disorder/low-sexual desire (HSDD) is a common complaint among women during the climacteric period and is thus frequently encountered in the primary care provider and OB/GYN practices. Causes of low sexual desire may be hormonal, neurologic, vascular, psychologic, or a result of illness/surgery or medications. Tribulus terrestris is a plant of India, recommended in the treatment of infertility, low libido and impotence in men. Tibolone, a synthetic progestin, have used in the treatment of climacteric complaints, with positive effects on sexual function and good tolerability.

Objective: To study the effects of Tribulus terrestris and Tibolone in post menopause women with HSDD.

Methods: This is a prospective, randomized, double blind study with 66 postmenopausal women with HSDD. Women were allocated randomly into three groups: Control Group (n = 20) received placebo; Tribulus group (n=22) received 750 mg/oral administration/day; and Tibolone group (n=24) 1.25 mg/oral administration/day. The Female Sexual Quotient (Quociente Sexual Feminino - QS-F) was applied to evaluate the sexual function, before and after 90 days of treatment. The women considered as being post-menopausal were those with amenorrhea ≥ 1 year and FSH ≥30mUI/mL. All patients signed a voluntary informed consent form prior to participating in this study, which was approved by the Medical Ethics Committees at the Faculty of Medical Sciences at Santa Casa de São Paulo and the Foundation for Research Support of the State of São Paulo (FAPESP).

Results: In Groups Control Tribulus all patients completed the study; in Tibolone Group four women did not complete it, three due to side effects. In Tribulus and Tibolone Groups there was a significantly improvement after treatment in all domain evaluated. In the Control Group there was improvement statistically significant in domains: desire and interest, and capacity of arousal; in relation to total score the Control Group presents lower statistic significantily. At baseline, all groups showed an unfavorable-regular pattern, and after 90 days treatment the Control Group kept the same pattern, Tribulus Group changed to a regular-good pattern and Tibolona Group to a good-excellent pattern.

Conclusion: There are only modest evidence-based no pharmacologic treatment options and no approved pharmacologic options for the treatment of HSDD. Tribulus terrestris and Tibolone may be evaluated as a good therapeutic option for post menopause women with HSDD/low sexual desire.Despite these treatment limitations, health care providers can address many of the sexual health concern of post menopause women. 

Disclosures:

Work supported by industry: no.

show poster

The universal math evidenced by the geometrical analysis of penile congenital curvature (#111)

E. Da Silva (Brazil)
show abstract

111

The universal math evidenced by the geometrical analysis of penile congenital curvature

Da Silva, E1; Ruellas, T1; Barrela, M1; Damiao, R1

1: Rio de Janeiro State University, Brazil

Objective: To evaluate whether the congenital ventral penile curvature presents a mathematical pattern related to golden spirals.

Materials & Methods: A case control study was designed. Five patients who presented congenital ventral penile curvature consisted the case group and three patients who presented acquired penile curvature (Peyronie’s disease) composed the control group. Penile photographs were taken during the prostaglandin (PGE-1) induced erection test, according five-line Kelâmi’s protocol. And thus penile curvature pictures were tested for equiangular spiral. In cases with positive relationship, the existence of a relation to the golden spiral – type of equiangular spiral – was also checked.

In order to check the described mathematical relationships, the following programs were used: Wolfram CDF Player (Logarithmic Spiral) and PhiMatrix. The Wolfram program generated logarithmic spirals equivalent to the penile curvature with its appropriate mathematical values. The PhiMatrix program, which builds any golden spirals from golden rectangles, was used to check whether the spiral, besides being equiangular, is also a golden one.

Results: In all cases (100%) of congenital ventral penile curvature an equiangular spiral was found, and, furthermore, was also a GOLDEN one. On the other hand, acquired penile curvatures presented no specific pattern.

Conclusion: There is a mathematical pattern in the congenital ventral penile curvature and it is related to a GOLDEN spiral. The results offer the math algorithm for the potential use on the fields of surgical reconstruction procedures, regenerative medicine, tissue engineering and robotics.

Disclosures:

Work supported by industry: no.

show poster

Nanotechnology improved stem cell therapy in erectile dysfunction in post radical prostatectomy animal model (#112)

Run Wang (USA)
show abstract

112

Nanotechnology improved stem cell therapy in erectile dysfunction in post radical prostatectomy animal model

Lin, H1; Dhanani, N 1; Tseng, H ; Souza, G ; Wang, R2

1: University of Texas Medical School at Houston, United States; 2: University of Texas Medical School at Houston and MD Anderson Cancer Center, United States.

Objective: Recently, intracavernous injection (ICI) of stem cells has shown some therapeutic potential for erectile dysfunction (ED). However, most stem cells were washed out immediately due to the communication between corpus cavernosum (CC) and the blood circulation. Keeping stem cells in the CC after ICI maybe the key step for successful stem cell therapy for ED. We investigated a novel nanotechnology to improve stem cell therapy in an animal model.

Material and Methods: Adipose-derived stem cells (ADSCs) were isolated from the inguinal fat tissue of adult male Sprague–Dawley (SD) rats and cultured in DMED/F12 medium. Magnetic nanoparticles were added to ADSCs. CellTracker™ Green CMFDA (5-Chloromethylfluorescein Diacetate) was used to track ADSCs present in the CC. ED animal models were created by bilateral cavernous nerve crush (BCNC) injury and randomly assigned into three groups. Group A: ADSCs ICI. Group B: ADSCs with nanoparticle ICI. Group C: ADSCs with nanoparticle ICI + magnet probes. Rats were sacrificed at day 1, 3, 5 and 9 after ICI, respectively. Rat penis was harvested for tracking ADSCs by immunofluorescence.

Results: Our in vitro study showed that ADSCs with nanoparticles promoted cell aggregation with the use of a magnet probe. In vivo study with the immunofluorescence confirmed that ADSCs with nanoparticle were successfully maintained in CC with the use of magnet probes for up to 9 days; while most ADSCs were washed out in other groups in day 1 and 3 after ICI.

Conclusions: Magnetic nanoparticle is a novel technology to improve ADSCs therapy for ED in animal model.

Disclosures:

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

show poster

Effect of hyperglycemia on the expression of aquaporins in rat vagina (#113)

Run Wang (USA)
show abstract

113

Effect of hyperglycemia on the expression of aquaporins in rat vagina

Jiang, R1; Wang, R2; Lin, H3; Yang, L4

1: Department of Urology, Affiliated Hospital, Luzhou medical college, China; 2: Division of Urology, University of Texas Medical School at Houston and MD Anderson Cancer Center; 3: Division of Urology, University of Texas Medical School at Houston, United States; 4: Department of Urology, Affiliated Hospital, Luzhou medical college, China.

Objective: A common female sexual dysfunction caused by hyperglycemia is vaginal lubrication difficulty. Vaginal lubrication may be related to transudation of fluid. Aquaporins (AQPs) are key membrane proteins that transport water through biological membranes. The objective of this study is to investigate the expression of AQP0, 5, 6, 10, 11 and 12 in vaginal tissue of diabetes mellitus rats.

Material and Methods: 8-week-old female Sprague-Dawley rats (n=24) were randomly divided into group A (12-week-old diabetic rats, n=6), group B (12-week-old non-diabetes control, n=6), group C (14-week-old diabetic rats, n=6) and group D (16-week-old non-diabetes control, n=6). The level of vaginal lubrication and the expression of AQP0, 5, 6, 10, 11 and 12 in vaginal tissue of rats were determined.

Results: The level of blood glucose was significantly increased in group A and group C compared with those in group B and group D (P<0.05). Vaginal lubrication was significantly lower in group A (2.12±1.41) and group C (2.64±0.88) than in group B (4.21±0.86) and group D (4.41±0.77) (P<0.05), respectively. The protein expressions of AQP0, 5, 6, 10, 11 and 12 in vaginal tissue were significantly lower in group A and group C than in group B and group D (P<0.05) determined by immunohistochemical study and/or Western blot, respectively.

Conclusions: Decreased vaginal lubrication in diabetic rats after electro-stimulation may be related to decreasing of the expression of AQPs in vaginal tissue.

Disclosures:

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

show poster

3D bioprinting PCLScaffolds for tissue engineering applications (#114)

Kwangsung Park (Korea)
show abstract

114

3D bioprinting PCLScaffolds for tissue engineering applications

Park, K1; Hwang, I1; Lee, H1; Park, J1; Park, S2

1: Department of Urology, Chonnam National University Medical School, Sexual Medicine Research Center, Chonnam National University, Gwangju, Korea; 2: Nano Convergence & Manufacturing Systems Research Division, Korea Institute of Machinery & Materials (KIMM), Daejeon, Korea

Objective(s): To investigate in vitro evaluation of a polycaprolactone (PCL) scaffold fabricated by 3D printing technique for tissue engineering applications in the field of sexual medicine.

Material and Method(s): Polycaprolactone (PCL) scaffold was fabricated by 3D bioprinting system. 3D printed scaffold has interconnected structure for cell ingrowth within scaffold. Stand thickness/period of scaffold was controlled by temperature, velocity, and pressure. Scaffolds were placed in six-well plate and seeded with human aortic smooth muscle cell (hSMC) at 5 x 105 cells per scaffold. Seeded and control scaffolds were cultured under static conditions for up to 4 weeks. The ability of these scaffolds to support smooth muscle cell growth was investigated in vitro.

Result(s): We fabricated three different groups (strand thickness/strand period); 300/150 um, 300/300 um, and 300/450 um.  3D scaffolds were characterized by SEM images and porosity measurement.

SEM images showed the surface morphology of PCL scaffold, and hSMC cells covered all the surface of the scaffold. Immunofluorescent staining images of α-smooth muscle actin on hSMC cells/scaffolds confirmed that the cells remained viable and proliferated throughout the time course of the culture.

Conclusion(s): This is a preliminary study showing that 3D printed PCL scaffolds could be used for tissue engineering applications in the field of sexual medicine.

Disclosures:

Work supported by industry: no.

show poster

Therapeutic potential of adipose-derived stem cells based micro-tissues in a rat model of post-prostatectomy erectile dysfunction (#115)

Zhong Cheng Xin (China)
show abstract

115

Therapeutic potential of adipose-derived stem cells based micro-tissues in a rat model of post-prostatectomy erectile dysfunction

Xu, Y1; G, R1; Lei, H1; Li, H1; Wang, L1; Gao, Z1; Song, W1; Xin, Z1

1: Andrology Center, Peking University First Hospital, Peking University, Beijing, China

Objective: Stem cells (SCs) show significant benefits in the treatment of post-prostatectomy erectile dysfunction (ED). However, the low retention rate of the tranditional single cell strategy at the injection sites limits its therapeutic potential.The aim of this study is to investigate the feasibility and mechanism of ADSCs based micro-tissues (MTs) in the treatment of ED in a rat model of bilateral cavernous nerves (CN) injury.

Materials and Methods: ADSCs labeled with 5-ethynyl-2-deoxyuridine (EdU) were used to generate MTs with hanging drop method. 10 Sprague-Dawley (SD) rats underwent sham sugery and intracavernous (IC) injection of PBS (the sham group). Another 70 rats underwent bilateral CN crush and were then treated with PBS (n=10, the crush group), dissociated ADSCs (n=30, the ADSCs group), and MTs (n=30, the MTs group) respectively. At day 1, 3, 7, 14 (n=5) and 28 (n=10) postsurgery, specimens were harvested for histology. At day 28, 10 rats in each group were examined for erectile function before tissue harvest.

Results: Three-day old MTs became stable and expressed NGF, VEGF, CXCR4, Wnt5a, and ColⅣ. More EdU+ ADSCs retained in the CC in the MTs group than that in the ADSCs group. IC injection of MTs resulted in significant restoration of the erectile function and histopathological changes compared to the ADSCs group.

Conclusion: IC injected MTs resulted in a better restoration of erectile function than tranditional single cell strategy. The underlying mechanisms of recovery appear to involve enhanced cellular retention in the penis and up-regulation of some paracrine factors.

Disclosures:

Work supported by industry: no.

Estrogen mediates metabolic syndrome-induced erectile dysfunction: A study in the rabbit (#116)

Mario Maggi (Italy)
show abstract

116

Estrogen mediates metabolic syndrome-induced erectile dysfunction: A study in the rabbit

Vignozzi, L1; Filippi, S2; Cellai, I 3; Comeglio, P3; Morelli, A4; 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 Florence, Florence, Italy; 3: Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy; 4: Section of Anatomy and Histology, Department of Experimental and Clinical Medicine,University of Florence, Florence, Italy

Objective: ERα is critical in mediating the harmful effects of hyperestrogenism in fetal or neonatal life on the developing penis. In contrast, little is known on the impact of an excess of estrogens on penile function in adulthood. The aim of this study was to investigate the effect of estrogens on metabolic syndrome (MetS)-associated erectile dysfunction (ED), in an animal model of MetS.

Material and Methods: To understand the role of sex steroid milieu, we treated subgroups of MetS rabbits with either testosterone (T) or tamoxifen, a classical ERs antagonist. We evaluated acetylcholine (Ach)- penile responsiveness as well as the expression of genes related to penile smooth muscle relaxation and contractility.

Results: MetS was associated to  elevated  estradiol  (E2)  and low T levels. E2, but not T, was independently and  negatively associated with  genes able to affect penile erection. Smooth muscle-related markers decreased as a function  of  E2 and were positively associated with all the variables investigated. Increasing  concentrations of circulating  E2 were negatively associated with Ach-induced relaxation. In HFD rabbits, in- vivo T dosing significantly improved MetS, and normalized circulating E2. Conversely, in-vivo tamoxifen dosing reduced visceral adiposity and partially restored T level. Ach-induced relaxation was severely impaired by HFD and significantly restored, up to the control level, by both tamoxifen and T. In rabbit smooth muscle cells culture 17 β estradiol significantly reduced the expression of αSMA, SM22 and PDE5.

Conclusions: Tamoxifen reverted completely these effects. In conclusion,  HFD-induced ED is more associated with a high estradiol, than to a low T, milieu.

Disclosures:

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

show poster

Sex steroid hormone and its relation with body mass index, waist circumference, body fat and visceral fat (#117)

S. Cedres (Uruguay)
show abstract

117

Sex steroid hormone and its relation with body mass index, waist circumference, body fat and visceral fat

Cedres, S1; Goñi, M1

1: Uruguay

Obesity is an issue that is increasingly affecting ageing men. With ageing, there is a decline in androgens as well. Visceral fat more than body fat is closely related to lifestyle related diseases such us hypertension, diabetes, hyperlipidemia and hypogonadism. Cross-sectional data suggest that it is associated with decreased production of testosterone. It has been hypothesized that there is increased aromatization of testosterone to estradiol and alteration of the hypothalamic-pituitary-adrenal axis in obese ageing men.

Objective: To examine the relation of obesity (body mass index (BMI) > 30 kg/m2), of central obesity (waist circumference > 100 cm), of body fat (> 20%) and of visceral fat (> 10%) to change in sex steroid hormones in men.

Methods: One hundred men with complete anthropometry and sex hormone level were included betwen April and July of 2008 from consulting in Uruguay. Free and total testosterone (FT and TT), were assessed at 10:00 AM. Health behaviours and medical history were obtained by structured interview. Body Composition Monitor was used to define the visceral and body fat. It estimates the percentage by the Bioelectrical Impedance method along with the electric resistance, weight, age and gender information. The dual energy x ray absorptiometry method uses two different frequency X rays and rates of absorption of the body to determinate the value based on the difference between the two. Repeated measures regression was used to describe trends in steroid hormones in relation to obesity status, adjusting for age, smoking, alcohol, chronic illness, and physical activity.

Results: Visceral fat rather than body fat or BMI was associated with decreased levels of total and free testosterone.

Conclusions: Viseral Fat may predict greater decline in testosterone levels with age than central obesity or body mass index. Further studies in this field are recommended to evaluate the clinical impact of nutricional factors in sex hormones.

Disclosures:

Work supported by industry: no.

show poster

Light-controlled relaxation of the penile corpus cavernosum using the novel nitric oxide releaser NOBL-1 (#118)

Y. Hotta (Japan)
show abstract

118

Light-controlled relaxation of the penile corpus cavernosum using the novel nitric oxide releaser NOBL-1

Hotta, Y1; Ieda, N1; Nakagawa, H1; Kimura, K1

1: Nagoya City University, Japan

Objective. Nitric oxide (NO) is very important for the initiation and maintenance of penile erection. NO is typically produced by nerve or endothelial cells; however, NO production requires sexual arousal or shear stress. These conditions may be impaired in some cases such as spinal cord injury or atherosclerosis. Therefore, controlling NO production may be very useful as therapy for erectile dysfunction (ED). Here, we focused on a novel blue light-controllable NO releaser called NOBL-1 and investigated whether we could control relaxation of the corpus cavernosum smooth muscle.

Materials and Methods. Male adult Wistar-ST rats were used in this study. The glans, urethra, blood vessels, and tunica albuginea were carefully removed from each penis and placed in chilled Krebs solution, a strip of corpus cavernosum was prepared, and an isometric tension study was performed. After pre-contraction with noradrenaline (10 μM) and the addition of NOBL-1 (1 μM or 10 μM), the response of the corpus cavernosum smooth muscle to irradiation with blue light (470–500 nm) was measured and recorded.

Results. The corpus cavernosum smooth muscle that had pre-contracted with noradrenaline relaxed in response to blue-light irradiation at both doses of NOBL-1. The relaxing response to blue light at 10 μM NOBL-1 was larger than that at 1 μM. In addition, after irradiation was stopped, relaxation at both concentrations of NOBL-1 disappeared and tension returned to that before irradiation.

Conclusions. This study demonstrated control of relaxation of the corpus cavernosum smooth muscle using NOBL-1, a novel blue light-controllable NO releaser. Although further in vitro and in vivo studies are needed to prove its potential for ED therapy, our results suggest that NOBL-1 may be a useful tool for penile rehabilitation.

Disclosures:

Work supported by industry: no.

show poster

Penis rupture – a topic for interdisciplinary consideration (#119)

R. Herwig (Austria)
show abstract

119

Penis rupture – a topic for interdisciplinary consideration

Herwig, R1; Bayerl, M1

1: Vienna International Medical Clinic, Vienna, Austria

Objective: The purpose of the interdisciplinary cooperation between urological surgery and physics is the development of a physical simulation tool to be used by surgeons in order to give prognosis of possible penis rupture at a certain degree of deviation of the penis and to take prophylactic action.

Materials and Methods: For the physicist it was the first challenge to translate the human organ of the penis into a physical model. Starting and marginal parameters had to be defined, whereby some of them had to be proceeded on the assumption, as physical data of the human living tissue have rarely been measured up to now, such as, f.i. the modulus of elasticity of the tunica, the mass of the penis in erect state and the maximum stress, the tunica can be subdued to. The algorithm and its dependencies had to be developed.

Results: This paper is a first step of mathematical-physical simulation with the assumption of a 100 % filled rigid penis. The calculation (see Fig. 1) gives proof of the hypothesis that the fibre-load-angle of the penis is 12 degree (see Fig . 2), much less than 30 degrees, which was the assessment of the authorities of urology up to now.

Conclusion: Physical simulation is able to provide the surgeon with a simple instrument to calculate and forecast the risk of the individual patient, based upon dependencies of geometry of the differential geometrical body of the penis.

Fig. 1:
Abstract 119
Fig. 2:
Abstract 119

Disclosures:

Work supported by industry: no.


11:30 - 12:30
Podium 3 - Peyronie's disease

Location: Transamérica Auditorium
Chairs: Fernando Facio (Brazil) & Wayne Hellstrom (USA)

The effects of four different suture materials on penile tissue of rats (#013)

Ege Can Serefoglu (Turkey)
show abstract

013

The effects of four different suture materials on penile tissue of rats

Tuken, M1; Altinay, S1; Temiz, M1; Cakir, O1; Alkan, S1; Semercioz, A1; Serefoglu, E1

1: Bagcilar Training and Research Hospital, Turkey

Introduction: Although several types of suture materials are being used for correction of penile curvatures, to the best of our knowledge, there are no studies in the literature about the effects of these materials on penile tissue.

Materials and Methods: A total of 30 male Sprague-Dawley rats were divided into 5 groups. After anesthesia, an abdominal wall incision was made and the proximal side of the right cavernosal body was sutured with 5/0 sutures (group 2: polyethylene terephthalate [ETB], group 3: polypropylene [PRL], group 4: polyglactine [VCR], group 5: polydioxanone [PDS]). An identical needle (3/8-13 mm cutting) without any suture material was passed through cavernosal bodies in the sham group (group 1). After 3 weeks, all rats were sacrificed and penile tissues were examined by the same pathologist to assess the level (0-3) of inflammation, granuloma formation and fibrosis.

Results: Kruskal-Wallis test revealed that there was statistically significant difference among five groups regarding inflammation, granuloma formation and fibrosis levels (p<0.01 for all)(table 1). The groups were further compared with Mann Whitney U test (table 2). The level of inflammation, granulation and fibrosis in the PRL group was not different than the SHAM group. Although the levels of granuloma and fibrosis in the PDS group were also similar to the SHAM group, inflammation level was significantly higher. The inflammation, granuloma formation and fibrosis levels were the highest in the ETB group. VCR caused similar levels of granuloma formation and fibrosis to ETB.

Conclusion: PRL suture is associated with the least histopathological changes in the penile tissue. However, non-absorbable nature of this suture may cause discomfort among patients who palpate the knots. PDS, which is a monofilament synthetic absorbable suture, can be a reasonable alternative to PRL as it caused similar levels of granuloma and fibrosis.

Disclosures:

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

The use of tunica albuginea crural graft for severe penile curvature due to Peyronie´s disease: 10 years follow up (#014)

Claudio Teloken (Brazil)
show abstract

014

The use of tunica albuginea crural graft for severe penile curvature due to Peyronie´s disease: 10 years follow up

Teloken, C1; Dal'Asta, I1; Coelho, L1; Graziottin, T1

1: UFCSPA - Federal University, Brazil

Introduction: Management of severe penile deformity due to Peyronie’s disease is surgically challenging. Various surgical techniques and graft materials have been used; however most of them exhibited suboptimal long-term results, especially with regard to curvature recurrence and erectile dysfunction. We first described the use of autologous tunica albuginea retrieved from the crura as a graft material – TACRUG - and present herein the long-term follow-up results.

Methods: We conducted a chart review of patients with preserved erectile function or erectile dysfunction (ED) responding to PDE-5 inhibitors who had undergone plaque incision and graft with crural tunica albuginea for stable penile deformity precluding vaginal intercourse. The TACRUG is obtained through a 3-cm longitudinal perineal incision. A longitudinal segment of tunica in the anterior aspect the corpus cavernosum 2mm larger than the defect is delimited with methylene blue, preserving the cavernous artery entry point, and carefully removed. A segment of tunica from the contralateral corpus cavernosum may also be retrieved if necessary. The corpus caversonum then is closed with continuous 4-0 polyglactin suture.

Results: One hundred and forty eight  patients with a mean follow up of 6 years  (range 3 to 11) were included in this analysis. Mean age was 54 years (range 42 to 75). Intraoperative penile straightening was obtained in all cases. Curvature recurrence requiring surgical intervention occurred in 8 % of the patients. Penile shortening was observed in 9%, and 15% patients reported glans numbness. Forteen percent developed postoperative ED, all of which responded to oral PDE-5 inhibitors. Twenty eight percent of individuals who preoperatively responded to PDE-5 inhibitors became unresponsive. Overall, 12.8% patients subsequently underwent penile prosthesis implantation. Eighty nine percent of patients classified the long term postoperative result as excellent or satisfactory.

Conclusions: The autologous tunica albuginea crural graft is easily obtained, does not carry the risk of rejection or transmission of infectious diseases and affords satisfactory long-term results, without added costs. Despite the lack of a control group, based on our experience and in comparison to published data, the tunica albuginea crural graft is associated with less curvature recurrence and does not lead to increase risk of ED than other graft material.

Disclosures:

Work supported by industry: no.

Ventral intralesional verapamil injections for Peyronie's disease: Feasability and safety (#015)

John Mulhall (USA)
show abstract

015

Ventral intralesional verapamil injections for Peyronie's disease: Feasability and safety

Berookhim, B1; Chevinsky, M1; Jakubowski, C1; Larish, Y 1; Nelson, C1; Mulhall, J1

1: Memorial Sloan Kettering Cancer Center, United States

Objective: To report our initial experience with ventral intralesional verapamil injections (ILI) for Peyronie’s Disease (PD).

Methods: We analyzed prospectively gathered data from an institutional database pertaining to PD patients. For the purposes of this analysis, inclusion criteria included men (i) with uniplanar curvature (ii) who had curvature assessment (CA) with the assistance of intracavernosal injection and developed at least an 80% rigid erection (iii) who underwent 6 ILI (10mg verapamil in 5ml saline) and (iv) had an end of treatment CA at least 3 months after treatment completion. Ventrally located plaques were treated similarly to dorsal, with special attention paid to avoid midline injection directly into the urethra.

Results: 154 men met all criteria. 144 (93%) had dorsal ILI and 10 (7%) underwent ventral ILI. Mean duration of PD was 8±18 months and 3±2 months (p=0.46) while mean age was 55±8 and 59±7 years (p=0.16) respectively. Comorbidity profiles were similar in both groups. Mean baseline curvature was 38±15 degrees and 39±11 degrees (p=0.96) respectively. No significant difference existed in change in curvature between groups (see Table, p=0.33). Those who improved in the ventral ILI group had higher mean baseline curvature (51±7 degrees) compared to those who remained stable or worsened (30±7 degrees, p=0.04). Ventral ILI patients reported rare self-limiting hematuria and occasional blood at the urethral meatus at procedure completion, with a penile ecchymosis rate identical to dorsal ILI patients. There were no reports of urinary clot retention, penile hematoma or delayed urinary symptoms suggestive of urethral stricture.

Conclusions: Ventral ILI is a safe procedure. Changes in curvature with ventral injections are similar to those seen with those administered dorsally, with 40% demonstrating clinical improvement. Given our initial data, ILI should be considered in men with ventral plaques.

Abstract 015

Disclosures:

Work supported by industry: no.

The chronology and severity of penile sensory changes after plaque incision and grafting surgery for Peyronie's disease (#016)

Raanan Tal (Israel)
show abstract

016

The chronology and severity of penile sensory changes after plaque incision and grafting surgery for Peyronie's disease

Tal, R1; Deveci, S1; Choi, J1; Mulhall, J1

1: Memorial Sloan-Kettering Cancer Center, United States

Objective: Besides changes in erectile function, Plaque incision and grafting surgery (PIGS) for PD when performed dorsally, is known to be associated with penile sensory loss. Rates of sensory changes have been cited at 0-12%. This analysis was conducted to define the rate, chronology and predictors of this problem.

Material and Methods: The study population consisted of men who (i) had dorsal PIGS (ii) at least 6 months follow-up. Patients are followed up in the office at 1 week, 1 and 6 months and by phone at 12 months and later if continued problems exist. Penile sensation was graded on visual analog 0-10 point scale, where 10 was perfect sensation and 0 total loss of sensation. Sensation loss degree was defined as extensive if circumferential, patchy if diffuse and focal if small and confined to one area of the penile shaft. Using multivariate analysis, predictors of sensation loss were sought including: patient age, diabetes presence, duration of PD, duration of operation.

Results: 60 patients were analyzed. Mean age = 52±20 years, mean follow-up of 16±11 months. Mean duration of PD at time of PIG surgery = 18±11 months. 10% had diabetes preop with a mean HBA1C = 7.2±1.8%. Mean duration of self-reported stability = 8 months. 75% of patients had curvature alone, while the remainder had associated indentations or hourglass deformity. Mean baseline primary curvature = 64±28 degrees. All patients were capable of sexual intercourse pre-operatively with or without erectogenic aids. Mean duration of operation = 3.5±1.8 hours. 20% had any sensation loss at 1 week, 20% at 1 month and 7% at 6 months. Severity presented in Table. 2/60 patients had some sensation loss at 1 year and a single patient at 2 years continued to have extensive sensation loss on the glans and distal shaft.  Only duration of operation was a predictor, with duration >4 hours being predictive of sensation loss at 6 months, OR 2.1, 95% CI 1.2-3.0 (p<0.01).

Conclusions: Sensation loss is not uncommon after PIG surgery. It decreases in frequency and severity with time with only rare cases occurring beyond 12 months. Longer operations are more likely associated with sensation loss, likely related to difficult neurovascular bundle elevation.

Disclosures:

Work supported by industry: no.

Selection criteria used to guide surgical approach for management of Peyronie's Disease: A single institution experience (#017)

Laurence Levine (USA)
show abstract

017

Selection criteria used to guide surgical approach for management of Peyronie's Disease: A single institution experience

Papagiannopoulos, D1; Yura, E1; Levine, L1

1: Rush Univeristy Medical Center, United States

Objective: Peyronie’s disease (PD) is manifest by a fibrotic plaque within the tunica albuginea of the penis. For select patients, several surgical techniques are available. In an attempt to guide operative selection, we report our series of penile straightening procedures for PD spanning six years, with the following selection criteria. Patients with satisfactory erections and curvature < 60 degrees and no hinge effect were treated with tunica albuginea plication (TAP). Those with satisfactory erections and curvature > 60 degrees and/or hinge effect were treated with partial plaque excision and grafting (PEG). Patients with unsatisfactory erections were treated with placement of inflatable penile prosthesis (IPP).

Methods: We retrospectively reviewed all patients who underwent penile straightening procedures for PD between 2007 and 2013. Work-up involved a history, physical exam, and a duplex ultrasound.  When possible, the Peyronie’s Disease Questionnaire (PDQ) was employed to assess bother and distress associated with PD. Objective outcomes and patient satisfaction were assessed post-operatively

Results: A total of 389 patients underwent penile straightening procedures for correction of PD by one surgeon between 2007 and 2013.  Of these patients, 29%, (n=114) received primary TAP, 40% (n=158) primary PEG, and 30% (N=114) IPP. Mean follow-up was 17 months. There was a significantly higher incidence of DM within the IPP group (P<0.01). The PDQ showed no difference in emotional status or bothersome score between groups. Patients with less satisfactory erectile function were more likely to undergo IPP placement (p<0.01). Those with superior erectile function, a hinge effect or severe curvature were more likely to undergo PEG (p<0.01). In the presence of a calcified plaque, PEG and IPP placement were significantly more common than TAP (PEG p< 0.01, IPP p=0.04). Regardless of surgical modality, there were no significant differences in satisfactory rigidity, residual bothersome curve, or ability to engage in intercourse.

Conclusion: Patient experience with post-surgical rigidity, ability to engage in intercourse, and residual bothersome curve was not statistically different across the three groups. These results support the use of our selection criteria, even in the face of patient preference. The primary factors that compromised patient adherence to our treatment algorithm were fear of length loss or hesitance to pursue IPP placement.

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.

Intraplaque injection of tiocolchicine and verapamil in Peyronie´s disease patients: A prospective randomized single-blind comparative study (#018)

Sidney Glina (Brazil)
show abstract

018

Intraplaque injection of tiocolchicine and verapamil in Peyronie´s disease patients: A prospective randomized single-blind comparative study

Toscano Jr, I1; Rezende, M1; Mello, L1; Pires, L1; Paulillo, D1; Glina, S2

1: Hospital Ipiranga, Brazil; 2: Hospital Ipiranga / Instituto H.Ellis, Brazil

Objective: To compare the effects of tiocolchicine or verapamil intraplaque injection on plaque size, sexual function and penile curvature in Peyronie’s Disease (PD) patients.

Materials & Methods: A prospective randomized single-blind study involving 25 patients treated with intraplaque tiocolchicine or verapamil injection between June 2008 and September 2012. All patients had been suffering from PD for up to 18 months. Cases with less than 3-month progression, history of trauma or history of surgical PD correction were excluded. Patients were treated weekly in 7 consecutive consultations. The parameters considered were IIEF (International Index of Erectile Function), sonographic measurement of plaque size and photograph-based measurement of penile curvature.   

Results: Twenty-five patients were randomly assigned to treatment with tiocolchicine (13) or verapamil (12). Mean penile curvature was 46.7° and 36.2° (p=0.019), and 50.4° and 42.08° (p=0.012) before and after treatment with tiocolchicine and verapamil, respectively. Penile curvature improved in 69% and remained stable in 23% of tiocolchicine-treated patients, while 66% improvement with 33% stability was documented in patients treated with verapamil. The mean IIEF scores (sexual function) increased from 16.69 to 20.85 (p=0.23) and decreased from 17.50 to 16.25 (p=0.58) in tiocolchicine- and verapamil-treated patients, respectively. Plaque size decreased in 61%, increased in 23% and remained unchanged in 15% of tiocolchicine-treated patients. Plaque size decreased in 8% and remained unchanged in 83% of patients in the verapamil group. No adverse effects were observed following tiocolchicine treatment.

Conclusions: Tiocolchicine injection improved penile curvature, increased IIEF scores and reduced plaque size in DP patients. Tiocolchicine was more effective than verapamil, with improvement in IIEF scores and reduction in plaque size, despite the lack of statistical significance. Tiocolchicine and verapamil had similar effects on penile curvature. No significant adverse effects were observed in this study.

Disclosures:

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


11:30 - 12:30
Instructional course 1 - Basic sexual therapy for physicians

Location: Ilhéus + Una Room
Chairs: Stanley Althof (USA) & Luis Alberto Finger (Argentina)

Dealing with sexuality in our patients with chronic disease & cancer

Woet Gianotten (The Netherlands)

Sex therapy approaches to the treatment of ejaculatory disorders

Stanley Althof (USA)

Sexual therapy for women with problems of desire

Kevan Wylie (United Kingdom)


Afternoon

12:30 - 14:00
Lunch break

Location: Comandatuba Room 1

14:00 - 15:30
Round table 1 - Outcomes of Peyronie's disease treatment

Location: Comandatuba Room 2+3
Chairs: Chris McMahon (Australia) & Claudio Teloken (Brazil)

PD pharmacotherapy and traction therapy

Ronny Tan (Singapore)

New horizons - CCH for PD

Wayne Hellstrom (USA)

Surgical treatment of PD - Indications and options

Laurence Levine (USA)

Outcomes from surgical treatment of PD

Giulio Garaffa (United Kingdom)


14:00 - 15:00
Podium 4 - Psychotherapy

Location: São Paulo Room
Chairs: Tamara Melnik (Brazil) & Eusebio Rubio-Aurioles (Mexico)

A neurocognitive model for psychogenic erectile dysfunction (#019)

Romulo Aponte (Venezuela)
show abstract

019

A neurocognitive model for psychogenic erectile dysfunction

Aponte, R1

1: Unidad de Estudios y Terapia Cognitiva y Sexual, Venezuela

Objective: Sexual tipping point model demonstrates both the mental and physical contributors to sexual function and dysfunction. Cognitive factors such as negative sexual automatic thoughts have been identified in patients suffering erectile dysfunction. The aim of this study and review is to propose an integrative model to understand how psychological-cognitive-factors could impact the molecular substratum of erectile dysfunction.         

Methods: Cognitive rehearsal was applied to fifty patients to identify cognitions in sexual situations. Sexual Health Inventory for Men (SHIM) was applied to evaluate self confidence in obtaining and maintaining an erection. Additionally, urological and hormonal screening was performed. A review of the literature concerning cognitions, central and peripheral neural pathways and neurotransmitters involved in cavernous vasoconstriction leading to psychogenic erectile dysfunction was performed.
Results: At the cognitive rehearsal all 50 patients (100%) had erectile failure anticipatory thoughts. At SHIM, sample evidence showed 38 (76%) very low or low and, 12 (22%) moderate self confidence to obtain and maintain erection. None of them showed high self confidence. Urological and hormonal screening was normal. Sexual negative cognitions, located at the prefrontal cortex, impact via corticalstriatumthalamic pathway the amygdale, the hypothalamus, the main modulator of the sympathetic system, and the locus ceruleus, the main norepinephrine nucleus at the central nervous system. Dendrites from the hypothalamus connect to the sympathetic chain and dendrites from the locus ceruleus project to the spinal cord modulating the peripheral response and affecting autonomic activity. The sympathetic system projects to α 1 adrenoreceptors at cavernous vascular smooth muscle  through  post ganglionar fibers  whose neurotransmitter is norepinephrine,  increasing  intracellular calcium concentration,  leading to constriction  of the penile vascular system and blocking  the erectile response.

Discussion: Negative sexual cognitions and low sexual self confidence found in this study is probably associated to central and peripheral neural pathway activation and norepinephrine liberation at the penis, blocking the erectile mechanism. Anxiety and depression neurocognitive models have been well documented. Anticipatory thoughts of threat are idiosyncratic to anxiety.  These cognitions located at the prefrontal and cingulate cortex increased amygdale activity associated to anxiety symptoms. Cognitive triad, distortions maladaptive schemas are idiosyncratic to depression. Dysfunctional prefrontal cortex, associated to poor control over stimulus incites aberrant limbic system activity in depressed patients.

Functional MRI is needed to confirm this hypothesis.

Conclusion: Anticipatory negative thoughts of failure to obtain or maintain erection and low sexual self-confidence almost surely activate central and peripheral neural pathways in psychogenic erectile dysfunction.

Disclosures:

Work supported by industry: no.

Brazilian men reporting themselves as black skinned color are at risk for genital dysmorphic disorder (#020)

R. Barboza (Brazil)
show abstract

020

Brazilian men reporting themselves as black skinned color are at risk for genital dysmorphic disorder

Barboza, R1; Da Silva, E1; Ruellas, T1; Damião, R1

1: Rio de Janeiro State University, Brazil

Objective: The vast majority of countries around the world can be considered phallocentric societies as evidenced by the high prevalence of sexual taboos and myths. Anthropologically, the myth of the larger penile size associated to Afro-Americans is a vestige of the African slavery in America.  Despite regional differences among human penile size were previously evaluated objectively, we also aimed to assess subjectively their self-perception of penis size and skin color.

Material and Method: Five hundred and two volunteers were interviewed. The IMAGE questionnaire was used to evaluate genital self-perception and its implication on quality of life.  Subjects were required to self-report as Caucasian, Afro-Brazilian or others. Finally, flaccid penis size was measured with an anthropometric ruler supported on the dorsal penis surface in maximum manual traction, depressing the fat against the pubic bone (RLTmax). When genital dysmorphic disorder was suspected, a mental health team provided additional support.

Results: One hundred thirty four (26.9%) men reported themselves as black skinned color, 224 (44.6%) as white skinned color and 143 (28.5%) as uncategorized. Their respective age mean were 54.9 ± 13.9 years old,  55.6 ± 15.6 years old and  54.1 ± 15.7 years old  (p=0.652). While the mean penile length of the self-reported black skinned people was 15.3 ± 4.0cm and the RLTmax was 16.4 ± 1.7cm (p=0.004), the mean reported by the white skinned people was 14.3 ± 3.0cm and the RLTmax of 15.8 ± 1.6cm (p<0.001). Men reported as Afro-Brazilians presented a mean of 6mm larger penis (RLTmax) than Caucasians in both subjectively (p=0.007) and objectively (p<0.001). Men tended to underestimate their penis size. However, Afro-Brazilians presented tendency to overestimate their penis size (32.6% x29.3%, p=0.045) and this influenced negatively their body image and health related quality of life. 

Conclusion: Brazilian men reporting themselves as black skinned color are at risk for genital dysmorphic disorder.

Disclosures:

Work supported by industry: no.

The sexual education in Latin-America – A preliminary evaluation (#021)

Raquel Simone Varaschin (Brazil)
show abstract

021

The sexual education in Latin-America – A preliminary evaluation

Varaschin, R1; Baigorri, G; Rivero, M

1: Centro Integrado de Psicologia, Brazil

Introduction: The sexual education has shown the maintenance of negative aspects in the sexual development when this sexual education sustains repression entail in the manifestation of female sexuality. It also reveals the mith of the human male as machine-man. For this reason and in order to identify more suitable instruments of intervention for sex education in developing satisfactory behaviors, attitudes and emotional and sexual response, a Latin America research was conducted, with an initial collaboration between Brazil and Argentina (Chapter of Sexual Medicine – SAU).

Materials and Methods: A survey with 17 questions idiomatically adapted to each country, using a structured self-administered questionnaire, non-probability random sample, in a cross-sectional analysis

Results: The research was set up with 537 people (16-73 years old), 59.03% females, 36.41% had a university degree, 87.10% were heterosexual, and 33.40% had no stable relationship. From the analyzed group, 67.94% received sexual education, most of them from an educational institution. The result of the education received was unsatisfactory for 27.34% of the interviewees; and those who rated it as satisfactory, considered it important to prevent STDs/HIV, undesired pregnancy, sexual abuse and sexual violence, or according to them, it improved care and their enjoyment of their sexuality.

Conclusions: These results underlie the need for an active participation of government authorities and scientific societies in sex education programs aimed to all ages; and especially at parents, educators, health professionals and communicators. They are the instruments for the realization of an adequate lifelong intervention, formal or informal, comprehensive and continuous constitution of a healthy sexuality. They are also the instruments for the development of the quality of life through the exercise of human and sexual rights.

Disclosures:

Work supported by industry: no.

The impact of interferon therapy on the sexual function of hepatitis C male patients (#022)

A. Mahran (Egypt)
show abstract

022

The impact of interferon therapy on the sexual function of hepatitis C male patients

Abdel Hafez, K1; Kamel, S1; Abdel Aal, A1; Mansour, E1; Mahran, A1

1: Assuit University Hospital, Egypt

Objective: To evaluate the impact of interferon therapy on male sexual function.

Material and methods:  One hundred patients suffering from hepatitis C infection were included in the study. Fifty two (52%) patients were receiving interferon and forty eight (48%) patients were not receiving interferon. All participants underwent history taking including IIEF-5 score, general and local examination, assessment of hormonal profile and pharmacopenile duplex Doppler ultrasonography.

Results: The IIEF-5 score of the non-interferon treated group (18±6.5) was significantly higher than the interferon treated group (12±4.5) (P= 0.022). Moreover, IIEF-5 score showed significant negative correlation with the duration of interferon therapy (r=-0.366, P=0.01). Forty (76.9%) patients on interferon reported low or absent sexual desire compared to twenty two (45.8%) patients of non-interferon treated group (P= 0.001).

Total testosterone among interferon treated patients (188 ± 0.32 ng/dL) was significantly lower than non-interferon treated patients (270 ± 0.52 ng/dL) (P= 0.001). Similarly, free testosterone level among interferon treated patients (3 ± 0.22 ng/dL) was significantly lower than non-interferon treated group (7 ± 2.3 ng/dL) (P= 0.05). Furthermore, there was statistically significant negative correlation between duration of interferon therapy and serum levels of total and free testosterone (r= - 0.326, P=0.001; r= - 0.252, P=0.01 respectively).

Serum estradiol level among interferon treated patients (80 ± 3.3 pg/ml)  were significantly higher than non-interferon treated patients (58 ± 2.3 pg/ml) (P= 0.01). Moreover, serum level of estradiol was significantly correlated to the interferon therapy duration (r=0.337, P=0.002).

Serum prolactin level showed no significant difference between the interferon treated (13 ± 1.3 ng/ml) and the non-interferon treated groups  (12 ± 1.5 ng/ml) (P=: 0.59). However, the serum prolactin level was positively correlated to the interferon therapy duration (r=0.421, P=0.03).

As regards penile duplex results, thirty eight (73%) patients on interferon showed vasculogenic erectile dysfunction compared to  thirty two (66.7%) patients not receiving interferon (P=0.11). Twenty two (42.2%) patients on interferon showed veno-occlusive dysfunction which was significantly higher than non-interferon group (16.6%) (P=0.03). On the other hand, eighteen (37.5%) patients of the non-interferon group showed mixed vasculogenic erectile dysfunction which was significantly higher compared to eight (15.4%) patients on interferon therapy (P=0.05).

Conclusion: Interferon had negative impact on male sexual function. Men on interferon showed loss of desire, lower IIEF-5 score, lower total and free testosterone levels and higher estradiol level compared to those not receiving interferon. However, interferon did not affect penile hemodynamics.

Disclosures:

Work supported by industry: no.

Female sexual function and its associations in a Brazilian sample (#023)

B. Lucena (Brazil)
show abstract

023

Female sexual function and its associations in a Brazilian sample

Lucena, B1; Abdo, C2

1: Brazil; 2: University of Sao Paulo, Brazil

Objectives:  (1) assess female sexual functioning, depression, and anxiety; (2) verify the association between female sexual dysfunction (FSD), depression, and anxiety; and (3) identify the variables associated with the sexual domains: desire, arousal, orgasm, and pain during intercourse.

Material and Methods: 110 healthy women (age: 18-61, mean: 38.5 years) among those waiting for gynecological routine consultations was randomly selected for this research. The patients were asked to fill sociodemographic questionnaire, Female Sexual Quotient (FSQ), Beck Depression Inventory (BDI-II), and the Beck Anxiety Inventory (BAI).

Results: The analysis of the responses show that 36 (32.7%) women present sexual desire inhibitions; 16 (14.5%) have arousal problems; 35 (31.8%) have orgasm difficulties; 31 (28.2%) report pain during intercourse; and 39 (35.5%) exhibit overall FSD. Depression and anxiety are present in 26 (23.6%) and 37 (33.6%) patients respectively. Low sexual desire is associated to depression, anxiety, education level, body issues, masturbation, and sexual education; arousal is connected to depression, anxiety, age, education level, body issues, sex-related fears, and sexual education; orgasm difficulties is related to depression, anxiety, education level, body issues, sex-related fears, sex-related shame, masturbation, and sexual education; pain during intercourse is associated with depression, monetary income, education level, and sex education. Regression models were used to identify the most significant variables for each domain, resulting in sexual desire being inhibited by the presence of depression; excitation levels being impaired by low education levels and the increase of age; ability to achieve orgasm being hindered by low education levels, anxiety, and sex-related fears; and pain during intercourse increasing with lower education levels and depression.

Conclusion: Numerous variables influence female sexual response, depression and anxiety being especially detrimental to sexual functioning. What is more, while depression is more harmful in the early stages of sexual response (desire and arousal), anxiety is the main influence on the orgasm phase.

Disclosures:

Work supported by industry: no.

Effect of isoflavone and/or counseling on sexual function during the menopausal transition: A pilot study (#024)

H. Fleury (Brazil)
show abstract

024

Effect of isoflavone and/or counseling on sexual function during the menopausal transition: A pilot study

Fleury, H1; Abdo, C1

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

Objective: To compare the effect of isoflavone with or without counseling on sexual function.

Material and Method: In a pilot study with 24 women aged 40 to 52 years (mean 44.4 years), the participants were randomized to receive 120 mg isoflavone (Glycine maxima) daily (n=10) or 120 mg isoflavone daily plus counseling (n=14).

The counseling model consisted of 16 weekly sessions of 90 minutes each. The thematic planning of these sessions was as follows: sexual function, communication and sexual intimacy, sexual self-image, female sexuality, menopausal transition/menopause, the woman’s psychosocial role, and marital relationship. The Female Sexual Function Index (FSFI) was obtained at baseline and 16 weeks later.

This project was approved by the Internal Review Board of the University of São Paulo.  Each of the patients signed an informed consent form prior to being admitted to the study.

The groups were compared using the Kruskal-Wallis test and the chi-square test of homogeneity. Spearman’s rank correlation coefficient was calculated to evaluate whether there was any correlation among sexual function domain scores. Repeated-measures analyses of variance (ANOVA) were used to evaluate whether there was any interaction effect between variables. When statistically significant differences were found, Tukey’s multiple comparisons were performed.

Results: There were no statistically significant differences between the groups at baseline. Mean overall FSFI tended to increase with the combination of isoflavone plus counseling (p=0.036). Statistically significant differences were found in the overall sexual function score and in its domains of desire, orgasm and satisfaction (p<0.05). Desire improved in both groups (p=0.038); orgasm decreased in the isoflavone group and increased with the isoflavone plus counseling combination (p=0.039) and a similar trend was found for satisfaction (p=0.034).

Conclusions: The overall FSFI and its domains improved significantly with the combined therapy. Isoflavone alone did not significantly improve sexual function. The continuity of the study points to a counseling group for women with this profile, aiming to confirm or not the results of the combined therapy.

Disclosures:

Work supported by industry: no.


14:00 - 15:30
Instructional course 2 - Addressing sexuality in the elderly couple

Location: Transamérica Auditorium
Chairs: Juza Chen (Israel) & John Dean (United Kingdom)

Changes in sexual functioning and its association with relationship functioning in old age

Marita McCabe (Australia)

Our aging female patients and sexuality

Michael Krychman (USA)

Our aging male patients and sexuality

Prithy Ramlachan (South Africa)

Dementia and sexuality

Woet Gianotten (The Netherlands)


14:00 - 14:45
Workshop 2 - Alternative management of hypogonadism

Location: Ilhéus + Una Room
Chair: Tarek Anis (Egypt)

Tamoxifen

Emmanuele Jannini (Italy)

DHEA and others

Mario Maggi (Italy)


14:45 - 15:30
Workshop 3 - Diagnostic strategies for the ED patient

Location: Ilhéus + Una Room
Chair: Ilan Gruenwald (Israel)

Mental

Stanley Althof (USA)

Body

Natalio Cruz Navarro (Spain)


15:00 - 15:30
Humor session

Location: São Paulo Room
Chair: Edgardo Becher (Argentina)

Humor session

Ira Sharlip (USA)


15:30 - 16:00
Coffee break

Location: Comandatuba Room 1

16:00 - 17:30
Round table 2 - Sexual orientation and gender identity

Location: Comandatuba Room 2+3
Chairs: Maria Luisa Banfi (Uruguay) & Alan Shindel (USA)

Body uneasiness in gender dysphoria

Giovanni Castellini (Italy)

Sexual orientation and gender identity

Michael Krychman (USA)

New surgical approaches in gender dysphoria

Javier Belinky (Argentina)


16:00 - 17:30
Moderated posters 3 - Other aspects of sexual medicine 1

Location: São Paulo Room
Chairs: Stanley Althof (USA) & Michal Lew-Starowicz (Poland)

Effect of nerve-sparing during radical prostatectomy on recovery of urinary continence in patients with preoperative erectile dysfunction (#120)

J. Lee (Korea)
show abstract

120

Effect of nerve-sparing during radical prostatectomy on recovery of urinary continence in patients with preoperative erectile dysfunction

Park, Y1; Hong, S1; Lee, J2; Kim, S2; Hwang, T2; Kim, C3

1: Seoul St. Mary's Hospital, The Catholic University of Korea, Korea South; 2: Seoul St. Mary's Hospital, The Catholic University of Korea, Korea, South; 3: Asan Medical Center, University of Ulsan

Objectives: To assess whether nerve-sparing radical prostatectomy (nsRP) is associated with improved recovery of urinary continence compared with non-nerve-sparing procedures (nnsRP) in organ-confined prostate cancer patients with preoperative erectile dysfunction.

Materials & Methods: A total of 360 patients (International Index of Erectile Function-score <17) with organ-confined prostate cancer were treated with NSRP or NNSRP in our institution. Patients who received neoadjuvant or adjuvant androgen deprivation therapy or had a history of prostate-related surgery were excluded. Recovery of urinary continence was assessed at 0, 1, 3, 6, 12 months, respectively. Postoperative recovery of continence was defined as no pads/day. Association between nerve-sparing status and urinary continence was assessed by univariate and multivariate Cox regression analysis after controlling for known predicting factors.

Results: At a mean follow-up of 22.5 months (range 6-123), 279 patients (77.5%) recovered urinary continence. Recovery of urinary continence was reported from 74.6 and 86.4% of patients after nnsRP and nsRP at 12 months, respectively (p=0.022). All groups had comparable perioperative criteria without significant preoperative morbidities. On univariate Cox regression analysis, age>70yrs, ASA score, and nerve-sparing status were significantly associated with recovery of urinary continence. On multivariate analysis, age>70yrs (HR 1.254, 95% CI 1.002-1.478, p=0.026) and nerve-sparing status (HR 0.713, 95% CI 0.548-0.929, p=0.012) were independently associated with recovery of urinary continence.

Conclusions: Patients with preoperative erectile dysfunction have higher chances of recovering urinary continence after nsRP. Whenever oncologically and technically feasible, a nerve-sparing procedure should be attempted irrespective of preoperative erectile function.

Disclosures:

Work supported by industry: no.

show poster

Training, attitude and practice of Brazilian residents about sexuality: Preliminary results (#121)

M. Ribeiro (Brazil)
show abstract

121

Training, attitude and practice of Brazilian residents about sexuality: Preliminary results

Vieira, T1; Souza, E2; Silva, I3; Torloni, M2; Ribeiro, M2; Nakamura, M2

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

Objectives: To assess the training, attitude and practice of Brazilian OB-GYN residents about sexuality.

Material and Methods: Cross-sectional study conducted between March/May 2014 with 198 residents enrolled to participate in a free, 20-hours online course about sexuality for medical doctors. Before starting the course, participants were asked to answer an on-line self-responsive questionnaire to assess their previous sexology training during medical school and residency as well as their attitude and practice up to that moment. 

Results: The mean age of the participants was 27.9 ± 2.2. Most were female (87.4%), catholic (66.7%), single (78.3%) and had graduated in the last 5 years (91.4%). The participants were from 21 different residency programs, most of which were located in Sao Paulo. Almost half of the participants were in their 2nd (25.8%) or 3rd (23.7%) year of residency, while 22.7% were in their 1st year, 14.0% in their 4th and 13.1% were in their 5th or 6th year of residency. Most (63.1%) of the residents stated that they did not have any classes about sexology in medical school, while 28.3% reported having ≤ 6 hours of training on this topic. Almost half of the participants (49.0%, n= 97) stated that up to that moment, they had received no formal training about sexology during their residency while 28.8% had received up to 6 hours of training. The main motives to enroll in the online sexology course were to acquire/improve their knowledge about sexology (68.2%) and because of personal interest on the topic (30.0%). Only 5.0% of the respondents routinely asked their patients about their sexual health. Over half of the participants (51.0%) said that they did not feel competent or confident to answer their patients´ questions and 55.1% stated that because they lacked knowledge about sexuality, they would try to minimize the patient´s sexual complaints and change the topic.

Conclusions: According to our preliminary results, Brazilian OB-GYN residents enrolling in an online sexuality course have had little previous formal training on sexuality, feel insecure and avoid dealing with these questions in their clinical practice. There is a clear need for additional training in sexuality among Brazilian residents. 

Disclosures:

Work supported by industry: no.

show poster

Female sexual function of overweight women with gestational diabetes mellitus (#122)

M. Ribeiro (Brazil)
show abstract

122

Female sexual function of overweight women with gestational diabetes mellitus

Ribeiro, M1; Nakamura, M2; Scanavino, M3; Torloni, M2; Mattar, R.2

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

Introduction: Obesity and Gestational Diabetes Mellitus (GDM) are increasing worldwide and may alter female sexual function. We hypothesize that among GDM women in the last trimester of pregnancy, those with excess body fat would have worse female sexual function scores than normal weight women. Our aim was to assess the sexual function of overweight compared to normal weight women with GDM, in the same gestational age.

Patient and Methods: This was a cross-sectional survey involving 143 Brazilian women with GDM, in the third trimester of pregnancy: 76 were overweight (pre-pregnancy body mass index-BMI≥25.0 Kg/m) and 67 were normal weight (BMI 18.5–24.9 Kg/m). Participants were recruited from March2010 to April2013 at the antenatal clinic of a single public tertiary teaching institution. The Female Sexual Function Index (FSFI) questionnaire 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: The main characteristics of the participants were similar among normal and overweight women. Most were married, catholic, multipara, employed and had at least 9 years of formal education. The mean total FSFI score of the 143 GDM was 23.3±8.6. A total of 46 overweight women scored ≤ 26 on the FSFI compared to 28 of the normal weight women (60.5% versus 41.8%, respectively, P = 0.038). Mean desire domain scores were significantly lower in overweight compared to normal weight patients (3.4±1.2 versus 4.0±1.4, P = 0.007). The proportion of overweight women reporting problems in desire (domain score ≤5) was significantly higher than normal weight women: 48.7% versus 28.3%, respectively (P = 0.021). Overweight women also had significantly lower scores for the lubrication domain, compared to normal weight women (3.8±2.0 versus 4.5±1.6, respectively, P = 0.023)

Conclusion: According to our results, being overweight seems to affect the sexual function of women with GDM during the last trimester of pregnancy, as measured by the FSFI questionnaire.

Disclosures:

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

show poster

Female sexual function and quality of life of pregnant women – Preliminary results (#123)

M. Ribeiro (Brazil)
show abstract

123

Female sexual function and quality of life of pregnant women – Preliminary results

Ribeiro, M1; Nakamura, M2; Scanavino, M3; Torloni, M2; Forte, B.2; Mancini, P2; Mattar, R1

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

Objectives: Pregnancy is a risk factor for female sexual dysfunction symptoms and may also affect the woman’s quality of life. The aim of this survey was to evaluate the association between sexual function and quality of life among Brazilian pregnant women in the third trimester of pregnancy.

Patient and Methods: Cross-sectional study conducted between March 2012 and February 2014 at the antenatal clinic of a public teaching hospital, with 89 healthy pregnant women, between 28 and 40 weeks’ gestation. The Female Sexual Function Index (FSFI) was used to assess sexual function; women scoring ≤ 26 were classified as having sexual dysfunction symptoms. The World Health Organization Quality of Life-Bref (WHOQoL-Bref) questionnaire was used to assess quality of life; the final scores ranges from 0 to 100, with higher scores indicating better quality of life. Student´s t test was used to compare mean WHOQoL-BREF scores between the women with and without sexual dysfunction symptoms. 

Results: Mean age of the 89 participants was 28.1 ± 5.6 years and mean gestational age was 34.1 ± 3.3 weeks.  A total of 56 women (62.9%) had sexual dysfunction symptoms (FSFI ≤ 26). Women in this group had significantly lower scores on the quality of life test than women without sexual dysfunction symptoms (58.8 ± 14.8 versus 66.9 + 10.7, respectively, p=0.006). The mean scores of women with sexual dysfunction symptoms were significantly lower than those of women without these symptoms, in all domains of the WHOQoL-BREF including physical health (53.4 ± 15.7 versus 60.7 ± 14.9, p=0.030), psychological health (63.8 ± 17.8 versus 71.3 ± 11.3, p=0.028), social relationships (63.5 ± 18.1 versus 72.7 ± 14.7, p=0.013) and environment (54.4 ± 17.9 versus 62.9 ± 13.1, p=0.017).

Conclusion: There is a high prevalence of sexual dysfunction symptoms in healthy Brazilian women in the third trimester of pregnancy, and these women are significantly more likely to have a worse quality of life than those without sexual dysfunction symptoms.  

Disclosures:

This study was funded by a grant from FAPESP – Fundação de Amparo à Pesquisa do Estado de São Paulo. Process n. 12/03670-4, 12/50225-6 and 12/11787-9.

show poster

Evaluation of a workshop course of human sexuality through a curriculum for professional competences in medical students of the UAQ (#124)

P. González Ortega (Mexico)
show abstract

124

Evaluation of a workshop course of human sexuality through a curriculum for professional competences in medical students of the UAQ

González Ortega, P1; Villaseñor Cuspinera, N1; Sánchez Fernández, L1; Ávila Morales, J1; Leo Amador, G1

1: Universidad Autonoma de Queretaro, Mexico

Objective: Evaluate the workshop course of human sexuality with a curriculum for professional competences in medical students of the UAQ.

Material and Method: Design of experimental study, by means of an educational intervention of workshop focused on human sexuality based on the theory of the Holon’s. Knowledge, skills, attitudes and satisfaction were evaluated by the workshop course through four instruments ad hoc applied before and after the educational intervention participants. With the respect to cognitive competences used a knowledge exam designed exclusively for the training workshop, evaluating the dimensions: General knowledge of sexuality, reproductivity, gender, eroticism and affection Holon´s. To assess the competency of skills, applied a check list, checking the development of the skills: correct positioning of the condom, application of the eligibility criteria for planning familiar and identification of myths of the sexuality. With regard to the attitudes, to measure these attitudes were items of the validated instrument “Attitudes to sexuality of others” of Alvarez Gayou, 2001.Also developed a satisfaction survey of the workshop on sexuality; to do so, was used the modified instrument of Gil Perez et al., 2010.

All designed instruments were validated through three rounds of the six experts from the areas of knowledge: Bioethics, Gynecology, Sexology and Educational Research. He piloted was developed in similar natural group of students from the bachelor of dentistry, with applications test and retest within eight days, calculating a Cronbach alpha ≥ 0.08.

 Information analysis was carried SPPS ver.19, using simple descriptive statistics and “t student” to measure the effect of the intervention at two times, prior to the workshop and subsequent.

Results: The findings for competences, showed significant results: knowledge= 8.562, p=.000; Skills t = -5.913, p= .000 and attitudes t=7.13, p= .000.

The satisfaction of the workshop on sexuality: satisfaction with the course (98%); satisfaction for the teachers (99%); satisfaction with competency-based methodology (98%) and satisfaction with the development of competences (97.4%).

Conclusions: Students of medicine, at some point will be counselors or sex educators, and educational intervention shows that it modified an attitude favorably to that is conducive to the respect, openness and tolerance to valid sexual practices that other develop. Finally, is important to incorporate sexuality education for physicians as a subject in their curriculum to strengthen their academic formation.

Disclosures:

Work supported by industry: no.

show poster

A long-term follow-up study after sex reassignment surgery with metoidioplasty in female-to-male transsexuals: Chinese experience (#125)

Z. Hui (China)
show abstract

125

A long-term follow-up study after sex reassignment surgery with metoidioplasty in female-to-male transsexuals: Chinese experience

Hui, Z1

1: Shenzhen Hospital, Peking University, China

Introduction: Transsexualism is a serious gender identity disorder which should receive appropriate therapies including sex reassignment surgery (SRS) in order to make the patients’ anatomic characteristics congruent with his/her psychological identity. Since the first SRS performed in 1986 in China, thousands of transsexuals have successfully transformed their gender identity through this procedure. However, there remains a lack of long-term follow-up studies after sex reassignment, especially in female-to-male (FTM) transsexuals in China.

Objectives: To evaluate the consequences of metoidioplasty among female-to-male transsexuals and provide data on quality of life, sexual and mental health after SRS.

Material and Method: A single-center, cross-sectional study among 10 female transsexuals currently undergoing long-term hormonal therapy, 8-12 years after SRS. Among the 10 patients who had undergone metoidioplasty, most are able to urinate while standing without further penile reconstruction. Both prior to and following SRS, all patients self-reported physical, mental and sexual health using the Life Satisfaction Scales, Minnesota Multiphasic Personality Inventory(MMPI), and a newly constructed specific questionnaire.

Results: Compared with the preoperative MMPI results, the 10 FTM transsexuals scored significantly better on self-perceived physical and mental health. The majority of them reported a significant improvement in the quality of physical, mental and sexual health after SRS. Most patients were satisfied with their masculine morphology, and were pleased with the ability to urinate while standing after metoidioplasty. For FTM patients, this ability is perceived as a highly essential male characteristic, and was achieved without penile reconstruction, which has higher rates of complication. Therefore, the results suggest Metoidioplasty is a recommendable alternative phalloplasty for female transsexuals.

Conclusion: Results of the follow-up study indicate FTM transsexuals generally have a good quality of life and experience satisfactory sexual and mental health after SRS. Metoidioplasty is an appropriate choice in certain female transsexuals.

Disclosures:

Work supported by industry: no.

Quality of life and sexual health in men with prostate cancer undergoing radical prostatectomy (#126)

A. Naccarato (Brazil)
show abstract

126

Quality of life and sexual health in men with prostate cancer undergoing radical prostatectomy

Naccarato, A1; Souto, S1; Ferreira, U1; Denardi, F1

1: UNICAMP, Brazil

Objective: To evaluate the relationship between quality of life(Qol), erectile function and the use of group psychoterapy in pacientes with prostate cancer(PCa) undergoing radical prostatectomy(RP).

Material and Methods: Sixty patients undergoing RP between 2002 and 2007, 30 of those had group psychoterapy two weeks before and 12 weeks after surgery. They were evaluated in 2012 for erectile function (IIEF), Qol (SF-36 short form); and ICQI-SF and ICQI-OAB for urinary incontinence.

Results: Among the 60 patients 65% accepted the disease and 20% reported concern. The 30 patients who underwent group psychoterapy had better scores in IIEF-5, in satisfaction with life in general, satisfaction with sexual life, satisfaction in the partner relationship; and better results of SF-36, excepting two domains: bodily pain and role emotional. There were significant correlations between IIEF-5 and perception of disconfort (p=0.030), Physical functioning (p= 0.021), Physical Component (p= 0.005) and Role Emotional (p= 0.009) in patients undergoing group psychoterapy. In patients who did not undergo group psychoterapy there were significant correlations between ICQI-OAB and perception of disconfort (p= 0.025),  Social functioning (p=0.052) and Role Emotional (p=0.034); between ICQI-SF and perception of disconfort (p=0.0001).

Conclusion: Group psychoterapy has a positive impact on the Qol of patients and the erectile function. Further studies are necessary to identify the impact  of self-perception and self-knowledge in the postoperative manegement of RP.

Disclosures:

Work supported by industry: no.

show poster

Clinical study on the treatment of lifelong premature ejaculation with paroxetine hydrochloride and tamsulosion (#127)

Y. Li (China)
show abstract

127

Clinical study on the treatment of lifelong premature ejaculation with paroxetine hydrochloride and tamsulosion

Li, Y1

1: Daping Hospital, Third Military Medical University, China

Background and objective: To evaluated the efficacy and safety of paroxetine and hydrochloric tamsulosin for the treatment of PE together and alone, and assessed the serum concentration of 5-HT in the PE diagnosis and judgement of treatment efficacy.

Methods: 225 cases of men with lifelong PE were included in this study. The patients were randomized divided into three groups. Group A were given paroxetine hydrochloride 20 mg/d for 8 weeks; Group B were given tamsulosion 0.2 mg/d for 8 weeks; Group C were given paroxetine hydrochloride and tamsulosion at the same dosage as above for 8 weeks. The effects and adverse events were evaluated by the overall change and folds increase in average IELT and the mean change in all four measures of the premature ejaculation profile (PEP). Blood sample was got from the candidates before and after treatment. The plasma concentration of 5-HT was measured by ELISA.

Results: The reliable data from 198 patients were achieved. The mean IELT after treatment were significantly improved in all groups .group C was increased for 8.15 min after treatment. The increased folds of mean IELT in group C (8.02 folds) was significantly higher than that in group B(1.98 folds)and group A(6.92 folds)P<0. 001).The mean PEP scores were significantly improved in all groups after treatment.  Group C have more significant improvements than that in group A and B. The mean plasma concentration of 5 - HT in group A,B,C before treatment was significant lower than that in normal control group(P<0.001). The mean plasma concentration of 5 - HT in group A and C was significant improved (P<0.001) and there is no significant difference between group A and C after treatment (P>0.05). The plasma concentration of 5 - HT in group B did not change after treatment (P>0.05).

Conclusions: Paroxetine hydrochloride combined with tamsulosion produce more better therapeutic effects and could be a priority selection for the treatment of primary PE. The plasma concentration of 5 - HT can be used as the objective diagnostic index of primary PE, and to some extent, it is meanful for the assessment of treatment effect of SSRIs.

Disclosures:

Work supported by industry: no.

Response profiles to men undergoing blinded spermatic cord blocks for chronic orchalgia (#128)

John Mulhall (USA)
show abstract

128

Response profiles to men undergoing blinded spermatic cord blocks for chronic orchalgia

Deveci, S1; Heck, M2; Tal, R3; Mulhall, J3

1: Medical School of Acibadem University, Turkey, Memorial Sloan Kettering Cancer Center, New York; 2: Memorial Sloan Kettering Cancer Center, New York; 3: Memorial Sloan Kettering Cancer Center New York

Objective: Chronic orchalgia is a crippling disorder for some men. Spermatic cord denervation (SCD) surgery is effective in carefully selected patients. It is recognized that some men with this condition do not have scrotal pathology and have a large psychological overlay. It is our practice to conduct blinded sperm cord blocks (SCB) to define the etiology of the condition and the potential for success with SCD surgery.

Materials: The study population included men who (i) had unilateral orchalgia of ≥6 months (ii) had no scrotal content structural abnormalities on examination or scrotal ultrasound (iii) had no varicocele and (iv) had pain confined solely to the scrotum. Demographic, comorbidity data and physical characteristics were recorded. Two SCB were administered within 1 month of each other. One was local anesthetic (LA, 0.5% bupivacaine) and the other normal saline (NS, 10mls each). The patient was blinded as to which agent was being administered. Pain was graded on a 0-10 point pain scale. Duration of relief after SCB was measured in minutes.

Results: 32 men with mean age = 42±21 years were analyzed. Mean duration of pain = 14±64 (6-120) months. 6 men were post-vasectomy, 4 had a history of chronic epididymitis, 4 had scrotal trauma preceding pain onset and 18 had not risk factor identified. Mean baseline pain = 6±3 (3-10); after LA 2.5±3.5 (0-8); after NS 4±5 (2-9) (p<0.01). In response to LA, 94% had at least a 4 point decrease in pain (mean duration 2.5 hours), but 2/32 (6%) had no significant pain reduction. In response to NS, 88% had no significant pain reduction, but 4/32 (12%) had >4 point reduction in pain (duration of relief 1-48 hours). Of the latter 4 patients, three also had a significant response to LA. All vasectomy and chronic epididymitis patients had a positive response to LA and a negative response to NS. All patients with a negative response to LA and positive response to NS belonged to the group with no identifiable risk factors for orchalgia.

Conclusions: While SCB with local anesthetic is valuable, the addition of patient blinding using saline injections may select out those patient with a psychological overlay to their orchalgia. This maneuver may, in turn, aid in the selection of those patients most likely to respond to SCD surgery. 

Disclosures:

Work supported by industry: no.

show poster

Characterization of patients with gender dysphoria followed at a tertiary hospital: A reflection on their experiences (#129)

M. Lerri (Brazil)
show abstract

129

Characterization of patients with gender dysphoria followed at a tertiary hospital: A reflection on their experiences

Lerri, M1; Romão , A1; Nadai, M1; Santos, M2; Rosa-e-Silva, A1; Reis, R1; Lara, L1

1: Faculdade de Medicina de Ribeirão - Universidade de São Paulo (FMRP-USP), Brazil; 2: Faculdade de Filosofia, Ciências e Letras de Ribeirão Preto - Universidade de São Paulo (FFCLRP-USP)

Objective: To present the social, emotional and affective aspects of patients with gender dysphoria, assisted in the clinic for Study of Human Sexuality (AESH)-Faculty of Medicine of Ribeirão Preto-University of São Paulo.

Methods: We used a semi-structured questionnaire to access socio-demographic and emotional aspects. The risk for anxiety and depression was accessed by using the Hospital Anxiety and Depression Scale (HAD).

Results: Forty transsexual with a mean age of 27(18-59) years participated in this study. Of these, 33(82.5%) are male to female (MtF) and 7(17.5%) are female to male (FtM). Twenty-six (6%) are white, and 14(35%) are black. As for origin, 39(97.5%) are from the of São Paulo state, and 1(2.5%) from Minas Gerais state. Thirty-four (85%) had middle school and 6(15%), higher education. Thirty-four (85%) are receiving US$324.74 to 1,620,00/monthly and 6(15%) are unemployed. The use of alcohol, cocaine, marijuana and cigarette is reported by 22(55%) patients. Thirty-six (90%), reported self-medication with hormones. The main reason for searching for AESH was to initiate hormone therapy. The first sexual intercourse occurred between 8 and 15 years for 25(62%) patients. Regarding the affective life of the 23(58%) patients who reported having a partner, 6(26%) are trans-men and 17(74%) are trans-women. Thirty-five (88%) patients reported feeling socially discriminated, 24(68%) felt discrimination at work, 10(28%) at family, and 7(20%) reported discrimination in healthcare units. The prevalence of suicide attempts is high in this sample. Twenty-nine (73%) reported one or more attempts. The motivating factors for suicide attempts were verbalized by patients as: discrimination in 23(48%), non-acceptance of family in 13(28%) and non-acceptance of their body in 12(26%). The attempts occured at age of 10 to 25 years in 24(60%) and at 26 to 31 years old in 5(13%). Thirty-eight (95%) of patients were at risk for depression. Regarding the average, 30(75%) patients were at risk for anxiety.

Conclusion: transgender people live in poor social and emotional conditions and are exposed to social and familial prejudices, as well as prejudices at work, that may impair their quality of life. This may explain the high prevalence of suicide attempts in this population. Expand knowledge to identify variables related to poor quality of life in this population is crucial to outline specific medical and psychological interventions. Also, effective public policies are required to promote health and well-being for transsexuals.

Disclosures:

Work supported by industry: no.

show poster

Barebacking behavior and personality among sexually compulsive individuals seeking treatment in São Paulo, Brazil (#130)

M. Amaral (Brazil)
show abstract

130

Barebacking behavior and personality among sexually compulsive individuals seeking treatment in São Paulo, Brazil

Amaral, M1; Scanavino, M1

1: Department and Institute of Psychiatry. Clínicas’ Hospital. School of Medicine. University of São Paulo (FMUSP), Brazil

Objectives: Investigate the association between barebacking behavior - intentional unprotected anal intercourse among men who have sex with men (MSM), and personality traits in 69 individuals in Sao Paulo, Brazil who sought treatment and met the criteria for compulsive sexual behavior.

Material and Methods: Participants underwent psychiatric evaluation, interview for defining the intentional condomless sex, and completed self-report instruments, including the Temperament and Character Inventory of Cloninger and Sexual Compulsivity Scale (SCS) of Kalichman and Rompa.

Results: Twenty-five (36%) reported intentional anal intercourse with casual partners, of whom 84% were gay and 16% bisexual (p = 0.03). The mean of sexual compulsivity showed associated with men who engage in barebacking (p = 0.01). Men who reported barebacking scored significantly higher on temperament dimension novelty seeking (p = 0.003) and scored significantly lower on character dimension self-directedness (p < 0.001). The variables self-directedness remained significantly associated with the outcome variable barebacking behavior in the multiple logistic regression analysis (p = 0.001).

Conclusions: Sexually compulsive individuals who engage in barebacking presented lower self-directedness than the group who not engage in barebacking, which means less autonomy regarding life itself. To the best of our knowledge, it is a first finding considering barebacking behavior in sexually compulsive men.

Disclosures:

Work supported by industry: no.

show poster

Patient reported outcomes after metoidioplasty (#131)

F.E. Kuehhas (Austria)
show abstract

131

Patient reported outcomes after metoidioplasty

Kuehhas, FE1; De Luca, F2; Spilotros, M 2; Richardson, S2; Garaffa, G2; Ralph, D2; Christopher, N2

1: Medical University of Vienna, Austria; 2: St. Peter's Andrology Centre and Institute of Urology, University College London, London, United Kingdom

Objective: To analyze patient reported outcomes after metoidioplasty in female-to-male gender reassignment surgery. Metoidioplasty is requested by patients because it is perceived to preserve sexual sensation, allow them to void standing and have minimal scarring with the appearance of a small but cosmetically acceptable penis.

Material and Methods: All patients who underwent metoidioplasty, between 1999 and 2014, were retrospectively analyzed and patient reported outcomes were evaluated through a non-validated questionnaire, which was designed in cooperation with trans-gender patients.

Results: 48 patients were identified of which 3 were lost to follow-up and 1 underwent gender reversal to female. The response rate to the questionnaire was (21/48) 44% of which 17/48 (35%) still had just a metoidioplasty. Mean age at the time of surgery was 37.8 years. Mean follow-up was 49.3 months. The complication rate was 59% (55% urethral fistulae or strictures, 25% infected testicular prosthesis, 20% other). Most patients (29/48, 60%) were content with the metoidioplasty but 12 (25%) went on to have a full size phalloplasty with a further 3 (6%) requesting a phalloplasty. Of the phalloplasties, 5 were radial forearm flap, 6 were abdominal flap and 1 was a Gillies phalloplasty. The mean length of the metoidioplasty was 3.8cm (range 2-5cm). Looking at just the 17 metoidioplasty patients, sexual function was very good with patients being satisfied or partially satisfied with erection quality (94%), masturbation (100%) and orgasm (100%). Desire for sexual intercourse was high (88%) but ability to penetrate was low (24%). Voiding function was much poorer in contrast, with patients being satisfied or partially satisfied with ability to void standing (47%), confidence using a public urinal (12%) and satisfaction voiding standing (71%). Spraying of urine was a feature in 59%. Cosmesis was moderate with patients being satisfied or partially satisfied with cosmetic appearance (77%) and penis length (71%). 94% were happy with the pre-operative information given but only 82% would recommend this operation to a friend and only 71% would do the operation again given current knowledge.

Conclusion: Metoidioplasty results in good patient reported outcomes with respect to sexual function and cosmesis but much poorer voiding outcomes than perceived.  Comprehensive preoperative information on the procedure and expected result is critical to patient satisfaction.

Disclosures:

Work supported by industry: no.

Profile of women with anorgasmia: a restrospective analysis (#132)

M. Lordello (Brazil)
show abstract

132

Profile of women with anorgasmia: a restrospective analysis

Lordello, M1; Ambrogini, C1; Fanganiello, AL1; Araújo, T1; Zaneti, M1; Veloso, L1; Piccirillo, L1; Crude, B1; Silva, I1

1: Unifesp, Brazil

Aim: Describe the profile of women who sought for outpatient treatment, complaining about anorgasmia, from June 2012 to June 2014.

Material and methods: The sample included 32 women, aged between 22 and 62 years old, sexually active, who performed medical, psychological and physiotherapy assessment at Aphrodite Project.  Were assessed the following aspects at their medical record: age, scholarity, relationship status, religion, psychiatric history, sexual violence, sexual response cycle and masturbation.

Results: Most of women with anorgasmia have between 20 and 30 years (34,5%), with a reduction of this percentage over the years. From 31 to 40 years (28,1%), from 41 to 50 years (25%), from 51 to 60 years (9,3%) and over 61 years (3,1%).  They have primary anorgasmia (59,4%) most of all, situational (28,1%) and secondary (12,5%). The majority of them have at least, complete high school (81,2%) and are married or in a consensual marriage (43,9%), followed by those who date (34,3%). The catholic religion is the most present among these women (43,9%). Most of  them don't have psychiatric disorders (47%), followed by those who had at least one depressive episode (28,1%).  Regarding to sexual violence, 75% mentioned never having gone through such experience.  Regarding to sexual response cycle, 46,8% present desire always or occasionally; sexual arousal always 56,3% and occasionally 31,2%.  Most of women don't practice masturbation or rarely practices it (56,3%) and 25% often practice, although don't achieve orgasm with the partner.

Conclusions: According with this profile, we can conclude that age is a significant parameter in anorgasmia, because the dysfunction decreases with increasing age, it shows the importance of experience and learning in capacity of achieve orgasm.  Psychiatric disorders and sexual violence are not among the main factors that predispose women to anorgasmia.  These women present, most of time, a sexual response cycle preserved, with normal desire and arousal, lacking only orgasm.  Finally, the absence of masturbation is directly linked to the inability to achieve orgasm.

Disclosures:

Work supported by industry: no.

show poster

Sexual function of Brazilian female adolescents and young adults managed in a family planning clinic (#133)

M. Negri (Brazil)
show abstract

133

Sexual function of Brazilian female adolescents and young adults managed in a family planning clinic

Negri, M1; Ribeiro, M1; Nohara, I1; Moraes, P1; Torloni, M1; de Souza, E1; Guazzelli, C1

1: Universidade Federal de São Paulo, Brazil

Objectives: The sexual function of female adolescents and young adults is still under investigation. Our aim was to assess the sexual function of Brazilian female adolescents compared to young adults.

Patient and Methods: This cross-sectional study involved 199 sexually active Brazilian females: 128 adolescents (13-19 years) and 71 young adults (20-25 years). Participants were recruited from September 2012 to September 2013 at a public university family planning clinic. The Female Sexual Function Index (FSFI) questionnaire 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: Most participants were single, catholic and had between 8 and 12 years of formal education. The mean age of the girls was 17.4 ± 1.5 vs 22.1 ± 1.8 years (P<0.0001), for adolescents and young adults, respectively. Mean age at first sexual intercourse was 14.8±2.0 vs 16.3 ± 2.2 years (P<0.0001) for adolescents and young adults, respectively. Most of them reported having had intercourse with 2 or more partners (46% adolescents versus 71.8% young adults, P=0.001). The mean total FSFI scores of the 199 participants was 26.5 ± 5.9 and 39.7% of them were at risk for sexual dysfunction symptoms. A total of 49 adolescents scored ≤ 26 on the FSFI compared to 30 young adults (38.3% versus 42.3%, respectively, P=0.651). Young adults had significantly lower mean total scores, compared to adolescents female (23.6 ± 6.2 versus 26.6 ± 5.7, P=0.001). The young adults group also had significantly lower scores for the sexual satisfaction domain, compared to the adolescents group (4.6 ± 1.5 versus 5.1 ± 1.1, P =0.008, respectively).

Conclusion: There is a high prevalence of sexual dysfunction symptoms among Brazilian female adolescents and young adults and they are significantly more likely to be at risk for sexual dysfunction than the female adolescents. However, adolescents have significantly higher overall and sexual satisfaction domain FSFI scores than young adults.

Disclosures:

Work supported by industry: no.

show poster


16:00 - 17:30
Instructional course 3 - Technical pearls of PP surgery

Location: Transamérica Auditorium
Chairs: Celso Gromatzky (Brazil) & Steven Wilson (USA)

The 6 essential steps assuring trainees can safely perform a penile implant

Gerald Brock (Canada)

Managements of infectious and non-infectious complications of penile implants

Rafael Carrion (USA)

The three "P's" of advanced penile implant usage: Peyonie's, phalloplasty, and priapism

Giulio Garaffa (United Kingdom)


16:00 - 16:45
Workshop 4 - Management of sexual function in patients with cancer

Location: Ilhéus + Una Room
Chair: Andrea Salonia (Italy)

Female cancer and sexual function

Luca Incrocci (The Netherlands)

Rehabilitation of sexual function after radical prostatectomy - What is the optimal clinical management?

Jens Sonksen (Denmark)


16:45 - 17:30
Workshop 5 - A structured sexual interview

Location: Ilhéus + Una Room
Chair: Eusebio Rubio-Aurioles (Mexico)

Challenges in the sexual health interview

Sharon Parish (USA)

The Sexual Status and the Sexual Tipping Point Model®

Eusebio Rubio-Aurioles (Mexico)