Matthew Ziegelmann

MP56-13 CLINICAL FACTORS NEGATIVELY IMPACTING SEXUAL RELATIONSHIPS IN MEN WITH PEYRONIE'S DISEASE

INTRODUCTION AND OBJECTIVES: Peyronie0s Disease (PD) is known to have a significant negative impact on the psychosocial and relationship functioning of male patients, with studies finding increased depression, distress, and sexual dysfunction in men with PD. In just the past year, researchers have also begun to attend to the female partners of these men, studying their own sexual function, relationship satisfaction, and mood. However, these few studies are flawed: by using the male patient as a gateway to access his female partner, they limit their access to women whose partners are comfortable making such a referral; by using surveys that emphasize sexual function, they restrict the opportunity for the partners to define their own concerns. This study seeks to address these problems, using narrative content analysis of Internet posts made by female PD partners to describe and rank the concerns expressed by these women, independent of their interactions with researchers and male partners. METHODS: This is a qualitative study, analyzing the content of Internet posts made by female PD partners on two patient-centered and member-operated, English-language PD support forums. In deference to ethical concerns regarding consent to research, only those posts within the public domain and readily accessible to non-members via Google search were analyzed. A Grounded theory process was used, with open coding to identify themes of concern. RESULTS: From 2/2005-10/2016, a total of 793 posts were published online, by 48 female PD partners. The primary concern expressed by these women related to difficulty communicating with their partners about PD, with 24/48 (50%) posting about this issue. Secondary concerns were partners0 emotional (18/48 (38%)) and physical (12/48 (25%)) pain. Only 10/48 (21%) expressed concern about their own diminished sexual pleasure, with 4/48 (8%) describing how their partners0 curvature enhanced their sexual experience. CONCLUSIONS: When evaluated through the nonintrusive method of Internet narrative analysis, female PD partners are most concerned with poor communication, followed by their partners0 emotional and physical pain. While their sexual needs do merit attention, this study suggests that interventions targeting the psychosocial needs of patients and their partners would be most meaningful for this population.

MP84-01 PREDICTORS OF INCREASED INTRACAVERNOSAL INJECTION REQUIREMENTS AT PENILE ULTRASOUND

INTRODUCTION AND OBJECTIVES: Penile duplex Doppler ultrasound (PDDU) with intracavernosal injection (ICI) with erectogenic agents is commonly used to evaluate vascular parameters in men with erectile dysfunction (ED). Recent studies have suggested significant variability in outcomes based on ICI dosing protocols, suggesting a need for standardization of injection protocols. Given a lack of literature on this topic, we sought to identify predictors for increased need of ICI dosing to achieve adequate rigidity at the time of PDDU. METHODS: A retrospective chart review was performed of all patients undergoing PDDU for evaluation of ED from January 2014 to November 2015. At the time of PDDU, men received a combination of papaverine(30 mg/mL), phentolamine(1 mg/mL), and alprostadil(10 mcg/mL) in 0.1 mL increments until an erection sufficient for penetration was achieved or 1.0 cc was administered. Clinicopathologic and demographic variables were reviewed, and univariate and multivariate analyses were used to identify characteristics associated with increased erectogenic requirements. RESULTS: A total of 262 men (mean age 53;) underwent PDDU during the study period. Mean IIEF-6 score was 12.4 (SD 10.2), and a mean 2.1 injections (SD 1.1) with 0.34 cc (SD 0.34) were administered. On multivariate analysis, lower IIEF-ED domain score (p<0.01), coronary disease (p1⁄40.03), and diabetes (p1⁄40.01) were associated with increased requirement for erectogenic medications. CONCLUSIONS: Patients with lower IIEF scores, coronary disease, and diabetes mellitus may require higher volumes of erectogenic medications at the time of PDDU. This information may help to create standardized and efficient protocols for repeated dosing regimen.

MP46-05 PREDICTING URETHRAL ATROPHY IN PATIENTS UNDERGOING PRIMARY PLACEMENT OF ARTIFICIAL URINARY SPHINCTER

INTRODUCTION AND OBJECTIVES: Long-term data on effects of testosterone therapy (TTh) on urinary function in hypogonadal men published so far are from observational studies without a control group. We present registry data including an untreated hypogonadal control group. METHODS: Registry study in 656 men with testosterone 350 ng/dL and hypogonadal symptoms. 360 received TU 1000 mg/12 weeks following an initial 6-week interval (T-group). 296 men opted against TTh and served as controls (CTRL). 8-year data are presented. Changes over time between groups were compared by a mixed effects model for repeated measures with a random effect for intercept and fixed effects for time, group and their interaction. Changes were adjusted for age, weight, waist circumference, blood pressure, fasting glucose, lipids and quality of life to account for baseline differences between groups. In order to further validate results, propensity matching was performed for baseline age, BMI, and waist circumference. 82 men in each group fulfilled criteria. RESULTS: Total group: mean age was 57.4 7.3 years in the T-group and 64.8 4.3 in CTRL, median follow-up time 7 years for both. In the T-group, IPSS decreased from 6.4 4.0 to 2.1 1.0 with a change from baseline of 5.0 points. In CTRL, IPSS increased from 4.5 2.0 to 6.5 2.6 after 8 years by 1.8 points (p<0.0001 for both). Residual urine volume decreased from 47.3 22.8 to 13.7 4.6 mL in the T-group and increased from 48.3 16.3 to 64.5 22.2 in CTRL. Prostate volume increased from 29.2 10.4 to 31.1 11.5 mL in the T-group (p<0.0001) and fell from 34.5 5.9 to 33.5 12.0 in CTRL (NS). Propensity-matched group: mean age was 61.7 5.1 years in the T-group and 61.6 2.9 in CTRL, median follow-up time 8 years in the T-group and 7 in CTRL. In the T-group, IPSS decreased from 7.4 4.2 to 2.0 0.9 with a change from baseline of 5.4 points. In CTRL, IPSS increased from 4.3 2.3 to 7.0 2.6 after 8 years by 1.9 points (p<0.0001 for both). Residual urine volume decreased from 50.6 23.6 to 14.0 4.7 mL in the T-group and increased from 45.7 16.4 to 64.6 16.7 in CTRL. Prostate volume increased from 31.4 12.0 to 33.2 12.7 mL in the T-group (p<0.0001) and from 33.4 6.2 to 33.6 11.0 in CTRL (NS). CONCLUSIONS: Urinary function is improved and preserved for a prolonged period of time by TTh in hypogonadal men and deteriorates in untreated hypogonadal men. The observed changes seem independent of prostate volume.

PD31-07 CONCURRENT PENILE TRACTION THERAPY IN MEN UNDERGOING COLLAGENASE CLOSTRIDIUM HISTOLYTICUM FOR PEYRONIE’S DISEASE

& physical 11 6; pain 5 6; bother 7 4. Theses trends are similar to PDQ scores reported in the phase 3 Xiaflex studies (IMPRESS I & II). On MVA, higher CES-D scores were related to the inability to penetrate (b1⁄40.18, p1⁄40.04). Lower SEAR total scores were related to inability to penetrate (b1⁄4-0.30 p1⁄40.01) and greater curvature (b1⁄40.25, p1⁄40.04). Higher PDQ Bother scores were related to greater curvature (b1⁄40.33, p1⁄40.02), and marginally related to perceived loss of penile length (b1⁄40.24, p1⁄40.06) and inability to penetrate (b1⁄40.22 p1⁄40.09). CONCLUSIONS: The data reinforce the significant prevalence of depression as well as psychosexual and relationship health in degree to men with ED. Common predictors of psychological and relationship variables were inability to penetrate, greater curvature, and perceived loss of penile length. Quality of life questionnaires into clinical practice might benefit some patients.