Serkan Deveci

Erectile Function Profiles in Men With Peyronie’s Disease

PURPOSE In this study we investigated the erectile function status of men presenting with Peyronies disease. MATERIALS AND METHODS Demographics of patients regarding age, duration of PD, nature of deformity and comorbidities were compared between the patients with PD, with and without erectile dysfunction. Patients with erectile dysfunction underwent dynamic infusion cavernosometry/cavernosography. The hemodynamic profile of patients presenting with combined PD and ED were analyzed and compared between those with onset of ED before and after diagnosis of PD. RESULTS Of the 222 patients 78 had ED (35%) by self-report at presentation. The mean age of patients with PD and ED was 52 +/- 22 years old. Hypertension (71.5%), hyperlipidemia (60.4%) and smoking (49.2%) were the leading comorbidities in the entire group. Statistically significant differences were found between the groups with and without ED for hypertension (p = 0.02) and cigarette smoking (p = 0.009). Of 222 patients 45 (20%) had ED that predated PD onset (group 1) and 33 (15%) had ED that postdated the onset of PD (group 2). DICC showed normal hemodynamics in 14 of 78 patients (18%), arteriogenic insufficiency in 50 (64%) and corporoveno-occlusive dysfunction in 16 (20%). CVOD was evenly distributed between groups 1 and 2, whereas arteriogenic ED was significantly higher in group 1 (82%). Site specific leak was seen in 4 of 33 (12%), all group 2 patients. CONCLUSIONS Patients in whom ED postdates the onset of PD are more likely to have normal erectile hemodynamics. Site specific leak is an uncommon contributor to PD and is seen only in the patients with PD in whom ED postdated PD onset. The leading vascular etiology of ED in PD is arteriogenic in older patients and those with greater associated comorbidities.

Can the International Index of Erectile Function distinguish between organic and psychogenic erectile function

To define the ability of the International Index of Erectile Function (IIEF) to differentiate between organic and psychogenic erectile dysfunction (ED).

Sildenafil citrate improves erectile function after castration in a rat model

The administration of phosphodiesterase 5 inhibitor commencing at the time of castration might preserve erectile function.

PD20-07 THE CHRONOLOGY AND SEVERITY OF PENILE SENSORY CHANGES AFTER PLAQUE INCISION AND GRAFTING SURGERY FOR PEYRONIE’S DISEASE.

INTRODUCTION AND OBJECTIVES: Besides changes in erectile function, Plaque incision and grafting surgery (PIGS) when performed dorsally, is known to be associated with penile sensory loss. Rates of sensory changes in the literature have been cited at 0-12%. This analysis was conducted to define the rate, chronology and predictors of this problem at our center. METHODS: The study population consisted of men who (i) had dorsal PIGS for PD and (ii) had at least 6 months follow-up. Patients are routinely followed up in the office at 1 week, 1 month 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. The degree of sensation loss 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 1⁄4 52 20 years, mean follow-up of 16 11 months. Mean duration of PD at time of PIG surgery 1⁄4 18 11 months. 10% had diabetes preop with a mean HBA1C 1⁄4 7.2 1.8%. Mean duration of self-reported stability 1⁄4 8 months. 75% of patients had curvature alone, while the remainder had associated indentations or hourglass deformity. Mean baseline primary curvature 1⁄4 64 28 degrees. All patients were capable of sexual intercourse pre-operatively with or without erectogenic aids. Mean duration of operation 1⁄4 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.

1204 EJACULATION PROFILES OF MEN FOLLOWING RADIATION THERAPY FOR PROSTATE CANCER

Objectives. Radical prostatectomy (RP) is associated with anejaculation, which for some men is a source of bother and sexual dissatisfaction. Clinical experience has shown us some men after pelvic radiation therapy (RT) also experience anejaculation. This analysis was conducted to define the ejaculation profiles of men after RT for prostate cancer (PCa). Methods. As a routine part of the sexual health evaluation for post-RT patients, men provided information regarding their ejaculatory function and orgasm. Analysis was conducted of a sexual medicine database reviewing demographic data, PCa factors, erectile, ejaculatory, and orgasmic function. Men with prior history of RP, cryotherapy, focal therapies, and androgen deprivation therapy (ADT) were excluded. Patients completed the International Index of Erectile Function (IIEF) questionnaire at follow-up visits commencing with the first posttreatment visit and specific attention was paid to the IIEF orgasm domain. Results. Three hundred and sixty-four consecutive patients were included. Two hundred and fifty-two patients had external beam, and 112 patients had brachytherapy (BT). Mean age was 64 11 (42–78) years and mean follow-up after RT was 6 4.5 years. Mean prostate size at time of RT was 42 21 g. Of the entire population, 72% lost the ability to ejaculate in an antegrade fashion after prostate RT by their last visit. The proportion experiencing anejaculation at 1, 3, and 5 years after RT was 16%, 69%, and 89%, respectively. For men with at least two IIEF questionnaires completed, the orgasm domain scores decreased dramatically over the follow-up period; orgasm domain scores (0–10): 36 months 2.8 (P 100 Gy, and smaller prostates at the time of RT. Conclusions. The vast majority of men after prostate RT will experience anejaculation and should be counseled accordingly prior to undergoing therapy. We have identified predictive factors. Sullivan JF, Stember DS, Deveci S, Akin-Olugbade Y, and Mulhall JP. Ejaculation profiles of men following radiation therapy for prostate cancer. J Sex Med 2013;10:1410‐1416.